Posts filed under ‘Micobacterias’

Treatment of Nontuberculous Mycobacterial Pulmonary Disease: An Official ATS/ERS/ESCMID/IDSA Clinical Practice Guideline: Executive Summary

Clinical Infectious Diseases July 6, 2020

Treatment of Nontuberculous Mycobacterial Pulmonary Disease: An Official ATS/ERS/ESCMID/IDSA Clinical Practice Guideline: Executive Summary

Nontuberculous mycobacteria (NTM) represent over 190 species and subspecies, some of which can produce disease in humans of all ages and can affect both pulmonary and extrapulmonary sites.

This guideline focuses on pulmonary disease in adults (without cystic fibrosis or human immunodeficiency virus infection) caused by the most common NTM pathogens such as Mycobacterium avium complex, Mycobacterium kansasii, and Mycobacterium xenopi among the slowly growing NTM and Mycobacterium abscessus among the rapidly growing NTM.

A panel of experts was carefully selected by leading international respiratory medicine and infectious diseases societies (ATS, ERS, ESCMID, IDSA) and included specialists in pulmonary medicine, infectious diseases and clinical microbiology, laboratory medicine, and patient advocacy.

Systematic reviews were conducted around each of 22 PICO (Population, Intervention, Comparator, Outcome) questions and the recommendations were formulated, written, and graded using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach.

Thirty-one evidence-based recommendations about treatment of NTM pulmonary disease are provided.

This guideline is intended for use by healthcare professionals who care for patients with NTM pulmonary disease, including specialists in infectious diseases and pulmonary diseases.



July 15, 2020 at 9:48 am

Magnetic Resonance Imaging in Differentatial Diagnosis of Pyogenic Spondylodiscitis and Tuberculous Spondylodiscitis

Pol J Radiol. February 2017 V.82 P.71-87.


La espondilodiscitis infecciosa se caracteriza por la participación de dos vértebras adyacentes y el disco intermedio.

La tasa de incidencia de la enfermedad se estima en 0.4-2 casos por 100000 por año.

Staphylococcus aureus es el agente infeccioso más común que causa espondilodiscitis piógena.

Las infecciones no piógenas de la columna vertebral son causadas con mayor frecuencia por Mycobacterium tuberculosis y hongos.

Los síntomas clínicos son inespecíficos.

El diagnóstico temprano y el tratamiento adecuado pueden evitar secuelas irreversibles desfavorables para el paciente.

Los desarrollos significativos en las técnicas de imagen de tejidos patológicos aumentaron las expectativas entre los médicos con respecto a la posibilidad de distinguir entre la espondilodiscitis tuberculosa y la espondilodiscitis piógena en las imágenes de RM.

El objetivo de este estudio fue identificar y diferenciar las características de la espondilodiscitis tuberculosa y piógena en las imágenes de RM.


Realizamos un análisis retrospectivo de imágenes de RM obtenidas de 34 pacientes con espondilodiscitis confirmada (18 con espondilodiscitis piógena y 16 con espondilodiscitis tuberculosa). La adquisición de datos se realizó utilizando escáneres de resonancia magnética de 1,5 T, donde se obtuvieron imágenes utilizando protocolos similares. T2 TIRM y las imágenes ponderadas en T1 con y sin realce de contraste fueron sujetas a evaluación en planos coronal, axial y sagital.


Las características de la espondilodiscitis piógena incluyen: afectación de la columna lumbar, aumento del contraste anormal paraespinal mal definido, aumento del contraste difuso / homogéneo de los cuerpos vertebrales, destrucción de grado bajo de los cuerpos vertebrales, señal hiperintensa / homogénea de los cuerpos vertebrales en las imágenes T2 TIRM . Las características predominantes de la espondilodiscitis tuberculosa incluyeron: afectación de la columna torácica, afectación de 2 o más cuerpos vertebrales adyacentes, destrucción severa del cuerpo vertebral, realce de contraste focal / heterogéneo de los cuerpos vertebrales, señal heterogénea de los cuerpos vertebrales en imágenes T2 TIRM, bien Mejora de contraste anormal paraespinal -definido, abscesos paraespinales y epidurales, realce meníngeo a nivel de la columna afectada.


La comparación de imágenes de RM de pacientes diagnosticados con espondilodiscitis piógena y espondilodiscitis tuberculosa permitió la identificación de características individuales para la diferenciación preliminar entre TB y espondilodiscitis infecciosa y, por lo tanto, permitió un tratamiento adecuado.


July 12, 2020 at 1:39 pm

Omadacycline as a promising new agent for the treatment of infections with Mycobacterium abscessus.

Omadacycline: A Potential New Treatment for Mycobacterium abscessus


J Antimicrob Chemother. October 1, 2019 V.74 N.10 P.2930-2933.

