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]
Persons with HIV can present with intrathoracic adenopathy. [cancertherapyadvisor.com]
A retrospective study has been presented at the American Thoracic Society in this matter and was very well received. [kamelharpulmonary.com]
Entire Body System
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Increased Energy
Effective therapy is usually associated with decreased cough and sputum production and systemic improvement, such as increased energy and resolution of low-grade fever. [academic.oup.com]
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Recurrent Bronchitis
The presence of bronchiectasis, part of the pulmonary pathology of NTM pulmonary infection, can result in recurrent chest infections with bacterial pathogens, presenting as recurrent bronchitis or pneumonia. [academic.oup.com]
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Noncompliance
The single clinical trial using clarithromycin monotherapy noted only 1 case of acquired clarithromycin resistance (8% of patients), in a noncompliant patient who prematurely discontinued therapy. 35 There are other case reports of clarithromycin resistance [jamanetwork.com]
Respiratoric
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Cough
If your primary care provider cannot help your chronic cough, you might need to see a lung specialist. [lung.org]
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]
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]
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]
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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 most common symptoms include a persistent cough, fatigue, weight loss, night sweats, and occasionally shortness of breath (dyspnea) and coughing up of blood (hemoptysis). [rarediseases.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]
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Chronic Cough
What Is Causing Your Chronic Cough? A chronic cough is a cough that persists over time. [medicinenet.com]
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]
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]
It can be caused by many NTM species which depends on region, but most frequently MAC and M. kansasii. [14] Clinical symptoms vary in scope and intensity but commonly include chronic cough, often with purulent sputum. Hemoptysis may also be present. [en.wikipedia.org]
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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]
She presented with productive cough, night sweats, and weight loss. Acid-fast bacilli were detectable on sputum smears. Sputum and bronchoalveolar lavage cultures grew M. malmoense. [karger.com]
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]
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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 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]
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]
Gastrointestinal
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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]
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]
Such symptoms include cough, fatigue, shortness of breath (dyspnea), coughing up of blood (hemoptysis), excessive mucus (sputum) production, fever, night sweats, loss of appetite, and unintended weight loss. Wheezing and chest pain may also occur. [rarediseases.org]
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Failure to Thrive
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]
Jaw & Teeth
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Metallic Taste
Table 1 Medications and drug combinations used to treat M. avium complex pulmonary infection Treatment regimen Drugs Doses and schedule Potential side effects Daily three-drug regimen Clarithromycin 500 mg BID GI intolerance (including metallic taste) [academic.oup.com]
Ears
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Hearing Impairment
Periodic audiometry may also be appropriate, especially when there is concern about an emerging hearing impairment. During the course of treatment, patients are monitored for symptoms. [academic.oup.com]
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Tinnitus
[…] of saliva, urine and tears Staining of soft contact lenses GI upset ( nausea, vomiting or diarrhea ) Fever and a rash Hepatitis Flu-like symptoms streptomycin, amikacin (Amikin), tobramycin (Tobi) Dizziness or Vertigo Hearing loss Ringing in ears ( tinnitus [medicinenet.com]
Ethionamide 250 mg PO BID Intermittent Streptomycin is recommended for only the first 2 to 3 months of treatment of extensive disease Patients receiving streptomycin should be instructed on the signs and symptoms of ototoxicity and vestibular toxicity( tinnitus [antimicrobe.org]
Neurologic
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Unable to Walk
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]
In late August, her shortness of breath worsened so that she was unable to walk across a room, and she visited the hospital. A chest radiograph showed increased interstitial markings in both lungs. [wwwnc.cdc.gov]
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]
X-Ray
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Air Bronchogram
A chest radiograph showed increased markings in the right lower lobe medially with associated peribronchial thickening and some faint air bronchograms consistent with an early bronchial pneumonia. [wwwnc.cdc.gov]
Microbiology
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Mycobacterium Kansasii
Rifampin-resistant Mycobacterium kansasii Clin Infect Dis 1994 ; 18 : 1736-1743 Varadi R.G., Marras T.K. [em-consulte.com]
Abstract Objective: To describe the main tomography findings in patients diagnosed with pulmonary infection caused by Mycobacterium kansasii. [scielo.br]
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]
Mycobacterium kansasii should be treated with at least 3 drugs for 12–18 months. One of the drugs must be rifampicin, which is still the cornerstone of treatment for these infections. [dermnetnz.org]
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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]
[…] 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]
Breast implant infection with Mycobacterium fortuitum group: report of case and review. J Infect. 2006 Mar. 52(3):e63-7. [Medline]. Murdoch DM, McDonald JR. [emedicine.medscape.com]
Rapidly growing potential pathogens: i) Mycobacterium fortuitum ii) Mycobacterium chelonei [histopathology-india.net]
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Mycobacterium Chelonae
M ycobacterium fortuitum, Mycobacterium chelonae, and Mycobacterium abscessus are environmental mycobacteria that can cause chronic infections of the skin, soft tissues, and lungs. [jamanetwork.com]
Treatment of mycobacterium avium and mycobacterium chelonae is difficult. Effective treatment requires three to four antibiotics given at once, sometimes intravenously. [sciencedaily.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]
Mycobacterium chelonae and M fortuitum are best treated with clarithromycin or azithromycin in localised infections, particularly if used with surgical debridement. [dermnetnz.org]
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]
Treatment
The decision to start treatment for NTM is influenced by the: Severity of NTM-pulmonary disease Risk of progressive NTM-pulmonary disease Presence of comorbidity and the goals of treatment Treatment of NTM pulmonary disease typically requires a combination [medicinenet.com]
Treatment Treatment of NTM pulmonary infection varies depending on the species of mycobacterium. [academic.oup.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]
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
Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10coded.com]
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]
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]
The etiology of these infections is unknown, but it is most likely due to direct implantation or contamination of surgical instruments. [ncbi.nlm.nih.gov]
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]
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]
Mycobacterium peregrinum can result in skin infections. [2] Pathophysiology Infections with atypical mycobacteria usually occur in immunocompromised hosts due to host immunity and resistance factors. [emedicine.medscape.com]
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
Currently, there no consensus on prevention among NTM experts. [medicinenet.com]
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]
Specific prevention options for Atypical Mycobacterial Infections depend on the infecting species type. [dovemed.com]
Steps for Preventing Infection After Breast Lift Another breast lift risk, postsurgical infection, can be prevented by taking antibiotics as prescribed for as long as prescribed. [sample.miautoperfecto.com]
Public health charge is to cure disease and prevent transmission. B. [cancertherapyadvisor.com]