Humans ; Retrospective Studies ; Bronchiectasis ; Mycobacterium avium Complex ; Syndrome ; Nocardia Infections/drug therapy* ; Nocardia ; Mycobacterium avium-intracellulare Infection

Although the treatment of pulmonary diseases due to nontuberculous mycobacteria (NTM) requires the long-term use of antibiotics in combination, the treatment success rates are unsatisfactory. We evaluated the clinical characteristics and surgical outcomes of 23 patients with NTM lung diseases who had underwent pulmonary resection. The median age of the patients was 45 yr. Of the 23 patients, 10 had Mycobacterium avium-intracellulare complex infection, 12 had M. abscessus infection, and one had M. xenopi infection. The indications for surgery were antibiotic therapy failure (n=11), remnant cavitary lesion with high probability of relapse (n=8), and massive hemoptysis (n=4). The most common procedure was lobectomy (48%). Postoperative complications occurred in eight patients (35%), including postoperative pneumonia (n=3) and late bronchopleural fistula (n=2). Negative sputum culture conversion was achieved and maintained in all except two mortalities. Although it is associated with a relatively high complication rate, patients with NTM lung disease whose disease is localized to one lung and who can tolerate resectional surgery might be considered for surgery, if there has been poor response to drug therapy or if the patients develop significant disease-related complications such as hemoptysis.
Adult ; Antitubercular Agents/therapeutic use ; Drug Resistance, Bacterial ; Female ; Hemoptysis/microbiology/surgery ; Humans ; Male ; Middle Aged ; Mycobacterium Infections, Atypical/drug therapy/*surgery ; *Mycobacterium avium Complex ; Mycobacterium avium-intracellulare Infection/drug therapy/*surgery ; *Mycobacterium xenopi ; Postoperative Complications ; Retrospective Studies ; Treatment Outcome

Mycobacterium avium complex (MAC) infection is a common opportunistic infection in patients with AIDS (acquired immune deficiency syndrome). Pulmonary involvement of MAC may range from asymptomatic colonization of the respiratory tract to invasive parenchymal or cavitary disease. However, endobronchial lesions with MAC infection are rare in immunocompetent and immunosuppressed hosts. Here, we report MAC infection presenting as an endobronchial mass in a patient with AIDS.
Acquired Immunodeficiency Syndrome/*complications ; Adult ; Antitubercular Agents/therapeutic use ; Bronchial Diseases/complications/diagnosis/drug therapy/*microbiology ; Bronchoscopy ; Humans ; Male ; Mycobacterium avium Complex ; Mycobacterium avium-intracellulare Infection/complications/*diagnosis/drug therapy ; Opportunistic Infections/*complications/diagnosis/drug therapy ; Tomography, X-Ray Computed

A case of Mycobacterium avium arthritis in a 39-year-old female patient with mixed connective tissue disease (MCTD) was reported. An extra-articular abscess had formed outside the knee joint and extended down the calf. A culture was taken of the abscess and synovial fluid disclosed Mycobacteriun avium. This was resistant to most anti-tuberculosis agents. A combination of anti-tuberculosis drugs followed a total resection of the abscess. We concluded that M avium septic arthritis could insidiously develop into an extra-articular abscess. A combination of anti-tuberculosis drugs with a total resection of the abscess was an effective treatment.
Adult ; Antitubercular Agents/therapeutic use ; Arthritis, Infectious/*microbiology/therapy ; Female ; Human ; Knee Joint/*microbiology/surgery ; Mixed Connective Tissue Disease/*complications ; Mycobacterium avium/drug effects/*isolation & purification ; Mycobacterium avium-intracellulare Infection/*complications/therapy

The incidence of pulmonary disease caused by nontuberculous mycobacteria (NTM) appears to be increasing worldwide. In Korea, M. avium complex and M. abscessus account for most of the pathogens encountered, whilst M. kansasii is a relatively uncommon cause of NTM pulmonary diseases. NTM pulmonary disease is highly complex in terms of its clinical presentation and management. Because its clinical features are indistinguishable from those of pulmonary tuberculosis and NTMs are ubiquitous in the environment, the isolation and identification of causative organisms are mandatory for diagnosis, and some specific diagnostic criteria have been proposed. The treatment of NTM pulmonary disease depends on the infecting species, but decisions concerning the institution of treatment are never easy. Treatment requires the use of multiple drugs for 18 to 24 months. Thus, treatment is expensive, often has significant side effects, and is frequently not curative. Therefore, clinicians should be confident that there is sufficient pathology to warrant prolonged, multidrug treatment regimens. In all of the situations, outcomes can be best optimized only when clinicians, radiologists, and laboratories work cooperatively.
Anti-Bacterial Agents/therapeutic use ; Female ; Humans ; Korea ; Lung Diseases/*diagnosis/drug therapy/microbiology ; Male ; Mycobacterium Infections, Atypical/*diagnosis/drug therapy/microbiology ; Mycobacterium avium-intracellulare Infection/diagnosis/drug therapy/microbiology ; Research Support, Non-U.S. Gov't

