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Nontuberculous mycobacterial infections of the lung

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Abstract

There is an increasing appreciation for the role of nontuberculous mycobacteria (NTM) as pathogens causing pulmonary disease, disseminated disease, or both in immunocompetent and immunocompromised individuals. Species previously considered nonpathogenic have been shown to cause pulmonary infection. The majority of immunocompetent patients with NTM pulmonary infection have underlying lung disease. New diagnostic techniques such as gene probes, gas-liquid and high-pressure chromatography, and polymerase chain reaction offer significant advantages in the rapid identification of NTM species. Some of these techniques allow identification of mycobacteria directly from clinical specimens. The fluoroquinolones, rifabutin, and newer macrolides offer advances in the treatment of infections that are caused by NTM and are resistant to the traditional antimycobacterial drugs.

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References and Recommended Reading

  1. Roberts GD, Bottger EC, Stockman L: Methods for the rapid identification of mycobacterial species. Clin Lab Med 1996, 16:603–615.

    PubMed  CAS  Google Scholar 

  2. American Thoracic Society: Diagnosis and treatment of disease caused by nontuberculous mycobacteria. Am J Respir Crit Care Med 1997, 156(suppl):S1-S25. This comprehensive review of the diagnosis, microbiology, and treatment of NTM infections includes the updated and revised diagnostic criteria.

    Google Scholar 

  3. Comincini S, Barbarini D, Telecco D, et al.: Rapid identification of Mycobacterium tuberculosis and Mycobacterium avium by polymerase chain reaction and restriction enzyme analysis within sigma factor regions. Microbiologica 1998, 21:391–395.

    PubMed  CAS  Google Scholar 

  4. Covert TC, Rodgers MR, Reyes AL, et al.: Occurrence of nontuberculous mycobacteria in environmental samples. Appl Environ Microbiol 1999, 65:2492–2496. This interesting study examines the widespread occurrence of NTM in water samples from a wide geographic area and raises the possibility that exposure to drinking water containing NTM could pose a health risk to immunocompromised hosts.

    PubMed  CAS  Google Scholar 

  5. Wallace RJ Jr, Brown BA, Griffith DE: Nosocomial outbreaks/ pseudooutbreaks caused by nontuberculous mycobacteria. Ann Rev Microbiol 1998, 52:453–490. This review of nosocomial outbreaks and pseudo-outbreaks attributed to NTM covers epidemiology, microbiology, pathogenesis, and new molecular diagnostic techniques.

    Article  CAS  Google Scholar 

  6. Falkingham JO: Epidemiology of infection by nontuberculous mycobacteria. Clin Microbiol Rev 1996, 9:177–215.

    Google Scholar 

  7. Bloch KC, Zwerling L, Pletcher MJ, et al.: Incidence and clinical implications of isolation of Mycobacterium kansasii: results of a 5-year, population based study. Ann Intern Med 1998, 129:698–704. This is an excellent review of the epidemiology, clinical presentation, and treatment of M. kansasii infections in immunocompetent and HIV-infected patients.

    PubMed  CAS  Google Scholar 

  8. Corbett EL, Blumberg L, Churchyard GJ, et al.: Nontuberculous mycobacteria: defining disease in a prospective cohort of South African miners. Am J Respir Crit Care Med 1999, 160:15–21.

    PubMed  CAS  Google Scholar 

  9. Ilnuma Y, Ichiyama S, Hasegawa Y, et al.: Large restriction fragment analysis of Mycobacterium kansasii genomic DNA and its application in molecular typing. J Clin Microbiol 1997, 35:596–599.

    Google Scholar 

  10. Richter E, Niemann S, Rusch-Gerdes S, et al.: Identification of Mycobacterium kansasii by using a DNA probe (AccuProbe) and molecular techniques. J Clin Microbiol 1999, 37:964–970.

    PubMed  CAS  Google Scholar 

  11. Evans SA, Colville A, Evans AJ, et al.: Pulmonary Mycobacterium kansasii infection: comparison of the clinical features, treatment and outcome with pulmonary tuberculosis. Thorax 1996, 51:1248–1252.

    PubMed  CAS  Google Scholar 

  12. Anzalone G, Cei M, Vizzaccaro A, et al.: M. kansasii pulmonary disease in idiopathic CD4+ T-lymphopenia. Eur Respir J 1996, 9:1754–1756.

    Article  PubMed  CAS  Google Scholar 

  13. Yamada H, Kohyama T, Terashi K, et al.: Fatal pulmonary infection due to multidrug resistant Mycobacterium kansasii developed in an immunocompetent young man. Intern Med 1997, 36:298–300.

