eMedicine Specialties > Infectious Diseases > Mycobacterial Infections

Mycobacterium Kansasii: Follow-up

Author: Janak Koirala, MD, MPH, FACP, Associate Professor, Department of Internal Medicine, Division of Infectious Diseases, Southern Illinois University School of Medicine
Contributor Information and Disclosures

Updated: Mar 18, 2009

Follow-up

Further Inpatient Care

  • Isolation is not required in patients with M kansasii infection.

Further Outpatient Care

  • Monitor patient care clinically and with chest radiography to assess response to therapy and clinical improvement. Induced sputum sample collection at regular intervals for AFB stain and culture are useful.
  • Monitor patients for drug toxicity, including periodic monitoring for the following:
    • Visual acuity, visual symptoms, and color vision in patients receiving ethambutol
    • Uveitis due to rifabutin, indicated by eye pain, decreased visual acuity, and anterior chamber fluid level
    • Liver enzymes for hepatotoxicity caused by drugs such as isoniazid, rifampin, rifabutin, and clarithromycin
    • Monitoring and education of patients to avoid drug interactions (The macrolides [clarithromycin, azithromycin] increase levels of many drugs metabolized in the liver, while rifampin and rifabutin decrease levels of other drugs metabolized in the liver.)

Transfer

Deterrence/Prevention

  • General HIV prevention recommendations

Prognosis

  • Untreated M kansasii infection persists in sputum and progresses both clinically and radiographically.
  • Before rifampin was available, treatment success rates with antimycobacterial drugs were disappointing when compared to tuberculosis. With the advent of rifampin, 4-month sputum conversion rates with rifampin-containing regimens were 100% in 180 patients from 3 studies. Researchers report that long-term relapse rates in patients on these regimens are less than 1%.
  • In patients infected with HIV, predictors of survival include higher CD4 counts, antiretroviral therapy, negative smear microscopy results, and adequate treatment for M kansasii infection.14

Patient Education

  • Explain the adverse effects of any medications used for treatment.
    • Visual problems may occur with administration of ethambutol.
    • Rifampin reduces the efficacy of oral contraceptives.
  • For excellent patient education resources, visit eMedicine's Lung and Airway Center and Procedures Center. Also, see eMedicine's patient education articles Tuberculosis and Bronchoscopy.

Miscellaneous

Medicolegal Pitfalls

  • Ethambutol may cause optic neuritis. Monthly monitoring may be useful.
  • Medications may cause liver failure. Advise patients to contact their physicians if they experience jaundice, abdominal pain, or discomfort.
  • Rifampin reduces the efficacy of medications such as oral contraceptives, antiretroviral drugs, and warfarin (Coumadin).
  • Macrolides (clarithromycin and azithromycin) increase serum levels of certain drugs metabolized in the liver (eg, statins), leading to potential toxicity.

Special Concerns

  • Aminoglycosides are contraindicated in pregnancy.
  • Rifampin, ethambutol, and isoniazid are considered safe in pregnancy; termination is unnecessary.
 


More on Mycobacterium Kansasii

Overview: Mycobacterium Kansasii
Differential Diagnoses & Workup: Mycobacterium Kansasii
Treatment & Medication: Mycobacterium Kansasii
Follow-up: Mycobacterium Kansasii
Multimedia: Mycobacterium Kansasii
References
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References

  1. Bloch KC, Zwerling L, Pletcher MJ. Incidence and clinical implications of isolation of Mycobacterium kansasii: results of a 5-year, population-based study. Ann Intern Med. Nov 1 1998;129(9):698-704. [Medline].

  2. Corbett EL, Churchyard GJ, Hay M. The impact of HIV infection on Mycobacterium kansasii disease in South African gold miners. Am J Respir Crit Care Med. Jul 1999;160(1):10-4. [Medline].

  3. Evans AJ, Crisp AJ, Hubbard RB. Pulmonary Mycobacterium kansasii infection: comparison of radiological appearances with pulmonary tuberculosis. Thorax. Dec 1996;51(12):1243-7. [Medline].

  4. Maliwan N, Zvetina JR. Clinical features and follow up of 302 patients with Mycobacterium kansasii pulmonary infection: a 50 year experience. Postgrad Med J. 2005;81:530-33. [Medline].

  5. Evans SA, Colville A, Evans AJ. Pulmonary Mycobacterium kansasii infection: comparison of the clinical features, treatment and outcome with pulmonary tuberculosis. Thorax. Dec 1996;51(12):1248-52. [Medline].

