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El Zein S, Mendoza MA, Wilson JW. Nontuberculous mycobacterial infections in patients with hematologic malignancies and recipients of hematopoietic stem cell transplantation. Transpl Infect Dis 2023; 25 Suppl 1:e14127. [PMID: 37594211 DOI: 10.1111/tid.14127] [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: 05/09/2023] [Revised: 07/17/2023] [Accepted: 08/08/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND The incidence of mycobacterial infections in patients with hematologic malignancies and hematopoietic stem cell transplant (HSCT) recipients is increasing, contributing to significant mortality and morbidity. This review explores the epidemiology, risk factors, clinical presentation, diagnosis, and treatment of nontuberculous mycobacteria (NTM) in this population. METHODS A literature search was performed using PubMed with keywords and MeSH terms pertaining to the topics of nontuberculous mycobacteria, hematologic malignancies, hematopoietic stem cell transplant, cellular therapies, chimeric antigen therapies, epidemiology, diagnosis, and treatment. Additionally, we examined the reference lists of the included articles to identify other pertinent studies. RESULTS Diagnosing mycobacterial disease among patients with hematologic disease and treatment-associated immunosuppressive conditions is challenging due to the lack of distinctive clinical, radiographic, and laboratory markers, as well as the atypical manifestations compared to immunocompetent patients. Treatment involves using a combination of antibiotics for extended durations, coupled with strategies to achieve source control and reduce immunosuppression when feasible. This is complicated by the absence of clear data correlating in-vitro drug susceptibility and clinical outcome for many antimicrobials use to treat NTM, adverse drug-drug interactions, and the frequent challenges related to poor medication tolerability and toxicities. CONCLUSION The rising incidence and corresponding clinical challenges of mycobacterial infections in this unique patient population necessitate a heightened awareness and familiarity of NTM disease by clinicians to achieve timely diagnosis and favorable treatment outcomes.
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Affiliation(s)
- Said El Zein
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Maria A Mendoza
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - John W Wilson
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
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Ali J. A multidisciplinary approach to the management of nontuberculous mycobacterial lung disease: a clinical perspective. Expert Rev Respir Med 2021; 15:663-673. [PMID: 33593217 DOI: 10.1080/17476348.2021.1887734] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Management of nontuberculous mycobacterial lung disease (NTM-LD) can be encumbered by difficult diagnostic criteria and complex treatment decisions. As prevalence of this debilitating, often refractory, progressive lung disease increases globally, management must evolve beyond antimicrobials to encompass holistic and customized treatments coordinated by practitioners across various specialties. AREAS COVERED This review aims to complement the recently updated NTM-LD treatment guidelines and expand current approaches to diagnosis, treatment, and disease management in a multidisciplinary dimension. The foundation of effective long-term management of NTM-LD is awareness of diagnostic criteria, individual patient risk factors, and the importance of managing underlying pulmonary and nonpulmonary comorbidities. The value of adopting all available pharmacological and nonpharmacological treatment modalities with a patient-centered approach to address the needs of long-term patient care cannot be minimized. EXPERT OPINION This section, while acknowledging the limited advances in understanding of NTM-LD and the availability of newer diagnostic and therapeutic tools over the last decade, underscores the need for a programmatic approach to this chronic, debilitating pulmonary infection. This will not only lead to more comprehensive patient care with better outcomes, but will also inspire and activate robust networks of research and public health initiatives in this field.
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Affiliation(s)
- Juzar Ali
- Section of Pulmonary/Critical Care Medicine & Allergy/Immunology, NTM-Bronchiectasis Program & Registry, University Medical Center, New Orleans, Louisiana State University Health Sciences Center, New Orleans, LA, USA
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Yamada A, Akahane D, Katagiri S, Yoshizawa S, Furuya N, Fujimoto H, Gotoh M, Gotoh A. Successful cord blood transplantation for myelodysplastic syndrome complicated by Mycobacterium kansasii pneumonia. Transpl Infect Dis 2020; 23:e13463. [PMID: 32918515 DOI: 10.1111/tid.13463] [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: 04/12/2020] [Revised: 08/24/2020] [Accepted: 08/28/2020] [Indexed: 11/29/2022]
Abstract
Non-tuberculous mycobacterial (NTM) disease is a rare cause of neutropenic fever in patients with hematological malignancies. There are few studies on the optimal management for such patients with NTM. We report a case of myelodysplastic syndrome (MDS) treated by umbilical cord blood transplantation (CBT) after Mycobacterium kansasii (M kansasii) pneumonia. A 38-year-old man diagnosed with MDS developed severe pneumonia during induction chemotherapy. Repeated sputum culture uncovered mycobacterium infection. Then, by the polymerase chain reaction of the bronchial lavage fluid, M kansasii infection was proven. After 140 days of anti-NTM therapy, CBT was successfully carried out and the patient recovered without recurrence of NTM infection. This case provides valuable evidence that hematopoietic stem cell transplantation is feasible after a reliable diagnosis and continuous anti-NTM therapy.
