An unusual pulmonary mycobacterial infection: Case report and literature review
Non-tuberculous mycobacteria (NTM) are mycobacterial species other than Mycobacterium tuberculosis complex (MTB) and the organisms that cause leprosy. They can cause pulmonary, central nervous system, lymph-node, joint, catheter-related as well as disseminated infection. NTM pulmonary disease (NTM-P...
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Elsevier
2024-11-01
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| Series: | Clinical Infection in Practice |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2590170224000426 |
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| author | Catriona Macrae Nicholas Kennedy |
| author_facet | Catriona Macrae Nicholas Kennedy |
| author_sort | Catriona Macrae |
| collection | DOAJ |
| description | Non-tuberculous mycobacteria (NTM) are mycobacterial species other than Mycobacterium tuberculosis complex (MTB) and the organisms that cause leprosy. They can cause pulmonary, central nervous system, lymph-node, joint, catheter-related as well as disseminated infection. NTM pulmonary disease (NTM-PD) occurs when NTM infection causes progressive inflammatory lung damage. NTM-PD is increasing in both incidence and prevalence. Mycobaterium szulgai, is an uncommon, slow-growing NTM. M. szulgai primarily causes pulmonary infections which present like MTB pulmonary infections. Due to low prevalence there are no standardised treatment guidelines for the management of M. szulgai infection.We describe a case of M. szulgai pulmonary infection in diabetic man in his fifties who presented with productive cough, dyspnoea, weight loss, fatigue and night sweats. Computed tomography (CT) showed three thick walled cavities in the right lung, with consolidation, emphysema and adenopathy, thought to be reactive. Sputum samples were positive for acid alcohol fast bacilli (AAFB) but MTB PCR testing was negative. Sputum culture grew M. szulgai. He was treated with on Rifampicin, Isoniazid, Ethambutol and Azithromycin for 13 months. The patient improved significantly following initiation of anti-mycobacterial treatment.The patient’s clinical presentation, radiological findings of upper lobe cavitating lesions, and characteristics; male, over 50 years old, immunosuppressed with underlying lung disease, are similar to most reported cases. M. szulgai can rarely infect immunocompetent hosts. Evidence to guide therapy is lacking. Treatment duration in the literature varies from six months to 39 months. Resistance to isoniazid has been reported and an isolate with both rifampicin and ethambutol resistance documented. Consensus guidelines recommend that NTM should be treated for at least 12 months from the first negative sputum culture. A combination of at least three susceptible drugs should be used, with rifampicin, ethambutol and azithromycin or clarithromycin recommended first line. |
| format | Article |
| id | doaj-art-8fedf75eaf044172ad72b1db294d6cfe |
| institution | Kabale University |
| issn | 2590-1702 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Clinical Infection in Practice |
| spelling | doaj-art-8fedf75eaf044172ad72b1db294d6cfe2024-12-12T05:22:39ZengElsevierClinical Infection in Practice2590-17022024-11-0124100382An unusual pulmonary mycobacterial infection: Case report and literature reviewCatriona Macrae0Nicholas Kennedy1Corresponding author.; NHS Lanarkshire Infectious Diseases Unit, University Hospital Monklands, Monkscourt Avenue, Airdrie, UKNHS Lanarkshire Infectious Diseases Unit, University Hospital Monklands, Monkscourt Avenue, Airdrie, UKNon-tuberculous mycobacteria (NTM) are mycobacterial species other than Mycobacterium tuberculosis complex (MTB) and the organisms that cause leprosy. They can cause pulmonary, central nervous system, lymph-node, joint, catheter-related as well as disseminated infection. NTM pulmonary disease (NTM-PD) occurs when NTM infection causes progressive inflammatory lung damage. NTM-PD is increasing in both incidence and prevalence. Mycobaterium szulgai, is an uncommon, slow-growing NTM. M. szulgai primarily causes pulmonary infections which present like MTB pulmonary infections. Due to low prevalence there are no standardised treatment guidelines for the management of M. szulgai infection.We describe a case of M. szulgai pulmonary infection in diabetic man in his fifties who presented with productive cough, dyspnoea, weight loss, fatigue and night sweats. Computed tomography (CT) showed three thick walled cavities in the right lung, with consolidation, emphysema and adenopathy, thought to be reactive. Sputum samples were positive for acid alcohol fast bacilli (AAFB) but MTB PCR testing was negative. Sputum culture grew M. szulgai. He was treated with on Rifampicin, Isoniazid, Ethambutol and Azithromycin for 13 months. The patient improved significantly following initiation of anti-mycobacterial treatment.The patient’s clinical presentation, radiological findings of upper lobe cavitating lesions, and characteristics; male, over 50 years old, immunosuppressed with underlying lung disease, are similar to most reported cases. M. szulgai can rarely infect immunocompetent hosts. Evidence to guide therapy is lacking. Treatment duration in the literature varies from six months to 39 months. Resistance to isoniazid has been reported and an isolate with both rifampicin and ethambutol resistance documented. Consensus guidelines recommend that NTM should be treated for at least 12 months from the first negative sputum culture. A combination of at least three susceptible drugs should be used, with rifampicin, ethambutol and azithromycin or clarithromycin recommended first line.http://www.sciencedirect.com/science/article/pii/S2590170224000426 |
| spellingShingle | Catriona Macrae Nicholas Kennedy An unusual pulmonary mycobacterial infection: Case report and literature review Clinical Infection in Practice |
| title | An unusual pulmonary mycobacterial infection: Case report and literature review |
| title_full | An unusual pulmonary mycobacterial infection: Case report and literature review |
| title_fullStr | An unusual pulmonary mycobacterial infection: Case report and literature review |
| title_full_unstemmed | An unusual pulmonary mycobacterial infection: Case report and literature review |
| title_short | An unusual pulmonary mycobacterial infection: Case report and literature review |
| title_sort | unusual pulmonary mycobacterial infection case report and literature review |
| url | http://www.sciencedirect.com/science/article/pii/S2590170224000426 |
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