DÄ internationalArchive9/2010Non-tuberculous Mycobacteria

Correspondence

Non-tuberculous Mycobacteria

Dtsch Arztebl Int 2010; 107(9): 147. DOI: 10.3238/arztebl.2010.0147b

Heinrich, N; Hoelscher, M; Richter, E

LNSLNS The author reported a case of mycobacterial infection, which was diagnosed after a lengthy process.

However, the case is actually not one of tuberculosis in the stricter sense: the confirmed species—Mycobacterium avium intracellulare complex—belongs to the group of non-tuberculous mycobacteria. These are often found in the environment and, in cultures, are possibly only contaminants. However, in this case the diagnosis was firmly established following the criteria of the American Thoracic Society (ATS) – the specimens came from otherwise sterile body fluids (1).

Microscopy using different staining methods, as mentioned in the article, is less relevant than cultures and PCR for confirming a diagnosis, since microscopy has lower sensitivity and, in contrast to the other methods, cannot differentiate between species (2). It therefore needs to be emphasized that the diagnostic mistake in the case report consisted mainly in not doing culture and PCR.

Non-tuberculous mycobacteria—such as the described species—display sensitivities to anti-mycobacterial chemotherapy different from Mycobacterium tuberculosis complex. After resistance testing, recommended initial treatment should therefore consist of a combination of clarithromycin, ethambutol, and, if required, rifabutin. By contrast to the treatment described in the article, however, isoniazid is not the treatment of choice (3).
DOI: 10.3238/arztebl.2010.0147b

Dr. med. Norbert Heinrich
PD Dr. med. Michael Hoelscher
Abteilung für Infektions- und Tropenmedizin
Klinikum der LMU
Leopoldstr. 5
80802 München, Germany
heinrich@lrz.uni-muenchen.de

PD Dr. rer. nat. Elvira Richter
Forschungszentrum Borstel
Nationales Referenzzentrum für
Mykobakterien
Parkallee 18
23845 Borstel, Germany
1.
Griffith DE, Aksamit T, Brown-Elliott BA, 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. MEDLINE
2.
Schaaf SH, Zumla AI: Tuberculosis. London: Elsevier; 2009; p. 1014.
3.
Kaplan JE, Benson C, Holmes KH, et al.: Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. MMWR Recomm Rep 2009: 58(RR-4): 1–207; quiz CE201–204. MEDLINE
4.
Herzog A: Case report: dangerous errors in the diagnosis and treatment of bony tuberculosis [Gefährliche Fehler in Diagnostik und Therapie einer Knochentuberkulose]. Dtsch Arztebl Int 2009; 106(36): 573–7. VOLLTEXT
1. Griffith DE, Aksamit T, Brown-Elliott BA, 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. MEDLINE
2. Schaaf SH, Zumla AI: Tuberculosis. London: Elsevier; 2009; p. 1014.
3. Kaplan JE, Benson C, Holmes KH, et al.: Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. MMWR Recomm Rep 2009: 58(RR-4): 1–207; quiz CE201–204. MEDLINE
4. Herzog A: Case report: dangerous errors in the diagnosis and treatment of bony tuberculosis [Gefährliche Fehler in Diagnostik und Therapie einer Knochentuberkulose]. Dtsch Arztebl Int 2009; 106(36): 573–7. VOLLTEXT