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In contrast to other common nontuberculous mycobacteria, is infrequently isolated from natural water sources or soil. The major reservoir appears to be tap water. Infection is likely acquired through the aerosol route, with low infectivity in regions of endemicity. Human-to-human transmission is not thought to occur despite few case reports of familial clustering. Clinically significant disease is occasionally discovered incidentally on radiology, but these patients are often symptomatic and represent less than 20% of cases in most published series. Disseminated disease is an uncommon presentation in HIV-negative patients and usually associated with severe immunosuppression. The majority of patients with pulmonary disease have underlying pulmonary comorbidities, such as smoking, chronic obstructive pulmonary disease, bronchiectasis, and prior or concurrent infection. A survey in Great Britain, however, noted higher rates, with 9% of infections presenting with extrapulmonary disease. Common sites of extrapulmonary disease include lymph nodes, skin, musculoskeletal, and genitourinary systems. The specificity of gamma interferon release assays (IGRAs) for may be reduced by infection, as encodes for CFP-10 and ESAT-6, two antigens targeted by IGRAs. In a study conducted to evaluate the therapy in rifampin-resistant disease, it was found that patients with acquired rifampin resistance were treated with daily high-dose ethambutol, isoniazid, sulfamethoxazole, and pyridoxine combined with aminoglycoside therapy. Given the potential toxicities, particularly with aminoglycoside therapy, clarithromycin and/or moxifloxacin therapy could be considered as alternatives.

Citation: Johnston J, Elwood K. 2011. , p 578-585. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch38

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Table 1.

ATS/IDSA recommended regimens

Citation: Johnston J, Elwood K. 2011. , p 578-585. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch38
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Table 2.

Duration of therapy and relapse rate in patients completing rifampin-containing regimens

Citation: Johnston J, Elwood K. 2011. , p 578-585. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch38

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