Pulmonary non-tuberculous mycobacterial (NTM) infection refers to pulmonary infection caused by one of the large number (at least 150) mycobacterial species other than Mycobacterium tuberculosis. However, certain species are much more common than others.
Some patients are relatively asymptomatic. However, most have a combination of respiratory and systemic features that may resemble tuberculosis:
- chronic cough
- shortness of breath on exertion
- hemoptysis
- low-grade fever
- night sweats
- fatigue
- weight loss
As with M. tuberculosis, NTMs commonly cause pulmonary infection. More than 150 species of NTM species are identified some of which have been can cause infections in humans. These include:
Risk factors
- chronic lung diseases such as 12
- older age and tall slim Caucasian females seem to be more susceptible
- immunodeficiency states 12
- inherited disorders of IFNγ-IL12 pathway (eg, IFNγR1 mutations)
- other cytokine signaling disorders (e.g. STAT mutations)
- macrophage and dendritic cell function disorders (e.g. GATA2 and NRAMP)
- acquired immunodeficiencies (HIV-AIDS)
- functional anti-interferon gamma antibodies
- gastro-esophageal reflux disease (GERD)
Associations
There may be an association between achalasia of gastric cardia and M. fortuitum/chelonae infection.
Treatment and prognosis
Detailed guidelines on the management approach are available 12. The general principles are:
- multidrug therapy according to the sensitivities of the organisms
- treatment for at least 12 months
- specialist follow-up to monitor compliance and drug side effects
- 1. Martinez S, Mcadams HP, Batchu CS. The many faces of pulmonary nontuberculous mycobacterial infection. AJR Am J Roentgenol. 2007;189 (1): 177-86. doi:10.2214/AJR.07.2074 - Pubmed citation
- 2. Han D, Lee KS, Koh WJ et-al. Radiographic and CT findings of nontuberculous mycobacterial pulmonary infection caused by Mycobacterium abscessus. AJR Am J Roentgenol. 2003;181 (2): 513-7. AJR Am J Roentgenol (full text) - Pubmed citation
- 3. Hanck C, Fleisch F, Katz G. Imaging appearance of nontuberculous mycobacterial infection of the neck. AJNR Am J Neuroradiol. 2004;25 (2): 349. AJNR Am J Neuroradiol (full text) - Pubmed citation
- 4. Erasmus JJ, Mcadams HP, Farrell MA et-al. Pulmonary nontuberculous mycobacterial infection: radiologic manifestations. Radiographics. 19 (6): 1487-505. Radiographics (citation) - Pubmed citation
- 5. Seibert CE, Tabrisky J. Radiological features of pulmonary atypical mycobacterial infections. Br J Radiol. 1969;42 (494): 140-4. Br J Radiol (citation) - Pubmed citation
- 6. Moore EH. Atypical mycobacterial infection in the lung: CT appearance. Radiology. 1993;187 (3): 777-82. Radiology (citation) - Pubmed citation
- 7. Levin DL. Radiology of pulmonary Mycobacterium avium-intracellulare complex. Clin. Chest Med. 2002;23 (3): 603-12. - Pubmed citation
- 8. Kim TS, Koh WJ, Han J et-al. Hypothesis on the evolution of cavitary lesions in nontuberculous mycobacterial pulmonary infection: thin-section CT and histopathologic correlation. AJR Am J Roentgenol. 2005;184 (4): 1247-52. doi:10.2214/ajr.184.4.01841247 - Pubmed citation
- 9. Hazelton TR, Newell JD, Cook JL et-al. CT findings in 14 patients with Mycobacterium chelonae pulmonary infection. AJR Am J Roentgenol. 2000;175 (2): 413-6. doi:10.2214/ajr.175.2.1750413 - Pubmed citation
- 10. Johnson MM, Odell JA. Nontuberculous mycobacterial pulmonary infections. J Thorac Dis. 2014;6 (3): 210-20. doi:10.3978/j.issn.2072-1439.2013.12.24 - Free text at pubmed - Pubmed citation
- 11. Griffith DE, Aksamit T, Brown-Elliott BA et-al. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am. J. Respir. Crit. Care Med. 2007;175 (4): 367-416. doi:10.1164/rccm.200604-571ST - Pubmed citation
- 12. Charles S Haworth, John Banks, Toby Capstick, Andrew J Fisher, Thomas Gorsuch, Ian F Laurenson, Andrew Leitch, Michael R Loebinger, Heather J Milburn, Mark Nightingale, Peter Ormerod, Delane Shingadia, David Smith, Nuala Whitehead, Robert Wilson, R Andres Floto. British Thoracic Society Guideline for the management of non-tuberculous mycobacterial pulmonary disease (NTM-PD). BMJ Open Respiratory Research. 4 (1): e000242. doi:10.1136/bmjresp-2017-000242
- 13. Sarro YD, Kone B, Diarra B, Kumar A, Kodio O, Fofana DB, Achenbach CJ, Beavogui AH, Seydi M, Holl JL, Taiwo B, Diallo S, Doumbia S, Murphy RL, McFall SM, Maiga M. Simultaneous diagnosis of tuberculous and non-tuberculous mycobacterial diseases: Time for a better patient management. (2018) Clinical microbiology and infectious diseases. doi:10.15761/CMID.1000144 - Pubmed
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