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Galindo-Rodríguez D, Moreno Hijazo M, Balint Ilie C, Rubio Castro D, Vallés Tormo I, Alias Alegre EG. Multidrug-resistant Mycobacterium abscessus infection in an anophthalmic socket treated with bedaquiline on a compassionate use basis: A case report. Am J Ophthalmol Case Rep 2024; 36:102139. [PMID: 39206414 PMCID: PMC11357776 DOI: 10.1016/j.ajoc.2024.102139] [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: 01/31/2024] [Revised: 06/23/2024] [Accepted: 08/07/2024] [Indexed: 09/04/2024] Open
Abstract
Purpose To explore the management of a rare ophthalmic infection caused by a multi-resistant strain of Mycobacterium abscessus in the anophthalmic cavity of a patient with a history of multiple eye surgeries. Observations A 60-year-old woman with a history of multiple ocular complications, culminating in the enucleation of the eye and subsequent dermograft implant, developed a resistant infection in the anophthalmic cavity. The infection persisted despite various local interventions and broad-spectrum systemic antibiotic treatments. Resolution of the infection was only achieved after precise diagnosis and the implementation of intensive treatment, which included a specific combination of antibiotics and appropriate surgical debridement of the anophthalmic cavity. Conclusions and importance This case highlights the complexity in managing ophthalmic infections caused by non-tuberculous mycobacteria. It underscores the importance of a multidisciplinary and personalized treatment approach, as well as the need to develop specific guidelines for ophthalmic infections caused by rapidly growing mycobacteria.
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Al-Jabri MY, Dousa KM, Wilson BM, Bonomo RA. The use of dual β-lactams to restore susceptibility of Mycobacterium avium complex. JAC Antimicrob Resist 2024; 6:dlae142. [PMID: 39281290 PMCID: PMC11398912 DOI: 10.1093/jacamr/dlae142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 08/12/2024] [Indexed: 09/18/2024] Open
Abstract
Background The Mycobacterium avium complex (MAC) are non-tuberculous mycobacteria responsible for chronic and debilitating conditions. Guideline-recommended therapy for MAC is a combination of clarithromycin/azithromycin, ethambutol and a rifamycin. However, culture conversion rates with this regimen are 67%. Alternative treatment options are needed. Recent findings of β-lactam combinations in the treatment of other mycobacterial diseases have been promising. The proposed mechanism is an additive inhibition of multiple enzymes in the peptidoglycan synthesis pathway by the β-lactam combinations. Given the similarity in cell wall structures of MAC and M. abscessus, we hypothesize that using dual β-lactams will result in interruption of peptidoglycan synthesis in MAC and reduction of MIC. In this study, we sought to determine the MIC of meropenem in combination with ceftaroline, cefdinir and cefuroxime in MAC. Methods A total of 31 clinical MAC isolates were used for susceptibility testing using broth microdilution method. MICs were tested for meropenem, ceftaroline, cefdinir and cefuroxime, alone, as well as combinations of meropenem plus ceftaroline, cefdinir, or cefuroxime. Results In vitro MAC susceptibility to meropenem was significantly enhanced with the addition of ceftaroline, cefdinir, and cefuroxime. This effect was most significant with addition of ceftaroline and cefdinir, with a change of meropenem MIC50/MIC90 from 16/32 to 0.125/0.5 and 0.125/4 mg/L, respectively (P value ≤0.0001, Wilcoxon signed-rank test). Conclusions This study demonstrates that the susceptibility of MAC to meropenem is restored with the addition of ceftaroline and cefdinir. These findings underscore the potential effectiveness of combining β-lactams as an alternative therapeutic strategy for MAC infections.
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Affiliation(s)
- Maha Y Al-Jabri
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, University Hospitals-Cleveland Medical Center, Cleveland, OH, USA
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Khalid M Dousa
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Geriatric Research Education and Clinical Center (GRECC), VA Northeast Ohio Healthcare System, 10701 East Boulevard, Cleveland, OH 44106, USA
| | - Brigid M Wilson
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Geriatric Research Education and Clinical Center (GRECC), VA Northeast Ohio Healthcare System, 10701 East Boulevard, Cleveland, OH 44106, USA
| | - Robert A Bonomo
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Geriatric Research Education and Clinical Center (GRECC), VA Northeast Ohio Healthcare System, 10701 East Boulevard, Cleveland, OH 44106, USA
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Ugedo J, Tabernero E, Altube L, Leal MV, García JA. Nontuberculous Mycobacteria Isolates in Respiratory Samples and Mycobacterial Pulmonary Disease in an Area of Northern Spain. OPEN RESPIRATORY ARCHIVES 2024; 6:100353. [PMID: 39318829 PMCID: PMC11421231 DOI: 10.1016/j.opresp.2024.100353] [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: 04/23/2024] [Accepted: 07/16/2024] [Indexed: 09/26/2024] Open
Abstract
Introduction The epidemiology of nontuberculous mycobacteria (NTM) is not well known. In this study, we aimed to determine the incidence of NTM isolates and nontuberculous mycobacterial pulmonary disease (NTM-PD) in five closely located hospitals in an area of northern Spain and analyse differences between them. Material and methods Demographic, microbiological, clinical and radiological data were collected retrospectively from all patients with a NTM isolated from respiratory specimens at five hospitals between 2012 and 2019. Mycobacterium gordonae isolates were excluded. Once the data was collected, it was determined which patients met the NMT-PD criteria. Results 594 patients were included in the study. The mean incidence rate of NTM isolates across all five hospitals in the period studied was 4.15 per 100,000 person-year, while the rate of NTM-PD was 1.2. The annual number of isolates showed an upward trend over this period, but the same did not occur in the number of cases of NTM-PD. The species most frequently isolated were Mycobacterium avium complex (MAC) and Mycobacterium xenopi and those most frequently causing disease were MAC and Mycobacterium kansassi. There were significant differences between the five centres. Conclusions Our results are in line with similar studies in Europe in terms of NTM isolation and NTM-PD incidence and species isolated; however, we do not see the upward trend in NTM-PD rates described elsewhere. The great variability in isolation and disease rates, as well as in species isolated in geographically close areas, underlines, in our opinion, the importance of local environmental factors.
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Affiliation(s)
- Javier Ugedo
- Department of Respiratory Medicine, San Pedro University Hospital, Logroño, La Rioja, Spain
| | - Eva Tabernero
- Department of Respiratory Medicine, Cruces University Hospital, BioBizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Lander Altube
- Department of Respiratory Medicine, Galdakao University Hospital, Bizkaia, Spain
| | - María Victoria Leal
- Department of Respiratory Medicine, Basurto University Hospital, Bizkaia, Spain
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Fujita K, Yamamoto Y, Kamita M, Tanaka K, Nakabayashi T, Imakita T, Oi I, Kanai O, Mio T, Tanizawa K, Ito Y. Exploratory Bronchoalveolar Lavage Fluid Analyses Reveal a High Diversity of Microbiome in NTM Lung Disease and a Low Diversity of Microbiome in Bronchiectasis. OPEN RESPIRATORY ARCHIVES 2024; 6:100351. [PMID: 39185443 PMCID: PMC11341927 DOI: 10.1016/j.opresp.2024.100351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2024] Open
Affiliation(s)
- Kohei Fujita
- Division of Respiratory Medicine, Center for Respiratory Diseases, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Yuki Yamamoto
- Division of Respiratory Medicine, Center for Respiratory Diseases, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
- HiLung, Inc., Kyoto, Japan
| | | | - Kosei Tanaka
- H.U. Group Research Institute G.K., Tokyo, Japan
| | | | - Takuma Imakita
- Division of Respiratory Medicine, Center for Respiratory Diseases, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Issei Oi
- Division of Respiratory Medicine, Center for Respiratory Diseases, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Osamu Kanai
- Division of Respiratory Medicine, Center for Respiratory Diseases, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Tadashi Mio
- Division of Respiratory Medicine, Center for Respiratory Diseases, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Kiminobu Tanizawa
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yutaka Ito
- Department of Respiratory Medicine, Allergy and Clinical Immunology, School of Medical Sciences, Nagoya City University, Nagoya, Japan
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Zhang W, Dong L, Men P, Jiang G, Wang F, Wang C, Cheng M, Huang H, Yu X. In vitro antimicrobial activity of doxycycline, minocycline, and tigecycline against Mycobacterium abscessus complex: A meta-analysis study. Diagn Microbiol Infect Dis 2024; 110:116435. [PMID: 39032320 DOI: 10.1016/j.diagmicrobio.2024.116435] [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] [Received: 03/24/2024] [Revised: 05/11/2024] [Accepted: 07/09/2024] [Indexed: 07/23/2024]
Abstract
PURPOSE Mycobacterium abscessus complex (MABC) infections are increasing worldwide. Furthermore, these infections have a low treatment success rate due to their resistance to many current antibiotics. This study aimed to determine the overall in vitro activity of the tetracyclines doxycycline (DOX), minocycline (MIN), and tigecycline (TGC) against MABC clinical isolates. PATIENTS AND METHODS A systematic review of PubMed/MEDLINE, Web of Science, and Embase was conducted up to August 28, 2023. Studies applying the drug susceptibility testing standards of the Clinical and Laboratory Standards Institute were considered. A random effects model was used to assess the total in vitro resistance rates of the MABC clinical isolates to DOX, MIN, and TGC. The I2 and Cochran's Q statistics were employed to evaluate the origins of heterogeneity. All analyses were conducted using CMA V.3 software. RESULTS Twenty-six publications (22, 12, and 11 studies on DOX, MIN, and TGC, respectively) were included. The pooled in vitro resistance rates of the MABC clinical isolates to DOX and MIN at the breakpoint of 8 μg/mL were 93.0 % (95 % CI, 89.2 %-95.5 %) and 87.2 % (95 % CI, 76.5 %-93.4 %), respectively. In the case of TGC, the breakpoints of 2, 4, and 8 μg/mL were associated with pooled resistance rates of 2.5 % (95 % CI, 0.5 %-11.6 %), 7.2 % (95 % CI, 4.0 %-12.5 %), and 16.8 % (95 % CI, 4.7 %-45.0 %), respectively. CONCLUSION Among the three examined tetracyclines, MABC exhibited extremely high resistance rates to DOX and MIN, thereby limiting their use in treating MABC infections. Conversely, MABC showed an increased susceptibility rate to TGC, highlighting TGC administration as a viable treatment option for patients with MABC infections.
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Affiliation(s)
- Weihe Zhang
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug-Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing 101149, China
| | - Lingling Dong
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug-Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing 101149, China
| | - Peixuan Men
- Institute of Medical Information/Medical Library, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100005, China
| | - Guanglu Jiang
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug-Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing 101149, China
| | - Fen Wang
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug-Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing 101149, China
| | - Congli Wang
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug-Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing 101149, China
| | - Mengli Cheng
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug-Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing 101149, China
| | - Hairong Huang
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug-Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing 101149, China
| | - Xia Yu
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug-Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing 101149, China.
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Lorè NI, Gramegna A, de Pretis S, Di Marco F, Giannese F, Saliu F, Oneto C, Contarini M, Cariani L, Blasi F, Cirillo DM. Single-Cell RNA Sequencing Shows that Circulating Monocytes Enriched in IFN Signaling Are Associated with Nontuberculous Mycobacteria Pulmonary Disease in Cystic Fibrosis. Am J Respir Crit Care Med 2024; 210:834-837. [PMID: 38889330 PMCID: PMC11418891 DOI: 10.1164/rccm.202312-2279le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 06/13/2024] [Indexed: 06/20/2024] Open
Affiliation(s)
- Nicola I. Lorè
- Emerging Bacterial Pathogens Unit, Division of Immunology, Transplantation and Infectious Diseases, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale San Raffaele, Milan, Italy
| | - Andrea Gramegna
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Respiratory Unit and Adult Cystic Fibrosis Center and
| | - Stefano de Pretis
- Center for Omics Sciences, IRCCS San Raffaele Institute, Milan, Italy
| | - Federico Di Marco
- Emerging Bacterial Pathogens Unit, Division of Immunology, Transplantation and Infectious Diseases, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale San Raffaele, Milan, Italy
| | | | - Fabio Saliu
- Emerging Bacterial Pathogens Unit, Division of Immunology, Transplantation and Infectious Diseases, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale San Raffaele, Milan, Italy
| | - Caterina Oneto
- Center for Omics Sciences, IRCCS San Raffaele Institute, Milan, Italy
| | | | - Lisa Cariani
- SC Clinical Pathology, Laboratory of Microbiology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; and
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Respiratory Unit and Adult Cystic Fibrosis Center and
| | - Daniela M. Cirillo
- Emerging Bacterial Pathogens Unit, Division of Immunology, Transplantation and Infectious Diseases, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale San Raffaele, Milan, Italy
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Kim JY, Bae J, Hyung K, Lee I, Park HJ, Kim SY, Lee KE, Ahn YH, Yoon SM, Kwak N, Yim JJ. Significance of changes in cavity after treatment in Mycobacterium avium complex pulmonary disease. Sci Rep 2024; 14:21133. [PMID: 39256432 PMCID: PMC11387760 DOI: 10.1038/s41598-024-71971-6] [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] [Received: 04/08/2024] [Accepted: 09/02/2024] [Indexed: 09/12/2024] Open
Abstract
Cavities are characteristic radiological features related to increased mycobacterial burden and poor prognosis in Mycobacterium avium complex pulmonary disease (MAC-PD). However, cavity changes following treatment and their clinical implications remain unknown. We aimed to elucidate whether cavity obliteration or reduction in cavity size or wall thickness correlates with microbiological cure. In total, 136 adult patients with cavitary MAC-PD treated for ≥ 6 months between January 1st, 2009, and December 31st, 2021, in a tertiary referral centre in South Korea were enrolled. The cavity with the largest diameter at treatment initiation was tracked for size and thickness changes. Following median treatment of 20.0 months, 74 (54.4%) patients achieved microbiological cure. Cavity obliteration, achieved in 58 (42.6%) patients at treatment completion, was independently associated with microbiological cure. In patients with persistent cavities, size reduction of ≥ 10% was significantly associated with microbiological cure, whereas thickness reduction was not. Five-year mortality rates in patients with cavity obliteration, persistent but reduced cavity, and persistent cavity without shrinkage were 95.6%, 72.1%, and 65.3%, respectively (P < 0.001). In conclusion, cavity obliteration or shrinkage at treatment completion is associated with microbiological cure and reduced mortality in MAC-PD, suggesting that cavity changes could serve as a proxy indicator for treatment response.
