INFECTIONS WITH NONTUBERCULOUS MYCOBACTERIA (NTM)

Mycobacteria other than those of the M. tuberculosis complex and M. leprae are referred to as nontuberculous or atypical mycobacteria and are ubiquitous in soil and water.

MICROBIOLOGY

NTM are broadly differentiated into rapidly and slowly growing forms (<7 days and ≥7 days, respectively). M. abscessus, M. fortuitum, and M. chelonae are examples of rapid growers; species such as M. avium and M. intracellulare (the M. avium complex, or MAC), M. kansasii, M. ulcerans, and M. marinum are slow growers.

EPIDEMIOLOGY: -

Most NTM cause disease in humans only rarely unless some aspect of host defense is impaired (as in bronchiectasis) or breached (as by inoculation— e.g., during liposuction or trauma). The bulk of nontuberculous mycobacterial disease in North America is due to M. kansasii, MAC organisms, and M. abscessus.

CLINICAL MANIFESTATIONS: -

Although there are many NTM species, the clinical presentations they cause can be broadly categorized by the organ system(s) affected.

• Disseminated disease is now quite rare; even pts with advanced HIV infection do not often develop disseminated NTM infection, given improved treatment of HIV infection and effective antimycobacterial prophylaxis.

– Organisms typically spread from the bowel to the bone marrow and bloodstream, but disease is indolent, and it can take weeks or months for the pt to present for medical attention with malaise, fever, weight loss, organomegaly, and lymphadenopathy.

– A child with involvement of ≥2 organ systems and no iatrogenic cause should be evaluated for defects in the interferon γ/interleukin-12 pathway.

• Pulmonary disease represents the most common NTM infection in industrialized countries. MAC organisms are most commonly involved in North America. Pts present with months or years of throat clearing.

HOMEOPATHIC MANAGEMENT: -

The medicines that can be thought of use are: -

• Arsenic
• Pyrogenium
• Veratrum
• Lachesis
• Sulphur.