scholarly journals Understanding nontuberculous mycobacterial lung disease: it’s been a long time coming

F1000Research ◽  
2016 ◽  
Vol 5 ◽  
pp. 2797 ◽  
Author(s):  
David E. Griffith ◽  
Timothy R. Aksamit
Keyword(s):  
Lung Disease ◽  
Treatment Strategies ◽  
Resistance Mechanisms ◽  
Great Distance ◽  
Ionization Time ◽  
Nontuberculous Mycobacterial Lung Disease ◽  
Disease Therapy ◽  
Long Time ◽  
Slow Progress ◽  
Ntm Lung Disease

With a surprising predictability, most studies and reviews addressing therapy for nontuberculous mycobacterial (NTM) lung disease either start or end by mentioning the paucity of data from randomized and controlled trials. That is a legitimate criticism for NTM lung disease therapy, but it also somehow seems to influence attitudes toward all aspects of NTM investigation. Certainly the study of NTM diseases in general and NTM lung disease in particular is a recent development. Previously, NTM were viewed as minor, if inconvenient, pathogens similar toMycobacterium tuberculosis. However, over the last three decades, NTM have emerged as increasingly important pathogens that are clearly different compared with tuberculosis. Although there has been frustratingly slow progress in the treatment of NTM diseases, in contrast there has unquestionably been impressive progress in almost every other realm of investigation into NTM disease. Our understanding of NTM lung disease a) pathophysiology, including mechanisms of organism acquisition, b) epidemiology, including estimates of disease prevalence, c) mycobacteriology, including application of molecular laboratory techniques and matrix-assisted laser desorption ionization–time of flight (MALDI–TOF) mass spectrometry, and d) even treatment strategies, including the recognition of innate drug resistance mechanisms, has immeasurably and permanently changed and advanced the landscape for NTM lung disease. It is no longer necessary to apologize for the state of NTM lung disease knowledge and understanding, but rather it is time to recognize the great distance we have travelled over the last 30 years.

scholarly journals Changing epidemiology of nontuberculous mycobacterial lung disease over the last two decades in a region of the Basque country

2019 ◽  
Vol 5 (4) ◽  
pp. 00110-2018
Author(s):  
Sandra Pedrero ◽  
Eva Tabernero ◽  
Eunate Arana-Arri ◽  
Elena Urra ◽  
Maialen Larrea ◽  
...  
Keyword(s):  
Lung Disease ◽  
Basque Country ◽  
Incidence Rates ◽  
Incident Rate Ratio ◽  
Nontuberculous Mycobacterial Lung Disease ◽  
High Incidence ◽  
Trends Over Time ◽  
Incident Rate ◽  
Ntm Lung Disease ◽  
Annual Mortality

Recent studies suggest an increasing prevalence of nontuberculous mycobacteria (NTM) lung disease. The aim of the present study was to describe incidence rates of NTM lung disease and trends therein in our area over a 20-year period.This was a retrospective study of all cases of NTM lung disease between 1997 and 2016 that met the 2007 American Thoracic Society criteria. We analysed the annual incidence rates, species of mycobacteria isolated, trends over time and annual mortality in 327 patients.Mycobacterium kansasii was the most common mycobacterium isolated (84%), followed by Mycobacterium avium complex (MAC) (13%). We compared two periods: 1997–2006 (257 cases, 79%) and 2007–2016 (70 cases, 21%). The incidence rates tended to decrease across these years, with a peak of incidence in 2000 with 10.6 cases per 100 000. There was a clearly decreasing trend in M. kansasii infection, not only in the first period (incident rate ratio (IRR) 0.915, 95% CI 0.88–0.90; p<0.0001) but also in the second (IRR 0.869, 95% CI 0.780–1.014; p=0.080), reaching 1.8 per 100 000 in 2016. In contrast, MAC infection tended to increase across the two periods (IRR 1.251, 95% CI 1.081–1.447; p=0.003).In our region, the incidence of NTM lung disease has notably decreased in recent years. M. kansasii had high incidence rates in the first decade but clearly decreased in the second decade.

scholarly journals Nontuberculous Mycobacterial Lung Diseases Caused by Mixed Infection with Mycobacterium avium Complex and Mycobacterium abscessus Complex

2018 ◽  
Vol 62 (10) ◽  
Author(s):  
Sun Hye Shin ◽  
Byung Woo Jhun ◽  
Su-Young Kim ◽  
Junsu Choe ◽  
Kyeongman Jeon ◽  
...  
Keyword(s):  
Lung Disease ◽  
Treatment Outcomes ◽  
Mycobacterium Avium ◽  
Mixed Infection ◽  
Mycobacterium Abscessus ◽  
Limited Data ◽  
Content Type ◽  
Nontuberculous Mycobacterial Lung Disease ◽  
Conversion Rates ◽  
Ntm Lung Disease