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Affiliation(s)
- Joong-Yub Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Juye Bae
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kwonhyung Hyung
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Inhan Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyun-Jun Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - So Yeon Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyung-Eui Lee
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Pulmonology, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Republic of Korea
| | - Yoon Hae Ahn
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Si Mong Yoon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Nakwon Kwak
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae-Joon Yim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Bolcato V, Bassetti M, Basile G, Bianco Prevot L, Speziale G, Tremoli E, Maffessanti F, Tronconi LP. The State-of-the-Art of Mycobacterium chimaera Infections and the Causal Link with Health Settings: A Systematic Review. Healthcare (Basel) 2024; 12:1788. [PMID: 39273812 PMCID: PMC11395465 DOI: 10.3390/healthcare12171788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Revised: 08/28/2024] [Accepted: 08/29/2024] [Indexed: 09/15/2024] Open
Abstract
(1) Background. A definition of healthcare-associated infections is essential also for the attribution of the restorative burden to healthcare facilities in case of harm and for clinical risk management strategies. Regarding M. chimaera infections, there remains several issues on the ecosystem and pathogenesis. We aim to review the scientific evidence on M. chimaera beyond cardiac surgery, and thus discuss its relationship with healthcare facilities. (2) Methods. A systematic review was conducted on PubMed and Web of Science on 7 May 2024 according to PRISMA 2020 guidelines for reporting systematic reviews, including databases searches with the keyword "Mycobacterium chimaera". Article screening was conducted by tree authors independently. The criterion for inclusion was cases that were not, or were improperly, consistent with the in-situ deposition of aerosolised M. chimaera. (3) Results. The search yielded 290 eligible articles. After screening, 34 articles (377 patients) were included. In five articles, patients had undergone cardiac surgery and showed musculoskeletal involvement or disseminated infection without cardiac manifestations. In 11 articles, respiratory specimen reanalyses showed M. chimaera. Moreover, 10 articles reported lung involvement, 1 reported meninges involvement, 1 reported skin involvement, 1 reported kidney involvement after transplantation, 1 reported tendon involvement, and 1 reported the involvement of a central venous catheter; 3 articles reported disseminated cases with one concomitant spinal osteomyelitis. (4) Conclusions. The scarce data on environmental prevalence, the recent studies on M. chimaera ecology, and the medicalised sample selection bias, as well as the infrequent use of robust ascertainment of sub-species, need to be weighed up. The in-house aerosolization, inhalation, and haematogenous spread deserve experimental study, as M. chimaera cardiac localisation could depend to transient bacteraemia. Each case deserves specific ascertainment before tracing back to the facility, even if M. chimaera represents a core area for healthcare facilities within a framework of infection prevention and control policies.
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Affiliation(s)
| | - Matteo Bassetti
- Department of Health Sciences (DISSAL), University of Genova, 16132 Genova, Italy
- Infectious Diseases Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Giuseppe Basile
- IRCCS Orthopaedic Institute Galeazzi, 20157 Milan, Italy
- Section of Legal and Forensic Medicine Clinical Institute San Siro, 20148 Milan, Italy
| | - Luca Bianco Prevot
- IRCCS Orthopaedic Institute Galeazzi, 20157 Milan, Italy
- Residency Program in Orthopaedics and Traumatology, University of Milan, 20122 Milan, Italy
| | | | - Elena Tremoli
- GVM Care and Research, Maria Cecilia Hospital, 49033 Cotignola, Italy
| | | | - Livio Pietro Tronconi
- GVM Care and Research, Maria Cecilia Hospital, 49033 Cotignola, Italy
- Department of Human Science, European University of Rome, 00163 Rome, Italy
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Takeda K, Takazono T, Mukae H. Drug-drug interactions in the management of non-tuberculous mycobacterial infections. Front Microbiol 2024; 15:1468383. [PMID: 39301186 PMCID: PMC11410596 DOI: 10.3389/fmicb.2024.1468383] [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: 07/22/2024] [Accepted: 08/28/2024] [Indexed: 09/22/2024] Open
Abstract
Non-tuberculous mycobacterial pulmonary disease (NTM-PD) is a refractory chronic respiratory infectious disease and its prevalence is increasing globally. The standard treatment regimen for NTM-PD involves long-term multidrug therapy including macrolides. The incidence of adverse events is high given the advanced age of many NTM-PD patients. In addition, drug-drug interactions under coexisting conditions add additional complexity. Despite guidelines advocating multidrug therapy for NTM-PD, low adherence rates probably owing to the relatively frequent adverse events and drug interactions. An appropriate treatment regimen can improve the bacteriological response rates, reduce the development of macrolide resistance, and mitigate adverse events. Of particular concern are the interactions arising from new complications that develop with NTM-PD. Notably, chronic pulmonary aspergillosis occasionally co-infects NTM-PD, which can lead to poor prognosis. The primary therapeutic modality for chronic pulmonary aspergillosis is the azoles. However, the interaction with rifamycin is problematic, making it challenging to continue standard treatment for NTM-PD and requiring drug adjustments. The implications of rifamycin extend beyond chronic pulmonary aspergillosis, impacting various other diseases such as those requiring immunosuppressive agents and AIDS patients requiring antiretroviral therapy. Hence, a comprehensive consideration of drug interactions is imperative for the initiation of NTM-PD treatment. This mini-review focuses on drug-drug interactions in a multidrug regimen for NTM-PD and discusses the essential points to be considered in the treatment of NTM.
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Affiliation(s)
- Kazuaki Takeda
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan
| | - Takahiro Takazono
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Phunpae P, Thongkum W, Panyasit W, Laopajon W, Takheaw N, Pata S, Yasamut U, Kasinrerk W, Tayapiwatana C. Rapid lateral flow test for Mycobacterium tuberculosis complex and non-tuberculous mycobacteria differentiation. Appl Microbiol Biotechnol 2024; 108:456. [PMID: 39222096 PMCID: PMC11369055 DOI: 10.1007/s00253-024-13293-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2024] [Revised: 08/03/2024] [Accepted: 08/19/2024] [Indexed: 09/04/2024]
Abstract
The diagnosis of mycobacterial infections, including both the Mycobacterium tuberculosis complex (MTBC) and non-tuberculous mycobacteria (NTM), poses a significant global medical challenge. This study proposes a novel approach using immunochromatographic (IC) strip tests for the simultaneous detection of MTBC and NTM. Traditional methods for identifying mycobacteria, such as culture techniques, are hindered by delays in distinguishing between MTBC and NTM, which can affect patient care and disease control. Molecular methods, while sensitive, are resource-intensive and unable to differentiate between live and dead bacteria. In this research, we developed unique monoclonal antibodies (mAbs) against Ag85B, a mycobacterial secretory protein, and successfully implemented IC strip tests named 8B and 9B. These strips demonstrated high concordance rates with conventional methods for detecting MTBC, with positivity rates of 93.9% and 85.9%, respectively. For NTM detection, the IC strip tests achieved a 63.2% detection rate compared to culture methods, considering variations in growth rates among different NTM species. Furthermore, this study highlights a significant finding regarding the potential of MPT64 and Ag85B proteins as markers for MTBC detection. In conclusion, our breakthrough method enables rapid and accurate detection of both MTBC and NTM bacteria within the BACTEC MGIT system. This approach represents a valuable tool in clinical settings for distinguishing between MTBC and NTM infections, thereby enhancing the management and control of mycobacterial diseases. KEY POINTS: • Panel of mAbs for differentiating MTB versus NTM • IC strips for diagnosing MTBC and NTM after the BACTEC MGIT • Combined detection of MTP64 and Ag85B enhances diagnostic accuracy.
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Affiliation(s)
- Ponrut Phunpae
- Division of Clinical Microbiology, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Weeraya Thongkum
- Division of Clinical Immunology, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, 50200, Thailand
- Center of Innovative Immunodiagnostic Development, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Wutthichai Panyasit
- Office of Disease Prevention and Control Region 1, Chiang Mai, 50100, Thailand
| | - Witida Laopajon
- Division of Clinical Immunology, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, 50200, Thailand
- Biomedical Technology Research Center, National Center for Genetic Engineering and Biotechnology, National Science and Technology Development Agency at the Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Nuchjira Takheaw
- Division of Clinical Immunology, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, 50200, Thailand
- Biomedical Technology Research Center, National Center for Genetic Engineering and Biotechnology, National Science and Technology Development Agency at the Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Supansa Pata
- Division of Clinical Immunology, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, 50200, Thailand
- Biomedical Technology Research Center, National Center for Genetic Engineering and Biotechnology, National Science and Technology Development Agency at the Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Umpa Yasamut
- Division of Clinical Immunology, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, 50200, Thailand
- Center of Innovative Immunodiagnostic Development, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Watchara Kasinrerk
- Division of Clinical Immunology, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, 50200, Thailand.
- Biomedical Technology Research Center, National Center for Genetic Engineering and Biotechnology, National Science and Technology Development Agency at the Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, 50200, Thailand.
| | - Chatchai Tayapiwatana
- Division of Clinical Immunology, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, 50200, Thailand.
- Center of Innovative Immunodiagnostic Development, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, 50200, Thailand.
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11
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Mann L, Siersleben F, Lang M, Richter A. Determination of bactericidal activity against 3HC-2-Tre-labelled Mycobacterium abscessus (Mycobacteroides abscessus) by automated fluorescence microscopy. J Microbiol Methods 2024; 224:107002. [PMID: 39038561 DOI: 10.1016/j.mimet.2024.107002] [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] [Received: 05/30/2024] [Revised: 07/18/2024] [Accepted: 07/18/2024] [Indexed: 07/24/2024]
Abstract
The minimum bactericidal concentration (MBC) of antibiotics is an important parameter for the potency of a drug in eradicating a bacterium as well as an important measure of the potential of a drug candidate in research and development. We have established a fluorescence-based microscopy method for the determination of MBCs against the non-tuberculous mycobacterium Mycobacterium abscessus (Mycobacteroides abscessus) to simplify and accelerate the performance of MBC determination compared to counting colony forming units on agar. Bacteria are labelled with the trehalose-coupled dye 3HC-2-Tre and analysed in a 96-well plate. The results of the new method are consistent with MBC determination by plating on agar. The method was used to evaluate the bactericidality of the antibiotics rifabutin, moxifloxacin, amikacin, clarithromycin and bedaquiline. Bactericidal effects against M. abscessus were observed, which are consistent with literature data.
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Affiliation(s)
- Lea Mann
- Institut für Pharmazie, Martin-Luther-Universität Halle-Wittenberg, Wolfgang-Langenbeck-Str. 4, 06120 Halle (Saale), Germany
| | - Fabienne Siersleben
- Institut für Pharmazie, Martin-Luther-Universität Halle-Wittenberg, Wolfgang-Langenbeck-Str. 4, 06120 Halle (Saale), Germany
| | - Markus Lang
- Institut für Pharmazie, Martin-Luther-Universität Halle-Wittenberg, Wolfgang-Langenbeck-Str. 4, 06120 Halle (Saale), Germany
| | - Adrian Richter
- Institut für Pharmazie, Martin-Luther-Universität Halle-Wittenberg, Wolfgang-Langenbeck-Str. 4, 06120 Halle (Saale), Germany.
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12
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Chang S, Kim S, Kang YA, Park MS, Sohn H, Park Y. Medical Costs of Nontuberculous Mycobacterial Pulmonary Disease, South Korea, 2015-2019. Emerg Infect Dis 2024; 30:1841-1849. [PMID: 39173659 PMCID: PMC11346975 DOI: 10.3201/eid3009.231448] [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] [Indexed: 08/24/2024] Open
Abstract
Nontuberculous mycobacterial pulmonary disease (NTM-PD) prevalence is a rising public health concern. We assessed the long-term healthcare systems perspective of costs incurred by 147 NTM-PD patients at a tertiary hospital in South Korea. Median cumulative total medical cost in managing NTM-PD patients was US $5,044 (interquartile range US $3,586-$9,680) over 49.7 months (interquartile range 33.0-68.2 months) of follow-up. The major cost drivers were diagnostic testing and medication, accounting for 59.6% of total costs. Higher costs were associated with hospitalization for Mycobacterium abscessus infection and pulmonary comorbidities. Of the total medical care costs, 50.2% were patient co-payments resulting from limited national health insurance coverage. As South Korea faces significant problems of poverty during old age and increasing NTM-PD prevalence, the financial and socio-economic burden of NTM-PD may become a major public health concern that should be considered with regard to adequate strategies for NTM-PD patients.
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Affiliation(s)
| | | | - Young Ae Kang
- Yonsei University College of Medicine, Seoul, South Korea (S. Chang, S. Kim, Y.A. Kang, M.S. Park, Y. Park)
- Severance Hospital, Seoul (S. Chang, S. Kim, Y.A. Kang, M.S. Park, Y. Park)
- Seoul National University College of Medicine, Seoul (H. Sohn)
- Seoul National University Institute of Health Policy and Management, Seoul (H. Sohn)
| | - Moo Suk Park
- Yonsei University College of Medicine, Seoul, South Korea (S. Chang, S. Kim, Y.A. Kang, M.S. Park, Y. Park)
- Severance Hospital, Seoul (S. Chang, S. Kim, Y.A. Kang, M.S. Park, Y. Park)
- Seoul National University College of Medicine, Seoul (H. Sohn)
- Seoul National University Institute of Health Policy and Management, Seoul (H. Sohn)
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13
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Dhillon P, Naidu M, Olson MC, VanBuren WM, Sheedy SP, Wells ML, Fidler JL, Heiken JP, Venkatesh SK, Kelm ZS. Diffusely Infiltrative Small Bowel Disease. Radiographics 2024; 44:e230148. [PMID: 39207924 DOI: 10.1148/rg.230148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Multiple infiltrative disorders can affect the small bowel, often resulting in diffuse small bowel wall thickening. These infiltrative disorders can manifest owing to various factors such as an influx of immunologic or neoplastic cells or the accumulation of substances within one or more layers of the intestinal wall. Although there can be considerable overlap in the appearances of infiltrative diseases on cross-sectional images, a comprehensive understanding of more specific ancillary imaging features and clinicopathologic correlation can substantially narrow the differential diagnosis. The radiologist can be instrumental in synthesizing the clinical and imaging information and guiding subsequent workup. The authors present a comprehensive review of the infiltrative disorders that commonly involve the small bowel. These disorders are organized on the basis of their pathophysiologic features, with multiple illustrative case examples to enhance understanding of these entities. CT and MRI are currently the most commonly used imaging modalities for evaluating small bowel disorders, and this review is focused on these two modalities. Detailed information regarding the pathologic features, clinical presentation, and imaging findings of these infiltrative disorders is provided to aid radiologists in recognizing and differentiating these conditions. ©RSNA, 2024.
