Nontuberculous Mycobacterial Infections

Question 1

NTM “Slow” growers

Answer 1

M. avium complex (MAC),
M. kansasii,
M. marinum,
M. xenop

(>2 weeks in AFB media, liquid media more quickly)

Question 2

NTM “Rapid” growers

RGM are usually not susceptible to antituberculous agents

Answer 2

M. abscessus,
M. chelonae,
M. fortuitum

Run F A Cs t

(4-7 days in routine blood agar)

Question 3

NTM “Need help” growing

Answer 3

M. marinum,
M. haemophilum,
M. ulcerans,
M. genavense

Need help –> H U G Mari

Question 4

NTM Disease Clinical Manifestations

• Pulmonary (75%)

Answer 4

M. kansasii (primarily in the South)
M. xenopi (northern US/ Canada, Europe)
M. abscessus - (Cystic Fibrosis )
M. malmoense - (Europe)

Question 5

NTM Disease Clinical Manifestations

Skin and Soft tissue (15%)

Answer 5

M. marinum, 
M. abscessus,  dah ! 
M. chelonae,
M. fortuitum,  
M. ulcerans,  dah !

Question 6

NTM Disease Clinical Manifestations

Lymph node disease (5%)

Answer 6

M. scrofulaceum
M. haemophilum
M. malmoense

Question 7

NTM Disease Clinical Manifestations

Disseminated (5%)

Answer 7

M. kansasii, 
M. abscessus, 
M. chelonae, 
M. haemophilum
M. fortuitum
M. genavense

Question 8

NTM Disease Clinical Manifestations

• Hypersensitivity pneumonitis (0%)

Answer 8

 MAC and hot-tubs

Question 9

MAC Clinical Manifestations

Answer 9

Pulmonary
Skin & soft tissue
Lymphadenitis
Disseminated

Basically all of them !

Question 10

NTM Bug-Setting Associations

 M. chelonae

Answer 10

> Corneal Disease

> Tattoo-ink outbreaks

Question 11

NTM Bug-Setting Associations

• Healthcare/hygiene associated outbreaks
Footbaths, Plastic Surgery

Answer 11

M. chelonae,

M. fortuitum (foot baths, pedicure)

M. abscessus

Question 12

NTM Bug-Setting Associations

• Line-associated

Answer 12

 M. mucogenicum

Question 13

NTM Bug-Setting Associations

Tropical setting

Answer 13

 M. ulcerans (buruli ulcer)

Equatorial Africa

Question 14

NTM Bug-Setting Associations

 Contaminant

Answer 14

• M. gordonae

Question 15

NTM Bug-Setting Associations

• Pseudo-outbreaks

Answer 15

• M. immunogenum,

* M. simiae

Question 16

NTM that Cross-react with IGRAs

Answer 16

• M. szulgai,
• M. kansasii,
• M. marinum

KaMarSzu - tra

Question 17

NTM - exposure risk factors

Answer 17

• Environmental organisms

> Soil, lakes, rivers, municipal water systems

Question 18

MAC Therapeutic Options

Answer 18

• Macrolide, rifampin, ethambutol
• for 18-24 months
• Recommended to test susceptibility for macrolide

Question 19

Pulmonary M. kansasii Therapy

Answer 19

• M. kansasii clinically more like TB
• INH, RIF, EMB
• RIF is key drug.

Question 20

MoCo causes a lung infection that mimics tuberculosis

Answer 20

M. kansasii

Tx: isoniazid, rifampin, and ethambutol

Question 21

Pulmonary M. abscessus Therapy

Answer 21

IV: Tigecycline, Cefoxitin, Imipenem,
Amikacin

PO: Clofazimine, Linezolid

Surgical resection

 Inducible macrolide resistance–erm

Question 22

M. chelonae and M. fortuitum treatment

Answer 22

 Macrolides, FQ, AG, imipenem, tigecycline

 Note: tobra is best for M. chelonae

Question 23

Hansen’s Disease

Answer 23

Leprosy

• M. leprae does not grow in culture]
• Armadillos and gulf region
• Tx: Dapsone, Rifampin, Clofazimine

Question 24

HIV disseminated MAC that doesn’t grow

. . .

Answer 24

Think of M. genavense

Question 25

Is PZA useful for any NTM

Answer 25

NO !