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The first 300 words of the full text of this section appear below.

Section 3. Summaries of Infectious Diseases

Diseases Caused by Nontuberculous Mycobacteria

(Atypical Mycobacteria, Mycobacteria Other Than Mycobacterium tuberculosis)

Clinical Manifestations
Etiology
Epidemiology
Diagnostic Tests
Treatment
Isolation of the Hospitalized Patient
Control Measures

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CLINICAL MANIFESTATIONS

Several syndromes are caused by nontuberculous mycobacteria (NTM). In children, the most common of these syndromes is cervical lymphadenitis. Less common infections include soft tissue infection, osteomyelitis, otitis media, central vascular catheter-associated infections, and pulmonary infection, especially in adolescents with cystic fibrosis. NTM, especially Mycobacterium avium complex (MAC [including M avium and Mycobacterium intracellulare]) and Mycobacterium abscessus, can be recovered from sputum in 10% to 20% of adolescents and young adults with cystic fibrosis and can be associated with fever and declining clinical status. Disseminated infections almost always are associated with impaired cell-mediated immunity, as found in congenital immune defects or advanced human immunodeficiency virus (HIV) infection. Disseminated MAC is rare in HIV-infected children during the first year of life. Its frequency increases with increasing age and declining CD4+ T-lymphocyte counts, typically less than 50 cells/µL) in children older than 6 years of age. Manifestations of disseminated NTM infections depend on the species and route of infection but include fever, night sweats, weight loss, abdominal pain, fatigue, diarrhea, and anemia. In HIV-infected patients developing immune restoration with initiation of highly active antiretroviral therapy (HAART), local MAC symptoms can worsen. This immune reconstitution syndrome usually occurs 2 to 4 weeks after initiation of HAART. Symptoms can include worsening fever, swollen lymph nodes, local pain, and laboratory abnormalities.


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ETIOLOGY

Of the more than 130 species of NTM that have been identified, only a few account for most human infections. The species most commonly infecting children in the United States are MAC, Mycobacterium fortuitum, M abscessus, and Mycobacterium marinum (see Table 3.86, p 703). . . . [Go to Full Text]


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