Medical Care

A physician detecting a positive M xenopi culture result must differentiate among colonization, contamination, and true disease.

Assess bacteriologic data (eg, repeated isolation, organism identification), clinical symptoms, and radiographic findings within the entire clinical context.

Treat with chemotherapy, although optimal therapy is not well established.

Surgical Care

Surgery may be curative for patients who present with solitary pulmonary nodules and for those with localized pulmonary disease who fail to respond to, or who relapse after, chemotherapy.

Consultations

See the list below:

Infectious disease specialist
Thoracic surgery specialist
Pulmonary medicine specialist

Diet

Patients do not require special diets.

Activity

Patients do not require activity restrictions.

Prevention

To date, no strategy, method, treatment, or therapy prevents M xenopi infection.

Long-Term Monitoring

Monitor the patient monthly for possible adverse effects.

Monitoring includes (but is not limited to) the following:

Liver palpation and, if any discomfort, liver function testing
Tests for visual acuity and color vision if ethambutol is used
Audiometric testing if aminoglycosides are used

Further Inpatient Care

Inpatient care is not necessary unless the patient is severely immunocompromised, has disseminated disease, or requires hospitalization for severity of the illness.

Inpatient & Outpatient Medications

Use at least 2 medications to avoid acquired resistance.

Intravenous administration may be required with disseminated disease.

Transfer

Consider referring difficult cases to a specialist center.

Consider sending cultures to a reference laboratory to test for susceptibility; however, routine susceptibility testing in a patient who has never been treated is not necessary.

Medication

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Author

Mansoor Arif, MD Hospitalist, Department of Medicine, Mount Auburn Hospital; Instructor, Department of Medicine, Harvard Medical School

Mansoor Arif, MD is a member of the following medical societies: American College of Physicians, Massachusetts Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Syed Faisal Mahmood, MBBS Associate Professor of Infectious Diseases, Program Director, Infectious Diseases Fellowship Program, Department of Medicine, Aga Khan University Hospital, Pakistan

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 E Glatt, MD, MACP, FIDSA, FSHEA Chairman, Department of Medicine, Chief, Division of Infectious Diseases, Hospital Epidemiologist, Mount Sinai South Nassau; Professor of Medicine, Icahn School of Medicine at Mount Sinai

Aaron E Glatt, MD, MACP, FIDSA, FSHEA 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

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America; Fellow of the Royal College of Physicians, London

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Medical Association, Association of Professors of Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Acknowledgements

Martin Backer, MD Fellow in Combined Adult and Pediatric Infectious Diseases, State University of New York Health Sciences Center