Bax HI1,2, de Vogel CP2, Mouton JW2, de Steenwinkel JEM2.

Author information

1 Department of Internal Medicine, Division of Infectious Diseases, Erasmus University Medical Centre, Rotterdam, The Netherlands.

2 Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre, Rotterdam, The Netherlands.



Despite intensive treatment regimens, the outcome of Mycobacterium abscessus infections is extremely poor and thus novel treatment regimens are needed. Although tigecycline seems to be one of the best options currently available, its long-term use is hampered by severe toxic side effects as well as the need for intravenous administration and the relatively high concentrations required for efficacy.


To assess the in vitro activity of omadacycline against M. abscessus and compare it with the activity of tigecycline.


The concentration- and time-dependent killing capacities of omadacycline and tigecycline against M. abscessus subspecies abscessus were determined using a time-kill kinetics assay. Time-kill curves as well as concentration-effect curves were generated.


Time-kill curves showed strong concentration-dependent antimicrobial activity for both omadacycline and tigecycline. Omadacycline showed inhibition of mycobacterial growth at 4 mg/L and mycobacterial killing at concentrations ≥16 mg/L. Tigecycline showed mycobacterial killing at concentrations ≥4 mg/L, achieving elimination at concentrations ≥16 mg/L. The concentration-effect curves after 7 days of exposure showed stasis, 1 log mycobacterial killing and 2 log mycobacterial killing at 3.3, 4.0 and 4.8 mg/L for omadacycline and 2.2, 2.7 and 3.4 mg/L for tigecycline, respectively.


The results of this in vitro study on omadacycline activity, together with its favourable (pharmacokinetic) properties, suggest that omadacycline is a potential new agent for the treatment of M. abscessus infections



November 18, 2019 at 7:07 pm

Mycobacterium tuberculosis prosthetic joint infections: A case series and literature review

Journal of Infection January 2019 V.78 N.1 P.27–34

Fabrice Uhel, Gregory Corvaisier, Yves Poinsignon, Catherine Chirouze, Guillaume Beraud, Olivier Grossi, Nicolas Varache, Cédric Arvieux, Rozenn Le Berre, Pierre Tattevin, for the Groupe d’Epidémiologie et Recherche en Infectiologie Clinique Centre-Ouest (GERICCO)


We aimed to characterize diagnosis, management, and outcome of Mycobacterium tuberculosis prosthetic joint infections (PJI).


Cases of M. tuberculosis PJI documented in 7 referral French centers were retrospectively reviewed. Data were collected from medical files on a standardized questionnaire. We performed a literature review using the keywords ‘prosthetic joint’, and ‘tuberculosis’.


During years 1997–2016, 13 patients (8 males, 5 females, median age 79 years [range, 60–86]) had documented M. tuberculosis PJI, involving hip (n = 6), knee (n = 6), or shoulder (n = 1). Median time from arthroplasty to diagnosis was 9 years [0.4–20]. The diagnosis was obtained on joint aspirates (n = 9), or synovial tissue (n = 4). PCR was positive in all cases tested (5/5). Median duration of antituberculosis treatment was 14 months [6–32]). Nine patients underwent surgery: debridement (n = 4), resection arthroplasty (n = 3), and revision arthroplasty (1-stage exchange, n = 2). PJI was controlled in 12 patients. Seventeen additional cases of documented M. tuberculosis PJI have been reported, with a favorable outcome in 79% (11/14) of patients with no surgery, 85% (11/13) with debridement, 86% (19/22) with revision arthroplasty, and 81% (17/21) with resection (NS).


  1. tuberculosis PJI can be controlled with prolonged antituberculosis treatment in most cases, with or without surgical treatment.



January 12, 2019 at 10:01 am

Outbreak of Tattoo-Associated Nontuberculous Mycobacterial Skin Infections.

Clinical Infectious Diseases

Isabel Griffin, MPH  Ann Schmitz, DVM  Christine Oliver  Scott Pritchard, MPH Guoyan Zhang, MD, MPH  Edhelene Rico, MPH  Emily Davenport  Anthoni Llau, PhD Emily Moore, MPH  Danielle Fernandez, MPH 


On April 29, 2015, the Florida Department of Health in Miami-Dade County (DOH-Miami-Dade) was notified by a local dermatologist of three patients with suspect nontuberculous mycobacterial (NTM) infection after receiving tattoos at a local tattoo studio.


DOH-Miami-Dade conducted interviews and offered testing, described below, to tattoo studio clients reporting rashes. Culture of clinical isolates and identification were performed at the Florida Bureau of Public Health Laboratories (BPHL). Characterization of NTM was performed by the Centers for Disease Control and Prevention (CDC) and the United States Food and Drug Administration (FDA), respectively. Whole-genome sequencing (WGS) and single-nucleotide polymorphism (SNP) analyses were used to construct a phylogeny among 21 Mycobacterium isolates at FDA.


