Early onset of nontuberculous mycobacterial pulmonary disease contributes to the lethal outcome in lung transplant recipients: report of two cases and review of the literature

Abstract

Lung transplant (LuTx) recipients represent a population at risk of nontuberculous mycobacterial pulmonary disease (NTM-PD). Yet the risk factors, the timing of NTM-PD after transplantation, and the association with allograft dysfunction all remain poorly defined. We report 2 cases of early-onset NTM-PD and review the literature, focusing on NTM-PD in LuTx recipients not colonized with NTM prior to transplantation. In addition, we summarize the main characteristics and differences between early- and late-onset disease.

Mycobacterium abscessus disease in lung transplant recipients: Diagnosis and management

“…MAbsC is a group of ubiquitous organisms that can cause significant morbidity, including chronic pulmonary infections and skin and soft tissue infections in lung transplant recipients, which can be challenging to treat in this patient population [36]. The overall incidence of NTM seems also to be increasing, and providers involved in the care of lung transplant candidates and recipients should screen patients at risk and have high clinical suspicion for these mycobacterial infections.…”

“…Disease in immunosuppressed lung transplant recipients ranges from pulmonary disease, lymph node involvement, localized cutaneous lesions, thoracotomy wound infection, sternal osteomyelitis, empyema to disseminated infections [6], [7], [21]. Most common initial presentation is pulmonary disease followed by cutaneous lesions [5], [21], [36].…”

“…MAbsC , in particular MAA and MAB, are resistant to many antimicrobial agents [4], [16], [43]. In vitro antibiotic susceptibilities correlation with in vivo response is supported by limited data [16], [18], [36]. The Clinical and Laboratory Standards Institute recommends testing the RGM for susceptibility to macrolides, aminoglycosides, cefoxitin, imipenem, tigecycline, fluoroquinolones, linezolid and doxycycline.…”

“…Clofazamine may be a treatment option for macrolide resistant or intolerant regimen. Inhaled amikacin may have some benefits in patients with refractory MAbsC disease although its role is still not very clear [36], [49]. However, the combination of clofazamine with amikacin or clarithromycin is synergistic in vitro [50], therefore and at least in theory, the combined use of inhaled amikacin with clofazimine and a macrolide might enhance the microbiological control of the infection at the airway and cavitary disease levels.…”

Combined Application of Juniperus communis Essential Oil and Amikacin, Clarithromycin and Rifampicin against Mycobacterium avium and Mycobacterium intracellulare

“…They are characterized by a distinct ability to form biofilms in water and on various surfaces. In the middle of the last century, many authors noticed the pathogenic potential of NTM, which especially came to the fore with the appearance of acquired immunodeficiency syndrome (AIDS) and other immunodeficiency conditions in patients with oncological, hematological, autoimmune and rheumatological diseases and after organ transplantation [2][3][4][5][6][7][8][9]. A recent study of the use of inhaled corticosteroids in chronic respiratory diseases, especially chronic obstructive pulmonary disease and asthma, indicates that such patients have a 16.5 times higher risk of NTM infection [10].…”