Treatment
a) Medical
–
When
mycobacterium identified, treatment geared towards MTB for therapeutic
and public health reasons, especially for children with lung disease.
–
NTM grow slowly, thus treatment directed at MTB rather than NTM won't
have a negative outcome on the NTM infection.
–
Guidelines for mgmt of NTM based on retrospective adult data.
Therapeutic results for MAI pulmonary disease are poor, based on failure
rates of 25-65%. Combination therapy included 4-6 drugs before clarithromycin.
Relapse in as many as 25% of those who initially cleared the organism
(Krause et al, Peds Infect. J, 1996)
–
Four drug regimen (isoniazid, rifampin, ethambutol, Clarithromycin) initially
to cover both MTB and NTM
–
Once NTM identified, multiple drug therapy for 6-12 months
–
No role for single agent therapy because of increased risk of resistance
–
Multiple drug therapy for > 12 months: Rifabutin, clarithromycin, ethambutol,
amikacin.
b)
Surgical
–
No
guidelines regarding need for surgery. Role for surgery in localized disease
or endobronchial compression.
–
One reported case of medical therapy and laser bronchoscopy without surgery
with good outcome.
Adjunct
investigations and therapy
–
Full immunological workup including HIV required in those with atypical
mycobacterium
–
?
Genetic defect in TNFa, and IL12 implicated
–
? Role for gamma INF in children (used successfully in adults with HIV)
–
? Use of GM-CSF, G-CSF in disseminated disease, not known in children
Prognosis
and Outcome
–
in insolated pulmonary disease, reported mortality is 20% however the
immune status is not known (Alan et al Pediatr infect Dis J 1992).
–
Generally good without underlying immunodeficiency
–
Variable follow-up and treatment from case reports
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