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Diagnosis and Treatment of Nontuberculous Mycobacterial Lung Disease.

Kwon YS, Koh WJ - J. Korean Med. Sci. (2016)

Bottom Line: Nontuberculous mycobacteria (NTM) are ubiquitous organisms; their isolation from clinical specimens does not always indicate clinical disease.Although the geographic diversity of NTM species is well known, Mycobacterium avium complex (MAC), M. abscessus complex (MABC), and M. kansasii are the most commonly encountered and important etiologic organisms.Thus, precise identification of species in MABC infection is needed for the prediction of antibiotic response.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea .

ABSTRACT
Nontuberculous mycobacteria (NTM) are ubiquitous organisms; their isolation from clinical specimens does not always indicate clinical disease. The incidence of NTM lung diseases has been increasing worldwide. Although the geographic diversity of NTM species is well known, Mycobacterium avium complex (MAC), M. abscessus complex (MABC), and M. kansasii are the most commonly encountered and important etiologic organisms. Two distinct types of NTM lung diseases have been reported, namely fibrocavitary and nodular bronchiectatic forms. For laboratory diagnosis of NTM lung diseases, both liquid and solid media cultures and species-level identification are strongly recommended to enhance growth detection and determine the clinical relevance of isolates. Treatment for NTM lung diseases consists of a multidrug regimen and a long course of therapy, lasting more than 12 months after negative sputum conversion. For MAC lung disease, several new macrolide-based regimens are now recommended. For nodular bronchiectatic forms of MAC lung diseases, an intermittent three-time-weekly regimen produces outcomes similar to those of daily therapy. Treatment of MABC lung disease is very difficult, requiring long-term use of parenteral agents in combination with new macrolides. Treatment outcomes are much better for M. massiliense lung disease than for M. abscessus lung disease. Thus, precise identification of species in MABC infection is needed for the prediction of antibiotic response. Likewise, increased efforts to improve treatment outcomes and develop new agents for NTM lung disease are needed.

No MeSH data available.


Related in: MedlinePlus

Two distinct manifestations of nontuberculous mycobacterial lung disease: fibrocavitary and nodular bronchiectatic forms. (A, B) A 56-year-old male with Mycobacterium avium lung disease. The chest radiograph shows cavities in both upper lung fields. The chest CT shows two thin walled cavities in bilateral upper lobes. (C, D) An 83-year-old female with Mycobacterium avium lung disease. The chest radiograph shows multiple nodules in both mid-lung fields. The chest CT shows multiple centrilobular nodules with bronchiectasis in the right middle lobe and the lingular segment of the left upper lobe.
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Figure 1: Two distinct manifestations of nontuberculous mycobacterial lung disease: fibrocavitary and nodular bronchiectatic forms. (A, B) A 56-year-old male with Mycobacterium avium lung disease. The chest radiograph shows cavities in both upper lung fields. The chest CT shows two thin walled cavities in bilateral upper lobes. (C, D) An 83-year-old female with Mycobacterium avium lung disease. The chest radiograph shows multiple nodules in both mid-lung fields. The chest CT shows multiple centrilobular nodules with bronchiectasis in the right middle lobe and the lingular segment of the left upper lobe.

Mentions: NTM lung disease has two different radiographic manifestations: fibrocavitary and nodular bronchiectatic forms (4445). Fibrocavitary forms of NTM lung disease have cavitary lesions predominantly in the upper lobes, with radiographic findings are similar to those of pulmonary TB (1) (Fig. 1A and 1B). This manifestation shows relatively rapid disease progression and frequently develops in older men with a history of smoking and underlying lung disease such as previous TB (1). The other form of NTM lung disease is nodular bronchiectatic disease. This manifestation can present as multifocal bronchiectasis, clusters of small nodules, and branching linear structures that frequently involve the right middle lobe and the lingular segment of the left upper lobe (4647) (Fig. 1C and 1D). Although these findings are quite specific for NTM lung disease, particularly MAC and MABC infections, other diseases such as diffuse panbronchiolitis may present with similar findings (4849). In the nodular bronchiectatic form of NTM lung disease, patients have unique body morphotypes, including a lower body mass index and body fat, taller stature, and increased instances of scoliosis and pectus excavatum, compared to control subjects (505152).


