Non-tuberculous mycobacteria - Revision history

Aidan at 17:02, 8 April 2026

2026-04-08T17:02:38Z

← Older revision		Revision as of 17:02, 8 April 2026
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	====[[Mycobacterium kansasii]]====		====[[Mycobacterium kansasii]]====

	*[[Mycobacterium kansasii]] pulmonary disease: ~~daily~~ [[~~isoniazid~~]] ~~(300~~ mg~~/d)~~, [[~~rifampin~~]] ~~(600~~ mg/d), and [[~~ethambutol~~]] ~~(15~~ mg~~/kg/d)~~		*[[Mycobacterium kansasii]] pulmonary disease: [[rifampin]] 600 mg daily, and [[ethambutol]] 15 mg/kg daily, and either daily [[isoniazid]] 300 mg daily or [[azithromycin]] 250-500 mg daily
	*Patients should be treated ~~until~~ ~~culture~~ ~~negative~~ on ~~therapy~~ ~~for~~ ~~1 year~~		*Patients should be treated 12 months, though some experts recommend longer
	*Could consider treating based on a single positive colony, as it is rarely a colonizer		*Could consider treating based on a single positive colony, as it is rarely a colonizer

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	*Audiology for [[aminoglycosides]]		*Audiology for [[aminoglycosides]]
	*Liver enzymes monthly for many others		*Liver enzymes monthly for many others

			== Further Reading ==

			* Treatment of nontuberculous mycobacterial pulmonary disease: an official ATS/ERS/ESCMID/IDSA clinical practice guideline. ''Eur Respir J''. 2020 Jul 7;56(1):2000535. doi: [https://doi.org/10.1183/13993003.00535-2020 10.1183/13993003.00535-2020]. PMID: [https://pubmed.ncbi.nlm.nih.gov/32636299/ 32636299]; PMCID: [https://pmc.ncbi.nlm.nih.gov/articles/PMC8375621/ PMC8375621].

	[[Category:Mycobacteria]]		[[Category:Mycobacteria]]

Aidan: /* Rapid Growers (Mycobacterium abscessus, Mycobacterium chelonae, Mycobacterium fortuitum) */

2024-05-02T14:49:06Z

Rapid Growers (Mycobacterium abscessus, Mycobacterium chelonae, Mycobacterium fortuitum)

