Mycobacterium haemophilum Infection Treatment & Management

Updated: Jun 11, 2020
  • Author: Shirin A Mazumder, MD, FIDSA; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Treatment

Medical Care

Treatment is determined by the degree of immunosuppression. In healthy children with lymphadenitis, surgical excision is the preferred treatment. In immunosuppressed patients, reversal of immunosuppression is the most effective treatment. Immunosuppressed patients require combination therapy to prevent the development of resistance. Susceptibility testing is not standardized, but M haemophilum is usually susceptible to amikacin, ciprofloxacin, and other quinolones (eg, levofloxacin, moxifloxacin), clarithromycin, rifabutin, rifampin. M haemophilum is usually resistant to ethambutol, ethionamide, isoniazid, and streptomycin. Although the optimal regimen is not known, combinations have had some clinical success.

Effective drug combinations include the following:

  • Rifampin and ciprofloxacin

  • Ciprofloxacin, clarithromycin, and rifampin

  • Rifampin and minocycline

  • Clarithromycin, minocycline, and rifampin

  • The treatment duration can vary from 12-24 months depending on numerous factors, including disease severity, anatomic location, and immunologic status of the host. [1]

  • Patients with M haemophilum infection may also experience immune reconstitution events analogous to paradoxical immune reactions seen after initiating antimycobacterial therapy in patients with M tuberculosis infection. [29]

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Surgical Care

Lymphadenitis in children: Total excision of the involved lymph node or nodes is the treatment of choice. [39]

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Consultations

See the list below:

  • Infectious disease expert

  • Pulmonologist

  • Mycobacterium expert

  • Health department

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Further Outpatient Care

Patients require close outpatient follow-up care to document response to therapy (eg, every 2-4 wk). Length of therapy is prolonged in immunosuppressed patients, and patients with irreversible immunosuppression may require life-long suppressive therapy. Relapses have occurred in patients with AIDS who were on suppressive therapy. Whether patients on highly active antiretroviral therapy (HAART) can stop therapy if they have a good HAART response is unknown.

Discuss adherence to medications extensively with the patient to avoid development of resistance.

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Further Inpatient Care

M haemophilum infection is diagnosed in many immunosuppressed patients who are hospitalized.

Treatment can be started or continued on an outpatient basis in most patients.

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