Mycobacterium Kansasii Treatment & Management

  • Author: Janak Koirala, MD, MPH, FACP, FIDSA; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Jan 11, 2012
 

Medical Care

In general, M kansasii shows good in vitro susceptibility to rifampin, rifabutin, ethambutol, ethionamide, amikacin, streptomycin, clarithromycin, sulfamethoxazole, and ciprofloxacin. Rifampin-resistant strains are usually cross-resistant to rifabutin and, therefore, need separate susceptibility testing. In vitro susceptibility of isoniazid should be interpreted carefully, as it does not correlate with clinical outcome. In patients with no prior exposure to isoniazid, the drug is useful in the treatment of M kansasii infection, regardless of poor susceptibility results. Isoniazid susceptibility testing in laboratories is performed at lower concentrations (0.2 or 1 mcg/mL), which were designed for M tuberculosis, whereas M kansasii susceptibility requires a higher concentration (5 mcg/mL) . Pyrazinamide should not be used to treat M kansasii infection.

Patients in whom M kansasii infection is diagnosed should be treated with at least 3 drugs. The initial drug regimen should include rifampin, which has been shown to yield low failure rates (1.1%) and low long-term relapse rates (< 1%).[14] Rifampin is the cornerstone of treatment for M kansasii infection.

The 2007 ATS/IDSA guidelines for nontuberculous mycobacterial (NTM) infections recommend the following regimens for treatment of M kansasii infection:[13]

  • First-line regimen: This consists of rifampin (10 mg/kg/day; maximum, 600 mg) plus ethambutol (15 mg/kg/day) plus isoniazid (5 mg/kg/day; maximum 300 mg) plus pyridoxine (50 mg/day), with the treatment duration continuing until sputum culture results are negative for 12 months.
  • Alternative regimen: In patients with rifampin-resistant M kansasii disease, a 3-drug regimen should be used based on in vitro susceptibilities. These 3 drugs should include clarithromycin or azithromycin, moxifloxacin, ethambutol, sulfamethoxazole, or streptomycin.

Patients with M kansasii pulmonary infection should be closely monitored with routine clinical examinations and regular sputum for AFB smears and cultures for mycobacteria during the treatment period. The antimycobacterials can be stopped after AFB sputum results are negative for at least 12 months.

Patients with extrapulmonary and disseminated M kansasii infections should be treated in a similar manner to those with pulmonary disease.

Next

Surgical Care

Surgical treatment is unnecessary in M kansasii infection, as it responds very well to antimycobacterial therapy.

Previous
Next

Consultations

  • Infectious disease specialist, especially in patients who are co-infected with HIV
  • Pulmonologist if bronchoscopy with bronchoalveolar lavage and transbronchial biopsies are needed
  • Dermatologist if skin is involved and biopsy is desired
  • Thoracic surgeon if open-lung biopsy is necessary (rare)
Previous
Next

Diet

A dietitian should evaluate malnourished patients.

Previous
Next

Activity

Activity is not limited in patients with M kansasii infection and should be performed as tolerated.

Previous
Proceed to Medication
 
 
Contributor Information and Disclosures
Author

Janak Koirala, MD, MPH, FACP, FIDSA  Associate Professor, Department of Internal Medicine, Division of Infectious Diseases, Southern Illinois University School of Medicine

Janak Koirala, MD, MPH, FACP, FIDSA 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.

Specialty Editor Board

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 Thoracic Society, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Aaron Glatt, MD  Professor of Clinical Medicine, New York Medical College; President and CEO, Former Chief Medical Officer, Departments of Medicine and Infectious Diseases, St Joseph Hospital (formerly 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.

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.

References

  1. Park HK, Koh WJ, Shim TS, Kwon OJ. Clinical characteristics and treatment outcomes of Mycobacterium kansasii lung disease in Korea. Yonsei Med J. Jul 2010;51(4):552-6. [Medline]. [Full Text].

  2. Han SH, Kim KM, Chin BS, Choi SH, Lee HS, Kim MS, et al. Disseminated Mycobacterium kansasii infection associated with skin lesions: a case report and comprehensive review of the literature. J Korean Med Sci. Feb 2010;25(2):304-8. [Medline]. [Full Text].

  3. 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].

  4. 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].

  5. 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].

  6. 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].

  7. 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].

  8. 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].

  9. 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.

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

  11. 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].

  12. 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].

  13. 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].

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

  15. 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].

  16. 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].

  17. Mitha M, Naicker P, Taljaard J. Cutaneous Mycobacterium kansasii infection in a patient with AIDS post initiation of antiretroviral therapy. J Infect Dev Ctries. Jul 27 2011;5(7):553-5. [Medline].

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

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

  20. 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].

  21. 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].

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

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

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

 
Previous
Next
 
Chest radiograph in a patient with Mycobacterium kansasii pulmonary infection shows left lower lung infiltrates.
Chest CT scan in a patient with Mycobacterium kansasii pulmonary infection.
Chest radiograph in a patient with classic right upper lobe cavitary lung disease secondary to Mycobacterium kansasii infection. Courtesy of Raj Sreedhar, MD, SIU School of Medicine, Springfield, IL.
CT thorax of a patient with classic right upper lobe cavitary lung disease secondary to Mycobacterium kansasii infection. Courtesy of Raj Sreedhar, MD, SIU School of Medicine, Springfield, IL.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.