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Affiliation(s)
- Preet Dhillon
- From the Department of Radiology (P.D., M.C.O., W.M.V., S.P.S., M.L.W., J.L.F., J.P.H., S.K.V., Z.S.K.), Mayo Clinic (M.N.), 200 First St SW, Rochester, MN 55905
| | - Madeline Naidu
- From the Department of Radiology (P.D., M.C.O., W.M.V., S.P.S., M.L.W., J.L.F., J.P.H., S.K.V., Z.S.K.), Mayo Clinic (M.N.), 200 First St SW, Rochester, MN 55905
| | - Michael C Olson
- From the Department of Radiology (P.D., M.C.O., W.M.V., S.P.S., M.L.W., J.L.F., J.P.H., S.K.V., Z.S.K.), Mayo Clinic (M.N.), 200 First St SW, Rochester, MN 55905
| | - Wendaline M VanBuren
- From the Department of Radiology (P.D., M.C.O., W.M.V., S.P.S., M.L.W., J.L.F., J.P.H., S.K.V., Z.S.K.), Mayo Clinic (M.N.), 200 First St SW, Rochester, MN 55905
| | - Shannon P Sheedy
- From the Department of Radiology (P.D., M.C.O., W.M.V., S.P.S., M.L.W., J.L.F., J.P.H., S.K.V., Z.S.K.), Mayo Clinic (M.N.), 200 First St SW, Rochester, MN 55905
| | - Michael L Wells
- From the Department of Radiology (P.D., M.C.O., W.M.V., S.P.S., M.L.W., J.L.F., J.P.H., S.K.V., Z.S.K.), Mayo Clinic (M.N.), 200 First St SW, Rochester, MN 55905
| | - Jeff L Fidler
- From the Department of Radiology (P.D., M.C.O., W.M.V., S.P.S., M.L.W., J.L.F., J.P.H., S.K.V., Z.S.K.), Mayo Clinic (M.N.), 200 First St SW, Rochester, MN 55905
| | - Jay P Heiken
- From the Department of Radiology (P.D., M.C.O., W.M.V., S.P.S., M.L.W., J.L.F., J.P.H., S.K.V., Z.S.K.), Mayo Clinic (M.N.), 200 First St SW, Rochester, MN 55905
| | - Sudhakar K Venkatesh
- From the Department of Radiology (P.D., M.C.O., W.M.V., S.P.S., M.L.W., J.L.F., J.P.H., S.K.V., Z.S.K.), Mayo Clinic (M.N.), 200 First St SW, Rochester, MN 55905
| | - Zachary S Kelm
- From the Department of Radiology (P.D., M.C.O., W.M.V., S.P.S., M.L.W., J.L.F., J.P.H., S.K.V., Z.S.K.), Mayo Clinic (M.N.), 200 First St SW, Rochester, MN 55905
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14
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Isago H. The Association between Dyslipidemia and Pulmonary Diseases. J Atheroscler Thromb 2024; 31:1249-1259. [PMID: 39010219 PMCID: PMC11374539 DOI: 10.5551/jat.rv22021] [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] [Indexed: 07/17/2024] Open
Abstract
Dyslipidemia is one of the most common diseases worldwide. As a component of metabolic syndrome, the prevalence and mechanism by which dyslipidemia promotes cardiovascular diseases has been well studied, although the relationship between pulmonary diseases is not well understood. Because the lung is a respiratory organ with a large surface area and is exposed to the environment outside the body, it continuously inhales various substances. As a result, pulmonary diseases have a vast diversity, including chronic inflammatory diseases, allergic diseases, cancers, and infectious diseases. Recently, growing evidence has suggested that dyslipidemia plays a role in the pathogenesis and prognosis of various pulmonary diseases. We herein review the current understanding of the relationship between dyslipidemia and pulmonary diseases, including chronic obstructive pulmonary diseases, asthma, and lung cancer, and infectious pulmonary diseases, including community-acquired pneumonia, tuberculosis, nontuberculous mycobacterial pulmonary disease, and COVID-19. In addition, we focus on recent evidence of the utility of statins, specifically 3-hydroxy-3-methylglutaryl-coA reductase inhibitors, in the prevention and treatment of the various pulmonary diseases described above.
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Affiliation(s)
- Hideaki Isago
- Department of Clinical Laboratory, The University of Tokyo Hospital
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15
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Hyung K, Kim SA, Kim JY, Kwak N, Yim JJ. Rates and Risk Factors of Progression in Patients With Nontuberculous Mycobacterial Pulmonary Disease: Secondary Analysis of a Prospective Cohort Study. Chest 2024; 166:452-460. [PMID: 38499238 DOI: 10.1016/j.chest.2024.03.024] [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] [Received: 12/10/2023] [Revised: 03/08/2024] [Accepted: 03/12/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND The clinical course of nontuberculous mycobacterial pulmonary disease (NTM-PD) is varied, and a watchful waiting management strategy is appropriate for a subset of patients. Understanding disease progression and risk factors for progression is essential for deciding on an appropriate follow-up strategy. RESEARCH QUESTION What is the rate of NTM-PD progression, and what are the predictors of progression? STUDY DESIGN AND METHODS Patients with NTM-PD who were enrolled in a prospective observational cohort study between July 1, 2011, and December 31, 2022, were included in this analysis. Clinical, bacterial, laboratory, and radiographic data were collected at enrollment and then regularly during follow-up. NTM-PD progression was defined as either the initiation of treatment or the clinician's intention to treat. The rate of progression was calculated and the predictors for progression were analyzed. RESULTS Of the 477 patients enrolled, NTM-PD progressed in 192 patients over a median follow-up of 5.4 years. The incidence of NTM-PD progression was 11.0 cases per 100 person-years (95% CI, 9.5-12.7 cases per 100 person-years). The proportion of patients experiencing disease progression was 21.4% at 1 year, 33.8% at 3 years, and 43.3% at 5 years. The final multivariable analysis model identified female sex (adjusted hazard ratio [aHR], 1.69; 95% CI, 1.19-2.39), elevated erythrocyte sedimentation rate (aHR, 1.79; 95% CI, 1.31-2.43), FEV1 % predicted (aHR, 0.89; 95% CI, 0.82-0.96), and the presence of a cavity (aHR, 2.78; 95% CI, 2.03-3.80) as predictors of progression. INTERPRETATION About one-half of patients with NTM-PD experienced progression during an observation period of > 5 years. Patients with risk factors for progression should be observed closely. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT01616745; URL: www. CLINICALTRIALS gov.
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Affiliation(s)
- Kwonhyung Hyung
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sung-A Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Joong-Yub Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Nakwon Kwak
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jae-Joon Yim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
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16
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Ali J, Wu J, Hassan M, Tsai JH, Touba N, McCarrier K, Ballard M, Chatterjee A. Qualitative Interviews Exploring Adverse Event Mitigation Strategies in Adults Receiving Amikacin Liposome Inhalation Suspension. Pulm Ther 2024; 10:315-330. [PMID: 39012432 PMCID: PMC11339226 DOI: 10.1007/s41030-024-00263-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 05/31/2024] [Indexed: 07/17/2024] Open
Abstract
INTRODUCTION This study aimed to gain insight from patients with refractory Mycobacterium avium complex lung disease (MAC-LD) into strategies used to manage adverse events (AEs) associated with amikacin liposome inhalation suspension (ALIS). METHODS We conducted semi-structured interviews with US patients with refractory MAC-LD prescribed ALIS in a real-world setting. Interview transcripts were analyzed and coded to identify patterns in participants' descriptions of their ALIS treatment experiences, including AEs and their disruptiveness, and AE mitigation strategies, including participants' ratings of strategies' effectiveness. Concept saturation was also assessed. RESULTS Twenty participants (mean age 48.7 years; 80% women; mean ALIS duration 5.45 months) were interviewed. At the time of the interview, 15 participants (75%) had received ALIS for > 1 month and 13 (65%) were currently receiving ALIS. Participants described 44 unique AE mitigation strategies, which can be categorized into three groups: prepare for treatment; prevent increased emergence of AEs; and persist on treatment by mitigating AEs. Common strategies (reported by ≥ 50% of participants) included use of educational materials from the patient support program, localized management of throat irritation, and symptom management to reduce fatigue. Evidence of concept saturation was observed: no new strategies were identified in the last five interviews, which suggests the sample was robust enough to identify all mitigation strategies likely to be used by the broader patient population. CONCLUSIONS This real-world study identified a diverse set of potential AE mitigation strategies intended to help individual patients prepare for ALIS treatment, prevent the increased emergence of certain AEs, and mitigate the impact of AEs on treatment persistence. Developing a comprehensive accounting of the types of mitigation strategies in use among patients in real-world settings can inform future investigation of the effectiveness of such strategies, and support evidence-based recommendations for treatment management.
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Affiliation(s)
- Juzar Ali
- Louisiana State University Health Sciences Center-New Orleans (LSU HSC), New Orleans, LA, USA
| | - Jasmanda Wu
- Insmed Incorporated, 700 US Highway 202/206, Bridgewater, NJ, USA.
| | - Mariam Hassan
- Insmed Incorporated, 700 US Highway 202/206, Bridgewater, NJ, USA
| | | | | | | | - Mark Ballard
- Insmed Incorporated, 700 US Highway 202/206, Bridgewater, NJ, USA
| | - Anjan Chatterjee
- Insmed Incorporated, 700 US Highway 202/206, Bridgewater, NJ, USA
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17
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Pedersen AA, Dahl VN, Løkke A, Holden IK, Fløe A, Ibsen R, Hilberg O, Johansen IS. Mortality Rate and Cause of Death in Adults with Extrapulmonary Nontuberculous Mycobacteria Infection, Denmark. Emerg Infect Dis 2024; 30:1790-1798. [PMID: 39173661 PMCID: PMC11346995 DOI: 10.3201/eid3009.240475] [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] [Indexed: 08/24/2024] Open
Abstract
Evidence on mortality rates and causes of death associated with extrapulmonary nontuberculous mycobacteria (NTM) infection is limited. This nationwide register-based study in Denmark used diagnostic codes to match adult patients with extrapulmonary NTM infection 1:4 to controls. During 2000–2017, we identified 485 patients, who had significantly more comorbidities than controls. The 5-year mortality rate for patients was 26.8% (95% CI 23.1%–31.0%) and for controls, 10.9% (95% CI 9.6%–12.4%). The median age at death was 76 (interquartile range 63–85) years for patients and 84 (interquartile range 73–90) years for controls. The adjusted hazard rate of death for patients was 1.34 (95% CI 1.10–1.63; p = 0.004). Patients and controls mainly died of cardiovascular disease and solid malignant neoplasms. Hematologic malignancies and HIV were more frequently causes of death in patients. Mortality rates are substantial among patients with extrapulmonary NTM infection, predominantly caused by underlying conditions.
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18
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Kawahara K, Tabusadani M, Ohta K, Morimoto K. Assessment of health-related quality of life in patients with nontuberculous mycobacterial pulmonary disease: A comprehensive review. Respir Investig 2024; 62:1006-1014. [PMID: 39217818 DOI: 10.1016/j.resinv.2024.08.009] [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: 06/03/2024] [Revised: 08/07/2024] [Accepted: 08/13/2024] [Indexed: 09/04/2024]
Abstract
The global incidence of nontuberculous mycobacterial pulmonary disease (NTM-PD) is increasing. The primary aim of pharmacotherapeutic treatment for NTM-PD is to achieve negative bacterial conversion, but this goal is challenging, especially in cases with poor prognosis factors. Moreover, recurrence frequently occurs following successful treatment. Consequently, patient-reported outcomes (PROs) have attracted an increasing amount of attention due to their potential to elucidate the pathophysiology of NTM-PD. The current review article aimed to describe the current understanding of PROs related to health-related quality of life (HRQoL). HRQoL is influenced by a variety of factors; notably, those factors associated with the prognosis of NTM-PD significantly impair HRQoL. In patients with refractory NTM-PD, HRQoL tends to worsen over time. Assessing HRQoL through PROs involves short-term or long-term evaluation tools, which are selected based on their relevance to the patient's condition and the clinician's goals. Understanding the nuances of PROs can be helpful for delivering empathetic care tailored to patients in even the most complex treatment scenarios.
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Affiliation(s)
- Kazuma Kawahara
- Respiratory Care and Rehabilitation Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association, 3-1-24 Matsuyama, Kiyose, Tokyo, 204-8522, Japan; Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Mitsuru Tabusadani
- Respiratory Care and Rehabilitation Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association, 3-1-24 Matsuyama, Kiyose, Tokyo, 204-8522, Japan
| | - Ken Ohta
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - Kozo Morimoto
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Tokyo, Japan; Department of Clinical Mycobacteriosis, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; Division of Clinical Research, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Tokyo, Japan.
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19
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André E, Lorent N, Beuselinck K, Deiwick S, Dupont L, Gafsi J, Laenen L, Raymaekers L, Van Bleyenbergh P, Perry JD, Kahl BC. Multicenter study of the performance of NTM Elite agar for the detection of nontuberculous mycobacteria from patients with cystic fibrosis. Microbiol Spectr 2024:e0273623. [PMID: 39194292 DOI: 10.1128/spectrum.02736-23] [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: 12/20/2023] [Accepted: 06/27/2024] [Indexed: 08/29/2024] Open
Abstract
The performance of a novel selective agar was evaluated against the performance of conventional mycobacterial cultures, i.e., a combination of the mycobacterial growth indicator tube (MGIT) with Löwenstein-Jensen (LJ), for the detection of nontuberculous mycobacteria (NTM) in sputum samples from people with cystic fibrosis (pwCF). Two hundred eighty-three sputum samples (231 fresh sputum and 52 spiked sputum) from 143 pwCF were collected. They were inoculated without prior decontamination on NTM Elite agar (30°C ± 2°C for 28 days) and inoculated on both MGIT and LJ (35°C-37°C for 6-8 weeks) after N-acetyl-L-cysteine-2% sodium hydroxide decontamination. NTM were identified by Matrix-Assisted Laser Desorption Ionization/Time of Flight Mass Spectrometry and/or PCR, and whole-genome sequencing. A total of 67 NTM were recovered overall by the combination of all culture media. NTM Elite agar allowed the recovery of 65 NTM (97%), compared to 22 for the conventional MGIT and LJ media combination (32.8%), including 22 NTM for MGIT (32.8%) and 3 NTM with the LJ medium (4.5%). For Mycobacterium abscessus complex, the sensitivity of NTM Elite agar was 95% compared with a sensitivity of 30% for the conventional MGIT and LJ media combination. Overall, 17.3% of cultures on NTM Elite agar were contaminated with other micro-organisms vs 46.3% on MGIT and 77% on LJ. This study shows that the novel selective agar (NTM Elite agar) significantly outperforms the conventional MGIT and LJ media combination in terms of sensitivity, selectivity, and ease of culture, without the requirement of an L3 laboratory.IMPORTANCENontuberculous mycobacteria (NTM) are significant pulmonary pathogens in patients with pre-existing structural lung conditions such as cystic fibrosis, bronchiectasis, or chronic obstructive pulmonary disease. Mycobacterium avium complex and Mycobacterium abscessus complex (MABSC) are the most frequently isolated organisms. Compared to the recommended culture method for NTM, which combines solid and liquid culture media, NTM Elite agar enables a faster/easier diagnosis and speeds up identification and susceptibility testing as the final reading is at 28 days instead of 6-8 weeks for the conventional mycobacterial cultures. In addition, for the NTM Elite agar, no decontamination stage before inoculation is necessary, unlike the conventional mycobacterial cultures. NTM Elite agar is derived from a formulation of medium adapted to rapidly growing mycobacteria (RGM). The medium enables the growth of RGM while suppressing other flora. It is supported with published clinical data showing the benefits of this medium.
