Non-TB Mycobacteria

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Are non-TB mycobacteria transmitted human-to-human?

No

Is there any need for infection control precautions?

No

Where can you find non-TB mycobacteria?

Water
Soil

What organisms are the Rapid Growers and how long does it take for them to grow?

FAC
-M. Fortuitum, Chelonae, Abscessus

days in broth
<1 weeks on solid media

How long does it take slow growers to grow?

1-2 weeks in broth
2-4 weeks on solid

What organisms have special diagnostic problems?

M. leprae--can't be cultured
M. marinum--lower temperature required

What 3 criteria are necessary in order to make a diagnosis of NTM?

1. Compatible clinical syndrome
2. Abnormal CXR or HRCT
3. Bacteriologic criteria (2 positive sputum cultures; positive culture from BAL; positive granuloma or AFB on biopsy WITH NTM on sputum)

What NTM mimics tuberculosis in that it is a fibrocavitary disease and shows systemic symptoms?

MAC in Association with COPD

What NTM is associated with weight loss?

MAC Pulmonary Disease in Non-Smoking Female Patients

What NTM may need an HRCT scan to diagnose?

MAC Pulmonary Disease in Non-Smoking Female Patients

What NTM shows diffuse infiltrates and nodularity on CXR/CT?

Hypersensitivity Pneumonitis "Hot Tub Lung"

What NTM shows nodular bronchiectasis/interstitial disease?

MAC Pulmonary Disease in Non-Smoking Female Patients

How long is treatment for NTM?

1-2 years

Is empiric therapy indicated for NTM?

No

What is the treatment for Pulmonary MAC?

Treat with 3 or more active drugs, usually for 18-24 months.
Obtain a monthly sputum culture and continue treatment until culture-negative for 12 months.

What CD4 cell count is Disseminated MAC in Patients with AIDS found commonly in?

<50 CD4 T cells

Where can Disseminated MAC be found in the US?

Geographically widespread

How is Disseminated MAC acquired?

Unclear
Could be GI, could be Respiratory

How do you diagnose someone with Disseminated MAC?

Blood cultures usually positive but bone marrow, liver or lymph node biopsy would be reasonable if blood cultures repeatedly negative

What happens to patients who undergo HAART?

Local MAC symptoms may worsen

What happens to the worsening patients undergoing HAART?

They will improve over a few weeks with no change in treatment

What do you treat the symptoms of IRIS patients with?

NSAIDS, or in extreme cases, steroids

What should HIV patients with CD4 cells of <50 do to avoid acquiring MAC?

Prophylactic Azithromycin or Clarithromycin

or Rifabutin

May discontinue when CD4 >100

What is the most treatable NTM?

M. kansasii

What is the treatment for M. kansasii?

INH + ethambutol + rifampin for 12 months

What NTM usually affects kids 1-5 and RARELY in adults?

NTM Lymphadenitis

What are the most common areas affected by NTM Lymphadenitis?
Bilateral or Unilateral?

Head and Neck
UNIlateral

How do you diagnose NTM Lymphadenitis?

Fine needle aspiration or Excisional biopsy

What is the treatment for NTM Lymphadenitis?

Surgical removal of involved nodes

Is relapse common in NTM Lymphadenitis?

Uncommon

If relapse: repeat surgery or start chemo

What is the course of M. marinum?

1 to 2 months of incubation, followed by granulomatous nodular-ulcerative lesions

Where are lesions common with M. marinum?

Hand

What to think of when you hear M. marinum

WATER, WATER, WATER, FISH, FISH, FISH

What is the treatment for M. marinum? What is unique to this treatment?

Clarithromycin + ethambutol

Should continue treatment 1-2 months after symptoms resolve

What are the 2 problems that Rapid Growers cause?

1. Skin problems
2. Lung problems

Which Rapid Growers are involved in skin/soft tissue infections?

All 3

Which Rapid Growers are involved in Pulmonary infections?

M. fortuitum, M. abscessus

Which Rpiad growers are most responsible for Health-care Associated Mycobacterial Outbreaks?

M. fortuitum and M. abscessus

What kind of Health-care things are Mycobacteria associated with?

Surgical wounds, prosthetics, implants, LASIK, catheters
Related to WATER contamination

What is the treatment regimen for M. fortuitum?

2-3 drugs for 4-12 months

Shorter for Skin--Longer for Lung

What is the most difficult Rapid Grower to treat?

M. abscessus

What is the treatment for M. chelonae?

2 drugs for 4 to 6 months

2-4-6!!!

Where is leprosy common?

Tropical countries

What is the route of transmission of leprosy?

UNKNOWN

Can M. leprae be cultured?

No

Is M. leprae contagious?

No

What are the different types of Leprosy syndromes?

Lepromatous
Tuberculoid
Mixed

What is Lepromatous Leprosy like?

High bacillary load
SKIN
Deformity of face
Anergy

What is Tuberculoid Leprosy like?

FEW bacilli
<5 skin lesions
Anesthesia present
React to M. Leprae skin tests
NERVE involvement

How do you treat Lepromatous Leprosy?

2 years of :
Dapsone + rifampin + clofazimine

How do you treat Tuberculoid Leprosy?

6 months of
Dapsone + Rifampin

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