Abstract
Background: Due to similar manifestation and detection of acid-fast bacilli in sputum, substantial part of patients with pulmonary nontuberculous mycobacteria (NTMB) diseases may be considered as pulmonary tuberculosis (TB).
Methods: In 2008-2010 28 pts (1,5%) from referred in Moscow TB Center as TB-suspected were identified as pulmonary NTMB diseases by ATS/IDSA criteria [Am J Respir Crit Care Med Vol 175 pp 367-416, 2007]. For NTMB identification cultivation (on liquid and solid media), biochemical testing, high-performance liquid chromatography and molecular methods were used. In 9 pts surgical specimens were obtained.
Results: All 28 pts (19-73 y.o., 50% male) were immunocompetent. In 22 cases were detected slow (MAC - 9, M.kansasii - 9, M.xenopi - 4) and in 6 - rapidly (M.fortuitum - 4, M.chelonae - 2) growing NTMB. In 26 pts (92,9%) various complains were obtained. X-ray pattern included cavities (75%) and/or nodular dissemination (78,6%) with multifocal bronchiectasis (60,7%), with some variations due to NTMB species. The treatment was complicated by drug resistance: in 60,7% (17 pts) was detected MDR (especially MAC - 8 and rapidly growing NTMB - all 6 pts), including 28,6% XDR (5 - MAC, 2 - M.xenopi and 3 - rapidly growing NTMB). The best treatment outcomes obtained in M.kansasii: in spite of resistance in all pts to H, susceptibility to R and Fq give an opportunity to create the adequate regimens (3-5 drugs). In 15 pts other antibacterial drugs (claritromycin, azithromycin etc) were used.
Conclusion: TB clinics must be concerned about NTMB, especially in MDR and XDR cases. For adequate treatment all NTMB must be tested with all TB-drugs and maximum available other antibacterial drugs.
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