The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지
DOI QR코드

DOI QR Code

Diagnosis and Treatment of Nontuberculous Mycobacterial Lung Disease

비결핵 항산균 폐질환의 진단과 치료

  • Kwon, Yong-Soo (Department of Internal Medicine, Chonnam National University Medical School)
  • 권용수 (전남대학교 의과대학 내과학교실)
  • Published : 2012.03.01
⟨ Previous Next ⟩

Abstract

The incidence of chronic pulmonary disease caused by nontuberculus mycobacteria (NTM) in human immunodeficiency virus (HIV)-negative patients has been increasing worldwide. In Korea, the common etiologic pathogens for this disease are Mycobacterium avium complex and Mycobacterium abscessus. Most NTM pulmonary diseases present one of two forms such as fibrocavitary or nodular bronchiectatic disease according to their radiographic features. However they also present hypersensitivity like diseases and solitary pulmonary nodules. NTM pulmonary disease has specific diagnostic criteria including repeated isolations of organisms because they are ubiquitous environmental organisms and NTM isolation can be a result of specimen contamination. However diagnosing NTM pulmonary disease does not mean the need for immediate treatment. Also since it needs multiple antibiotics for a long time, treatment is expensive and has significant side effects. Therefore treating NTM lung diseases can be extremely difficult and factors such as patient's age, comorbid conditions, and progression rates of symptoms and disease should be considered in the decision of treatment.