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Affiliation(s)
- Arisa Yamada
- Department of Hematology, Tokyo Medical University, Tokyo, Japan
| | - Daigo Akahane
- Department of Hematology, Tokyo Medical University, Tokyo, Japan
| | | | | | - Nahoko Furuya
- Department of Hematology, Tokyo Medical University, Tokyo, Japan
| | - Hiroaki Fujimoto
- Department of Hematology, Tokyo Medical University, Tokyo, Japan
| | - Moritaka Gotoh
- Department of Hematology, Tokyo Medical University, Tokyo, Japan
| | - Akihiko Gotoh
- Department of Hematology, Tokyo Medical University, Tokyo, Japan
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Machado E, Vasconcellos SEG, Cerdeira C, Gomes LL, Junqueira R, Carvalho LDD, Ramos JP, Redner P, Campos CED, Caldas PCDS, Gomes APCS, Goldenberg T, Montes FF, Mello FCDQ, Mussi VDO, Lasunskaia E, Soolingen DV, Miranda ABD, Rigouts L, Jong BCD, Meehan CJ, Catanho M, Suffys PN. Whole genome sequence of Mycobacterium kansasii isolates of the genotype 1 from Brazilian patients with pulmonary disease demonstrates considerable heterogeneity. Mem Inst Oswaldo Cruz 2018; 113:e180085. [PMID: 29947722 PMCID: PMC6012682 DOI: 10.1590/0074-02760180085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 06/05/2018] [Indexed: 11/02/2022] Open
Abstract
Mycobacterium kansasii is an opportunistic pathogen and one of the most commonly encountered species in individuals with lung disease. We here report the complete genome sequence of 12 clinical isolates of M. kansasii from patients with pulmonary disease in Brazil.
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Affiliation(s)
- Edson Machado
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Genômica Funcional e Bioinformática, Rio de Janeiro, RJ, Brasil
| | - Sidra Ezidio Gonçalves Vasconcellos
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Biologia Molecular Aplicada a Micobactérias, Rio de Janeiro, RJ, Brasil
| | - Camillo Cerdeira
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Genômica Funcional e Bioinformática, Rio de Janeiro, RJ, Brasil.,Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Biologia Computacional e Sistemas, Rio de Janeiro, RJ, Brasil
| | - Lia Lima Gomes
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Biologia Molecular Aplicada a Micobactérias, Rio de Janeiro, RJ, Brasil
| | - Ricardo Junqueira
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Biologia Computacional e Sistemas, Rio de Janeiro, RJ, Brasil
| | - Luciana Distasio de Carvalho
- Fundação Oswaldo Cruz-Fiocruz, Escola Nacional de Saúde Pública, Centro de Referência Professor Hélio Fraga, Laboratório de Referência Nacional para Tuberculose, Rio de Janeiro, RJ, Brasil
| | - Jesus Pais Ramos
- Fundação Oswaldo Cruz-Fiocruz, Escola Nacional de Saúde Pública, Centro de Referência Professor Hélio Fraga, Laboratório de Referência Nacional para Tuberculose, Rio de Janeiro, RJ, Brasil
| | - Paulo Redner
- Fundação Oswaldo Cruz-Fiocruz, Escola Nacional de Saúde Pública, Centro de Referência Professor Hélio Fraga, Laboratório de Referência Nacional para Tuberculose, Rio de Janeiro, RJ, Brasil
| | - Carlos Eduardo Dias Campos
- Fundação Oswaldo Cruz-Fiocruz, Escola Nacional de Saúde Pública, Centro de Referência Professor Hélio Fraga, Laboratório de Referência Nacional para Tuberculose, Rio de Janeiro, RJ, Brasil
| | - Paulo Cesar de Souza Caldas
- Fundação Oswaldo Cruz-Fiocruz, Escola Nacional de Saúde Pública, Centro de Referência Professor Hélio Fraga, Laboratório de Referência Nacional para Tuberculose, Rio de Janeiro, RJ, Brasil
| | - Ana Paula Chaves Sobral Gomes
- Fundação Oswaldo Cruz-Fiocruz, Escola Nacional de Saúde Pública, Centro de Referência Professor Hélio Fraga, Laboratório de Referência Nacional para Tuberculose, Rio de Janeiro, RJ, Brasil
| | - Telma Goldenberg
- Fundação Oswaldo Cruz-Fiocruz, Escola Nacional de Saúde Pública, Centro de Referência Professor Hélio Fraga, Laboratório de Referência Nacional para Tuberculose, Rio de Janeiro, RJ, Brasil
| | - Fatima Fandinho Montes
- Fundação Oswaldo Cruz-Fiocruz, Escola Nacional de Saúde Pública, Centro de Referência Professor Hélio Fraga, Laboratório de Referência Nacional para Tuberculose, Rio de Janeiro, RJ, Brasil
| | | | - Vinicius de Oliveira Mussi
- Universidade Estadual do Norte Fluminense Darcy Ribeiro, Laboratório de Biologia do Reconhecer, Campos dos Goytacazes, RJ, Brasil
| | - Elena Lasunskaia
- Universidade Estadual do Norte Fluminense Darcy Ribeiro, Laboratório de Biologia do Reconhecer, Campos dos Goytacazes, RJ, Brasil
| | - Dick van Soolingen
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Antonio Basílio de Miranda
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Biologia Computacional e Sistemas, Rio de Janeiro, RJ, Brasil
| | - Leen Rigouts
- Institute of Tropical Medicine, Unit of Mycobacteriology, Antwerp, Belgium
| | - Bouke C de Jong
- Institute of Tropical Medicine, Unit of Mycobacteriology, Antwerp, Belgium
| | - Conor J Meehan
- Institute of Tropical Medicine, Unit of Mycobacteriology, Antwerp, Belgium
| | - Marcos Catanho
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Genômica Funcional e Bioinformática, Rio de Janeiro, RJ, Brasil
| | - Philip N Suffys
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Biologia Molecular Aplicada a Micobactérias, Rio de Janeiro, RJ, Brasil.,Institute of Tropical Medicine, Unit of Mycobacteriology, Antwerp, Belgium
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