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Affiliation(s)
- Emmanuel André
- Laboratory Medicine Department, UZ Leuven University Hospitals, Leuven, Belgium
- Department of Microbiology, Immunology, and Transplantation, Laboratory of Clinical Microbiology, KU Leuven, Leuven, Belgium
| | - Natalie Lorent
- Respiratory Diseases Department, University Hospitals Leuven, Leuven, Belgium
| | - Kurt Beuselinck
- Laboratory Medicine Department, UZ Leuven University Hospitals, Leuven, Belgium
| | - Susanne Deiwick
- University Hospital Münster, Institute of Medical Microbiology, Münster, Germany
| | - Lieven Dupont
- Respiratory Diseases Department, University Hospitals Leuven, Leuven, Belgium
| | - Johanne Gafsi
- BioMérieux Global Clinical Affairs, Marcy-l'Etoile, France
| | - Lies Laenen
- Laboratory Medicine Department, UZ Leuven University Hospitals, Leuven, Belgium
- Department of Microbiology, Immunology, and Transplantation, Laboratory of Clinical Microbiology, KU Leuven, Leuven, Belgium
| | - Lise Raymaekers
- Laboratory Medicine Department, UZ Leuven University Hospitals, Leuven, Belgium
| | | | - John D Perry
- Microbiology Department, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Barbara C Kahl
- University Hospital Münster, Institute of Medical Microbiology, Münster, Germany
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20
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Bento CM, van Calster K, Piller T, Oliveira GS, de Vooght L, Cappoen D, Cos P, Gomes MS, Silva T. Characterization of novel double-reporter strains of Mycobacterium abscessus for drug discovery: a study in mScarlet. Microbiol Spectr 2024:e0036224. [PMID: 39189762 DOI: 10.1128/spectrum.00362-24] [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: 02/07/2024] [Accepted: 07/26/2024] [Indexed: 08/28/2024] Open
Abstract
Mycobacterium abscessus (Mab) is an emerging pathogen that poses a severe health threat, especially in people with cystic fibrosis and other chronic lung diseases. Available drugs are largely ineffective due to an exquisite intrinsic resistance, making Mab infections only comparable to multidrug-resistant tuberculosis. Current treatment is based on lengthy multidrug therapy, complicated by poor outcomes and high rates of treatment failure, recurrence, and mortality. Thus, finding new and more efficient drugs to combat this pathogen is urgent. However, drug discovery efforts targeting Mab have been limited, and traditional drug screening methods are labor-intensive, low-throughput, and do not reflect clinical effectiveness. Therefore, this work aimed to develop a new, efficient, and reliable tool for drug screening against Mab that can be used in vitro for identifying hits in a high-throughput manner and in vivo to select drug candidates for future clinical trials. We engineered two stable double-reporter strains of Mab capable of emitting strong fluorescent and luminescent signals. This is due to the expression of mScarlet protein and luciferase enzyme or the entire lux operon. Importantly, these strains maintain the same ground characteristics as the non-transformed Mab strain. We show that these new strains can be applied to various setups, from MIC determination in broth cultures and macrophage infection assays to in vivo infection (using the Galleria mellonella model). Using these strains enhances the potential for high-throughput screening of thousands of compounds in a fast and reliable way. IMPORTANCE Mycobacterium abscessus (Mab) is currently considered an "incurable nightmare." Its intrinsic resistance, high toxicity, long duration, and low cure rates of available therapies often lead to the clinical decision not to treat. Moreover, one of the significant drawbacks of anti-Mab drug development is the lack of correlation between in vitro susceptibility and clinical efficacy. Most drug screening assays are performed on Mab growing in liquid cultures. But being an intracellular pathogen, inducing granulomas and biofilm formation, the broth culture is far from ideal as in vitro drug-testing setup. This study presents new double-reporter Mab strains that allow direct real-time bacterial detection and quantification in a non-invasive way. These strains can be applied to an extensive range of experimental settings, far surpassing the utility of single-reporter bacteria. They can be used in all steps of the pre-clinical anti-Mab drug development pipeline, constituting a highly valuable tool to increase its success.
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Affiliation(s)
- Clara M Bento
- i3S-Instituto de Investigação e Inovação e Saúde, Universidade do Porto, Porto, Portugal
- IBMC-Instituto de Biologia Celular e Molecular, Universidade do Porto, Porto, Portugal
- Programa Doutoral em Biologia Molecular e Celular (MCBiology), Instituto de Ciências Biomédicas Abel Salazar da Universidade do Porto, Porto, Portugal
| | - Kevin van Calster
- Laboratory for Microbiology, Parasitology and Hygiene (LMPH), Wilrijk, Belgium
| | - Tatiana Piller
- Laboratory for Microbiology, Parasitology and Hygiene (LMPH), Wilrijk, Belgium
| | - Gabriel S Oliveira
- i3S-Instituto de Investigação e Inovação e Saúde, Universidade do Porto, Porto, Portugal
- ICBAS-Instituto de Ciências Biomédicas Abel Salazar da Universidade do Porto, Porto, Portugal
| | - Linda de Vooght
- Laboratory for Microbiology, Parasitology and Hygiene (LMPH), Wilrijk, Belgium
| | - Davie Cappoen
- Laboratory for Microbiology, Parasitology and Hygiene (LMPH), Wilrijk, Belgium
| | - Paul Cos
- Laboratory for Microbiology, Parasitology and Hygiene (LMPH), Wilrijk, Belgium
| | - M Salomé Gomes
- i3S-Instituto de Investigação e Inovação e Saúde, Universidade do Porto, Porto, Portugal
- ICBAS-Instituto de Ciências Biomédicas Abel Salazar da Universidade do Porto, Porto, Portugal
| | - Tânia Silva
- i3S-Instituto de Investigação e Inovação e Saúde, Universidade do Porto, Porto, Portugal
- ICBAS-Instituto de Ciências Biomédicas Abel Salazar da Universidade do Porto, Porto, Portugal
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21
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Capstick T, Hurst R, Keane J, Musaddaq B. Supporting Patients with Nontuberculous Mycobacterial Pulmonary Disease: Ensuring Best Practice in UK Healthcare Settings. PHARMACY 2024; 12:126. [PMID: 39195855 PMCID: PMC11359432 DOI: 10.3390/pharmacy12040126] [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: 04/17/2024] [Revised: 07/25/2024] [Accepted: 07/29/2024] [Indexed: 08/29/2024] Open
Abstract
Nontuberculous mycobacterial pulmonary disease (NTM-PD) results from opportunistic lung infections by mycobacteria other than Mycobacterium tuberculosis or Mycobacterium leprae species. Similar to many other countries, the incidence of NTM-PD in the United Kingdom (UK) is on the rise for reasons that are yet to be determined. Despite guidelines established by the American Thoracic Society (ATS), the Infectious Diseases Society of America, and the British Thoracic Society, NTM-PD diagnosis and management remain a significant clinical challenge. In this review article, we comprehensively discuss key challenges in NTM-PD diagnosis and management, focusing on the UK healthcare setting. We also propose countermeasures to overcome these challenges and improve the detection and treatment of patients with NTM-PD.
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Affiliation(s)
| | - Rhys Hurst
- Royal Papworth Hospital NHS Foundation Trust, Cambridge CB2 0AY, UK;
| | - Jennie Keane
- Essex Partnership University NHS Foundation Trust (EPUT), Rochford SS4 1DD, UK;
| | - Besma Musaddaq
- Department of Radiology, Royal Free Hospital NHS Foundation Trust, London NW3 2QG, UK;
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22
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Sreekumar A, Kumar A, Biswas R, Biswas L. Emerging and alternative strategies for the treatment of nontuberculous mycobacterial infections. Expert Rev Anti Infect Ther 2024:1-19. [PMID: 39161153 DOI: 10.1080/14787210.2024.2395003] [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: 07/13/2024] [Accepted: 08/18/2024] [Indexed: 08/21/2024]
Abstract
INTRODUCTION Nontuberculous mycobacteria (NTM) infections have emerged as a significant clinical challenge due to their intrinsic multidrug resistance and the limited efficacy of existing treatments. These infections are becoming increasingly prevalent, with a need for new and effective therapeutic strategies. AREAS COVERED This review addresses several key aspects of NTM infections: i) pathogenesis and epidemiology; ii) the limitations and challenges of current treatment options; iii) emerging and alternative therapeutic strategies; iv) advanced drug delivery systems such as nanoparticles and efflux pump inhibitors; v) innovative antibacterial alternatives like antimicrobial peptides, bacteriophage therapy, and phytochemicals; and vi) other potential treatment modalities such as inhaled nitric oxide, small molecules, surgical debridement, phototherapy, and immunomodulatory therapy. EXPERT OPINION Personalized medicine, advanced drug delivery systems, and alternative therapies hold promise for the future of NTM treatment. Early and accurate identification of NTM species, enabled by improved diagnostic methods, is critical for tailoring treatment regimens. Emerging therapies show promise against drug-resistant NTM strains, but overcoming barriers like clinical trials, regulatory hurdles, and high production costs is crucial. Continued research and innovation are essential to improve treatment efficacy and patient outcomes.
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Affiliation(s)
| | - Anil Kumar
- Department of Microbiology, Amrita Institute of Medical Sciences & Research Centre, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Raja Biswas
- Amrita Center for Nanosciences and Molecular Medicine, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Lalitha Biswas
- Amrita Center for Nanosciences and Molecular Medicine, Amrita Vishwa Vidyapeetham, Kochi, India
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23
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Longo BM, Trunfio M, Calcagno A. Dual β-lactams for the treatment of Mycobacterium abscessus: a review of the evidence and a call to act against an antibiotic nightmare. J Antimicrob Chemother 2024:dkae288. [PMID: 39150384 DOI: 10.1093/jac/dkae288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024] Open
Abstract
Mycobacterium abscessus complex is a group of rapidly growing non-tuberculous mycobacteria (NTM), increasingly emerging as opportunistic pathogens. Current treatment options for these microorganisms are limited and associated with a high rate of treatment failure, toxicity and recurrence. In search of new therapeutic strategies, interest has grown in dual β-lactam (DBL) therapy, as research recently discovered that M. abscessus cell wall synthesis is mainly regulated by two types of enzymes (d,d-transpeptidases and l,d-transpeptidases) differently susceptible to inhibition by distinct β-lactams. In vitro studies testing several DBL combinations have shown synergy in extracellular broth cultures as well as in the intracellular setting: cefoxitin/imipenem, ceftaroline/imipenem, ceftazidime/ceftaroline and ceftazidime/imipenem. The addition of specific β-lactamase inhibitors (BLIs) targeting M. abscessus β-lactamase did not significantly enhance the activity of DBL combinations. However, in vivo data are lacking. We reviewed the literature on DBL/DBL-BLI-based therapies for M. abscessus infections to raise greater attention on this promising yet overlooked treatment option and to guide future preclinical and clinical studies.
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Affiliation(s)
- Bianca Maria Longo
- Department of Medical Sciences, Unit of Infectious Diseases, Amedeo di Savoia Hospital, University of Turin, 10149 Turin, Italy
| | - Mattia Trunfio
- Department of Medical Sciences, Unit of Infectious Diseases, Amedeo di Savoia Hospital, University of Turin, 10149 Turin, Italy
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA 92037, USA
| | - Andrea Calcagno
- Department of Medical Sciences, Unit of Infectious Diseases, Amedeo di Savoia Hospital, University of Turin, 10149 Turin, Italy
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24
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van der Niet S, Green KD, Schimmel IM, de Bakker J, Lodder B, Reits EA, Garneau-Tsodikova S, van der Wel NN. Zafirlukast induces DNA condensation and has bactericidal effect on replicating Mycobacterium abscessus. Antimicrob Agents Chemother 2024; 68:e0002924. [PMID: 38990015 PMCID: PMC11304721 DOI: 10.1128/aac.00029-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 06/09/2024] [Indexed: 07/12/2024] Open
Abstract
Mycobacterium abscessus infections are emerging in cystic fibrosis patients, and treatment success rate in these patients is only 33% due to extreme antibiotic resistance. Thus, new treatment options are essential. An interesting target could be Lsr2, a nucleoid-associated protein involved in mycobacterial virulence. Zafirlukast is a Food and Drug Administration (FDA)-approved drug against asthma that was shown to bind Lsr2. In this study, zafirlukast treatment is shown to reduce M. abscessus growth, with a minimal inhibitory concentration of 16 µM and a bactericidal concentration of 64 µM in replicating bacteria only. As an initial response, DNA condensation, a known stress response of mycobacteria, occurs after 1 h of treatment with zafirlukast. During continued zafirlukast treatment, the morphology of the bacteria alters and the structural integrity of the bacteria is lost. After 4 days of treatment, reduced viability is measured in different culture media, and growth of M. abscessus is reduced in a dose-dependent manner. Using transmission electron microscopy, we demonstrated that the hydrophobic multilayered cell wall and periplasm are disorganized and ribosomes are reduced in size and relocalized. In summary, our data demonstrate that zafirlukast alters the morphology of M. abscessus and is bactericidal at 64 µM. The bactericidal concentration of zafirlukast is relatively high, and it is only effective on replicating bacteria but as zafirlukast is an FDA-approved drug, and currently used as an anti-asthma treatment, it could be an interesting drug to further study in in vivo experiments to determine whether it could be used as an antibiotic for M. abscessus infections.
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Affiliation(s)
- Sanne van der Niet
- Electron Microscopy Centre Amsterdam, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - Keith D. Green
- College of Pharmacy, University of Kentucky, Lexington, Kentucky, USA
| | - Irene M. Schimmel
- Electron Microscopy Centre Amsterdam, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - Jordy de Bakker
- Electron Microscopy Centre Amsterdam, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - Bastiaan Lodder
- Electron Microscopy Centre Amsterdam, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - Eric A. Reits
- Electron Microscopy Centre Amsterdam, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | | | - Nicole N. van der Wel
- Electron Microscopy Centre Amsterdam, Amsterdam University Medical Centre, Amsterdam, the Netherlands
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25
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Raccagni AR, Mori G, de Chaurand VP, Dell'Acqua R, Cirillo DM, Oltolini C, Mazzi B, Scomazzoni F, Castagna A, Guffanti M. Long-term successfull management of recurrent episodes of nontuberculous mycobacterial infection in an apparently healthy Chinese woman. Ann Clin Microbiol Antimicrob 2024; 23:68. [PMID: 39097716 PMCID: PMC11298074 DOI: 10.1186/s12941-024-00732-0] [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] [Received: 02/13/2024] [Accepted: 07/29/2024] [Indexed: 08/05/2024] Open
Abstract
BACKGROUND Disseminated non-tuberculous mycobacteria (dNTM) infections are mostly reported among individuals with an underlying congenital or acquired immunodeficiency or receiving immunosuppressive treatment, but are rarely documented in otherwise healthy subjects. CASE PRESENTATION We describe a case of recurrent disseminated mycobacterial infection in an apparently immunocompetent Chinese woman. Mycobacterium szulgai and Mycobacterium avium-complex were identified in distinct episodes. Long-term antimycobacterial therapy was administered given the occurrence of recurrent events when off-treatment. Successful management over more than 10 years and immunologic data are reported. CONCLUSIONS This case-report highlights that dNTM should be suspected also among apparently immunocompetent hosts and that thorough assessment of underling immune-impairments is helpful to define patients' management. Long-term antimycobacterial therapy and close monitoring is required to grant successful outcomes in case of recurrent dNTM infections.
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Affiliation(s)
| | - Giovanni Mori
- Vita-Salute San Raffaele University, Via Stamira D'Ancona 20, Milano, 20127, Italy
| | - Valeria Poletti de Chaurand
- Emerging Bacterial Pathogens Unit, Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Raffaele Dell'Acqua
- Unit of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Daniela Maria Cirillo
- Vita-Salute San Raffaele University, Via Stamira D'Ancona 20, Milano, 20127, Italy
- Emerging Bacterial Pathogens Unit, Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Oltolini
- Unit of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Benedetta Mazzi
- Immunogenetics Laboratory, Department of Immunohematology & Blood Transfusion, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Scomazzoni
- Department of Neuroradiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonella Castagna
- Vita-Salute San Raffaele University, Via Stamira D'Ancona 20, Milano, 20127, Italy
- Unit of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Monica Guffanti
- Unit of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
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26
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Mitsutome E, Yanagi S, Uchida T, Horiguchi T, Tsubouchi H, Sumiyoshi M, Kitamura A, Oda Y, Ueno H, Yamaguchi H, Miyazaki T. Postprandial hypoglycemia caused by the combination of clarithromycin and rifampicin in a patient with nontuberculous mycobacterial pulmonary disease. J Infect Chemother 2024:S1341-321X(24)00207-1. [PMID: 39097170 DOI: 10.1016/j.jiac.2024.07.022] [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: 04/21/2024] [Revised: 07/04/2024] [Accepted: 07/29/2024] [Indexed: 08/05/2024]
Abstract
Most cases of nontuberculous mycobacterial pulmonary disease (NTM-PD) have a progressive clinical course, and initiation of treatment is recommended rather than watchful waiting. The NTM-PD medications are frequently associated with adverse reactions, occasionally serious. Optimization of the methods for monitoring and managing adverse events in NTM-PD treatment is thus an important medical issue. Here we report a first case of postprandial hypoglycemia caused by the combination of clarithromycin (CAM) and rifampicin (RFP) in a patient with NTM-PD. A 73-year-old Japanese woman with NTM-PD was hospitalized for treatment with a combination of oral CAM, RFP, and ethambutol. She took the first doses of antibiotics before breakfast, and 3 h later went into a hypoglycemic state. Postprandial hypoglycemia occurred with high reproducibility and was accompanied by relative insulin excess. Continuous glucose monitoring with or without food and in combination with various patterns of medication revealed that the combination of CAM and RFP specifically induced postprandial hypoglycemia. Shifting the timing of administration of the CAM and RFP combination from morning to before sleep corrected the hypoglycemia and enabled continuation of the antimicrobial treatment. In conclusion, our report suggests the importance of introducing NTM-PD medication under inpatient management in order to closely monitor and early detect postprandial hypoglycemia and other serious adverse events.