Keywords

References

  1. Schlossberg D. Tuberculosis and Nontuberculous Mycobacterial Infections. 6th ed. Washington, DC: ASM Press, 2011.
  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;175:367-416. https://doi.org/10.1164/rccm.200604-571ST
  3. Olivier KN, Weber DJ, Wallace RJ Jr, et al. Nontuberculous mycobacteria. I: multicenter prevalence study in cystic fibrosis. Am J Respir Crit Care Med 2003;167:828-834. https://doi.org/10.1164/rccm.200207-678OC
  4. Iseman MD, Marras TK. The importance of nontuberculous mycobacterial lung disease. Am J Respir Crit Care Med 2008;178:999-1000. https://doi.org/10.1164/rccm.200808-1258ED
  5. Korean Academy of Tuberculosis and Respiratory Disease. National survey of mycobacterial diseases other than tuberculosis in Korea. Tuberc Respir Dis 1995;42:277-294.
  6. Lew WJ. Clinical manifestations and epidermiology of nontuberculous mycobacterial infection in Korea. Tuberc Respir Dis 2002;53:83-87.
  7. Koh WJ, Kwon OJ. Treatment of nontuberculous mycobacterial pulmonary diseases. Tuberc Respir Dis 2004;56:5-17.
  8. Koh WJ, Kwon OJ, Jeon K, et al. Clinical significance of nontuberculous mycobacteria isolated from respiratory specimens in Korea. Chest 2006;129:341-348. https://doi.org/10.1378/chest.129.2.341
  9. Kim SJ, Hong YP, Kim SC, Bai GH, Jin BW, Park CD. A case of pulmonary disease due to mycobacterium aviumintracellulare complex. Tuberc Respir Dis 1981;28:121-124.
  10. Koh WJ, Kwon OJ, Yu CM, et al. Recovery rate of nontuberculous mycobacteria from acid-fast-bacilli smearpositive sputum specimens. Tuberc Respir Dis 2003;54:22-32.
  11. Lee JY, Choi HJ, Lee H, et al. Recovery rate and characteristics of nontuberculous mycobacterial isolates in a university hospital in Korea. Tuberc Respir Dis 2005;58: 385-391.
  12. Management of opportunist mycobacterial infections: Joint Tuberculosis Committee Guidelines 1999. Subcommittee of the Joint Tuberculosis Committee of the British Thoracic Society. Thorax 2000;55:210-218. https://doi.org/10.1136/thorax.55.3.210
  13. Marras TK, Daley CL. Epidemiology of human pulmonary infection with nontuberculous mycobacteria. Clin Chest Med 2002;23:553-567. https://doi.org/10.1016/S0272-5231(02)00019-9
  14. Sakatani M. The non-tuberculous mycobacteriosis. Kekkaku 2005;80:25-30.
  15. Choi SP, Lee BK, Min JH, Kim JH. Pathogenic classification and clinical characteristics of nontuberculous mycobacterial pulmonary disease in a National Tuberculosis Hospital. Tuberc Respir Dis 2005;59:606-612.
  16. Bae E, Im JH, Kim SW, et al. Evaluation of combination of BACTEC mycobacteria growth indicator tube 960 system and Ogawa media for mycobacterial culture. Korean J Lab Med 2008;28:299-306. https://doi.org/10.3343/kjlm.2008.28.4.299
  17. Jun HJ, Jeon K, Um SW, Kwon OJ, Lee NY, Koh WJ. Nontuberculous mycobacteria isolated during the treatment of pulmonary tuberculosis. Respir Med 2009;103:1936-1940. https://doi.org/10.1016/j.rmed.2009.05.025
  18. Griffith DE, Girard WM, Wallace RJ Jr. Clinical features of pulmonary disease caused by rapidly growing mycobacteria: an analysis of 154 patients. Am Rev Respir Dis 1993;147: 1271-1278. https://doi.org/10.1164/ajrccm/147.5.1271
  19. Wallace RJ Jr, Zhang Y, Brown BA, et al. Polyclonal Mycobacterium avium complex infections in patients with nodular bronchiectasis. Am J Respir Crit Care Med 1998; 158:1235-1244. https://doi.org/10.1164/ajrccm.158.4.9712098
  20. Lim HJ, Park CM, Park YS, et al. Isolation of multiple nontuberculous mycobacteria species in the same patients. Int J Infect Dis 2011;15:e795-e798. https://doi.org/10.1016/j.ijid.2011.07.004
  21. Jeon K, Kwon OJ, Lee NY, et al. Antibiotic treatment of Mycobacterium abscessus lung disease: a retrospective analysis of 65 patients. Am J Respir Crit Care Med 2009; 180:896-902. https://doi.org/10.1164/rccm.200905-0704OC
  22. Ahn CH, Wallace RJ Jr, Steele LC, Murphy DT. Sulfonamidecontaining regimens for disease caused by rifampin-resistant Mycobacterium kansasii. Am Rev Respir Dis 1987;135:10-16.
  23. Diagnosis and treatment of disease caused by nontuberculous mycobacteria. This official statement of the American Thoracic Society was approved by the Board of Directors, March 1997. Medical Section of the American Lung Association. Am J Respir Crit Care Med 1997;156(2 Pt 2): S1-S25.
  24. Reich JM, Johnson RE. Mycobacterium avium complex pulmonary disease presenting as an isolated lingular or middle lobe pattern: the Lady Windermere syndrome. Chest 1992;101:1605-1609. https://doi.org/10.1378/chest.101.6.1605
  25. Swensen SJ, Hartman TE, Williams DE. Computed tomographic diagnosis of Mycobacterium avium-intracellulare complex in patients with bronchiectasis. Chest 1994;105: 49-52. https://doi.org/10.1378/chest.105.1.49
  26. Tanaka E, Amitani R, Niimi A, Suzuki K, Murayama T, Kuze F. Yield of computed tomography and bronchoscopy for the diagnosis of Mycobacterium avium complex pulmonary disease. Am J Respir Crit Care Med 1997;155:2041-2046. https://doi.org/10.1164/ajrccm.155.6.9196113
  27. Jeong YJ, Lee KS, Koh WJ, Han J, Kim TS, Kwon OJ. Nontuberculous mycobacterial pulmonary infection in immunocompetent patients: comparison of thin-section CT and histopathologic findings. Radiology 2004;231:880-886. https://doi.org/10.1148/radiol.2313030833
  28. Han D, Lee KS, Koh WJ, Yi CA, Kim TS, Kwon OJ. Radiographic and CT findings of nontuberculous mycobacterial pulmonary infection caused by Mycobacterium abscessus. AJR Am J Roentgenol 2003;181:513-517. https://doi.org/10.2214/ajr.181.2.1810513
