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Radiologic Clinics of North America May 2022Mycobacterial species other than Mycobacterium tuberculosis and Mycobacterium leprae constitute nontuberculous mycobacteria (NTM). NTM infections are on the rise,... (Review)
Review
Mycobacterial species other than Mycobacterium tuberculosis and Mycobacterium leprae constitute nontuberculous mycobacteria (NTM). NTM infections are on the rise, particularly in the Western world. They cause a wide range of pulmonary and systemic manifestations. The 2 most common types are as follows: classical cavitary type, seen with preexisting lung disease, and the nonclassical bronchiectatic type, seen in elderly women without preexisting lung disease. Disseminated infections by the hematogenous route are common in immunocompromised patients including those with HIV. Imaging plays a key role in the diagnosis and monitoring of NTM infection.
Topics: Aged; Bronchiectasis; Female; Humans; Lung Diseases; Mycobacterium Infections, Nontuberculous; Mycobacterium avium Complex; Nontuberculous Mycobacteria
PubMed: 35534127
DOI: 10.1016/j.rcl.2022.01.012 -
Microbiology Spectrum Apr 2017Despite the ubiqitous nature of Mycobacterium avium complex (MAC) organisms in the environment, relatively few of those who are infected develop disease. Thus, some... (Review)
Review
Despite the ubiqitous nature of Mycobacterium avium complex (MAC) organisms in the environment, relatively few of those who are infected develop disease. Thus, some degree of susceptibility due to either underlying lung disease or immunosuppression is required. The frequency of pulmonary MAC disease is increasing in many areas, and the exact reasons are unknown. Isolation of MAC from a respiratory specimen does not necessarily mean that treatment is required, as the decision to treatment requires the synthesis of clinical, radiographic, and microbiologic information as well as a weighing of the risks and benefits for the individual patient. Successful treatment requires a multipronged approach that includes antibiotics, aggressive pulmonary hygiene, and sometimes resection of the diseased lung. A combination of azithromycin, rifampin, and ethambutol administered three times weekly is recommend for nodular bronchiectatic disease, whereas the same regimen may be used for cavitary disease but administered daily and often with inclusion of a parenteral aminoglycoside. Disseminated MAC (DMAC) is almost exclusively seen in patients with late-stage AIDS and can be treated with a macrolide in combination with ethambutol, with or without rifabutin: the most important intervention in this setting is to gain HIV control with the use of potent antiretroviral therapy. Treatment outcomes for many patients with MAC disease remain suboptimal, so new drugs and treatment regimens are greatly needed. Given the high rate of reinfection after cure, one of the greatest needs is a better understanding of where infection occurs and how this can be prevented.
Topics: Anti-Bacterial Agents; Humans; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Treatment Outcome
PubMed: 28429679
DOI: 10.1128/microbiolspec.TNMI7-0045-2017 -
Clinical Infectious Diseases : An... Aug 2020Nontuberculous mycobacteria (NTM) represent over 190 species and subspecies, some of which can produce disease in humans of all ages and can affect both pulmonary and...
Nontuberculous mycobacteria (NTM) represent over 190 species and subspecies, some of which can produce disease in humans of all ages and can affect both pulmonary and extrapulmonary sites. This guideline focuses on pulmonary disease in adults (without cystic fibrosis or human immunodeficiency virus infection) caused by the most common NTM pathogens such as Mycobacterium avium complex, Mycobacterium kansasii, and Mycobacterium xenopi among the slowly growing NTM and Mycobacterium abscessus among the rapidly growing NTM. A panel of experts was carefully selected by leading international respiratory medicine and infectious diseases societies (ATS, ERS, ESCMID, IDSA) and included specialists in pulmonary medicine, infectious diseases and clinical microbiology, laboratory medicine, and patient advocacy. Systematic reviews were conducted around each of 22 PICO (Population, Intervention, Comparator, Outcome) questions and the recommendations were formulated, written, and graded using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Thirty-one evidence-based recommendations about treatment of NTM pulmonary disease are provided. This guideline is intended for use by healthcare professionals who care for patients with NTM pulmonary disease, including specialists in infectious diseases and pulmonary diseases.