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Affiliation(s)
- Eriko Mitsutome
- Division of Respirology Rheumatology Infectious Diseases and Neurology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, 889-1692, Japan
| | - Shigehisa Yanagi
- Division of Respirology Rheumatology Infectious Diseases and Neurology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, 889-1692, Japan.
| | - Taisuke Uchida
- Division of Hematology, Diabetes, and Endocrinology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, 889-1692, Japan
| | - Takanori Horiguchi
- Division of Respirology Rheumatology Infectious Diseases and Neurology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, 889-1692, Japan
| | - Hironobu Tsubouchi
- Division of Respirology Rheumatology Infectious Diseases and Neurology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, 889-1692, Japan
| | - Makoto Sumiyoshi
- Division of Respirology Rheumatology Infectious Diseases and Neurology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, 889-1692, Japan
| | - Akiko Kitamura
- Division of Respirology Rheumatology Infectious Diseases and Neurology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, 889-1692, Japan
| | - Yasuharu Oda
- Division of Respirology Rheumatology Infectious Diseases and Neurology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, 889-1692, Japan
| | - Hiroaki Ueno
- Division of Hematology, Diabetes, and Endocrinology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, 889-1692, Japan
| | - Hideki Yamaguchi
- Division of Hematology, Diabetes, and Endocrinology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, 889-1692, Japan
| | - Taiga Miyazaki
- Division of Respirology Rheumatology Infectious Diseases and Neurology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, 889-1692, Japan
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27
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Chiang PY, Huang YS, Huang YC, Lee MY, Kang VJW, Shu CC, Chang YC. CT findings as predictive factors for treatment failure in Mycobacterium abscessus complex lung disease: a retrospective cohort study. Jpn J Radiol 2024; 42:852-861. [PMID: 38705936 PMCID: PMC11286655 DOI: 10.1007/s11604-024-01570-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/08/2024] [Indexed: 05/07/2024]
Abstract
PURPOSE Mycobacterium abscessus complex (MABC) commonly causes lung disease (LD) and has a high treatment failure rate of around 50%. In this study, our objective is to investigate specific CT patterns for predicting treatment prognosis and monitoring treatment response, thus providing valuable insights for clinical physicians in the management of MABC-LD treatment. METHODS We retrospectively assessed 34 patients with MABC-LD treated between January 2015 and December 2020. CT scores for bronchiectasis, cellular bronchiolitis, consolidation, cavities, and nodules were measured at initiation and after treatment. The ability of the CT scores to predict treatment outcomes was analyzed in logistic regression analyses. RESULTS The CT scoring system had excellent inter-reader agreement (all intraclass correlation coefficients, > 0.82). The treatment failure (TF) group (17/34; 50%) had higher cavitation diameter (p = 0.049) and extension (p = 0.041) at initial CT and higher cavitation diameter (p = 0.049) and extension (p =0 .045), consolidation (p = 0.022), and total (p = 0.013) scores at follow-up CT than the treatment success (TS) group. The changes of total score and consolidation score (p = 0.049 and 0.024, respectively) increased in the TF group more than the TS group between the initial and follow-up CT. Multivariable logistic regression analysis showed initial cavitation extension, follow-up consolidation extension, and change in consolidation extension (adjusted odds ratio: 2.512, 2.495, and 9.094, respectively, per 1-point increase; all p < 0.05) were significant predictors of treatment failure. CONCLUSIONS A high pre-treatment cavitation extension score and an increase in the consolidation extension score during treatment on CT could be alarm signs of treatment failure requiring tailor the treatment of MABC-LD carefully.
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Affiliation(s)
- Pin-Yi Chiang
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Sen Huang
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Cheng Huang
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Yann Lee
- Department of Medical Imaging, National Taiwan University Hospital Yun-Lin Branch, Yunlin, Taiwan
| | - Victor Jing-Wei Kang
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | - Chin-Chung Shu
- Department of Internal Medicine, National Taiwan University Hospital, No 7, Chung Shan South Road, Taipei, Taiwan.
| | - Yeun-Chung Chang
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
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28
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Kato Y, Ihara H, Takei S, Nakamura A, Fujimoto Y, Handoh T, Kurokawa K, Arai Y, Shibayama K, Sumiyoshi I, Ochi Y, Watanabe J, Hoshi K, Misawa S, Togo S, Naito T, Tabe Y, Miida T, Takahashi K. Antimicrobial susceptibility analysis of isepamicin combination treatments in Mycobacterium abscessus species. J Clin Tuberc Other Mycobact Dis 2024; 36:100464. [PMID: 39099802 PMCID: PMC11295537 DOI: 10.1016/j.jctube.2024.100464] [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] [Indexed: 08/06/2024] Open
Abstract
This study evaluated the antimicrobial potency of the combination of isepamicin (ISP) for Mycobacterium abscessus species (MABS). 34 clinical MABS strains were isolated from clinical samples. Of them, 11 (32.4 %) were M. abscessus subsp. abscessus (Mab), 22 (64.7 %) were M. abscessus subsp. massiliense (Mma), and one (2.9 %) was M. abscessus subsp. bolletii (Mbo). We compared susceptibility to sitafloxacin (STFX)-ISP and clarithromycin (CLR)-ISP combinations with those of the antimicrobial agents alone, and synergistic effects were observed in 41.2 % and 17.6 % when treated with STFX-ISP and CLR-ISP. By hierarchical cluster analysis, the isolates divided into treatment-sensitive and treatment-resistant groups. Non-Mma or rough colony isolates were significantly likely to belong to the treatment-sensitive group (p = 0.024, p < 0.001, respectively). These results suggest that the ISP-containing combination could be a new therapeutic strategy for MABS, especially in cases of non-Mma: treatment-refractory subspecies, and rough morphotypes: high-virulence morphotypes.
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Affiliation(s)
- Yukari Kato
- Department of Respiratory Medicine, Graduate School of Medicine, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Hiroaki Ihara
- Department of Respiratory Medicine, Graduate School of Medicine, Juntendo University, Faculty of Medicine, Tokyo, Japan
- Koto Hospital, Tokyo, Japan
| | - Satomi Takei
- Department of Clinical Laboratory Medicine, Graduate School of Medicine, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Ayako Nakamura
- Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan
| | - Yuichi Fujimoto
- Department of Respiratory Medicine, Graduate School of Medicine, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Tetsuya Handoh
- Department of Clinical Laboratory Medicine, Graduate School of Medicine, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Kana Kurokawa
- Department of Respiratory Medicine, Graduate School of Medicine, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Yuta Arai
- Department of Respiratory Medicine, Graduate School of Medicine, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Kohei Shibayama
- Department of Respiratory Medicine, Graduate School of Medicine, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Issei Sumiyoshi
- Department of Respiratory Medicine, Graduate School of Medicine, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Yusuke Ochi
- Department of Respiratory Medicine, Graduate School of Medicine, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Junko Watanabe
- Department of Respiratory Medicine, Graduate School of Medicine, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Kazuaki Hoshi
- Department of Respiratory Medicine, Graduate School of Medicine, Juntendo University, Faculty of Medicine, Tokyo, Japan
- Leading Center for the Development and Research of Cancer Medicine, Graduate School of Medicine, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Shigeki Misawa
- Department of Clinical Laboratory Technology, Juntendo University, Faculty of Medical Science, Tokyo, Japan
| | - Shinsaku Togo
- Department of Respiratory Medicine, Graduate School of Medicine, Juntendo University, Faculty of Medicine, Tokyo, Japan
- Research Institute for Diseases of Old Ages, Graduate School of Medicine, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Toshio Naito
- Department of General Medicine, Graduate School of Medicine, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Yoko Tabe
- Department of Clinical Laboratory Medicine, Graduate School of Medicine, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Takashi Miida
- Department of Clinical Laboratory Medicine, Graduate School of Medicine, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Kazuhisa Takahashi
- Department of Respiratory Medicine, Graduate School of Medicine, Juntendo University, Faculty of Medicine, Tokyo, Japan
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29
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Bertuccio F, Baio N, Montini S, Ferroni V, Chino V, Pisanu L, Russo M, Giana I, Cascina A, Conio V, Primiceri C, Stella G, Corsico A. Adjuvant surgical treatment of non-tuberculous mycobacterial lung disease in chronic thromboembolic pulmonary hypertension: A first case report. J Clin Tuberc Other Mycobact Dis 2024; 36:100462. [PMID: 39050410 PMCID: PMC11268100 DOI: 10.1016/j.jctube.2024.100462] [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] [Indexed: 07/27/2024] Open
Abstract
Pulmonary hypertension (PH) is not considered a known risk factor for non-tuberculous mycobacterial lung disease (NTM-LD), despite that many studies state that incidence is almost equal to other chronic lung diseases. Current standard of care for NTM-LD consists in multidrug antibiotic regimen for several months. However, it results in negative culture conversion in a minority of cases. Therefore, when feasible an adjuvant surgical approach is indicated. In this case report we highlight the importance of multidisciplinary team discussion in providing the best therapeutic strategy in presence of significant comorbidities like chronic thromboembolic pulmonary hypertension.
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Affiliation(s)
- F.R. Bertuccio
- Cardiothoracic and Vascular Department, Unit of Respiratory Disease, IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
- Department of Internal Medicine and Pharmacology, University of Pavia, Pavia 27100, Italy
| | - N. Baio
- Cardiothoracic and Vascular Department, Unit of Respiratory Disease, IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
- Department of Internal Medicine and Pharmacology, University of Pavia, Pavia 27100, Italy
| | - S. Montini
- Department of Internal Medicine and Pharmacology, University of Pavia, Pavia 27100, Italy
| | - V. Ferroni
- Cardiothoracic and Vascular Department, Unit of Respiratory Disease, IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
- Department of Internal Medicine and Pharmacology, University of Pavia, Pavia 27100, Italy
| | - V. Chino
- Cardiothoracic and Vascular Department, Unit of Respiratory Disease, IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
- Department of Internal Medicine and Pharmacology, University of Pavia, Pavia 27100, Italy
| | - L. Pisanu
- Cardiothoracic and Vascular Department, Unit of Respiratory Disease, IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
- Department of Internal Medicine and Pharmacology, University of Pavia, Pavia 27100, Italy
| | - M. Russo
- Department of Internal Medicine and Pharmacology, University of Pavia, Pavia 27100, Italy
| | - I. Giana
- Department of Internal Medicine and Pharmacology, University of Pavia, Pavia 27100, Italy
| | - A. Cascina
- Cardiothoracic and Vascular Department, Unit of Respiratory Disease, IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
- Department of Internal Medicine and Pharmacology, University of Pavia, Pavia 27100, Italy
| | - V. Conio
- Cardiothoracic and Vascular Department, Unit of Respiratory Disease, IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
- Department of Internal Medicine and Pharmacology, University of Pavia, Pavia 27100, Italy
| | - C. Primiceri
- Department of Thoracic Surgery, Azienda Ospedaliera Santi Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - G.M. Stella
- Cardiothoracic and Vascular Department, Unit of Respiratory Disease, IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
- Department of Internal Medicine and Pharmacology, University of Pavia, Pavia 27100, Italy
| | - A.G. Corsico
- Cardiothoracic and Vascular Department, Unit of Respiratory Disease, IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
- Department of Internal Medicine and Pharmacology, University of Pavia, Pavia 27100, Italy
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30
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Vincent MN, Jaggers J, Fiske C, Phillips EJ, Stollings JL. Amikacin symmetrical drug-related intertriginous and flexural exanthema on the basis of neomycin cross-reactivity managed with desensitization and treating through. Ann Allergy Asthma Immunol 2024; 133:215-217. [PMID: 38648976 DOI: 10.1016/j.anai.2024.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/14/2024] [Accepted: 04/16/2024] [Indexed: 04/25/2024]
Affiliation(s)
| | - Jordon Jaggers
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Christina Fiske
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Elizabeth J Phillips
- Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, Tennessee; Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee; Institute for Immunology & Infectious Disease, Murdoch University, Perth, Australia
| | - Joanna L Stollings
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, Tennessee; Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, Tennessee.
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31
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Sanchez R, Simono K, Duran D, Liriano C, Martinez S. Navigating Middle Lobe Syndrome: Exploring the Impact of Mycobacterium avium. Cureus 2024; 16:e67663. [PMID: 39314608 PMCID: PMC11418582 DOI: 10.7759/cureus.67663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2024] [Indexed: 09/25/2024] Open
Abstract
Middle lobe syndrome (MLS) is characterized by recurrent or chronic collapse (atelectasis) of the middle lobe of the right lung. Despite its clinical significance, MLS often goes unnoticed in medical practice. It manifests with obstructive symptoms, either due to external compression or internal causes, commonly stemming from infectious agents such as Mycobacterium avium complex (MAC) or occasionally from tumors. We present a unique case of MLS induced by MAC in an immunocompetent 74-year-old female patient with a history of bronchiectasis. Imaging revealed typical findings associated with MLS. Additional testing confirmed the diagnosis, and the patient was successfully treated. This case presents the opportunity to recognize and correctly treat cases of MLS with infectious etiology.
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Affiliation(s)
- Roberto Sanchez
- School of Medicine, Universidad Iberoamericana, Santo Domingo, DOM
| | - Krystal Simono
- School of Medicine, Pontificia Universidad Catolica Madre y Maestra, Santiago, DOM
| | - Diana Duran
- School of Medicine, Pontificia Universidad Catolica Madre y Maestra, Santiago, DOM
| | - Cristal Liriano
- School of Medicine, Pontificia Universidad Catolica Madre y Maestra, Santiago, DOM
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32
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Ihara H, Kondo K, Muto Y, Haba M, Nakazawa H, Handoh T, Arai Y, Shibayama K, Sumiyoshi I, Ochi Y, Watanabe J, Takei S, Nakamura A, Fujimoto Y, Togo S, Takahashi K. The epidemiology of pulmonary Mycobacterium abscessus species in Japanese population. J Infect Chemother 2024; 30:757-767. [PMID: 38432559 DOI: 10.1016/j.jiac.2024.02.018] [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] [Received: 11/05/2023] [Revised: 12/20/2023] [Accepted: 02/18/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Mycobacterium abscessus species (MABS) is now a most virulent rapidly growing mycobacteria (RGM), and the rapid increase of MABS was recently observed worldwide, including in Japan. Thus, we gathered evidences of the presence of pulmonary MABS in Japanese population from Japanese articles. METHODS we searched studies that addressed the isolation of pulmonary non-tuberculous Mycobacteria (NTM) or MABS from clinical respiratory specimens in Japan. RESULTS the ratio of MABS to NTM was 3.04% (95% confidence interval [CI]: 2.51-3.68), found using the meta-analysis of single proportions. The estimated mean age of patients infected with MABS was 67.72 years (95% CI: 65.41-70.02), found using the meta-analysis of single means. The estimated proportion of females, never smoker, and the co-infection with Mycobacterium avium complex (MAC) was 66.75% (95% CI: 59.23-73.50), 67.57% (95% CI: 62.43-72.32), and 36.74% (95% CI: 25.30-49.90), respectively. The characteristics of MABS in Japan were considerably different from that in Europe and United States from the perspective of age, gender, and complications, wherein the patients in these countries tended to be younger, had lower number of females, and had more occurrences of hereditary diseases, including cystic fibrosis (CF). CONCLUSION we hypothesized that the characteristics of MABS in the Japanese were involved in those of non-CF MABS, and the distribution of gender and age of MABS were similar to that of MAC in the Japanese.
