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Information

Editors

PaulaMaasilta
TuulaVasankari

Pulmonary Diseases Caused by Environmental Mycobacteria

Essentials

  • Consider environmental (also "atypical" or "non-tuberculous") mycobacteria as causative agents in patients with
    • persistent pulmonary infection and chronic pulmonary disease or immunosuppression
    • undetermined prolonged pulmonary infections
    • suspected pulmonary tuberculosis that responds poorly to treatment.

Epidemiology

  • The incidence of infections caused by environmental mycobacteria is increasing.
  • The infection is acquired from water or soil, etc.
  • Human-to-human transmission has not been reported.
  • Development of a disease often requires an earlier damage to the lungs (e.g. earlier tuberculosis, pulmonary fibrosis, etc.)

Causative agent

  • The following species cause pulmonary infections: M. avium-intracellulare, M. kansasi, M. xenopi, M. malmoense, M. scrofulaceum, M. simiae, M. szulgai, M. chelonei and M. fortuitum.

Symptoms

  • Cough
  • Sputum production
  • Dyspnoea
  • Weight loss
  • Fever and bloody sputum are rare.

Investigations

Bacterial culture

  • Repeated ample growth of the same species of environmental Mycobacteria in the culture of sputum or bronchial secretion is a significant finding.
  • Pulmonary disease caused by environmental mycobacteria must be differentiated from mere colonization (or contamination of the specimen).

Radiology

  • In subacute disease the parenchymal infiltrates and caverns are situated unilaterally in the upper lobe.
  • In chronic forms the patient often has bilateral fibrotic changes.

Treatment

  • The treatment is clearly more difficult than the treatment of ordinary tuberculosis.
  • Treatment options include antituberculous medication, other antimicrobial drugs, and occasionally surgery.
  • Eradication of the environmental mycobacteria is not always possible.
  • Treatment is indicated if
    • there is growth in sputum culture samples repeatedly or in a single sample taken from a location that otherwise is sterile and
    • chest x-ray shows findings that match with an infection caused by environmental mycobacteria and
    • the patient has matching symptoms.
  • If the patient has no or only minimal symptoms, follow-up without medication is in some cases a valid option.
  • Treatment is started in specialized care.

Notification

  • Follow the local regulation concerning notification of infectious diseases and reimbursement of treatment.

    References

    • Haworth CS, Banks J, Capstick T ym. British Thoracic Society guidelines for the management of non-tuberculous mycobacterial pulmonary disease (NTM-PD). Thorax 2017;72(Suppl 2):ii1-ii64. [PubMed]