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Nontuberculous Mycobacterial Disease Management Principles

  • Timothy R. Aksamit
  • David E. Griffith
Chapter
Part of the Respiratory Medicine book series (RM)

Abstract

The management of patients with nontuberculous mycobacterial (NTM) disease, especially pulmonary disease (PD), is neither intuitive nor simple. As is often lamented, treatment of NTM PD is typically more complicated and difficult than the treatment of tuberculosis (TB). Complexity begins with the requirement to select patients that meet established diagnostic criteria and who would benefit from therapy. Essentially all patients with NTM PD have respiratory comorbidities, typically bronchiectasis and/or chronic obstructive lung disease which also requires evaluation and treatment. Management of these comorbidities in the presence of NTM PD is critical but presents additional challenges such as symptomatic overlap with NTM PD that obfuscates NTM treatment responses. Likewise, the decision to begin a multidrug mycobacterial regimen must always involve careful risk-benefit assessment on an individual patient basis. In those instances that treatment for NTM PD is not started, continued monitoring and follow-up of patients are essential. For successful treatment outcomes, clinicians managing NTM PD patients must be familiar with the characteristics of individual NTM PD pathogens and especially the nuances and peculiarities of drug susceptibility patterns. For selected pathogens and antibiotics, the avoidance of acquired mutational drug resistance is imperative. Management requires close and ongoing patient monitoring to assess treatment response and drug toxicity. There are multiple impediments to successful NTM PD therapy so that even with optimal management strategies, treatment success can be elusive. In that context, however, adherence to basic management principles will maximize the chances for a successful treatment outcome. Specific recommendations for comprehensive NTM disease management are offered in this chapter.