    PubMed  CAS  Google Scholar 

  14. Griffith DE: Mycobacteria as pathogens of respiratory infection. Infect Dis Clin North Am 1998, 12:593–609. This is a comprehensive review of the epidemiology, clinical presentation, and treatment of NTM and M. tuberculosis infections in normal and immunocompromised hosts.

    Article  PubMed  CAS  Google Scholar 

  15. Alangaden GJ, Lerner SA: The clinical use of fluoroquinolones for the treatment of mycobacterial diseases. Clin Infect Dis 1997, 25:1213–1221.

    PubMed  CAS  Google Scholar 

  16. Valero G, Peters J, Jorgensen JH, et al.: Clinical isolates of Mycobacterium simiae in San Antonio, Texas: an 11 year review. Am J Respir Crit Care Med 1995, 152:1555–1557.

    PubMed  CAS  Google Scholar 

  17. Vogiatzakis E, Stefanou S, Skroubelou A, et al.: Molecular markers for the investigation of Mycobacterium gordonae epidemics. J Hosp Infect 1998, 38:217–222.

    Article  PubMed  CAS  Google Scholar 

  18. Resch B, Eber E, Beitzke A, et al.: Pulmonary infection due to Mycobacterium gordonae in an adolescent immunocompetent patient. Respiration 1997, 64:300–303.

    PubMed  CAS  Google Scholar 

  19. Swanson DS, Pan X, Musser JM: Identification and subspecific differentiation of Mycobacterium scrofulaceum by automated sequencing of a region of the gene (hsp65) encoding a 65-kilodalton heat shock protein. J Clin Microbiol 1996, 34:3151–3159.

    PubMed  CAS  Google Scholar 

  20. Hsueh P, Hsiue T, Jarn J, et al.: Disseminated infection due to Mycobacterium scrofulaceum in an immunocompetent host. Clin Infect Dis 1996, 22:159–161.

    PubMed  CAS  Google Scholar 

  21. Tortoli E, Besozzi G, Lacchini C, et al.: Pulmonary infection due to Mycobacterium szulgai: case report and review of the literature. Eur Respir J 1998, 11:975–977.

    Article  PubMed  CAS  Google Scholar 

  22. Tsuyuguchi K, Amitani R, Matsumoto H, et al.: A resected case of Mycobacterium szulgai pulmonary disease. Int J Tuberc Lung Dis 1998, 2:258–260.

    PubMed  CAS  Google Scholar 

  23. Jiva T, Jacoby H, Weymouth L, et al.: M. xenopi: innocent bystander or emerging pathogen? Clin Infect Dis 1997, 24:226–232. This study investigates the clinical significance of M. xenopi isolation and reviews the clinical spectrum of disease. The authors conclude that M. xenopi is a potential pathogen that can cause morbidity in patients with chronic lung disease or impaired immunity.

    PubMed  CAS  Google Scholar 

  24. Aronson T, Holtzman A, Glover N, et al.: Comparison of large restriction fragments of Mycobacterium avium olates from AIDS and non-AIDS patients with those of isolates from potable water. J Clin Microbiol 1999, 37:1008–1012.

    PubMed  CAS  Google Scholar 

  25. Kansal RG, Gomez-Flores R, Mehta RT: Change in colony morphology influences the virulence as well as the biochemical properties of the Mycobacterium avium complex. Microb Pathog 1998, 25:203–214.

    Article  PubMed  CAS  Google Scholar 

  26. Hartmann P, Plum G: Immunological defense mechanisms in tuberculosis and MAC-infection. Diagn Microbiol Infect Dis 1999, 34:147–152. This is an interesting review of the immunologic mechanisms in tuberculosis and MAC infection.

    Article  PubMed  CAS  Google Scholar 

  27. Viljanen MK, Olkkonen L, Katila M: Conventional identification characteristics, mycolate and fatty acid composition, and clinical significance of MAIX AccuProbe-positive isolates of Mycobacterium avium complex. J Clin Microbiol 1993, 31:1376–1378.

    PubMed  CAS  Google Scholar 

  28. Matsumoto H, Tsuyuguchi K, Suzuki K, et al.: Evaluation of Roche Amplicor PCR assay for Mycobacterium avium complex in bronchial washing. Int J Tuberc Lung Dis 1998, 2:935–940.

    PubMed  CAS  Google Scholar 

  29. Epstein MD, Aranda CP, Bonk S, et al.: The significance of Mycobacterium avium complex cultivation in the sputum of patients with pulmonary tuberculosis. Chest 1997, 111:142–147.

