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Pulmonary Non-Tuberculous Mycobacterial Infection

Non-Tuberculous Mycobacterial Lung Disease


Presentation

  • A retrospective study has been presented at the American Thoracic Society in this matter and was very well received.[kamelharpulmonary.com]
  • There are less common presentations of NTM infection.[rarediseases.org]
  • Although survival of patients with NTM infections is similar, a striking difference in BOS rates is present in the NTM and NTM groups.[arizona.pure.elsevier.com]
  • Increasingly, it presents as an indolent lung disease in seemingly normal hosts, especially (in the USA) among middle-aged and elderly women.[academic.oup.com]
  • Patients with NTM at present typically have to use several antibiotics to avoid the emergence of resistance.[finance.yahoo.com]
Arachnodactyly
  • Congenital contractural arachnodactyly (CCA) is caused by mutations within the fibrillin-2 gene ( FBN2 ), which is crucial for microfibril structure.[ingentaconnect.com]
  • Marfan syndrome, hyper-IgE syndrome, and congenital contractural arachnodactyly have also been associated with pulmonary NTM disease.[rarediseases.org]
Recurrent Respiratory Infections
  • Affected individuals may experience recurrent respiratory infections. In some cases, these infections can cause progressive damage to the lungs and, eventually, the lungs will not function as well as they should (impaired lung function).[rarediseases.org]
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]
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]
Increased Susceptibility to Infections
  • This condition has been associated to an increased susceptibility to infections, including mycobacterial infections [31], [32]. A low proportion of HIV infected patients was observed among the NTM patients, as proven by serology in this study.[journals.plos.org]
Persistent Cough
  • 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]
Exertional Dyspnea
  • Widespread disease may result in mixed restrictive and obstructive pulmonary function abnormalities and exertional dyspnea.[academic.oup.com]
Chest Pain
  • 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]
  • Wheezing and chest pain may also occur. Affected individuals may experience recurrent respiratory infections.[rarediseases.org]
  • Pleuritic chest pain in this setting is most likely the result of bacterial superinfection of bronchiectatic airways at the lung periphery. Physical examination is often normal, even in the presence of extensive pulmonary involvement.[academic.oup.com]
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]
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]
Skin Discoloration
  • discoloration; GI intolerance Some drug doses may need to be reduced due to renal or hepatic dysfunction, low body weight ( BID, twice daily; QD, once daily; IM, intramuscular administration; GI, gastrointestinal. a To a maximum dose of 500 mg in those[academic.oup.com]
Excitement
  • This exciting work appears to be a particularly fertile and rapidly expanding area of NTM research.[f1000research.com]

Treatment

  • Treatment Treatment of NTM pulmonary infection varies depending on the species of mycobacterium.[academic.oup.com]
  • Aradigm’s inhaled ciprofloxacin formulations including Linhaliq are also product candidates for treatment of patients with cystic fibrosis and non-tuberculous mycobacteria, and for the prevention and treatment of high threat and bioterrorism infections[finance.yahoo.com]
  • Diagnosis does not imply treatment Discovery of NTM lung disease does not necessarily mean physicians should immediately begin treatment.[consultqd.clevelandclinic.org]
  • Standard Therapies Treatment The decision to begin treatment for NTM infection is a challenging and difficult one. Treatment with a combination of antibiotic drugs (drug regimen) is the mainstay of therapy for these diseases.[rarediseases.org]
  • Current treatment strategies are largely based on expert opinion. The lack of randomized clinical trials to inform treatment leave clinicians with many questions regarding the most effective and safe regimens.[link.springer.com]

Prognosis

  • Chest CT findings Regardless of the specific infective mycobacterial specifes and irrespective of prognosis, the most common CT findings of pulmonary NTM infection were as follows (Figure 2). Small...[epos.myesr.org]
  • Treatment and prognosis The guideline on the management approach can be found in reference 12. Promoted articles (advertising)[radiopaedia.org]
  • Ollé Goig JE, Sandy R (2003) Prognosis of mono-and polydrug resistant pulmonary tubercolosis in the city of Santa Cruz, Bolivia. Arch Bronconeumol 39:382–386 PubMed CrossRef Google Scholar 13.[link.springer.com]
  • […] multifactorial and includes consideration of: • How symptomatic the patient is • Whether the NTM lung disease is associated with pulmonary cavities • The patient’s pulmonary co-morbidities and whether they are compensated • The patient’s short- and long-term prognosis[prescriber.co.uk]

