Respiratory Care |

Infected Lung Bullae With an Acid-Fast Organism FREE TO VIEW

Pragnesh Patel, MD
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East Tennessee State University, Jonesborough, TN

Chest. 2014;146(4_MeetingAbstracts):909A. doi:10.1378/chest.1979867
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SESSION TITLE: Respiratory Infections Posters I

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Mycobacterium kansasii, is the second most common respiratory Non-TB Mycobacterial isolate which is associated with pulmonary disease that is indistinguishable from Tuberculosis infection in immunocompetent persons. Symptomatic illness, clinical and radiologic evidence of infection have been found regardless of immune status.

METHODS: 83 year old male with history of O2 dependent moderately severe restrictive airway disease who presented to the emergency department due to increased morning productive cough with yellow sputum production, weight loss of around 20lbs in past month. No history of occupational, environmental or chemical exposure. Objectively, decreased air entry on both lower lungs was noted. Initial evaluation revealed hypoxia on 4 liter of oxygen via nasal cannula. Plain radiograph was evident for cavitory lesion in the both posterior basal segments with air-fluid levels. Contrast CT chest confirmed above findings as possibility of infected bullae. Broad spectrum antibiotic coverage was initiated. Pertinent microbiology studies inludes three sputum samples were positive for Acid fast bacilli; thus Anti-TB treatment with four drug regimen was started. PPD and sputum PCR for TB was negative, so Anti-TB treatment was terminated & antibiotic treatment was adjusted. His hospital course was complicated by worsening of respiratory status. In spite of aggressive supportive measures, patient’s condition continued to deteriorate and resulted into the patient’s demise. 5 weeks later, identification of sputum culture tested positive for M. kansasii.

RESULTS: M. kansasii is a nontuberculous, photochromogenic mycobacterium. Usually discovered from various water sources; rarely from animals (cattle, swine) or soil. Human-to-human transmission has not been documented. Annual rates of infection have been in the range of 0.5 to 1 per 100,000; It seems to predominate along the southeastern and southern coastal states and the central plains states. People at risk includes- pre-existing lung pathology, occupational groups including miners, sandblasters.

CONCLUSIONS: For the best possible therapeutic & favorable outcome, M. kansasii should be actively investigated in certain high risk patients.

CLINICAL IMPLICATIONS: An early identification of M. kansasii and sensitivity to antimicrobial agent is essential, as it has shown in vitro resistance to pyrazinamide & isoniazid. Relapse rate of 9% over a follow up period of five years after standard treatment combinations with rifampicin and ethambutol has been documented.

DISCLOSURE: The following authors have nothing to disclose: Pragnesh Patel

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