← Older revision		Revision as of 14:49, 2 May 2024
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	\|		\|
	\|-		\|-
		⚫	\| colspan="2" \|[[Mycobacterium chelonae]]
	\|
⚫	\|[[Mycobacterium chelonae]]
	\|		\|
	\|-		\|-
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	\|		\|
	\|-		\|-
		⚫	\| colspan="2" \|[[Mycobacterium smegmatis]]
	\|
⚫	\|[[Mycobacterium smegmatis]]
	\|		\|
	\|-		\|-
		⚫	\| colspan="2" \|[[Mycobacterium mucogenicum]]
	\|
⚫	\|[[Mycobacterium mucogenicum]]
	\|		\|
	\|-		\|-
	\| rowspan="16" \|slow		\| rowspan="16" \|slow
	\| rowspan="2" \|photochromogen		\| rowspan="2" \|photochromogen
		⚫	\| colspan="2" \|[[Mycobacterium kansasii]]
	\|
⚫	\| [[Mycobacterium kansasii]]
	\|Always assumed to be pathogenic, never colonizer.		\|Always assumed to be pathogenic, never colonizer.
	\|-		\|-
		⚫	\| colspan="2" \|[[Mycobacterium marinum]]
	\|
⚫	\| [[Mycobacterium marinum]]
	\|Intermediate-grower (7-10 days).		\|Intermediate-grower (7-10 days).
	\|-		\|-
	\| rowspan="2" \|scotochromogen		\| rowspan="2" \|scotochromogen
		⚫	\| colspan="2" \|[[Mycobacterium gordonae]]
	\|
⚫	\| [[Mycobacterium gordonae]]
	\|Intermediate-grower (7-10 days). Common tap-water contaminant.		\|Intermediate-grower (7-10 days). Common tap-water contaminant.
	\|-		\|-
		⚫	\| colspan="2" \|[[Mycobacterium scrofulaceum]]
	\|
⚫	\|[[Mycobacterium scrofulaceum]]
	\|		\|
	\|-		\|-
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	\|		\|
	\|-		\|-
		⚫	\| colspan="2" \|[[Mycobacterium ulcerans]]
	\|
⚫	\|[[Mycobacterium ulcerans]]
	\|		\|
	\|-		\|-
		⚫	\| colspan="2" \|[[Mycobacterium xenopi]]
	\|
⚫	\|[[Mycobacterium xenopi]]
	\|Grows optimally at 42-45 ºC.		\|Grows optimally at 42-45 ºC.
	\|-		\|-
		⚫	\| colspan="2" \|[[Mycobacterium simiae]]
	\|
⚫	\|[[Mycobacterium simiae]]
	\|		\|
	\|-		\|-
		⚫	\| colspan="2" \|[[Mycobacterium malmoense]]
	\|
⚫	\|[[Mycobacterium malmoense]]
	\|		\|
	\|-		\|-
		⚫	\| colspan="2" \|[[Mycobacterium szulgai]]
	\|
⚫	\|[[Mycobacterium szulgai]]
	\|		\|
	\|-		\|-
		⚫	\| colspan="2" \|[[Mycobacterium asiaticum]]
	\|
⚫	\|[[Mycobacterium asiaticum]]
	\|		\|
	\|-		\|-
		⚫	\| colspan="2" \|[[Mycobacterium haemophilum]]
	\|
⚫	\|[[Mycobacterium haemophilum]]
	\|Grows optimally at 28-30 ºC.		\|Grows optimally at 28-30 ºC.
	\|}		\|}
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	===Non-Pulmonary Disease===		===Non-Pulmonary Disease===

			====Rapid Growers====
⚫	~~====Rapid~~ ~~Growers (~~[[Mycobacterium abscessus]], [[Mycobacterium chelonae]], [[Mycobacterium fortuitum]]~~)====~~

		⚫	*Includes [[Mycobacterium abscessus]], [[Mycobacterium chelonae]], and [[Mycobacterium fortuitum]]
	*~~Based~~ on in vitro susceptibilities		*Antimicrobial selection is based on in vitro susceptibilities
	*For ''Mycobacterium abscessus'', a macrolide-based regimen is frequently used		*For ''Mycobacterium abscessus'', a macrolide-based regimen is frequently used
	*Surgical debridement may be necessary		*Surgical debridement may be necessary

Aidan: /* Mycobacterium avium Complex */

2023-11-21T16:00:24Z

Mycobacterium avium Complex

← Older revision		Revision as of 16:00, 21 November 2023
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	===Pulmonary Disease===		===Pulmonary Disease===

	====[[Mycobacterium avium ~~Complex~~\|''Mycobacterium avium'' Complex]]====		====[[Mycobacterium avium complex\|''Mycobacterium avium'' Complex]]====