Etiology

  • Stamatoula Tsikrika (Athens, Greece), Stamatoula Tsikrika, Katerina Dimakou, Andriana Papaioannou, George Hillas, Kostantinos Kostikas, Stelios Loukides, Spyros Papiris, Nikos Koulouris, Petros Bakakos [ ] 2557 Non CF-bronchiectasis in a Moldovan population: Etiologic[ers-education.org]
  • Bronchiectasis in a diverse US population: effects of ethnicity on etiology and sputum culture. Chest. 2012;142(1):159–67. PubMed CrossRef Google Scholar 12. Mirsaeidi M, Hadid W, Ericsoussi B, Rodgers D, Sadikot RT.[link.springer.com]
  • […] with normal underlying lung anatomy may create bronchiectasis as a consequence of bronchial wall infection and necrosis, as occurs in tuberculosis. 39 Alternatively, persons with long-standing bronchiectasis, such as caused by cystic fibrosis or other etiologies[academic.oup.com]
  • The etiology of bronchiectasis for many patients remains elusive, but recent work suggests that for at least some patients with “idiopathic” bronchiectasis, there is probably a polygenic explanation for the presence of bronchiectasis 39.[f1000research.com]
  • More common infectious etiologies such as fungal, bacterial, and viral infections and non-infectious etiologies such as PTLD or other malignancy must be ruled out.[antimicrobe.org]

Epidemiology

  • O'Brien RJ: The epidemiology of nontuberculous mycobacterial disease. Clin Chest Med. 1989; 10 (3): 407–18. PubMed Abstract 17.[f1000research.com]
  • Thomson RM (2010) Changing epidemiology of pulmonary nontuberculous mycobacteria infections. Emerg Infect Dis 16(10) : 1576–83. View Article Google Scholar 11.[journals.plos.org]
  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and[ingentaconnect.com]
  • Each pulmonary TB suspect patient needed clinical settings to suspect causative agents of MTBC and/or NTM species; clinicians have to understand the local epidemiological data for the evaluation of causes of lung infection to determine appropriate therapy[ijmyco.org]
  • According to a report from NIH based on an epidemiological study in U.S. adults aged 65 years or older, PNTM infections are an important cause of morbidity among older adults in the United States.[finance.yahoo.com]
Sex distribution
Age distribution

Pathophysiology

  • While it is unlikely that FBN2 defects account for susceptibility to NTM infection in the majority of cases, the overlap between these two diseases suggests some shared pathophysiology. No Reference information available - sign in for access.[ingentaconnect.com]
  • Pathophysiology Thirty years ago, almost nothing was known about NTM disease pathophysiology, as it was assumed to be analogous to TB with the exception that NTM lung disease pathogens were known not to be transmitted between humans.[f1000research.com]
  • 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]
  • Respiratory Unit, San Gerardo Hospital, ASST di Monza, Via Pergolesi 33, 20900 Monza, Italy 2 Department of Internal Medicine, Division of Infectious Diseases, San Gerardo Hospital, ASST di Monza, Via Pergolesi 33, 20900 Monza, Italy 3 Department of Pathophysiology[mdpi.com]

Prevention

  • About Aradigm Aradigm is an emerging specialty pharmaceutical company focused on the development and commercialization of drugs for the prevention and treatment of severe respiratory diseases.[finance.yahoo.com]
  • Typically, measures are taken to prevent aspiration and esophageal reflux and to compensate for the bronchial tubes’ inability to sufficiently cleanse themselves.[kamelharpulmonary.com]
  • Centers for Disease Control and Prevention (July 1, 2010 Reviewed). Diagnosis of Tuberculous Disease. Available online at . Accessed January 2011. Centers for Disease Control and Prevention.[labtestsonline.it]
  • Ancillary goals are improvement in lung function (or prevention of further loss of function) and clearing of radiographic abnormalities (or prevention of progression).[academic.oup.com]
  • In addition to medications, our doctors also recommend therapies to clear the airways, which can help prevent more serious lung problems.[nyulangone.org]

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