    PubMed  CAS  Google Scholar 

  30. Fujita J, Ohtsuki Y, Suemitsu I, et al.: Pathological and radiological changes in resected lung specimens in Mycobacterium avium complex disease. Eur Respir J 1999, 13:535–540.

    Article  PubMed  CAS  Google Scholar 

  31. Kubo K, Yamazaki Y, Hachiya T, et al.: Mycobacterium aviumintracellulare pulmonary infection in patients without known predisposing lung disease. Lung 1998, 176:381–391. This excellent study characterizes the clinical features and radiologic and bronchoalveolar lavage findings in patients with MAC without predisposing lung disease. It suggests an association with mucociliary dysfunction.

    Article  PubMed  CAS  Google Scholar 

  32. Tanaka E, Amitani R, Niimi A, et al.: Yield of computed tomography and bronchoscopy for the diagnosis of Mycobacterium avium complex pulmonary disease. Am J Respir Crit Care Med 1997, 155:2041–2046.

    PubMed  CAS  Google Scholar 

  33. Wallace RJ Jr, Zhang Y, Brown BA, et al.: Polyclonal Mycobacterium avium complex infection in patients with nodular bronchiectasis. Am J Respir Crit Care Med 1998, 158:1235–1244. This study demonstrates the polyclonality of MAC strains in patients with the nodular bronchiectatic form of disease as compared with single strains in upper-lobe cavitary disease.

    PubMed  Google Scholar 

  34. Embil J, Warren P, Yakrus M, et al.: Pulmonary illness associated with Mycobacterium avium complex in hot tub water: hypersensitivity pneumonitis or infection? Chest 1997, 111:813–816.

    PubMed  CAS  Google Scholar 

  35. Griffith DE, Brown BA, Girard WM, et al.: Azithromycin activity against Mycobacterium avium complex lung disease in patients who were not infected with human immunodeficiency virus. Clin Infect Dis 1996, 23:983–989.

    PubMed  CAS  Google Scholar 

  36. Al-Moamary MS, Black W, Elwood K: Pulmonary disease due to Mycobacterium malmoense in British Columbia. Can Respir J 1998, 5:135–138.

    PubMed  CAS  Google Scholar 

  37. Kiehn TE, White M, Pursell KJ, et al.: A cluster of four cases of Mycobacterium haemophilum infection. Eur J Clin Microbiol Infect Dis 1993, 12:114–118.

    Article  PubMed  CAS  Google Scholar 

  38. Levett PN, Brown PD, Hector S, et al.: Clustering of cases of Mycobacterium fortuitum infection investigated by molecular typing. West Indian Med J 1999, 48:16–19.

    PubMed  CAS  Google Scholar 

  39. Hadjiliadis D, Adlakha A, Prakash U: Rapidly growing mycobacterial lung infection in association with esophageal disorders. Mayo Clin Proc 1999, 74:45–51. This comprehensive review of infections caused by rapidly growing mycobacteria in patients with esophageal disorders describes the clinical features, radiology, and microbiology.

    PubMed  CAS  Google Scholar 

  40. Jouannic I, Desrues B, Léna H, et al.: Exogenous lipoid pneumonia complicated by Mycobacteria fortuitum and Apergillus fumigatus infections. Eur Respir J 1996, 9:172–174.

    PubMed  CAS  Google Scholar 

  41. Jacobson K, Garcia H, Libshitz H, et al.: Clinical and radiological features of pulmonary disease caused by rapidly growing mycobacteria in cancer patients. J Clin Microbiol Infect Dis 1998, 17:615–621.

    CAS  Google Scholar 

  42. Wallace RJ, Meier A, Brown BA, et al.: Genetic basis for clarithromycin resistance among isolates of Mycobacterium chelonae and Mycobacterium abscessus. Antimicrob Agents Chemother 1996, 40:1676–1681.

    PubMed  CAS  Google Scholar 

  43. Prammananan T, Sander P, Brown BA, et al.: A single 16S ribosomal RNA substitution is responsible for resistance to amikacin and other 2-deoxystreptamine aminoglycosides in Mycobacterium abscessus and Mycobacterium chelonae. J Infect Dis 1998, 177:1573–1581.

    Article  PubMed  CAS  Google Scholar 

  44. Wallace RJ Jr: Treatment of infections caused by rapidly growing mycobacteria in the era of newer macrolides. Res Microbiol 1996, 147:30–35.

    Article  PubMed  CAS  Google Scholar 

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Kourbeti, I.S., Maslow, M.J. Nontuberculous mycobacterial infections of the lung. Curr Infect Dis Rep 2, 193–200 (2000). https://doi.org/10.1007/s11908-000-0035-7

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