Emerging pathology: Pulmonary disease caused by Mycobacterium xenopi - a challenge in clinical practice
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...
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Ministry of Defence of the Republic of Serbia, University of Defence, Belgrade
2018-01-01
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| Series: | Vojnosanitetski Pregled |
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| Online Access: | http://www.doiserbia.nb.rs/img/doi/0042-8450/2018/0042-84501700026P.pdf |
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| author | Pešut Dragica P. Stević Ruža S. Marić-Živković Jasmina Đ. Savić Biljana Đ. Nagorni-Obradović Ljudmila M. |
| author_facet | Pešut Dragica P. Stević Ruža S. Marić-Živković Jasmina Đ. Savić Biljana Đ. Nagorni-Obradović Ljudmila M. |
| author_sort | Pešut Dragica P. |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-fd6abfc0b7584eb685144ef061a52f32 |
| institution | OA Journals |
| issn | 0042-8450 2406-0720 |
| language | English |
| publishDate | 2018-01-01 |
| publisher | Ministry of Defence of the Republic of Serbia, University of Defence, Belgrade |
| record_format | Article |
| series | Vojnosanitetski Pregled |
| spelling | doaj-art-fd6abfc0b7584eb685144ef061a52f322025-08-20T02:04:40ZengMinistry of Defence of the Republic of Serbia, University of Defence, BelgradeVojnosanitetski Pregled0042-84502406-07202018-01-0175994995310.2298/VSP151224026P0042-84501700026PEmerging pathology: Pulmonary disease caused by Mycobacterium xenopi - a challenge in clinical practicePešut Dragica P.0Stević Ruža S.1Marić-Živković Jasmina Đ.2Savić Biljana Đ.3Nagorni-Obradović Ljudmila M.4Faculty of Medicine, Belgrade + Clinical Centre of Serbia, Teaching Hospital of Pulmonology, BelgradeFaculty of Medicine, Belgrade + Centre of Radiology and Magnetic Resonance, BelgradeClinical Centre of Serbia, Teaching Hospital of Pulmonology, BelgradeClinical Centre of Serbia, Teaching Hospital of Pulmonology, BelgradeFaculty of Medicine, Belgrade + Clinical Centre of Serbia, Teaching Hospital of Pulmonology, BelgradeIntroduction. 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.http://www.doiserbia.nb.rs/img/doi/0042-8450/2018/0042-84501700026P.pdflung diseasesMycobacterium xenopirisk factorsdiagnosisdrug therapycombinationantibioticstreatment outcome |
| spellingShingle | Pešut Dragica P. Stević Ruža S. Marić-Živković Jasmina Đ. Savić Biljana Đ. Nagorni-Obradović Ljudmila M. Emerging pathology: Pulmonary disease caused by Mycobacterium xenopi - a challenge in clinical practice Vojnosanitetski Pregled lung diseases Mycobacterium xenopi risk factors diagnosis drug therapy combination antibiotics treatment outcome |
| title | Emerging pathology: Pulmonary disease caused by Mycobacterium xenopi - a challenge in clinical practice |
| title_full | Emerging pathology: Pulmonary disease caused by Mycobacterium xenopi - a challenge in clinical practice |
| title_fullStr | Emerging pathology: Pulmonary disease caused by Mycobacterium xenopi - a challenge in clinical practice |
| title_full_unstemmed | Emerging pathology: Pulmonary disease caused by Mycobacterium xenopi - a challenge in clinical practice |
| title_short | Emerging pathology: Pulmonary disease caused by Mycobacterium xenopi - a challenge in clinical practice |
| title_sort | emerging pathology pulmonary disease caused by mycobacterium xenopi a challenge in clinical practice |
| topic | lung diseases Mycobacterium xenopi risk factors diagnosis drug therapy combination antibiotics treatment outcome |
| url | http://www.doiserbia.nb.rs/img/doi/0042-8450/2018/0042-84501700026P.pdf |
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