Common Presentations of Nontuberculous Mycobacterial Infections

Hatzenbuehler, Lindsay A.; Starke, Jeffrey R.

doi:10.1097/inf.0000000000000170

Cited by 22 publications

(18 citation statements)

References 11 publications

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“…The common NTM species isolated in organ transplant recipients are the fast growers such as Mycobacterium fortuitum , Mycobacterium abscessus , and Mycobacterium chelonae . [6] They are more often associated with hematopoietic stem cell transplantation. Slow-growing NTM species such as Mycobacterium avium complex ( Mycobacterium avium , Mycobacterium intracellulare , Mycobacterium silvaticum , Mycobacterium hominissuis , and M. paratuberculosis ), Mycobacterium kansasii , Mycobacterium marinum , Mycobacterium ulcerans , and M. haemophilum are usually associated with solid organ transplants.…”

Section: Discussionmentioning

confidence: 99%

Nontubercular mycobacterial infection in a renal allograft recipient

Anandh

Jayanna

2017

Indian J Nephrol

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A 71-year-old male, a renal allograft recipient, presented to us with a history of fever and right palm swelling. He had a history of fever 7 years back when he was treated with antitubercular treatment (ATT). Three years back, he was diagnosed to have gout and he was started on allopurinol. He developed severe bone marrow toxicity and allopurinol was changed to febuxostat. On admission, routine investigations did not reveal any focus of infection. The fluid aspirate from the palm revealed acid-fast bacilli (AFB). He was started on ATT; however, he did not show significant improvement. Two months later, he developed multiple subcutaneous lesions, and the pus again came positive for AFB. Due to lack of improvement, the aspirate was sent for molecular diagnostic identification. The mycobacteria was identified as Mycobacterium haemophilum. His treatment was changed to rifampicin, clarithromycin, and ciprofloxacin. As he showed slow improvement, his immunosuppression was tapered slowly. At 7 months of therapy, he is clinically better and his lesions are healing. His renal functions stayed stable despite tapering of cyclosporine in a patient who is on rifampicin. This case, the first report of M. haemophilum infection in a kidney transplant recipient in India, illustrates the difficulty in diagnosing nontubercular mycobacterial infection in transplant recipients. It also emphasizes the dilemma in tapering immunosuppressive drugs in disseminated nontubercular mycobacterial infections where there are considerable interactions between ATT and immunosuppressives.

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Section: Discussionmentioning

confidence: 99%

Nontubercular mycobacterial infection in a renal allograft recipient

Anandh

Jayanna

2017

Indian J Nephrol

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“…NTM are a miscellaneous collection of acid-fast bacilli (AFB) that are widely spread in the environment (2, 4–6). More than 160 NTM species have been identified, but not all of them cause human disease (2, 6, 7). …”

Section: Environmental Sources Of Ntmmentioning

confidence: 99%

“…Slowly growing NTM require several weeks to grow and they include MAC, M. kansasii, M. marinum, M. ulcerans, M. xenopi, M. simiae, M. szulgi, M. genavense, M. gordonae, M. haemophilum , and M. malmoense in addition to many other species (2, 6, 7). MAC complex includes M avium, M. intracellulare, M. silvaticum, M. hominissius, M. paratuberculosis , and many others (2).…”

Section: Classification Of Ntm Speciesmentioning

confidence: 99%

“…Infections caused by NTM may present with (1) lymphadenopathy, (2) skin and soft tissue infections, (3) pulmonary disease, particularly in patients with underlying lung disease, or (4) disseminated disease, particularly in immunocompromised individuals (2, 5–7). Clinical manifestations and complications of NTM infections vary according to the species isolated and the site of involvement and they include fever, weight loss, abdominal pain, diarrhea, dyspnea, productive cough, chest pain, lymphadenopathy, hepatosplenomegaly, and infections involving CVCs, skin and soft tissues, genital tract, and central nervous system (6, 18, 37, 38).…”

Section: Clinical Aspects Of Ntm Infectionsmentioning

confidence: 99%

“…Disseminated NTM infections occur almost exclusively in immunocompromised hosts (6, 7, 18, 19). MAC is the most common NTM species associated with disseminated infections (6, 18, 19).…”

