scholarly journals Surgery in nontuberculous mycobacteria pulmonary disease

Breathe ◽  
2018 ◽  
Vol 14 (4) ◽  
pp. 288-301 ◽  
Author(s):  
Mimi Lu ◽  
Dominic Fitzgerald ◽  
Jonathan Karpelowsky ◽  
Hiran Selvadurai ◽  
Chetan Pandit ◽  
...  
Keyword(s):  
Medical Treatment ◽  
Lung Disease ◽  
Pulmonary Disease ◽  
Nontuberculous Mycobacteria ◽  
Mycobacterium Abscessus ◽  
Surgical Approaches ◽  
List Type ◽  
Persistent Symptoms ◽  
Increased Risk ◽  
Study Results

Medical treatment of pulmonary nontuberculous mycobacteria (NTM) disease has highly variable outcomes. Despite the use of multiple antibiotics, sputum clearance is often difficult to achieve, especially in cases with macrolide resistant NTM infection. Immunocompromised patients and those with structural lung disease are at increased risk, although occurrence in immunocompetent patients without structural lung disease is well recognised. Most pulmonary NTM disease involvesMycobacterium aviumcomplex (MAC), but with enhanced identification multiple species have now been recognised as opportunistic pathogens. The observed increase in NTM disease, especially infection with multidrug-resistantMycobacterium abscessuscomplex, is probably multifactorial. Surgery has been used as adjuvant treatment in patients with 1) focal disease that can be removed or 2) bothersome symptoms despite medical treatment that can be ameliorated. Early post-surgical mortality is low, but long-term morbidity and mortality are highly dependent on the degree of lung involvement and the residual lung function, the potency of medical treatment and the type of surgical intervention. In conjunction with antibiotic therapy, reported post-surgical sputum clearance was excellent, although publication bias should be considered. Bronchopleural fistulae were problematic, especially in pneumonectomy cases. Study results support the use of minimal resection surgery, in a carefully selected subgroup of patients with focal disease or persistent symptoms.Educational aimsTo critically review the literature describing the use of surgery in the treatment of pulmonary disease caused by nontuberculous mycobacteria (NTM).To assess the outcomes and complications observed with different surgical approaches used in the treatment of pulmonary NTM disease.

scholarly journals The Changing Pattern of Nontuberculous Mycobacterial Disease

2003 ◽  
Vol 14 (5) ◽  
pp. 281-286 ◽  
Author(s):  
Joseph O Falkinham
Keyword(s):  
Pulmonary Disease ◽  
Nontuberculous Mycobacteria ◽  
Mycobacterial Infection ◽  
Mycobacterium Abscessus ◽  
Mycobacterium Fortuitum ◽  
Older Individuals ◽  
Mycobacterial Disease ◽  
Cervical Lymphadenitis ◽  
Source Of Infection ◽  
Increased Risk

Nontuberculous mycobacteria are human opportunistic pathogens whose source of infection is the environment. These include both slow-growing (eg,Mycobacterium kansasii and Mycobacterium avium) and rapid-growing (eg,Mycobacterium abscessusandMycobacterium fortuitum) species. Transmission is through ingestion or inhalation of water, particulate matter or aerosols, or through trauma. The historic presentation of pulmonary disease in older individuals with predisposing lung conditions and in children has been changing. Pulmonary disease in elderly individuals who lack the classic predisposing lung conditions is increasing. Pulmonary disease and hypersensitivity pneumonitis have been linked with occupational or home exposures to nontuberculous mycobacteria. There has been a shift fromMycobacterium scrofulaceumtoM aviumin children with cervical lymphadenitis. Further, individuals who are immunosuppressed due to therapy or HIV-infection are at a greatly increased risk for nontuberculous mycobacterial infection. The changing pattern of nontuberculous mycobacterial disease is due in part to the ability of these pathogens to survive and proliferate in habitats that they share with humans, such as drinking water. The advent of an aging population and an increase in the proportion of immunosuppressed individuals suggest that the prevalence of nontuberculous mycobacterial disease will increase.

