Non-Tuberculous Mycobacterial Diseases Flashcards
Approximately what percentage of Mycobacterial diseases are caused by non-tuberculous bacteria?
10%
What are two unique characteristics of non-tuberculous bacteria?
Not communicable from person to person
Often resistant to standard TB drugs
What is the most common non-tuberculous mycobacteria?
Mycobacterium Avium Complex
What two systems does Mycobacterium Avium Complex infect?
Lungs
Lymph
What two systems are most commonly affected by non-tuberculous mycobacteria?
Lungs (77%)
Skin and Soft Tissue (12%)
Non-tuberculous mycobacteria infections of the Skin and Soft Tissue commonly appear where?
Extremities
- community outbreaks from tattoo parlors
Disseminated infection of MAC is most commonly seen in patients with what?
Late Stages of HIV
- CD4 less than 50/mcL
How do you treat a disseminated infection of MAC?
Clarithromycin or Azithromycin + ethambutol
- may also add Rifabutin
What are the two major phenotypes of MAC Lung Disease?
Nodular + Brochiectatic (NB)
Fibrocavitary (FC)
Nodular + Brochiectatic is typically found in what types of patients?
Post-menopausal White Women who don’t Smoke
What is Nodular + Brochiectatic MAC commonly known as?
Lady Windermere Syndrome
What is the clinical course of Nodular + Brochiectatic MAC?
Prolonged Cough
Fatigue
Weight Loss
- 50% won’t Progress
- 33% may spontaneously convert to negative
What might you find on a CT of a patient with Nodular Brochiectatic MAC?
Bronchiectasis with Nodules
“Tree-in-Bud Appearance
Where is Nodular + Brochiectatic MAC usually found inside the lungs?
Right Middle Lobe
What type of patients develop Fibrocavitary MAC?
50+ year old male with an underlying chronic lung condition
What is the clinical course of Fibrocavitary MAC?
Progressive
Systemic Symptoms
Worse Outcome and Prognosis than NB type
Where is Fibrocavitary MAC usually found inside the lungs?
Upper Lobe
Over half of the patients who meet the diagnostic criteria for MAC Lung Disease progress within 3 - 5 years, which means you as a provider should do what?
Start treatment
- don’t wait you fool
What type of susceptibility testing should be performed when beginning to treat MAC?
Macrolide-Resistance
How long should MAC be treated for
12 months
What three medications are used to treat MAC?
Clarithromycin or Azithromycin
Rifampin or Rifabutin
Ethambutol
What other Non-tuberculous Mycobacteria can infect the lungs?
M. kansasii
How long is pulmonary M. kansasii treated for?
18 months
What three drugs are used to treat pulmonary M. kansasii?
Isoniazid
Rifampin
Ethambutol
How should skin and soft tissue infections caused by M. kansasii should be treated?
Surgical Debridement
Two ABX (3 months)
What can arise if only Macrolide monotherapy is given?
Macrolide Resistance
A 2014 study found that only what percentage of patients with MAC were being treated correctly?
13%
