Télécharger surgery for pulmonary mycobacterial disease an

Objective : Since the introduction of clarithromycin, it has been assumed that pulmonary Mycobacterium avium complex MAC disease can be treated with medication alone.

This study examines whether surgery can still play an important role in the management of MAC lung disease in the current era. Methods : Between April and January21 patients 11 men and 10 women underwent a pulmonary resection for MAC infection.

The median age of the patients was 56 years range: 27—67 years. None of the patients were immunocompromised. Regimens employing clarithromycin were initiated preoperatively in all patients. The indications for surgery were failure of drug therapy in 19 patients and discontinuation of chemotherapy because of drug toxicity in two patients. The pulmonary resections 19 right lung, 2 left lung performed included lobectomy in 16 patients, pneumonectomy in three, bilobectomy in one, and lobectomy plus segmentectomy in one.

Results : All of the patients survived the surgery. Six major postoperative complications occurred in six patients All postoperative complications were manageable, and four of these were treated surgically. All patients had sputum-negative status after their operation. Relapse occurred in two patients 9. The first patient, who originally had a right upper lobectomy, underwent a left upper lobectomy during the follow-up period, attaining sputum conversion.

The second patient underwent a right pneumonectomy and then died of respiratory failure four years postoperatively. This one late death was the only fatality. Conclusions : Although it is associated with relatively high morbidity, surgery provides a high sputum conversion rate for patients whose MAC disease responds poorly to drug therapy. Even in the present clarithromycin era, pulmonary resection remains the treatment of choice when MAC lung disease has not been successfully eradicated by drug treatment alone.

Pulmonary disease caused by Mycobacterium avium complex MAC is usually resistant to conventional antituberculous agents. A recent study has demonstrated that pulmonary MAC disease is still difficult to eradicate with regimens containing rifampicin, ethambutol, and isoniazid [1].

Therefore, when feasible, resectional surgery has been advocated to treat this disease in cases where drug regimens have failed to correct the disorder [2—8]. Since the introduction of clarithromycin, there have been greater expectations that pulmonary MAC disease can be treated with medication alone.Learn More.

There are also nontuberculous NTM mycobacteria, ubiquitous in soil, water, food, on the surfaces of many plants and within buildings, particularly within water pipes. Usually these bacteria are harmless to people but for unknown reasons, NTM lung infections are becoming more common in the developed world, including the United States, particularly in the Southwest including southern CaliforniaSoutheast and Hawaii.

Though the prevalence of NTM infections is rising, these infections remain relatively rare, occurring in about out ofpeople in America. Because of this, many primary care physicians may not be familiar with the condition and people with a chronic cough caused by an NTM infection may go undiagnosed for a year or sometimes more.

NTM infections, however, are not contagious. If a NTM infection is present, we will also identify the specific type of NTM, a process critical for determining which antimicrobial agents to use, or if treatment is even necessary or advised.

Nontuberculous mycobacterial pulmonary infections

NTM lung infections may be resistant or hard to treat with antibiotics. As a result, patients may need to use several antibiotics, for up to years. Since many of these medications have side effects, close monitoring is important. NTM infections that have spread beyond the lungs may need to be treated with chemotherapy.

Surgery may also, in severe and rare instances, be performed. You may be trying to access this site from a secured browser on the server. Please enable scripts and reload this page.

Menu Search. Mycobacterial Lung Infections. Page Content. TB and Nontuberculous Lung Infections Mycobacterial lung infections are caused by a group of bacteria, mycobacteria, that includes the causative-agents of tuberculosis TB and leprosy. Those at greater risk of NTM lung infections include: Post-menopausal women Caucasians Those with a compromised immune system Those with lung damage from another condition such as chronic bronchitis, emphysema or COPD Though the prevalence of NTM infections is rising, these infections remain relatively rare, occurring in about out ofpeople in America.

Content Area Two.Outcomes of antibiotic treatment for lung disease caused by nontuberculous mycobacteria NTM are unsatisfactory. The role of adjunctive surgery in the treatment of NTM lung disease is still unclear. We conducted a retrospective review of 70 patients who underwent pulmonary resection for NTM lung disease from March to February All patients received recommended antibiotic treatment before and after the surgery.

A total of 70 patients underwent 74 operations.