scholarly journals FRI0072 DISCONTINUATION OF DMARD USE IN RHEUMATOID ARTHRITIS PATIENTS WITH LUNG DISEASE

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 612.1-613
Author(s):  
S. Pedro ◽  
T. Mikuls ◽  
J. Zhuo ◽  
K. Michaud
Keyword(s):  
Rheumatoid Arthritis ◽  
Lung Disease ◽  
Pulmonary Disease ◽  
Treatment Patterns ◽  
Dmard Treatment ◽  
Increased Risk ◽  
Pulmonary Manifestations ◽  
Clinical Models ◽  
Comorbidity Index ◽  
Time Varying Covariates

Background:Pulmonary manifestations such as interstitial lung disease (ILD) and chronic obstructive pulmonary disease (COPD) are frequent extra-articular features that carry a poor prognosis in Rheumatoid Arthritis (RA). Little data is available on how RA patients (pts) with pulmonary disease are managed in real-world settings.Objectives:To assess treatment patterns and DMARD discontinuation in RA patients with comorbid lung disease in comparison with other RA patients.Methods:The study included RA Patients enrolled in the Forward Databank with ≥1 year observation after 2000 initiating a DMARD. Forward is a large longitudinal rheumatic disease registry in the US. RA patients’ diagnoses were rheumatologist-confirmed, and every 6 months participants completed comprehensive questionnaires regarding symptoms, disease outcomes, medications, and clinical events. Lung disease (LD+) was defined as at least one of the following: emphysema, asthma, bronchitis, COPD, pleural effusion, fibrosis of the lung, “RA lung”, or ILD, the later classified by ICD9 codes (England 2019). DMARDs were categorized hierarchically into four groups: csDMARDs, TNFi and NTNFi (bDMARDs), and tsDMARDs. Percentage of patients who initiated different DMARDs were reported for pts with LD+/LD-. Discontinuation was analyzed by Kaplan Meier (KM) curves, log-ranks tests, and Cox regression models using time-varying covariates. Best models were created using backward selection models (10% probability of removal) and pre-defined clinical models.Results:Of the 21,525 eligible RA patients, 13.8% had LD+ at the time they initiated a DMARD (follow-up: 69,597 pt-yrs (median 1.9 yrs/pt)). LD+ patients tended to have more severe RA outcomes and comorbidities. MTX-monotherapy (48% vs 44%, p<0.001) and NTNFi were initiated more frequently in LD+ pts with lower use of TNFi (Figure). DMARD discontinuation rates were higher among LD+ patients for all DMARD groups, but KM curves were only significantly different for csDMARDs and TNFi. Different HRs for LD+ were found depending on the model used ranging from 1.18 to 1.28, and all models revealed an increased risk of discontinuation for LD+ patients. Compared to csDMARDs, TNFi were more often discontinued (Table). Other variables associated with an increased risk of discontinuation included: HAQ, Rheumatoid Disease (RD) comorbidity index, pain, prior bDMARDs, and csDMARDs.Conclusion:Different DMARD treatment patterns were found for LD+ patients, who tended to initiate more csDMARD and NTNFi and less likely to initiate a TNFi. LD+ patients were at a higher risk of discontinuation irrespectively of the DMARD treatment, but with greater risk for TNF users.References:[1]England BR, et al. Arth Care Res. doi:10.1002/acr.24043.Figure.DMARD treatment initiators by disease groupTable .Cox models for DMARD discontinuation by stepwise (removal probability 10%) and clinical models including DMARD treatment.Model of DMARD persistence*Model 1- Stepwise-Without drugsModel 2 – StepwiseModel 3 - ClinicalLD+ vs LD–1.181.281.20(1.08 - 1.29)(1.13 - 1.45)(1.08 - 1.34)TNF vs csDmard1.321.22(1.08 - 1.63)(1.04 - 1.44)NTNF vs csDmard1.131.13(0.83 - 1.52)(0.90 - 1.41)tsDmard vs csDmard1.301.02(0.65 - 2.60)(0.64 - 1.62)*Best models searched/Clinical adjusted for LD+/LD-, DMARDs, age, sex, education, HAQ disability, RD comorbidity index, smoking, pain, glucocorticoids, year of entry, prior bDMARDs and csDMARDs counts and MRC breath scale.Disclosure of Interests:Sofia Pedro: None declared, Ted Mikuls Grant/research support from: Horizon Therapeutics, BMS, Consultant of: Pfizer, Joe Zhuo Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Kaleb Michaud: None declared

