感染科 Infectious diseases topic one: NTM (nontuberculous mycobacteria)

NTM

1. Pathogen types

- Rapid growing: abscessus

- Soft tissue related: marinum

- Immunocompromised pts: kanasii

2. Pathogen from...

- Aquarium, fish: marinum

- Tap water: gordonae

3. Body parts involved

- LN: by MAC

- Soft tissue:  by marinum

- Lung: AFP(+), PCR(-), CT may present with TB-like patterns(tree in bud, LNs)

- Disseminated: beware of AIDS, interferon gamma pathway defect

4. Examination

- Use LJ culture with liquid

- Take samples from sputum, bronchial washing, soft tissue, blood

5. Diagnosis by

- Clinical symptoms

- Image proof

- Pathology or culture

*** Fungal infection of lung can also last long.

6.  Sweet's syndrome

- Epidemiology: rare

- Presentation: fever, painful skin lesions on arms, neck, head, and trunk

- Etiology: infection(ex:NTM), cancer, drug

7. Treatment

- Principle: treat early even with only one set of blood culture done

- Kanasii: treat as TB, except PZD(Pyrazinamide)

- MAC: macrolide with other drugs combined

8. Take home message:
Consider NTM infection if wounds do not heal for a long time
***Further reading: https://www.ncbi.nlm.nih.gov/pubmed/27109150