Respiratory Review of 2009: Nontuberculous Mycobacterium

Jae Seuk Park

doi:10.4046/trd.2009.67.5.395

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Park: Respiratory Review of 2009: Nontuberculous Mycobacterium

Review

Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2009; 67(5): 395-401.

Published online: 30 November 2009

DOI: https://doi.org/10.4046/trd.2009.67.5.395

Respiratory Review of 2009: Nontuberculous Mycobacterium

Jae Seuk Park, M.D.

Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea.

Address for correspondence: Jae Seuk Park, M.D. Department of Internal Medicine, Dankook University College of Medicine, 16-5, Anseo-dong, Cheonan 330-715, Korea. Phone: 82-41-550-3055, Fax: 82-41-556-3256, jspark@dankook.ac.kr

Received 8 June 2009 Accepted 10 June 2009

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.

Keywords: Mycobacterium avium-intracellulare Infection, Culture Media, Mycobacterium avium Complex, Surgery

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.

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.

Table 1

Recovery rate of MIGT and Ogawa

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

Table 3

Criteria for the diagnosis of nontuberculous mycobacterial lung disease (American Thoracic Society and Infectious Disease Society of America, 2007)

Table 4

Frequency of 1,548 NTM isolates from 794 patients

Data are presented as No. (%).

NTM: nontuberculous mycobacterium.

Table 5

Etiology of clinically significant NTM lung infection

NTM: nontuberculous mycobacterium.

Table 6

Pathogenicity of NTM species isolated from respiratory specimen

NTM: nontuberculous mycobacterium.

Table 7

Treatment protocol for nontuberculous mycobacterial lung diseases (Korean Academy of Tuberculosis and Respiratory Disease, 2005)

Table 8

Operative procedures and postoperative complications

^*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.

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