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Pennington KM, Vu A, Challener D, Rivera CG, Shweta FNU, Zeuli JD, Temesgen Z. Approach to the diagnosis and treatment of non-tuberculous mycobacterial disease. J Clin Tuberc Other Mycobact Dis 2021; 24:100244. [PMID: 34036184 PMCID: PMC8135042 DOI: 10.1016/j.jctube.2021.100244] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
Non-tuberculous mycobacteria (NTM) is a collective name given to a group of more than 190 species of Mycobacterium. The clinical presentation for most NTM infections is non-specific, often resulting in delayed diagnosis. Further complicating matters is that NTM organisms can be difficult to isolate. Medications used to treat NTM infection can be difficult for patients to tolerate, and prolonged courses of anti-mycobacterial therapy are often required for adequate suppression or eradication. Herein, we review different NTM syndromes, appropriate diagnostic tests, and treatment regimens.
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Key Words
- ADR, adverse drug reactions
- AFB, acid fast bacilli
- AST, antimicrobial-susceptibility testing
- ATS, American Thoracic Society
- BCG, Bacille Calmette-Guerin
- CLSI, Clinical and Laboratory Standards Institute
- COPD, chronic obstructive pulmonary disease
- ECG, electrocardiogram
- EMB, ethambutol
- Erm, erythromycin ribosomal methylase
- FDA, Food and Drug Administration
- HIV, human immunodeficiency virus
- HRCT, high resolution computed tomography
- IDSA, Infectious Disease Society of America
- INF-γ, interferon- γ
- INH, isoniazid
- MAC, Mycobacterium avium complex
- MALDI-TOF, matrix-assisted laser desorption ionization time-of-flight mass spectrometry
- MGIT, mycobacteria growth indicator tube
- MIC, minimum inhibitory concentrations
- Mycobacterium abscessus
- Mycobacterium avium
- NTM, non-tuberculous mycobacteria
- Non-tuberculous mycobacteria
- PCR, polymerase chain reaction
- PFT, pulmonary function test
- TB, tuberculosis
- TDM, therapeutic drug monitoring
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Affiliation(s)
- Kelly M Pennington
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic Rochester, MN, USA
| | - Ann Vu
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic Rochester, MN, USA
| | - Douglas Challener
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic Rochester, MN, USA
| | | | - F N U Shweta
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic Rochester, MN, USA
| | - John D Zeuli
- Department of Pharmacy, Mayo Clinic Rochester, MN, USA
| | - Zelalem Temesgen
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic Rochester, MN, USA
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Clinical significance of Mycobacterium fortuitum isolated from respiratory specimens. Respir Med 2007; 102:437-42. [PMID: 17997087 DOI: 10.1016/j.rmed.2007.10.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2007] [Revised: 08/18/2007] [Accepted: 10/05/2007] [Indexed: 11/23/2022]
Abstract
BACKGROUND Although Mycobacterium fortuitum is not an uncommon organism among the non-tuberculous mycobacteria isolated from respiratory specimens, its clinical significance had not been well studied. METHODS We identified all patients whose respiratory specimens were positive for M. fortuitum between January 2003 and December 2005. Among 182 patients whose specimens were positive for M. fortuitum, 26 were positive at least twice. We retrospectively reviewed their characteristics, and clinical courses. RESULTS Of the 26 patients, 15 had two positive culture results for M. fortuitum; the other 11 had three or more. Sixteen patients were male and the median age was 61.5 years. Major presenting symptoms were cough (65%) and sputum (58%). Most patients had known underlying lung diseases, including prior tuberculosis (54%), lung cancer (15%), idiopathic pulmonary fibrosis (15%), and other mycobacterial lung disease (15%). The most common CT findings were bronchiectasis (80%). Only one patient received specific prolonged antibiotic therapy against M. fortuitum infection; the other 25 did not. No patients showed clinical aggravation during the follow-up period, although in five patients their underlying lung diseases continued to progress. The median follow-up duration was 12.5 months and none of the patients whose sputum specimens were available had persistent positive cultures for M. fortuitum. CONCLUSION M. fortuitum usually causes colonization or transient infection in patients with underlying lung disease, such as prior tuberculosis or bronchiectasis. The majority of patients may not need to receive prolonged antibiotic therapy for M. fortuitum isolates.
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Mukhopadhya A, Samal SC, Mukundan U, Patra S, Moses BV, Chacko A. Perianal fistulae caused by Mycobacterium fortuitum. J Clin Gastroenterol 2003; 36:147-8. [PMID: 12544199 DOI: 10.1097/00004836-200302000-00012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Mycobacterium fortuitum is a rapidly growing Mycobacterium , which usually colonizes the soil, dust and water. It commonly causes skin and soft tissue infections especially in patients who have preceding trauma. We report a case of perianal fistulae caused by M. fortuitum.
