Other established species, including M. mageritense and M. senegalense, have been proposed as members of this group. However, there have been several retrospective and prospective studies of various treatment regimens (341, 344, 345, 347–350). Biphasic media, such as the Septi-Chek System (Becton Dickinson), provide enhanced recovery of most NTM in one system, but these are not rapid detection systems. Treatment regimen options for MAC lung disease are outlined in Table 5. The timing of the positive culture is strongly associated with either relapse or reinfection. Centers for Disease Control and Prevention. In addition, even though rifampin lowers clarithromycin levels more than rifabutin, there is no clear outcome advantage of rifabutin over rifampin in MAC lung disease (266, 275, 276). MAC lung disease also presents with nodular and interstitial nodular infiltrates frequently involving the right middle lobe or lingula, predominantly in postmenopausal, nonsmoking, white females (36, 37, 90, 91, 256). 195 0 obj An important exception is MAC because the differentiation between, 3. A reduction in total white blood cell count below 5,000 cells/μl is also common with doses of rifabutin at 300 to 600 mg/day, although a reduction in white blood cell counts to below 2,000 cells/μl or an absolute granulocyte count of below 1,000 cells/μl is unusual (291). x�+� � | x�+� � |

��% All 116 patients who had four or more MAC isolates had progressive radiographic abnormalities. Many laboratories, however, do not report quantitative smear and culture results, especially those using only liquid (broth) culture media. www.atsjournals.orgtrue2019-11-1510.1164/rccm.201909-1874ST Am J Respir Crit Care Med 2019 ;200: e93 – e142 . 92 0 obj ͐,.�. 3. Meier A, Kirschner P, Burkhardt S, Steingrube VA, Brown BA, Wallace RJ Jr, Bottger E. Identification of mutations in 23S rRNA gene of clarithromycin-resistant, Meier A, Heifets L, Wallace RJ Jr, Zhang Y, Brown BA, Sander P, Bottger EC. Interest in developing new drugs with mycobacterial disease activity is limited by the lack of economic return for these relatively rare diseases. Rifabutin toxicity is dose related, common, and frequently requires dosage adjustment.

The M. smegmatis group is currently composed of M. smegmatis and the recently described M. wolinskyi and M. goodii. The alternative concept of “strong risk factors,” for example, known colonization of methicillin-resistant. endobj Some of the important unresolved controversies in the management of MAC lung disease are outlined in Table 4. Several investigators have reported a lack of consistency and correlation between clinical response and in vitro antimicrobial susceptibilities among strains, which may be at least partially explained by differences in susceptibility techniques (197, 400, 402, 405, 406). Although several reports have suggested that the incidence of NTM diseases has increased over the past several decades, this observation has not been conclusively established due to the lack of comprehensive surveillance efforts. We weighed the comments made by displaying the number of experts who made the same or similar statement concerning a certain guideline recommendation. endstream

endstream

͐,.�. There have been no comparative trials of treatment regimens for skin and soft tissue infections due to M. marinum but a reasonable approach is to treat with two active agents for 1 to 2 months after resolution of symptoms, typically 3 to 4 months in total (410). False-positive cultures also delay the ordering of tests to identify an alternative diagnosis. Previous unsuccessful or failed therapy for MAC lung disease, with or without a macrolide, decreases the chances for subsequent treatment success, even with macrolide-susceptible MAC isolates (, 7. Withholding therapy for these patients has no benefit.
The utility of fine needle aspiration for obtaining diagnostic material is variable (199–201). In the first published study of macrolide-containing regimens for MAC lung disease, clarithromycin was given in doses of 500 to 2,000 mg per day in a multicenter open trial to HIV-negative patients with MAC lung disease (269). The isolation of high catalase, MacSwiggan DA, Collins CH. ͐,.�. However, HRCT of the chest is now routinely indicated to demonstrate the characteristic abnormalities of nodular/bronchiectatic NTM lung disease. endstream The distribution of these discrete granulomas is generally centrilobular and bronchiocentric, differentiating MAC hypersensitivity-like lung from sarcoidosis or other hypersensitivity pneumonitis.

