Beyond antibiotics: recent developments in the diagnosis and management of nontuberculous mycobacterial infection

Gleeson, Laura E.; Waterer, Grant

doi:10.1183/20734735.0171-2021

Cited by 4 publications

(3 citation statements)

References 99 publications

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“…It is noteworthy that the resistance of M fortuitum strains varies geographically, and the choice of antibiotics should be based on local antimicrobial susceptibility data. A study by Zheng et al [13] has shown that in China, the resistance of M fortuitum strain is lower to moxifloxacin and amikacin, but significantly higher to macrolides, compared to that reported in the studies by Shahraki et al, and Gleeson et al [5,14] This might be related to the frequent use of macrolides by Chinese doctors to treat respiratory mycoplasma infections, leading to increased exposure to the drug. [15,16]…”

Section: Discussionmentioning

confidence: 99%

“…NTMs are opportunistic pathogen that can cause various infections, including skin and soft tissue infections, pulmonary infections, and disseminated infections in immunocompromised individuals. [1][2][3][4][5] Skin and soft tissue infections caused by NTMs often occur after surgery, trauma, or injection. [6] As a subgroup of NTMs, M fortuitum is characterized by its weak pathogenicity, non-toxin production, high tolerance and rapid growth compared to other NTM members.…”

Section: Introductionmentioning

confidence: 99%

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A case report of Mycobacterium fortuitum infection after muscle injection

Li,

Zhang

2023

Medicine

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Rationale: Injection-related abscesses are a common complication in clinical practice, but the identification of infected bacteria might be difficult. Patient concerns: A 51-year-old female patient was admitted to the hospital due to a lump on her right buttock that emerged after receiving intramuscular injections to treat left shoulder joint pain. The lump gradually enlarged into a 3.0 to 4.5 cm mass at the time of admission with symptoms such as skin redness, itching, and pain. Diagnoses: The patient received ultrasonic and other laboratory examinations. Laboratory results from the drainage indicated that the infection was caused by a rapidly growing mycobacteria and was confirmed as Mycobacterium fortuitum by matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry. Interventions: The patient was treated with antibiotics for 12 days after incision and drainage of the abscess in the right buttock. Local dressings were changed regularly. A migration lesion that appeared 3 days after treatment was drained and cleaned when it matured. Outcomes: The lesion substantially decreased in size and the patient was discharged after 2 months of treatment. Lessons: Rapidly growing mycobacteria are rare but important pathogens that should be considered in patients with injection-related abscesses. Early identification and appropriate treatment can result in a favorable prognosis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A case report of Mycobacterium fortuitum infection after muscle injection

Li,

Zhang

2023

Medicine

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“…Treatment often involves harsh and protracted effects, potentially leading to patient discontinuation or non-adherence [57]. On average, culture conversion (two consecutive pathogen free sputum cultures) rates hover around 60-70%, with recurrence rates reaching 50% [58]. Hence, it is imperative to optimize treatment strategies and explore novel, effective, and well-tolerated medications [59].…”

Section: Nontuberculous Mycobacteria: Environmentally Versatile Oppor...mentioning

confidence: 99%

Drinking Water Microbiota, Entero-Mammary Pathways and Breast Cancer: Focus on Nontuberculous Mycobacteria

Maranha,

Alarico,

Nunes-Costa

et al. 2024

Preprint

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The prospect of drinking water serving as a conduit for gut bacteria, artificially selected by disinfection strategies and lack of monitoring at the point of use, is concerning. Certain opportunistic pathogens, notably some nontuberculous mycobacteria (NTM), often exceed coliform bacteria levels in drinking water, posing safety risks. NTM and other microbiota resist chlorination and thrive in plumbing systems. When inhaled, opportunistic NTM can infect the lungs of immunocompromised or chronically ill patients, and the elderly, primarily postmenopausal women. When ingested with drinking water, NTM often survive stomach acidity, reach the intestines, migrate to other organs using immune cells as vehicles, potentially colonizing tumor tissue, including in breast cancer. The link between the microbiome and cancer is not new, yet the recognition of intratumoral microbiomes is a recent development. Breast cancer risk rises with age, and NTM infections emerged as a concern among breast cancer patients. In addition to studies hinting at a potential association between chronic NTM infections and lung cancer, NTM have also been detected in breast tumors at levels higher than normal adjacent tissue. Evaluating the risks of continued ingestion of contaminated drinking water is paramount, especially given the ability of various bacteria to migrate from the gut to breast tissue via entero-mammary pathways. This underscores a pressing need to revise water safety monitoring guidelines and delve into hormonal factors, which includes addressing the disproportionate impact of NTM infections and breast cancer on women and examining the potential health risks posed by the cryptic and unchecked microbiota from drinking water.

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Growing from common ground: nontuberculous mycobacteria and bronchiectasis

Van Braeckel,

Bosteels

2024

Eur Respir Rev

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Bronchiectasis and nontuberculous mycobacteria (NTM) are intricately intertwined, with NTM capable of being both a cause and consequence of bronchiectatic disease. This narrative review focuses on the common ground of bronchiectasis and NTM pulmonary disease (NTM-PD) in terms of diagnostic approach, underlying risk factors and treatment strategies. NTM-PD diagnosis relies on a combination of clinical, radiological and microbiological criteria. Although their epidemiology is complicated by detection and reporting biases, the prevalence and pathogenicity of NTM species vary geographically, withMycobacterium aviumcomplex andMycobacterium abscessussubspecies most frequently isolated in bronchiectasis-associated NTM-PD. Diagnosis of nodular bronchiectatic NTM-PD should prompt investigation of host factors, including disorders of mucociliary clearance, connective tissue diseases and immunodeficiencies, either genetic or acquired. Treatment of NTM-PD in bronchiectasis involves a multidisciplinary approach and considers the (sub)species involved, disease severity and comorbidities. Current guideline-based antimicrobial treatment of NTM-PD is considered long, cumbersome and unsatisfying in terms of outcomes. Novel treatment regimens and strategies are being explored, including rifampicin-free regimens and inclusion of clofazimine and inhaled antibiotics. Host-directed therapies, such as immunomodulators and cytokine-based therapies, might enhance antimycobacterial immune responses. Optimising supportive care, as well as pathogen- and host-directed strategies, is crucial, highlighting the need for personalised approaches tailored to individual patient needs. Further research is warranted to elucidate the complex interplay between host and mycobacterial factors, informing more effective management strategies.

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Beyond antibiotics: recent developments in the diagnosis and management of nontuberculous mycobacterial infection

Cited by 4 publications

References 99 publications

A case report of Mycobacterium fortuitum infection after muscle injection

A case report of Mycobacterium fortuitum infection after muscle injection

Drinking Water Microbiota, Entero-Mammary Pathways and Breast Cancer: Focus on Nontuberculous Mycobacteria

Growing from common ground: nontuberculous mycobacteria and bronchiectasis

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