Main Article Content
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.
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.
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.
This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
2. Griffith DE. Overview of nontuberculous mycobacterial infections in HIV-negative patients. (Accessed April 29, 2014 at http://www.uptodate.com/contents/overview-of- nontuberculous-myobacterial-infections-in-HIV- negative-patients.).
3. Chetchotisakd P, Kicrtiburanakul S, Mootsikapun P, et al. Disseminated nontuberculous mycobacterial infections in patients who are not infected with HIV in Thailand. Clin Infect Dis 2007;45:421-7.
4. Gopinath K, Singh S. Non-tuberculous mycobacteria in TB-endemic countries: are we neglecting the danger?. PLoS Negl Trop Dis 2010;4:e615.
5. Griffith DE, Aksamit T, Brown-Elliott BA, et al. An official ATS/IDSA statement: diagnosis, treatment, and prevention of non tuberculous mycobacterial diseases. Am J Respir Crit Care Med 2007;175:367-416.
6. Falkinham JO 3rd. Nontuberculous mycobacteria in the environment. Clin Chest Med 2002;23:529-51.
7. Chan ED, Iseman MD. Slender, older women appear to be more susceptible to nontuberculous mycobacterial lung disease. Gend Med 2010;7:5-18.
8. Okumura M, Iwai K, Ogata H, et al. Clinical factors on cavitary and nodular bronchiectatc types in pulmonary Myobacterium avium complex disease. Intern Med 2008;47:1465-72.