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Semin Respir Crit Care Med 2013; 34(01): 135-142
DOI: 10.1055/s-0033-1333575
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Management of Nontuberculous Mycobacterial (NTM) Lung Disease

Julie V. Philley
1   Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Tyler, Tyler, Texas
,
David E. Griffith
1   Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Tyler, Tyler, Texas
› Author Affiliations
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Publication History

Publication Date:
04 March 2013 (online)

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Abstract

Nontuberculous mycobacterial (NTM) lung diseases present formidable obstacles to successful management, especially when compared with tuberculosis, beginning with diagnosis and extending through treatment. Factors peculiar to NTM disease such as extensive microbial resistance mechanisms and difficult to interpret, even misleading, in vitro drug susceptibility patterns are just two of the multiple and frustrating clinical management challenges. More conventional problems such as drug–drug interactions, medication side-effects, and nonadherence with therapy add further impediments to successful outcomes. In spite of these difficulties, the majority of NTM lung disease patients are still treated successfully. Because the prevalence of NTM is rising, it is increasingly necessary for clinicians to understand those unique aspects of NTM lung disease diagnosis and treatment that differ from tuberculosis and that contribute to limited treatment options.

Keywords

Mycobacterium abscessus - Mycobacterium avium complex - nontuberculous mycobacteria
 

