ATYPICAL MYCOBACTERIA

Mycobacteria Other than tuberculosis (MOTT)

Non tuberculous mycobacteria (NTM)
Environmental mycobacteria

MOTT
MOTT can be found in soil, water (tap water),

dust, milk and various animals and birds.

Low grade pathogens in humans and cross
infection is very rare.
Human disease is primarily associated with a
limited number of species
In USA NTM comprised 33% a total
mycobacterial Isolates in the lab

Principle MOTT species causing human disease

Disease site
Pulmonary

Lymph nodes

Opportunist
species

M avium complex
M kansasii
M xenopi
M malmoense
M avium complex
M malmoense
M scrofulaceum
M genavense

Principle MOTT species causing human disease

Disease site
species
Cutaneous/musculoskeletal

Disseminated

Opportunist

M marinum
M ulcerans
M fortuitum
M abscessus
M avium complex
M kansasii
M genavense
M chelonae

Diagnostic methods
Multiple Isolates are needed from non sterile sites to establish disease
One positive culture from a sterile site particularly where there is

supportive HPE
Clinical presentation and predisposing factors

Persisting lung disease, COPD, old TB,

immune deficiency(HIV)
Infection with NTM should be suspected when a patient suspected to

have TB doesnt respond to Anti TB

DIAGNOSIS

1. Ziehl Nelsons stain or fluorochrome methods

2. AFB Culture LJ medium - solid medium

BACTEC 460 A Liquid

medium
3. MOTT are identified by pigmentation, growth
characteristics microscopic appearance and
by chemical reactions
4. DNA probes PCR, are used for diagnosis
mainly for mac, m kansasi and m gordanae

Treatment
Lack of consensus due to absence of large
clinical trials

Recommended regimens for HIV negative patients

_________________________________________
regimen
Duration
_______________________________________________________________
Pulmonary disease:
Rifampicin 450mg orally o.m if <50kg;
months
M Kansasii
600mg orally if 50kg
Ethambutol 15mg/kg orally o.m
M avium complex
years
(MAC)
M Malmoense
M xenopi

Rifampicin (dose as above)

Ethambotol (dose as above)

( isoniazid 300mg orally

Recommended regimens for HIV negative patients

______________________________________________
regimen
Duration
_______________________________________________________________________
Lymph nodes:
M Kansasii
Excision. If recurrence, further
yaers
M malmoense
excision + rifampicin and ethambutol
M xenopi
daily (doses as above)
MAC
years

Excision. If recurrence, further excision +

Rifampicin and Ethambutol (doses as above)
Clarithromycin (500mg orally

Intolerance to
Rifampicin or
Ethambutol

substitute clarithromycin and/or ciprofloxacin

Recommended regimens for HIV positive patients with disease due to opportunist
mycobacteria
_______________________________________________________________________________
Regimen
Duration
_______________________________________________________________________________
Pulmonary or disseminated
disease
M avium complex (MAC)
M Kansasii
M Malmoense
M xenopi
Prophylaxis against MAC
1st choice
Indefinitely
2nd choice
Indefinitely
3rd choice

Indefinitely

Rifampicin 450 or 600mg orally once

daily (or rifabutin 300mg once daily),
ethambutol 15mg per kg orally once daily,
and clarithromycin 500mg orally bd

Azithromycin 1200mg orally weekly

Clarithromycin 500mg orally bd
Azithromycin 1200mg orally weekly
+
Rifabutin 300mg orally once weekly

lifelong

MAC
Regimen
comprising
Rifampicin 600mg
INH 300mg
Ethambutol 1.2 gm
In SM 0.75gm
has been recommended by ATS
Effective in pulmonary cavity disease
Rifampicin 600mg od
Ehtambutol 1gm od
Clofazamine 100mg od
Ciprofloxacin 750mg bd

treatment
M kansasii

INH, Rifa, EMB for 18- 24 months

Treatment of other NTM infections

M fortuitum
Cefoxtin, sulfa drugs, Amikacin
Clarithromycin, Amikacin + Doxycycline