Treatment outcomes of adjuvant resectional surgery for nontuberculous mycobacterial lung disease

Although adjuvant pulmonary resection is associated with a relatively high complication rate, this procedure may provide a high level of treatment success for selected patients with NTM lung disease, such as those with a poor response to antibiotic treatment alone. Nontuberculous mycobacteria NTM refer generally to mycobacteria other than Mycobacterium tuberculosis complex and M. The prevalence of lung diseases caused by NTM is increasing worldwide [ 12 ]. NTM Lung disease occurs commonly in structural lung disease, such as prior tuberculosis and bronchiectasis.

A major therapeutic advance in the treatment of NTM lung disease was the introduction of the newer macrolides, clarithromycin and azithromycin, which have substantial in vitro and clinical activity against MAC and M. However, the treatment success rates for patients receiving combination antibiotic treatment for NTM lung disease are unsatisfactory. Therefore, adjuvant resectional surgery could be considered in patients with intractable NTM lung disease predominantly localized to one lung and who can tolerate resectional surgery [ 1011 ].

The increasing prevalence of NTM lung disease has been paralleled by increasing reports on the role of surgery since the introduction of the newer macrolides [ 12 - 25 ], suggesting more frequent use of thoracic surgery in the management of NTM lung disease. However, a majority of these reports were from limited centers in the Unites States and Japan, and the criteria for selecting the patients who may benefit from the operation remain controversial [ 102627 ].

More data on the treatment outcomes of patients with NTM lung disease undergoing surgical resection in settings of various etiologic organisms will help determine the optimal role of adjuvant surgery. We previously reported the treatment outcomes in 23 patients who underwent pulmonary resections for NTM lung disease [ 20 ].

This study reports our further experience of adjuvant surgical therapy in 70 patients with NTM lung disease. We retrospectively reviewed the medical records of all patients who underwent adjunctive pulmonary resectional surgery for NTM lung disease at Samsung Medical Center a 1,bed referral hospital in Seoul, Korea between March and February During this period, a total of 70 patients underwent pulmonary resection for NTM lung disease.

All patients met the diagnostic criteria for NTM lung disease [ 1 ]. NTM species were identified using polymerase chain reaction PCR -restriction fragment length polymorphism analysis or a PCR-reverse blot hybridization assay of the mycobacterial rpoB gene [ 32 - 34 ].

We classified chest radiography and high-resolution computed tomography HRCT scan findings as showing either fibrocavitary disease or nodular bronchiectatic disease.

télécharger surgery for pulmonary mycobacterial disease an

When the disease did not belong to either the fibrocavitary form or the nodular bronchiectatic form, it was deemed unclassifiable [ 35 - 38 ]. Informed consent was waived for the use of patient medical data and patient information was anonymized and de-identified prior to analysis. All patients with NTM lung disease received the standard combination antibiotic therapy according to the American Thoracic Society guidelines [ 1 ]. For treating MAC lung disease, patients received antibiotic therapy consisting of oral macrolide clarithromycin or azithromycinethambutol, and rifampin.

When necessary, streptomycin injection was added to the regimen in patients with severe MAC lung disease [ 353940 ]. Patients with M. For patients with M. The same oral regimens were used after discharge in patients with M.

Patients were selected for surgery based on consensus by medical and surgical specialists. For patients with bilateral lesions, the area with the larger bacterial burden was resected, and the remaining lesion with the smaller bacterial burden in the ipsilateral or contralateral lung was controlled with medical therapy.Metrics details.

Outcomes of antibiotic treatment for lung disease caused by nontuberculous mycobacteria NTM are unsatisfactory. The role of adjunctive surgery in the treatment of NTM lung disease is still unclear.

Diagnosis and treatment of chronic pulmonary aspergillosis

We conducted a retrospective review of 70 patients who underwent pulmonary resection for NTM lung disease from March to February All patients received recommended antibiotic treatment before and after the surgery. A total of 70 patients underwent 74 operations.

Although adjuvant pulmonary resection is associated with a relatively high complication rate, this procedure may provide a high level of treatment success for selected patients with NTM lung disease, such as those with a poor response to antibiotic treatment alone. Peer Review reports.

Nontuberculous mycobacteria NTM refer generally to mycobacteria other than Mycobacterium tuberculosis complex and M. The prevalence of lung diseases caused by NTM is increasing worldwide [ 12 ].