ABSTRACT Mycobacterium avium complex (MAC) and M. abscessus complex (MABC) comprise the two most important human pathogen groups causing nontuberculous mycobacterial lung disease (NTM-LD). However, there are limited data regarding NTM-LD caused by mixed NTM infections. This study aimed to evaluate the clinical characteristics and treatment outcomes in patients with NTM-LD caused by mixed infection with these two major NTM pathogen groups. Seventy-one consecutive patients who had been diagnosed with NTM-LD caused by mixed infection with MAC (M. avium or M. intracellulare) and MABC (M. abscessus or M. massiliense) between January 2010 and December 2015 were identified. Nearly all patients (96%) had the nodular bronchiectatic form of NTM-LD. Mixed infection with MAC and M. massiliense (n = 47, 66%) was more common than mixed infection with MAC and M. abscessus (n = 24, 34%), and among the 43 (61%) patients who were treated for NTM-LD for more than 12 months, sputum culture conversion rates were significantly lower in patients infected with MAC and M. abscessus (25% [3/12]) than in patients infected with MAC and M. massiliense (61% [19/31, P = 0.033]). Additionally, M. massiliense and M. abscessus showed marked differences in clarithromycin susceptibility (90% versus 6%, P < 0.001). Of the 23 patients who successfully completed treatment, 11 (48%) redeveloped NTM lung disease, with mycobacterial genotyping results indicating that the majority of cases were due to reinfection. Precise identification of etiologic NTM organisms could help predict treatment outcomes in patients with NTM-LD due to mixed infections.

scholarly journals Inhaled Antibiotics for Mycobacterial Lung Disease

Pharmaceutics ◽  
2019 ◽  
Vol 11 (7) ◽  
pp. 352 ◽  
Author(s):  
Banaschewski ◽  
Hofmann
Keyword(s):  
Lung Disease ◽  
Lung Diseases ◽  
Treatment Strategies ◽  
Health Concern ◽  
Development Programs ◽  
Ongoing Research ◽  
Nontuberculous Mycobacterial Lung Disease ◽  
Inhaled Antibiotics ◽  
Clinical Diagnoses ◽  
Causative Agents

Mycobacterial lung diseases are an increasing global health concern. Tuberculosis and nontuberculous mycobacteria differ in disease severity, epidemiology, and treatment strategies, but there are also a number of similarities. Pathophysiology and disease progression appear to be relatively similar between these two clinical diagnoses, and as a result these difficult to treat pulmonary infections often require similarly extensive treatment durations of multiple systemic drugs. In an effort to improve treatment outcomes for all mycobacterial lung diseases, a significant body of research has investigated the use of inhaled antibiotics. This review discusses previous research into inhaled development programs, as well as ongoing research of inhaled therapies for both nontuberculous mycobacterial lung disease, and tuberculosis. Due to the similarities between the causative agents, this review will also discuss the potential cross-fertilization of development programs between these similar-yet-different diseases. Finally, we will discuss some of the perceived difficulties in developing a clinically utilized inhaled antibiotic for mycobacterial diseases, and potential arguments in favor of the approach.

Clinical Investigation of Nontuberculous Mycobacterial Lung Disease in Japanese Patients with Rheumatoid Arthritis Receiving Biologic Therapy

2013 ◽  
Vol 40 (12) ◽  
pp. 1994-2000 ◽  
Author(s):  
Hideaki Yamakawa ◽  
Noboru Takayanagi ◽  
Takashi Ishiguro ◽  
Tetsu Kanauchi ◽  
Toshiko Hoshi ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Lung Disease ◽  
Biologic Therapy ◽  
Clinical Investigation ◽  
Japanese Patients ◽  
Radiological Outcome ◽  
Disease Extent ◽  
Nontuberculous Mycobacterial Lung Disease ◽  
High Erythrocyte Sedimentation Rate ◽  
Ntm Lung Disease

Objective.To review patients with rheumatoid arthritis (RA) receiving biologic therapy following a diagnosis of nontuberculous mycobacterial (NTM) lung disease and to evaluate disease deterioration according to clinical and radiological features and anti-NTM therapy.Methods.We retrospectively analyzed medical records of 11 human immunodeficiency virus-negative patients with RA (median age, 64 years) receiving biologic therapy following diagnosis of NTM lung disease.Results.NTM species included Mycobacterium avium complex in 9 patients (81.8%) and M. gordonae in 2 (18.2%). Underlying respiratory disease was present in 6 patients (54.5%), and most (81.8%) had radiographic features of nodular/bronchiectatic disease. Extent of NTM disease was 1–2 pulmonary lobes in 6 patients (54.5%), 3–4 lobes in 5 patients (45.5%), and 5–6 lobes in none. The results of radiological evaluations were unchanged or improved in 7 patients (63.6%) and worsened in 4 (36.4%). Radiological outcome was worse in patients with poor RA control despite their receiving biologic therapies for RA. Two of 3 patients receiving anti-NTM therapy as initial management for NTM improved, and 1 worsened. Three of 4 patients with worsened radiological outcome had high erythrocyte sedimentation rate (> 50 mm/h).Conclusion.Radiological deterioration was not observed in the majority of patients with RA receiving biologic therapy with NTM lung disease, and radiological outcome of pulmonary NTM was favorable in some patients undergoing anti-NTM therapy. Further studies focusing on disease deterioration according to biologic therapy received during NTM followup are warranted to determine appropriate treatment of RA patients with NTM lung disease.