  • References

  • 1 Adjemian J, Olivier KN, Seitz AE, Holland SM, Prevots DR. Prevalence of nontuberculous mycobacterial lung disease in U.S. Medicare beneficiaries. Am J Respir Crit Care Med 2012; 185 (8) 881-886
    CrossrefPubMedGoogle Scholar
  • 2 Prevots DR, Shaw PA, Strickland D , et al. Nontuberculous mycobacterial lung disease prevalence at four integrated health care delivery systems. Am J Respir Crit Care Med 2010; 182 (7) 970-976
    CrossrefPubMedGoogle Scholar
  • 3 Winthrop KL, McNelley E, Kendall B , et al. Pulmonary nontuberculous mycobacterial disease prevalence and clinical features: an emerging public health disease. Am J Respir Crit Care Med 2010; 182 (7) 977-982
    CrossrefPubMedGoogle Scholar
  • 4 Griffith DE, Aksamit T, Brown-Elliott BA , et al; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med 2007; 175 (4) 367-416 (dosage error corrected in Am J Respir Crit Care Med 2007;175(7):744–745)
    CrossrefPubMedGoogle Scholar
  • 5 Ray WA, Murray KT, Hall K, Arbogast PG, Stein CM. Azithromycin and the risk of cardiovascular death. N Engl J Med 2012; 366 (20) 1881-1890
    CrossrefPubMedGoogle Scholar
  • 6 van Ingen J, Boeree MJ, van Soolingen D, Mouton JW. Resistance mechanisms and drug susceptibility testing of nontuberculous mycobacteria. Drug Resist Updat 2012; 15 (3) 149-161
    CrossrefPubMedGoogle Scholar
  • 7 Griffith DE, Aksamit TR. Bronchiectasis and nontuberculous mycobacterial disease. Clin Chest Med 2012; 33 (2) 283-295
    CrossrefPubMedGoogle Scholar
  • 8 Corpe RF. Surgical management of pulmonary disease due to Mycobacterium avium-intracellulare. Rev Infect Dis 1981; 3 (5) 1064-1067
    CrossrefPubMedGoogle Scholar
  • 9 Nelson KG, Griffith DE, Brown BA, Wallace Jr RJ. Results of operation in Mycobacterium avium-intracellulare lung disease. Ann Thorac Surg 1998; 66 (2) 325-330
    CrossrefPubMedGoogle Scholar
  • 10 Shiraishi Y, Nakajima Y, Takasuna K, Hanaoka T, Katsuragi N, Konno H. Surgery for Mycobacterium avium complex lung disease in the clarithromycin era. Eur J Cardiothorac Surg 2002; 21 (2) 314-318
    CrossrefPubMedGoogle Scholar
  • 11 Mitchell JD, Bishop A, Cafaro A, Weyant MJ, Pomerantz M. Anatomic lung resection for nontuberculous mycobacterial disease. Ann Thorac Surg 2008; 85 (6) 1887-1892 , discussion 1892–1893
    CrossrefPubMedGoogle Scholar
  • 12 Yu JA, Pomerantz M, Bishop A, Weyant MJ, Mitchell JD. Lady Windermere revisited: treatment with thoracoscopic lobectomy/segmentectomy for right middle lobe and lingular bronchiectasis associated with non-tuberculous mycobacterial disease. Eur J Cardiothorac Surg 2011; 40 (3) 671-675
    PubMedGoogle Scholar
  • 13 Griffith DE, Girard WM, Wallace Jr RJ. Clinical features of pulmonary disease caused by rapidly growing mycobacteria: an analysis of 154 patients. Am Rev Respir Dis 1993; 147 (5) 1271-1278
    CrossrefPubMedGoogle Scholar
  • 14 Jeon K, Kwon OJ, Lee NY , et al. Antibiotic treatment of Mycobacterium abscessus lung disease: a retrospective analysis of 65 patients. Am J Respir Crit Care Med 2009; 180 (9) 896-902
    CrossrefPubMedGoogle Scholar
  • 15 Jarand J, Levin A, Zhang L, Huitt G, Mitchell JD, Daley CL. Clinical and microbiologic outcomes in patients receiving treatment for Mycobacterium abscessus pulmonary disease. Clin Infect Dis 2011; 52 (5) 565-571
    CrossrefPubMedGoogle Scholar
  • 16 Feazel LM, Baumgartner LK, Peterson KL, Frank DN, Harris JK, Pace NR. Opportunistic pathogens enriched in showerhead biofilms. Proc Natl Acad Sci U S A 2009; 106 (38) 16393-16399
    CrossrefPubMedGoogle Scholar
  • 17 Nishiuchi Y, Maekura R, Kitada S , et al. The recovery of Mycobacterium avium-intracellulare complex (MAC) from the residential bathrooms of patients with pulmonary MAC. Clin Infect Dis 2007; 45 (3) 347-351
    CrossrefPubMedGoogle Scholar
  • 18 Falkinham III JO, Iseman MD, de Haas P, van Soolingen D. Mycobacterium avium in a shower linked to pulmonary disease. J Water Health 2008; 6 (2) 209-213
    PubMedGoogle Scholar
  • 19 Field SK, Fisher D, Cowie RL. Mycobacterium avium complex pulmonary disease in patients without HIV infection. Chest 2004; 126 (2) 566-581
    CrossrefPubMedGoogle Scholar