Section: Disseminated Ntm Infectionsmentioning

confidence: 99%

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Infections Caused by Non-Tuberculous Mycobacteria in Recipients of Hematopoietic Stem Cell Transplantation

2014

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Non-tuberculous mycobacteria (NTM) are acid-fast bacteria that are ubiquitous in the environment and can colonize soil, dust particles, water sources, and food supplies. They are divided into rapidly growing mycobacteria such as Mycobacterium fortuitum, Mycobacterium chelonae, and Mycobacterium abscessus as well as slowly growing species such as Mycobacterium avium, Mycobacterium kansasii, and Mycobacterium marinum. About 160 different species, which can cause community acquired and health care-associated infections, have been identified. NTM are becoming increasingly recognized in recipients of hematopoietic stem cell transplantation (HSCT) with incidence rates ranging between 0.4 and 10%. These infections are 50–600 times commoner in transplant recipients than in the general population and the time of onset ranges from day 31 to day 1055 post-transplant. They have been reported following various forms of HSCT. Several risk factors predispose to NTM infections in recipients of stem cell transplantation and these are related to the underlying medical condition and its treatment, the pre-transplant conditioning therapies as well as the transplant procedure and its complications. Clinically, NTM may present with: unexplained fever, lymphadenopathy, osteomyelitis, soft tissue and skin infections, central venous catheter infections, bacteremia, lung, and gastrointestinal tract involvement. However, disseminated infections are commonly encountered in severely immunocompromised individuals and bloodstream infections are almost always associated with catheter-related infections. It is usually difficult to differentiate colonization from true infection, thus, the threshold for starting therapy remains undetermined. Respiratory specimens such as sputum, pleural fluid, and bronchoalveolar lavage in addition to cultures of blood, bone, skin, and soft tissues are essential diagnostically. Susceptibility testing of mycobacterial isolates is a basic component of optimal care. Currently, there are no guidelines for the treatment of NTM infections in recipients of stem cell transplantation, but such infections have been successfully treated with surgical debridement, removal of infected or colonized indwelling intravascular devices, and administration of various combinations of antimicrobials. Monotherapy can be associated with development of drug resistance due to new genetic mutation. The accepted duration of treatment is 9 months in allogeneic stem cell transplantation and 6 months in autologous setting. Unfortunately, eradication of NTM infections may be impossible and their treatment is often complicated by adverse effects and interactions with other transplant-related medication.

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Mycobacterium abscessus Complex Infections in Children: A Review

Sabin

Ferrieri

Kline

2017

Curr Infect Dis Rep

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Purpose of Review Infections in children with Mycobacterium abscessus complex represent a particular challenge for clinicians. Increasing incidence of these infections worldwide has necessitated focused attention to improve both diagnostic as well as treatment modalities. Published medical literature was reviewed, with emphasis on material published in the past 5 years. Recent Findings Increasing availability of new diagnostic tools, such as matrix-assisted laser desorption ionization-time of flight mass spectrometry and custom PCRs, has provided unique insights into the subspecies within the complex and improved diagnostic certainty. Microbiological review of all recent isolates at the University of Minnesota Medical Center was also conducted, with description of the antimicrobial sensitivity patterns encountered in our center, and compared with those published from other centers in the recent literature. A discussion of conventional antimicrobial treatment regimens, alongside detailed description of the relevant antimicrobials, is derived from recent publications. Summary Antimicrobial therapy, combined with surgical intervention in some cases, remains the mainstay of pediatric care. Ongoing questions remain regarding the transmission mechanics, immunologic vulnerabilities exploited by these organisms in the host, and the optimal antimicrobial regimens necessary to enable a reliable cure. Updated treatment guidelines based on focused clinical studies in children and accounting especially for the immunocompromised children at greatest risk are very much needed.

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Common Presentations of Nontuberculous Mycobacterial Infections

Cited by 22 publications

References 11 publications

Nontubercular mycobacterial infection in a renal allograft recipient

Nontubercular mycobacterial infection in a renal allograft recipient

Infections Caused by Non-Tuberculous Mycobacteria in Recipients of Hematopoietic Stem Cell Transplantation

Mycobacterium abscessus Complex Infections in Children: A Review

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