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Saad E, Abunseir M, Abdalla MS, Mustafa A, Faris ME, Friedman H. A Case Series of Non-Tuberculous Mycobacterial Pulmonary Disease Masquerading as Malignancy From a Community-Based Hospital. J Med Cases 2023; 14:141-147. [PMID: 37188296 PMCID: PMC10181294 DOI: 10.14740/jmc4098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 04/20/2023] [Indexed: 05/17/2023] Open
Abstract
Non-tuberculous mycobacteria (NTM) are ubiquitous organisms in the environment that can potentially cause a range of pulmonary and extrapulmonary infections in humans. Epidemiological risk factors and the host's immune status determine the susceptibility to various clinical syndromes caused by different NTM species. Non-tuberculous mycobacteria pulmonary disease (NTM-PD) is primarily reported in patients with underlying lung disease. These infections often pose a significant disease burden on affected patients as they are often chronic, difficult to treat, and necessitate long-term multi-drug therapy. Mycobacterium avium complex (MAC) is the most common causative pathogen of NTM-PD in the USA, followed by Mycobacterium kansasii (M. kansasii). Less common species in the USA include Mycobacterium xenopi (M. xenopi), Mycobacterium abscessus, and others, largely depending upon the geographic location and exposure to species-specific predisposing risks. In this case series, the authors report on three elderly patients with chronic lung diseases who had pulmonary NTM disease caused by M. xenopi and MAC. The patients were encountered in both inpatient and outpatient settings from a community-based hospital in the midwestern USA. The clinical and radiological features of NTM-PD masqueraded as malignancy and posed a diagnostic dilemma. The epidemiology, clinical and radiological features, diagnosis, and management of NTM-PD are reviewed in this report.
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Affiliation(s)
- Eltaib Saad
- Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, IL, USA
- Corresponding Author: Eltaib Saad, Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, IL, USA.
| | - Maria Abunseir
- Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, IL, USA
| | - Mohammed S. Abdalla
- Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, IL, USA
| | - Abdurrahman Mustafa
- Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, IL, USA
| | - Mohammed Elamin Faris
- Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, IL, USA
| | - Harvey Friedman
- Department of Critical Care and Pulmonology, Ascension Saint Francis Hospital, Evanston, IL, USA
- University of Illinois College of Medicine, IL, USA
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2
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Yan M, Brode SK, Marras TK. The Other Nontuberculous Mycobacteria: Clinical Aspects of Lung Disease Caused by Less Common Slowly Growing Nontuberculous Mycobacteria Species. Chest 2023; 163:281-291. [PMID: 36174743 DOI: 10.1016/j.chest.2022.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 09/16/2022] [Accepted: 09/21/2022] [Indexed: 01/14/2023] Open
Abstract
Slowly growing nontuberculous mycobacteria (NTM) comprise a diverse group of environmental organisms, many of which are important human pathogens. The most common and well-known member of this group is Mycobacterium avium, the leading cause of nontuberculous mycobacterial pulmonary disease (NTM-PD) globally. This review focuses on the less common, but notable, species of slowly growing NTM with respect to lung disease. To prepare this article, literature searches were performed using each species name as the key word. Society guidelines were consulted, and relevant articles also were identified through the reference lists of key articles. The specific organisms highlighted include Mycobacterium kansasii, Mycobacterium xenopi, Mycobacterium malmoense, Mycobacterium simiae, and Mycobacterium szulgai. Although these organisms are closely related, they have distinct epidemiologic features and behavior as pathogens. Therefore, the diagnosis and management of NTM-PD require a nuanced approach that takes into consideration the unique characteristics of each species. There is limited evidence to inform the optimal treatment of NTM-PD. Antimicrobial therapy is often challenging because of the presence of drug resistance and few antibiotic options. Regimen selection should generally be guided by drug susceptibility testing, although the correlation between clinical outcomes and in vitro susceptibility thresholds has not been defined for most species.
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Affiliation(s)
- Marie Yan
- Department of Medicine, University of Toronto, Toronto, ON, Canada; Clinician Investigator Program, University of British Columbia, Vancouver, BC, Canada
| | - Sarah K Brode
- Department of Medicine, University of Toronto, Toronto, ON, Canada; Division of Respirology, University Health Network, Toronto, ON, Canada; Division of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada
| | - Theodore K Marras
- Department of Medicine, University of Toronto, Toronto, ON, Canada; Division of Respirology, University Health Network, Toronto, ON, Canada.
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3
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Raats D, Brode SK, Mehrabi M, Marras TK. Increasing and More Commonly Refractory Mycobacterium avium Pulmonary Disease, Toronto, Ontario, Canada. Emerg Infect Dis 2022; 28:1589-1596. [PMID: 35876492 PMCID: PMC9328931 DOI: 10.3201/eid2808.220464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
In mid-2014, Public Health Ontario Laboratories identified coincident increasing Mycobacterium avium isolation and falling M. xenopi isolation in the Toronto, Ontario, Canada, area. We performed a retrospective cohort of all patients in a Toronto clinic who began treatment for either M. avium or M. xenopi pulmonary disease during 2009–2012 (early period) or 2015–2018 (late period), studying their relative proportions and sputum culture conversion. We conducted a subgroup analysis among patients who lived in the Toronto-York region. The proportion of patients with M. avium was higher in the late period (138/146 [94.5%] vs. 82/106 [77.4%]; p<0.001). Among M. avium patients, conversion was lower in the late period (26.1% vs. 39.0%; p = 0.05). The increase in the proportion of patients with M. avium pulmonary disease and the reduction in the frequency of sputum culture conversion is unexplained but could suggest an increase in environmental M. avium exposure.
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Hassan S, Berenson CS. Novel case of empyema necessitans caused by Mycobacterium xenopi. BMJ Case Rep 2022; 15:e245953. [PMID: 35550319 PMCID: PMC9109015 DOI: 10.1136/bcr-2021-245953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2022] [Indexed: 11/03/2022] Open
Abstract
Poorly controlled long-standing empyema can dissect through soft tissues and skin resulting in empyema necessitans. We present the first reported case of empyema necessitans caused by Mycobacterium xenopi, which was treated successfully with antimycobacterial therapy. The case highlights the indolent nature of the pathogen and the importance of an accurate diagnosis.
