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Pulmonary Atypical Mycobacterial Infection

Lung Mycobacterium Infection Atypical


Presentation

  • Hot tub lung: an intriguing diffuse parenchymal lung disease Abstract In pulmonary medicine, identical pathogenesis due to varied etiological agents can present with indistinguishable clinical presentation, and produce similar laboratory and radiological[ajol.info]
  • Histologically, granulomatous inflammation, with or without necrosis, is present.[uscapknowledgehub.org]
  • This is known as Lady Windermere syndrome. [ 6 ] MAC can also present as a hypersensitivity pneumonitis.[patient.info]
  • A retrospective study has been presented at the American Thoracic Society in this matter and was very well received.[kamelharpulmonary.com]
  • It can present as an acute pulmonary illness with fever and dyspnea. The pathology of hot tub lung is thought to be related to an infection, a hypersensitivity reaction (the latter is more favoured) or both.[radiopaedia.org]
Cough
  • If your primary care provider cannot help your chronic cough, you might need to see a lung specialist.[lung.org]
  • That makes it hard for you to cough up and clear out mucus. Older women are most at risk for this type. A more severe form is called cavitary NTM lung disease. In addition to scars, cavities or pits also form in your lungs.[webmd.com]
  • What Is Causing Your Chronic Cough? A chronic cough is a cough that persists over time.[medicinenet.com]
  • Episodes of fever and dyspnoea are common, as well as a more gradual onset of dyspnoea and cough.[err.ersjournals.com]
  • Over the course of a week, fevers with temperatures up to 102.4 F, night sweats, progressive dyspnea, and a worsening, now productive cough developed.[uscapknowledgehub.org]
Hemoptysis
  • The most common respiratory symptoms of NTM lung disease are: Cough that won't go away Coughing up blood (hemoptysis) Shortness of breath when active Other symptoms of NTM lung disease include: Fatigue Low-grade fever Night sweats Weight loss What Causes[lung.org]
  • However, most have a combination of respiratory and systemic features similar to tuberculosis ; chronic cough shortness of breath on exertion hemoptysis low-grade fever night sweats fatigue weight loss As with M. tuberculosis NTMs commonly cause pulmonary[radiopaedia.org]
  • The classic symptoms include cough, hemoptysis, fatigue, weight loss, and night sweats, though atypical presentations are common.[cancertherapyadvisor.com]
  • Hemoptysis often complicates the course of M. avium complex infection, as it does any cause of bronchiectasis.[academic.oup.com]
Chronic Cough
  • If your primary care provider cannot help your chronic cough, you might need to see a lung specialist.[lung.org]
  • Figure 2. 83 year old lady with a chronic cough.[massgeneral.org]
  • What Is Causing Your Chronic Cough? A chronic cough is a cough that persists over time.[medicinenet.com]
  • However, most have a combination of respiratory and systemic features similar to tuberculosis ; chronic cough shortness of breath on exertion hemoptysis low-grade fever night sweats fatigue weight loss As with M. tuberculosis NTMs commonly cause pulmonary[radiopaedia.org]
  • Symptoms may include chronic cough, hemoptysis, weight loss and ‘failure to thrive’. Some patients present with a history of recurrent chest infections.[academic.oup.com]
Dry Cough
  • She was first to get sick, with shortness of breath and a dry cough that progressed to fevers as high as 104, chills, night sweats and weight loss.[nytimes.com]
  • The most common symptom of NTM lung disease is a chronic or recurring dry cough , occasionally with sputum.[medicinenet.com]
  • Case A 56-year-old Caucasian man with past medical history of COPD secondary to tobacco abuse (40 packs per year of smoking) and chronic alcohol abuse presented to the Emergency Department with several months of increasing dyspnea, dry cough, fatigue,[pulmonarychronicles.com]
  • Case 1: This patient, a 46-year-old woman, was in excellent health until early June, when she noted the onset of shortness of breath and a dry cough. A chest radiograph at that time was consistent with early right lower lobe bronchial pneumonia.[wwwnc.cdc.gov]
Productive Cough
  • Over the course of a week, fevers with temperatures up to 102.4 F, night sweats, progressive dyspnea, and a worsening, now productive cough developed.[uscapknowledgehub.org]
  • Case 2: The 44-year-old husband of Patient 1 was well until mid-August when he had onset of productive cough, fever, and night sweats. Over the next month, he had an 8-pound weight loss.[wwwnc.cdc.gov]
  • Pu lmonary Disease Pulmonary disease usually presents with chronic productive cough in the absence of hemoptysis. Diagnosis can be delayed due to underlying lung disease.[antimicrobe.org]
Loss of Appetite
  • Some people may have mild symptoms, while others have severe problems: Cough, sometimes with blood Fatigue Fever Large amount of mucus Loss of appetite or weight Night sweats Shortness of breath Other symptoms include wheezing, chest pain, and repeat[webmd.com]
  • They are: Coughing Fever Fatigue Loss of Appetite Trouble Breathing Weight Loss Night Sweats Because these symptoms are so common, hot tub lung is often misdiagnosed as anything from bronchitis to asthma to tuberculosis.[swimuniversity.com]
  • […] of appetite or weight, fevers, or night sweats .[medicinenet.com]
  • Two weeks prior to presentation, he had intermittent fever associated with sweating and loss of appetite but no rigors or weight loss.[alliedacademies.org]
  • It is important to look for evidence of adverse reactions, which would cause drug discontinuation or revision of therapy: Signs of hepatotoxicity - jaundice, abdominal pain, loss of appetite, pruritis (INH, RIF, PZA).[cancertherapyadvisor.com]
Lethargy
  • J Fam Pract . 2006 August;55(8):694-696 A 49-year-old white male came to our Family Medicine Center with a complaint of lethargy, night sweats, fever, dyspnea on exertion, myalgias, and an 8-pound weight loss over a 4-week period.[mdedge.com]

