Atypical mycobacteria causing pulmonary disease: rapid diagnosis using skin test profiles

Area of Science:

• Immunology
• Infectious Diseases
• Pulmonology

Background:

• Mycobacterial infections, particularly pulmonary disease, pose diagnostic challenges.
• Accurate and timely diagnosis is crucial for effective treatment of mycobacteriosis.
• Purified protein derivatives (PPDs) are used for diagnosing mycobacterial infections.

Purpose of the Study:

• To evaluate the utility of simultaneous skin testing with various mycobacterial PPDs in diagnosing pulmonary mycobacteriosis.
• To assess the effectiveness of different treatment regimens for atypical mycobacterial lung disease.

Main Methods:

• Patients with roentgenologically suspected mycobacteriosis underwent simultaneous skin testing with PPDs from M tuberculosis (PPD-S), M kansasii (PPD-Y), M scrofulaceum (PPD-G), M avium (PPD-A), M intracellulare (PPD-B), and M fortuitum (PPD-F).
• Skin test reactivity profiles were analyzed to determine specific mycobacterial causes.
• Treatment outcomes were compared for different drug regimens and surgical interventions.

Main Results:

• Skin testing profiles accurately delineated the specific cause of mycobacterial disease, enabling early diagnosis weeks before bacteriologic confirmation.
• A two- to three-drug regimen for M avium or M intracellulare disease was ineffective.
• A five-drug regimen, particularly when combined with surgical resection, yielded the best treatment outcomes, achieving apparent cures in all patients.

Conclusions:

• Simultaneous PPD skin testing is a valuable tool for early and specific diagnosis of pulmonary mycobacteriosis.
• Effective treatment of atypical mycobacterial lung disease requires a multi-drug approach, with surgical intervention significantly improving cure rates.
• Early diagnosis and appropriate treatment strategies are essential for managing mycobacterial infections.