Keywords

Nontuberculous mycobacteria Mycobacterium avium complex Treatment 

Bibliography

  1. 1.
    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.CrossRefGoogle Scholar
  2. 2.
    van Ingen J, Griffith DE, Aksamit TR, Wagner D. Chapter 3. Pulmonary diseases caused by non-tuberculous mycobacteria. Eur Respir Monogr. 2012;58:25–37.Google Scholar
  3. 3.
    Jeong BH, Kim SY, Jeon K, Lee SY, Shin SJ, Koh WJ. Serodiagnosis of Mycobacterium avium complex and Mycobacterium abscessus complex pulmonary disease by use of IgA antibodies to glycopeptidolipid core antigen. J Clin Microbiol. 2013;51(8):2747–9.CrossRefGoogle Scholar
  4. 4.
    Shu CC, Ato M, Wang JT, et al. Sero-diagnosis of Mycobacterium avium complex lung disease using serum immunoglobulin a antibody against glycopeptidolipid antigen in Taiwan. PLoS One. 2013;8(11):e80473.CrossRefGoogle Scholar
  5. 5.
    Kitada S, Kobayashi K, Ichiyama S, et al. Serodiagnosis of Mycobacterium avium-complex pulmonary disease using an enzyme immunoassay kit. Am J Respir Crit Care Med. 2008;177(7):793–7.CrossRefGoogle Scholar
  6. 6.
    Kitada S, Maekura R, Toyoshima N, et al. Use of glycopeptidolipid core antigen for serodiagnosis of mycobacterium avium complex pulmonary disease in immunocompetent patients. Clin Diagn Lab Immunol. 2005;12(1):44–51.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Qvist T, Pressler T, Taylor-Robinson D, Katzenstein TL, Hoiby N. Serodiagnosis of Mycobacterium abscessus complex infection in cystic fibrosis. Eur Respir J. 2015;46(3):707–16.CrossRefGoogle Scholar
  8. 8.
    Kitada S, Levin A, Hiserote M, et al. Serodiagnosis of Mycobacterium avium complex pulmonary disease in the USA. Eur Respir J. 2013;42(2):454–60.CrossRefGoogle Scholar
  9. 9.
    Peralta G, Barry P, Pascopella L. Use of Nucleic Acid Amplification Tests in Tuberculosis Patients in California, 2010-2013. Open Forum Infect Dis. 2016;3(4):ofw230.CrossRefGoogle Scholar
  10. 10.
    Kendall BA, Varley CD, Hedberg K, Cassidy PM, Winthrop KL. Isolation of non-tuberculous mycobacteria from the sputum of patients with active tuberculosis. Int J Tuberc Lung Dis. 2010;14(5):654–6.PubMedPubMedCentralGoogle Scholar
  11. 11.
    Huang CT, Tsai YJ, Shu CC, et al. Clinical significance of isolation of nontuberculous mycobacteria in pulmonary tuberculosis patients. Respir Med. 2009;103(10):1484–91.CrossRefGoogle Scholar
  12. 12.
    Chung MJ, Lee KS, Koh WJ, et al. Drug-sensitive tuberculosis, multidrug-resistant tuberculosis, and nontuberculous mycobacterial pulmonary disease in nonAIDS adults: comparisons of thin-section CT findings. Eur Radiol. 2006;16(9):1934–41.CrossRefGoogle Scholar
  13. 13.
    Yakrus MA, Metchock B, Starks AM. Evaluation of a u.S. public health laboratory service for the molecular detection of drug resistant tuberculosis. Tuberc Res Treat. 2015;2015:701786.PubMedPubMedCentralGoogle Scholar
  14. 14.
    Ahn CH, Lowell JR, Onstad GD, Ahn SS, Hurst GA. Elimination of Mycobacterium intracellulare from sputum after bronchial hygiene. Chest. 1979;76(4):480–2.CrossRefGoogle Scholar
  15. 15.
    Prince D, Peterson D, Steiner R, et al. Infection with Mycobacterium avium complex in patients without predisposing conditions. N Engl J Med. 1989;321:863–8.CrossRefGoogle Scholar
  16. 16.
    Koh WJ, Kwon OJ, Jeon K, et al. Clinical significance of nontuberculous mycobacteria isolated from respiratory specimens in Korea. Chest. 2006;129(2):341–8.CrossRefGoogle Scholar
  17. 17.
    Lee G, Lee KS, Moon JW, et al. Nodular bronchiectatic Mycobacterium avium complex pulmonary disease. Natural course on serial computed tomographic scans. Ann Am Thorac Soc. 2013;10(4):299–306.CrossRefGoogle Scholar
  18. 18.
    Polverino E, Goeminne PC, McDonnell MJ, et al. European Respiratory Society guidelines for the management of adult bronchiectasis. Eur Respir J. 2017;50(3):1700629.CrossRefGoogle Scholar
  19. 19.
    Martinez-Garcia MA, Maiz L, Olveira C, et al. Spanish guidelines on the evaluation and diagnosis of bronchiectasis in adults. Arch Bronconeumol. 2018;54:79.PubMedGoogle Scholar
  20. 20.
    Hayashi M, Takayanagi N, Kanauchi T, Miyahara Y, Yanagisawa T, Sugita Y. Prognostic factors of 634 HIV-negative patients with Mycobacterium avium complex lung disease. Am J Respir Crit Care Med. 2012;185(5):575–83.CrossRefGoogle Scholar