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Affiliation(s)
- Sidra Hassan
- Division of Infectious Diseases, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo and VA Western New York Healthcare System, Buffalo, New York, USA
| | - Charles S Berenson
- Division of Infectious Diseases, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo and VA Western New York Healthcare System, Buffalo, New York, USA
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5
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Raats D, Aldhaheri SMS, Marras TK, Mehrabi M, Brode SK. Aspergillus isolation in nontuberculous mycobacterial pulmonary disease: Associated with antimycobacterial treatment initiation but not response. Respir Med 2021; 179:106338. [PMID: 33611086 DOI: 10.1016/j.rmed.2021.106338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/27/2020] [Accepted: 02/06/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Chronic pulmonary aspergillosis is a serious complication of nontuberculous mycobacterial pulmonary disease (NTM-PD), and diagnosis remains challenging. The present study examined associations between the respiratory isolation of Aspergillus and the clinical characteristics and treatment outcomes of patients with NTM-PD. METHODS All patients meeting NTM-PD criteria as defined by the ATS/IDSA statement, with at least one respiratory sample cultured for fungi, were included in this retrospective cohort analysis. Patients with at least one respiratory sample isolating Aspergillus were compared to patients who did not isolate Aspergillus. The primary outcomes were culture conversion and radiologic evolution 12 months after NTM-PD treatment initiation. RESULTS During a 12 year period, 497 patients meeting the inclusion criteria were seen in our tertiary care center, of whom 130 grew Aspergillus. Median follow up after NTM-PD diagnosis was 46 months. Inhaled corticosteroid use, a nodular-bronchiectatic CT pattern and NTM-PD treatment initiation were more frequent in patients who isolated Aspergillus compared to those who did not (p-value respectively 0.01, 0.03 and < 0.001). Rates of culture conversion (63.0% vs. 62.2%, respectively; p-value 1) and radiologic evolution (improvement or stability in 69.7% vs. 77.2%, respectively; p-value 0.25) were not significantly different between treatment groups. Likewise, culture reversion rate and 5-year mortality were not significantly different. Additionally, A. fumigatus and repeated detection of Aspergillus were not associated with treatment outcomes. CONCLUSION There was no association between respiratory isolation of Aspergillus and NTM-PD treatment outcomes in this cohort. However, treatment for NTM-PD was initiated more frequently in patients who isolated Aspergillus.
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Affiliation(s)
- Daan Raats
- Toronto Western Hospital, University Health Network, Department of Medicine, Division of Respirology, Toronto, Ontario, Canada; West Park Healthcare Centre, Department of Respiratory Medicine, Toronto, Ontario, Canada; University of Toronto, Department of Medicine, Division of Respirology, Toronto, Ontario, Canada.
| | - Sharina M S Aldhaheri
- Tawam Hospital, Pulmonary Department, Internal Medicine, Al Ain, United Arab Emirates.
| | - Theodore K Marras
- Toronto Western Hospital, University Health Network, Department of Medicine, Division of Respirology, Toronto, Ontario, Canada; University of Toronto, Department of Medicine, Division of Respirology, Toronto, Ontario, Canada.
| | - Mahtab Mehrabi
- Toronto Western Hospital, University Health Network, Department of Medicine, Division of Respirology, Toronto, Ontario, Canada.
| | - Sarah K Brode
- Toronto Western Hospital, University Health Network, Department of Medicine, Division of Respirology, Toronto, Ontario, Canada; West Park Healthcare Centre, Department of Respiratory Medicine, Toronto, Ontario, Canada; University of Toronto, Department of Medicine, Division of Respirology, Toronto, Ontario, Canada.
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6
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Daley CL, Iaccarino JM, Lange C, Cambau E, Wallace RJ, Andrejak C, Böttger EC, Brozek J, Griffith DE, Guglielmetti L, Huitt GA, Knight SL, Leitman P, Marras TK, Olivier KN, Santin M, Stout JE, Tortoli E, van Ingen J, Wagner D, Winthrop KL. Treatment of Nontuberculous Mycobacterial Pulmonary Disease: An Official ATS/ERS/ESCMID/IDSA Clinical Practice Guideline. Clin Infect Dis 2020; 71:e1-e36. [PMID: 32628747 PMCID: PMC7768748 DOI: 10.1093/cid/ciaa241] [Citation(s) in RCA: 357] [Impact Index Per Article: 89.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 03/05/2020] [Indexed: 12/14/2022] Open
Abstract
Nontuberculous mycobacteria (NTM) represent over 190 species and subspecies, some of which can produce disease in humans of all ages and can affect both pulmonary and extrapulmonary sites. This guideline focuses on pulmonary disease in adults (without cystic fibrosis or human immunodeficiency virus infection) caused by the most common NTM pathogens such as Mycobacterium avium complex, Mycobacterium kansasii, and Mycobacterium xenopi among the slowly growing NTM and Mycobacterium abscessus among the rapidly growing NTM. A panel of experts was carefully selected by leading international respiratory medicine and infectious diseases societies (ATS, ERS, ESCMID, IDSA) and included specialists in pulmonary medicine, infectious diseases and clinical microbiology, laboratory medicine, and patient advocacy. Systematic reviews were conducted around each of 22 PICO (Population, Intervention, Comparator, Outcome) questions and the recommendations were formulated, written, and graded using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Thirty-one evidence-based recommendations about treatment of NTM pulmonary disease are provided. This guideline is intended for use by healthcare professionals who care for patients with NTM pulmonary disease, including specialists in infectious diseases and pulmonary diseases.
