Rapidly growing nontuberculous mycobacteria (RGM) can produce numerous types of infections including cutaneous disease, lymphadenitis, disseminated disease and pulmonary infection. The management of pulmonary infection due to RGM has proved unusually difficult to treat because the organism is invariably resistant to traditional antituberculous drugs and has varying susceptibility to other antibiotics. We evaluated the clinical manifestations, treatment, and therapeutic outcomes of RGM pulmonary infection.SUBJECTS AND METHOD: Fifty-four cases with RGM from respiratory specimens were identified between 1996 and 2002 in Asan medical center. Medical records and radiographic findings were retrospectively reviewed in 20 patients who fulfilled the diagnostic criteria of nontuberculous mycobacteria (NTM) pulmonary disease by ATS guideline. Clinical, laboratory, and radiologic parameters were compared between subgroups.
Of the 20 patients, 15 were female. The mean age was 57.7 yrs (± 7.5). All of the patients had a history of pulmonary tuberculosis. Most of them (90%) had underlying lung diseases. The majority of isolates (65%) were M abscessus. Chest radiography showed bilateral involvement in 80% of patients. Bronchiectasis and multiple nodules were predominant findings. Cavitation was present in 35% of the patients. Even though seventy percent of the patients received antituberculous drugs before correct diagnosis, eventually all of the patients received antibiotics. Mean 3.5 antibiotics were given for an average of 439 days (± 168). After completion of treatment, nine patients showed improvement for a mean 591 (± 311) days of treatment, whereas the antibiotic treatment was unsuccessful in 2 patients.
RGM pulmonary infection developed predominantly in female, nonsmokers, and in patients with preexisting pulmonary diseases including tuberculosis. Most of the patients treated for prolonged period than M tuberculosis infection because of inappropriate and delayed diagnosis. For RGM pulmonary infection, speciesidentification and antimycobacterial susceptibility tests based on species were needed for the optimum management of the patients as soon as possible.
E. Kim, None.