Development of Peptides that Inhibit Aminoglycoside-Modifying Enzymes and β-Lactamases for Control of Resistant Bacteria

2020 ◽  
Vol 21 (10) ◽  
pp. 1011-1026
Author(s):  
Bruna O. Costa ◽  
Marlon H. Cardoso ◽  
Octávio L. Franco
Keyword(s):  
Drug Target ◽  
Bacterial Infections ◽  
Antimicrobial Agents ◽  
Treatment Strategies ◽  
Resistance Mechanisms ◽  
Resistant Bacteria ◽  
Specific Chemical ◽  
Target Interaction ◽  
Multiresistant Bacteria ◽  
Acute Bacterial Infections

: Aminoglycosides and β-lactams are the most commonly used antimicrobial agents in clinical practice. This occurs because they are capable of acting in the treatment of acute bacterial infections. However, the effectiveness of antibiotics has been constantly threatened due to bacterial pathogens producing resistance enzymes. Among them, the aminoglycoside-modifying enzymes (AMEs) and β-lactamase enzymes are the most frequently reported resistance mechanisms. AMEs can inactivate aminoglycosides by adding specific chemical molecules in the compound, whereas β-lactamases hydrolyze the β-lactams ring, preventing drug-target interaction. Thus, these enzymes provide a scenario of multidrug-resistance and a significant threat to public health at a global level. In response to this challenge, in recent decades, several studies have focused on the development of inhibitors that can restore aminoglycosides and β-lactams activity. In this context, peptides appear as a promising approach in the field of inhibitors for future antibacterial therapies, as multiresistant bacteria may be susceptible to these molecules. Therefore, this review focused on the most recent findings related to peptide-based inhibitors that act on AMEs and β-lactamases, and how these molecules could be used for future treatment strategies.

A Review of the Therapeutic Benefits of Moringa oleifera in Controlling High Blood Pressure (Hypertension)

2019 ◽  
Vol 5 (3) ◽  
pp. 232-245
Author(s):  
Chuku Okorie ◽  
Kola Ajibesin ◽  
Adekunle Sanyaolu ◽  
Adeena Islam ◽  
Selciya Lamech ◽  
...  
Keyword(s):  
Blood Pressure ◽  
High Blood Pressure ◽  
Moringa Oleifera ◽  
Kidney Diseases ◽  
Treatment Strategies ◽  
Secondary Hypertension ◽  
Therapeutic Benefits ◽  
Northern Regions ◽  
Long Time ◽  
Life Threatening

Moringa oleifera (M. oleifera) is an angiosperm plant that is a member of the Moringaceae family. It is a natural plant that is native to the sub-Himalayan northern regions of India, Bangladesh, Pakistan, and Afghanistan. The plant grows abundantly throughout tropical and subtropical areas of the world. For several centuries, many cultures have utilized various parts of the moringa plant as traditional medicine to treat common illnesses and control life-threatening conditions such as hypertension (HTN), diabetes, hyperlipidemia, inflammation, etc. This article reviewed the current literature on the therapeutic benefits of M. oleifera on hypertension, primarily focusing on identifying the plant’s key components and its roles in hindering the common pathophysiological pathways associated with hypertension. The number of people living with HTN has been predicted to increase to 1.56 billion worldwide by 2025 in spite of the myriads of preventive and treatment strategies available today. Therefore, it would be of great value to explore alternative complementary ways of controlling high blood pressure. HTN is commonly defined as blood pressure equal to or higher than 140/90 mm Hg. HTN itself is not a disease condition and does not elicit specific symptoms, however, if left untreated for a long time, it can lead to complicated cardiovascular diseases such as angina, congestive heart failure, myocardial infarction as well as stroke and chronic kidney diseases. Primary hypertension is diagnosed when there is no known identifiable underlying cause for the onset of the condition. Secondary hypertension is diagnosed when there is evidence of a disease or disorder triggering the onset of the condition. It is apparent that understanding the role of M. oleifera in the management of hypertension would expand the valuable strategies for the control of this condition.

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