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Affiliation(s)
- Charles L Daley
- Department of Medicine, National Jewish Health, Denver, Colorado, USA
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jonathan M Iaccarino
- Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Christoph Lange
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany
- German Center for Infection Research (DZIF), Clinical Tuberculosis Unit, Borstel, Germany
- Respiratory Medicine & International Health, University of Lübeck, Lübeck, Germany
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Emmanuelle Cambau
- National Reference Center for Mycobacteria and Antimycobacterial Resistance, APHP -Hôpital Lariboisière, Bacteriology; Inserm, University Paris Diderot, IAME UMR1137, Paris, France
| | - Richard J Wallace
- Mycobacteria/Nocardia Laboratory, Department of Microbiology, The University of Texas Health Science Center, Tyler, Texas, USA
| | - Claire Andrejak
- Respiratory and Intensive Care Unit, University Hospital Amiens, Amiens, France
- EA 4294, AGIR, Jules Verne Picardy University, Amiens, France
| | - Erik C Böttger
- Institute of Medical Microbiology, National Reference Center for Mycobacteria, University of Zurich, Zurich, Switzerland
| | - Jan Brozek
- Department of Clinical Epidemiology & Biostatistics, McMaster University Health Sciences Centre, Hamilton, Ontario, Canada
| | - David E Griffith
- Pulmonary Infectious Disease Section, University of Texas Health Science Center, Tyler, Texas, USA
| | - Lorenzo Guglielmetti
- National Reference Center for Mycobacteria and Antimycobacterial Resistance, APHP -Hôpital Lariboisière, Bacteriology; Inserm, University Paris Diderot, IAME UMR1137, Paris, France
- Team E13 (Bactériologie), Centre d’Immunologie et des Maladies Infectieuses, Sorbonne Université, Université Pierre et Marie Curie, Université Paris 06, Centre de Recherche 7, INSERM, IAME UMR1137, Paris, France
| | - Gwen A Huitt
- Department of Medicine, National Jewish Health, Denver, Colorado, USA
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Shandra L Knight
- Library and Knowledge Services, National Jewish Health, Denver, Colorado, USA
| | | | - Theodore K Marras
- Department of Medicine, University of Toronto and University Health Network, Toronto, Ontario, Canada
| | - Kenneth N Olivier
- Pulmonary Branch, National Heart, Lung and Blood Institute, Bethesda, Maryland, USA
| | - Miguel Santin
- Service of Infectious Diseases, Bellvitge University Hospital-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Jason E Stout
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina, USA
| | - Enrico Tortoli
- Emerging Bacterial Pathogens Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Jakko van Ingen
- Radboud Center for Infectious Diseases, Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dirk Wagner
- Division of Infectious Diseases, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kevin L Winthrop
- Divisions of Infectious Diseases, Schools of Public Health and Medicine, Oregon Health and Science University, Portland, Oregon, USA
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7
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Daley CL, Iaccarino JM, Lange C, Cambau E, Wallace RJ, Andrejak C, Böttger EC, Brozek J, Griffith DE, Guglielmetti L, Huitt GA, Knight SL, Leitman P, Marras TK, Olivier KN, Santin M, Stout JE, Tortoli E, van Ingen J, Wagner D, Winthrop KL. Treatment of nontuberculous mycobacterial pulmonary disease: an official ATS/ERS/ESCMID/IDSA clinical practice guideline. Eur Respir J 2020; 56:2000535. [PMID: 32636299 PMCID: PMC8375621 DOI: 10.1183/13993003.00535-2020] [Citation(s) in RCA: 364] [Impact Index Per Article: 91.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 03/03/2020] [Indexed: 12/28/2022]
Abstract
Nontuberculous mycobacteria (NTM) represent over 190 species and subspecies, some of which can produce disease in humans of all ages and can affect both pulmonary and extrapulmonary sites. This guideline focuses on pulmonary disease in adults (without cystic fibrosis or human immunodeficiency virus infection) caused by the most common NTM pathogens such as Mycobacterium avium complex, Mycobacterium kansasii, and Mycobacterium xenopi among the slowly growing NTM and Mycobacterium abscessus among the rapidly growing NTM. A panel of experts was carefully selected by leading international respiratory medicine and infectious diseases societies (ATS, ERS, ESCMID, IDSA) and included specialists in pulmonary medicine, infectious diseases and clinical microbiology, laboratory medicine, and patient advocacy. Systematic reviews were conducted around each of 22 PICO (Population, Intervention, Comparator, Outcome) questions and the recommendations were formulated, written, and graded using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Thirty-one evidence-based recommendations about treatment of NTM pulmonary disease are provided. This guideline is intended for use by healthcare professionals who care for patients with NTM pulmonary disease, including specialists in infectious diseases and pulmonary diseases.
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Affiliation(s)
- Charles L. Daley
- National Jewish Health and University of Colorado Health
Sciences, Denver, Colorado, USA
| | | | - Christoph Lange
- Division of Clinical Infectious Diseases, Research Center
Borstel, Borstel, Germany, German Center for Infection Research (DZIF), Respiratory
Medicine & International Health, University of Lübeck, Lübeck,
Germany, and Dept of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Emmanuelle Cambau
- National Reference Center for Mycobacteria and
Antimycobacterial Resistance, APHP -Hôpital Lariboisière,
Bacteriology; Inserm University Paris Diderot, IAME UMR1137, Bacteriology, Paris,
France
| | - Richard J. Wallace
- Mycobacteria/Nocardia Laboratory, Dept of Microbiology, The
University of Texas Health Science Center, Tyler, TX, USA
| | - Claire Andrejak
- Respiratory and Intensive Care Unit, University Hospital
Amiens, Amiens, France and EA 4294, AGIR, Jules Verne Picardy University, Amiens,
France
| | - Erik C. Böttger
- Institute of Medical Microbiology, National Reference
Center for Mycobacteria, University of Zurich, Zurich, Switzerland
| | - Jan Brozek
- Department of Clinical Epidemiology & Biostatistics,
McMaster University Health Sciences Centre, 1200 Main Street West, Hamilton, ON L8N
3Z5 Canada
| | - David E. Griffith
- Pulmonary Infectious Disease Section, University of Texas
Health Science Center, Tyler, TX, USA
| | - Lorenzo Guglielmetti
- National Reference Center for Mycobacteria and
Antimycobacterial Resistance, APHP -Hôpital Lariboisière,