	*[[MAC]] is the prototype		*[[MAC]] is the prototype

Aidan at 18:07, 21 June 2023

2023-06-21T18:07:32Z

Show changes

Aidan: styling

2022-10-07T02:45:29Z

styling

← Older revision		Revision as of 02:45, 7 October 2022
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	\| rowspan="10" \|nonchromogen		\| rowspan="10" \|nonchromogen
	\| rowspan="3" \|''M. fortuitum'' complex		\| rowspan="3" \|''M. fortuitum'' complex
	\| ~~style="padding-left:1.5em;" \|~~''M. fortuitum''		\| ''M. fortuitum''
	\|		\|
	\|-		\|-
	\| ~~style="padding-left:1.5em;" \|~~''M. peregrinum''		\| ''M. peregrinum''
	\|		\|
	\|-		\|-
	\| ~~style="padding-left:1.5em;" \|~~''M. porcinum''		\| ''M. porcinum''
	\|		\|
	\|-		\|-
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	\|-		\|-
	\|''[[M. abscessus]]''		\|''[[M. abscessus]]''
	~~\| style="padding-left:1.5em;"~~ \|''M. abscessus'' subsp. ''abscessus''		\|''M. abscessus'' subsp. ''abscessus''
	\|		\|
	\|-		\|-
	\|''[[M. abscessus]]''		\|''[[M. abscessus]]''
	\| ~~style="padding-left:1.5em;" \|~~''M. abscessus'' subsp. ''bolletii''		\| ''M. abscessus'' subsp. ''bolletii''
	\|		\|
	\|-		\|-
	\|''[[M. abscessus]]''		\|''[[M. abscessus]]''
	\| ~~style="padding-left:1.5em;" \|~~''M. abscessus'' subsp. ''massiliense''		\| ''M. abscessus'' subsp. ''massiliense''
	\|		\|
	\|-		\|-
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	\| rowspan="2" \|photochromogen		\| rowspan="2" \|photochromogen
	\|		\|
	\| ~~style="padding-left:1.5em;" \|~~''M. kansasii''		\| ''M. kansasii''
	\|Always assumed to be pathogenic, never colonizer.		\|Always assumed to be pathogenic, never colonizer.
	\|-		\|-
	\|		\|
	\| ~~style="padding-left:1.5em;" \|~~''M. marinum''		\| ''M. marinum''
	\|Intermediate-grower (7-10 days).		\|Intermediate-grower (7-10 days).
	\|-		\|-
	\| rowspan="2" \|scotochromogen		\| rowspan="2" \|scotochromogen
	\|		\|
	\| ~~style="padding-left:1.5em;" \|~~''M. gordonae''		\| ''M. gordonae''
	\|Intermediate-grower (7-10 days). Common tap-water contaminant.		\|Intermediate-grower (7-10 days). Common tap-water contaminant.
	\|-		\|-
	\|		\|
	~~\| style="padding-left:1.5em;"~~ \|''M. scrofulaceum''		\|''M. scrofulaceum''
	\|		\|
	\|-		\|-
	\| rowspan="12" \|nonchromogen		\| rowspan="12" \|nonchromogen
	\| rowspan="4" \|[[M. avium complex]]		\| rowspan="4" \|[[M. avium complex]]
	~~\| style="padding-left:1.5em;"~~ \|[[M. avium complex]]		\|[[M. avium complex]]
	\|In HIV, rarely pulmonary and almost always disseminated.		\|In HIV, rarely pulmonary and almost always disseminated.
	\|-		\|-
	~~\| style="padding-left:2.5em;"~~ \|''M. avium''		\|''M. avium''
	\|Most common subspecies.		\|Most common subspecies.
	\|-		\|-
	~~\| style="padding-left:2.5em;"~~ \|''M. intracellulare''		\|''M. intracellulare''
	\|		\|
	\|-		\|-
	~~\| style="padding-left:2.5em;"~~ \|''[[Mycobacterium chimaera\|M. chimaera]]''		\|''[[Mycobacterium chimaera\|M. chimaera]]''
	\|Associated with contaminated heater-cooler units in cardiac bypass machines.		\|Associated with contaminated heater-cooler units in cardiac bypass machines.
	\|-		\|-
	~~\|''M. terrae'' complex\| style="padding-left:1.5em;"~~ \|''M. terrae'' complex		\|''M. terrae'' complex
			\|''M. terrae'' complex
	\|		\|
	\|-		\|-
	\|		\|
	~~\| style="padding-left:1.5em;"~~ \|''M. ulcerans''		\|''M. ulcerans''
	\|		\|
	\|-		\|-
	\|		\|
	~~\| style="padding-left:1.5em;"~~ \|''M. xenopi''		\|''M. xenopi''
	\|Grows optimally at 42-45 ºC.		\|Grows optimally at 42-45 ºC.
	\|-		\|-
	\|		\|
	~~\| style="padding-left:1.5em;"~~ \|''M. simiae''		\|''M. simiae''
	\|		\|
	\|-		\|-
	\|		\|
	~~\| style="padding-left:1.5em;"~~ \|''M. malmoense''		\|''M. malmoense''
	\|		\|
	\|-		\|-
	\|		\|
	~~\| style="padding-left:1.5em;"~~ \|''M. szulgai''		\|''M. szulgai''
	\|		\|
	\|-		\|-
	\|		\|
	~~\| style="padding-left:1.5em;"~~ \|''M. asiaticum''		\|''M. asiaticum''
	\|		\|
	\|-		\|-
	\|		\|
	~~\| style="padding-left:1.5em;"~~ \|''M. haemophilum''		\|''M. haemophilum''
	\|Grows optimally at 28-30 ºC.		\|Grows optimally at 28-30 ºC.
	\|}		\|}