Thirty-eight of 226 interviewed clients were identified as outbreak-associated cases. Multivariate logistic regression revealed individuals who reported grey tattoo ink in their tattoos were 8.2 times as likely to report a rash [95% CI: 3.07—22.13]. Multiple NTM species were identified in clinical and environmental specimens. Phylogenetic results from environmental samples and skin biopsies indicated that two M. fortuitum isolates (greywash ink and a skin biopsy) and 11 M. abscessus isolates (five from the implicated bottle of greywash tattoo ink, two from tap water, and four from skin biopsies) were indistinguishable. In addition, M. chelonae was isolated from five unopened bottles of greywash ink provided by two other tattoo studios in Miami-Dade County.


WGS and SNP analyses identified the tap water and the bottle of greywash tattoo ink as the sources of the NTM infections.



November 28, 2018 at 8:19 am

Infections in patients affected by rheumatologic diseases associated to glucocorticoid use or tumor necrosis factor-alpha inhibitors.

Rev Chilena Infectol. April 2014 V.31 N.2 P.181-95.

[Article in Spanish]

Fica A.


A great diversity of infectious agents can affect patients that use steroids at immunosuppressive doses or tumor necrosis factor alpha (TNF-alpha) antagonists.

The list of participating microorganisms is more restricted in the case of anti TNF-alpha blockers.

Overlapping agents include intracellular bacteria, Mycobacterium tuberculosis, geographic fungal agents that have the ability to establish granulamotous infections, herpes zoster, and reactivation of chronic hepatitis B virus infection.

An important conceptual issue for these infections is the existence of a threshold prednisone daily dose for the emergence of opportunistic infections but higher levels of immunosuppression and cofactors are required in the case of Pneumocystis jiroveci and cytomegalovirus infections.

In order to prevent these threats, a detailed medical evaluation is needed before prescription to detect potential risks and manage them properly.

Prevention rules must be prescribed in every case, that include common sense behaviors, vaccines, and in selected cases, chemoprophylaxis for latent tuberculosis (TB) infection, P. jiroveci pneumonia (PCP) or other specific requirements.

Latent TB infection is probable and requires chemoprophylaxis in the case of remote or recent exposure to a patient with lung TB, a positive tuberculin or interferon-gamma release assay result or residual lung scars in a chest x-ray exam.

PCP prevention is suggested when the patient reaches a daily dose of prednisone of 30 mg but might be needed at lower doses in case of other concomitant immunosuppressive drugs or when lymphopenia arises shortly after prednisone initiation.



November 19, 2018 at 11:12 am

A patient-level pooled analysis of treatment-shortening regimens for drug-susceptible pulmonary tuberculosis

Nature Medicine November 5, 2018

Marjorie Z. Imperial, Payam Nahid, Patrick P. J. Phillips, Geraint R. Davies, Katherine Fielding, Debra Hanna, David Hermann, Robert S. Wallis, John L. Johnson, Christian Lienhardt & Rada M. Savic

Tuberculosis kills more people than any other infectious disease. Three pivotal trials testing 4-month regimens failed to meet non-inferiority margins; however, approximately four-fifths of participants were cured.

Through a pooled analysis of patient-level data with external validation, we identify populations eligible for 4-month treatment, define phenotypes that are hard to treat and evaluate the impact of adherence and dosing strategy on outcomes.

In 3,405 participants included in analyses, baseline smear grade of 3+ relative to <2+, HIV seropositivity and adherence of ≤90% were significant risk factors for unfavorable outcome.

Four-month regimens were non-inferior in participants with minimal disease defined by <2+ sputum smear grade or non-cavitary disease. A hard-to-treat phenotype, defined by high smear grades and cavitation, may require durations >6 months to cure all.

Regimen duration can be selected in order to improve outcomes, providing a stratified medicine approach as an alternative to the ‘one-size-fits-all’ treatment currently used worldwide…



November 14, 2018 at 8:31 am

Ecological Analyses of Mycobacteria in Showerhead Biofilms and Their Relevance to Human Health

mBio 2018 September/October 2018 V.9 N.5 P.e01614-18

Matthew J. Gebert, Manuel Delgado-Baquerizo, Angela M. Oliverio, Tara M. Webster, Lauren M. Nichols, Jennifer R. Honda, Edward D. Chan, Jennifer Adjemian, Robert R. Dunn, Noah Fierer

Bacteria within the genus Mycobacterium can be abundant in showerheads, and the inhalation of aerosolized mycobacteria while showering has been implicated as a mode of transmission in nontuberculous mycobacterial (NTM) lung infections.

Despite their importance, the diversity, distributions, and environmental predictors of showerhead-associated mycobacteria remain largely unresolved.