Workup

  • In cases of lung infection, a diagnostic workup will include a chest x ray and tests on discharges from the respiratory passages (sputum).[medical-dictionary.thefreedictionary.com]
  • The patient was transferred for further workup and treatment of combined MTB and MAC infection. Two months later, the patient was diagnosed with IL-12 deficiency.[alliedacademies.org]
Mycobacterium Kansasii
  • Rifampin-resistant Mycobacterium kansasii Clin Infect Dis 1994 ; 18 : 1736-1743 Varadi R.G., Marras T.K.[em-consulte.com]
  • Applicable To Infection due to Mycobacterium avium Infection due to Mycobacterium intracellulare [Battey bacillus] Infection due to Mycobacterium kansasii The following code(s) above A31.0 contain annotation back-references Annotation Back-References[icd10data.com]
  • The most common species of mycobacterium that cause such infections include: Mycobacterium avium-intracellulare Mycobacterium kansasii Mycobacterium marinum Mycobacterium ulcerans Mycobacterium chelonae Mycobacterium fortuitum Mycobacterium abscessus[dovemed.com]
  • Abstract Objective: To describe the main tomography findings in patients diagnosed with pulmonary infection caused by Mycobacterium kansasii .[scielo.br]
  • We report two cases of disabling myelopathy in association with pulmonary infection by Mycobacterium kansasii and Mycobacterium malmoense; the myelopathy is presumed to be a para-infectious phenomenon. ID: 4108158[research.ed.ac.uk]
Mycobacterium Fortuitum
  • Levofloxacin alone efficiently treated a cutaneous Mycobacterium fortuitum infection. J Dermatol 2002;29452- 454 PubMed Google Scholar 41.[jamanetwork.com]
  • The most common species of mycobacterium that cause such infections include: Mycobacterium avium-intracellulare Mycobacterium kansasii Mycobacterium marinum Mycobacterium ulcerans Mycobacterium chelonae Mycobacterium fortuitum Mycobacterium abscessus[dovemed.com]
  • Rapidly growing potential pathogens: i) Mycobacterium fortuitum ii) Mycobacterium chelonei[histopathology-india.net]
  • […] avium-intracellulare and Mycobacterium kansasii primarily cause lung disease similar to pulmonary TB, whilst Mycobacterium marinum, Mycobacterium ulcerans, Mycobacterium fortuitum and Mycobacterium chelonae cause skin infections.[dermnetnz.org]
  • These organisms include: Mycobacterium avium-intracellulare : 60% (on bronchial secretions) see: pulmonary MAIC infection Mycobacterium kansasii : 25% Mycobacterium fortuitum Mycobacteriumgordonae Mycobacterium szulgai Mycobacterium scrofulaceum / Mycobacterium[radiopaedia.org]
Mycobacterium Chelonae
  • Treatment of mycobacterium avium and mycobacterium chelonae is difficult. Effective treatment requires three to four antibiotics given at once, sometimes intravenously.[sciencedaily.com]
  • An outbreak of Mycobacterium chelonae infection following liposuction. Clin Infect Dis 2002;341500- 1507 PubMed Google Scholar Crossref 8. Murillo JTorres MBofill L et al.[jamanetwork.com]
  • The most common species of mycobacterium that cause such infections include: Mycobacterium avium-intracellulare Mycobacterium kansasii Mycobacterium marinum Mycobacterium ulcerans Mycobacterium chelonae Mycobacterium fortuitum Mycobacterium abscessus[dovemed.com]
  • chelonae : pulmonary Mycobacterium chelonae infection Mycobacterium simiae Mycobacterium abscesssus : pulmonary Mycobacterium abscessus infection 2 Risk factors The organisms have a predilection for individuals with pre-existing chronic obstructive pulmonary[radiopaedia.org]
  • Mycobacterium chelonae and M fortuitum are best treated with clarithromycin or azithromycin in localised infections, particularly if used with surgical debridement .[dermnetnz.org]