NTM Lung disease occurs commonly in structural lung disease, such as prior tuberculosis and bronchiectasis. A major therapeutic advance in the treatment of NTM lung disease was the introduction of the newer macrolides, clarithromycin and azithromycin, which have substantial in vitro and clinical activity against MAC and M. However, the treatment success rates for patients receiving combination antibiotic treatment for NTM lung disease are unsatisfactory.

Therefore, adjuvant resectional surgery could be considered in patients with intractable NTM lung disease predominantly localized to one lung and who can tolerate resectional surgery [ 1011 ]. The increasing prevalence of NTM lung disease has been paralleled by increasing reports on the role of surgery since the introduction of the newer macrolides [ 12 - 25 ], suggesting more frequent use of thoracic surgery in the management of NTM lung disease. However, a majority of these reports were from limited centers in the Unites States and Japan, and the criteria for selecting the patients who may benefit from the operation remain controversial [ 102627 ].

More data on the treatment outcomes of patients with NTM lung disease undergoing surgical resection in settings of various etiologic organisms will help determine the optimal role of adjuvant surgery.

We previously reported the treatment outcomes in 23 patients who underwent pulmonary resections for NTM lung disease [ 20 ]. This study reports our further experience of adjuvant surgical therapy in 70 patients with NTM lung disease.

We retrospectively reviewed the medical records of all patients who underwent adjunctive pulmonary resectional surgery for NTM lung disease at Samsung Medical Center a 1,bed referral hospital in Seoul, Korea between March and February During this period, a total of 70 patients underwent pulmonary resection for NTM lung disease. All patients met the diagnostic criteria for NTM lung disease [ 1 ].

NTM species were identified using polymerase chain reaction PCR -restriction fragment length polymorphism analysis or a PCR-reverse blot hybridization assay of the mycobacterial rpoB gene [ 32 - 34 ].

We classified chest radiography and high-resolution computed tomography HRCT scan findings as showing either fibrocavitary disease or nodular bronchiectatic disease. When the disease did not belong to either the fibrocavitary form or the nodular bronchiectatic form, it was deemed unclassifiable [ 35 - 38 ].

télécharger surgery for pulmonary mycobacterial disease an

Informed consent was waived for the use of patient medical data and patient information was anonymized and de-identified prior to analysis. All patients with NTM lung disease received the standard combination antibiotic therapy according to the American Thoracic Society guidelines [ 1 ]. For treating MAC lung disease, patients received antibiotic therapy consisting of oral macrolide clarithromycin or azithromycinethambutol, and rifampin.The student will be able to describe the features of latent infection and disease caused by Mycobacterium tuberculosis.

The student will be able to recognize characteristic radiographic patterns of the pulmonary disease caused by Mycobacterium spp. The student will be able to explain the epidemiology of nontuberculous mycobacterial diseases in specific clinical conditions including cystic fibrosis, bronchiectasis, COPD, and other structural diseases of the lungs.

The student will be able to develop treatment approaches for clinical cases of pulmonary mycobacterial disease. Mycobacterial diseases of the lung encompass tuberculous and nontuberculous diseases, which have important differences in pathogenesis, transmissibility, therapeutic approach, and public health implications.

Although at least 15 million persons are infected with TB in the United States, the actual number of cases has been decreasing sinceprimarily due to more effective public health policies, enhanced awareness resulting in earlier diagnosis, and implementation of directly observed therapy DOT as standard of care in appropriate settings. The present incidence of tuberculosis in the United States varies significantly depending on the place of birth of U. It is as high as These data underscore the importance of ongoing overseas screening for tuberculosis with follow-up evaluation after arrival in U.

Elimination of tuberculosis in the United States therefore mandates control and prevention of tuberculosis in foreign-born persons. Development of disease from Mycobacterium tuberculosis MTB is the most common global infectious cause of death. Such disease caused by bacteria of the MTB complex preeminently affects the lungs, although other organs are involved in up to one-third of cases. Transmission of TB occurs when a contagious patient cough, sneezes, or otherwise spreads the bacilli through generation of airborne droplet nuclei to individuals in close proximity sharing the same ventilatory space.

