Diagnosis dan Tatalaksana Penyakit Paru Nontuberculous mycobacteria

Abstract

AbstrakNontuberculous mycobacteria (NTM) juga dikenal dengan atypical mycobacteria atau mycobacteria other than tuberculosis merupakan organisme patogen oportunistik yang dapat menyebabkan penyakit paru progresif. Spesies yang paling banyak ditemukan adalah Mycobacteria avium complex (MAC), M. kansasii, M. malmose, dan M. xenopi. Diagnosis penyakit paru NTM berdasarkan manisfestasi klinis dan radiologis (fibrokavitas dan bronkiektasis nodular). Kultur merupakan standar emas untuk konfirmasi laboratorium dari NTM dan diperlukan untuk identifikasi genotipe dan drug suscebtibility test (DST). Antibiotik golongan makrolida seperti azitromisin dan klaritomisin merupakan terapi dasar untuk infeksi paru NTM. Rekomendasi menganjurkan terapi kombinasi makrolida (azitromisin atau klaritromisin), rifampin atau rifabutin, dan etambutol dengan atau tanpa aminoglikosida intravena. Terapi medikamentosa dilakukan secara kontiniu diberikan minimal selama 12 bulan setelah didapatkan biakan sputum negatif. AbstractNontuberculous mycobacteria (NTM) also known as atypical mycobacteria or mycobacteria other than tuberculosis is an opportunistic pathogen organism that cause progressive pulmonary disease. The most commonly found species are MAC, M. kansasii, M.malmose, and M. xenopi. Diagnosis of NTM pulmonary disease consist of clinical and radiological thorax x-ray manifestations (fibrocavities and nodular bronchiectasis). Culture is the gold standard for laboratory confirmation from NTM and needed for genotype identification and drug susceptibility test (DST). Macrolide antibiotics such as azithromycin and clarithomycin are the basic therapies for NTM lung infection. Recommendations suggest combination macrolide therapy (azithromycin or clarithromycin), rifampin or rifabutin, and ethambutol with or without intravenous aminoglycosides. Medical therapy is continuously given for a minimum of 12 months after negative sputum cultures are obtained.

Risk Factors and Prognosis of Nontuberculous Mycobacteria Infection in a High Prevalence of Tuberculosis Setting

“…These results indicate that patients with NTM lung infection who did not receive antibiotic therapy had a prognosis 18.93 times worse than patients with NTM lung infection who received combination antibiotic therapy and patients with NTM lung infection who received single antibiotic therapy had a prognosis 0.70 times worse than patients with NTM lung infections receiving combination antibiotic therapy. The American Thoracic Society (ATS) in 2007 recommended combination therapy of macrolides (azithromycin or clarithromycin), rifampin or rifabutin with ethambutol with or without intravenous aminoglycosides (Griffith et al, 2007;Juita and Fauzar, 2018). In this study, 68.50% of patients received antibiotic therapy with macrolide (azithromycin or clarithromycin) rifampin or rifabutin and ethambutol with or without intravenous aminoglycosides, but 11.20% were still given single antibiotic therapy and as many as 20.30% were not given antibiotics.…”

“…This bacteria easily transmitted through water and air. Chronic pulmonary disease is the most common clinical manifestation (65-90%) (Stout et al, 2016;Juita and Fauzar, 2018). The prevalence and incidence of NTM infections in the world in general have continued to increase in the last two to three decades.…”