Febrile 7: MACsterclass
Mar 22, 2021
Dr. Ruvandhi Nathavitharana, an expert in infectious diseases and tuberculosis, shares insights on pulmonary non-tuberculous mycobacterial (NTM) disease. The conversation covers the nuances of diagnosing NTM, highlighting the significance of imaging and microbiological tests. They delve into the complexities of species-specific treatment and managing mixed infections. Ruvandhi also discusses emerging therapies and emphasizes the importance of a multidimensional approach to patient care, including surgery and advocacy for better diagnostics.
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Immunosuppression Raises NTM Concern
- Anti-TNF therapy raises suspicion for mycobacterial disease even without classic TB exposures.
- Non-tuberculous mycobacteria (NTM) become higher on the differential for chronic cough and weight loss in this host.
Collect Sputum And Image For Dissemination
- Obtain sputum AFB smears, cultures, and an MTB nucleic acid amplification test to distinguish TB from NTM.
- Image the abdomen and pelvis when LFTs and GI symptoms raise concern for disseminated disease.
NTM Diagnosis Is A Constellation
- Diagnosing NTM disease requires integrating clinical symptoms, imaging patterns, and microbiology over time.
- Meeting microbiologic criteria often needs two positive sputum cultures or one positive BAL plus compatible clinicoradiographic findings.