Nontuberculous Mycobacteria (NTM) Infections Mycobacterial species other than those belonging to the Mycobacterium tuberculosis complex and M. leprae Found In: • Water/soil • Domestic and wild animals • Milk • Food products Risk Factors For NTM Infections: • Immunocompromised status • Chronic lung disease • Postoperative status NTM Cause Many Illnesses: • Pulmonary • Skin & Soft tissue • Lymphadenitis • Catheter related bloodstream infections • Disseminated infections Lungs: • 90% of patient encounters due to NTM: Chronic lung infections • Nodular or cavitary lesions - Centrilobular nodules - Bronchiectasis - Tree-in-bud opacities Lady Windermere Syndrome: • Syndrome of right middle lobe or lingular infiltrates. Noted in older women without predisposing lung disease, volume loss, adenopathy, or cavitation. Slow Growers (Runyon Classification grp I-III): Pulmonary: • MAC • M kansasii • M xenopi • M malmoense Disseminated: • MAC • M kansasii • M haemophilum • M marinum • M genavense Skin/Soft Tissue/Catheter: • MAC • M marinum • M haemophilum Lymphadenitis: • MAC Rapid Growers (Runyon Classification grp IV): Pulmonary: • M abscessus - M. abscessus, M. chelonae, and M. fortuitum can produce lung disease, adenitis, skin and soft tissue infections, surgical site infections, and prosthetic device infections. Disseminated: • M chelonae • M abscessus • M fortuitum Skin/Soft Tissue/Catheter: • M abscessus • M chelonae • M fortuitum • M mucogenicum Lymphadenitis: • M. abscessus • M. fortuitum • M. scrofulaceum • M. malmoense NTM Pearls: • Corneal disease: M. chelonae • Healthcare/hygiene outbreaks: M. chelonae, M. fortuitum, M. abscessus • Line associated: M. mucogenicum • HIV: MAC, M. kansasii, M. genavense, M. haemophilum • Tropical setting: M. ulcerans (buruli ulcer) • M. gordonae - 99.9% a contaminant • NTM not communicable: Except M. massiliense in CF • Cross reacts with IGRAs: M. kansasii, M. marinarum, M. szulgai • M. fortuitum fish tank disease: Aspiration • M. marinum - fish/fish tanks • Footbaths: M. fortuitum or other RGM • Plastic surgery: M. chelonae/Other RGM • Cardiac surgery: M. chimaera M. Kansasii: • Mimics TB with: Cavitary lung disease. • Predisposing conditions: Underlying lung disease, alcohol, cancer, and immunocompromised status. M. Avium Complex (MAC): • Acquired from the environment • Municipal water sources may be an important source • MAC Encompasses: - M. avium - M. intracellulare - M. chimaera, M. colombiense, M. interjectum - M. timonense - M. bouchedurhonense, M. vulneris, and M. yongonense Disseminated Disease: • Disseminated MAC disease may complicate MAC pulmonary disease through local multiplication and entry into the bloodstream - seeding of other organs and tissues. • Primarily occurs in severely immunocompromised patients such as: 1. Advanced HIV (CD4 cell counts less than 50/μL) 2. Hematologic malignancy 3. History of immunosuppressive therapy including therapy with tumor necrosis alpha inhibitors • Presentation: Fever, night sweats, weight loss, and gastrointestinal symptoms (elevations of liver enzymes, diarrhea, abdominal pain, hepatomegaly.) - Bone Marrow - Anemia, neutropenia - Lymphoreticular - Adenopathy, Hepatosplenomegaly - Lung - Cough and lung infiltrates NTM Pulmonary Disease: Clinical Manifestations: • Fever (>80 percent), • Cough (productive or dry) • Night sweats (>35 percent) • Fatigue, • Malaise, • Weakness, • Dyspnea, • Chest discomfort, • +/- Hemoptysis. • Fever and weight loss occur less frequently than in patients with typical tuberculosis. Diagnosis Of NTM Lung Disease: • Clinical (Symptoms, Imaging, high res CT) • Exclusion of other diagnosis • Microbiologic studies (Sputum, bronchial washings, Lung biopsy) by Dr. Kushal Vaishnani @k_vaishnani and Ravi Singh @rav7ks #Nontuberculous #Mycobacteria #NTM #Infections #differential #diagnosis #infectiousdiseases