Nontuberculous Mycobacteria

2021 ◽  
Vol 42 (04) ◽  
pp. 567-586
Author(s):  
Shera Tan ◽  
Shannon Kasperbauer
Keyword(s):  
Risk Factor ◽  
Pulmonary Disease ◽  
Mycobacterium Avium ◽  
Mycobacterium Avium Complex ◽  
Nontuberculous Mycobacteria ◽  
Mycobacterium Abscessus ◽  
Pulmonary Infections ◽  
Human Pathogens ◽  
Common Manifestation

AbstractNontuberculous mycobacteria (NTM) are ubiquitous in the environment and 193 species of NTM have been discovered thus far. NTM species vary in virulence from benign environmental organisms to difficult-to-treat human pathogens. Pulmonary infections remain the most common manifestation of NTM disease in humans and bronchiectasis continues to be a major risk factor for NTM pulmonary disease (NTM PD). This article will provide a useful introduction and framework for clinicians involved in the management of bronchiectasis and NTM. It includes an overview of the epidemiology, pathogenesis, diagnosis, and management of NTM PD. We will address the challenges faced in the diagnosis of NTM PD and the importance of subspeciation in guiding treatment and follow-up, especially in Mycobacterium abscessus infections. The treatment of both Mycobacterium avium complex and M. abscessus, the two most common NTM species known to cause disease, will be discussed in detail. Elements of the recent ATS/ERS/ESCMID/IDSA NTM guidelines published in 2020 will also be reviewed.

scholarly journals Sequential Bilateral Lung Resection in a Patient with Mycobacterium Abscessus Lung Disease Refractory to Medical Treatment

2010 ◽  
Vol 51 (1) ◽  
pp. 141 ◽  
Author(s):  
Seung Heon Lee ◽  
Joo-Won Min ◽  
Sang-Won Um ◽  
Seon-Sook Han ◽  
Sung Koo Han ◽  
...  
Keyword(s):  
Medical Treatment ◽  
Lung Disease ◽  
Lung Resection ◽  
Mycobacterium Abscessus ◽  
Bilateral Lung

scholarly journals Toll-Like Receptor 2 Polymorphisms and Nontuberculous Mycobacterial Lung Diseases

2006 ◽  
Vol 13 (7) ◽  
pp. 818-819 ◽  
Author(s):  
Yon Ju Ryu ◽  
Eun Joo Kim ◽  
Won-Jung Koh ◽  
Hojoong Kim ◽  
O Jung Kwon ◽  
...  
Keyword(s):  
Lung Disease ◽  
Pulmonary Disease ◽  
Lung Diseases ◽  
Nontuberculous Mycobacteria ◽  
Host Susceptibility ◽  
Korean Population ◽  
Toll Like Receptor ◽  
Toll Like Receptor 2 ◽  
Ntm Lung Disease

ABSTRACT To investigate the occurrence of the Toll-like receptor 2 (TLR2) polymorphisms in patients with pulmonary disease caused by nontuberculous mycobacteria (NTM), TLR2 Arg677Trp and Arg753Gln polymorphisms were examined. TLR2 polymorphisms do not appear to be responsible for host susceptibility to NTM lung disease, at least in the Korean population.

scholarly journals Short Communication: Subtyping ofMycobacterium kansasiiby PCR-Restriction Enzyme Analysis of thehsp65Gene

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Zofia Bakuła ◽  
Aleksandra Safianowska ◽  
Magdalena Nowacka-Mazurek ◽  
Jacek Bielecki ◽  
Tomasz Jagielski
Keyword(s):  
Lung Disease ◽  
Pulmonary Disease ◽  
Restriction Enzyme ◽  
Short Communication ◽  
Nontuberculous Mycobacteria ◽  
Enzyme Analysis ◽  
Restriction Enzyme Analysis ◽  
Mycobacterium Kansasii ◽  
Clinical Specimens ◽  
Common Causes

