TB/NTM Flashcards
NTM recovered almost exclusively from municipal water sources
M kansasii
M xenopi
M simiae
**NTM are generally resistant to chlorination
Risk factors for disseminated NTM
- cell-mediated immunodeficiency (HIV, steroid use)
- IFNg or IL2 defects
Rapid-Growing NTM
- M abscessus
- M chelonae
- M fortuitum complex
- M immunogenum
- M mucogenicum
- M smegmatis
Slow-Growing NTM
- Photogromogens (demonstrate pigment only in presence of light)
- M kansasii
- M marinum
- Scotochromogens (pigment with or without presence of light)
- M gordonae
- M scrofulaceum
- Nonchromogens (no pigment)
- MAC
- M haemophilum
- M malmoense
- M simiae
NTM a/w metalworking fluid
M immunogenum
NTM a/w lasik
M chelonae
Complications of leprosy
- reversal reaction
- increased warmth, erythema, edema of preexisting lesions
- d/t development of exuberant local T-cell mediated immune response to living or dead bacilli
- permanent nerve damage if left untreated
- can’t occur in tuberculoid form
- erythema nodosum leprosum
- acute new SQ nodules - painful, red, tender
- extensor surfaces of legs and the face
- d/t complement activation following immune complex deposition
disseminated NTM infection in AIDS patient suspected but cultures negative
M genavense
has been implicated in pseudo-outbreaks a/w contaminated scopes
M immunogenum
NTM in equitorial Africa
M ulcerans
Leprosy tx
- PB - dapsone + rifampin x6mos
- MB - dapsone + clofazimine daily x12mos
+ hypoanesthesia
leprosy (this is lepromatous classification - will be punch bx AFB+)
Classification of leprosy
- Paucibacillary - most common. Bacillary load <1mil, skin bx = AFB negative. <5 skin lesions
- Multibacillary - “lepromatous”, massive bacillary load, skin bx = AFB floridly positive. >5 skin lesions
disseminated fortuitum tx
3rx (including 1 IV) x4-6mos
- macrolides, quinolones, bactrim, doxy (50%)
- IV: aminoglycosides, imipenem, cefoxitin, tigecycline
disseminated chelonae tx
3rx (including 1 IV) x4-6mos
- macrolides, fluoroquinolone, linezolid
- IV: aminoglycosides, imipenem, cefoxitin, tigecycline
***tobra = best for chelonae
NTM a/w tattoos
M chelonae
2-3mos PO therapy - 1-2rx based on susc, but typically always includes macrolide
nail salon furunculosis
and tx
a/w outbreaks and/or sporadic
rapid growers most common (fortuitum)
PO abx - 4mos quinolones and/or doxy
likes to tunnel and involve the tendons
M marinum (fishtank granuloma)
tx: multiple rxs = 2 agents x3-4mos typical + debridement if possible
NTM post-plastic surgery (and typical tx)
chelonae
remove foreign bodies
tx as per susc
typical 4-6mos
Tx for pulm abscessus
3-4 drugs x18-24mos (though cure = rare)
4-6mos induction, followed by suppressive
- PO options: clofazimine, linezolid, moxifloxacin
- Parenteral options: tigecycline, cefoxitin, imipenem, amikacin
M abscessus subspp
boletti, massiliense, abscessus
subspp abscessus almost always have inducible macrolide resistance - erm(41) gene
Pulm kansasii therapy
clinically more like TB = curable
thin-walled cavities, involving upper lobes
Tx = INH, RIF (= key rx), EMB
actually high success rate (90+%)
Typical option for MAC treatment
macrolide, rifampin, ethambutol - typically daily, though TIW is optional if non-cavitary
if cavitary dz: amikacin 1-2mos
ultimately require minimum 18-24mos (need 12 mo culture negative)
Pulm NTM common in Europe: and in northern US/Canada:
- Canada/northern US: xenopi
- Europe: malmoense
NTM a/w saltwater fish and fishtanks
M marinum
NTM a/w with lung disease after aspiration
fortuitum
NTM that demonstrate cross-reactivity with IGRAs
szulgai, kansasii, marinum
The only NTM that is communicable
M massilense (in CF patients)
NTM that is often contaminant
M gordonae
NTM a/w tropical setting
M ulcerans (buruli ulcer) - wading in water = RF
line-associated NTM
M mucogenicum
NTM a/w healthcare/hygiene outbreaks
chelonae, fortuitum, abscessus
NTM corneal disease
M chelonae
