Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Treatment of lung infection with Mycobacterium kansasii and other less common nontuberculous mycobacteria in adults

Charles L Daley, MD
Shannon Kasperbauer, MD
Section Editor
C Fordham von Reyn, MD
Deputy Editor
Allyson Bloom, MD


Treatment of nontuberculous mycobacterial (NTM) infection of the lung is dependent upon a number of factors, including the species of the infecting organism. Depending on the geographic area, the most common slow growing NTM to cause lung disease are Mycobacterium avium complex (MAC), Mycobacterium kansasii, Mycobacterium malmoense, and Mycobacterium xenopi [1-3].

The treatment of lung infections due to M. kansasii and other non-MAC slow growing nontuberculous mycobacteria will be reviewed here. Management of pulmonary infections due to MAC and to rapidly growing mycobacterium (Mycobacterium abscessus, Mycobacterium fortuitum complex, and Mycobacterium chelonae) are discussed separately. (See "Treatment of Mycobacterium avium complex lung infection in adults" and "Rapidly growing mycobacterial infections: Mycobacteria abscessus, chelonae, and fortuitum".)

The epidemiology, microbiology, clinical manifestations, and diagnosis of NTM infection are discussed elsewhere. (See "Overview of nontuberculous mycobacterial infections in HIV-negative patients" and "Epidemiology of nontuberculous mycobacterial infections" and "Diagnosis of nontuberculous mycobacterial infections of the lungs in HIV-negative patients".)


M. kansasii was first described by Buhler and Pollack in 1953 as a cause of progressive lung disease [4]. In the United States, M. kansasii is the second most common slow growing nontuberculous mycobacteria (NTM) causing pulmonary disease.

Rationale for treatment — Antimycobacterial treatment is indicated for most patients diagnosed with M. kansasii lung disease because untreated M. kansasii usually leads to chronic progressive lung disease [5]. Furthermore, outcomes are generally good with treatment of M. kansasii, with rare treatment failures and uncommon relapse. Thus, the benefits of treatment outweigh potential risks in most individuals.

