Emerging pathology: pulmonary disease caused by Mycobacterium xenopi – a challenge in clinical practice

Dragica P. Pešut; Ruža S. Stević; Jasmina Dj Marić-Živković; Biljana Dj Savić; Ljudmila M. Nagorni-Obradović

doi:10.2298/VSP151224026P

Dragica P. Pešut University of Belgrade, Faculty of Medicine, Belgrade, Serbia
Ruža S. Stević University of Belgrade, Faculty of Medicine, Belgrade, Serbia
Jasmina Dj Marić-Živković Clinical Centre of Serbia, Teaching Hospital of Pulmonology, Belgrade, Serbia
Biljana Dj Savić Teaching Hospital of Pulmonology, Clinical Centre of Serbia, Belgrade
Ljudmila M. Nagorni-Obradović University of Belgrade, Faculty of Medicine, Belgrade, Serbia

DOI: https://doi.org/10.2298/VSP151224026P

Keywords: lung diseases;, mycobacterium xenopi;, risk factors;, diagnosis;, drug therapy, combination;, antibiotics;, treatment outcome.

Abstract

Abstract

Introduction. Human nontuberculous mycobacteria (NTM) or environmental mycobacteria related disease is on increase. Risk factors are unclear and associations are observed in relation to climate differences, population density, or host susceptibility. With availability of molecular techniques for NTM identification, we faced emergence of NTM pulmonary cases. The work is an invitation more to colleagues to enroll the rare NTM cases into large study group. Case report. During an episode of productive cough and fever in a 73-year-old HIV-negative man smoker with minimal sequellae of pulmonary tuberculosis, sputum smears were acid fast bacilli positive on direct microscopy. The Löwenstein-Jensen culture results were positive with 20, 30 and 50 colonies, and molecular identification confirmed Mycobacterium xenopi (M. xenopi). Standard chest radiography showed no signs of active lesions. Examination was completed with bronchoscopy and thorax multi-slice computed tomography (MSCT). Cavitary lesions in the apico-posterior part of the left upper lobe (LUL) were detected. Under treatment (rifampicin, ethambutol, clarithromycin) sputum conversion was achieved, but irregular cavitation in the LUL remained at MSCT after 6 and after 12 months with signs of minimal regression. Patient’s general condition only mildly improved and asthenia remained. Observed risk factors were previous pulmonary disease, tobacco smoking, malnutrition and prolonged emotional stress. Conclusion. M. xenopi related pulmonary disease, difficult to cure and with uncertain prognosis, is a challenge in clinical practice. Since treatment is still controversial, more randomized clinical trials are needed. Current international multicentre approach might be a good option for a larger sample size and development of new guide.

Author Biographies

Dragica P. Pešut, University of Belgrade, Faculty of Medicine, Belgrade, Serbia

N/A

Ruža S. Stević, University of Belgrade, Faculty of Medicine, Belgrade, Serbia

N/A

Jasmina Dj Marić-Živković, Clinical Centre of Serbia, Teaching Hospital of Pulmonology, Belgrade, Serbia

N/A

Biljana Dj Savić, Teaching Hospital of Pulmonology, Clinical Centre of Serbia, Belgrade

N/A

Ljudmila M. Nagorni-Obradović, University of Belgrade, Faculty of Medicine, Belgrade, Serbia

N/A

References

Prevots RD, Marras TK. Epidemiology of human pulmo¬nary in-fection with nontuberculous mycobacteria: A re¬view. Clin Chest Med 2015; 36(1): 13‒34.

Thomson RM. Changing epidemiology of pulmonary nontu-berculous mycobacteria infections. Emerg Infect Dis 2010; 16(10): 1576‒83.

Marras TK, Daley CL. Epidemiology of human pulmonary in-fection with nontuberculous mycobacteria. Clin Chest Med 2002; 23(3): 553‒67.

Stjepanović MI, Pešut DP, Lešić AR, Stević RS. Pulmonary and Vertebral Mycobacterium avium Disease in a HIV-negative 71-year-old Man A Case Report. Infez Med 2016; 24(4): 345‒8.

Timpe A, Runyon EH. The relationship of atypical acid-fast bacteria to human disease: A preliminary report. J Lab Clin Med 1954; 44(2): 202‒9.

Runyon EH. Anonymous mycobacteria in pulmonary dis¬ease. Med Clin North Am 1959; 43(1): 273‒90.

van Ingen J. Diagnosis of nontuberculous mycobacterial in-fections. Semin Respir Crit Care Med 2013; 34(1): 103‒9.

Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro A, Daley C, Gordin F, et al. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med 2007; 175(4): 367‒416.

Hoefsloot W, van Ingen J, Andrejak C, Angeby K, Bauriaud R, Be-mer P, et al. The geographic diversity of nontubercu¬lous my-cobacteria isolated from pulmonary samples: an NTM-NET collaborative study. Eur Respir J 2013; 42(6): 1604‒13.