Bacteriology; Inserm University Paris Diderot, IAME UMR1137, Bacteriology, Paris,
France
- Team E13 (Bactériologie), Centre
d’Immunologie et des Maladies Infectieuses, Sorbonne Université,
Université Pierre et Marie Curie, Université Paris 06, Centre de
Recherche 7, INSERM, IAME UMR1137, Paris, Francis
| | - Gwen A. Huitt
- Library and Knowledge Services, National Jewish Health,
Denver, Colorado, USA
| | - Shandra L. Knight
- Library and Knowledge Services, National Jewish Health,
Denver, Colorado, USA
| | | | - Theodore K. Marras
- Dept of Medicine, University of Toronto and University
Health Network, Toronto, ON, Canada
| | - Kenneth N. Olivier
- Pulmonary Branch, National Heart, Lung and Blood
Institute, Bethesda, MD, USA
| | - Miguel Santin
- Service of Infectious Diseases, Bellvitge University
Hospital-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat,
Barcelona, Spain
| | - Jason E. Stout
- Division of Infectious Diseases and International Health,
Duke University Medical Center, Durham, NC, USA
| | - Enrico Tortoli
- Emerging Bacterial Pathogens Unit, IRCCS San Raffaele
Scientific Institute, Milan, Italy
| | - Jakko van Ingen
- Radboud Center for Infectious Diseases, Dept of Medical
Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dirk Wagner
- Division of Infectious Diseases, Dept of Medicine II,
Medical Center - University of Freiburg, Faculty of Medicine, University of
Freiburg, Freiburg, Germany
| | - Kevin L. Winthrop
- Divisions of Infectious Diseases, Schools of Public
Health and Medicine, Oregon Health and Science University, Portland, OR, USA
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Ghio AJ, Smith GS, DeFlorio-Barker S, Messier KP, Hudgens E, Murphy MS, Maillard JM, Stout JE, Hilborn ED. Application of diagnostic criteria for non-tuberculous mycobacterial disease to a case series of mycobacterial-positive isolates. J Clin Tuberc Other Mycobact Dis 2019; 17:100133. [PMID: 31867444 PMCID: PMC6904831 DOI: 10.1016/j.jctube.2019.100133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The American Thoracic Society (ATS) and Infectious Diseases Society of America (IDSA) have provided guidelines to assist in the accurate diagnosis of lung disease caused by nontuberculous mycobacteria (NTM). These microbiologic, radiographic, and clinical criteria are considered equally important and all must be met to make the diagnosis of NTM lung disease. To assess the significance of the three criteria, each was evaluated for its contribution to the diagnosis of NTM lung disease in a case series. Laboratory reports of any specimen positive for NTM isolation were collected between January 1, 2006 and December 31, 2010 at a university medical center. Medical records were reviewed in detail using a standardized form. The total number of patients with a culture from any site positive for NTM was 297 while the number from respiratory specimens during the same period was 232 (78%). Samples from two of these patients also yielded M. tuberculosis complex and were excluded. While 128 of the remaining 230 patients (55.7%) in the cohort met the microbiologic criterion for diagnosis of NTM lung disease, 151 (65.6%) and 189 (78.3%) met the radiologic and clinical criteria respectively. Only 78 patients (33.9%) met all three criteria provided by the ATS/IDSA for diagnosis of NTM lung disease. This evaluation reaffirms that defining NTM lung disease using either one or two of the criteria provided by the 2007 ATS/IDSA guidelines may significantly overestimate the number of cases of NTM lung disease. Based on the experience of defining NTM lung disease in this case series, recommendations for modification of the ATS/IDSA guidelines are provided which include expansion of both radiologic patterns and the list of symptoms associated with NTM lung disease.
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Affiliation(s)
- Andrew J Ghio
- Human Studies Facility, US Environmental Protection Agency, 104 Mason Farm Road, Chapel Hill, NC 27514, USA
| | - Genee S Smith
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Stephanie DeFlorio-Barker
- Human Studies Facility, US Environmental Protection Agency, 104 Mason Farm Road, Chapel Hill, NC 27514, USA
| | | | - Edward Hudgens
- Human Studies Facility, US Environmental Protection Agency, 104 Mason Farm Road, Chapel Hill, NC 27514, USA
| | | | | | | | - Elizabeth D Hilborn
- Human Studies Facility, US Environmental Protection Agency, 104 Mason Farm Road, Chapel Hill, NC 27514, USA
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9
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Aznar ML, Marras TK, Elshal AS, Mehrabi M, Brode SK. Safety and effectiveness of low-dose amikacin in nontuberculous mycobacterial pulmonary disease treated in Toronto, Canada. BMC Pharmacol Toxicol 2019; 20:37. [PMID: 31159865 PMCID: PMC6547538 DOI: 10.1186/s40360-019-0302-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 04/17/2019] [Indexed: 01/15/2023] Open
Abstract
Background Treatment guidelines suggest either a low-dose or high-dose approach when prescribing amikacin for nontuberculous mycobacterial pulmonary disease (NTM PD), but data supporting the low-dose approach are limited. The purpose of this study was to describe the safety and efficacy of the use of a low-dose of intravenous amikacin in a cohort of patients with NTM PD. Methods We retrospectively reviewed all patients with NTM PD who received amikacin at our institution between July 1, 2003 and February 28, 2017. Demographics, clinical, microbiological and radiological data, indication and dose of amikacin, and adverse drug effects were recorded. Results A total of 107 patients received a regimen containing amikacin for a median (IQR) of 7 (4–11) months. Seventy (65.4%) were female and the mean age (SD) was 58.3 (14.9) years. Amikacin was started at a median dose of 9.9 (2.5) mg/kg/day. Ototoxicity was observed in 30/77 (39%) patients and it was related to female sex (OR 4.96, 95%CI 1.24–19.87), and total dose of amikacin per bodyweight (OR 1.62, 95%CI 1.08–2.43). Patients of East Asian ethnicity were less likely to develop ototoxicity (0.24, 95%CI 0.06–0.95). Out of 96 patients who received amikacin for more than 3 months, 65 (67.7%) experienced symptom improvement and 30/62 (49.2%) converted their sputum to culture negative within a year. Conclusions Patients with NTM PD treated with low-dose intravenous amikacin frequently developed ototoxicity, which was associated with female sex, and total dose of amikacin per bodyweight. Physicians should carefully consider dose, treatment duration, and long term prognosis in balancing risks and benefits of intravenous amikacin in NTM PD.
