Pulmonary Disease Caused by Non-Tuberculous Mycobacteria

Wassilew, Nasstasja; Hoffmann, Harald; Andréjak, Claire; Lange, Christoph

doi:10.1159/000445906

Cited by 128 publications

(104 citation statements)

References 128 publications

(183 reference statements)

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“…Nontuberculous mycobacterium (NTM) is ubiquitous in the environment, frequently isolated from water and soil [1,2]. Thus, most NTM organisms detected from human samples have been considered as colonization or contamination.…”

Section: Introductionmentioning

confidence: 99%

Clinical Features and Prognosis of Nontuberculous Mycobacterial Pleuritis

et al. 2018

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Background: While nontuberculous mycobacterial (NTM) pleuritis rarely complicates pulmonary NTM infection, high mortality has been reported in case reports and small studies. Objectives: The purpose of this study was to clarify the clinical features and treatment outcomes of pulmonary NTM infection cases accompanied by NTM pleuritis. Methods: Medical records of 1,044 patients with pulmonary NTM disease were retrospectively reviewed to select patients complicated by NTM-proven pleuritis. We investigated clinical characteristics, pathogens, pleural effusion examinations, radiographic findings, treatments, and clinical course of the NTM pleuritis patients. Results: Among 1,044 cases with pulmonary NTM, NTM pleuritis occurred in 15 cases (1.4%). The mean age was 69 years with a performance status of mostly 2 or better (80.0%), and 6 cases (40.0%) were complicated by pneumothorax. Subpleural cavities were radiologically detected in 11 cases (73.3%), and extrapulmonary air-fluid level was detected in 14 cases (93.3%). Eleven patients were treated with combinations of 2–4 antimycobacterial drugs, including clarithromycin, and 2 patients were treated with isoniazid, rifampicin, and ethambutol. Chest tube drainage was performed in 11 cases, and surgical approach was added in 6 cases. The pleural effusion of 2 patients treated with only antimycobacterial medications gradually deteriorated. Two patients died from NTM pleuritis, and 1 patient died from pneumonitis during a mean of 1.8 years of follow-up. Conclusions: Comorbid NTM pleuritis was difficult to treat by medical therapy alone and resulted in a poor prognosis. In addition to antimycobacterial agents, chest tube drainage and surgical procedures in the early stages should be considered to treat NTM pleuritis.

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Section: Introductionmentioning

confidence: 99%

Clinical Features and Prognosis of Nontuberculous Mycobacterial Pleuritis

et al. 2018

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“…These include the repeated isolation of mycobacteria from respiratory samples, compatible clinical and radiological presentation, and the exclusion of any alternative diagnosis. Nevertheless, these criteria are not generally applicable to all patients with NTM-PD in the same manner [34]. They may for example differ between patients with nodular-bronchiectatic and those with fibrocavitary disease, with the latter disease often necessitating a more aggressive treatment approach.…”

Section: Current Standardized Management Approachmentioning

confidence: 99%

“…Different management approaches depending on the NTM species isolated, the underlying diseases, or different disease presentations (e.g. nodular-bronchiectatic vs. fibrocavitary disease) are discussed but not established [34]. There is a severe lack of knowledge about the correlation of in vitro susceptibility with in vivo efficacy of antimicrobial drugs, making DST-guided therapy difficult [37].…”

Section: Is Personalized Medicine Established For Treatment Of the DImentioning

confidence: 99%

“…Newly proposed short-course regimens of 9-12 months are rarely applicable for patients in Europe (manuscript submitted). Treatment for CPA and NTM-PD is generally recommended for 6 and 12 months, respectively, despite large intrapatient variability in disease severity and response to therapy [34,49]. …”

Section: Future Perspective: Personalized Medicine To Improve Clinicamentioning

confidence: 99%

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Personalized Medicine for Chronic Respiratory Infectious Diseases: Tuberculosis, Nontuberculous Mycobacterial Pulmonary Diseases, and Chronic Pulmonary Aspergillosis

et al. 2016

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Chronic respiratory infectious diseases are causing high rates of morbidity and mortality worldwide. Tuberculosis, a major cause of chronic pulmonary infection, is currently responsible for approximately 1.5 million deaths per year. Although important advances in the fight against tuberculosis have been made, the progress towards eradication of this disease is being challenged by the dramatic increase in multidrug-resistant bacilli. Nontuberculous mycobacteria causing pulmonary disease and chronic pulmonary aspergillosis are emerging infectious diseases. In contrast to other infectious diseases, chronic respiratory infections share the trait of having highly variable treatment outcomes despite longstanding antimicrobial therapy. Recent scientific progress indicates that medicine is presently at a transition stage from programmatic to personalized management. We explain current state-of-the-art management concepts of chronic pulmonary infectious diseases as well as the underlying methods for therapeutic decisions and their implications for personalized medicine. Furthermore, we describe promising biomarkers and techniques with the potential to serve future individual treatment concepts in this field of difficult-to-treat patients. These include candidate markers to improve individual risk assessment for disease development, the design of tailor-made drug therapy regimens, and individualized biomarker-guided therapy duration to achieve relapse-free cure. In addition, the use of therapeutic drug monitoring to reach optimal drug dosing with the smallest rate of adverse events as well as candidate agents for future host-directed therapies are described. Taken together, personalized medicine will provide opportunities to substantially improve the management and treatment outcome of difficult-to-treat patients with chronic respiratory infections.

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“…The latter is not specific to NTM infections, but the presence of bronchiectasis has been suggested to be typical in patients with Myobacterium avium complex infection. Generally, the clinical course of nodular-bronchiectatic disease seems less aggressive than that of fibrocavitary disease in NTM pulmonary disease [6] . The particularity of the CT image of the RMPL phenotype should always direct the attention to NTM disease as an important differential diagnosis.…”

mentioning

confidence: 94%