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What organisms are the Rapid Growers and how long does it take for them to grow?
-M. Fortuitum, Chelonae, Abscessus
days in broth
<1 weeks on solid media
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 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
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.
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 the worsening patients undergoing HAART?
They will improve over a few weeks with no change in treatment
What should HIV patients with CD4 cells of <50 do to avoid acquiring MAC?
Prophylactic Azithromycin or Clarithromycin
May discontinue when CD4 >100
What are the most common areas affected by NTM Lymphadenitis?
Bilateral or Unilateral?
Head and Neck
What is the course of M. marinum?
1 to 2 months of incubation, followed by granulomatous nodular-ulcerative lesions
What is the treatment for M. marinum? What is unique to this treatment?
Clarithromycin + ethambutol
Should continue treatment 1-2 months after symptoms resolve
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 Tuberculoid Leprosy like?
<5 skin lesions
React to M. Leprae skin tests
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