Journal List > Tuberc Respir Dis > v.67(5) > 1001440

Park: Respiratory Review of 2009: Nontuberculous Mycobacterium

Abstract

As the prevalence of tuberculosis declines, the proportion of nontuberculous mycobacterial (NTM) lung disease is increasing in Korea. The combined use of liquid and solid media increases the sensitivity of mycobacterial culture and shortens culture time. Because NTMs are ubiquitous in the environment, NTM lung disease requires strict diagnostic criteria to prevent over-diagnosis of NTM lung disease. Mycobacterium avium complex is the most common pathogen of NTM lung disease in Korea and present in two forms: upper lobe cavitary and nodular bronchiectatic form. Decision of treatment of NTM lung disease depends on the infecting species and overall condition of the patient. Because medical therapy requires the use of multiple drugs over 18 to 24 months, surgery for localized disease may be useful for those species refractory to medical therapy.

Figures and Tables

Figure 1
M. intracellulare pulmonary disease of the upper lobe cavitary form in a 72-year-old man. Chest radiograph shows thin-walled cavity in the right upper lobe.
trd-67-395-g001
Figure 2
M. avium pulmonary disease of the nodular bronchiectatic form in a 47-year-old woman. Chest radiograph shows a multifocal patchy distribution of small nodular clusters in both lower lung zones. HRCT show small centrilobular nodules and bronchiectasis in the both lungs, especially in the right middle lobe and in the lingular division of the left upper lobe.
trd-67-395-g002
Table 1
Recovery rate of MIGT and Ogawa
trd-67-395-i001

MTB: mycobacterium tuberculosis; NTM: nontuberculous mycobacterium; MIGT: mycobactria growth tube indicator.

Table 2
American Thoracic Society Criteria for the diagnosis of nontuberculous mycobacterial pulmonary disease, 1997
trd-67-395-i002
Table 3
Criteria for the diagnosis of nontuberculous mycobacterial lung disease (American Thoracic Society and Infectious Disease Society of America, 2007)
trd-67-395-i003
Table 4
Frequency of 1,548 NTM isolates from 794 patients
trd-67-395-i004

Data are presented as No. (%).

NTM: nontuberculous mycobacterium.

Table 5
Etiology of clinically significant NTM lung infection
trd-67-395-i005

NTM: nontuberculous mycobacterium.

Table 6
Pathogenicity of NTM species isolated from respiratory specimen
trd-67-395-i006

NTM: nontuberculous mycobacterium.

Table 7
Treatment protocol for nontuberculous mycobacterial lung diseases (Korean Academy of Tuberculosis and Respiratory Disease, 2005)
trd-67-395-i007
Table 8
Operative procedures and postoperative complications
trd-67-395-i008

*Bronchopleural fistula, Left upper lobectomy plus lower lobe superior segmentectomy in one patient and left lower lobectomy plus upper lobe linugular segmentectomy in one patient.

References

1. Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro A, Daley C, Gordin F, et al. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med. 2007. 175:368–416.
2. Lee JY, Choi HJ, Lee H, Joung EY, Huh JW, Oh YM, et al. Recovery rate and characteristics of nontuberculous mycobacterial isolates in a university hospital in Korea. Tuberc Respir Dis. 2005. 58:385–391.
3. Ryoo SW, Shin S, Shim MS, Park YS, Lew WJ, Park SN, et al. Spread of nontuberculous mycobacteria from 1993 to 2006 in Koreans. J Clin Lab Anal. 2008. 22:416–420.
4. Bae E, Im JH, Kim SW, Yoon NS, Sung H, Kim MN, et al. Evaluation of combination of BACTEC Mycobacteria growth indicator tube 960 system and Ogawa media for mycobacterial culture. Korean J Lab Med. 2008. 28:299–306.
5. Diagnosis and treatment of disease caused by nontuberculous mycobacteria. This official statement of the American Thoracic Society was approved by the Board of Directors, March 1997. Medical Section of the American Lung Association. Am J Respir Crit Care Med. 1997. 156:S1–S25.
6. Koh WJ, Kwon OJ, Jeon K, Kim TS, Lee KS, Park YK, et al. Clinical significance of nontuberculous mycobacteria isolated from respiratory specimens in Korea. Chest. 2006. 129:341–348.
7. Subcommittee of the Joint Tuberculosis Committee of the British Thoracic Society. Management of opportunist mycobacterial infections: Joint Tuberculosis Committee Guidelines 1999. Thorax. 2000. 55:210–218.
8. Koh WJ, Kwon OJ. Diagnosis and treatment of nontuberculous mycobacterial lung disease. Korean J Med. 2008. 74:120–131.
9. Koh WJ, Kim YH, Kwon OJ, Choi YS, Kim K, Shim YM, et al. Surgical treatment of pulmonary diseases due to nontuberculous mycobacteria. J Korean Med Sci. 2008. 23:397–401.
TOOLS
Similar articles