  29. Koh WJ, Kwon OJ, Kang EH, et al. Clinical and radiographic characteristics of 12 patients with Mycobacterium abscessus pulmonary disease. Tuberc Respir Dis 2003;54:45-56.
  30. Koh WJ, Lee KS, Kwon OJ, Jeong YJ, Kwak SH, Kim TS. Bilateral bronchiectasis and bronchiolitis at thin-section CT: diagnostic implications in nontuberculous mycobacterial pulmonary infection. Radiology 2005;235:282-288. https://doi.org/10.1148/radiol.2351040371
  31. Kim EY, Kwon YS, Oh IJ, et al. A case of hypersensitivity pneumonitis caused by Mycobacterium terrae in a fishery worker. Korean J Med 2011;80(Suppl 2):S204-S208.
  32. Hahm CR, Park HY, Jeon K, et al. Solitary pulmonary nodules caused by Mycobacterium tuberculosis and Mycobacterium avium complex. Lung 2010;188:25-31. https://doi.org/10.1007/s00408-009-9203-1
  33. Lim J, Lyu J, Choi CM, et al. Non-tuberculous mycobacterial diseases presenting as solitary pulmonary nodules. Int J Tuberc Lung Dis 2010;14:1635-1640.
  34. Kwon YS, Koh WJ, Kwon OJ, et al. Mycobacterium abscessus pulmonary infection presenting as a solitary pulmonary nodule. Intern Med 2006;45:169-171. https://doi.org/10.2169/internalmedicine.45.1398
  35. Chae DR, Kim YI, Kee SJ, et al. The impact of the 2007 ATS/IDSA diagnostic criteria for nontuberculous mycobacterial disease on the diagnosis of nontuberculous mycobacterial lung disease. Respiration 2011;82:124-129. https://doi.org/10.1159/000320254
  36. Koh WJ, Kwon OJ. Diagnosis and treatment of nontuberculous mycobacterial lung disease. Korean J Med 2008;74: 120-131.
  37. Thomson RM, Yew WW. When and how to treat pulmonary non-tuberculous mycobacterial diseases. Respirology 2009; 14:12-26. https://doi.org/10.1111/j.1440-1843.2008.01408.x
  38. Sim YS, Park HY, Jeon K, Suh GY, Kwon OJ, Koh WJ. Standardized combination antibiotic treatment of Mycobacterium avium complex lung disease. Yonsei Med J 2010;51: 888-894. https://doi.org/10.3349/ymj.2010.51.6.888
  39. Lam PK, Griffith DE, Aksamit TR, et al. Factors related to response to intermittent treatment of Mycobacterium avium complex lung disease. Am J Respir Crit Care Med 2006; 173:1283-1289. https://doi.org/10.1164/rccm.200509-1531OC
  40. Kim EY, Chi SY, Oh IJ, et al. Treatment outcome of combination therapy including clarithromycin for Mycobacterium avium complex pulmonary disease. Korean J Intern Med 2011;26:54-59. https://doi.org/10.3904/kjim.2011.26.1.54
  41. Kobashi Y, Matsushima T. The microbiological and clinical effects of combined therapy according to guidelines on the treatment of pulmonary Mycobacterium avium complex disease in Japan-including a follow-up study. Respiration 2007;74:394-400. https://doi.org/10.1159/000095674
  42. Hasegawa N, Nishimura T, Ohtani S, et al. Therapeutic effects of various initial combinations of chemotherapy including clarithromycin against Mycobacterium avium complex pulmonary disease. Chest 2009;136:1569-1575. https://doi.org/10.1378/chest.08-2567
  43. Griffith DE, Brown-Elliott BA, Shepherd S, McLarty J, Griffith L, Wallace RJ Jr. Ethambutol ocular toxicity in treatment regimens for Mycobacterium avium complex lung disease. Am J Respir Crit Care Med 2005;172:250-253. https://doi.org/10.1164/rccm.200407-863OC
  44. Kobashi Y, Matsushima T, Oka M. A double-blind randomized study of aminoglycoside infusion with combined therapy for pulmonary Mycobacterium avium complex disease. Respir Med 2007;101:130-138. https://doi.org/10.1016/j.rmed.2006.04.002
  45. Field SK, Fisher D, Cowie RL. Mycobacterium avium complex pulmonary disease in patients without HIV infection. Chest 2004;126:566-581. https://doi.org/10.1378/chest.126.2.566
  46. Griffith DE, Brown-Elliott BA, Langsjoen B, et al. Clinical and molecular analysis of macrolide resistance in Mycobacterium avium complex lung disease. Am J Respir Crit Care Med 2006;174:928-934. https://doi.org/10.1164/rccm.200603-450OC
  47. Adekambi T, Reynaud-Gaubert M, Greub G, et al. Amoebal coculture of "Mycobacterium massiliense" sp. nov. from the sputum of a patient with hemoptoic pneumonia. J Clin Microbiol 2004;42:5493-5501. https://doi.org/10.1128/JCM.42.12.5493-5501.2004
  48. Adékambi T, Berger P, Raoult D, Drancourt M. rpoB gene sequence-based characterization of emerging non-tuberculous mycobacteria with descriptions of Mycobacterium bolletii sp. nov., Mycobacterium phocaicum sp. nov. and Mycobacterium aubagnense sp. nov. Int J Syst Evol Microbiol 2006;56(Pt 1):133-143.
  49. Kim HY, Kook Y, Yun YJ, et al. Proportions of Mycobacterium massiliense and Mycobacterium bolletii strains among Korean Mycobacterium chelonae-Mycobacterium abscessus group isolates. J Clin Microbiol 2008;46: 3384-3390. https://doi.org/10.1128/JCM.00319-08
  50. Nash KA, Brown-Elliott BA, Wallace RJ Jr. A novel gene, erm(41), confers inducible macrolide resistance to clinical isolates of Mycobacterium abscessus but is absent from Mycobacterium chelonae. Antimicrob Agents Chemother 2009;53:1367-1376. https://doi.org/10.1128/AAC.01275-08
  51. Koh WJ, Jeon K, Lee NY, et al. Clinical significance of differentiation of Mycobacterium massiliense from Mycobacterium abscessus. Am J Respir Crit Care Med 2011;183: 405-410. https://doi.org/10.1164/rccm.201003-0395OC

Cited by

  1. 비결핵 항산균 폐질환 환자의 한의치료로 증상 호전에 대한 증례보고 vol.41, pp.5, 2012, https://doi.org/10.22246/jikm.2020.41.5.856
  2. Population Pharmacokinetic Analysis of Amikacin for Optimal Pharmacotherapy in Korean Patients with Nontuberculous Mycobacterial Pulmonary Disease vol.9, pp.11, 2020, https://doi.org/10.3390/antibiotics9110784
  3. 최근 10년간 광주 2차병원의 호흡기검체에서 분리된 비결핵 항산균의 폐질환 유병률에 대한 연구 vol.52, pp.4, 2012, https://doi.org/10.15324/kjcls.2020.52.4.349