Non-tuberculous Mycobacterial Infection

Question 1

mesotherapy

Answer 1

a cosmetic medicine treatment

multiple injections of pharmaceutical and homeopathic medications, plant extracts, vitamins, and other ingredients into the subcutaneous fat

allegedly targets fat cells, inducing lipolysis, rupture, and cell death among adipocytes

Question 2

Nontuberculous Mycobacteria (NTM)

Answer 2

>/= 125 NMT species

no latent infection

clinical presentation include granulomatous pneumonia or bronchiectasis

Question 3

group I NTM

Answer 3

photochormogens

• M. kansasii*
• M. marinum*

Question 4

group II NTM

Answer 4

scotochromogens

M. xenopi

Question 5

group III NTM

Answer 5

nophochromogens

• M. avium*
• M. intracellulare*

often called the MAC (M. avium complex) because the two strains are hard to differentiate

Question 6

group IV NTM

Answer 6

rapid growers

• M. fortuitum*
• M. chelonae*
• M. abscessus*

Question 7

rapidly growing mycobacteria

Answer 7

growth on agar plates within 7 days

includes M. fortuitum, M. chelonae, M. abscessus

amny grow best at 30 degrees C, no special nutritional requirements

Question 8

intermediately growing mycobacteria

Answer 8

grows in 7-10 days

includes M. marinum and M. gordonae

• M. marinum* grows best at 28-30 degrees C
• M. gordonae* prefers 35-37 degrees C

Question 9

slowly growing mycobacteria

Answer 9

growth in > 7 days

includes MAC, M. kansasii

some species require nutritional supplementation of routine media

most grow best at 35-37 degrees C

Question 10

source of NTM infection

Answer 10

environmental, not other humans

water- fresh, salt, domestic, hot tubs, metal-working fluids

soild - 80% of soil samples in the SE U.S.

nocosomial sources

Question 11

common NTM causes of chronic bronchopulmonary disease

Answer 11

MAC, M. kansasii, M. chelonae-abscessus

Question 12

common NTM causes of disseminated infection

Answer 12

MAC

Question 13

common NTM causes of skin abscesses

Answer 13

M. marinum, M. chelonae-avscessus, M. fortuitum

Question 14

clinical diagnostic criteria for NTM lung disease

Answer 14

pulmonary symptoms, nodular or cavitary opacities on chest radiograph

CT scan that shows multifocal bronchiectasis with multiple small nodules

and

exclusion of other diseases

Question 15

microbiologic criteria for diagnosis of NTM lung disease

Answer 15

>/= 2 positive culture results from sputum

or

positive culture results from bacterial wash or lavage

or

transbronchial or other lung biopsy showing granulomatous inflammation or +AFB and positive culture for NTM

Question 16

Mycobacterium avium complex (MAC)

Answer 16

includes two closely related organisms M. avium and M. intracellulare

organism common in many environmental sites such as water, soil, and animals

probably acquired by inhalation or ingestion

no person-to-person spread

Question 17

major disease syndromes for MAC

Answer 17

pulmonary disease

disseminated disease (in HIV/AIDS)

cervical lymphadenitis

Question 18

Hot-tub lung

Answer 18

a hypersensitivity reaction to inhaled MAC and not an invasive infection

Question 19

Lady Windemere Syndrome

Answer 19

right middle lobe or lingular bronchiectasis

often found in white women in the 50s or 60s

usually taller and thinner women

consists of years of nagging intermittent cough and fatigue

often comes with scoliosis and cystic fibrosis transmembrane condutance gene mutation

Question 20

MAC treatment

Answer 20

clarithromycin (or azithromycin) plus rifampin (or rifabutin) plus ethambutol x12-18 months

alternative agents are fluoroquinolones, clofazimine, and linezolid

surgical resection - may be useful when medical therapy fails

Question 21

Mycobacterium kansasii

Answer 21

pulmonary infection mimics pulmonary TB

acquired from the environment

not transmitted from person-to-person

Question 22

treatment for M. kansasii infections

Answer 22

isoniazid, rifampin, and ethambutol for >/= 18 months (>/= 12 months after respiratory cultures are negative)