  6. Witzig RS, Fazal BA, Mera RM. Clinical manifestations and implications of coinfection with Mycobacterium kansasii and human immunodeficiency virus type 1. Clin Infect Dis. Jul 1995;21(1):77-85. [Medline].

  7. National Committee for Clinical Laboratory Standards. Susceptibility Testing of Mycobacteria, Nocardiae, and Other Aerobic Actinomycetes; Approved Standard. M24-A. Wayne, PA: National Committee for Clinical Laboratory Standards; 2003.

  8. Woods GL. Susceptibility testing for mycobacteria. Clin Infect Dis. 2000;31:1209-1. [Medline].

  9. Smith MB, Molina CP, Schnadig VJ. Pathologic features of Mycobacterium kansasii infection in patients with acquired immunodeficiency syndrome. Arch Pathol Lab Med. 2003;127:554-60. [Medline].

  10. American Thoracic Society. Diagnosis and treatment of disease caused by nontuberculous mycobacteria. This official statement of the American Thoracic Society was approved by the Board of Directors, March 1997. Medical Section of the American Lung Association. Am J Respir Crit Care Med. Aug 1997;156(2 Pt 2):S1-25. [Medline].

  11. Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro A, Daley C, Gordin F, et al. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med. Feb 15 2007;175(4):367-416. [Medline].

  12. Griffith DE. Management of disease due to Mycobacterium kansasii. Clin Chest Med. 2002;23:613-21. [Medline].

  13. Guna R, Munoz C, Dominguez V. In vitro activity of linezolid, clarithromycin and moxifloxacin against clinical isolates of Mycobacterium kansasii. J Antimicrob Chemother. 2005;55:950-53. [Medline].

  14. Marras TK, Morris A, Gonzalez LC. Mortality prediction in pulmonary Mycobacterium kansasii infection and human immunodeficiency virus. Am J Respir Crit Care Med. 2004;170:793-98. [Medline].

  15. Alcaide F, Benitez MA, Martin R. Epidemiology of Mycobacterium kansasii. Ann Intern Med. Aug 17 1999;131(4):310-1. [Medline].

  16. Breathnach A, Levell N, Munro C. Cutaneous Mycobacterium kansasii infection: case report and review. Clin Infect Dis. Apr 1995;20(4):812-7. [Medline].

  17. Davidson PT. The diagnosis and management of disease caused by M. avium complex, M. kansasii, and other mycobacteria. Clin Chest Med. Sep 1989;10(3):431-43. [Medline].

  18. Fishman JE, Schwartz DS, Sais GJ. Mycobacterium kansasii pulmonary infection in patients with AIDS: spectrum of chest radiographic findings. Radiology. Jul 1997;204(1):171-5. [Medline].

  19. O'Brien RJ. The epidemiology of nontuberculous mycobacterial disease. Clin Chest Med. Sep 1989;10(3):407-18. [Medline].

  20. Wolinsky E. Mycobacterial diseases other than tuberculosis. Clin Infect Dis. Jul 1992;15(1):1-10. [Medline].

  21. Woods GL, Meyers WM. Mycobacterial Diseases. In: Damjanov I, Linder J, eds. Anderson's Pathology. Vol 10. St. Louis, Mo: Mosby; 1996:843-55.

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Further Reading

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Keywords

Mycobacterium kansasii, M kansasii, acid-fast bacillus, AFB, nontuberculous mycobacterial infection, NTM infection, AIDS, Mycobacterium avium complex, MAC, M kansasii chronic pulmonary disease, pulmonary tuberculosis, cutaneous M kansasii infection, M kansasii nodule, M kansasii pustule, M kansasii verrucous lesion, M kansasii erythematous plaque, M kansasii abscess, M kansasii ulcer, M kansasii bacteremia, M kansasii pericarditis, M kansasii oral ulcer, chronic M kansasii sinusitis, M kansasii osteomyelitis, M kansasii scalp abscess

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Contributor Information and Disclosures

Author

Janak Koirala, MD, MPH, FACP, Associate Professor, Department of Internal Medicine, Division of Infectious Diseases, Southern Illinois University School of Medicine
Janak Koirala, MD, MPH, FACP is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians-American Society of Internal Medicine, American Society for Microbiology, Infectious Diseases Society of America, International AIDS Society, International Society for Infectious Diseases, and International Society of Travel Medicine
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: Nothing to disclose.

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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