Treatment

  • Guidelines based on expert opinion must be calibrated to consider the risks of treatment vs no treatment based on the potential severity of the disease in question.[journals.plos.org]
  • The treatment options may include: Treatment with antibiotic medications: More than one type of antibiotic is typically prescribed (usually 2 or 3), due to the relative antibiotic-resistant nature of nontuberculous mycobacterial pathogens The treatment[dovemed.com]
  • If you get a mild case, you might not need treatment. If you do, it could take as long as 2 years of treatment to clear it up. You might even need ongoing treatment. NTM lung disease isn’t tuberculosis (TB).[webmd.com]
  • In other cases, further treatment is required. In these cases, antibiotics and anti-inflammatory steroids are used for the patients. Be prepared for the treatment to last a while, as many cases can take up to a year to heal fully.[swimuniversity.com]
  • Infected by a Hot Tub Despite antibiotic treatment for suspected pneumonia, she got worse and worse; within two months she was unable to walk across a room.[nytimes.com]

Prognosis

  • Focal nodular disease has the best prognosis and tends to be fairly benign.[patient.info]
  • Treatment and prognosis Detailed guidelines on the management approach are available 12.[radiopaedia.org]
  • Prognosis The prognosis is good with proper medical and surgical treatment.[patient.info]
  • Antimycobacterial therapy may be given but the prognosis is good even without such treatment. No chronic or mortal cases have been reported [ 1 , 7 ].[err.ersjournals.com]

Etiology

  • Hot tub lung: an intriguing diffuse parenchymal lung disease Abstract In pulmonary medicine, identical pathogenesis due to varied etiological agents can present with indistinguishable clinical presentation, and produce similar laboratory and radiological[ajol.info]
  • Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology.[icd10coded.com]
  • Nontuberculous Mycobacteria Lymph node disease Common etiological agents MAC M. kansasii M. malmoense M. haemophilum Uncommon etiological agents M. scrofulaceum M.fortuitum/ peregrinum M.abscessus/ chelonae 62.[de.slideshare.net]
  • The pericardial effusion was suggestive of tuberculous origin, however, lack of response to conventional anti-tuberculous therapy raised suspicion about the etiology of the effusion being non-tuberculous.[ispub.com]
  • (Etiology) Atypical Mycobacterial Infections are caused by any species of non-tuberculous mycobacteria. Up to 13 distinct species of atypical mycobacteria are known to cause human infection.[dovemed.com]

Epidemiology

  • ., Jr The epidemiology of nontuberculous mycobacterial diseases in the United States. Results from a national survey.[ncbi.nlm.nih.gov]
  • Based on our review, we suggest two sets of modifications for epidemiologic and clinical studies.[journals.plos.org]
  • For several NTM species, environmental sources have been linked epidemiologically to cases of disease ( 15 - 20 ).[wwwnc.cdc.gov]
  • The true international epidemiology of infections due to NTM is hard to determine because the isolation of these organisms often is not reported and speciation often ...[accessmedicine.mhmedical.com]
  • To identify imaging and epidemiological features that can help to distinguish ATB infection from Mycobacterium tuberculosis (MTB) infection. Epidemiology Mycobacteria that cause human disease can be divided into two broad groups.[epos.myesr.org]
Sex distribution
Age distribution

Pathophysiology

  • Childhood lymphadenitis due to MAC is very rare but appears to be on the increase in developed countries. [ 3 ] Pathophysiology M. avium causes 95% of AIDS-related MAC infections. [ 4 ] M. intracellulare causes 40% of MAC infections in the immunocompetent[patient.info]
  • In contrast, most patients could be easily classified as having primary or secondary disease, and these categories are more likely to facilitate better understanding of pathophysiology.[journals.plos.org]
  • The pathophysiology of disseminated Mycobacterium avium complex disease in AIDS. J Infect Dis. 1999; 179: S461-465. Vankayalapati R, Wizel B, Samten B, et al. Cytokine profiles in immunocompetent persons infected with Mycobacterium avium complex.[alliedacademies.org]
  • Voluntary cough suppression as a pathophysiologic explanation for the high prevalence of M. avium complex infection in older (Caucasian) women and for its tendency to involve middle lobe and lingula has not gained widespread support over the years.[academic.oup.com]

Prevention

  • The great thing about this disease is that it is very easy to prevent. All it takes is a little work from you. The main way to prevent these types of infections is to properly clean your hot tub and its filters on a regular basis.[swimuniversity.com]
  • Currently, there no consensus on prevention among NTM experts.[medicinenet.com]
  • Specific prevention options for Atypical Mycobacterial Infections depend on the infecting species type.[dovemed.com]
  • (November 6, 2017) Centers for Disease Control and Prevention. CDC Features: Pneumonia can be prevented—vaccines can help. Available online at . Accessed on September 8, 2018. (November 10, 2017) Centers for Disease Control and Prevention.[labtestsonline.it]
  • Typically, measures are taken to prevent aspiration and esophageal reflux and to compensate for the bronchial tubes’ inability to sufficiently cleanse themselves.[kamelharpulmonary.com]

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