BACKGROUND/AIMS: The frequency of nontuberculous mycobacteria pulmonary disease in HIV-negative patients is increasing; the most common pathogen in Korea is the Mycobacterium avium complex (MAC). However, few studies have evaluated the treatment outcome of MAC pulmonary disease in Korea. METHODS: The efficacy of a clarithromycin-containing regimen for MAC pulmonary disease was studied in 42 patients treated for more than 6 months between January 2005 and December 2008. All patients were treated with a regimen consisting of clarithromycin, rifampin, and ethambutol. Streptomycin was added in 10 patients. RESULTS: Among the 42 patients, a negative culture conversion was achieved in 33 (78.6%), and the median duration of treatment in these patients was 19 months (interquartile range [IQR], 16 to 22). Of the 33 patients with a negative culture conversion, 14 completed treatment. During the follow-up period (median, 10 months; IQR, 4 to 20) for the 14 patients, one relapsed at 24 months after treatment completion. The culture conversion rate was significantly higher in patients who were treated with more than 500 mg/day clarithromycin (87.1% vs. 54.5%, p = 0.038). CONCLUSIONS: The combined regimen including clarithromycin was effective against MAC pulmonary disease. High-dose clarithromycin of more than 500 mg/day may improve the outcome of patients with MAC pulmonary disease.
Aged ; Anti-Bacterial Agents/*administration & dosage ; Clarithromycin/*administration & dosage/adverse effects ; Drug Therapy, Combination ; Female ; Humans ; Lung Diseases/*drug therapy ; Male ; Middle Aged ; Mycobacterium avium-intracellulare Infection/*drug therapy ; Retrospective Studies ; Treatment Outcome

We report a very rare case of a bronchogenic cyst combined with nontuberculous mycobacterial pulmonary disease in an immunocompetent patient. A 21-year-old male was referred to our institution because of a cough, fever, and worsening of abnormalities on his chest radiograph, despite anti-tuberculosis treatment. Computed tomography of the chest showed a large multi-cystic mass over the right-upper lobe. Pathological examination of the excised lobe showed a bronchogenic cyst combined with a destructive cavitary lesion with granulomatous inflammation. Microbiological culture of sputum and lung tissue yielded Mycobacterium avium. The patient was administered anti-mycobacterial treatment that included clarithromycin.
Anti-Bacterial Agents/therapeutic use ; Biopsy ; Bronchogenic Cyst/*complications/diagnosis/immunology/surgery ; Humans ; *Immunocompetence ; Male ; Mycobacterium avium Complex/*isolation & purification ; Mycobacterium avium-intracellulare Infection/*complications/diagnosis/drug therapy/immunology/microbiology ; Pneumonectomy ; Respiratory Tract Infections/*complications/diagnosis/drug therapy/immunology/microbiology ; Sputum/microbiology ; Tomography, X-Ray Computed ; Treatment Outcome ; Young Adult

Isolated bone marrow infection by nontuberculous mycobacteria (NTM) is extremely rare. Recently, we encountered a case of bone marrow Mycobacterium avium complex (MAC) infection, which presented as a fever of unknown origin shortly after starting continuous ambulatory peritoneal dialysis (CAPD). The patient was diagnosed with MAC infection on the basis of PCR-restriction fragment length polymorphism analysis and sequencing of DNA obtained from bone marrow specimens. Although this was a case of severe MAC infection, there was no evidence of infection of other organs. End-stage renal disease (ESRD) patients undergoing dialysis can be considered immunodeficient; therefore, when these patients present with fever of unknown origin, opportunistic infections such as NTM infection should be considered in the differential diagnosis.
Aged ; Anti-Bacterial Agents/therapeutic use ; Bacterial Proteins/genetics ; Bone Marrow/microbiology/pathology ; Diagnosis, Differential ; Female ; HIV Infections/diagnosis ; Humans ; Kidney Failure, Chronic/therapy ; *Mycobacterium avium Complex/genetics/isolation &purification ; Mycobacterium avium-intracellulare Infection/*diagnosis/drug therapy/microbiology ; *Peritoneal Dialysis, Continuous Ambulatory ; Polymerase Chain Reaction ; Polymorphism, Restriction Fragment Length ; Sequence Analysis, DNA