Aidan: /* Species */

2022-10-07T02:44:02Z

Species

← Older revision		Revision as of 02:44, 7 October 2022
Line 20:		Line 20:

	*More than 200 species of ''Mycobacterium'' spp. that are not in ''M. tuberculosis'' complex or ''M. leprae''		*More than 200 species of ''Mycobacterium'' spp. that are not in ''M. tuberculosis'' complex or ''M. leprae''
			*Often divided into rapid growers (visible in culture in less than 5-7 days) and slow growers (more than 7 days)
	*Photochromagenic mycobacteria have pigmentation in the presence of light, versus scotochromogenic which do not
			*Slow-growers are further classified by production of yellow-orange pigment
			**Photochromagens produce pigment when exposed to light
			**Scotochromogens produce pigment regardless of light
		⚫	**Nonchromogens do not produce pigment

	{\| class="wikitable"		{\| class="wikitable sortable"
			!Slow or Rapid
			!Pigmentation
			!Complex
	!Species		!Species
	!Notes		!Notes
	\|-		\|-
			\| rowspan="10" \|rapid
	! colspan="2" \|Rapid-growers (visible in culture in <7 days)
			\| rowspan="10" \|nonchromogen
⚫	\|-
	\|''M. fortuitum'' complex		\| rowspan="3" \|''M. fortuitum'' complex
⚫	\|
⚫	\|-
	\| style="padding-left:1.5em;" \|''M. fortuitum''		\| style="padding-left:1.5em;" \|''M. fortuitum''
	\|		\|
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	\|		\|
	\|-		\|-
		⚫	\|
	\|''M. chelonae''		\|''M. chelonae''
	\|		\|
	\|-		\|-
		⚫	\|
	\|''[[M. abscessus]]''		\|''[[M. abscessus]]''
	\|		\|
	\|-		\|-
			\|''[[M. abscessus]]''
	\| style="padding-left:1.5em;" \|''M. abscessus'' subsp. ''abscessus''		\| style="padding-left:1.5em;" \|''M. abscessus'' subsp. ''abscessus''
	\|		\|
	\|-		\|-
			\|''[[M. abscessus]]''
	\| style="padding-left:1.5em;" \|''M. abscessus'' subsp. ''bolletii''		\| style="padding-left:1.5em;" \|''M. abscessus'' subsp. ''bolletii''
	\|		\|
	\|-		\|-
			\|''[[M. abscessus]]''
	\| style="padding-left:1.5em;" \|''M. abscessus'' subsp. ''massiliense''		\| style="padding-left:1.5em;" \|''M. abscessus'' subsp. ''massiliense''
	\|		\|
	\|-		\|-
		⚫	\|
	\|''M. smegmatis''		\|''M. smegmatis''
	\|		\|
	\|-		\|-
		⚫	\|
	\|''M. mucogenicum''		\|''M. mucogenicum''
	\|		\|
	\|-		\|-
			\| rowspan="16" \|slow
	! colspan="2" \|Slow-growers (visible in culture in >7 days)
			\| rowspan="2" \|photochromogen
⚫	\|-
		⚫	\|
	\| colspan="2" \|Photochromogens (develop pigments in light)
⚫	\|-
	\| style="padding-left:1.5em;" \|''M. kansasii''		\| style="padding-left:1.5em;" \|''M. kansasii''