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Affiliation(s)
- Hiroaki Ihara
- Department of Respiratory Medicine, Tokyo, Japan; Koto Hospital, Tokyo, Japan.
| | | | - Yuki Muto
- Department of Respiratory Medicine, Tokyo, Japan; Koto Hospital, Tokyo, Japan
| | - Manami Haba
- Department of Respiratory Medicine, Tokyo, Japan
| | | | - Tetsuya Handoh
- Department of Clinical Laboratory Medicine, Tokyo, Japan
| | - Yuta Arai
- Department of Respiratory Medicine, Tokyo, Japan
| | | | | | - Yusuke Ochi
- Department of Respiratory Medicine, Tokyo, Japan
| | | | - Satomi Takei
- Department of Clinical Laboratory Medicine, Tokyo, Japan
| | - Ayako Nakamura
- Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan
| | | | - Shinsaku Togo
- Department of Respiratory Medicine, Tokyo, Japan; Research Institute for Diseases of Old Ages, Juntendo University, Faculty of Medicine & Graduate School of Medicine, Tokyo, Japan
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33
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Tobias Cudahy PG, Liu PC, Warren JL, Sobkowiak B, Yang C, Ioerger TR, Wu CY, Lu PL, Wang JY, Chang HH, Huang HL, Cohen T, Lin HH. Phylogeographic Analysis of Mycobacterium kansasii Isolates from Patients with M. kansasii Lung Disease in Industrialized City, Taiwan. Emerg Infect Dis 2024; 30:1562-1570. [PMID: 39043390 PMCID: PMC11286038 DOI: 10.3201/eid3008.240021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024] Open
Abstract
Little is known about environmental transmission of Mycobacterium kansasii. We retrospectively investigated potential environmental acquisition, primarily water sources, of M. kansasii among 216 patients with pulmonary disease from an industrial city in Taiwan during 2015-2017. We analyzed sputum mycobacterial cultures using whole-genome sequencing and used hierarchical Bayesian spatial network methods to evaluate risk factors for genetic relatedness of M. kansasii strains. The mean age of participants was 67 years; 24.1% had previously had tuberculosis. We found that persons from districts served by 2 water purification plants were at higher risk of being infected with genetically related M. kansasii isolates. The adjusted odds ratios were 1.81 (1.25-2.60) for the Weng Park plant and 1.39 (1.12-1.71) for the Fongshan plant. Those findings unveiled the association between water purification plants and M. kansasii pulmonary disease, highlighting the need for further environmental investigations to evaluate the risk for M. kansasii transmission.
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34
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Degiacomi G, Chiarelli LR, Riabova O, Loré NI, Muñoz-Muñoz L, Recchia D, Stelitano G, Postiglione U, Saliu F, Griego A, Scoffone VC, Kazakova E, Scarpa E, Ezquerra-Aznárez JM, Stamilla A, Buroni S, Tortoli E, Rizzello L, Sassera D, Ramón-García S, Cirillo DM, Makarov V, Pasca MR. The novel drug candidate VOMG kills Mycobacterium abscessus and other pathogens by inhibiting cell division. Int J Antimicrob Agents 2024; 64:107278. [PMID: 39069229 DOI: 10.1016/j.ijantimicag.2024.107278] [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: 04/05/2024] [Revised: 06/14/2024] [Accepted: 07/16/2024] [Indexed: 07/30/2024]
Abstract
AIMS The incidence of lung infections is increasing worldwide in individuals suffering from cystic fibrosis and chronic obstructive pulmonary disease. Mycobacterium abscessus is associated with chronic lung deterioration in these populations. The intrinsic resistance of M. abscessus to most conventional antibiotics jeopardizes treatment success rates. To date, no single drug has been developed targeting M. abscessus specifically. The objective of this study was to characterize VOMG, a pyrithione-core drug-like small molecule, as a new compound active against M. abscessus and other pathogens. METHODS A multi-disciplinary approach including microbiological, chemical, biochemical and transcriptomics procedures was used to validate VOMG as a promising anti-M. abscessus drug candidate. RESULTS To the authors' knowledge, this is the first study to report the in-vitro and in-vivo bactericidal activity of VOMG against M. abscessus and other pathogens. Besides being active against M. abscessus biofilm, the compound showed a favourable pharmacological (ADME-Tox) profile. Frequency of resistance studies were unable to isolate resistant mutants. VOMG inhibits cell division, particularly the FtsZ enzyme. CONCLUSIONS VOMG is a new drug-like molecule active against M. abscessus, inhibiting cell division with broad-spectrum activity against other microbial pathogens.
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Affiliation(s)
- Giulia Degiacomi
- Department of Biology and Biotechnology 'Lazzaro Spallanzani', University of Pavia, Pavia, Italy
| | - Laurent R Chiarelli
- Department of Biology and Biotechnology 'Lazzaro Spallanzani', University of Pavia, Pavia, Italy
| | - Olga Riabova
- Federal Research Centre 'Fundamentals of Biotechnology' of the Russian Academy of Sciences, Moscow, Russia
| | - Nicola Ivan Loré
- Emerging Bacterial Pathogens Unit, Division of Immunology, Transplantation and Infectious Disease, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lara Muñoz-Muñoz
- Department of Microbiology/Faculty of Medicine, University of Zaragoza, Zaragoza, Spain
| | - Deborah Recchia
- Department of Biology and Biotechnology 'Lazzaro Spallanzani', University of Pavia, Pavia, Italy
| | - Giovanni Stelitano
- Department of Biology and Biotechnology 'Lazzaro Spallanzani', University of Pavia, Pavia, Italy
| | - Umberto Postiglione
- Department of Biology and Biotechnology 'Lazzaro Spallanzani', University of Pavia, Pavia, Italy
| | - Fabio Saliu
- Emerging Bacterial Pathogens Unit, Division of Immunology, Transplantation and Infectious Disease, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Anna Griego
- Department of Pharmaceutical Sciences, University of Milan, Milan, Italy; National Institute of Molecular Genetics, Milan, Italy
| | - Viola Camilla Scoffone
- Department of Biology and Biotechnology 'Lazzaro Spallanzani', University of Pavia, Pavia, Italy
| | - Elena Kazakova
- Federal Research Centre 'Fundamentals of Biotechnology' of the Russian Academy of Sciences, Moscow, Russia
| | - Edoardo Scarpa
- Department of Pharmaceutical Sciences, University of Milan, Milan, Italy; National Institute of Molecular Genetics, Milan, Italy
| | | | - Alessandro Stamilla
- Department of Biology and Biotechnology 'Lazzaro Spallanzani', University of Pavia, Pavia, Italy
| | - Silvia Buroni
- Department of Biology and Biotechnology 'Lazzaro Spallanzani', University of Pavia, Pavia, Italy
| | - Enrico Tortoli
- Emerging Bacterial Pathogens Unit, Division of Immunology, Transplantation and Infectious Disease, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Loris Rizzello
- Department of Pharmaceutical Sciences, University of Milan, Milan, Italy; National Institute of Molecular Genetics, Milan, Italy
| | - Davide Sassera
- Department of Biology and Biotechnology 'Lazzaro Spallanzani', University of Pavia, Pavia, Italy; Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Santiago Ramón-García
- Department of Microbiology/Faculty of Medicine, University of Zaragoza, Zaragoza, Spain; Research and Development Agency of Aragon Foundation, Zaragoza, Spain; Spanish Network for Research on Respiratory Diseases, Carlos III Health Institute, Madrid, Spain.
| | - Daniela Maria Cirillo
- Emerging Bacterial Pathogens Unit, Division of Immunology, Transplantation and Infectious Disease, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Vadim Makarov
- Federal Research Centre 'Fundamentals of Biotechnology' of the Russian Academy of Sciences, Moscow, Russia.
| | - Maria Rosalia Pasca
- Department of Biology and Biotechnology 'Lazzaro Spallanzani', University of Pavia, Pavia, Italy; Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
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Tejedor MT, Rial-Crestelo D, Diab L, de Lagarde M, Álvarez CJ, Lopez-Roa P. Fibrocavitary disease caused by Mycobacterium chimaera in a patient with HIV. AIDS 2024; 38:1446-1448. [PMID: 38932751 DOI: 10.1097/qad.0000000000003918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Affiliation(s)
- Maria Teresa Tejedor
- Pneumology Department
- Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
| | - David Rial-Crestelo
- HIV Unit - Internal Medicine Department, Hospital 12 de Octubre
- Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Layla Diab
- Pneumology Department
- Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Maria de Lagarde
- HIV Unit - Internal Medicine Department, Hospital 12 de Octubre
- CIBERINFEC
- Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Carlos José Álvarez
- Pneumology Department
- Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Paula Lopez-Roa
- Microbiology Department, Hospital 12 de Octubre
- Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
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36
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Gaviraghi A, de Nicolò A, Venuti F, Stroffolini G, Quaranta M, Cat Genova E, Ponzetta L, Alladio F, Marinaro L, D'Avolio A, Calcagno A. Low azithromycin maximal concentrations in patients concomitantly taking rifampicin: time to move away from rifampicin in the treatment of non-tuberculous mycobacteria? Antimicrob Agents Chemother 2024; 68:e0023424. [PMID: 38785450 PMCID: PMC11232375 DOI: 10.1128/aac.00234-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Affiliation(s)
- Alberto Gaviraghi
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino at the Amedeo di Savoia Hospital, ASL Città di Torino, Turin, Italy
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Via Don A. Sempreboni, Verona, Italy
| | - Amedeo de Nicolò
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Francesco Venuti
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino at the Amedeo di Savoia Hospital, ASL Città di Torino, Turin, Italy
| | - Giacomo Stroffolini
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Via Don A. Sempreboni, Verona, Italy
| | - Matilde Quaranta
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino at the Amedeo di Savoia Hospital, ASL Città di Torino, Turin, Italy
| | - Elena Cat Genova
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Laura Ponzetta
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino at the Amedeo di Savoia Hospital, ASL Città di Torino, Turin, Italy
| | - Francesca Alladio
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Via Don A. Sempreboni, Verona, Italy
| | - Letizia Marinaro
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino at the Amedeo di Savoia Hospital, ASL Città di Torino, Turin, Italy
| | - Antonio D'Avolio
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Andrea Calcagno
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino at the Amedeo di Savoia Hospital, ASL Città di Torino, Turin, Italy
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37
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Kim SY, Zo S, Kim DH, Shin SJ, Jhun BW. Single-cell transcriptomics by clinical course of Mycobacterium avium complex pulmonary disease. Sci Rep 2024; 14:15663. [PMID: 38977917 PMCID: PMC11231222 DOI: 10.1038/s41598-024-66523-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 07/02/2024] [Indexed: 07/10/2024] Open
Abstract
Mycobacterium avium complex pulmonary disease (MAC-PD) has a heterogeneous clinical course. However, immune profiles associated with MAC-PD clinical course are limited. We performed single-cell RNA sequencing of peripheral blood mononuclear cells from 21 MAC-PD patients divided into three clinical courses: group A, spontaneous culture conversion; group B, stable disease without antibiotic treatment; and group C, progressive disease with antibiotic treatment. A lower proportion of NK cells and higher proportion of monocytes were noted in group C compared to combined groups A and B. The proportion of classical monocytes was higher in group C compared to groups A and B, while the proportion of non-classical monocytes decreased. EGR1, HSPA1A, HSPA1B, and CD83 were up-regulated in spontaneous culture conversion group A compared to progressive disease group C. Up-regulation of MYOM2 and LILRA4 and down-regulation of MT-ATP8, CD83, and CCL3L1 was found in progressive disease group C. PCBP1, FOS, RGCC, S100B, G0S2, AREG, and LYN were highly expressed in favorable treatment response compared to unfavorable response. Our findings may offer a comprehensive understanding of the host immune profiles that influence a particular MAC-PD clinical course and could suggest an immunological mechanism associated with the disease progression of MAC-PD.
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Affiliation(s)
- Su-Young Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sungmin Zo
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Dae Hun Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sung Jae Shin
- Department of Microbiology, Institute for Immunology and Immunological Disease, Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul, South Korea
| | - Byung Woo Jhun
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
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38
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Anh NK, Phat NK, Thu NQ, Tien NTN, Eunsu C, Kim HS, Nguyen DN, Kim DH, Long NP, Oh JY. Discovery of urinary biosignatures for tuberculosis and nontuberculous mycobacteria classification using metabolomics and machine learning. Sci Rep 2024; 14:15312. [PMID: 38961191 PMCID: PMC11222504 DOI: 10.1038/s41598-024-66113-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 06/27/2024] [Indexed: 07/05/2024] Open
Abstract
Nontuberculous mycobacteria (NTM) infection diagnosis remains a challenge due to its overlapping clinical symptoms with tuberculosis (TB), leading to inappropriate treatment. Herein, we employed noninvasive metabolic phenotyping coupled with comprehensive statistical modeling to discover potential biomarkers for the differential diagnosis of NTM infection versus TB. Urine samples from 19 NTM and 35 TB patients were collected, and untargeted metabolomics was performed using rapid liquid chromatography-mass spectrometry. The urine metabolome was analyzed using a combination of univariate and multivariate statistical approaches, incorporating machine learning. Univariate analysis revealed significant alterations in amino acids, especially tryptophan metabolism, in NTM infection compared to TB. Specifically, NTM infection was associated with upregulated levels of methionine but downregulated levels of glutarate, valine, 3-hydroxyanthranilate, and tryptophan. Five machine learning models were used to classify NTM and TB. Notably, the random forest model demonstrated excellent performance [area under the receiver operating characteristic (ROC) curve greater than 0.8] in distinguishing NTM from TB. Six potential biomarkers for NTM infection diagnosis, including methionine, valine, glutarate, 3-hydroxyanthranilate, corticosterone, and indole-3-carboxyaldehyde, were revealed from univariate ROC analysis and machine learning models. Altogether, our study suggested new noninvasive biomarkers and laid a foundation for applying machine learning to NTM differential diagnosis.
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Affiliation(s)
- Nguyen Ky Anh
- Department of Pharmacology and PharmacoGenomics Research Center, Inje University College of Medicine, Busan, 47392, Republic of Korea
- Faculty of Pharmacy, Ton Duc Thang University, Ho Chi Minh City, Vietnam
| | - Nguyen Ky Phat
- Department of Pharmacology and PharmacoGenomics Research Center, Inje University College of Medicine, Busan, 47392, Republic of Korea
| | - Nguyen Quang Thu
- Department of Pharmacology and PharmacoGenomics Research Center, Inje University College of Medicine, Busan, 47392, Republic of Korea
| | - Nguyen Tran Nam Tien
- Department of Pharmacology and PharmacoGenomics Research Center, Inje University College of Medicine, Busan, 47392, Republic of Korea
| | - Cho Eunsu
- Department of Pharmacology and PharmacoGenomics Research Center, Inje University College of Medicine, Busan, 47392, Republic of Korea
| | - Ho-Sook Kim
- Department of Pharmacology and PharmacoGenomics Research Center, Inje University College of Medicine, Busan, 47392, Republic of Korea
| | - Duc Ninh Nguyen
- Section for Comparative Pediatrics and Nutrition, Department of Veterinary and Animal Sciences, University of Copenhagen, 1870, Frederiksberg, Denmark
| | - Dong Hyun Kim
- Department of Pharmacology and PharmacoGenomics Research Center, Inje University College of Medicine, Busan, 47392, Republic of Korea
| | - Nguyen Phuoc Long
- Department of Pharmacology and PharmacoGenomics Research Center, Inje University College of Medicine, Busan, 47392, Republic of Korea.
| | - Jee Youn Oh
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Seoul, 08308, Republic of Korea.