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Oct 2017. | This topic last updated: Mar 16, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Wolinsky E. Nontuberculous mycobacteria and associated diseases. Am Rev Respir Dis 1979; 119:107.
  2. 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.
  3. Hoefsloot W, van Ingen J, Andrejak C, et al. The geographic diversity of nontuberculous mycobacteria isolated from pulmonary samples: an NTM-NET collaborative study. Eur Respir J 2013; 42:1604.
  4. BUHLER VB, POLLAK A. Human infection with atypical acid-fast organisms; report of two cases with pathologic findings. Am J Clin Pathol 1953; 23:363.
  5. Francis PB, Jay SJ, Johanson WG Jr. The course of untreated Mycobacterium kansasii disease. Am Rev Respir Dis 1975; 111:477.
  6. Ahn CH, Wallace RJ Jr, Steele LC, Murphy DT. Sulfonamide-containing regimens for disease caused by rifampin-resistant Mycobacterium kansasii. Am Rev Respir Dis 1987; 135:10.
  7. Pezzia W, Raleigh JW, Bailey MC, et al. Treatment of pulmonary disease due to Mycobacterium kansasii: recent experience with rifampin. Rev Infect Dis 1981; 3:1035.
  8. 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.
  9. Brown-Elliott BA, Crist CJ, Mann LB, et al. In vitro activity of linezolid against slowly growing nontuberculous Mycobacteria. Antimicrob Agents Chemother 2003; 47:1736.
  10. Guna R, Muñoz C, Domínguez V, et al. In vitro activity of linezolid, clarithromycin and moxifloxacin against clinical isolates of Mycobacterium kansasii. J Antimicrob Chemother 2005; 55:950.
  11. Alcaide F, Calatayud L, Santín M, Martín R. Comparative in vitro activities of linezolid, telithromycin, clarithromycin, levofloxacin, moxifloxacin, and four conventional antimycobacterial drugs against Mycobacterium kansasii. Antimicrob Agents Chemother 2004; 48:4562.
  12. Wallace RJ Jr, Dunbar D, Brown BA, et al. Rifampin-resistant Mycobacterium kansasii. Clin Infect Dis 1994; 18:736.
  13. Griffith DE, Brown-Elliott BA, Wallace RJ Jr. Thrice-weekly clarithromycin-containing regimen for treatment of Mycobacterium kansasii lung disease: results of a preliminary study. Clin Infect Dis 2003; 37:1178.
  14. Cynamon MH, Elliott SA, DeStefano MS, Yeo AE. Activity of clarithromycin alone and in combination in a murine model of Mycobacterium kansasii infection. J Antimicrob Chemother 2003; 52:306.
  15. Rodriguez Díaz JC, López M, Ruiz M, Royo G. In vitro activity of new fluoroquinolones and linezolid against non-tuberculous mycobacteria. Int J Antimicrob Agents 2003; 21:585.
  16. Ahn CH, Lowell JR, Ahn SS, et al. Short-course chemotherapy for pulmonary disease caused by Mycobacterium kansasii. Am Rev Respir Dis 1983; 128:1048.
  17. Mycobacterium kansasii pulmonary infection: a prospective study of the results of nine months of treatment with rifampicin and ethambutol. Research Committee, British Thoracic Society. Thorax 1994; 49:442.
  18. Sauret J, Hernández-Flix S, Castro E, et al. Treatment of pulmonary disease caused by Mycobacterium kansasii: results of 18 vs 12 months' chemotherapy. Tuber Lung Dis 1995; 76:104.
  19. Evans SA, Colville A, Evans AJ, et al. Pulmonary Mycobacterium kansasii infection: comparison of the clinical features, treatment and outcome with pulmonary tuberculosis. Thorax 1996; 51:1248.
  20. Santin M, Dorca J, Alcaide F, et al. Long-term relapses after 12-month treatment for Mycobacterium kansasii lung disease. Eur Respir J 2009; 33:148.
  21. Park HK, Koh WJ, Shim TS, Kwon OJ. Clinical characteristics and treatment outcomes of Mycobacterium kansasii lung disease in Korea. Yonsei Med J 2010; 51:552.
  22. Pulmonary disease caused by Mycobacterium avium-intracellulare in HIV-negative patients: five-year follow-up of patients receiving standardised treatment. Int J Tuberc Lung Dis 2002; 6:628.
  23. Schröder KH, Juhlin I. Mycobacterium malmoense sp. nov. J Syst Bacteriol 1977; 27:241.
  24. Martín-Casabona N, Bahrmand AR, Bennedsen J, et al. Non-tuberculous mycobacteria: patterns of isolation. A multi-country retrospective survey. Int J Tuberc Lung Dis 2004; 8:1186.
  25. Henriques B, Hoffner SE, Petrini B, et al. Infection with Mycobacterium malmoense in Sweden: report of 221 cases. Clin Infect Dis 1994; 18:596.
  26. Hoefsloot W, van Ingen J, de Lange WC, et al. Clinical relevance of Mycobacterium malmoense isolation in The Netherlands. Eur Respir J 2009; 34:926.
  27. Buchholz UT, McNeil MM, Keyes LE, Good RC. Mycobacterium malmoense infections in the United States, January 1993 through June 1995. Clin Infect Dis 1998; 27:551.
  28. Heginbothom ML, Lindholm-Levy PJ, Heifets LB. Susceptibilities of Mycobacterium malmoense determined at the growth optimum pH (pH 6.0). Int J Tuberc Lung Dis 1998; 2:430.
  29. Pulmonary disease caused by M. malmoense in HIV negative patients: 5-yr follow-up of patients receiving standardised treatment. Eur Respir J 2003; 21:478.
  30. Brown-Elliott BA, Nash KA, Wallace RJ Jr. Antimicrobial susceptibility testing, drug resistance mechanisms, and therapy of infections with nontuberculous mycobacteria. Clin Microbiol Rev 2012; 25:545.
  31. van Ingen J, Boeree MJ, van Soolingen D, Mouton JW. Resistance mechanisms and drug susceptibility testing of nontuberculous mycobacteria. Drug Resist Updat 2012; 15:149.