	\|Always assumed to be pathogenic, never colonizer.		\|Always assumed to be pathogenic, never colonizer.
	\|-		\|-
		⚫	\|
	\| style="padding-left:1.5em;" \|''M. marinum''		\| style="padding-left:1.5em;" \|''M. marinum''
	\|Intermediate-grower (7-10 days).		\|Intermediate-grower (7-10 days).
	\|-		\|-
			\| rowspan="2" \|scotochromogen
	\| colspan="2" \|Scotochromogens (develop pigments in darkness)
	\|-		\|
	\| style="padding-left:1.5em;" \|''M. gordonae''		\| style="padding-left:1.5em;" \|''M. gordonae''
	\|Intermediate-grower (7-10 days). Common tap-water contaminant.		\|Intermediate-grower (7-10 days). Common tap-water contaminant.
	\|-		\|-
			\|
	\| style="padding-left:1.5em;" \|''M. scrofulaceum''		\| style="padding-left:1.5em;" \|''M. scrofulaceum''
	\|		\|
	\|-		\|-
			\| rowspan="12" \|nonchromogen
⚫	~~\| colspan="2" \|~~Nonchromogens (do not ~~develop~~ ~~pigments)~~
			\| rowspan="4" \|[[M. avium complex]]
⚫	\|-
	\| style="padding-left:1.5em;" \|[[M. avium complex]]		\| style="padding-left:1.5em;" \|[[M. avium complex]]
	\|In HIV, rarely pulmonary and almost always disseminated.		\|In HIV, rarely pulmonary and almost always disseminated.
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	\|Associated with contaminated heater-cooler units in cardiac bypass machines.		\|Associated with contaminated heater-cooler units in cardiac bypass machines.
	\|-		\|-
	\| style="padding-left:1.5em;" \|''M. terrae'' complex		\|''M. terrae'' complex\| style="padding-left:1.5em;" \|''M. terrae'' complex
	\|		\|
	\|-		\|-
			\|
	\| style="padding-left:1.5em;" \|''M. ulcerans''		\| style="padding-left:1.5em;" \|''M. ulcerans''
	\|		\|
	\|-		\|-
			\|
	\| style="padding-left:1.5em;" \|''M. xenopi''		\| style="padding-left:1.5em;" \|''M. xenopi''
	\|Grows optimally at 42-45 ºC.		\|Grows optimally at 42-45 ºC.
	\|-		\|-
			\|
	\| style="padding-left:1.5em;" \|''M. simiae''		\| style="padding-left:1.5em;" \|''M. simiae''
	\|		\|
	\|-		\|-
			\|
	\| style="padding-left:1.5em;" \|''M. malmoense''		\| style="padding-left:1.5em;" \|''M. malmoense''
	\|		\|
	\|-		\|-
			\|
	\| style="padding-left:1.5em;" \|''M. szulgai''		\| style="padding-left:1.5em;" \|''M. szulgai''
	\|		\|
	\|-		\|-
			\|
	\| style="padding-left:1.5em;" \|''M. asiaticum''		\| style="padding-left:1.5em;" \|''M. asiaticum''
	\|		\|
	\|-		\|-
			\|
	\| style="padding-left:1.5em;" \|''M. haemophilum''		\| style="padding-left:1.5em;" \|''M. haemophilum''
	\|Grows optimally at 28-30 ºC.		\|Grows optimally at 28-30 ºC.