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Affiliation(s)
- Maria Luisa Aznar
- Joint Division of Respirology, Department of Medicine, University Health Network and Sinai Health System, 399 Bathurst Street, Toronto, M5T 2S8, ON, Canada. .,Medicine Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Theodore K Marras
- Joint Division of Respirology, Department of Medicine, University Health Network and Sinai Health System, 399 Bathurst Street, Toronto, M5T 2S8, ON, Canada
| | - Ahmed Said Elshal
- Joint Division of Respirology, Department of Medicine, University Health Network and Sinai Health System, 399 Bathurst Street, Toronto, M5T 2S8, ON, Canada.,Gastroenterology Department, National Hepatology and Tropical Medicine Institute, Cairo, Egypt
| | - Mahtab Mehrabi
- Joint Division of Respirology, Department of Medicine, University Health Network and Sinai Health System, 399 Bathurst Street, Toronto, M5T 2S8, ON, Canada
| | - Sarah K Brode
- Joint Division of Respirology, Department of Medicine, University Health Network and Sinai Health System, 399 Bathurst Street, Toronto, M5T 2S8, ON, Canada.,West Park Healthcare Centre, Toronto, Canada
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10
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Hirama T, Brode SK, Marras TK. Radiologic types of Mycobacterium xenopi pulmonary disease: different patients with similar short-term outcomes. Eur J Clin Microbiol Infect Dis 2018; 38:373-381. [DOI: 10.1007/s10096-018-3437-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 11/14/2018] [Indexed: 10/27/2022]
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11
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Habib S, Rajdev K, Pervaiz S, Hasan Siddiqui A, Azam M, Chalhoub M. Pulmonary Cavitary Disease Secondary to Mycobacterium xenopi Complicated by Respiratory Failure. Cureus 2018; 10:e3512. [PMID: 30648049 PMCID: PMC6318116 DOI: 10.7759/cureus.3512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 10/29/2018] [Indexed: 11/05/2022] Open
Abstract
Non-tuberculous mycobacteria (NTM) are a significant cause of pulmonary infection worldwide and can be clinically challenging. Mycobacterium xenopi (M. xenopi) has low pathogenicity and usually requires either host immune impairment, as in the case of a human immunodeficiency virus infection, or a structural lung disease to cause a clinical disease. Comorbidities have an essential role in M. xenopi occurrence. Herein, we present a rare case of pulmonary cavitary disease caused by M. xenopi complicated by respiratory failure and superinfection in a patient with a chronic obstructive pulmonary disease. An 81-year-old woman presented to the hospital with the chief concerns of shortness of breath and productive cough lasting a few weeks before presentation. A computed tomography scan of the chest showed a right upper lobe, thick-walled, cavitary lesion measuring 2.1 cm x 4.3 cm x 3.1 cm with associated bronchiectasis and pleural parenchymal scarring. One year ago, the patient underwent bronchoscopy for a right upper lobe cavitary lesion, which revealed M. xenopi on bronchoalveolar lavage culture. During the current admission, she was started on rifampin, isoniazid, ethambutol, and clarithromycin because the M. xenopi was clinically significant and fulfilled the American Thoracic Society diagnostic criteria for NTM lung disease. A diagnosis of NTM pulmonary disease does not necessarily suggest that treatment is required. The distinction between colonization and illness may be difficult upon the isolation of M. xenopi. A patient-centered approach is essential given that M. xenopi is often considered a commensal pathogen. When treatment is required, a multidrug approach with an individualized, optimal duration of therapy should be considered.
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Affiliation(s)
- Saad Habib
- Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, USA
| | - Kartikeya Rajdev
- Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, USA
| | - Sami Pervaiz
- Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, USA
| | - Abdul Hasan Siddiqui
- Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, USA
| | - Mohammed Azam
- Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, USA
| | - Michel Chalhoub
- Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, USA
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Aznar ML, Zubrinic M, Siemienowicz M, Hashimoto K, Brode SK, Mehrabi M, Patsios D, Keshavjee S, Marras TK. Adjuvant lung resection in the management of nontuberculous mycobacterial lung infection: A retrospective matched cohort study. Respir Med 2018; 142:1-6. [PMID: 30170795 DOI: 10.1016/j.rmed.2018.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 06/18/2018] [Accepted: 07/07/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND OBJECTIVES Lung resection in patients with nontuberculous mycobacterial pulmonary disease (NTM-PD) is considered when medical therapy alone fails to provide long term control. Data regarding comparative and long-term outcomes are limited. We aimed to review indications and outcomes of adjuvant lung resection for NTM-PD compared with controls. METHODS We retrospectively studied 27 surgically treated patients, matched 1:1 for age, sex, NTM species, and radiologic pattern of disease, with control patients treated exclusively with antibiotics. RESULTS In the surgical group, the median (IQR) age was 55 (49-61) years and 74.1% were female. Eighteen patients had Mycobacterium avium complex, and 9 had M. xenopi. Operations included 8 pneumonectomies, 20 lobectomies, one segmentectomy and one lobectomy plus segmentectomy. Post-surgical complications occurred in 6 patients (20%), including 2 acute respiratory distress syndrome, 1 bronchopleural fistula, 1 pericardial tamponade, and 2 empyema. Complications were more common among patients operated upon for progressive disease despite medical therapy (OR 10, p = 0.025). Of 24 matched pairs followed for ≥1 year, sustained culture conversion was observed in 21 (87.5%) patients in the surgical group and in 11 (45.8%) patients in the non-surgical group (RR 2.36, 95%CI 1.37-4.03, p = 0.002). Median (IQR) percentage of follow-up time on antibiotics was 14% (0-100%) in the surgical group and 83% (10.8%-100%) in the non-surgical group (p = 0.195) during a median (IQR) follow-up of 16 (2-36) months. CONCLUSIONS NTM-PD patients who underwent adjuvant lung resection experienced significant morbidity and more frequently achieved sputum culture conversion. Long term antibiotic requirements may have been reduced.
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Affiliation(s)
- María Luisa Aznar
- Division of Respirology, Department of Medicine, University Health Network, Toronto Western Hospital, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada
| | - Marijana Zubrinic
- Division of Thoracic Surgery, University Health Network, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, M5G2C4, Canada
| | - Miranda Siemienowicz
- Joint Department of Medical Imaging, University Health Network, Women's College Hospital and Mount Sinai Hospital, Toronto, ON, Canada
| | - Kohei Hashimoto
- Division of Thoracic Surgery, University Health Network, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, M5G2C4, Canada
| | - Sarah Kathleen Brode
- Division of Respirology, Department of Medicine, University Health Network, Toronto Western Hospital, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada; West Park Healthcare Centre, 82 Buttonwood Ave., Toronto, ON, M6M 2J5, Canada; Department of Medicine, University of Toronto, 27 King's College Circle, Toronto, ON, M5S 1A1, Canada
| | - Mahtab Mehrabi
- Division of Respirology, Department of Medicine, University Health Network, Toronto Western Hospital, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada
| | - Demetris Patsios
- Joint Department of Medical Imaging, University Health Network, Women's College Hospital and Mount Sinai Hospital, Toronto, ON, Canada
| | - Shafique Keshavjee
- Division of Thoracic Surgery, University Health Network, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, M5G2C4, Canada
| | - Theodore Konstantine Marras
- Division of Respirology, Department of Medicine, University Health Network, Toronto Western Hospital, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada; Department of Medicine, University of Toronto, 27 King's College Circle, Toronto, ON, M5S 1A1, Canada.
