Non TB Mycobacterium

Question 1

How are NTM divided?

Answer 1

Under 7 days growth (Rapid Growers)
Non pigmented Rapid growers
Pigmented species–rarely pathogenic

Slowly growing (7-10 days)

Intermediate (7-10 days)

Question 2

What are the major syndromes assoc with NTM?

Answer 2

1) Chronic bronchopulmonary disease similar to TB, such as M Kansasii, M Abscessus, MAC
2) Cervical or other lymphadentis- children with MAI, scrofulaceum and M. Malmoense
3) Skin and soft tissue–M Marinum and rapidly growing NTM
4) Skeletal (bone or tendon)- MAC/MAI, M Marinum, M Kansasii
5) Disseminated infection–HIV/AIDS patients
6) Iatrogenic such as catheter assoc infection- M Fortuitum, M Abscessus

Question 3

What do you think of in middle aged men, smokers and heavy alcohol with upper lobe cavitary disease?

Answer 3

MAI, M Kansasii

Question 4

Older Nonsmoking females with no apparent underlying disease? Right middle lobe and lingular bronchiectasis

Answer 4

MAI, M Abscessus

Question 5

What NMT do you think of with achalsia, chronic vomiting and lipoid Pneumonia?

Answer 5

M. Fortuitum
M Abscessus
MAI

Question 6

What is MAC?

Answer 6

Mycobacteriam Avium Complex
Does not have propensity for upper lobes like TB
Can be lower and upper lobes

Question 7

What are rice bodies?

Answer 7

Occur in tendon sheaths
Granulomatous inflammation

Question 8

What do you see in Disseminated HIV associated MAC?

Answer 8

Feve, drenching swets, diarrhoea, wasting and multi organ damage
Anaemia, hypoalbuminaemia, neutropenia
Hepatomegaly, splenomegaly, peripheral adenopathy

Question 9

How do you treat MAC in HIV individuals?

Answer 9

Combination of clarithromycin and Ethambutol and rifampicin +/- Amikacin

Question 10

What can MAC cause in HIV patients?

Answer 10

IRIS
See things like left supraclavicular lymphadenitis

Question 11

What does M Kansasii present like? Tx?

Answer 11

Cavitary lung disease
Presents very similar to TB
Tx with INH, rifabutin and Ethambutol

Question 12

What is M Scrofulaceum?

Answer 12

Causes lumps/swellings preauricular and cervical

Question 13

What does Mycobacteriam Haemophilum present like?

Answer 13

Found especially in T cell compromised hosts
Does not grow on AFB media
Suspect in AFB smear and negative routine AFB culture
Tx with clarithromycin, ciprofloxacin, amikacin, rifampin, rifabutin

Question 14

Mycobacteriam Ulcerans presentation and tx?

Answer 14

Buruli ulcer
Endemic in Australia, Central and South America as well as Africa
Chronic, necrotising ulcerative lesions
Tx: Clarithromycin and rifampin

Question 15

Mycobacteriam Marinum presentation?

Answer 15

Typically contact with fish tanks/ fish
Painful lesions
Tx: Clarithromycin and Ethambutol or rifampicin

Question 16

What is M Abscessus/Chelonae?

Answer 16

Rapidly growing mycobacterium
Found In tap water
Typically causes cutaneous infections especially in corticosteroid use
Disseminated disease can involve numerous painful draining red nodules

Question 17

What is best tx for M Abscessus/Chelonae?

Answer 17

Clarithromycin and Linezolid best drugs
Localised disease– clarithromycin for 4-6 months
Disseminated disease– 4 months of combo therapy for 6-12 months

Question 18

Most common cause of nosocomial outbreaks?

Answer 18

M Fortuitum