Aidan at 16:07, 5 November 2020

2020-11-05T16:07:02Z

← Older revision		Revision as of 16:07, 5 November 2020
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	==Background==		==Background==

	* Mycobacteria that excludes tuberculosis and leprosy		*Mycobacteria that excludes tuberculosis and leprosy

	===Microbiology===		===Microbiology===
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	\|		\|
	\|-		\|-
	\| style="padding-left:2.5em;" \|''M. chimaera''		\| style="padding-left:2.5em;" \|''[[Mycobacterium chimaera\|M. chimaera]]''
			\|Associated with contaminated heater-cooler units in cardiac bypass machines.
	\|
	\|-		\|-
	\| style="padding-left:1.5em;" \|''M. terrae'' complex		\| style="padding-left:1.5em;" \|''M. terrae'' complex
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	**PCR/NAAT can be done for TB and MAC, but only done on smear positive samples unless specifically requested		**PCR/NAAT can be done for TB and MAC, but only done on smear positive samples unless specifically requested

	=== Diagnostic Criteria for Pulmonary Disease ===		===Diagnostic Criteria for Pulmonary Disease===

	* Diagnosis requires clinical, radiologic, and microbiologic criteria		*Diagnosis requires clinical, radiologic, and microbiologic criteria
	* Clinical: pulmonary or systemic symptoms		*Clinical: pulmonary or systemic symptoms
	* Radiologic: nodular or cavitary opacities on chest radiograph, or a high-resolution cCT scan that shows bronchiectasis with multiple small nodules		*Radiologic: nodular or cavitary opacities on chest radiograph, or a high-resolution cCT scan that shows bronchiectasis with multiple small nodules
	* Microbiologic:		*Microbiologic:
	** Positive cultures from at least 2 separate expectorate sputums, or		**Positive cultures from at least 2 separate expectorate sputums, or
	** One positive culture from bronchial wash or lavage		**One positive culture from bronchial wash or lavage
	** Transbronchial or other lung biopsy with mycobacterial histologic features (granulomatous inflammation or AFB) and positive culture for NTM or biopsy showing mycobacterial histologic features (granulomatous inflammation or AFB) and one or more sputum or bronchial washings that are culture positive for NTM		**Transbronchial or other lung biopsy with mycobacterial histologic features (granulomatous inflammation or AFB) and positive culture for NTM or biopsy showing mycobacterial histologic features (granulomatous inflammation or AFB) and one or more sputum or bronchial washings that are culture positive for NTM
	* Exclusion of other diagnoses		*Exclusion of other diagnoses

	==Management==		==Management==

Aidan at 15:55, 5 November 2020

2020-11-05T15:55:02Z

← Older revision		Revision as of 15:55, 5 November 2020
Line 1:		Line 1:
⚫	*Mycobacteria that excludes tuberculosis and leprosy

	==Background==		==Background==

		⚫	* Mycobacteria that excludes tuberculosis and leprosy

	===Microbiology===		===Microbiology===

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	*Broadly divided into slow-growers and fast-growers		*Broadly divided into slow-growers and fast-growers
	**Fast-growers produce colonies within 7 days on solid media		**Fast-growers produce colonies within 7 days on solid media
	***Grows optimally at 28-30º C, with some preferring 35º C		***Grows optimally at 28-30º C, with some preferring 35 ºC
	***May grow in blood culture if mycobacteremic		***May grow in blood culture if mycobacteremic
	**Slow-growers produce colonies after more than 7 days on solid media		**Slow-growers produce colonies after more than 7 days on solid media
	***MAC, ''M. xenopi'', and ''M. kansasii'' are the three most important		***MAC, ''M. xenopi'', and ''M. kansasii'' are the three most important
	***Grows optimally at 35-37º C except ''M. haemophilum'' (28-30º C) and ''M. xenopi'' (42-45º C)		***Grows optimally at 35-37º C except ''M. haemophilum'' (28-30 ºC) and ''M. xenopi'' (42-45 ºC)
	*Media includes blood or chocolate agar, MTBC media, etc		*Media includes blood or chocolate agar, MTBC media, etc
	*Species-level identifiation requires molecular tests		*Species-level identifiation requires molecular tests
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	*More than 200 species of ''Mycobacterium'' spp. that are not in ''M. tuberculosis'' complex or ''M. leprae''		*More than 200 species of ''Mycobacterium'' spp. that are not in ''M. tuberculosis'' complex or ''M. leprae''
			*Photochromagenic mycobacteria have pigmentation in the presence of light, versus scotochromogenic which do not

