Non-TB mycobacterium

Question 1

What is the Runyan classification?

Answer 1

Runyan classification based on production of pigmentation, whether the pigmentation occurred in darkness or light, and growth rates

Question 2

Grown in dark develop a pigment?

Answer 2

Scotochromogens

Question 3

Grown in light and produce a yellow pigment?

Answer 3

Photochromogens

Question 4

Name some examples from group I to IV

Answer 4

Class I: Photochromogens (M kansasii, M
marinum, M simiae, M asiaticum)
* Class II: Scotochromogens (M scrofulaceum,
M gordonae, M szulgai, M xenopi)
* Class III: Nonchromogenic (M avium-
intracellulare, M terrae, M paratuberculosis)
* Class IV: Rapid Growers (M chelonae, M
abscessus, M fortuitum)

Question 5

What are the most important non pigmented species fast growers?

Answer 5

M abscessus, M fortuitum

Question 6

What are slow growing NTMs?

Answer 6

M. avium complex (MAC, MAI, M. avium-intracellulare)
M. kansasii
M. ulcerans
M. xenopi
M. terrae complex
M. simiae
M. haemophilum
M. szulgai
M. genavensae
M. scrofulaceum
M. malmoense

Question 7

Intermediately slow growing NTM?

Answer 7

M. marinum, M. gordonae

Question 8

What is often caught in a swimming pool?

Answer 8

M. marinum

Question 9

What are the major clinical syndromes of NTMs?

Answer 9

Chronic pulmonary disease
lymphadenitis
Skin and soft tissue

Question 10

What are the most common NTM causes of pulmonary disease?

Answer 10

Mycobacterium avium-intracellulare
M. kansasii,
M. abscessus

Question 11

What are the common NTM causing lymphadenitis?

Answer 11

MAI
M. scrofulaceum
M. malmoense

Question 12

What are the common causes of NTM causing skin disease?

Answer 12

M. marinum
M. chelonae

Question 13

What causes skeletal disease?

Answer 13

MAC/MAI, M. marinum, M. kansasii, M. fortuitum, M.
abscessus, M. chelonae

Question 14

What NTM causes disseminated infection and in who?

Answer 14

HIV

MAI, M. kansasii and M. haemophilum

HIV negative patients - M. abscessus, M. chelonae

Question 15

What NTM cause line infections/healthcare associated infections?

Answer 15

M. fortuitum, M. abscessus, and M. chelonae

Question 16

Which NTM do Middle age male smokers, often heavy alcohol users get?

Answer 16

MAI, M. kansasii

Upper lobe cavitary disease; resembles M. tuberculosis disease

Question 17

Which NTM do Older nonsmoking females with no apparent underlying disease get?

Answer 17

MAC

RML, lingular bronchiectasis (Lady Windermere Syndrome)

Question 18

Which NTM causes Achalasia, chronic vomiting, lipoid pneumonia?

Answer 18

M. fortuitum, M. abscessus, MAI

Question 19

What is the most common NTM in South America?

Answer 19

M.Kansasii

Question 20

What is the most common NTM in the world?

Answer 20

MAC
(includes M. avium-intracellulare)

Question 21

Do you treat everyone with positive NTM on sputum?

Answer 21

No!
- Symptomatic
- Aggressive clinically and radiologically

Question 22

What are the public health concerns of NTM?

Answer 22

Nil
Non contagious
Live in environment everywhere

Question 23

Most prominent risk factor for MAC?

Answer 23

Immunosuppression with CD4 less than 50

Question 24

What is the transmission?

Answer 24

Ingestion or inhalation

Question 25

Differentials of Cavitating lesions on CXR?

Answer 25

TB Non-TB mycobacterium Fungal Bacterial Parasitic

Question 26

What are rice bodies? What causes it?

Answer 26

Granulomatous infection of tendon sheath TB NTM - MAC most common fungal infection

Question 27

What are globi?

Answer 27

Overwhelming bone marrow infiltration with an NTM

Question 28

How does M.Kansasii present?

Answer 28

Almost always pulmonary disease, interstitial infiltrates and lobar infiltrates Can be disseminated disease (in HIV) Very similar to TB!

Question 29

What is the Rx of M.Kansasii?

Answer 29

Same as TB except without the PZA

Question 30

How do you differentiate species of NTM?

Answer 30

Culture

Question 31

What is this?

Answer 31

M scrofulaceum Differentials - TB (more likely) - M. malmoense

Question 32

In who do you find M.haemophilum?

Answer 32

Immunocompromised Aquatic reservoirs.

Question 33

3 most common mycobacterium

Answer 33

M.TB M.Leprae M.Ulcerans

Question 34

How do you manage a Buruli ulcer?

Answer 34

Clarithromycin and rifampin Surgical excision

Question 35

Which NTM do you get from fresh water esp if an injury?

Answer 35

M.marinum All patients reported contact with fish tanks at home or work prior to infection.

Question 36

Which NTM do you get from fresh water esp if an injury?

Answer 36

M.marinum All patients reported contact with fish tanks at home or work prior to infection.

Question 37

Injury in a fish tank, Diagnosis? Key differential?

Answer 37

Infection began as papulonodular lesion on finger or hand in all 8 patients, and remained confined to the skin and lymphatics. (resembles sporotrichosis).

Question 38

45 year old transplant patient, develops bilateral ulcerative lesions on Lower limbs, works as a farmer. Diagnosis?

Answer 38

M. abscessus/chelonae Commonly found in tap water Causes skin and soft tissue disease

Question 39

How do you treat M.Kansasii

Answer 39

Same as TB minus the PZA

Question 40

How do you treat MAC?

Answer 40

Clarith/azith plus rifampicin plus ethambutol (plus amino glycoside in some cases)