Mycobacterium kansasiiis one of the most common causes of pulmonary disease resulting from nontuberculous mycobacteria (NTM). It is also the most frequently isolated NTM species from clinical specimens in Poland. The aim of this study was to investigate the distribution ofM. kansasiisubtypes among patients suspected of having pulmonary NTM disease. Fifty clinical isolates ofM. kansasiirecovered from as many patients with suspected mycobacterial lung disease between 2000 and 2010 in Poland were genotyped by PCR-restriction enzyme analysis (PCR-REA) of partialhsp65gene.Mycobacterium kansasiisubtype I was the only genotype to be identified among the isolates, both disease-associated and non-disease-associated. Isolation ofM. kansasiisubtype I from clinical specimens may be indicative of infection but may also merely represent colonization.

scholarly journals Recent advances in nontuberculous mycobacterial lung infections

F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 1710 ◽  
Author(s):  
David Horne ◽  
Shawn Skerrett
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Natural History ◽  
Lung Disease ◽  
Chronic Lung Disease ◽  
Nontuberculous Mycobacteria ◽  
Mycobacterium Leprae ◽  
Mycobacterium Abscessus ◽  
Recent Developments ◽  
Lung Infections ◽  
Ntm Lung Disease

Nontuberculous mycobacteria (NTM) are members of the Mycobacterium genus other than Mycobacterium tuberculosis complex and Mycobacterium leprae. NTM are widely distributed in the environment and are increasingly recognized as causes of chronic lung disease that can be challenging to treat. In this brief review, we consider recent developments in the ecology, epidemiology, natural history, and treatment of NTM lung disease with a focus on Mycobacterium avium complex (MAC) and Mycobacterium abscessus complex.

Occupational rhinitis and allergic conjunctivitis

2014 ◽  
Vol 155 (5) ◽  
pp. 170-175
Author(s):  
László Endre
Keyword(s):  
Medical Treatment ◽  
Allergic Conjunctivitis ◽  
Clinical Symptoms ◽  
Nasal Congestion ◽  
Clinical Signs ◽  
Airflow Limitation ◽  
High Concentration ◽  
Occupational Rhinitis ◽  
Persistent Symptoms ◽  
Increased Risk

Occupational rhinitis is an inflammatory disease of the nose, which is characterised by intermittent or persistent symptoms, arising from causes and conditions attributable to a particular work environment and not from stimuli encountered outside the workplace. Its clinical symptoms such as nasal congestion, sneezing, rhinorrhoea, itching, nasal airflow limitation are very similar to the symptoms of allergic rhinitis caused by other (classical) agents. Occupational allergic conjunctivitis is an IgE mediated disease, provoked by a substance in the air of the workplace. Its clinical signs (itching, tearing, conjunctival hyperaemia and oedema and, in some cases when the cornea is also involved, blurred vision, photosensitivity) are similar to other forms of allergic conjunctivitis. Risk factors (which in most of the cases occur in both diseases) include history of atopy, high concentration of the irritant agent and multiple irritant agents in the air of the workplace. Atopy has been associated with an increased risk of specific sensitisation to a variety of high molecular weight agents. For the diagnosis of occupational rhinitis and occupational allergic conjunctivitis objective investigations such as allergen specific provocations are necessary in addition to clinical and occupational history. Management of these occupational diseases needs environmental interventions (increasing ventilation, decreasing the time of exposure, substitution of the irritant agent). Medical treatment of occupational rhinitis is very similar to other allergic diseases: oral antihistamines, local (nasal) corticosteroids, combined (antihistamine plus membrane stabilizer) eyedrops. The most important step in medical treatment of occupational allergic conjunctivitis is the daily application of combined eyedrops (for example: olopatadine). Orv. Hetil., 2014, 155(5), 170–175.

scholarly journals General Overview of Nontuberculous Mycobacteria Opportunistic Pathogens: Mycobacterium avium and Mycobacterium abscessus