The two major risk factors for macrolide-resistant MAC disease are macrolide montherapy or treatment with macrolide and inadequate companion medications (274). Semiquantitative (0–4+) reporting of NTM colony counts on solid media is recommended by the CLSI. 81 0 obj The transmissibility of other pathogens between patients with CF, such as Burkholderia cepacia, and the frequent aggregation of patients on hospital wards for prolonged periods of time raise questions about person-to-person transfer or nosocomial acquisition from institutional water supplies. Wallace RJ Jr, Brown BA, Griffith DE. There is no recommended prophylaxis or suppressive regimen for disseminated M. kansasii disease. “Flu-like” syndrome, thrombocytopenia, renal failure, Clinical symptoms; platelet count, serum creatinine as indicated, Polymyalgia, polyarthralgia, leukopenia, granulocytopenia, anterior uveitis (rifabutin with clarithromycin), Vestibular/auditory toxicity (dizziness, vertigo, ataxia, tinnitus, hearing loss), Clinical symptoms including changes in hearing, ability to walk, dizziness; periodic hearing tests in high-risk patients or those with auditory/vestibular symptoms; periodic amikacin serum levels, Gastrointestinal disturbance (nausea, vomiting, diarrhea), Periodic alkaline phosphatase, AST and ALT for first 3 mo, Inhibited hepatic metabolism of several agents, including rifabutin, some protease inhibitors, Monitor clinical status and appropriate serum levels when possible, Central nervous system (headache, insomnia), Central nervous system (insomnia, agitation, anxiety), Hypersensitivity (fever, rash, eosinophilia), Cutaneous (photosensitivity, rash, hyperpigmentation), Central nervous system (dizziness, vertigo [minocycline]), Sulfonamides, trimethoprim/sulfamethoxazole, Hematologic (leukopenia, anemia, thrombocytopenia), Hypersensitivity (fever, rash, Stevens-Johnson syndrome), Central nervous system (seizures, confusion state), Hematologic (leukopenia, anemia, thrombocytopenia, pancytopenia). Maloney S, Welbel S, Daves B, Adams K, Becker S, Bland L, Arduino M, Wallace RJ Jr, Zhang Y, Buck G. Carson LA, Bland LA, Cusick LB, Favero MS, Bolan GA, Reingold AL, Good RC. endobj Expert consultation may be helpful for making this decision. Perhaps the highest priority and one that would facilitate most of the other NTM research questions and goals is a mechanism for reporting or collecting data on all patients diagnosed with NTM diseases. <>>>/BBox[0 0 584.96 782.99]/Length 47>>stream New species were defined on the ability to phenotypically separate the new taxon from established species. 121 0 obj However, broth media cultures alone may not be satisfactory because of bacterial overgrowth. <>stream

endstream IFN-γ and IL-12 control mycobacteria in large part through the up-regulation of tumor necrosis factor (TNF)-α, made predominantly by monocytes/macrophages.

The time (in days) to detection of mycobacterial growth should be stated on the laboratory report (C, III). Symptomatic improvement is also important, but can be complicated by the progression or exacerbation of underlying diseases such as bronchiectasis and COPD. Rubin BK, Henke MO. The remaining NTM are listed in alphabetical order by species name. There are, however, significant limitations to the wide application of these findings.

Pulmonary tuberculosis and. �B Novick RJ, Moreno-Cabral CE, Stinson EB, Oyer PE, Starnes VA, Hunt SA, Shumway NE. Document No. 160 0 obj 199 0 obj

Empiric therapy for TB, especially with positive AFB smears and results of nucleic acid amplification testing, may be necessary pending confirmation of the diagnosis of NTM lung disease (C, III). ͐,.�. In vivo response to therapy may not correlate with in vitro susceptibility. Community-acquired polymicrobial pneumonia in the intensive care unit: aetiology and prognosis. In support for MAC as a pathogen in this setting, HIV-seronegative patients with clusters of small nodules in the periphery of the lung associated with ectatic changes of the draining bronchi frequently have positive respiratory cultures for MAC and granulomatous inflammation recovered by transbronchial biopsy, suggesting tissue invasion by MAC rather than airway colonization (109). Many clinicians add a rifamycin as the third drug in the treatment of disseminated MAC, although it is not certain that there is added benefit. 15 0 obj Smear results were positive in 26% of culture-positive specimens.

Imipenem may still be useful clinically in treatment regimens for these organisms. ��w3T0WI�2T0 BC#KC=3CK��\. No other drugs are recommended for susceptibility testing of new, previously untreated MAC isolates.

Resistance to isoniazid and ethambutol acquired on therapy may also occur, but resistance to these agents is usually associated with resistance to rifampin (68). Seventeen of 29 patients (59%) with at least 6 months of therapy had sputum conversion with 12 months of negative sputum AFB cultures. Research Committee of the British Thoracic Society. Long-term linezolid therapy at usually recommended antibacterial doses (600 mg twice daily) is often associated with severe side effects, such as anemia, peripheral neuropathy, nausea, and vomiting. Other species known to be present in tap water that may reflect contamination when recovered from a single sample include M. simiae and M. lentiflavum.

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