Topics: Adult; Humans; Mycobacterium Infections, Nontuberculous; Mycobacterium abscessus; Mycobacterium avium Complex; Mycobacterium kansasii; Nontuberculous Mycobacteria
PubMed: 32797222
DOI: 10.1093/cid/ciaa1125 -
European Respiratory Review : An... Mar 2022Nontuberculous mycobacterial pulmonary disease (NTM-PD) remains a challenging condition to diagnose and treat effectively. Treatment of NTM-PD is prolonged, frequently... (Review)
Review
Nontuberculous mycobacterial pulmonary disease (NTM-PD) remains a challenging condition to diagnose and treat effectively. Treatment of NTM-PD is prolonged, frequently associated with adverse effects and has variable success. In this review, we consider the factors influencing clinicians when treating NTM-PD and discuss outcomes from key studies on the pharmacological management of complex pulmonary disease and pulmonary disease. We highlight issues relating to treatment-related toxicity and provide an overview of repurposed and emerging therapies for NTM-PD.
Topics: Humans; Lung; Lung Diseases; Mycobacterium abscessus; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection
PubMed: 35140106
DOI: 10.1183/16000617.0212-2021 -
The Journal of Infectious Diseases Aug 2020Nontuberculous mycobacteria (NTM) are ubiquitous in the environment and an important cause of disease. The most common species causing pulmonary disease are members of...
Nontuberculous mycobacteria (NTM) are ubiquitous in the environment and an important cause of disease. The most common species causing pulmonary disease are members of Mycobacterium avium complex (MAC). MAC pulmonary disease (MAC-PD) can be chronic, debilitating, costly, and associated with a high mortality. However, MAC diagnoses are often delayed due to the nonspecific presentation of MAC-PD and radiological findings that overlap with other pulmonary diseases. Patients with risk factors and who meet the diagnostic criteria-which include clinical, radiological, and microbiologic criteria-should be considered for treatment. Diagnosis requires 2 or more positive sputum cultures or 1 bronchoscopic specimen culture. The recommendation for those who are treated is a 3-drug regimen including macrolide, rifamycin, and ethambutol that is continued for 12 months beyond sputum culture conversion to negative. MAC-PD is difficult to treat, with frequent drug-related side effects and suboptimal treatment outcomes. Refractory and recurrent disease is common, leading to lifelong follow-up of patients. There are limited treatment options for patients with macrolide-resistant or refractory disease. Amikacin liposome inhalation suspension is recommended for treatment-refractory patients whose cultures remain positive after 6 months of guideline-based therapy. Among the research priorities to improve patient outcomes and quality of life are developing new, more rapid diagnostic tests, investigating biomarkers associated with disease progression, and identifying new drugs and routes of administration as well as new, shorter, and better-tolerated regimens.
Topics: Administration, Inhalation; Administration, Oral; Aged; Anti-Bacterial Agents; Biomarkers; Bronchoscopy; Disease Progression; Drug Administration Schedule; Drug Therapy, Combination; Female; Humans; Lung; Lung Diseases; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Professional Practice Gaps; Sputum; Time Factors; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 32814943
DOI: 10.1093/infdis/jiaa354 -
Revista Peruana de Medicina... 2020We present the case of an immunocompetent patient whose illness began at age 49 with a cough, followed by purulent and hemoptoic sputum; bronchiectasis was diagnosed....
We present the case of an immunocompetent patient whose illness began at age 49 with a cough, followed by purulent and hemoptoic sputum; bronchiectasis was diagnosed. Three years later, after hemoptysis, she underwent medial segmentectomy of the middle lobe and was asymptomatic for months. When tuberculosis was found in the pathology report, she was treated with 4HREZ2R2H2. Five years later her BK was 2+, thus receiving a new scheme of 4HREZ2R2H2, which did not succeed in obtaining negative results and the treatment was declared as a failure. After genotyping her Mycobacterium intracellulare culture, the patient received azithromycin, moxifloxacin and ethambutol. There was improvement, but she abandoned the treatment at 8 months; she restarted it 18 months later, along with treatment for depression and gastroesophageal reflux. After one month the patient was asymptomatic, but she had a dermal reaction to moxifloxacin which was replaced with amikacin. One year later, she was cured and discharged, at the age of 64.
