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  • Authors: James C. Johnston1, Leslie Chiang2, Kevin Elwood3
  • Editor: David Schlossberg4
  • VIEW AFFILIATIONS HIDE AFFILIATIONS
    Affiliations: 1: Division of Tuberculosis Control, British Columbia Centre for Disease Control, Vancouver, British Columbia V5Z 4R4, Canada; 2: Division of Tuberculosis Control, British Columbia Centre for Disease Control, Vancouver, British Columbia V5Z 4R4, Canada; 3: Division of Tuberculosis Control, British Columbia Centre for Disease Control, Vancouver, British Columbia V5Z 4R4, Canada; 4: Philadelphia Health Department, Philadelphia, PA
  • Source: microbiolspec February 2017 vol. 5 no. 1 doi:10.1128/microbiolspec.TNMI7-0011-2016
  • Received 28 September 2016 Accepted 01 December 2016 Published 10 February 2017
  • James C. Johnston, James.Johnston@bccdc.ca
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  • Abstract:

    The incidence of varies widely over time and by region, but this organism remains one of the most clinically relevant isolated species of nontuberculous mycobacteria. 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 thought not to occur. Clinical syndromes and radiological findings of infection are mostly indistinguishable from that of , thus requiring microbiological confirmation. Disseminated disease is uncommon 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. Surveys in Great Britain, however, noted higher rates, with 8 to 9% of infections presenting with extrapulmonary disease. Common sites of extrapulmonary disease include the lymph nodes, skin, and musculoskeletal and genitourinary systems. The specificity of gamma interferon release assays (IGRAs) for may be reduced by infection, as encodes CFP-10 and ESAT-6, two antigens targeted by IGRAs. A study conducted to evaluate the therapy in rifampin-resistant disease 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, Chiang L, Elwood K. 2017. . Microbiol Spectrum 5(1):TNMI7-0011-2016. doi:10.1128/microbiolspec.TNMI7-0011-2016.

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/content/journal/microbiolspec/10.1128/microbiolspec.TNMI7-0011-2016
2017-02-10
2017-06-29

Abstract:

The incidence of varies widely over time and by region, but this organism remains one of the most clinically relevant isolated species of nontuberculous mycobacteria. 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 thought not to occur. Clinical syndromes and radiological findings of infection are mostly indistinguishable from that of , thus requiring microbiological confirmation. Disseminated disease is uncommon 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. Surveys in Great Britain, however, noted higher rates, with 8 to 9% of infections presenting with extrapulmonary disease. Common sites of extrapulmonary disease include the lymph nodes, skin, and musculoskeletal and genitourinary systems. The specificity of gamma interferon release assays (IGRAs) for may be reduced by infection, as encodes CFP-10 and ESAT-6, two antigens targeted by IGRAs. A study conducted to evaluate the therapy in rifampin-resistant disease 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.

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Figures

Image of FIGURE 1
FIGURE 1

This Ziehl-Neelsen-stained photomicrograph of an unknown species demonstrates the cross-barred pattern that is also typically exhibited in . Image courtesy of the CDC-Public Health Image Library/Ronald W. Smithwick (ID#14600).

Source: microbiolspec February 2017 vol. 5 no. 1 doi:10.1128/microbiolspec.TNMI7-0011-2016
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Tables

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TABLE 1

ATS/IDSA-recommended regimens

Source: microbiolspec February 2017 vol. 5 no. 1 doi:10.1128/microbiolspec.TNMI7-0011-2016
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TABLE 2

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

Source: microbiolspec February 2017 vol. 5 no. 1 doi:10.1128/microbiolspec.TNMI7-0011-2016

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