Diagnosis
What is a typical finding seen on pulmonary imaging that indicates an NTM infection?
cavities or nodules
Rapid growers may show culture positivity within how many days?
7
Slow growers may show culture positivity beyond how many days?
7
What is the definition of culture conversion?
at least three consecutive negative cultures
Ethambutol
ototoxicity, nephrotoxicity
What is the least amount of sputum cultures that should be positive in order to diagnose NTM pulmonary disease?
2
What is an example of a rapid NTM species?
Mycobacterium abscessus, Mycobacterium massiliense, Mycobacterium fortuitum, Mycobacterium chelonae
What is an example of a slow growing NTM species?
Mycobacterium avium complex (MAC), Mycobacterium kansasii, Mycobacterium xenopi
When does day 1 of therapy begin?
day of culture conversion
QTc
What histologic exam may diagnose NTM infection?
Acid fast bacilli smear
Which gene of M. abscessus is responsible for mutational resistance to macrolides?
rrl
Typical therapy may consist of how many antimicrobials?
3-4
How long should treatment of M. xenopi be continued for?
at least 2 months after culture conversion
Linezolid
CBC (cytopenia), peripheral neuropathy
Name a pulmonary symptom patients may present with if experiencing NTM disease.
cough, throat clerance without production
In which phase of therapy may you use only oral antimicrobials?
Continuation phase
In what settings would you consider the addition of amikacin against MAC?
cavitary or advanced/severe bronchiectatic or macrolide-resistant MAC pulmonary disease
Culture conversion is seen more often in patients who received treatment for at least how many months against MAC?
12
Amikacin
ototoxicity, nephrotoxicity
Name a systemic sign or symptom which may support diagnosis of NTM infection.
fever, malaise, fatigue
How many antibiotics should be used to treat M. abscessus pulmonary disease?
3-4
Which slow grower should you avoid treatment with an aminoglycoside?
M. Kansasii
Which subspecies of M. abscessus has been shown to have good clinical outcomes with shorter durations of therapy?
M. massiliense
Doxycycline
phototoxicity, tinnitus, vertigo