Empfehlungen zur Diagnostik und Therapie nichttuberkulöser Mykobakteriosen des Deutschen Zentralkomitees zur Bekämpfung der Tuberkulose (DZK) und der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin (DGP)

Schönfeld, Nicolas; Haas, Walter; Richter, Elvira; Bauer, TT; Bös, Lena; Castell, Stefanie; Hauer, Barbara; Magdorf, K.; Matthiessen, W; Mauch, H.; Reuß, Annicka; Rüsch-Gerdes, Sabine; Zabel, P.; Dalhoff, K; Schaberg, T.; Loddenkemper, R.

doi:10.1055/s-0033-1344790

Cited by 45 publications

(30 citation statements)

References 47 publications

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“…While the American Clinical and Laboratory Standards Institute (CLSI) provides clear guidelines as to when and how to use AST of NTM and how to interpret minimal inhibitory concentrations, British guidelines do not mention AST, the European Committee on Antimicrobial Susceptibility Testing (EUCAST) provides breakpoints only for 2 antimycobacterial drugs (delamanid and bedaquiline) which are not recommended for the treatment of NTM-PD at present, and German guidelines advise caution with reference to missing evidence for the clinical relevance of AST results from large cohorts [76,84,95,96,97]. Following CLSI standards, evidence of in vitro susceptibility and clinical outcome is satisfactory for MAC, M. kansasii , M. marinum , and M. abscessus subsp.…”

Section: Diagnosismentioning

confidence: 99%

Pulmonary Disease Caused by Non-Tuberculous Mycobacteria

Wassilew¹,

Hoffmann²,

Andréjak³

et al. 2016

Respiration

125

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Non-tuberculous mycobacteria (NTM) include more than 160 ubiquitous, environmental, acid-fast-staining bacterial species, some of which may cause disease in humans. Chronic pulmonary infection is the most common clinical manifestation. Although patients suffering from chronic lung diseases are particularly susceptible to NTM pulmonary disease, many affected patients have no apparent risk factors. Host and pathogen factors leading to NTM pulmonary disease are not well understood and preventive therapies are lacking. NTM isolation and pulmonary disease are reported to rise in frequency in Europe as well as in other parts of the world. Differentiation between contamination, infection, and disease remains challenging. Treatment of NTM pulmonary disease is arduous, lengthy, and costly. Correlations between results of in vitro antibiotic susceptibility testing and clinical treatment outcomes are only evident for the Mycobacterium avium complex, M. kansasii, and some rapidly growing mycobacteria. We describe the epidemiology of NTM pulmonary disease as well as emerging NTM pathogens and their geographical distribution in non-cystic fibrosis patients in Europe. We also review recent innovations for the diagnosis of NTM pulmonary disease, summarize treatment recommendations, and identify future research priorities to improve the management of patients affected by NTM pulmonary disease.

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Section: Diagnosismentioning

confidence: 99%

Pulmonary Disease Caused by Non-Tuberculous Mycobacteria

Wassilew¹,

Hoffmann²,

Andréjak³

et al. 2016

Respiration

125

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“…In adults, the disease mostly affects the lung, and preexisting lung diseases (i.e., cOPD, Asthma, smoking), immunodeficiency syndromes (i.e., HIV infection, post-transplantation, malignant tumors), and a genetic predisposition are discussed as probable causes for this disease [7]. In immunocompetent children, improved diagnostic tools of tissues seem also lead to an increased number of AM cases [8,9].…”

Section: Discussionmentioning

confidence: 99%

Atypical mycobacteriosis in children: a diagnostic and therapeutic challenge

Deichmueller

Emmanouil

Welkoborsky

2014

Eur Arch Otorhinolaryngol

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Atypical mycobacteriosis (AM) is a rare disease, which is caused by an infection with mycobacteria other than tuberculosis (MOTT). In children, the cervical lymph nodes are frequently affected. MOTT are a pathogen or facultative pathogen environmental germs, which can affect otherwise healthy individuals. The diagnostic and therapeutic management is often challenging. Currently, there are only few data published about the systematic investigation and therapy of children with AM. In a retrospective study, 29 children with AM were evaluated. The clinical records of these patients were reviewed and analyzed along with the results of histopathological and microbiological findings. The clinical parameters were correlated to patients' therapy and clinical follow-up. 29 otherwise healthy and immunocompetent children (18 girls, 11 boys, average age of 3.5 years, range 1.5-9.5 years) with AM of the head and neck region have been evaluated. Clinically, all patients were admitted with a swelling of cervical lymph nodes and discoloration of the overlaying skin. In five patients, an abscess formation of the lymph nodes occurred. Ultrasound examinations typically revealed a hypoechoic mass with central necrosis and intralesional septa. Histologically, epithelioid granuloma with caseating necrosis was described in any case. Germ identification by either microbiological culture or PCR was successful in 20 cases, with Mycobacterium avium and Mycobacterium intercellulare being the most frequent germs. In all patients, lymph nodes were surgically removed. In a clinical follow-up of at least 18 months, a recurrence occurred in five cases. Diagnosis of atypical mycobacteriosis is often difficult and challenging, since clinical appearance is unspecific and MOTT can only be identified microbiologically or by PCR in about two-thirds of cases. Therefore, a close cooperation between clinician, pathologist, and microbiologist is required. Therapeutically excision of all affected lymph nodes is recommended. Alternative or concomitant medical treatment with tuberculostatics is indicated in particular cases, i.e., recurrence, persistence or systemically lymph node involvement.

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“…Der Krankheitswert wurde anhand der ATS-Kriterien von 2007 sowie der aktuellen DZK/DGP-Empfehlungen von 2013 bemessen [6,20] Orginalarbeit 529…”

Section: Materials Und Methodenunclassified