Pulmonary infection with mycobacterium xenopi: review of treatment and response.

Abstract

ABsTRAcr Forty seven patients (82 % male) with pulmonary infection caused by Mycobacterium xenopi have been reviewed. Pre-existing lung disease was present in 35 (75 %). In 21 patients the disease was characterised by a subacute illness developing over a period of two to four months, while in another 20 patients there was a longer history of chronic respiratory problems often associated with slowly progressive changes evident from chest radiographs. Response to treatment was poor and unpredictable, and was not related to the results of in vitro sensitivity tests, pre-existing lung disease, or mode of onset of symptoms. Eleven patients (23 %) were cured with chemotherapy. The best drug regimen appeared to be rifampicin and isoniazid combined with either streptomycin or ethambutol. Another 12 (26%) showed favourable responses to drug treatment initially, but eventually relapsed. Four patients had progressive disease while receiving prolonged courses of chemotherapy. Resection was performed in five patients with resultant cure in four. Since the prognosis with drug treatment alone is so unpredictable it is suggested that resection might be part of first line treatment, and that it should usually be performed if patients fail to respond to initial chemotherapy or if they relapse.Published reports have suggested that pulmonary infection with Mycobacterium xenopi responds to antituberculous chemotherapy and carries a relatively good prognosis for cure.'3 Much of the information on which these views are based, however, has been obtained from small series or case reports on individual patients. Moreover, with the exception of a recent paper by Smith and Citron,4 follow up periods have been either short or not documented.'-3 S-9 It has not therefore been possible to assess accurately the effect of chemotherapy or surgery on the long term prognosis of patients with this condition. We have studied 47 patients with M xenopi infection presenting over a 10 year period in an attempt to assess their response to treatment and prognosis for cure and to identify the forms of treatment most likely to lead to successful outcome. MethodsThe names of 90 patients whose sputa had yielded

Epidemiology and Clinical Significance of Nontuberculous Mycobacteria in Patients Negative for Human Immunodeficiency Virus in Switzerland

“…In 15 of these patients, pulmonary disease due to this organism was suspected. Banks et al [77] reviewed treatment and response in patients with pulmonary mycobacteriosis due to M. xenopi in 1984. Of the 47 patients, 39 (83%) were men, and the mean age of the group was 61.5 years (range, 36-84 years).…”

Pulmonary Infection due to Mycobacterium xenopi.

“…He showed satisfactory clinical and bacteriological responses after the regimen was changed, based on the results of susceptibility testing. Banks et al reported that there was a poor correlation between in vitro susceptibility results and clinical response (7). In the present two cases, pulmonary infection due to M. xenopi was successfully treated not with first-line drugs but with drugs to which the organisms had shownin vitro susceptibility.…”

“…Since then, this organism has been isolated both as an environmental contaminant, particularly from hot water systems, and as a presumedetiologic agent of human disease (2)(3)(4). The prevalence of M. xenopi varies geographically, being one of the most commonlyisolated nontuberculous mycobacteria in France (5), England (6,7) and Canada (8), and less commonly identified in the USA (9) and Sweden ( 10). In Japan, few cases have appeared in the literature since the first case of-lung infection due to M. xenopi was reported in 1984 (ll, 12).…”

Management of Infection With Nontuberculosis Mycobacteria

“…Retrospective studies have shown that patients treated for 18-24 mo with regimens that included rifampicin and ethambutol did better than those treated with other regimens or who had shorter durations of treatment (32). The addition of second-or thirdline drugs increased the rate at which adverse events were reported without improving the outcome.…”

“…Therefore, it will be present in multiple specimens, thus passing the test for "significance," although in many such cases it is not responsible for clinical symptoms. In addition, infection with M. xenopi is normally indolent, with disease developing over a number of years (32). Thus, an isolate in an apparently asymptomatic patient cannot be lightly dismissed, especially in HIV-infected individuals.…”