eMedicine Specialties > Infectious Diseases > Mycobacterial Infections

Mycobacterium Chelonae: Follow-up

Author: F Matthew Kuhlmann, MD, Fellow, Division of Infectious Diseases, Washington University School of Medicine
Coauthor(s): Keith F Woeltje, MD, PhD, Associate Professor, Department of Internal Medicine, Division of Infectious Diseases, Washington University School of Medicine
Contributor Information and Disclosures

Updated: Aug 26, 2009

Follow-up

Further Inpatient Care

  • Most patients do not require inpatient care. The duration of inpatient care is dictated by the time needed to recover from any procedures performed.

Further Outpatient Care

  • The frequency of outpatient visits is determined by the extent of the disease, its sequelae, and whether the patient is receiving oral or intravenous therapy.
    • Initially, at least monthly follow-up care for adverse effects is reasonable.
    • More frequent visits may be necessary for patients with central catheters to evaluate for line infections.
  • Outpatients taking aminoglycoside therapy should undergo periodic (at least weekly) assessment of renal function and, possibly, antibiotic levels. Peak levels are not necessary, and trough levels may be useful to document a nontoxic range.
  • Monthly sputum cultures may be useful in patients with pulmonary disease to determine the efficacy of therapy.

Inpatient & Outpatient Medications

  • Administer antibiotics daily (see Medication). Infrequent dosing (eg, 2-3 times per week, as for tuberculosis) has not been evaluated and is not recommended.

Transfer

  • Patients who require intravenous antibiotic therapy but who are unable to receive home intravenous therapy need to be placed in a facility capable of administering antibiotics.
  • Patients with refractory disease may require a referral to a specialty center (usually as an outpatient rather than as an inpatient transfer).

Deterrence/Prevention

  • No specific deterrence methods are available. M chelonae and M abscessus are ubiquitous organisms.
  • Isolation is not indicated.
  • Patients with disease due to nontuberculous mycobacteria should be considered for treatment prior to starting anti-TNF alpha agents.

Complications

  • Severe lung disease or disseminated disease may cause death.
  • Skin lesions and subsequent debridement may be disfiguring.
  • Antimycobacterial monotherapy may lead to drug resistance.

Prognosis

  • With debridement and antibiotic therapy, the prognosis is very good for most infection. Prognosis is worse if the patient is immunocompromised.
  • Lung disease may be difficult or impossible to eradicate. Chronic suppression of the infection and slowing of the progression of lung disease may be the only achievable goals in this setting.
  • Cure of infected implants that cannot be removed may be impossible.
  • Toxicities due to prolonged antibiotic use may develop.

Patient Education

  • Educate patients on the importance of adherence with multiple drug regimens to avoid the development of antibiotic resistance.
  • Patients may confuse this disease with tuberculosis. Reassure patients that they are not contagious to others.
  • Discuss possible medication adverse effects with most patients to increase the chance of early diagnosis.
    • Restrict sports activities for patients receiving quinolones to avoid Achilles tendon ruptures (rare).
    • Advise patients to prevent pregnancy during therapy.
  • For excellent patient education resources, visit eMedicine's Procedures Center. Also, see eMedicine's patient education article Bronchoscopy.

Miscellaneous

Medicolegal Pitfalls

  • No specific pitfalls are documented. The following are potential problems:
    • Failure to consider the diagnosis in patients with chronic infection is possible.
    • Because M chelonae or M abscessus may be contaminants, consider the possibility of pseudoinfection in any patient with a positive culture before committing the patient to an extended course of treatment. This is especially true of sputum samples and cultures from other nonsterile sources (eg, a swab culture of a wound).
    • Because disease caused by these organisms can be indolent, a culture positive for M chelonae or M abscessus should prompt a careful evaluation to exclude unrecognized disease.
    • Before starting medications such as amikacin, documenting whether the patient is pregnant may be useful. Documenting counseling about potential medication adverse effects may also be useful.

Special Concerns

  • If an M chelonae or an M abscessus infection is believed to be nosocomial, notify hospital infection control. Finding even a single case of nosocomial NTM may warrant an investigation.
 


More on Mycobacterium Chelonae

Overview: Mycobacterium Chelonae
Differential Diagnoses & Workup: Mycobacterium Chelonae
Treatment & Medication: Mycobacterium Chelonae
Follow-up: Mycobacterium Chelonae
Multimedia: Mycobacterium Chelonae
References
Further Reading
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Keywords

Mycobacterium chelonei, M chelonei, M chelonae, Mycobacterium chelonae, Mycobacterium abscessus, M abscessus, nontuberculous mycobacterium, nontuberculous mycobacteria, mycobacterium other than tuberculosis, MOTT, Mycobacterium tuberculosis, mycobacterial cutaneous infection, NTM, NTM lung disease, AIDS, HIV, Runyon classification, Runyon's classification, Runyon classification group IV, Runyon group IV, rapidly growing mycobacteria, osteomyelitis, keratitis, corneal ulcers

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Contributor Information and Disclosures

Author

F Matthew Kuhlmann, MD, Fellow, Division of Infectious Diseases, Washington University School of Medicine
F Matthew Kuhlmann, MD is a member of the following medical societies: American Medical Association and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Coauthor(s)

Keith F Woeltje, MD, PhD, Associate Professor, Department of Internal Medicine, Division of Infectious Diseases, Washington University School of Medicine
Keith F Woeltje, MD, PhD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Medical Informatics Association, Infectious Diseases Society of America, and Society for Healthcare Epidemiology of America
Disclosure: Nothing to disclose.

Medical Editor

Klaus-Dieter Lessnau, MD, FCCP, Clinical Associate Professor of Medicine, New York University School of Medicine; Medical Director, Pulmonary Physiology Laboratory; Director of Research in Pulmonary Medicine, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital
Klaus-Dieter Lessnau, MD, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Medical Association, American Society for Artificial Internal Organs, American Thoracic Society, Physicians for Social Responsibility, and Society of Critical Care Medicine
Disclosure: sepracor Ownership interest None

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Aaron Glatt, MD, Professor of Clinical Medicine, New York Medical College; President and CEO, Former Chief Medical Officer, Departments of Medicine and Infectious Diseases, New Island Hospital
Aaron Glatt, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physician Executives, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Infectious Diseases Society of America, International AIDS Society, and Society for Healthcare Epidemiology of America
Disclosure: Nothing to disclose.

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

 
 
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