	{\| class="wikitable"		{\| class="wikitable"
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	\|-		\|-
	\| style="padding-left:1.5em;" \|''M. xenopi''		\| style="padding-left:1.5em;" \|''M. xenopi''
	\|Grows optimally at 42-45º C.		\|Grows optimally at 42-45 ºC.
	\|-		\|-
	\| style="padding-left:1.5em;" \|''M. simiae''		\| style="padding-left:1.5em;" \|''M. simiae''
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	\|-		\|-
	\| style="padding-left:1.5em;" \|''M. haemophilum''		\| style="padding-left:1.5em;" \|''M. haemophilum''
	\|Grows optimally at 28-30º C.		\|Grows optimally at 28-30 ºC.
	\|}		\|}

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	**Also tap water (especially ''M. gordonae'', ''M. kansasii'', ''M. xenopi'', ''M. simiae'', MAC, and ''M. mucogenicum'')		**Also tap water (especially ''M. gordonae'', ''M. kansasii'', ''M. xenopi'', ''M. simiae'', MAC, and ''M. mucogenicum'')
	*90% of patients with NTM infections have underlying pulmonary disease		*90% of patients with NTM infections have underlying pulmonary disease
			*No person-to-person transmission
	*In Ontario: ''M. avium'' complex (25%), ''M. xenopi'' (10%), ''M. abscessus''/''M. chelonae'', ''M. fortuitum''		*In Ontario: ''M. avium'' complex (25%), ''M. xenopi'' (10%), ''M. abscessus''/''M. chelonae'', ''M. fortuitum''

	{\| class="wikitable"		{\| class="wikitable"
	!~~Presentation and~~ Species		!Species
	!Distribution		!Distribution
	\|-		\|-
	! colspan="2" \|Pulmonary ~~disease~~		! colspan="2" \|Pulmonary Disease
	\|-		\|-
	\|''M. abscessus''		\|''M. abscessus''
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	\|Worldwide; previously common, now rarely isolated in US		\|Worldwide; previously common, now rarely isolated in US
	\|-		\|-
	! colspan="2" \|Disseminated ~~disease~~		! colspan="2" \|Disseminated Disease
	\|-		\|-
	\|''M. avium'' complex		\|''M. avium'' complex
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	===Pulmonary Disease===		===Pulmonary Disease===

	*Risk factors include COPD and CF [[CiteRef::honda2015pa]]		*Risk factors include COPD and CF[[CiteRef::honda2015pa]]
	*Most common clinical manifestation of NTM		*Most common clinical manifestation of NTM
	*Most commonly caused by MAC, ''M. kansasii'', ''M. xenopi'', and ''M. abscessus''		*Most commonly caused by MAC, ''M. kansasii'', ''M. xenopi'', and ''M. abscessus''
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	*Almost always needs CT; may repeat to monitor for progression		*Almost always needs CT; may repeat to monitor for progression
	*3 sputums for AFB; may treat ''M. kansasii'' based on only a single colony but everything else needs 2-3 positives		*3 sputums for AFB; may treat ''M. kansasii'' based on only a single colony but everything else needs 2-3 positives
	**Rule out TB		**Rule out [[tuberculosis]]