  • 20 Wallace Jr RJ, Brown BA, Griffith DE , et al. Initial clarithromycin monotherapy for Mycobacterium avium-intracellulare complex lung disease. Am J Respir Crit Care Med 1994; 149 (5) 1335-1341
    CrossrefPubMedGoogle Scholar
  • 21 Wallace Jr RJ, Brown BA, Griffith DE, Girard WM, Murphy DT. Clarithromycin regimens for pulmonary Mycobacterium avium complex. The first 50 patients. Am J Respir Crit Care Med 1996; 153 (6 Pt 1) 1766-1772
    CrossrefPubMedGoogle Scholar
  • 22 Kobashi Y, Yoshida K, Miyashita N, Niki Y, Oka M. Relationship between clinical efficacy of treatment of pulmonary Mycobacterium avium complex disease and drug-sensitivity testing of Mycobacterium avium complex isolates. J Infect Chemother 2006; 12 (4) 195-202
    CrossrefPubMedGoogle Scholar
  • 23 Kobashi Y, Abe M, Mouri K, Obase Y, Miyashita N, Oka M. Clinical usefulness of combination chemotherapy for pulmonary Mycobacterium avium complex disease. J Infect 2010; Nov 19. [Epub ahead of print]
    PubMedGoogle Scholar
  • 24 Kobashi Y, Abe M, Mouri K, Obase Y, Kato S, Oka M. Relationship between clinical efficacy for pulmonary MAC and drug-sensitivity test for isolated MAC in a recent 6-year period. J Infect Chemother 2012; 18 (4) 436-443
    CrossrefPubMedGoogle Scholar
  • 25 Bates JH. Mycobacterium avium disease: progress at last. Am J Respir Crit Care Med 1996; 153 (6 Pt 1) 1737-1738
    CrossrefPubMedGoogle Scholar
  • 26 Griffith DE, Brown BA, Murphy DT, Girard WM, Couch L, Wallace Jr RJ. Initial (6-month) results of three-times-weekly azithromycin in treatment regimens for Mycobacterium avium complex lung disease in human immunodeficiency virus-negative patients. J Infect Dis 1998; 178 (1) 121-126
    CrossrefPubMedGoogle Scholar
  • 27 Lam PK, Griffith DE, Aksamit TR , et al. Factors related to response to intermittent treatment of Mycobacterium avium complex lung disease. Am J Respir Crit Care Med 2006; 173 (11) 1283-1289
    CrossrefPubMedGoogle Scholar
  • 28 van Ingen J, Egelund EF, Levin A , et al. The pharmacokinetics and pharmacodynamics of pulmonary Mycobacterium avium complex disease treatment. Am J Respir Crit Care Med 2012; Jun 28. [Epub ahead of print]
    PubMedGoogle Scholar
  • 29 Kobashi Y, Matsushima T, Oka M. A double-blind randomized study of aminoglycoside infusion with combined therapy for pulmonary Mycobacterium avium complex disease. Respir Med 2007; 101 (1) 130-138
    CrossrefPubMedGoogle Scholar
  • 30 Ramsey BW, Pepe MS, Quan JM , et al; Cystic Fibrosis Inhaled Tobramycin Study Group. Intermittent administration of inhaled tobramycin in patients with cystic fibrosis. N Engl J Med 1999; 340 (1) 23-30
    CrossrefPubMedGoogle Scholar
  • 31 Davis KK, Kao PN, Jacobs SS, Ruoss SJ. Aerosolized amikacin for treatment of pulmonary Mycobacterium avium infections: an observational case series. BMC Pulm Med 2007; 7: 2
    CrossrefPubMedGoogle Scholar
  • 32 Meier A, Heifets L, Wallace Jr RJ , et al. Molecular mechanisms of clarithromycin resistance in Mycobacterium avium: observation of multiple 23S rDNA mutations in a clonal population. J Infect Dis 1996; 174 (2) 354-360
    CrossrefPubMedGoogle Scholar
  • 33 Griffith DE, Brown-Elliott BA, Langsjoen B , et al. Clinical and molecular analysis of macrolide resistance in Mycobacterium avium complex lung disease. Am J Respir Crit Care Med 2006; 174 (8) 928-934
    CrossrefPubMedGoogle Scholar
  • 34 McArdle JR, Talwalkar JS. Macrolides in cystic fibrosis. Clin Chest Med 2007; 28 (2) 347-360
    CrossrefPubMedGoogle Scholar
  • 35 Yates B, Murphy DM, Forrest IA , et al. Azithromycin reverses airflow obstruction in established bronchiolitis obliterans syndrome. Am J Respir Crit Care Med 2005; 172 (6) 772-775
    CrossrefPubMedGoogle Scholar
  • 36 Poletti V, Casoni G, Chilosi M, Zompatori M. Diffuse panbronchiolitis. Eur Respir J 2006; 28 (4) 862-871
    CrossrefPubMedGoogle Scholar
  • 37 Piacentini GL, Peroni DG, Bodini A , et al. Azithromycin reduces bronchial hyperresponsiveness and neutrophilic airway inflammation in asthmatic children: a preliminary report. Allergy Asthma Proc 2007; 28 (2) 194-198
    CrossrefPubMedGoogle Scholar
  • 38 Albert RK, Connett J, Bailey WC , et al; COPD Clinical Research Network. Azithromycin for prevention of exacerbations of COPD. N Engl J Med 2011; 365 (8) 689-698
    CrossrefPubMedGoogle Scholar