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Yamatani I, Aono A, Fujiwara K, Asami T, Kamada K, Morishige Y, Igarashi Y, Chikamatsu K, Murase Y, Yamada H, Takaki A, Komiya K, Mitarai S. In vitro effects of the new oral β-lactamase inhibitor xeruborbactam in combination with oral β-lactams against clinical Mycobacterium abscessus isolates. Microbiol Spectr 2024; 12:e0008424. [PMID: 38842354 PMCID: PMC11218443 DOI: 10.1128/spectrum.00084-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 05/02/2024] [Indexed: 06/07/2024] Open
Abstract
Non-tuberculosis mycobacteria (NTM), particularly Mycobacterium abscessus subsp. abscessus (M. abscessus), are increasingly being recognized as etiological agents of NTM pulmonary disease. However, treatment options for M. abscessus are limited owing to their natural resistance to most antibiotics, including β-lactams. M. abscessus produces a class A β-lactamase, whose activity is inhibited by cyclic boronic acid β-lactamase inhibitors. We aimed to evaluate the in vitro effects of xeruborbactam, a cyclic boronic acid β-lactamase inhibitor, against M. abscessus when combined with five β-lactams (amoxicillin, tebipenem, cefdinir, cefuroxime, and cefoxitin). The drug susceptibilities of 43 M. abscessus clinical isolates obtained from 43 patients between August 2005 and May 2014 were tested. The MIC results for each β-lactam with or without 4 µg/mL xeruborbactam were examined. Xeruborbactam lowered the MIC90 values of tebipenem, amoxicillin, cefuroxime, and cefdinir by 5, ≥4, 3, and 3 dilutions, respectively. The MIC90 values of cefoxitin without xeruborbactam were 32 µg/mL and did not change upon the addition of xeruborbactam. The lowest MIC90 value was obtained for tebipenem with xeruborbactam. Almost all isolates had an MIC of 4 µg/mL; one isolate had an MIC of 2 µg/mL. With respect to the susceptibility to the same family drug, the number of susceptible isolates increased from 1/43 (2%) to 43/43 (100%) for tebipenem with xeruborbactam. Combining tebipenem and xeruborbactam could be considered an effective all-oral regimen that benefits outpatient treatment of M. abscessus pulmonary disease. IMPORTANCE Mycobacterium abscessus subsp. abscessus (M. abscessus) disease is treated in two phases; injectable drugs for initial followed by others for continuation. There is a need to develop all-oral treatment methods for M. abscessus infection, especially in the continuation phase. However, treatment options for M. abscessus are limited owing to their natural resistance to most antibiotics. This is the first report to evaluate the in vitro effects of xeruborbactam, a cyclic boronic acid β-lactamase inhibitor capable of inhibiting the class A β-lactamase produced by M. abscessus, against 43 M. abscessus clinical isolates when combined with five β-lactam antibiotics. Xeruborbactam lowered the MIC90 values of tebipenem by five dilutions, and the number of susceptible isolates increased from 1/43 (2%) to 43/43 (100%). We showed that the tebipenem-xeruborbactam combination might be of interest to explore further as a potentially effective oral regimen for outpatient treatment of M. abscessus pulmonary disease.
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Affiliation(s)
- Izumi Yamatani
- Department of Mycobacterium Reference and Research, Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Oita, Japan
| | - Akio Aono
- Department of Mycobacterium Reference and Research, Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - Keiji Fujiwara
- Department of Mycobacterium Reference and Research, Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - Takahiro Asami
- Department of Mycobacterium Reference and Research, Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - Keisuke Kamada
- Department of Mycobacterium Reference and Research, Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - Yuta Morishige
- Department of Mycobacterium Reference and Research, Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - Yuriko Igarashi
- Department of Mycobacterium Reference and Research, Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - Kinuyo Chikamatsu
- Department of Mycobacterium Reference and Research, Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - Yoshiro Murase
- Department of Mycobacterium Reference and Research, Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - Hiroyuki Yamada
- Department of Mycobacterium Reference and Research, Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - Akiko Takaki
- Department of Mycobacterium Reference and Research, Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Oita, Japan
- Department of Basic Mycobacteriosis, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kosaku Komiya
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Oita, Japan
| | - Satoshi Mitarai
- Department of Mycobacterium Reference and Research, Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan
- Department of Basic Mycobacteriosis, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Lee G, Kim S, Chang S, Sohn H, Kang YA, Park Y. Epidemiological Characteristics of Nontuberculous Mycobacterial Pulmonary Disease in South Korea: A Meta-analysis of Individual Participant Data. Tuberc Respir Dis (Seoul) 2024; 87:386-397. [PMID: 38590075 PMCID: PMC11222092 DOI: 10.4046/trd.2023.0193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/29/2024] [Accepted: 04/07/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Despite the global increase in nontuberculous mycobacterial pulmonary disease (NTM-PD), clinical characteristics show geographical variations. We investigated the clinical characteristics of patients with NTM-PD in South Korea. METHODS We systematically reviewed articles concerning patients with NTM-PD in South Korea until February 2022. Individual participant data, regardless of treatment, were collected using a standard case report form. RESULTS Data of 6,489 patients from 11 hospitals between 2002 and 2019 were analyzed. The mean age was 61.5±11.7 years, of whom 57.7% were women. Mycobacterium avium (41.4%) and Mycobacterium intracellulare (38.4%) comprised most of the causative species, followed by Mycobacterium abscessus subspecies abscessus (8.6%) and M. abscessus subspecies massiliense (7.8%). Bronchiectasis (59.4%) was the most common pulmonary comorbidity. Although reported cases of NTM-PD increased over the years, the proportions of causative species and radiologic forms remained similar. Distinct clinical characteristics were observed according to age and sex. Men were older at the time of diagnosis (median 63.8 years vs. 59.9 years, p<0.001), and had more cavitary lesions than women (38.8% vs. 21.0%, p<0.001). The older group (≥65 years) had higher proportions of patients with body mass index <18.5 kg/m2 (27.4% vs. 18.6%, p<0.001) and cavitary lesions (29.9% vs. 27.6%, p=0.009) than the younger group. CONCLUSION We conducted a meta-analysis of the clinical characteristics of patients with NTM-PD in South Korea, and found age- and sex-related differences in disease- specific severity. Further investigation would enhance our comprehension of the nature of the disease, and inherited and acquired host factors.
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Affiliation(s)
- Geunin Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sol Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Shihwan Chang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hojoon Sohn
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young Ae Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute of Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Youngmok Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute for Innovation in Digital Healthcare, Yonsei University, Seoul, Republic of Korea
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Lee J, Fujiwara N, Kim JY, Kang M, Yang JS, Yim JJ, Whang J, Kwak N. The Impact of Trehalose Dimycolate on the Clinical Course of Mycobacterium avium Complex Pulmonary Disease. Ann Am Thorac Soc 2024; 21:1015-1021. [PMID: 38285897 DOI: 10.1513/annalsats.202308-746oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 01/24/2024] [Indexed: 01/31/2024] Open
Abstract
Rationale: The clinical implications of trehalose 6,6'-dimycolate (TDM) in nontuberculous mycobacterial pulmonary disease have not been studied. Objectives: To examine the presence of TDM in clinical isolates obtained from patients with Mycobacterium avium complex (MAC) pulmonary disease (PD) and its impact on disease severity and treatment outcomes. Methods: We analyzed clinical isolates from patients with diagnoses of MAC PD at Seoul National University Hospital between January 1, 2019, and December 31, 2021. The lipids were extracted from clinical isolates obtained at the time of diagnosis using mass spectrometry. Mass peaks between 300 and 3,500 m/z were obtained, and the peak patterns of the total lipids were analyzed. Results: TDM was identified in clinical isolates from 176 of 343 patients. Cavities were more prevalent in patients with TDM-negative isolates (19.8%) than in those with TDM-positive isolates (10.2%) (P = 0.015). The time to antibiotic treatment was shorter in patients with TDM-negative isolates (4 mo [interquartile range, 2-10 mo]) than in those with TDM-positive isolates (7 mo [interquartile range, 3-16 mo]) (P = 0.032). Patients with TDM-negative isolates had a significantly lower proportion of culture conversions (P = 0.012). TDM was associated with higher likelihood of culture conversion (adjusted hazard ratio, 2.29; P = 0.035). Conclusions: TDM-negative isolates were linked to a higher occurrence of cavities, earlier initiation of treatment, and worse treatment outcome in patients with MAC PD.
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Affiliation(s)
- Jihoo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Nagatoshi Fujiwara
- Department of Food and Nutrition, Faculty of Contemporary Human Life Science, Tezukayama University, Nara, Japan; and
| | - Joong-Yub Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Minji Kang
- Research and Development Center, The Korean Institute of Tuberculosis, Osong, South Korea
| | - Jeong Seong Yang
- Research and Development Center, The Korean Institute of Tuberculosis, Osong, South Korea
| | - Jae-Joon Yim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Jake Whang
- Research and Development Center, The Korean Institute of Tuberculosis, Osong, South Korea
| | - Nakwon Kwak
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
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Sebastian Hurtado T, Alvelo A, Colon Estarellas G, Velez Maymi S. A Puerto Rican Variant of Lady Windermere Syndrome: Reanalyzing the Characteristics of Non-tuberculous Mycobacterial Infection. Cureus 2024; 16:e63900. [PMID: 38974397 PMCID: PMC11225544 DOI: 10.7759/cureus.63900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2024] [Indexed: 07/09/2024] Open
Abstract
Lady Windermere syndrome (LWS) is a disease caused by a non-tuberculous Mycobacterium (NTM) that is commonly found in thin women who voluntarily suppress their cough reflex. The NTM that causes this syndrome is Mycobacterium avium complex, an organism commonly present in chlorinated city water and soil. Patients with LWS are tall, lean, elderly white women. We report a case of an immunocompetent 81-year-old thin Puerto Rican female with a recurrent cough since childhood, who was misdiagnosed with tuberculosis (TB) and prophylactically treated. While the patient fitted the clinical picture of NTM pulmonary infection based on symptoms, imaging, and microbiologic findings, her demography and morphologic features were not completely consistent with published findings. The incidence and prevalence of NTM lung disease are rising worldwide due to the aging population, increased use of immunosuppressive medications, and prevalence of chronic pulmonary obstructive disease and bronchiectasis. The goal of this report is to increase awareness of LWS as one of the diagnoses that should be considered in patients presenting with clinical findings resembling TB and bring attention to the different clinical characteristics this patient with LWS possessed.
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Affiliation(s)
| | - Amanda Alvelo
- Internal Medicine, San Juan City Hospital, San Juan, PRI
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Sun JM, Li J, Xu XH. Successful management of Mycobacterium abscessus pneumonia in a 53-day-old immunocompetent infant. Diagn Microbiol Infect Dis 2024; 109:116296. [PMID: 38640607 DOI: 10.1016/j.diagmicrobio.2024.116296] [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] [Received: 11/01/2023] [Revised: 03/28/2024] [Accepted: 03/30/2024] [Indexed: 04/21/2024]
Abstract
Pulmonary infection due to Mycobacterium abscessus complex (MABC) usually occurs in children with underlying risk factors including cystic fibrosis (CF), chronic lung disease, and immunocompromised status, but rarely in immunocompetent children without underlying lung disease, especially in infants. We present a case of MABC pulmonary disease (MABC-PD) in an otherwise healthy 53-day-old male infant with one week of cough and respiratory distress. Computed tomography showed multiple masses across both lungs. Isolated mycobacteria from his bronchoalveolar lavage fluid were identified as MABC. We describe our complete evaluation, including immunodeficiency evaluation incorporating whole exome sequencing and our therapeutic process given complicated susceptibility pattern of the M. abscessus isolate, and review literature for MABC-PD in immunocompetent children. The infant was successfully treated through prolonged treatment with parenteral Amikacin, Cefoxitin, Linezolid, and Clarithromycin, combined with inhaled Amikacin.
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Affiliation(s)
- Jing-Min Sun
- Department of Pediatric Intensive Care Unit, The First Affiliated Hospital of Anhui Medical University, 18th Floor of Medicine and Medical Tech Building, 218 Jixi Road, Hefei 230022, Anhui, China.
| | - Jing Li
- Department of Pediatric Intensive Care Unit, The First Affiliated Hospital of Anhui Medical University, 18th Floor of Medicine and Medical Tech Building, 218 Jixi Road, Hefei 230022, Anhui, China.
| | - Xi-Hai Xu
- Department of Infectious Diseases, The First Affiliated Hospital of Anhui Medical University, Infectious Diseases Ward Building, 218 Jixi Road, Hefei 230022, Anhui, China.
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Kohli A, Tajik S, Abdulfattah O. Immune Reconstitution Syndrome Caused by Nontuberculous Mycobacteria: A Case Report and Review of Literature. Cureus 2024; 16:e64146. [PMID: 39119403 PMCID: PMC11308748 DOI: 10.7759/cureus.64146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2024] [Indexed: 08/10/2024] Open
Abstract
Immune reconstitution inflammatory syndrome (IRIS) is a potentially life-threatening phenomenon associated with the initiation of antiretroviral therapy in patients with acquired immunodeficiency syndrome due to a human immunodeficiency virus (HIV) infection. It is thought to be an exaggerated inflammatory response to an existing pathogen or even its antigen. We present a case of IRIS due to a non-tuberculous mycobacteria infection in a young patient with HIV infection who was recently started on therapy. This case highlights the challenges of making such a diagnosis and the importance of multidisciplinary team discussions with pulmonary and infectious diseases for optimal management of these patients.
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Affiliation(s)
- Akshay Kohli
- Pulmonary and Critical Care Medicine, Southern Illinois University School of Medicine, Springfield, USA
| | - Shadee Tajik
- Internal Medicine, Southern Illinois University School of Medicine, Springfield, USA
| | - Omar Abdulfattah
- Critical Care, Southern Illinois University School of Medicine, Springfield, USA
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45
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Kwak N, Henkle E, Hwang H, Jeon D, Jhun BW, Jo KW, Kang YA, Kim HJ, Kim JY, Kim YR, Kwon YS, Lee JH, Mok J, Park Y, Shim TS, Sohn H, Whang J, Yim JJ. Improvement in Health-Related Quality of Life Following Antibiotic Treatment in Nontuberculous Mycobacterial Pulmonary Disease: Initial Analysis of the NTM-KOREA Cohort. Clin Infect Dis 2024; 78:1690-1697. [PMID: 38563246 DOI: 10.1093/cid/ciae131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Improving health-related quality of life (HRQOL) has emerged as a priority in the management of nontuberculous mycobacterial pulmonary disease (NTM-PD). We aimed to evaluate HRQOL and its changes after 6 months' treatment in patients with NTM-PD. METHODS The NTM-KOREA is a nationwide prospective cohort enrolling patients initiating treatment for NTM-PD in 8 institutions across South Korea. We conducted the Quality of Life-Bronchiectasis (QOL-B) at 6-month intervals and evaluated baseline scores (higher scores indicate better quality of life) and changes after 6 months' treatment. Multivariate logistic regression was performed to identify factors associated with improvement in the QOL-B physical functioning and respiratory symptoms domains. RESULTS Between February 2022 and August 2023, 411 patients were included in the analysis. Baseline scores (95% confidence interval [CI]) for physical functioning and respiratory symptoms were 66.7 (46.7-86.7) and 81.5 (70.4-92.6), respectively. Among 228 patients who completed the QOL-B after 6 months' treatment, improvements in physical functioning and respiratory symptoms were observed in 61 (26.8%) and 71 (31.1%) patients, respectively. A lower score (adjusted odds ratio; 95% CI) for physical functioning (0.93; 0.91-0.96) and respiratory symptoms (0.92; 0.89-0.95) at treatment initiation was associated with a greater likelihood of physical functioning and respiratory symptom improvement, respectively; achieving culture conversion was not associated with improvement in physical functioning (0.62; 0.28-1.39) or respiratory symptoms (1.30; 0.62-2.74). CONCLUSIONS After 6 months of antibiotic treatment for NTM-PD, HRQOL improved in almost one-third, especially in patients with severe initial symptoms, regardless of culture conversion. CLINICAL TRIALS REGISTRATION ClinicalTrials.gov identifier: NCT03934034.