	====Diagnosis====

	*Requires both clinical and microbiological evidence of disease
	*Clinical diagnosis
	**Pulmonary symptoms, or
	**Presence of nodules or cavities as seen on chest radiograph, or
	**HRCT scan with multifocal bronchiectasis with multiple small nodules, and
⚫	**Exclusion of other diagnoses
⚫	*Microbiologic ~~diagnosis~~
	**At least 2 (of 3) expectorated sputa (or at least 1 bronchial wash or lavage) with positive cultures for NTM
⚫	**Transbronchial or other lung biopsy showing ~~the~~ ~~presence~~ of granulomatous inflammation or AFB ~~with~~ 1 or more sputum or bronchial washings that are culture positive for NTM.

	===Skin and Soft Tissue Infection===		===Skin and Soft Tissue Infection===
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	**Spontaneous, induced, or BAL		**Spontaneous, induced, or BAL
	**PCR/NAAT can be done for TB and MAC, but only done on smear positive samples unless specifically requested		**PCR/NAAT can be done for TB and MAC, but only done on smear positive samples unless specifically requested

			=== Diagnostic Criteria for Pulmonary Disease ===

			* Diagnosis requires clinical, radiologic, and microbiologic criteria
			* Clinical: pulmonary or systemic symptoms
			* Radiologic: nodular or cavitary opacities on chest radiograph, or a high-resolution cCT scan that shows bronchiectasis with multiple small nodules
		⚫	* Microbiologic:
			** Positive cultures from at least 2 separate expectorate sputums, or
			** One positive culture from bronchial wash or lavage
		⚫	** Transbronchial or other lung biopsy with mycobacterial histologic features (granulomatous inflammation or AFB) and positive culture for NTM or biopsy showing mycobacterial histologic features (granulomatous inflammation or AFB) and one or more sputum or bronchial washings that are culture positive for NTM
		⚫	* Exclusion of other diagnoses

	==Management==		==Management==

Aidan: /* Species */

2020-08-18T15:36:36Z

Species

← Older revision		Revision as of 15:36, 18 August 2020
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	\|Intermediate-grower (7-10 days).		\|Intermediate-grower (7-10 days).
	\|-		\|-
			\| colspan="2" \|Scotochromogens (develop pigments in darkness)
	\| Scotochromogens
	\|Develop pigments in darkness.
	\|-		\|-
	\| style="padding-left:1.5em;" \|''M. gordonae''		\| style="padding-left:1.5em;" \|''M. gordonae''
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	\|		\|
	\|-		\|-
	\| colspan="2" \|Nonchromogens (do not develop pigments ~~in light~~)		\| colspan="2" \|Nonchromogens (do not develop pigments)
	\|-		\|-
	\| style="padding-left:1.5em;" \|[[M. avium complex]]		\| style="padding-left:1.5em;" \|[[M. avium complex]]
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	**Need susceptibilities for macrolides in MAC; needs to be specifically requested		**Need susceptibilities for macrolides in MAC; needs to be specifically requested

	=== Pulmonary Disease ===		===Pulmonary Disease===

	====''Mycobacterium avium'' Complex====		====''Mycobacterium avium'' Complex====
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	*Surgical resection of localized disease combined with multidrug clarithromycin-based therapy offers the best chance for cure of this disease		*Surgical resection of localized disease combined with multidrug clarithromycin-based therapy offers the best chance for cure of this disease

	=== Non-Pulmonary Disease ===		===Non-Pulmonary Disease===

	==== Rapid Growers (''M. abscessus'', ''M. chelonae'', ''M. fortuitum'') ====		====Rapid Growers (''M. abscessus'', ''M. chelonae'', ''M. fortuitum'')====

	*Based on in vitro susceptibilities		*Based on in vitro susceptibilities

Aidan at 15:31, 18 August 2020

2020-08-18T15:31:55Z

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