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Diagnosis

Could It Be NTM?

How has NTM affected your practice? Answer the question below and see how other physicians around the country have answered.

At the time of diagnosis of NTM infection, how long, on average, have a patient's symptoms persisted?

Could it be NTM?

Time for a clear diagnosis

Because pulmonary NTM infection is a chronic and progressive disease, if you suspect your patient may have NTM, it is important to make a definitive diagnosis as soon as possible. Delaying diagnosis can lead to delaying treatment, which may lead to worsening symptoms, compounding respiratory problems for patients. At the time of final NTM diagnosis, almost 2 out of 3 patients with NTM pulmonary infection have moderate-to-severe lung disease.5 And in some very severe cases, a late diagnosis can lead to irreversible lung damage.12

If a patient has one positive culture, it is urgent that testing is continued and The British Thoracic Society (BTS) Guidelines or American Thoracic Society (ATS)/Infectious Diseases Society of America (IDSA) Statement is followed.

Clinical, radiographic, and microbiologic criteria for diagnosing NTM pulmonary disease

Is it a pulmonary NTM infection?

Consider referring patients in whom you suspect an NTM infection to an NTM expert.

Clinical/radiographic criteria

Bronchopulmonary symptoms, nodular or cavitary opacities on chest radiograph, or multifocal bronchiectasis with multiple small nodules on HRCT scan (examples)

and

Exclusion of other causes

Microbiologic criteria

Positive culture results from at least 2 separate expectorated sputum samples

or

Positive culture result from at least 1 bronchial wash or lavage

or

Transbronchial or other lung biopsy with mycobactetrial histopathologic features* and positive culture for NTM, or biopsy showing mycobacterial histopathologic features*, and 1 or more sputum sample or bronchial wash that are positive for NTM


*Granulomatous inflammation or acid-resistant rods

Diagnosis: NTM infection
Therapy according to
treatment recommendations
  • A diagnosis does not, per se, necessitate initiation of therapy but is rather a decision based on potential risks and benefits of therapy for individual patients
  • Antimycobacterial treatment can be associated with substantial side effects and, with the recommended treatment duration of 18 months, demands a high level of compliance on behalf of the patient. Therefore, it is recommended to prepare and educate the patient accordingly ahead of treatment initiation

Adapted from: Schönfeld et al., Empfehlungen zur Diagnostik und Therapie nichttuberkulöser Mykobakteriosen des Deutschen Zentralkomitees zur Bekämpfung der Tuberkulose (DZK) und der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin (DGP). In: Pneumologie 2013; 67(11): 605-633, © Georg Thieme Verlag KG Stuttgart, New York and 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;175:367-416.

Further infomation:

The clinical, radiological, and microbiological criteria are equally important and must all be met to diagnosis a pulmonary NTM infection.

Examples of a radiological diagnosis [HRCT]

Case from German recommendations:
Schönfeld et al., Empfehlungen zur Diagnostik und Therapie nichttuberkulöser Mykobakteriosen des Deutschen Zentralkomitees zur Bekämpfung der Tuberkulose (DZK) und der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin (DGP). In: Pneumologie 2013; 67(11): 605-633, © Georg Thieme Verlag KG Stuttgart, New York

Patient:

  • Male, 59 years, history of lung disease
  • Microbiological detection of M. malmoense
  • HRCT shows bronchiectasis in the lingula with surrounding infiltrate

Case taken from:
http://radiopaedia.org/cases/right-middle-lobe-bronchiectasis-mac 20

Patient:

  • Female, 65 years, existing lung disease
  • Microbiological detection of MAC
  • HRCT shows bronchiectasis in the right middle lobe and centrilobular densities with tree-in-bud pattern in the medial basal segment of the right lower lobe
HRCT= High-resolution computed tomography