  • 39 Renna M, Schaffner C, Brown K , et al. Azithromycin blocks autophagy and may predispose cystic fibrosis patients to mycobacterial infection. J Clin Invest 2011; 121 (9) 3554-3563
    CrossrefPubMedGoogle Scholar
  • 40 Kohno Y, Ohno H, Miyazaki Y , et al. In vitro and in vivo activities of novel fluoroquinolones alone and in combination with clarithromycin against clinically isolated Mycobacterium avium complex strains in Japan. Antimicrob Agents Chemother 2007; 51 (11) 4071-4076
    CrossrefPubMedGoogle Scholar
  • 41 Jenkins PA, Campbell IA, Banks J, Gelder CM, Prescott RJ, Smith AP. Clarithromycin vs ciprofloxacin as adjuncts to rifampicin and ethambutol in treating opportunist mycobacterial lung diseases and an assessment of Mycobacterium vaccae immunotherapy. Thorax 2008; 63 (7) 627-634
    CrossrefPubMedGoogle Scholar
  • 42 Field SK, Cowie RL. Treatment of Mycobacterium avium-intracellulare complex lung disease with a macrolide, ethambutol, and clofazimine. Chest 2003; 124 (4) 1482-1486
    CrossrefPubMedGoogle Scholar
  • 43 Chaisson RE, Keiser P, Pierce M , et al. Clarithromycin and ethambutol with or without clofazimine for the treatment of bacteremic Mycobacterium avium complex disease in patients with HIV infection. AIDS 1997; 11 (3) 311-317
    CrossrefPubMedGoogle Scholar
  • 44 Wallace Jr RJ, Zhang Y, Brown-Elliott BA , et al. Repeat positive cultures in Mycobacterium intracellulare lung disease after macrolide therapy represent new infections in patients with nodular bronchiectasis. J Infect Dis 2002; 186 (2) 266-273
    CrossrefPubMedGoogle Scholar
  • 45 van Ingen J, Boeree MJ, de Lange WC, de Haas PE, Dekhuijzen PN, van Soolingen D. Clinical relevance of Mycobacterium szulgai in the Netherlands. Clin Infect Dis 2008; 46 (8) 1200-1205
    CrossrefPubMedGoogle Scholar
  • 46 van Ingen J, Boeree MJ, Dekhuijzen PN, van Soolingen D. Clinical relevance of Mycobacterium simiae in pulmonary samples. Eur Respir J 2008; 31 (1) 106-109
    CrossrefPubMedGoogle Scholar
  • 47 van Ingen J, Totten SE, Heifets LB, Boeree MJ, Daley CL. Drug susceptibility testing and pharmacokinetics question current treatment regimens in Mycobacterium simiae complex disease. Int J Antimicrob Agents 2012; 39 (2) 173-176
    CrossrefPubMedGoogle Scholar
  • 48 Hoefsloot W, Boeree MJ, van Ingen J , et al. The rising incidence and clinical relevance of Mycobacterium malmoense: a review of the literature. Int J Tuberc Lung Dis 2008; 12 (9) 987-993
    PubMedGoogle Scholar
  • 49 Hoefsloot W, van Ingen J, de Lange WC, Dekhuijzen PN, Boeree MJ, van Soolingen D. Clinical relevance of Mycobacterium malmoense isolation in The Netherlands. Eur Respir J 2009; 34 (4) 926-931
    CrossrefPubMedGoogle Scholar
  • 50 van Ingen J, Boeree MJ, de Lange WC , et al. Mycobacterium xenopi clinical relevance and determinants, the Netherlands. Emerg Infect Dis 2008; 14 (3) 385-389
    CrossrefPubMedGoogle Scholar
  • 51 Andréjak C, Lescure FX, Pukenyte E , et al; Xenopi Group. Mycobacterium xenopi pulmonary infections: a multicentric retrospective study of 136 cases in north-east France. Thorax 2009; 64 (4) 291-296
    CrossrefPubMedGoogle Scholar
  • 52 Nash KA, Brown-Elliott BA, Wallace Jr RJ. A novel gene, erm(41), confers inducible macrolide resistance to clinical isolates of Mycobacterium abscessus but is absent from Mycobacterium chelonae. Antimicrob Agents Chemother 2009; 53 (4) 1367-1376
    CrossrefPubMedGoogle Scholar
  • 53 Koh WJ, Jeon K, Lee NY , et al. Clinical significance of differentiation of Mycobacterium massiliense from Mycobacterium abscessus. Am J Respir Crit Care Med 2011; 183 (3) 405-410
    CrossrefPubMedGoogle Scholar
  • 54 Leao SC, Tortoli E, Euzéby JP, Garcia MJ. Proposal that Mycobacterium massiliense and Mycobacterium bolletii be united and reclassified as Mycobacterium abscessus subsp. bolletii comb. nov., designation of Mycobacterium abscessus subsp. abscessus subsp. nov. and emended description of Mycobacterium abscessus. Int J Syst Evol Microbiol 2011; 61 (Pt 9) 2311-2313
    CrossrefPubMedGoogle Scholar
  • 55 Lyu J, Jang HJ, Song JW , et al. Outcomes in patients with Mycobacterium abscessus pulmonary disease treated with long-term injectable drugs. Respir Med 2011; 105 (5) 781-787
    CrossrefPubMedGoogle Scholar