Topics: Female; Humans; Immunocompromised Host; Lung Diseases; Middle Aged; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Peru
PubMed: 32876230
DOI: 10.17843/rpmesp.2020.372.4632 -
Journal of Leukocyte Biology Jan 2021Discussion on how antibiotic treatment routes Mycobacterium avium to phagolysosomes without eliciting an immune response in human macrophages.
Discussion on how antibiotic treatment routes Mycobacterium avium to phagolysosomes without eliciting an immune response in human macrophages.
Topics: Humans; Immune Evasion; Macrophages; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection
PubMed: 32767408
DOI: 10.1002/JLB.3CE0520-104R -
Tuberculosis (Edinburgh, Scotland) Jan 2019Mycobacterium avium is an environmental microorganism found in soil and water sources worldwide. It is the most prevalent species of nontuberculous mycobacteria that... (Review)
Review
Mycobacterium avium is an environmental microorganism found in soil and water sources worldwide. It is the most prevalent species of nontuberculous mycobacteria that causes infectious diseases, especially in immunocompromised individuals. This review discusses and highlights key topics about M. avium, such as epidemiology, pathogenicity, glycopeptidolipids, laboratory identification, genotyping, antimicrobial therapy and antimicrobial resistance. Additionally, the main comorbidities associated with M. avium infection are discussed.
Topics: Antibiotics, Antitubercular; Drug Resistance, Bacterial; Genotype; Glycolipids; Humans; Mycobacterium Infections, Nontuberculous; Mycobacterium avium Complex; Virulence
PubMed: 30711152
DOI: 10.1016/j.tube.2018.12.004 -
Frontiers in Immunology 2022complex (MAC) is the main causative agent of infectious diseases in humans among nontuberculous mycobacteria (NTM) that are ubiquitous organisms found in environmental... (Review)
Review
complex (MAC) is the main causative agent of infectious diseases in humans among nontuberculous mycobacteria (NTM) that are ubiquitous organisms found in environmental media such as soil as well as in domestic and natural waters. MAC is a primary causative agent of NTM-lung disease that threaten immunocompromised or structural lung disease patients. The incidence and the prevalence of infection have been reduced, while MAC infections and mortality rates have increased, making it a cause of global health concern. The emergence of drug resistance and the side effects of long-term drug use have led to a poor outcome of treatment regimens against MAC infections. Therefore, the development of host-directed therapy (HDT) has recently gained interest, aiming to accelerate mycobacterial clearance and reversing lung damage by employing the immune system using a novel adjuvant strategy to improve the clinical outcome of MAC infection. Therefore, in this review, we discuss the innate immune responses that contribute to MAC infection focusing on macrophages, chief innate immune cells, and host susceptibility factors in patients. We also discuss potential HDTs that can act on the signaling pathway of macrophages, thereby contributing to antimycobacterial activity as a part of the innate immune response during MAC infection. Furthermore, this review provides new insights into MAC infection control that modulates and enhances macrophage function, promoting host antimicrobial activity in response to potential HDTs and thus presenting a deeper understanding of the interactions between macrophages and MACs during infection.
Topics: Humans; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Macrophages; Nontuberculous Mycobacteria; Mycobacterium tuberculosis; Lung Diseases
PubMed: 36505429
DOI: 10.3389/fimmu.2022.931876 -
Lung Aug 2018Defense of Lady Windermere Syndrome (LWS) provides a critical analysis of its proposed pathogenesis, evidence supporting a causal role of volitional cough suppression,...
Defense of Lady Windermere Syndrome (LWS) provides a critical analysis of its proposed pathogenesis, evidence supporting a causal role of volitional cough suppression, pathogenesis of M. avium complex (MAC) superimposition, a defense of the eponym, and cites a possible contribution of LWS to the bronchiectasis population.
Topics: Age Factors; Bronchiectasis; Cough; Eponyms; Female; Humans; Lung; Male; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Risk Factors; Sex Factors; Syndrome; Volition
PubMed: 29766262
DOI: 10.1007/s00408-018-0122-x