With the increasing number of NTM infections in patients on immunosuppressive medications, it is important to consider these pathogens in an infectious differential diagnosis. Molecular techniques have expedited the diagnosis and identification of NTM infections.2 It is, therefore, prudent to consider early, aggressive diagnostic evaluation of immunocompromised patients for chronic syndromes that could represent an atypical pathogen.
You Might Also Like
Explore This IssueMay 2021
Kayleigh A. Sullivan, MD, MA, MPH, completed her internal medicine residency at Dartmouth-Hitchcock Medical Center, N.H. She is an integrated geriatrics and palliative medicine fellow at the Icahn School of Medicine, Mount Sinai, N.Y.
Nicole M. Orzechowski, DO, is an associate professor of medicine at the University of North Carolina at Chapel Hill and medical director of the Rheumatology Specialty Clinic.
Elizabeth A. Talbot, MD, is a professor of medicine at Geisel School of Medicine at Dartmouth College and the medical director of the NonTuberculous Mycobacterial Infections Clinic. She also serves as New Hampshire’s deputy state epidemiologist.
Dr. Talbot is a consultant for Oxford Immunotec, the maker of T-Spot.TB, and a consultant with participation in an advisory board for Insmed, the maker of Arikayce.
- Buhler VB, Pollak A. Human infection with atypical acid-fast organisms: Report of two cases with pathologic findings. Am J Clin Pathol. 1953 Apr;23(4):363–374.
- Brown-Elliott BA, Wallace RJ. Infections caused by nontuberculous mycobacteria other than Mycobacterium avium complex. In Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Disease. 9th ed. Philadelphia, PA: Elsevier; 2020:3049–3058.
- Steadham JE. High-catalase strains of Mycobacterium kansasii isolated from water in Texas. J Clin Microbiol. 1980 May;11(5):496–498.
- Brown-Elliott BA, Philley JV. Rapidly growing mycobacteria. Microbiol Spectr. 2017 Jan;5(1).
- Roach DR, Bean AG, Demangel C, et al. TNF regulates chemokine induction essential for cell recruitment, granuloma formation, and clearance of mycobacterial infection. J Immunol. 2002 May 1;168(9):4620–4627.
- Laurence A, Gadina M, O’Shea JJ. Protein kinase antagonists in therapy of immunological and inflammatory diseases. In Rich RR, Fleisher TA, Shearer WT, et al., eds. Clinical Immunology: Principles and Practice. 5th ed. Philadelphia, PA: Elsevier; 2019:1185–1196.
- Winthrop KL, Park SH, Gul A, et al. Tuberculosis and other opportunistic infections in tofacitinib-treated patients with rheumatoid arthritis. Ann Rheum Dis. 2016 Jun;75(6):1133–1138.
- Chatham WW. Biological modifiers of inflammatory diseases. In Rich RR, Fleisher TA, Shearer WT, et al., eds. Clinical Immunology: Principles and Practice. 5th ed. Philadelphia, PA: Elsevier; 2019:1197–1210.
- Shim HH, Cai SCS, Chan W, et al. Mycobacterium abscessus infection during ustekinumab treatment in Crohn’s disease: A case report and review of the literature. J Crohns Colitis. 2018 Nov;12(12):1505–1507.
- Thibodeaux Q, Ly K, Reddy V, et al. Dual biologic therapy for recalcitrant psoriasis and psoriatic arthritis. JAAD Case Rep. 2019 Oct 10;5(10):928–930.
- Le Berre C, Loeuille D, Peyrin-Biroulet L. Combination therapy with vedolizumab and tofacitinib in a patient with ulcerative colitis and spondyloarthropathy. Clin Gastroenterol Hepatol. 2019 Mar;17(4):794–796.
- Boleto G, Kanagaratnam L, Dramé M, et al. Safety of combination therapy with two bDMARDs in patients with rheumatoid arthritis: A systematic review and meta-analysis. Semin Arthritis Rheum. 2019 Aug;49(1);35–42.