Management of Nontuberculous Mycobacterial (NTM) Lung Disease

Philley, Julie V.; Griffith, David E.

doi:10.1055/s-0033-1333575

Cited by 31 publications

(22 citation statements)

References 51 publications

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“…CAM resistance has also been reported to be a poor prognostic factor for MAC pulmonary disease. [33] Although recent studies revealed various mechanisms of resistance in NTM, the relationship between in vitro antibiotic susceptibility testing and treatment outcome in a clinical setting has not been established. [34] Since CAM resistance may have been associated with mortality rate in the present study, further investigations, including microbiological studies, are required.…”

Section: Discussionmentioning

confidence: 99%

Pneumothorax associated with nontuberculous mycobacteria

et al. 2016

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The incidence of nontuberculous mycobacterial pulmonary disease (NTMPD) is increasing worldwide. Secondary spontaneous pneumothorax occurs as a complication of underlying lung disease and is associated with higher morbidity, mortality, and recurrence than primary spontaneous pneumothorax. We here investigated the clinical features and long-term outcomes of pneumothorax associated with NTMPD.We conducted a retrospective study on consecutive adult patients with pneumothorax associated with NTMPD at Fukujuji Hospital and Keio University Hospital from January 1992 to December 2013. We reviewed the medical records of 69 such patients to obtain clinical characteristics, radiological findings, and long-term outcomes, including pneumothorax recurrence and mortality.The median age of the patients was 68 years; 34 patients were women. The median body mass index was 16.8 kg/m2. Underlying pulmonary diseases mainly included chronic obstructive pulmonary disease and pulmonary tuberculosis. On computed tomography, nodules and bronchiectasis were observed in 46 (98%) and 45 (96%) patients, respectively. Consolidation, pleural thickening, interlobular septal thickening, and cavities were most common, and observed in 40 (85%), 40 (85%), 37 (79%), and 36 (77%) patients, respectively. Regarding pneumothorax treatment outcomes, complete and incomplete lung expansion were observed in 49 patients (71%) and 15 patients (22%), respectively. The survival rate after pneumothorax was 48% at 5 years. By the end of the follow-up, 33 patients had died, and the median survival was 4.4 years with a median follow-up period of 1.7 years. The rate of absence of recurrence after the first pneumothorax was 59% at 3 years. By the end of the follow-up, 18 patients had experienced pneumothorax recurrence. Furthermore, 12/18 patients (66%) with recurrent pneumothorax died during the study period. Twenty-three patients (70%) died because of NTMPD progression. Low body mass index (BMI) was a negative prognostic factor for pneumothorax associated with NTMPD in multivariate analysis (HR 0.79, 95% CI 0.64−0.96; P = 0.018)Patients with pneumothorax associated with NTMPD have advanced disease, a high rate of pneumothorax recurrence, and poor prognosis, regardless of the pneumothorax treatment used. Further improvements in early diagnosis of NTMPD and appropriate management in both NTMPD and NTMPD-associated pneumothorax are needed.

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Section: Discussionmentioning

confidence: 99%

Pneumothorax associated with nontuberculous mycobacteria

et al. 2016

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“…In deciding antibiotic regimens for pulmonary infections caused by nontuberculous mycobacteria, it is helpful to first divide these organisms into the categories of rapidly growing mycobacteria (RGM) and slow-growing mycobacteria (SGM). Antibiotic regimens for RGM are dictated primarily by the susceptibility patterns of Mycobacterium abscessus and M. fortuitum (10,11). Both M. abscessus and M. fortuitum exhibit inducible macrolide resistance, which is believed to work through activation of the erm gene (12).…”