  32. van Ingen J, van der Laan T, Dekhuijzen R, et al. In vitro drug susceptibility of 2275 clinical non-tuberculous Mycobacterium isolates of 49 species in The Netherlands. Int J Antimicrob Agents 2010; 35:169.
  33. Jenkins PA, Campbell IA, Banks J, et al. Clarithromycin vs ciprofloxacin as adjuncts to rifampicin and ethambutol in treating opportunist mycobacterial lung diseases and an assessment of Mycobacterium vaccae immunotherapy. Thorax 2008; 63:627.
  34. Karassova V, Weissfeiler J, Krasznay E. Occurrence of atypical mycobacteria in Macacus rhesus. Acta Microbiol Acad Sci Hung 1965; 12:275.
  35. van Ingen J, Boeree MJ, de Lange WC, et al. Clinical relevance of Mycobacterium szulgai in The Netherlands. Clin Infect Dis 2008; 46:1200.
  36. Valero G, Peters J, Jorgensen JH, Graybill JR. Clinical isolates of Mycobacterium simiae in San Antonio, Texas. An 11-yr review. Am J Respir Crit Care Med 1995; 152:1555.
  37. van Ingen J, Boeree MJ, Dekhuijzen PN, van Soolingen D. Clinical relevance of Mycobacterium simiae in pulmonary samples. Eur Respir J 2008; 31:106.
  38. van Ingen J, Totten SE, Helstrom NK, et al. In vitro synergy between clofazimine and amikacin in treatment of nontuberculous mycobacterial disease. Antimicrob Agents Chemother 2012; 56:6324.
  39. Baghaei P, Tabarsi P, Farnia P, et al. Pulmonary disease caused by Mycobacterium simiae in Iran's national referral center for tuberculosis. J Infect Dev Ctries 2012; 6:23.
  40. Qvist T, Katzenstein TL, Lillebaek T, et al. First report of lung transplantation in a patient with active pulmonary Mycobacterium simiae infection. Transplant Proc 2013; 45:803.
  41. Barzilai A, Rubinovich B, Blank-Porat D, et al. Successful treatment of disseminated Mycobacterium simiae infection in AIDS patients. Scand J Infect Dis 1998; 30:143.
  42. Shitrit D, Peled N, Bishara J, et al. Clinical and radiological features of Mycobacterium kansasii infection and Mycobacterium simiae infection. Respir Med 2008; 102:1598.
  43. Watson SR, Auclair LK, Collins FM. The effect of combined chemotherapy on suppressor T-cell activity in Mycobacterium simiae-infected mice. Immunology 1981; 43:459.
  44. Valero G, Moreno F, Graybill JR. Activities of clarithromycin, ofloxacin, and clarithromycin plus ethambutol against Mycobacterium simiae in murine model of disseminated infection. Antimicrob Agents Chemother 1994; 38:2676.
  45. Marks J, Jenkins PA, Tsukamura M. Mycobacterium szulgai--a new pathogen. Tubercle 1972; 53:210.
  46. O'Brien RJ, Geiter LJ, Snider DE Jr. The epidemiology of nontuberculous mycobacterial diseases in the United States. Results from a national survey. Am Rev Respir Dis 1987; 135:1007.
  47. Yoo H, Jeon K, Kim SY, et al. Clinical significance of Mycobacterium szulgai isolates from respiratory specimens. Scand J Infect Dis 2014; 46:169.
  48. Kitada S, Uenami T, Yoshimura K, et al. Long-term radiographic outcome of nodular bronchiectatic Mycobacterium avium complex pulmonary disease. Int J Tuberc Lung Dis 2012; 16:660.
  49. Sánchez-Alarcos JM, De Miguel-Díez J, Bonilla I, et al. Pulmonary infection due to Mycobacterium szulgai. Respiration 2003; 70:533.
  50. Benator DA, Kan V, Gordin FM. Mycobacterium szulgai infection of the lung: case report and review of an unusual pathogen. Am J Med Sci 1997; 313:346.
  51. Inomata S, Tanaka H, Nakajima K, et al. Pulmonary nontuberculous mycobacterial infection caused by Mycobacterium szulgai in a young healthy woman. Intern Med 2006; 45:913.
  52. SCHWABACHER H. A strain of Mycobacterium isolated from skin lesions of a cold-blooded animal, Xenopus laevis, and its relation to atypical acid-fast bacilli occurring in man. J Hyg (Lond) 1959; 57:57.
  53. Dailloux M, Abalain ML, Laurain C, et al. Respiratory infections associated with nontuberculous mycobacteria in non-HIV patients. Eur Respir J 2006; 28:1211.
  54. Varadi RG, Marras TK. Pulmonary Mycobacterium xenopi infection in non-HIV-infected patients: a systematic review. Int J Tuberc Lung Dis 2009; 13:1210.
  55. van Ingen J, Boeree MJ, de Lange WC, et al. Mycobacterium xenopi clinical relevance and determinants, the Netherlands. Emerg Infect Dis 2008; 14:385.
  56. Andréjak C, Lescure FX, Pukenyte E, et al. Mycobacterium xenopi pulmonary infections: a multicentric retrospective study of 136 cases in north-east France. Thorax 2009; 64:291.
  57. Manfredi R, Nanetti A, Morelli S, et al. A decade surveillance study of Mycobacterium xenopi disease and antimicrobial susceptibility levels in a reference teaching hospital of northern Italy: HIV-associated versus non-HIV-associated infection. HIV Clin Trials 2004; 5:206.
  58. Andréjak C, Almeida DV, Tyagi S, et al. Improving existing tools for Mycobacterium xenopi treatment: assessment of drug combinations and characterization of mouse models of infection and chemotherapy. J Antimicrob Chemother 2013; 68:659.
  59. Ferro BE, van Ingen J, Wattenberg M, et al. Time-kill kinetics of slowly growing mycobacteria common in pulmonary disease. J Antimicrob Chemother 2015; 70:2838.
  60. Lounis N, Truffot-Pernot C, Bentoucha A, et al. Efficacies of clarithromycin regimens against Mycobacterium xenopi in mice. Antimicrob Agents Chemother 2001; 45:3229.
  61. Klemens SP, Cynamon MH. Activities of azithromycin and clarithromycin against nontuberculous mycobacteria in beige mice. Antimicrob Agents Chemother 1994; 38:1455.