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]

Surgical Care

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

Consultations

See the list below:

Infectious disease expert
Pulmonologist
Mycobacterium expert
Health department

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.

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.

Medication

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Shirin A Mazumder, MD, FIDSA Associate Professor of Medicine, Director of Infectious Disease Fellowship Program, Division of Infectious Diseases, Department of Internal Medicine, University of Tennessee Health Science Center College of Medicine, University of Tennessee Methodist Physicians

Shirin A Mazumder, MD, FIDSA is a member of the following medical societies: American Academy of HIV Medicine, American College of Physicians, American Medical Association, HIV Medicine Association, Infectious Diseases Society of America, Memphis Medical Society, Society for Healthcare Epidemiology of America, Tennessee Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

Aaron Glatt, MD Chairman, Department of Medicine, Chief, Division of Infectious Diseases, Hospital Epidemiologist, South Nassau Communities Hospital

Aaron Glatt, MD is a member of the following medical societies: American Association for Physician Leadership, American College of Chest Physicians, 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, Society for Healthcare Epidemiology of America

Disclosure: Nothing to disclose.

Chief Editor

Pranatharthi Haran Chandrasekar, MBBS, MD Professor, Chief of Infectious Disease, Department of Internal Medicine, Wayne State University School of Medicine

Pranatharthi Haran Chandrasekar, MBBS, MD is a member of the following medical societies: American College of Physicians, American Society for Microbiology, International Immunocompromised Host Society, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

Natalie C Klein, MD, PhD Associate Director, Infectious Disease Division, Associate Professor of Medicine, The School of Medicine at Stony Brook University Medical Center

Natalie C Klein, MD, PhD is a member of the following medical societies: American College of Physicians, American Society for Microbiology, New York County Medical Society, American Medical Association, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Klaus-Dieter Lessnau, MD, FCCP Former 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, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Sections Mycobacterium haemophilum Infection
Overview
Presentation
- History
- Physical
- Causes
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DDx
Workup
Treatment
Medication
References

Mycobacterium haemophilum Infection Treatment & Management

Medical Care

Surgical Care

Consultations

Further Outpatient Care

Further Inpatient Care

References

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