Bluth MH, Vera R, Razeq J, Kramer M, Abu-Lawi KI. Myco-bacterium xenopi: Evidence for Increased Rate of Clinical Isolation. Int J Biomed Sci 2009; 5(2): 96–100.

American Thoracic Society. Diagnostic standards and classifi-cation of tuberculosis and other mycobacterial dis¬eases. New York: American Lung Association; 1974.

Wallace RJ Jr, O’Brien R, Glassroth J, Raleigh J, Dutt A, Ameri-can Thoracic Society. Diagnosis and treatment of disease caused by nontuberculous mycobacteria. Am Rev Respir Dis 1990; 142(4): 940‒53.

Medical Section of the American Lung Association. Diagnosis and treatment of disease caused by nontuberculous myco¬bacteria. This official statement of the American Thoracic Society was approved by the Board of Directors, March 1997. Am JRespir Crit Care Med 1997; 156(2 Pt 2): S1‒25.

van Ingen J, Bendien SA, de Lange WCM, Hoefsloot W, Dek¬huijzen PNR, Boeree MJ, et al. Clinical relevance of non-tu¬berculous mycobacteria isolated in the Nijmegen-Arnhem region, The Netherlands. Thorax 2009; 64(6): 502‒6.

Banks J, Hunter AM, Campbell IA, Jenkins PA, Smith AP. Pul-monary infection with Mycobacterium xenopi: Review of treatment and response. Thorax 1984; 39(5): 376‒82.

Carrillo MC, Patsios D, Wagnetz U, Jamieson F, Marras TK. Comparison of the spectrum of radiologic and clinical mani-festations of pulmonary disease caused by Mycobac¬terium avi-um complex and Mycobacterium xenopi. Can Assoc Radiol J 2014; 65(3): 207‒13.

Schmitt H, Schnitzler N, Riehl J, Adam G, Sieberth HG, Haase G. Successful treatment of pulmonary Mycobacte¬rium xenopi in-fection in a natural killer cell-deficient pa¬tient with clarithro-mycin, rifabutin, and sparfloxacin. Clin Infect Dis 1999; 29(1): 120‒4.

Research Committee of the British Thoracic Society. First ran-domised trial of treatments for pulmonary disease caused by M avium intracellulare, M malmoense, and M. xenopi in HIV negative patients: Rifampicin, ethambutol and isoniazid versus rifampicin and ethambutol. Thorax 2001; 56(3): 167‒72.

Dauendorffer JN, Laurain C, Weber M, Dailloux M. In vitro sen-sitivity of Mycobacterium xenopi to five antibiotics. Pathol Biol (Paris) 2002; 50(10): 591‒4.

Ferro BE, van Ingen J, Wattenberg M, van Soolingen D, Mou¬ton JW. Time-kill kinetics of slowly growing mycobacteria common in pulmonary disease. J Antimicrob Chemother 2015; 70(10): 2838‒43.

Andrejak C. (PI) Treatment of M. xenopi infections (CaMoMy Trial) TBnet #34 / NTM-NET #5. [cited 2015 Dec 15]. Available from:

http//:www.tb-net.org/index.php/tbnet-research/ongoing-projects

Okano Y, Shinohara T, Imanishi S, Takahashi N, Naito N, Taoka T, et al. Miliary pulmonary nodules due to Myco¬bacterium xe-nopi in a steroid-induced immunocompro¬mised patient suc-cessfully treated with chemotherapy: A case report. BMC Pulm Med 2016; 16(1): 92.

Terashima T, Sakamaki F, Hasegawa N, Kanazawa M, Kawa¬shiro T. Pulmonary Infection due to Mycobacterium xenopi. Int Med 1994; 33(9): 536‒9.

Matsui Y, Tamura A, Nagayama N, Akashi S, Araki K, Ki¬mura H, et al. Review of pulmonary Mycobacterium xenopi infec-tion cases: 11 cases of our own and 18 other cases reported in Japan. Kekkaku 2010; 85(8): 647‒53. (Japanese)

Sexton P, Harrison AC. Susceptibility to nontuberculous my-cobacterial lung disease. Eur Respir J 2008; 31(6): 1322‒33.

Wassilew N, Hoffmann H, Andrejak C, Lange C. Pulmo¬nary Disease Caused by Non-Tuberculous Mycobacteria. Respira-tion 2016; 91(5): 386‒402.

Sopori M. Science and society: Effects of cigarette smoke on the immune system. Nat Rev Immunol 2002; 2(5): 372‒7.

Zellweger JP, Cattamanchi A, Sotgiu G. Tobacco and tubercu-losis: Could we improve tuberculosis outcomes by helping pa-tients to stop smoking? Eur Respir J 2015; 45(3): 583‒5.