Mycobacterium Kansasii Follow-up

Updated: Oct 07, 2015
  • Author: Janak Koirala, MD, MPH, FACP, FIDSA; Chief Editor: Mark R Wallace, MD, FACP, FIDSA  more...
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Follow-up

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
  • Monitor renal function (for nephrotoxicity) and audiogram (for ototoxicity) at regular intervals if the patient is receiving aminoglycosides (amikacin or streptomycin)
  • 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.)
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Further Inpatient Care

Isolation is not required in patients with M kansasii infection.

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Transfer

In treatment-resistant cases, consulting the National Jewish Hospital Medical and Research Center in Denver, Colo; the Centers for Disease Control and Prevention in Atlanta, Ga; or other local experts may be useful.

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Deterrence/Prevention

General HIV prevention recommendations

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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. [21, 22]

Patients with CNS infection have high rates of morbidity and mortality despite appropriate treatment.

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Patient Education

Explain the adverse effects of any medications used for treatment, as follows:

  • Visual problems may occur with administration of ethambutol.
  • Rifampin reduces the efficacy of oral contraceptives.

For excellent patient education resources, visit eMedicineHealth's Lung Disease and Respiratory Health Center. Also, see eMedicineHealth's patient education articles Tuberculosis and Bronchoscopy.

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