Overview of nontuberculous mycobacterial infections in HIV-negative patients
- David E Griffith, MD
David E Griffith, MD
- Professor of Medicine
- University of Texas Health Center at Tyler
Nontuberculous mycobacteria (NTM) species are mycobacterial species other than those belonging to the Mycobacterium tuberculosis complex (eg, M. tuberculosis, Mycobacterium bovis, Mycobacterium africanum, and Mycobacterium microti) and Mycobacterium leprae. NTM are generally free-living organisms that are ubiquitous in the environment. There have been more than 140 NTM species identified.
In broad terms, NTM can cause four clinical syndromes in humans [1,2]:
●Pulmonary disease, especially in older persons with or without underlying lung disease and patients with cystic fibrosis, caused primarily by Mycobacterium avium complex (MAC) and Mycobacterium kansasii.
Other species that cause lung disease include Mycobacterium abscessus, Mycobacterium fortuitum, Mycobacterium xenopi, Mycobacterium malmoense, Mycobacterium szulgai, and Mycobacterium simiae (table 1) . Geography plays a prominent role in the epidemiology of NTM pulmonary disease. M. xenopi is relatively more common in Europe, Great Britain, and Canada, while M. malmoense is relatively more common in Scandinavia and Northern Europe [1,4]. (See "Epidemiology of nontuberculous mycobacterial infections".)
●Superficial lymphadenitis, especially cervical lymphadenitis, in children caused mostly by MAC, Mycobacterium scrofulaceum, and, in northern Europe, M. malmoense and Mycobacterium haemophilum. (See "Overview of disseminated nontuberculous mycobacterial (NTM) infections and NTM bacteremia in children" and "Overview of nontuberculous mycobacterial lymphadenitis in children".)
●Disseminated disease in severely immunocompromised patients (most commonly caused by MAC and less commonly by the rapidly growing mycobacteria [RGM], eg, M. abscessus, M. fortuitum, and Mycobacterium chelonae). (See "Mycobacterium avium complex (MAC) infections in HIV-infected patients" and "Rapidly growing mycobacterial infections in HIV-negative patients".)
- Wolinsky E. Nontuberculous mycobacteria and associated diseases. Am Rev Respir Dis 1979; 119:107.
- Griffith DE, Aksamit T, Brown-Elliott BA, et al. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med 2007; 175:367.
- Diagnosis and treatment of disease caused by nontuberculous mycobacteria. This official statement of the American Thoracic Society was approved by the Board of Directors, March 1997. Medical Section of the American Lung Association. Am J Respir Crit Care Med 1997; 156:S1.
- Wolinsky E, Rynearson TK. Mycobacteria in soil and their relation to disease-associated strains. Am Rev Respir Dis 1968; 97:1032.
- Phillips MS, von Reyn CF. Nosocomial infections due to nontuberculous mycobacteria. Clin Infect Dis 2001; 33:1363.
- Mullis SN, Falkinham JO 3rd. Adherence and biofilm formation of Mycobacterium avium, Mycobacterium intracellulare and Mycobacterium abscessus to household plumbing materials. J Appl Microbiol 2013; 115:908.
- Wallace RJ Jr, Iakhiaeva E, Williams MD, et al. Absence of Mycobacterium intracellulare and presence of Mycobacterium chimaera in household water and biofilm samples of patients in the United States with Mycobacterium avium complex respiratory disease. J Clin Microbiol 2013; 51:1747.
- Falkinham JO 3rd. Reducing human exposure to Mycobacterium avium. Ann Am Thorac Soc 2013; 10:378.
- Prince DS, Peterson DD, Steiner RM, et al. Infection with Mycobacterium avium complex in patients without predisposing conditions. N Engl J Med 1989; 321:863.
- Ahn CH, McLarty JW, Ahn SS, et al. Diagnostic criteria for pulmonary disease caused by Mycobacterium kansasii and Mycobacterium intracellulare. Am Rev Respir Dis 1982; 125:388.
- Teirstein AS, Damsker B, Kirschner PA, et al. Pulmonary infection with Mycobacterium avium-intracellulare: diagnosis, clinical patterns, treatment. Mt Sinai J Med 1990; 57:209.
- Kilby JM, Gilligan PH, Yankaskas JR, et al. Nontuberculous mycobacteria in adult patients with cystic fibrosis. Chest 1992; 102:70.
- Reich JM, Johnson RE. Mycobacterium avium complex pulmonary disease presenting as an isolated lingular or middle lobe pattern. The Lady Windermere syndrome. Chest 1992; 101:1605.
- Iseman MD, Buschman DL, Ackerson LM. Pectus excavatum and scoliosis. Thoracic anomalies associated with pulmonary disease caused by Mycobacterium avium complex. Am Rev Respir Dis 1991; 144:914.
- Kim RD, Greenberg DE, Ehrmantraut ME, et al. Pulmonary nontuberculous mycobacterial disease: prospective study of a distinct preexisting syndrome. Am J Respir Crit Care Med 2008; 178:1066.
- Lim J, Lyu J, Choi CM, et al. Non-tuberculous mycobacterial diseases presenting as solitary pulmonary nodules. Int J Tuberc Lung Dis 2010; 14:1635.