Diagnosis and Treatment of Nontuberculous Mycobacterial Lung Disease.

Kwon YS, Koh WJ - J. Korean Med. Sci. (2016)

Two distinct manifestations of nontuberculous mycobacterial lung disease: fibrocavitary and nodular bronchiectatic forms. (A, B) A 56-year-old male with Mycobacterium avium lung disease. The chest radiograph shows cavities in both upper lung fields. The chest CT shows two thin walled cavities in bilateral upper lobes. (C, D) An 83-year-old female with Mycobacterium avium lung disease. The chest radiograph shows multiple nodules in both mid-lung fields. The chest CT shows multiple centrilobular nodules with bronchiectasis in the right middle lobe and the lingular segment of the left upper lobe.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4835588&req=5

Figure 1: Two distinct manifestations of nontuberculous mycobacterial lung disease: fibrocavitary and nodular bronchiectatic forms. (A, B) A 56-year-old male with Mycobacterium avium lung disease. The chest radiograph shows cavities in both upper lung fields. The chest CT shows two thin walled cavities in bilateral upper lobes. (C, D) An 83-year-old female with Mycobacterium avium lung disease. The chest radiograph shows multiple nodules in both mid-lung fields. The chest CT shows multiple centrilobular nodules with bronchiectasis in the right middle lobe and the lingular segment of the left upper lobe.
Mentions: NTM lung disease has two different radiographic manifestations: fibrocavitary and nodular bronchiectatic forms (4445). Fibrocavitary forms of NTM lung disease have cavitary lesions predominantly in the upper lobes, with radiographic findings are similar to those of pulmonary TB (1) (Fig. 1A and 1B). This manifestation shows relatively rapid disease progression and frequently develops in older men with a history of smoking and underlying lung disease such as previous TB (1). The other form of NTM lung disease is nodular bronchiectatic disease. This manifestation can present as multifocal bronchiectasis, clusters of small nodules, and branching linear structures that frequently involve the right middle lobe and the lingular segment of the left upper lobe (4647) (Fig. 1C and 1D). Although these findings are quite specific for NTM lung disease, particularly MAC and MABC infections, other diseases such as diffuse panbronchiolitis may present with similar findings (4849). In the nodular bronchiectatic form of NTM lung disease, patients have unique body morphotypes, including a lower body mass index and body fat, taller stature, and increased instances of scoliosis and pectus excavatum, compared to control subjects (505152).

Bottom Line: Nontuberculous mycobacteria (NTM) are ubiquitous organisms; their isolation from clinical specimens does not always indicate clinical disease.Although the geographic diversity of NTM species is well known, Mycobacterium avium complex (MAC), M. abscessus complex (MABC), and M. kansasii are the most commonly encountered and important etiologic organisms.Thus, precise identification of species in MABC infection is needed for the prediction of antibiotic response.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea .

ABSTRACT
Nontuberculous mycobacteria (NTM) are ubiquitous organisms; their isolation from clinical specimens does not always indicate clinical disease. The incidence of NTM lung diseases has been increasing worldwide. Although the geographic diversity of NTM species is well known, Mycobacterium avium complex (MAC), M. abscessus complex (MABC), and M. kansasii are the most commonly encountered and important etiologic organisms. Two distinct types of NTM lung diseases have been reported, namely fibrocavitary and nodular bronchiectatic forms. For laboratory diagnosis of NTM lung diseases, both liquid and solid media cultures and species-level identification are strongly recommended to enhance growth detection and determine the clinical relevance of isolates. Treatment for NTM lung diseases consists of a multidrug regimen and a long course of therapy, lasting more than 12 months after negative sputum conversion. For MAC lung disease, several new macrolide-based regimens are now recommended. For nodular bronchiectatic forms of MAC lung diseases, an intermittent three-time-weekly regimen produces outcomes similar to those of daily therapy. Treatment of MABC lung disease is very difficult, requiring long-term use of parenteral agents in combination with new macrolides. Treatment outcomes are much better for M. massiliense lung disease than for M. abscessus lung disease. Thus, precise identification of species in MABC infection is needed for the prediction of antibiotic response. Likewise, increased efforts to improve treatment outcomes and develop new agents for NTM lung disease are needed.

No MeSH data available.


Related in: MedlinePlus