Pulmonary non-tuberculous mycobacterial infection
Updates to Article Attributes
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.
Epidemiology
Risk factors
- chronic lung diseases such as 12
- older age and tall slim
Caucasianwhite females seem to be more susceptible - immunodeficiency states 12
- inherited disorders of IFNγ-IL12 pathway (e.g. IFNγR1 mutations)
- other cytokine signalling 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-oesophageal reflux disease (GORD)
Associations
There may be an association between achalasia of the gastric cardia and M. fortuitum/chelonae infection.
Clinical presentation
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
- haemoptysis
- low grade fever
- night sweats
- fatigue
- weight loss
Pathology
As with M. tuberculosis, NTMs commonly cause pulmonary infection. More than 150 species of NTM species arehave been identified some of which have been can cause infections in humans. These include:
- Mycobacterium avium-intracellulare(MAI): ~60% (on bronchial secretions)
- Mycobacterium kansasii: ~25%
- Mycobacterium fortuitum
- Mycobacterium malmoense: pulmonary Mycobacterium malmoense infection
- Mycobacterium gordonae
- Mycobacterium szulgai
- Mycobacterium scrofulaceum / Mycobacterium parascrofulaceum
- Mycobacterium xenopi
- Mycobacterium chelonae: pulmonary Mycobacterium chelonae infection
- Mycobacterium simiae
- Mycobacterium palustre
- Mycobacterium kumamotonense
- Mycobacterium kubicae
- Mycobacterium morokaense
- Mycobacterium abscessus: pulmonary Mycobacterium abscessus infection 2
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
-<li><a href="/articles/cystic-fibrosis">cystic fibrosis</a></li>- +<li><a href="/articles/cystic-fibrosis">cystic fibrosis (CF)</a></li>
-<li>non-CF <a title="Bronchiectasis" href="/articles/bronchiectasis">bronchiectasis</a>- +<li>non-CF <a href="/articles/bronchiectasis">bronchiectasis</a>
-<li>older age and tall slim Caucasian females seem to be more susceptible</li>- +<li>older age and tall slim white females seem to be more susceptible</li>
-</ul><h5>Associations</h5><p>There may be an association between achalasia of the <a title="Gastric cardia" href="/articles/stomach">gastric cardia</a> and <em>M. fortuitum</em>/<em>chelonae </em>infection.</p><h4>Clinical presentation</h4><p>Some patients are relatively asymptomatic. However, most have a combination of respiratory and systemic features that may resemble <a href="/articles/tuberculosis">tuberculosis</a>:</p><ul>- +</ul><h5>Associations</h5><p>There may be an association between achalasia of the <a href="/articles/stomach">gastric cardia</a> and <em>M. fortuitum</em>/<em>chelonae </em>infection.</p><h4>Clinical presentation</h4><p>Some patients are relatively asymptomatic. However, most have a combination of respiratory and systemic features that may resemble <a href="/articles/tuberculosis">tuberculosis</a>:</p><ul>
-<li>night sweats</li>- +<li><a title="Night sweats" href="/articles/night-sweats">night sweats</a></li>
-</ul><h4>Pathology</h4><p>As with <em>M. tuberculosis</em>, 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:</p><ul>- +</ul><h4>Pathology</h4><p>As with <em>M. tuberculosis</em>, NTMs commonly cause pulmonary infection. More than 150 species of NTM species have been identified some of which can cause infections in humans. These include:</p><ul>
-<em>Mycobacterium avium-intracellulare</em>: ~60% (on bronchial secretions)<ul><li>see: <a href="/articles/pulmonary-mycobacterium-avium-complex-infection">pulmonary MAIC infection</a>- +<em>Mycobacterium avium-intracellulare </em>(MAI): ~60% (on bronchial secretions)<ul><li>see: <a href="/articles/pulmonary-mycobacterium-avium-complex-infection">pulmonary MAIC infection</a>
References changed:
- 2. Han D, Lee K, Koh W, Yi C, Kim T, Kwon O. Radiographic and CT Findings of Nontuberculous Mycobacterial Pulmonary Infection Caused by Mycobacterium Abscessus. AJR Am J Roentgenol. 2003;181(2):513-7. <a href="https://doi.org/10.2214/ajr.181.2.1810513">doi:10.2214/ajr.181.2.1810513</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/12876037">Pubmed</a>
- 12. Haworth C, Banks J, Capstick T et al. British Thoracic Society Guideline for the Management of Non-Tuberculous Mycobacterial Pulmonary Disease (NTM-PD). BMJ Open Respir Res. 2017;4(1):e000242. <a href="https://doi.org/10.1136/bmjresp-2017-000242">doi:10.1136/bmjresp-2017-000242</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/29449949">Pubmed</a>
- 15. Hong S, Kim T, Lee J, Park J. Nontuberculous Mycobacterial Pulmonary Disease Mimicking Lung Cancer: Clinicoradiologic Features and Diagnostic Implications. Medicine (Baltimore). 2016;95(26):e3978. <a href="https://doi.org/10.1097/MD.0000000000003978">doi:10.1097/MD.0000000000003978</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/27367996">Pubmed</a>
- 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. <a href="http://www.ajronline.org/cgi/content/full/181/2/513">AJR Am J Roentgenol (full text)</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/12876037">Pubmed citation</a><div class="ref_v2"></div>
- 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. <a href="https://doi.org/10.1136/bmjresp-2017-000242">doi:10.1136/bmjresp-2017-000242</a> <span class="ref_v4"></span>
- 15. Hong S, Kim T, Lee J, Park J. Nontuberculous Mycobacterial Pulmonary Disease Mimicking Lung Cancer. Medicine. 2016;95(26):e3978. <a href="https://doi.org/10.1097/md.0000000000003978">doi:10.1097/md.0000000000003978</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/27367996">Pubmed</a>