Friday, July 15, 2005

Mycobacterial epidemic

I will post this as a quick question/poll. I have previously posted on the two patients with M. kansasii and now we have two patients, both males in their late 60s one with moderate and one with severe COPD with NTM. Both have been ill which is why we got the cultures. One had an infiltrate and now has M. gordonae growing from his sputum. The other has a chronic productive cough but his new HRCT showed no infiltrates, no bronchiectasis and barely any changes of COPD but his sputum is growing M. abscessus...
Some of the previous cases were isolated from bronchs some from expectorated sputum. Also these are different species so I doubt lab cross-contamination...
Kansasii and abscessus are seldom if ever colonizers and ought to be treated. Have you been seeing a lot of NTM (besides MAC) in COPD? Any comments, opinions on our mini-epidemic?

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Baleeiro said...

Those are great suggestions. The most interesting thing has been the variety: some have been from bronch samples (incidentally from different scopes) and some from sputum samples. The cases with kansassi had clear disease: smear-positive with infiltrates (one had a cavity) the rapid-grower isolates were less clear and we are repeating sputum Cxs and will be bronching the Pt with M. abscessus later in the week. Earlier in the year we finished treating someone for M. szulgai (a less common isolate) . He has severe COPD with bronchiectasis and had multiple positive samples (though smear-negative) and clinically improved with Tx.