Adult

Mycobacterial Diseases

Non-tuberculous mycobacterium

Wallace RJ, Brown-Elliot BA, McNulty S, et al. Macrolide/azalide therapy for nodular/bronchiectatic mycobacterium avium complex lung disease. Chest 2014;146(2):276-282. First study to evaluate treatment efficacy of macrolide based regimen in non-tuberculous mycobacterium patients with uniform disease phenotype following current guidelines. In 180 patients who completed >12 months of therapy, sputum conversion to culture negative occurred in 86% of patients without development of macrolide resistance. Microbiologic recurrences during and after therapy were common.

PMID: 24457542

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Griffith DE, Aksamit T, Brown-Elliott BA, et al. The official ATS/IDSA statement: Diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med 2007; 175:367-416. More comprehensive than its 1997 predecessor, this statement provides a general overview of NTM pathogenesis, presentation, and diagnosis as well as easily retrieved treatment recommendations on specific organisms. New guidelines are expected in 2020.  

PMID: 17277290

Haworth CS, Banks J, Capstick T, et al. British Thoracic Society guidelines for the management of non-tuberculous mycobacterial pulmonary disease (NTM-PD). Thorax. 2017; 72 (Suppl 2):ii1-ii64. This guideline includes useful recommendations on indications for treatment, susceptibility testing, treatment regimens for various organisms, and monitoring during treatment.

PMID: 29054853

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Latent tuberculosis

Lewinsohn DM, Leonard MK, LoBue PA et al. Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention Clinical Practice Guidelines: Diagnosis of tuberculosis in adults and children. Clin Infect Dis. 2017 Jan 15;64:111-115. Updated ATS/IDSA guidelines focusing on diagnostic testing for latent tuberculosis infection, pulmonary tuberculosis, and extrapulmonary tuberculosis.

PMID: 28052967

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Menzies D, Adjobimey M, Ruslami R, et al. Four months of rifampin or nine months of isoniazid for latent tuberculosis in adults. N Engl J Med. 2018;379(5):440-453. This study randomly assigned 6859 adults with latent tuberculosis to receive 4 months of rifampin or 9 months of isoniazid. The rifampin regimen was not inferior to the isoniazid regimen and had higher rate of treatment completion and better safety. New CDC guidelines regarding treatment of latent tuberculosis are expected in 2020.

PMID: 30067931

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Active Tuberculosis- Diagnosis

Lewinsohn DM, Leonard MK, LoBue PA et al. Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention Clinical Practice Guidelines: Diagnosis of tuberculosis in adults and children. Clin Infect Dis. 2017 Jan 15;64:111-115. Updated ATS/IDSA guidelines focusing on diagnostic testing for latent tuberculosis infection, pulmonary tuberculosis, and extrapulmonary tuberculosis.

PMID: 28052967

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Conde MB, Loivos AC, Rezende VM, et al. Yield of sputum induction in the diagnosis of pleural tuberculosis. Am J Respir Crit Care Med 2003;167:723-5. Prospective study of 84 patients with pleural tuberculosis found induced sputum culture was helpful in patients with no infiltrate on CXR; 55% of patients with effusion and otherwise clear CXR were culture positive, although only 12% had a rapid diagnosis via positive smears.

PMID: 12598215

Active Tuberculosis- Treatment

Nahid P, Dorman SE, Alipanah N, et al. Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America clinical practice guidelines: treatment of drug-susceptible tuberculosis. Clin Infect Dis. 2016; 63:853-67. This update to the 2003 guideline focuses primarily on non-drug resistant disease and emphasizes the importance of case management and avoiding excessive delay of ART in HIV-positive patients initiating treatment of active tuberculosis.

PMID: 27621353

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