Section: Paraffinicum Was Initially Isolated From a Soil Sample Inmentioning

confidence: 99%

Mycobacterium paraffinicum Causing Symptomatic Pulmonary Infection

et al. 2014

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c Mycobacterium paraffinicum has been newly recognized as a species. A case of symptomatic pulmonary infection caused by M. paraffinicum is described, and as far as we know, this is the first case of the organism as a human pathogen. CASE REPORT In May 2012, an 85-year-old female presented to our tertiary referral hospital with acute shortness of breath. Her medical history included hypertension, for which she was not treated. She noted progressive generalized weakness, malaise, anorexia, and a chronic cough productive of white sputum for the past 6 years. On review of systems, she reported no fevers, chills, night sweats, or hemoptysis. She denied any history of smoking (but lived with a smoker), pneumonia, or other lung infections, tuberculosis exposure, homelessness, health care work, history of imprisonment, or recent travel. On physical examination, the patient had a temperature of 37.0°C, blood pressure of 158/88 mm Hg, a heart rate of 109 beats per minute (bpm), a respiratory rate of 20, and a 93% oxygen saturation as determined by pulse oximetry on ambient air. On examination, the patient had moderate kyphosis and pectus carinatum with no cervical lymphadenopathy. There was a 3/6 holosystolic murmur present at the cardiac apex and bibasilar rales on the left lung greater than on the right with no evidence of egophony. She exhibited 5/5 strength throughout all extremities. Laboratory data were as follows: white blood cell count of 16,400/l, with a differential of 1% band forms, 94% segmented neutrophils, 3% lymphocytes, and 2% monocytes, hemoglobin of 11.4 g/dl, platelet count of 507,000/l, sodium at 129 meq/liter, potassium at 3.6 meq/ liter, glucose at 131 mg/dl, and creatinine at 1.1 mg/dl. The patient was started on ceftriaxone and azithromycin for treatment of community-acquired pneumonia, which was consistent with her presentation. On the second day of hospitalization, a computed tomography (CT) scan of the chest, abdomen, and pelvis with contrast revealed near-complete occlusion of the left main bronchus with associated atelectasis of the lingula and cylindrical and cystic bronchiectasis within the left lower lobe and right middle lobe (Fig. 1). Also present were numerous nodules within the atelectatic lung, with central hypoattenuation, numerous additional nodules with central hypoattenuation present bilaterally, and moderate bilateral pleural effusions. A transthoracic echocardiogram was also obtained, revealing an impaired relaxation pattern of diastolic filling and elevated right ventricular systolic pressure. On the fourth day, the patient underwent bronchoscopy with bronchoalveolar lavage (BAL) of the left lower lobe, revealing severe mucous plugging of the left lung and thick mucoid secretions without evidence of endobronchial lesions, which grew Candida spp. Treatment of the BAL fluid with acid-fast (Kinyoun) stain revealed rare acid-fast bacilli. The infectious disease service was consulted, and PCR testing using a laboratory-developed test of the primary BAL sample was requested and was n...

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“…Furthermore, treatment of NTM infections in SOT recipients creates challenges because of drug-drug interactions and overlapping drug toxicities [3], with treatment regimens based on observational data from the non-transplant population [4]. Previous studies of the long-term outcomes of NTM infection among SOT recipients have been limited to lung transplant population [5–7], with conflicting findings regarding the relationship between NTM infection and mortality.…”

Section: Introductionmentioning

confidence: 99%

Non-tuberculous mycobacterial infections after solid organ transplantation: a survival analysis

Longworth

Blumberg

Barton

et al. 2015

Clinical Microbiology and Infection

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The relationship of nontuberculous mycobacterial (NTM) infections and survival among solid organ transplant (SOT) recipients is unknown. We conducted a retrospective cohort study to measure the impact of NTM infection on survival in this patient population, comparing the effect of M. abscessus infection versus infection due to other pathogenic NTM species. We identified 33 patients with NTM infection post-transplantation, 18 with infection that was diagnosed within the first year. Although drug resistance was common among M. abscessus isolates, patients with M. abscessus infection did not have increased mortality compared to patients with other types of NTM infections (p=0.64). In contrast, we observed a significant association overall between early NTM infection and 3-year mortality post-transplantation (HR 8.76, 95% CI 2.69, 28.57). The mortality burden of NTM infection following transplantation may be due to factors other than the virulence of the organisms. Multicenter studies are needed to identify the optimal approach for diagnosing and treating these uncommon but serious infections.

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Management of Nontuberculous Mycobacterial (NTM) Lung Disease

Cited by 31 publications

References 51 publications

Pneumothorax associated with nontuberculous mycobacteria

Pneumothorax associated with nontuberculous mycobacteria

Mycobacterium paraffinicum Causing Symptomatic Pulmonary Infection

Non-tuberculous mycobacterial infections after solid organ transplantation: a survival analysis

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