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Affiliation(s)
- Ashis Mukhopadhya
- Department of GI Sciences, Christian Medical College & Hospital, Vellore, Tamil Nadu, India.
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Brown-Elliott BA, Wallace RJ. Clinical and taxonomic status of pathogenic nonpigmented or late-pigmenting rapidly growing mycobacteria. Clin Microbiol Rev 2002; 15:716-46. [PMID: 12364376 PMCID: PMC126856 DOI: 10.1128/cmr.15.4.716-746.2002] [Citation(s) in RCA: 600] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The history, taxonomy, geographic distribution, clinical disease, and therapy of the pathogenic nonpigmented or late-pigmenting rapidly growing mycobacteria (RGM) are reviewed. Community-acquired disease and health care-associated disease are highlighted for each species. The latter grouping includes health care-associated outbreaks and pseudo-outbreaks as well as sporadic disease cases. Treatment recommendations for each species and type of disease are also described. Special emphasis is on the Mycobacterium fortuitum group, including M. fortuitum, M. peregrinum, and the unnamed third biovariant complex with its recent taxonomic changes and newly recognized species (including M. septicum, M. mageritense, and proposed species M. houstonense and M. bonickei). The clinical and taxonomic status of M. chelonae, M. abscessus, and M. mucogenicum is also detailed, along with that of the closely related new species, M. immunogenum. Additionally, newly recognized species, M. wolinskyi and M. goodii, as well as M. smegmatis sensu stricto, are included in a discussion of the M. smegmatis group. Laboratory diagnosis of RGM using phenotypic methods such as biochemical testing and high-performance liquid chromatography and molecular methods of diagnosis are also discussed. The latter includes PCR-restriction fragment length polymorphism analysis, hybridization, ribotyping, and sequence analysis. Susceptibility testing and antibiotic susceptibility patterns of the RGM are also annotated, along with the current recommendations from the National Committee for Clinical Laboratory Standards (NCCLS) for mycobacterial susceptibility testing.
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Ainsworth DM, Erb HN, Eicker SW, Yeagar AE, Viel L, Sweeney CR, Lavoie JP. Effects of pulmonary abscesses on racing performance of horses treated at referral veterinary medical teaching hospitals: 45 cases (1985-1997). J Am Vet Med Assoc 2000; 216:1282-7. [PMID: 10767971 DOI: 10.2460/javma.2000.216.1282] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine whether results of physical or radiographic examination or biochemical analyses in adult racehorses with primary lung abscesses were associated with ability to race following treatment. DESIGN Multiple-center retrospective study. ANIMALS 25 Standardbreds and 20 Thoroughbreds. PROCEDURE Medical records of horses with a primary lung abscess that were admitted to any of 4 veterinary teaching hospitals were reviewed. Results of physical examination, laboratory testing, and thoracic radiography were reviewed. Racing performance after treatment was compared with performance before illness and with performance of the general population of racehorses of similar age, sex, and breed. RESULTS 23 of 25 Standardbreds and 13 of 20 Thoroughbreds raced after diagnosis and treatment of a lung abscess. Most horses had a solitary abscess in the dorsal to caudodorsal lung fields. Results of initial physical examination, biochemical analyses, and culture and identification of the microbial isolate were not associated with whether a horse returned to racing. For horses that had raced prior to the illness, race performance after treatment of the lung abscess was not significantly different from performance before the illness. CONCLUSIONS AND CLINICAL RELEVANCE On the basis of racing performance in those horses that resumed racing after treatment, long-term residual lung damage did not develop in horses with primary lung abscesses that were treated appropriately. It is not known whether horses that recovered would be more likely to bleed from the site of a prior infection when resuming strenuous exercise and whether lung abscesses contributed to a failure to resume racing.
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Affiliation(s)
- D M Ainsworth
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA
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Svahn A, Hoffner SE, Petrini B, Källenius G. Mycobacterium fortuitum complex in Sweden during an 11-year period. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 1998; 29:573-7. [PMID: 9571737 DOI: 10.3109/00365549709035897] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Records of patients have been retrospectively examined studied during an 11-y period, from whom Mycobacterium fortuitum or M. chelonae was isolated in Sweden. Respiratory isolates were obtained from 71 patients. Clinical information was accessible in 52, chest X-ray was pathological in 51, and 42 had underlying diseases. Four skin and 4 urine isolates were observed. Two cases of osteitis and 2 bone marrow isolates of M. chelonae were found. One girl had a submandibular lymph node abscess with M. fortuitum. Of 2 HIV patients, 1 had positive blood cultures with M. fortuitum and the other positive sputum culture with M. chelonae. The broad spectrum of infections with M. fortuitum complex necessitates an integrated judgement of clinical and bacteriological data to determine the relevance of such isolates.