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13
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Marras TK, Campitelli MA, Lu H, Chung H, Brode SK, Marchand-Austin A, Winthrop KL, Gershon AS, Kwong JC, Jamieson FB. Pulmonary Nontuberculous Mycobacteria-Associated Deaths, Ontario, Canada, 2001-2013. Emerg Infect Dis 2018; 23:468-476. [PMID: 28221106 PMCID: PMC5382758 DOI: 10.3201/eid2303.161927] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Survival implications of nontuberculous mycobacterial pulmonary disease (NTM-PD) and NTM pulmonary isolation without disease (NTM-PI) are unclear. To study deaths associated with NTM-PD and NTM-PI and differences in survival between them, we conducted a population-based cohort study of persons with microbiologically defined NTM-PD or NTM-PI diagnosed during 2001–2013 in Ontario, Canada. We used propensity score matching and Cox proportional hazards models to compare survival. Among 9,681 NTM-PD patients and 10,936 NTM-PI patients, 87% and 91%, respectively, were successfully matched with unexposed controls. Both NTM-PD and NTM-PI were associated with higher rates of death for all species combined and for most individual species. Compared with NTM-PI, NTM-PD was associated with higher death rates for all species combined, Mycobacterium avium complex, and M. xenopi. NTM-PD and NTM-PI were significantly associated with death, NTM-PD more so than NTM-PI.
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Hirama T, Marchand-Austin A, Ma J, Alexander DC, Brode SK, Marras TK, Jamieson FB. Mycobacterium xenopi Genotype Associated with Clinical Phenotype in Lung Disease. Lung 2018; 196:213-217. [DOI: 10.1007/s00408-018-0087-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 01/04/2018] [Indexed: 11/28/2022]
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15
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Abdulfattah O, Salhan D, Kandel S, Rahman EU, Dahal S, Alnafoosi Z, Schmidt F. Fatal pulmonary cavitary disease secondary to Mycobacterium xenopi in a patient with sarcoidosis. J Community Hosp Intern Med Perspect 2017; 7:372-377. [PMID: 29296252 PMCID: PMC5738639 DOI: 10.1080/20009666.2017.1407211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 11/09/2017] [Indexed: 11/01/2022] Open
Abstract
Introduction: Mycobacterium xenopi (M. xenopi) has low pathogenicity and usually requires either host immune impairment or structural lung disease to cause clinical disease. Fatal cavitary infection in a patient without immunosuppression is rarely presented. Case report: A 62-year-old female with history of sarcoidosis and hypertension presented with cough, fever and dyspnea for one week. Chest imaging showed irregular opacification of upper lung zones. The sputum samples tested positive for acid-fast bacilli (AFB) and the subsequent testing identified M. xenopi. She was started on rifampin, isoniazid, pyrazinamide and ethambutol along with azithromycin, and was discharged with plans to continue the same. A follow up sputum test was negative for AFB. She was, however, readmitted ten months later with sepsis due to pneumonia. Chest imaging revealed worsening cavitary lung lesions. Despite starting her on intravenous antibiotics while continuing anti-tubercular therapy, she developed severe respiratory distress and had to be intubated. Her condition continued to deteriorate and she expired the following day. Conclusion: Fatal cavitary infections with M. xenopi have been reported in the absence of established optimal management. Well-designed studies with sufficient power are needed to establish new treatment guidelines.
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Affiliation(s)
- Omar Abdulfattah
- Pulmonary and Critical Care Department, Interfaith Medical Center, Brooklyn, NY, USA
| | - Divya Salhan
- Pulmonary and Critical Care Department, Interfaith Medical Center, Brooklyn, NY, USA
| | - Saroj Kandel
- Pulmonary and Critical Care Department, Interfaith Medical Center, Brooklyn, NY, USA
| | - Ebad Ur Rahman
- Internal Medicine Department, Interfaith Medical Center, Brooklyn, NY, USA
| | - Sumit Dahal
- Internal Medicine Department, Interfaith Medical Center, Brooklyn, NY, USA
| | - Zainab Alnafoosi
- Internal Medicine Department, Interfaith Medical Center, Brooklyn, NY, USA
| | - Frances Schmidt
- Pulmonary and Critical Care Department, Interfaith Medical Center, Brooklyn, NY, USA
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16
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Martín Asenjo M, Martín Guerra JM, López Pedreira MR, Prieto de Paula JM. Mycobacterium xenopi and squamous cell carcinoma of the lung. Arch Bronconeumol 2017. [PMID: 28641879 DOI: 10.1016/j.arbres.2017.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Miguel Martín Asenjo
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valladolid, Valladolid, España.
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Fleshner M, Olivier KN, Shaw PA, Adjemian J, Strollo S, Claypool RJ, Folio L, Zelazny A, Holland SM, Prevots DR. Mortality among patients with pulmonary non-tuberculous mycobacteria disease. Int J Tuberc Lung Dis 2017; 20:582-7. [PMID: 27084809 DOI: 10.5588/ijtld.15.0807] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
SETTING Tertiary referral center, National Institutes of Health (NIH), USA. OBJECTIVE To estimate the mortality rate and its correlates among persons with pulmonary non-tuberculous mycobacteria (PNTM) disease. DESIGN A retrospective review of 106 patients who were treated at the NIH Clinical Center and met American Thoracic Society/Infectious Diseases Society of America criteria for PNTM. Eligible patients were aged ⩾18 years and did not have cystic fibrosis or human immunodeficiency virus (HIV) infection. RESULTS Of 106 patients followed for a median of 4.9 years, 27 (25%) died during follow-up, for a mortality rate of 4.2 per 100 person-years. The population was predominantly female (88%) and White (88%), with infrequent comorbidities. Fibrocavitary disease (adjusted hazard ratio [aHR] 3.3, 95% confidence interval [CI] 1.3-8.3) and pulmonary hypertension (aHR 2.1, 95%CI 0.9-5.1) were associated with a significantly elevated risk of mortality in survival analysis. CONCLUSIONS PNTM remains a serious public health concern, with a consistently elevated mortality rate across multiple populations. Significant risk factors for death include fibrocavitary disease and pulmonary hypertension. Further research is needed to more specifically identify clinical and microbiologic factors that jointly influence disease outcome.