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Affiliation(s)
- Nakwon Kwak
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
- Department of Internal Medicine, Seoul National University, Seoul National University College of Medicine, Seoul, South Korea
| | - Emily Henkle
- OHSU-PSU School of Public Health, Portland, Oregon, USA
| | - Hyeontaek Hwang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Doosoo Jeon
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, South Korea
| | - Byung Woo Jhun
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kyung-Wook Jo
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Young Ae Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyung-Jun Kim
- Department of Internal Medicine, Seoul National University, Seoul National University College of Medicine, Seoul, South Korea
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Joong-Yub Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
- Department of Internal Medicine, Seoul National University, Seoul National University College of Medicine, Seoul, South Korea
| | - Young Ran Kim
- Division of Clinical Research, International Tuberculosis Research Centre, Seoul, South Korea
| | - Yong-Soo Kwon
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, South Korea
| | - Jae Ho Lee
- Department of Internal Medicine, Seoul National University, Seoul National University College of Medicine, Seoul, South Korea
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jeongha Mok
- Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea
| | - Youngmok Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Tae Sun Shim
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Hojoon Sohn
- Department of Preventive Medicine, College of Medicine, Seoul National University, Seoul, South Korea
| | - Jake Whang
- Korea Mycobacterium Resource Center and Basic Research Section, The Korean Institute of Tuberculosis, Cheongju, South Korea
| | - Jae-Joon Yim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
- Department of Internal Medicine, Seoul National University, Seoul National University College of Medicine, Seoul, South Korea
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Kurahara Y, Tanaka Y, Kobayashi T, Yoshida S, Tsuyuguchi K. Changes in skin discoloration according to clofazimine dosage in nontuberculous mycobacterial pulmonary disease. J Infect Chemother 2024:S1341-321X(24)00159-4. [PMID: 38871252 DOI: 10.1016/j.jiac.2024.06.004] [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: 05/09/2024] [Revised: 06/03/2024] [Accepted: 06/10/2024] [Indexed: 06/15/2024]
Abstract
Although clofazimine is currently one of the standard regimens for Mycobacterium abscessus, it frequently causes skin discoloration, posing esthetic concerns for patients. We studied thirteen Asian patients with pulmonary nontuberculous mycobacterial disease treated with clofazimine at the NHO Kinki Chuo Chest Medical Center. In three patients (two women and one man) whose dosing regimens were altered owing to skin discoloration, we continuously measured luminance (L*), red-green (a*), and yellow-blue (b*) values (using a colorimeter) in both sun-exposed and sun-unexposed skin areas at each visit. Compared to baseline L* and a* values, the ΔL* values were negative (decreased brightness) and Δa* values were positive (increased redness) while patients received daily clofazimine. After switching to intermittent or reduced dosing, these changes gradually diminished. If such a dose reduction does not affect the therapeutic outcome, an even lower clofazimine dose may be attempted to minimize skin adverse effects.
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Affiliation(s)
- Yu Kurahara
- Department of Internal Medicine, NHO Kinki Chuo Chest Medical Center, Osaka, Japan; Department of Infectious Diseases, NHO Kinki Chuo Chest Medical Center, Osaka, Japan; Clinical Research Center, NHO Kinki Chuo Chest Medical Center, Osaka, Japan
| | - Yuya Tanaka
- Department of Internal Medicine, NHO Kinki Chuo Chest Medical Center, Osaka, Japan; Department of Infectious Diseases, NHO Kinki Chuo Chest Medical Center, Osaka, Japan
| | - Takehiko Kobayashi
- Clinical Research Center, NHO Kinki Chuo Chest Medical Center, Osaka, Japan
| | - Shiomi Yoshida
- Clinical Research Center, NHO Kinki Chuo Chest Medical Center, Osaka, Japan
| | - Kazunari Tsuyuguchi
- Department of Internal Medicine, NHO Kinki Chuo Chest Medical Center, Osaka, Japan; Department of Infectious Diseases, NHO Kinki Chuo Chest Medical Center, Osaka, Japan; Clinical Research Center, NHO Kinki Chuo Chest Medical Center, Osaka, Japan.
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Abbas M, Khan MT, Iqbal Z, Ali A, Eddine BT, Yousaf N, Wei D. Sources, transmission and hospital-associated outbreaks of nontuberculous mycobacteria: a review. Future Microbiol 2024; 19:715-740. [PMID: 39015998 PMCID: PMC11259073 DOI: 10.2217/fmb-2023-0279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/20/2024] [Indexed: 07/18/2024] Open
Abstract
Nontuberculous mycobacteria (NTM) are widespread environmental organisms found in both natural and man-made settings, such as building plumbing, water distribution networks and hospital water systems. Their ubiquitous presence increases the risk of transmission, leading to a wide range of human infections, particularly in immunocompromised individuals. NTM primarily spreads through environmental exposures, such as inhaling aerosolized particles, ingesting contaminated food and introducing it into wounds. Hospital-associated outbreaks have been linked to contaminated medical devices and water systems. Furthermore, the rising global incidence, prevalence and isolation rates highlight the urgency of addressing NTM infections. Gaining a thorough insight into the sources and epidemiology of NTM infection is crucial for devising novel strategies to prevent and manage NTM transmission and infections.
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Affiliation(s)
- Munawar Abbas
- College of Food Science & Technology, Henan University of Technology, Zhengzhou, Henan, 450001, China
| | - Muhammad Tahir Khan
- Institute of Molecular Biology & Biotechnology (IMBB), The University of Lahore, 1KM Defense Road, Lahore, 58810, Pakistan
- Zhongjing Research & Industrialization Institute of Chinese Medicine, Zhongguancun Scientific Park, Meixi, Nanyang, Henan, 473006, PR China
| | - Zafar Iqbal
- School of Life Science, Anhui Normal University, Wuhu, Anhui, China
| | - Arif Ali
- Department of Bioinformatics & Biological Statistics, School of Life Sciences & Biotechnology, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Benarfa Taki Eddine
- Echahid Cheikh Larbi Tebessi University Faculty of Exact Sciences & Natural & Life Sciences, Département of Microbiology, Algeria
| | - Numan Yousaf
- Department of Biosciences, COMSATS University Islamabad, Pakistan
| | - Dongqing Wei
- College of Food Science & Technology, Henan University of Technology, Zhengzhou, Henan, 450001, China
- State Key Laboratory of Microbial Metabolism, Shanghai-Islamabad-Belgrade Joint Innovation Center on Antibacterial Resistances, Joint International Research Laboratory of Metabolic & Developmental Sciences & School of Life Sciences & Biotechnology, Shanghai Jiao Tong University, Shanghai, 200030, PR China
- Zhongjing Research & Industrialization Institute of Chinese Medicine, Zhongguancun Scientific Park, Meixi, Nanyang, Henan, 473006, PR China
- Henan Biological Industry Group, 41, Nongye East Rd, Jinshui, Zhengzhou, Henan, 450008, China
- Peng Cheng National Laboratory, Vanke Cloud City Phase I Building 8, Xili Street, Nashan District, Shenzhen, Guangdong, 518055, PR China
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Uwamino Y, Aoki W, Inose R, Kamoshita Y, Mikita K, Namkoong H, Nishimura T, Matsushita H, Hasegawa N. Minimum inhibitory concentrations of azithromycin in clinical isolates of Mycobacterium avium complex in Japan. Microbiol Spectr 2024; 12:e0021824. [PMID: 38687080 PMCID: PMC11237530 DOI: 10.1128/spectrum.00218-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 04/17/2024] [Indexed: 05/02/2024] Open
Abstract
The latest guidelines include azithromycin as a preferred regimen for treating Mycobacterium avium complex (MAC) pulmonary disease. However, serially collected susceptibility data on clinical MAC isolates are limited, and no breakpoints have been determined. We investigated the minimum inhibitory concentrations (MICs) of azithromycin and clarithromycin for all MAC strains isolated in 2021 from a single center in Japan, excluding duplicates. The MICs were determined using a panel based on the microbroth dilution method, according to the latest Clinical and Laboratory Standards Institute recommendations. The MICs were determined for 318 MAC strains. Although there was a significant positive correlation between the MICs of azithromycin and clarithromycin, the MICs of azithromycin tended to be higher than those of clarithromycin. Among the cases in which the strains were isolated, 18 patients initiated treatment, including azithromycin treatment, after sample collection. Some patients infected with stains with relatively high azithromycin MICs achieved a microbiological cure with azithromycin-containing regimens. This study revealed a higher MIC distribution for azithromycin than clarithromycin, raising questions about the current practice of estimating azithromycin susceptibility based on the clarithromycin susceptibility test result. However, this was a single-center study that included only a limited number of cases treated with azithromycin. Therefore, further multicenter studies that include a greater number of cases treated with azithromycin are warranted to verify the distribution of azithromycin MICs and examine the correlation between azithromycin MICs and treatment effectiveness.IMPORTANCEThe macrolides serve as key drugs in the treatment of pulmonary Mycobacterium avium complex infection, and the administration of macrolide should be guided by susceptibility test results. Azithromycin is recommended as a preferred choice among macrolides, surpassing clarithromycin; however, drug susceptibility testing is often not conducted, and clarithromycin susceptibility is used as a surrogate. This study represents the first investigation into the minimum inhibitory concentration of azithromycin on a scale of several hundred clinical isolates, revealing an overall tendency for higher minimum inhibitory concentrations compared with clarithromycin. The results raise questions about the appropriateness of using clarithromycin susceptibility test outcomes for determining the administration of azithromycin. This study highlights the need for future discussions on the clinical breakpoints of azithromycin, based on large-scale clinical research correlating azithromycin susceptibility with treatment outcomes.
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Affiliation(s)
- Yoshifumi Uwamino
- Department of Laboratory Medicine, Keio University School of Medicine, Tokyo, Japan
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
| | - Wataru Aoki
- Clinical Laboratory, Keio University Hospital, Tokyo, Japan
| | - Rika Inose
- Clinical Laboratory, Keio University Hospital, Tokyo, Japan
| | - Yuka Kamoshita
- Department of Laboratory Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kei Mikita
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
| | - Ho Namkoong
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
| | | | - Hiromichi Matsushita
- Department of Laboratory Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Naoki Hasegawa
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
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Cristancho-Rojas C, Varley CD, Lara SC, Kherabi Y, Henkle E, Winthrop KL. Epidemiology of Mycobacterium abscessus. Clin Microbiol Infect 2024; 30:712-717. [PMID: 37778416 DOI: 10.1016/j.cmi.2023.08.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/28/2023] [Accepted: 08/31/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Nontuberculous mycobacteria (NTM) are highly abundant in soil, dust, and water sources, making human-pathogen contact frequent and recurrent. NTM represents over 200 species/subspecies; some are considered strict or opportunistic pathogens. Mycobacterium abscessus, often regarded as one of the most antibiotic-resistant mycobacteria, is the second most frequent NTM pulmonary disease pathogen. OBJECTIVES To describe the epidemiology of M. abscessus through a literature review focusing on clinical aspects. SOURCES We conducted searches on PubMed and Web of Knowledge for articles published from 2010 to the present using the keywords 'Mycobacterium abscessus', 'Nontuberculous mycobacteria', and 'epidemiology'. Our search prioritized original reports on the occurrence of NTM and M. abscessus infection/disease. CONTENT Advanced molecular and genetic diagnostic techniques have refined the M. abscessus complex (MABC) microbiological classification over the last few decades. MABC can adhere to surfaces and form a biofilm. This characteristic and its resistance to common disinfectants allow these microorganisms to persist in the water distribution systems, becoming a constant reservoir. The frequency and manifestation of NTM species vary geographically because of environmental conditions and population susceptibility differences. MABC lung disease, the most frequent site of NTM infection in humans, is often seen in patients with underlying lung diseases such as bronchiectasis, whereas MABC disseminated disease is related to immunosuppression. Skin and soft tissue infections are associated with surgical or injection procedures. Epidemiological evidence suggests an overall increase in MABC infection and disease in the last decade. IMPLICATIONS Establishing the burden of this disease is challenging because of varying measures of incidence and prevalence, referral bias, and differences in medical practices and reporting. Furthermore, environmental and structural determinants, infection routes, and MABC pulmonary disease mechanisms require additional investigation. This review contributes to a better understanding of the epidemiology of MABC, which could inform clinical practice and future research.
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Affiliation(s)
- Cesar Cristancho-Rojas
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR, USA
| | - Cara D Varley
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR, USA; Department of Medicine, Division of Infectious Diseases, Oregon Health & Science University, Portland, OR, USA
| | - Sofia Chapela Lara
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR, USA
| | - Yousra Kherabi
- Department of Infectious Diseases, Bichat-Claude Bernard Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Emily Henkle
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR, USA
| | - Kevin L Winthrop
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR, USA; Department of Medicine, Division of Infectious Diseases, Oregon Health & Science University, Portland, OR, USA.
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Choi H, McShane PJ, Aliberti S, Chalmers JD. Bronchiectasis management in adults: state of the art and future directions. Eur Respir J 2024; 63:2400518. [PMID: 38782469 PMCID: PMC11211698 DOI: 10.1183/13993003.00518-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024]
Abstract
Formerly regarded as a rare disease, bronchiectasis is increasingly recognised. A renewed interest in this disease has led to significant progress in bronchiectasis research. Randomised clinical trials (RCTs) have demonstrated the benefits of airway clearance techniques, inhaled antibiotics and long-term macrolide therapy in bronchiectasis patients. However, the heterogeneity of bronchiectasis remains one of the most challenging aspects of management. Phenotypes and endotypes of bronchiectasis have been identified to help find "treatable traits" and partially overcome disease complexity. The goals of therapy for bronchiectasis are to reduce the symptom burden, improve quality of life, reduce exacerbations and prevent disease progression. We review the pharmacological and non-pharmacological treatments that can improve mucociliary clearance, reduce airway inflammation and tackle airway infection, the key pathophysiological features of bronchiectasis. There are also promising treatments in development for the management of bronchiectasis, including novel anti-inflammatory therapies. This review provides a critical update on the management of bronchiectasis focusing on treatable traits and recent RCTs.
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Affiliation(s)
- Hayoung Choi
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Pamela J McShane
- Division of Pulmonary and Critical Care, University of Texas Health Science Center at Tyler, Tyler, TX, USA
| | - Stefano Aliberti
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Respiratory Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - James D Chalmers
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
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