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?

2 comments - CLICK HERE to read & add your own!:

ABetens said...

A few years ago I reviewed the last 100 or so respiratory cultures with NTM at Henry Ford Hospital and presented it a Pembine. We had a good number of cases where M. abscessus and/or chelonae were likely colonizing or contaminants. M. gordonae is frequently a lab contaminant, although case reports occasionally suggest it can be a pathogen.

Are these patients smear positive? If so, this may indicate a higher burden of organisms and actualy disease. Are multiple cultures positive? Do you have any old radiographs and do they show progression, especially with bronchiectasis or nodular disease?

If these samples are from bronchoscopy, you may want to see if there is contamination coming from the bronch suite. This has been reported at other institutions.

I would suggest that progression and organism load (e.g. smear positive) should be used to indicate true disease.

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.