2020 ◽  
Vol 9 (8) ◽  
pp. 2541 ◽  
Author(s):  
Kimberly To ◽  
Ruoqiong Cao ◽  
Aram Yegiazaryan ◽  
James Owens ◽  
Vishwanath Venketaraman
Keyword(s):  
Pulmonary Disease ◽  
Mycobacterium Avium ◽  
Nontuberculous Mycobacteria ◽  
Clinical Manifestations ◽  
Developed Countries ◽  
Incidence Rates ◽  
Mycobacterium Abscessus ◽  
Human Pathogens ◽  
General Overview ◽  
Wide Range

Nontuberculous mycobacteria (NTM) are emerging human pathogens, causing a wide range of clinical diseases affecting individuals who are immunocompromised and who have underlying health conditions. NTM are ubiquitous in the environment, with certain species causing opportunistic infection in humans, including Mycobacterium avium and Mycobacterium abscessus. The incidence and prevalence of NTM infections are rising globally, especially in developed countries with declining incidence rates of M. tuberculosis infection. Mycobacterium avium, a slow-growing mycobacterium, is associated with Mycobacterium avium complex (MAC) infections that can cause chronic pulmonary disease, disseminated disease, as well as lymphadenitis. M. abscessus infections are considered one of the most antibiotic-resistant mycobacteria and are associated with pulmonary disease, especially cystic fibrosis, as well as contaminated traumatic skin wounds, postsurgical soft tissue infections, and healthcare-associated infections (HAI). Clinical manifestations of diseases depend on the interaction of the host’s immune response and the specific mycobacterial species. This review will give a general overview of the general characteristics, vulnerable populations most at risk, pathogenesis, treatment, and prevention for infections caused by Mycobacterium avium, in the context of MAC, and M. abscessus.

Therapeutic options in male osteoporosis

2013 ◽  
Vol 22 (04) ◽  
pp. 271-276 ◽  
Author(s):  
P. Farahmand ◽  
J. D. Ringe
Keyword(s):  
Risk Factors ◽  
Vitamin D ◽  
Public Health Problem ◽  
Male Osteoporosis ◽  
Individual Risk ◽  
Modes Of Action ◽  
Increased Risk ◽  
Study Results ◽  
Long Term Treatment ◽  
Male Patients

SummaryOsteoporosis in men is increasingly recognized as an important public health problem but affected patients are still under-diagnosed and -treated. As in women the diagnostic and therapeutic strategy has to be adapted to the individual case. In the practical management it is very important to detect possible causes of secondary osteoporosis, to explain the possibilities of basic therapy counteracting individual risk factors and communicate that osteoporosis is a chronic disease and adherence to a long-term treatment is crucial. In established severe osteoporosis a careful analgesic therapy is important to avoid further bone loss related to immobility. In elderly men with increased risk of falling insufficient Vitamin D supply or impaired activation of Vitamin D due to renal insufficiency must be taken into consideration. Specific medications available today for the treatment of male osteoporosis comprise among antiresorptive drugs the bis phosphonates alendronate, risedronate and zoledronic acid. Denosumab, the first biological therapy is approved for men with androgen deprivation therapy for prostate cancer. An important advantage of this potent antiresorptive drug is the increased adherence due to the comfortable application by sixmonthly subcutaneous injections. Study results from the 2-year multi-center randomized controlled ADAMO-Study will very soon allow the use of denosumab in all types of male osteoporosis. Teriparatide, the 34 N-terminal amino acid sequence of parathyroid hormone was approved for men with osteoporosis as an anabolic agent based on proven efficacy by different studies. Among drugs with other modes of action the D-hormone pro-drug alfacalcidol can be used in men alone or in combination with the advantage of pleiotropic effects on calcium absorption, parathyroids, bone and muscle. Recently also Strontium-ranelate was approved for male patients with the limitation to exclude men with clinical relevant cardiovascular risk factors. In general the possibilities to treat male osteoporosis have considerably improved during recent years. Today there is a choice of a spectrum of drugs from mild to strong potency with different modes of action on bone turnover to design strategies for individual male patients.

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