  21. 21.
    Lee MR, Yang CY, Chang KP, et al. Factors associated with lung function decline in patients with non-tuberculous mycobacterial pulmonary disease. PLoS One. 2013;8(3):e58214.CrossRefGoogle Scholar
  22. 22.
    Aksamit TR. Mycobacterium avium complex pulmonary disease in patients with pre-existing lung disease. Clin Chest Med. 2002;23(3):643–53.CrossRefGoogle Scholar
  23. 23.
    Andrejak C, Nielsen R, Thomsen VO, Duhaut P, Sorensen HT, Thomsen RW. Chronic respiratory disease, inhaled corticosteroids and risk of non-tuberculous mycobacteriosis. Thorax. 2013;68(3):256–62.CrossRefGoogle Scholar
  24. 24.
    Brode SK, Campitelli MA, Kwong JC, et al. The risk of mycobacterial infections associated with inhaled corticosteroid use. Eur Respir J. 2017;50(3):1700037.CrossRefGoogle Scholar
  25. 25.
    Mitchell JD, Bishop A, Cafaro A, Weyant MJ, Pomerantz M. Anatomic lung resection for nontuberculous mycobacterial disease. Ann Thorac Surg. 2008;85(6):1887–92. discussion 1892-1883CrossRefGoogle Scholar
  26. 26.
    Hwang JA, Kim S, Jo KW, Shim TS. Natural history of Mycobacterium avium complex lung disease in untreated patients with stable course. Eur Respir J. 2017;49(3):1600537.CrossRefGoogle Scholar
  27. 27.
    Kim SJ, Park J, Lee H, et al. Risk factors for deterioration of nodular bronchiectatic Mycobacterium avium complex lung disease. Int J Tuberc Lung Dis. 2014;18(6):730–6.CrossRefGoogle Scholar
  28. 28.
    Ford ES, Horne DJ, Shah JA, Wallis CK, Fang FC, Hawn TR. Species-specific risk factors, treatment decisions, and clinical outcomes for laboratory isolates of less common Nontuberculous mycobacteria in Washington state. Ann Am Thorac Soc. 2017;14(7):1129–38.PubMedPubMedCentralGoogle Scholar
  29. 29.
    Hoefsloot W, van Ingen J, Andrejak C, et al. The geographic diversity of nontuberculous mycobacteria isolated from pulmonary samples: an NTM-NET collaborative study. Eur Respir J. 2013;42(6):1604–13.CrossRefGoogle Scholar
  30. 30.
    Hempel S, Newberry SJ, Maher AR, et al. Probiotics for the prevention and treatment of antibiotic-associated diarrhea: a systematic review and meta-analysis. JAMA. 2012;307(18):1959–69.CrossRefGoogle Scholar
  31. 31.
    Griffith DE, Brown-Elliott BA, Langsjoen B, et al. Clinical and molecular analysis of macrolide resistance in Mycobacterium avium complex lung disease. Am J Respir Crit Care Med. 2006;174(8):928–34.CrossRefGoogle Scholar
  32. 32.
    van Ingen J, Boeree MJ, van Soolingen D, Mouton JW. Resistance mechanisms and drug susceptibility testing of nontuberculous mycobacteria. Drug Resist Updat. 2012;15(3):149–61.CrossRefGoogle Scholar
  33. 33.
    Griffith DE, Adjemian J, Brown-Elliott BA, et al. Semiquantitative culture analysis during therapy for Mycobacterium avium complex lung disease. Am J Respir Crit Care Med. 2015;192(6):754–60.CrossRefGoogle Scholar
  34. 34.
    Adjemian J, Prevots DR, Gallagher J, Heap K, Gupta R, Griffith D. Lack of adherence to evidence-based treatment guidelines for nontuberculous mycobacterial lung disease. Ann Am Thorac Soc. 2014;11(1):9–16.CrossRefGoogle Scholar
  35. 35.
    van Ingen J, Wagner D, Gallagher J, et al. Poor adherence to management guidelines in nontuberculous mycobacterial pulmonary diseases. Eur Respir J 2017;49(2).Google Scholar
  36. 36.
    Wallace RJ Jr, Brown-Elliott BA, McNulty S, et al. Macrolide/Azalide therapy for nodular/Bronchiectatic: Mycobacterium avium complex lung disease. Chest. 2014;146:276.CrossRefGoogle Scholar
  37. 37.
    Jeong BH, Jeon K, Park HY, et al. Intermittent antibiotic therapy for nodular bronchiectatic Mycobacterium avium complex lung disease. Am J Respir Crit Care Med. 2015;191(1):96–103.CrossRefGoogle Scholar
  38. 38.
    Nahid P, Dorman SE, Alipanah N, et al. Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America clinical practice guidelines: treatment of drug-susceptible tuberculosis. Clin Infect Dis. 2016;63(7):e147-e195.CrossRefGoogle Scholar
  39. 39.
    Matz J, Borish LC, Routes JM, Rosenwasser LJ. Oral desensitization to rifampin and ethambutol in mycobacterial disease. Am J Respir Crit Care Med. 1994;149(3 Pt 1):815–7.CrossRefGoogle Scholar
  40. 40.
    Bermudez LE, Nash KA, Petrofsky M, Young LS, Inderlied CB. Effect of ethambutol on emergence of clarithromycin-resistant Mycobacterium avium complex in the beige mouse model. J Infect Dis. 1996;174(6):1218–22.CrossRefGoogle Scholar