Of note, M. Mycobacteria, including M. AFB smear showing M. See also Fig. Other microorganisms may also display some acid fastness, including species of Nocardia and RhodococcusLegionella micdadeiand the protozoa Isospora and Cryptosporidium. With respect to the mycobacteria, the cell wall contains lipids eg, mycolic acids that are linked to underlying arabinogalactan and peptidoglycan residues. These collectively confer low permeability characteristics to the cell wall, and so reduce the effectiveness of most antimicrobial drugs.

Tuberculosis is broadly classified as pulmonary or extrapulmonary; pulmonary tuberculosis represents the majority of disease cases. MTB bacilli are deposited in the small airways and the alveoli of better-ventilated areas of the lung.Background: Limited data are available regarding the detailed characteristics and outcomes of surgically resected nontuberculous mycobacterial NTM granulomas. Five patients received postoperative antibiotic therapy.

Over a median follow-up period of Conclusions: Most NTM granulomas can be treated completely by surgical resection without antibiotic therapy, and microbiological examination of surgical specimens is important for optimal management. Non-tuberculous mycobacteria-pulmonary disease NTM-PD is a chronic progressive infectious disease, and its burden is rapidly increasing worldwide [ 12 ].

Although the major causative organisms of NTM-PD differ by geographical region, the most common pathogens include Mycobacterium avium complex including M. NTM-PD has heterogeneity with regard to radiologic findings, but it traditionally has been divided into two phenotypes. The fibrocavitary form is progressive and is characterized by cavitary lesions that are typically in the upper lobes, while the nodular bronchiectatic form presents as bilateral bronchiectasis with nodular infiltrates involving the middle lung zones [ 45 ].

Studies have shown that these findings correspond histopathologically to granuloma formation [ 78 ]. The introduction of chest computed tomography CT for lung cancer screening has increased detection of SPNs.

SPNs are a common, worrisome clinical problem because they can indicate early-stage lung cancer and are often difficult to non-invasively distinguish NTM SPNs from other inflammatory nodules such as tuberculosis granulomas. Thus, SPNs are frequently surgically resected for definitive diagnosis or treatment. Current guidelines state that, in the absence of other radiographic evidence of NTM-related disease, surgical resection of the SPN alone may be curative and antibiotic therapy is unnecessary, especially for M.

However, these guidelines are primarily based on expert opinion and clinical experience with lung resection for possible neoplasia or lung volume reduction surgery in obstructive lung disease [ 10 ], and it is not known if this approach is applicable to NTM species other than M.

Patients who were diagnosed with a solitary NTM granuloma between January and December were retrospectively identified among patients who underwent thoracic surgery for benign lung disease at Samsung Medical Center bed university-affiliated tertiary referral hospital in South Korea using medical records.

A solitary NTM granuloma was diagnosed as follows: 1 solitary lung nodule defined as a round or oval lesion, on chest CT with no nodular clusters in the same lobe except for lesions adjacent to the main nodule; 2 positive NTM culture from a respiratory specimen such sputum, bronchial washing fluid, or lung biopsy; and 3 histopathologic features of an inflammatory granuloma.

Patients who had been treated with chemotherapy before surgery were excluded given the potential effects on pathologic features. Postoperative chemotherapy was prescribed at the discretion of the attending physician. Forty-nine patients who underwent surgical resection of an NTM granuloma were included in the final analysis.

Informed consent was waived as this was a retrospective study. Institutional Review Board of Samsung Medical Center is the local ethics committee that reviewed and approved the protocol. Informed consent was obtained from all individual participants included in the study.

Sputum, bronchial washing fluid, or tissue was obtained for microbiological evaluation. Acid-fast bacilli smears and cultures were conducted using standard methods. NTM species were identified using polymerase chain reaction-restriction fragment length polymorphism analysis or reverse-blot hybridization of the rpoB gene.En savoir plus. SlideShare Explorer Recherche Vous. Soumettre la recherche. Accueil Explorer. Atypical mycobacteria.

Nontuberculous Mycobacteria (NTM) Infections

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Atypical Mycobacteria Dr. NTM are highly adaptable and can inhabit hostile environments, including industrial solvents. Examples include M. Other examples are M. Other examples cause disease rarely, such as M. In patients with acquired immunodeficiency syndrome, mediastinal or hilar adenopathy is the most common radiographic finding.

The tissue obtained can be used for cultures of the tissue and for histopathologic examination. Suppurative granulomas are the most characteristic feature in skin biopsy specimens from cutaneous atypical mycobacteria infections.


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