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Affiliation(s)
- M Fleshner
- Epidemiology Unit, Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - K N Olivier
- Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, NIH, Bethesda, Maryland, USA
| | - P A Shaw
- Biostatistics Research Branch, Division of Clinical Research, Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - J Adjemian
- Epidemiology Unit, Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Bethesda, USA
| | - S Strollo
- Epidemiology Unit, Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Bethesda, USA
| | - R J Claypool
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Bethesda, USA
| | - L Folio
- Department of Radiology and Imaging Sciences, Clinical Center, NIH, Bethesda, USA
| | - A Zelazny
- Department of Laboratory Medicine, Clinical Center, NIH, Bethesda, Maryland, USA
| | - S M Holland
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Bethesda, USA
| | - D R Prevots
- Epidemiology Unit, Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Bethesda, USA
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18
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Blanc P, Dutronc H, Peuchant O, Dauchy FA, Cazanave C, Neau D, Wirth G, Pellegrin JL, Morlat P, Mercié P, Tunon-de-Lara JM, Doutre MS, Pélissier P, Dupon M. Nontuberculous Mycobacterial Infections in a French Hospital: A 12-Year Retrospective Study. PLoS One 2016; 11:e0168290. [PMID: 27959960 PMCID: PMC5154556 DOI: 10.1371/journal.pone.0168290] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 11/29/2016] [Indexed: 01/08/2023] Open
Abstract
Background Nontuberculous mycobacteria (NTM) are environmental organisms associated with a range of infections. Reports of NTM epidemiology are mainly focused on pulmonary infections and isolations, and extrapulmonary infections are less frequently described. Methods We conducted a retrospective study of NTM infections at the Bordeaux University Hospital, France, between January 2002 and December 2013. We used the microbiologic component of the American Thoracic Society/Infectious Diseases Society of America's pulmonary NTM disease criteria to define cases of pulmonary NTM, and patients with isolates from a normally sterile site were classified as having extrapulmonary disease. Results In our setting, 170 patients were included. Pulmonary cases predominated (54.1%), followed by skin and soft tissue infections (22.9%), disseminated cases (10.6%), lymphadenitis (7.7%), bone and joint infections (2.9%) and the remaining 1.8% catheter-related infections. Overall, 16 NTM species were isolated. Mycobacterium avium (31.8%) and M. intracellulare (20%) were the most common species identified, followed by M. marinum (13.5%), M. kansasii (10.6%), M. xenopi (9.4%), rapidly growing mycobacteria (9.4%) and other slowly growing mycobacteria (5.3%). In general, NTM isolates were largely prevalent in people older than 50 (62.4%); patients aged 1–10 year-old exclusively yielded M. avium from lymph nodes, almost cases having being diagnosed after 2007. Among the 121 patients with complete follow-up, 78 (64.5%), 24 (19.8%), and 19 (15.7%) were cured, experienced relapse, or died, respectively. Conclusion In our study, extrapulmonary NTM infections represented almost half of cases, consisting mainly in skin and soft tissue infections. The increase lymphadenitis cases in children after 2007 could be linked to the cessation of mandatory BCG vaccination in France. We observed similar cure rates (64%) between pulmonary and extrapulmonary infections.
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Affiliation(s)
- Peggy Blanc
- Service de maladies infectieuses et tropicales, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Hervé Dutronc
- Service de maladies infectieuses et tropicales, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Olivia Peuchant
- Laboratoire de Bactériologie, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- Université de Bordeaux, Infections humaines à mycoplasmes et à chlamydiae, Bordeaux, France
- INRA, Infections humaines à mycoplasmes et à chlamydiae, Bordeaux, France
- * E-mail:
| | - Frédéric-Antoine Dauchy
- Service de maladies infectieuses et tropicales, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Charles Cazanave
- Service de maladies infectieuses et tropicales, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Didier Neau
- Service de maladies infectieuses et tropicales, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Gaëtane Wirth
- Service de maladies infectieuses et tropicales, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Jean-Luc Pellegrin
- Service de médecine interne, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Philippe Morlat
- Service de médecine interne, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Patrick Mercié
- Service de médecine interne, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | | | - Marie-Sylvie Doutre
- Service de dermatologie, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Philippe Pélissier
- Service de chirurgie plastique, reconstructrice et esthétique -brulés- chirurgie de la main, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Michel Dupon
- Service de maladies infectieuses et tropicales, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
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Okano Y, Shinohara T, Imanishi S, Takahashi N, Naito N, Taoka T, Kadota N, Ogushi F. Miliary pulmonary nodules due to Mycobacterium xenopi in a steroid-induced immunocompromised patient successfully treated with chemotherapy: a case report. BMC Pulm Med 2016; 16:92. [PMID: 27287608 PMCID: PMC4902965 DOI: 10.1186/s12890-016-0252-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 06/01/2016] [Indexed: 11/13/2022] Open
Abstract
Background Mycobacterium xenopi-infected patients have a high prevalence of pulmonary cavities and nodules. However, the clinical course for patients with miliary nodules due to M. xenopi has not yet been reported. Case presentation We encountered a case of miliary nodules with gradually worsening coughing and sputum production in a 44-year-old male who had renal dysfunction due to glomerulosclerosis with a decade-long history of steroid therapy. Although we started anti-tuberculosis treatment on clinical suspicion of miliary tuberculosis, cultures of sputum and bronchial lavage were both positive for M. xenopi. The patient was successfully treated with rifampin, ethambutol and clarithromycin, without fibrosis. It was unclear whether the miliary pattern was induced by hematogenous or endobronchial spread of the M. xenopi infection. Conclusion Even when clinical and radiological disease manifestations are similar to those of miliary tuberculosis, M. xenopi infection should be considered in the differential diagnosis of miliary nodules.