  41. 41.
    Olivier KN, Shaw PA, Glaser TS, et al. Inhaled amikacin for treatment of refractory pulmonary nontuberculous mycobacterial disease. Ann Am Thorac Soc. 2014;11(1):30–5.CrossRefGoogle Scholar
  42. 42.
    Yagi K, Ishii M, Namkoong H, et al. The efficacy, safety, and feasibility of inhaled amikacin for the treatment of difficult-to-treat non-tuberculous mycobacterial lung diseases. BMC Infect Dis. 2017;17(1):558.CrossRefGoogle Scholar
  43. 43.
    Davis KK, Kao PN, Jacobs SS, Ruoss SJ. Aerosolized amikacin for treatment of pulmonary Mycobacterium avium infections: an observational case series. BMC Pulm Med. 2007;7:2.CrossRefGoogle Scholar
  44. 44.
    Safdar A. Aerosolized amikacin in patients with difficult-to-treat pulmonary nontuberculous mycobacteriosis. Eur J Clin Microbiol Infect Dis. 2012;31(8):1883–7.CrossRefGoogle Scholar
  45. 45.
    Olivier KN, Griffith DE, Eagle G, et al. Randomized trial of liposomal Amikacin for inhalation in Nontuberculous mycobacterial lung disease. Am J Respir Crit Care Med. 2017;195(6):814–23.PubMedPubMedCentralGoogle Scholar
  46. 46.
    Griffith DE, Eagle G, Thomson R, Aksamit TR, Hasegawa N, Morimoto K, Addrizzo-Harris DJ, O’Donnell AE, Marras TK, Flume PA, Loebinger MR, Morgan L, Codecasa LR, Hill AT, Ruoss SJ, Yim JJ, Ringshausen FC, Field SK, Philley JV, Wallace RJ Jr, van Ingen J, Coulter C, Nezamis J, Winthrop KL; CONVERT Study Group. Amikacin Liposome Inhalation Suspension for Treatment-Refractory Lung Disease Caused by Mycobacterium avium Complex (CONVERT): a Prospective, Open-Label, Randomized Study. Am J Respir Crit Care Med. 2018.Google Scholar
  47. 47.
    Henkle E, Aksamit T, Barker A, et al. Patient-centered research priorities for pulmonary Nontuberculous mycobacteria (NTM) infection. An NTM research consortium workshop report. Ann Am Thorac Soc. 2016;13(9):S379–84.CrossRefGoogle Scholar
  48. 48.
    Blumberg HM, Burman WJ, Chaisson RE, et al. American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: treatment of tuberculosis. Am J Respir Crit Care Med. 2003;167(4):603–62.CrossRefGoogle Scholar
  49. 49.
    Griffith DE, Philley JV, Brown-Elliott BA, et al. The Significance of Mycobacterium abscessus Subspecies abscessus Isolation During Mycobacterium avium Complex Lung Disease Therapy. Chest. 2015;147(5):1369–75.CrossRefGoogle Scholar
  50. 50.
    Kunst H, Wickremasinghe M, Wells A, Wilson R. Nontuberculous mycobacterial disease and Aspergillus-related lung disease in bronchiectasis. Eur Respir J. 2006;28(2):352–7.CrossRefGoogle Scholar
  51. 51.
    Zoumot Z, Boutou AK, Gill SS, et al. Mycobacterium avium complex infection in non-cystic fibrosis bronchiectasis. Respirology. 2014;19(5):714–22.CrossRefGoogle Scholar
  52. 52.
    Pinel C, Fricker-Hidalgo H, Lebeau B, et al. Detection of circulating Aspergillus fumigatus galactomannan: value and limits of the Platelia test for diagnosing invasive aspergillosis. J Clin Microbiol. 2003;41(5):2184–6.CrossRefGoogle Scholar
  53. 53.
    Woodworth MH, Saullo JL, Lantos PM, Cox GM, Stout JE. Increasing Nocardia incidence associated with bronchiectasis at a tertiary care center. Ann Am Thorac Soc. 2017;14(3):347–54.CrossRefGoogle Scholar
  54. 54.
    Miller WT Jr, Panosian JS. Causes and imaging patterns of tree-in-bud opacities. Chest. 2013;144(6):1883–92.CrossRefGoogle Scholar
  55. 55.
    Falkinham JO 3rd. Reducing human exposure to Mycobacterium avium. Ann Am Thorac Soc. 2013;10(4):378–82.CrossRefGoogle Scholar
  56. 56.
    Kim RD, Greenberg DE, Ehrmantraut ME, et al. Pulmonary nontuberculous mycobacterial disease: prospective study of a distinct preexisting syndrome. American journal of respiratory and critical care medicine. 2008;178(10):1066–74.CrossRefGoogle Scholar
  57. 57.
    Chan ED, Iseman MD. Underlying host risk factors for nontuberculous mycobacterial lung disease. Semin Respir Crit Care Med. 2013;34(1):110–23.CrossRefGoogle Scholar
  58. 58.
    Wolinsky E. Nontuberculous mycobacteria and associated diseases. Am Rev Respir Dis. 1979;119:107–59.PubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Mayo Clinic, Pulmonary Disease and Critical Care MedicineRochesterUSA
  2. 2.University of Texas Health Science CenterTylerUSA

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