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Affiliation(s)
- A Svahn
- Swedish Institute for Infectious Disease Control, Karolinska Institute and Hospital, Stockholm, Sweden
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Nziramasanga P, Shah P, Stille W. Intracellular Antimycobacterial Activity of Ciprofloxacin and Ofloxacin in Mycobacterium Fortuitum Infected Human Polymorphonuclear Leucocytes. Int J Immunopathol Pharmacol 1995. [DOI: 10.1177/039463209500800307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The broadspectrum quinolone antibiotics ciprofloxacin and ofloxacin were tested for activity against the atypical mycobacterium M.fortuitum. In vitro minimal inhibitory concentrations (MIC) were done in Brain Heart Infusion broth and intracellular determinations in Medium 199 cell culture medium. The PMNs with intracellular bacteria and controls with or without drugs were incubated for six hours at 37°C. Hourly, 0.1 ml aliquotes were taken for colony forming units (cfu) assays. In vitro and intracellular MIC's for ciprofloxacin were 0.125mg/l and 0.625 mg/l respectively, while for ofloxacin they were 0.2mg/l and 0.4 mg/l, respectively.
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Affiliation(s)
- P. Nziramasanga
- Infektiologie, Zentrum der Innere Medizin, Klinikum der J.W. Goethe, Universitaet, Theodor Stern - Kai 7, 60596 Frankfurt am Main, Germany
| | - P.M. Shah
- Infektiologie, Zentrum der Innere Medizin, Klinikum der J.W. Goethe, Universitaet, Theodor Stern - Kai 7, 60596 Frankfurt am Main, Germany
| | - W. Stille
- Infektiologie, Zentrum der Innere Medizin, Klinikum der J.W. Goethe, Universitaet, Theodor Stern - Kai 7, 60596 Frankfurt am Main, Germany
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Chapnick EK. Non-tuberculous mycobacterial infections. Tuberculosis (Edinb) 1995. [DOI: 10.1007/978-1-4899-2869-6_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Barber PG, Goldman WM, Avicolli AJS, Smith R, Rairden N, Maragni O, Chirico J, Mangone C. Antitubercular drugs. Tuberculosis (Edinb) 1995. [DOI: 10.1007/978-1-4899-2869-6_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Griffith DE, Girard WM, Wallace RJ. Clinical features of pulmonary disease caused by rapidly growing mycobacteria. An analysis of 154 patients. THE AMERICAN REVIEW OF RESPIRATORY DISEASE 1993; 147:1271-8. [PMID: 8484642 DOI: 10.1164/ajrccm/147.5.1271] [Citation(s) in RCA: 357] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The role of rapidly growing mycobacteria (RGM) as pulmonary pathogens has been unclear. We identified 154 cases of lung disease caused by RGM using the microbiologic and radiographic criteria of the American Thoracic Society (ATS) and availability of the causative organism for study. More than one third of patients had positive lung biopsy cultures. Patients were predominantly white (83%), female (65%) nonsmokers (66%), and they had prolonged periods from onset of symptoms to diagnosis of their disease. Cough was an almost universal presenting symptom, whereas constitutional symptoms became more important with progression of disease. Upper lobe infiltrates were most common (88%), with 77% of patients developing bilateral disease. Cavitation was present in only 16% of the patients. Specific underlying diseases were infrequent, but they included previously treated mycobacterial disease (18%), coexistent Mycobacterium avium complex (8%), cystic fibrosis (6%), and gastroesophageal disorders with chronic vomiting (6%). The majority of isolates (82%) were M. abscessus (formerly M. chelonae subsp. abscessus). Effective treatment for M. fortuitum long disease was accomplished with drug therapy, whereas surgical resection of localized disease was the only effective long-term therapy for M. abscessus. Although the disease was generally slowly progressive, 21 of 154 (14%) patients died as a consequence of progressive RGM lung disease and respiratory failure. RGM should be recognized as a cause of chronic mycobacterial lung disease, and respiratory isolates should be assessed carefully.
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Affiliation(s)
- D E Griffith
- Department of Medicine, University of Texas Health Center, Tyler 75710
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Affiliation(s)
- W T Miller
- Department of Radiology, University of Pennsylvania Medical Center, Philadelphia 19104
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