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Description

The diagnosis of a nontuberculous mycobacterial lung infection can be made based on laboratory data.


 

Patient groups:

(1) normal host defenses

(2) local immunosuppression

(3) systemic immunosuppression

 

Diseases associated with local immunosuppression:

(1) alcoholism

(2) bronchiectasis

(3) cyanotic heart disease

(4) cystic fibrosis

(5) previous mycobacterial disease

(6) pulmonary fibrosis

(7) smoking

(8) chronic obstructive pulmonary disease

 

Diseases associated with systemic immunosuppression:

(1) acute or chronic leukemia

(2) malignant lymphoma

(3) solid organ transplant recipient

(4) systemic immunosuppression

 

Criteria for diagnosis of nontuberculous mycobacterial pulmonary disease:

(1) using single bronchial washing

(2) using multiple respiratory cultures in 1 year

(3) tissue biopsy

 

Criteria for single bronchial washing - both of the following:

(1) culture positive for nontuberculous mycobacteria

(2) one of the following:

(2a) AFB smear with grade 2+ to +4 acid fast bacilli

(2b) normal host defenses and culture growth 2+ to 4+

(2c) local immunosuppression and culture growth 2+ to 4+

(2d) systemic immunosuppression and culture growth 1+ to 4+

 

Criteria for multiple respiratory cultures - both of the following:

(1) >= 3 respiratory samples (sputum and/or washings) in past year

(2) one of the following:

(2a) >= 3 cultures positive for nontuberculous mycobacteria and all AFB smears negative

(2b) >= 2 cultures positive for nontuberculous mycobacteria and >= 1 AFB positive

 

Criteria for tissue biopsy - one of the following:

(1) any growth of a nontuberculous mycobacteria from a lung biopsy

(2) lung disease with a positive culture for a nontuberculous mycobacterium from a usually sterile extrapulmonary site

(3) both of the following:

(3a) >= 1 respiratory culture for nontuberculous mycobacterium

(3b) granuloma and/or AFB detected in lung biopsy

 


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