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Affiliation(s)
- Yoshio Okano
- Division of Pulmonary Medicine, National Hospital Organization Kochi Hospital, 1-2-25 Asakuranishimachi, Kochi, 780-8077, Japan
| | - Tsutomu Shinohara
- Department of Clinical Investigation, National Hospital Organization Kochi Hospital, 1-2-25 Asakuranishimachi, Kochi, 780-8077, Japan.
| | - Shino Imanishi
- Division of Pulmonary Medicine, National Hospital Organization Kochi Hospital, 1-2-25 Asakuranishimachi, Kochi, 780-8077, Japan
| | - Naoki Takahashi
- Division of Pulmonary Medicine, National Hospital Organization Kochi Hospital, 1-2-25 Asakuranishimachi, Kochi, 780-8077, Japan
| | - Nobuhito Naito
- Division of Pulmonary Medicine, National Hospital Organization Kochi Hospital, 1-2-25 Asakuranishimachi, Kochi, 780-8077, Japan
| | - Takanari Taoka
- Division of Pulmonary Medicine, National Hospital Organization Kochi Hospital, 1-2-25 Asakuranishimachi, Kochi, 780-8077, Japan
| | - Naoki Kadota
- Division of Pulmonary Medicine, National Hospital Organization Kochi Hospital, 1-2-25 Asakuranishimachi, Kochi, 780-8077, Japan
| | - Fumitaka Ogushi
- Division of Pulmonary Medicine, National Hospital Organization Kochi Hospital, 1-2-25 Asakuranishimachi, Kochi, 780-8077, Japan
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Wassilew N, Hoffmann H, Andrejak C, Lange C. Pulmonary Disease Caused by Non-Tuberculous Mycobacteria. Respiration 2016; 91:386-402. [PMID: 27207809 DOI: 10.1159/000445906] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 03/31/2016] [Indexed: 11/19/2022] Open
Abstract
Non-tuberculous mycobacteria (NTM) include more than 160 ubiquitous, environmental, acid-fast-staining bacterial species, some of which may cause disease in humans. Chronic pulmonary infection is the most common clinical manifestation. Although patients suffering from chronic lung diseases are particularly susceptible to NTM pulmonary disease, many affected patients have no apparent risk factors. Host and pathogen factors leading to NTM pulmonary disease are not well understood and preventive therapies are lacking. NTM isolation and pulmonary disease are reported to rise in frequency in Europe as well as in other parts of the world. Differentiation between contamination, infection, and disease remains challenging. Treatment of NTM pulmonary disease is arduous, lengthy, and costly. Correlations between results of in vitro antibiotic susceptibility testing and clinical treatment outcomes are only evident for the Mycobacterium avium complex, M. kansasii, and some rapidly growing mycobacteria. We describe the epidemiology of NTM pulmonary disease as well as emerging NTM pathogens and their geographical distribution in non-cystic fibrosis patients in Europe. We also review recent innovations for the diagnosis of NTM pulmonary disease, summarize treatment recommendations, and identify future research priorities to improve the management of patients affected by NTM pulmonary disease.
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Affiliation(s)
- Nasstasja Wassilew
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany
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21
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Novosad S, Henkle E, Winthrop KL. The Challenge of Pulmonary Nontuberculous Mycobacterial Infection. CURRENT PULMONOLOGY REPORTS 2015; 4:152-161. [PMID: 26877911 DOI: 10.1007/s13665-015-0119-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The incidence of nontuberculous mycobacterial (NTM) lung disease is increasing. Current treatment strategies are largely based on expert opinion. The lack of randomized clinical trials to inform treatment leave clinicians with many questions regarding the most effective and safe regimens. The risk-benefit ratio of therapy is often thought to favor observation given the chronic nature of the disease, multiple long-term antibiotics recommended for therapy, side effects associated with treatment, and perceived lack of efficacious therapies.
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Affiliation(s)
- Shannon Novosad
- Pulmonary & Critical Care Medicine Oregon Health & Science University 3181 SW Sam Jackson Park Road, UHN 67 Portland, OR, 97239 USA
| | - Emily Henkle
- School of medicine Public Health & Preventive Medicine Oregon Health & Science University 3181 SW Sam Jackson Park Road Portland, OR, 97239 USA
| | - Kevin L Winthrop
- Department of Medicine Division of Infectious Diseases Oregon Health & Science University 3181 SW Sam Jackson Park Road Portland, OR, 97239 USA
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Kim J, Seong MW, Kim EC, Han SK, Yim JJ. Frequency and clinical implications of the isolation of rare nontuberculous mycobacteria. BMC Infect Dis 2015; 15:9. [PMID: 25572753 PMCID: PMC4297383 DOI: 10.1186/s12879-014-0741-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 12/23/2014] [Indexed: 11/28/2022] Open
Abstract
Background To date, more than 125 species of nontuberculous mycobacteria (NTM) have been identified. In this study, we investigated the frequency and clinical implication of the rarely isolated NTM from respiratory specimens. Methods Patients with NTM isolated from their respiratory specimens between July 1, 2010 and June 31, 2012 were screened for inclusion. Rare NTM were defined as those NTM not falling within the group of eight NTM species commonly identified at our institution: Mycobacterium avium, M. intracellulare, M. abscessus, M. massiliense, M. fortuitum, M. kansasii, M. gordonae, and M. peregrinum. Clinical, radiographic and microbiological data from patients with rare NTM were reviewed and analyzed. Results During the study period, 73 rare NTM were isolated from the respiratory specimens of 68 patients. Among these, M. conceptionense was the most common (nine patients, 12.3%). The median age of the 68 patients with rare NTM was 68 years, while 39 of the patients were male. Rare NTM were isolated only once in majority of patient (64 patients, 94.1%). Among the four patients from whom rare NTM were isolated two or more times, only two showed radiographic aggravation caused by rare NTM during the follow-up period. Conclusions Most of the rarely identified NTM species were isolated from respiratory specimens only once per patient, without concomitant clinical aggravation. Clinicians could therefore observe such patients closely without invasive work-ups or treatment, provided the patients do not have decreased host immunity towards mycobacteria.
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Affiliation(s)
- Junghyun Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 110-744, Republic of Korea.
| | - Moon-Woo Seong
- Department of Laboratory Medicine, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 110-744, Republic of Korea.
| | - Eui-Chong Kim
- Department of Laboratory Medicine, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 110-744, Republic of Korea.
| | - Sung Koo Han
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 110-744, Republic of Korea.
| | - Jae-Joon Yim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 110-744, Republic of Korea.
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