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Immune Dysfunction and Nontuberculous Mycobacterial Disease

  • Emily Henkle
  • Kevin L. Winthrop
Chapter
Part of the Respiratory Medicine book series (RM)

Abstract

The following chapter focuses on the epidemiology, prevention, diagnosis, and treatment of nontuberculous mycobacterial disease in different immunosuppressed and immunocompromised patient populations. Underlying causes of immunosuppression that increase the risk of nontuberculous mycobacterial disease include acquired immunodeficiency syndrome and certain types of primary immunodeficiency, cancer and its treatment, and solid organ and hematologic transplantation. More recently, evidence has suggested an increased risk with the use of immunosuppressive medications such as oral and inhaled corticosteroids, and biologic therapies used to treat autoimmune inflammatory diseases. In many immunocompromised patients, nontuberculous mycobacterial infections more commonly present as extrapulmonary disease (i.e., skin, soft tissue, or disseminated infections), although in some settings of immunosuppression (e.g., sarcoid, lung transplant), pulmonary presentations are common. Mycobacterium avium complex and rapid-growing mycobacteria (e.g., Mycobacterium abscessus and Mycobacterium fortuitum) cause the most disease, with several uncommon species (e.g., Mycobacterium haemophilum and Mycobacterium genavense) causing disease exclusively in immunocompromised patients. Treatment of those with nontuberculous mycobacterial infections and underlying immunosuppression frequently involves parenteral-based multidrug antimicrobial therapy and efforts to reduce immunosuppression. Treatment should be undertaken by experts per current American Thoracic Society/Infectious Disease Society of America treatment guidelines.

Keywords

Nontuberculous mycobacteria Mycobacterium avium complex Mycobacterium abscessus Mycobacterium haemophilum Immunosuppression 

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.OHSU-PSU School of Public Health, Oregon Health and Science UniversityPortlandUSA

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