To address these knowledge gaps, we worked with citizen scientists to collect showerhead biofilm samples and associated water chemistry data from 656 households located across the United States and Europe.

Our cultivation-independent analyses revealed that the genus Mycobacterium was consistently the most abundant genus of bacteria detected in residential showerheads, and yet mycobacterial diversity and abundances were highly variable.

Mycobacteria were far more abundant, on average, in showerheads receiving municipal water than in those receiving well water and in U.S. households than in European households, patterns that are likely driven by differences in the use of chlorine disinfectants.

Moreover, we found that water source, water chemistry, and household location also influenced the prevalence of specific mycobacterial lineages detected in showerheads.

We identified geographic regions within the United States where showerheads have particularly high abundances of potentially pathogenic lineages of mycobacteria, and these “hot spots” generally overlapped those regions where NTM lung disease is most prevalent. Together, these results emphasize the public health relevance of mycobacteria in showerhead biofilms.

They further demonstrate that mycobacterial distributions in showerhead biofilms are often predictable from household location and water chemistry, knowledge that advances our understanding of NTM transmission dynamics and the development of strategies to reduce exposures to these emerging pathogens.



November 9, 2018 at 8:14 am

A Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2018 Update by the Infectious Diseases Society of America and the American Society for Microbiology

Clinical Infectious Diseases September 15, 2018 V.67 N.6 P.813–816


J Michael Miller; Matthew J Binnicker; Sheldon Campbell; Karen C Carroll; Kimberle C Chapin …

The critical nature of the microbiology laboratory in infectious disease diagnosis calls for a close, positive working relationship between the physician/advanced practice provider and the microbiologists who provide enormous value to the healthcare team.

This document, developed by experts in laboratory and adult and pediatric clinical medicine, provides information on which tests are valuable and in which contexts, and on tests that add little or no value for diagnostic decisions.

This document presents a system-based approach rather than specimen-based approach, and includes bloodstream and cardiovascular system infections, central nervous system infections, ocular infections, soft tissue infections of the head and neck, upper and lower respiratory infections, infections of the gastrointestinal tract, intra-abdominal infections, bone and joint infections, urinary tract infections, genital infections, and other skin and soft tissue infections; or into etiologic agent groups, including arthropod-borne infections, viral syndromes, and blood and tissue parasite infections.

Each section contains introductory concepts, a summary of key points, and detailed tables that list suspected agents; the most reliable tests to order; the samples (and volumes) to collect in order of preference; specimen transport devices, procedures, times, and temperatures; and detailed notes on specific issues regarding the test methods, such as when tests are likely to require a specialized laboratory or have prolonged turnaround times.

In addition, the pediatric needs of specimen management are also emphasized. There is intentional redundancy among the tables and sections, as many agents and assay choices overlap.

The document is intended to serve as a guidance for physicians in choosing tests that will aid them to quickly and accurately diagnose infectious diseases in their patients.



September 2, 2018 at 10:40 am

Pulmonary Infections with Nontuberculous Mycobacteria, Catalonia, Spain, 1994–2014

Emerging Infectious Diseases June 2018 V.24 N.6

Santin et al.

Bellvitge University Hospital-IDIBELL, L’Hospitalet de Llobregat, Spain (M. Santin, P. Malchair, L. Gonzalez-Luquero, M.D. Grijota-Camino, J. Dorca, F. Alcaide); University of Barcelona, Barcelona, Spain (M. Santin, J. Dorca, F. Alcaide); Agency of Public Health of Catalonia, Barcelona (I. Barrabeig); Consorci del Laboratory Intercomarcal de l’Alt Penedès, l’Anoia i el Garraf, Vilafranca del Penedès, Spain (M.A. Benitez); Hospital Moisés Broggi, Sant Joan Despí, Spain (J. Sabria, C. Cañete); Hospital de Viladecans, Viladecans, Spain (M. Palau-Benavent, J.A. Lloret-Queraltó)

In Spain, systematic reporting of pulmonary infections with nontuberculous mycobacteria is not mandatory. Therefore, to determine trends, we retrospectively identified cases for January 1994–December 2014 in Catalonia. Over the 21 years, prevalence increased and was associated with being male. Mycobacterium avium complex and M. abscessus prevalence increased; M. kansasii prevalence decreased.

En España, la notificación sistemática de infecciones pulmonares por micobacterias no tuberculosas no es obligatoria. Por lo tanto, para determinar las tendencias, identificamos casos de enero de 1994 a diciembre de 2014 de forma retrospectiva en Cataluña. Durante los 21 años, la prevalencia aumentó y se asoció con ser hombre. El complejo Mycobacterium avium y la prevalencia de M. abscessus aumentaron; La prevalencia de M. kansasii disminuyó.



May 22, 2018 at 7:40 am

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