Nontuberculous Mycobacterium, Myobacterium and Mixed Pulmonary Infections: A Case Report

Abstract

In the 1980’s, nontuberculous myobacteria (NTM) was recognized as the common cause of disseminated infection in patients who were severely immunocompromised. In Thailand, a study was reported where almost half of the disseminated NTM infections in HIV negative cases were related to farming. NTM contaminated soil and water lead to tissue invasion and cause disease. In recent years, Bangkok Hospital Medical Center has observed a constant rise of patients diagnosed with NTM with or without accompanying disease or infection. Diagnosing NTM has been made easier with the availability and aid of endobronchial ultrasound (EBUS) in collecting specimens for culture and to indicate sensitivity.
OBJECTIVES:
To illustrate 10 different cases and management of NTM.
MATERIALS AND METHODS:
From 2012-2014, data from NTM positive patients from culture and sensitivity results were collected.
RESULTS:
10 HIV negative cases of NTM were identified by bronchoscopy, endobronchial ultrasonogram guided sheath (EBUS-GS) and sputum culture. The age ranged from 41 to 89 years old with a mean of 64 years. There were eight females (80%), most were menopausal (87.5%) and two males (20%). Underlying conditions included diabetes mellitus (30%), coexisting Tuberculosis (50%) and 10% with lung cancer. All suffered from respiratory symptoms such as fever, dyspnea, sputum production and abnormal chest x-ray and chest CT scan results. All were identified by using EBUS (70%) or sputum culture (20%) or bronchoscopy (10%). Bacteria recorded were myobacterium avium complex (MAC) (30%), myobacterium intracellulare complex (MIC) (10%) and 60% were unidentified specific NTM bacteria. All responded well to Macrolide and Quinolone treatment. Specimens obtained from EBUS are highly reliable with the right laboratory setting to identify specific types of NTM.