Case Report

Mycobacterium abscessus and Other Nontuberculous Mycobacteria: Evolving Respiratory Pathogens in Cystic Fibrosis: A Case Report and Review

Authors: Don Hayes, Jr, MD

Abstract

Cystic fibrosis (CF) is a risk factor for the development of nontuberculous mycobacteria (NTM) infection. Prevalence of these organisms varies from center to center with the predominance of affected patients being in the adult population. The difficulty in diagnosing NTM infection in CF involves the overlap between signs and symptoms of underlying CF lung disease with its variable pathogens and the signs and symptoms attributable to pulmonary disease caused by NTM. Bacterial overgrowth, especially with Pseudomonas aeruginosa, is problematic, leading to the difficulty in recovering mycobacteria from sputum. There is varying opinion whether the presence of NTM in pulmonary secretions of patients with CF indicates infection or colonization from an environmental organism. This report describes a 14-year-old asymptomatic female patient with CF with minimal bronchiectasis on high-resolution computed tomography scan of the chest who clinically deteriorated over the next 29 months after acquiring Mycobacterium abscessus to the point of being listed for lung transplantation. As more is discovered about NTM, the pathogenicity and virulence of these organisms should be considered in the setting of CF and treated.

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References

1. Davis PB, Drumm M, Konstan MW. State of the art: CF. Am J Resp Crit Care Med 1996;154:1229–1256.
 
2. Burns JL, Emerson J, Stapp JR, et al. Microbiology of sputum from patients at cystic fibrosis centers in the United States. Clin Infect Dis 1998;27:158–163.
 
3. Burns JL, Saiman L. Burkholderia cepacia infections in cystic fibrosis. Pediatr Infect Dis J1999;18:155–156.
 
4. Olivier KN, Yankaskas JR, Knowles MR. Nontuberculous mycobacterial pulmonary disease in cystic fibrosis. Semin Respir Infect 1996;11:272–284.
 
5. Falkinham JO. Epidemiology of infection by nontuberculous mycobacteria. Clin Micro Rev1996;9:177–215.
 
6. Kourbeti IS, Maslow MJ. Nontuberculous mycobacteria infections of the lung. Curr Infect Dis Rep2000;2:193–200.
 
7. Ebert DL, Olivier KN. Nontuberculous mycobacteria in the setting of cystic fibrosis. Clin Chest Med2002;23:655–663.
 
8. Hjelte L, Petrini B, Kallenius G, et al. Prospective study of mycobacterial infections in patients with CF. Thorax 1990;45:397–400.
 
9. Hjelt K, Hojlyng N, Howitz P, et al. The role of mycobacteria other than tuberculosis (MOTT) in patients with CF. Scand J Infect Dis 1994;26:569–576.
 
10. Hodson ME. Bacterial infection in CF: special reference to mycobacteria and Burkholderia cepacia. Pediatr Pulmonol Suppl 1995;11:66–67.
 
11. Fauroux B, Delaisi B, Clement A, et al. Mycobacterial lung disease in CF: a prospective study.Pediatr Infect Dis J 1997;16:354–358.
 
12. Olivier KN, Weber DJ, Wallace RJ Jr, et al. Nontuberculous mycobacteria, I: multicenter prevalence study in cystic fibrosis. Am J Respir Crit Care Med 2003;167:828–834.
 
13. Whittier S, Hopfer RL, Knowles MR, et al. Improved recovery of mycobacteria from respiratory secretions of patients with CF. J Clin Microbiol 1993;31:861–864.
 
14. Whittier S, Olivier K, Gilligan P, et al. Proficiency testing of clinical microbiology laboratories using modified decontamination procedures for detection of nontuberculous mycobacteria in sputum samples from CF patients. J Clin Microbiol 1997;35:2706–2708.
 
15. Bange FC, Kirschner P, Bottger EC. Recovery of mycobacteria from patients with CF. J Clin Microbiol 1999;37:3761–3762.
 
16. Official statement of the American Thoracic Society approved by the Board of Directors, Diagnosis and treatment of disease caused by nontuberculous mycobacteria. Am J Respir Crit Care Med1997;156:S1–25.
 
17. Griffith DE, Girard WM, Wallace RJ Jr. Clinical features of pulmonary disease caused by rapidly growing mycobacteria: an analysis of 154 patients. Am Rev Respir Dis 1993;147:1271–1278.
 
18. Peloquin CA. Serum concentrations of the antimycobacterial drugs. Chest 1998;113:1154–1155.
 
19. Wallace RJ, Brown BA, Griffith DE, et al. Initial clarithromycin monotherapy for Mycobacterium avium-intracellulare complex lung disease. Am J Respir Crit Care Med 1994;149:1335–1341.
 
20. Wallace RJ, Brown BA, Griffith DE, et al. Clarithromycin regimens for pulmonary Mycobacterium avium complex. Am J Respir Crit Care Med 1996;153:1762–1772.
 
21. Cullen AR, Cannon CL, Mark EJ, et al. Mycobacterium abscessus infection in CF. Am J Respir Crit Care Med 2000;161:641–645.
 
22. Colin AA. Eradication of Mycobacterium abscessus in a chronically infected patient with cystic fibrosis. Pediatr Pulmonol 2000;30:267–268.
 
23. Brown-Elliot BA, Wallace RJ Jr. Clarithromycin resistance in Mycobacterium abscessus. J Clin Microbiol 2001;39:2745–2746.
 
24. Tebas P, Sultan F, Wallace RJ Jr, et al. Rapid development of resistance to clarithromycin following monotherapy for disseminated Mycobacterium chelonae infection in a heart transplant patient. Clin Infect Dis 1995;20:443–444.
 
25. Wallace RJ Jr, Meier A, Brown BA, et al. Genetic basis for clarithromycin resistance among isolates of Mycobacterium chelonae and Mycobacterium abscessus. Antimicrob Agents Chemother1996;40:1676–1681.
 
26. Wallace RJ, Tanner D, Brennan PJ, et al. Clinical trial of clarithromycin for cutaneous (disseminated) infection due to Mycobacterium chelonae. Ann Intern Med 1993;119:482–486.
 
27. Wallace RJ Jr, Brown-Elliott BA, Ward SC, et al. Activities of Linezolid against rapidly growing mycobacteria. Antimicrob Agents Chemother 2001;45:764–767.
 
28. Brown-Elliott BA, Wallace RJ Jr, Blinkhorn R, et al. Successful treatment of disseminatedMycobacterium chelonae infection with linezolid. Clin Infect Dis 2001;33:1433–1434.
 
29. Malouf MA, Glanville AR. The spectrum of mycobacterial infection after lung transplantation. Am J Respir Crit Care Med 1999;160:1611–1616.
 
30. Sanguinetti M, Ardito F, Fiscarelli E, et al. Fatal pulmonary infection due to multidrug-resistantMycobacterium abscessus in a patient with cystic fibrosis. J Clin Microbiol 2001;39:816–819.
 
31. Fairhurst RM, Kubak BM, Shpiner RB, et al. Mycobacterium abscessus empyema in a lung transplant recipient. J Heart Lung Transplant 2002;21:391–394.