Advances in the management of pulmonary disease due to Mycobacterium abscessus complex

• Published in: The international journal of tuberculosis and lung disease Vol. 18; no. 10; pp. 1141 - 1148
• Main Authors: Koh, W-J., Stout, J. E., Yew, W-W.
• Format: Journal Article
• Language: English
• Published: Paris International Union Against Tuberculosis and Lung Disease 01.10.2014; International Union against Tuberculosis and Lung Disease
• Subjects: Anti-Bacterial Agents - therapeutic use; Bacterial diseases; Biological and medical sciences; Disease Management; Drug Resistance, Bacterial; Human bacterial diseases; Humans; Infectious diseases; Lung Diseases - diagnosis; Lung Diseases - drug therapy; Lung Diseases - microbiology; Macrolides; Macrolides - therapeutic use; Medical sciences; Mycobacterium; Mycobacterium Abscessus; Mycobacterium Infections, Nontuberculous - diagnosis; Mycobacterium Infections, Nontuberculous - drug therapy; Non-Tuberculous Mycobacteria; Nontuberculous Mycobacteria - classification; Nontuberculous Mycobacteria - drug effects; Nontuberculous Mycobacteria - growth & development; Pneumology; Prevalence; Tuberculosis and atypical mycobacterial infections; Lung disease; Respiratory disease; Mycobacterial infection; Complexes; Macrolide; Mycobacterium abscessus; Complexity; Infection; macrolides; Clinical management; Tuberculosis; Mycobacteriales; Bacteriosis; Mycobacteriaceae; Bacteria; non-tuberculous mycobacteria; Actinomycetes; Antibacterial agent
• ISSN: 1027-3719; 1815-7920
• DOI: 10.5588/ijtld.14.0134

Mycobacterium abscessus complex is a group of rapidly growing mycobacteria, and an emerging cause of non-tuberculous mycobacterial lung disease in patients with cystic fibrosis and chronic lung diseases, such as bronchiectasis. M. abscessus complex is the most drug-resistant of the mycobacterial pathogens, resulting in limited therapeutic options and a high treatment failure rate. M. abscessus complex is comprised of three closely related subspecies: M. abscessus (sensu stricto), M. massiliense and M. bolletii. M. abscessus encodes a functional erythromycin ribosomal methylase gene, erm(41), which modifies the binding site for macrolide antibiotics, causing inducible macrolide resistance. However, this inducible macrolide resistance is not seen in M. massiliense, as the erm(41) gene of this subspecies is non-functional. Accordingly, treatment success rates with macrolide-based antibiotic treatment are much higher in patients with M. massiliense infections than in those infected with M. abscessus. Precise speciation of M. abscessus complex is important for predicting antibiotic susceptibilities and patient outcome.