- Cappelluti E, Fraire AE, Schaefer OP. A case of "hot tub lung" due to Mycobacterium avium complex in an immunocompetent host. Arch Intern Med 2003; 163:845.
- Khoor A, Leslie KO, Tazelaar HD, et al. Diffuse pulmonary disease caused by nontuberculous mycobacteria in immunocompetent people (hot tub lung). Am J Clin Pathol 2001; 115:755.
- Kahana LM, Kay JM, Yakrus MA, Waserman S. Mycobacterium avium complex infection in an immunocompetent young adult related to hot tub exposure. Chest 1997; 111:242.
- Embil J, Warren P, Yakrus M, et al. Pulmonary illness associated with exposure to Mycobacterium-avium complex in hot tub water. Hypersensitivity pneumonitis or infection? Chest 1997; 111:813.
- Colombo RE, Hill SC, Claypool RJ, et al. Familial clustering of pulmonary nontuberculous mycobacterial disease. Chest 2010; 137:629.
- Vankayalapati R, Wizel B, Samten B, et al. Cytokine profiles in immunocompetent persons infected with Mycobacterium avium complex. J Infect Dis 2001; 183:478.
- Safdar A, White DA, Stover D, et al. Profound interferon gamma deficiency in patients with chronic pulmonary nontuberculous mycobacteriosis. Am J Med 2002; 113:756.
- Horsburgh CR Jr, Mason UG 3rd, Farhi DC, Iseman MD. Disseminated infection with Mycobacterium avium-intracellulare. A report of 13 cases and a review of the literature. Medicine (Baltimore) 1985; 64:36.
- Nightingale SD, Byrd LT, Southern PM, et al. Incidence of Mycobacterium avium-intracellulare complex bacteremia in human immunodeficiency virus-positive patients. J Infect Dis 1992; 165:1082.
- Winthrop KL, Baxter R, Liu L, et al. Mycobacterial diseases and antitumour necrosis factor therapy in USA. Ann Rheum Dis 2013; 72:37.
- Kohler P, Kuster SP, Bloemberg G, et al. Healthcare-associated prosthetic heart valve, aortic vascular graft, and disseminated Mycobacterium chimaera infections subsequent to open heart surgery. Eur Heart J 2015; 36:2745.
- Sax H, Bloemberg G, Hasse B, et al. Prolonged Outbreak of Mycobacterium chimaera Infection After Open-Chest Heart Surgery. Clin Infect Dis 2015; 61:67.
- Perkins KM, Lawsin A, Hasan NA, et al. Notes from the Field: Mycobacterium chimaera Contamination of Heater-Cooler Devices Used in Cardiac Surgery - United States. MMWR Morb Mortal Wkly Rep 2016; 65:1117.
- UPDATE: Mycobacterium chimaera Infections Associated with LivaNova PLC (formerly Sorin Group Deutschland GmbH) Stӧckert 3T Heater-Cooler System: FDA Safety Communication http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm520191.htm?source=govdelivery&utm_medium=email&utm_source=govdelivery (Accessed on October 17, 2016).
- CDC Advises Hospitals to Alert Patients at Risk from Contaminated Heater-Cooler Devices Used during Cardiac Surgery, October 13, 2016. https://emergency.cdc.gov/han/han00397.asp (Accessed on October 17, 2016).
- Johanson WG Jr, Nicholson DP. Pulmonary disease due to Mycobacterium Kansasii. An analysis of some factors affecting prognosis. Am Rev Respir Dis 1969; 99:73.
- Christensen EE, Dietz GW, Ahn CH, et al. Radiographic manifestations of pulmonary Mycobacterium kansasii infections. AJR Am J Roentgenol 1978; 131:985.
- Shitrit D, Baum GL, Priess R, et al. Pulmonary Mycobacterium kansasii infection in Israel, 1999-2004: clinical features, drug susceptibility, and outcome. Chest 2006; 129:771.
- Chetchotisakd P, Mootsikapun P, Anunnatsiri S, et al. Disseminated infection due to rapidly growing mycobacteria in immunocompetent hosts presenting with chronic lymphadenopathy: a previously unrecognized clinical entity. Clin Infect Dis 2000; 30:29.
- Chetchotisakd P, Kiertiburanakul S, Mootsikapun P, et al. Disseminated nontuberculous mycobacterial infection in patients who are not infected with HIV in Thailand. Clin Infect Dis 2007; 45:421.
- Majoor CJ, Schreurs AJ, Weers-Pothoff G. Mycobacterium xenopi infection in an immunosuppressed patient with Crohn's disease. Thorax 2004; 59:631.
- MYCOBACTERIUM AVIUM COMPLEX
- Pulmonary disease
- - Clinical manifestations
- - Diagnostic criteria
- - Pathogenesis
- Disseminated disease
- - Clinical symptoms and signs
- - Diagnosis
- - Management
- - M. chimaera associated with cardiac surgery
- MYCOBACTERIUM KANSASII
- Clinical features
- RAPIDLY GROWING MYCOBACTERIA
- OTHER NONTUBERCULOUS MYCOBACTERIA