781. Non Tuberculous Mycobacterium: Often a Missed Entity
Session: Poster Abstract Session: Tuberculosis and Other Mycobacterial Infections
Thursday, October 4, 2018
Room: S Poster Hall
Background:

Initially referred to as Lady Windermere syndrome, the prevalence of Non Tuberculous Mycobacterium (NTM) is on the rise globally. In India, the TB capital of the world, these infections still go unrecognised, as the clinical presentation of all mycobacterial diseases are similar. This is of clinical relevance as misdiagnosis may lead to unwarranted or inappropriate therapy.

Methods:

We conducted a retrospective study of adults suspected of having mycobacterial infection. Records of patients admitted with suspected TB from January 2015 to December 2017 were reviewed; clinicoradiological features were correlated with the organism isolated; treatment given and outcomes were recorded.

Results:

Out of 877 suspected patients, 245 patients had microbiologically proven Mycobacterium tuberculosis and 34 had NTM (3.8%). Pulmonary infection was seen in 19 cases (56%), rest were extra pulmonary (34%).

Pulmonary

Skin

Pleural/Ascitic

Bone joints

Lymph Node

M. abscessus

3

-

1

1

-

M. intracellulare

7

-

1

-

-

M. kansassi

7

-

-

-

-

M. fortuitum

-

-

-

-

1

M. chelone

-

1

-

-

-

M. interjectum

1

-

-

-

-

Others

1

3

5

2

-

Total

19

4

7

3

1

Fever was the commonest symptom (62%) others being cough (50%), breathlessness (41%), hemoptysis (15%), weight loss (3%), chest pain (3%) and back ache (12%). Symptoms were prolonged (> 1month) in 65% of cases. Radiologically, cavitations (42%), lung nodules (32%) and infiltrates (32%) were commonly seen. Upper zone predilection was noted in 68% of cases. Past tuberculosis was the major risk factor seen in 42% of cases while 26% were immunocompromised. Macrolide resistance was noted in none of our patients. 24 out of 34 cases were AFB smear positive (71%) but MTB gene Xpert was negative. Our series includes 4 patients who did not respond to first line anti-tubercular therapy (ATT) and were suspected to have multi-drug resistant (MDR) tuberculosis. Cultures later grew NTM and the patients improved with macrolide regime.

Conclusion:

NTM is an underreported infection in a developing country like India with a high TB prevalence. Similar clinical features and morphology create a greater diagnostic dilemma. Usage of molecular techniques and AFB culture should be made mandatory in all suspected cases of tuberculosis. NTM should always be considered in ATT non responders before starting them on MDR regime.

Sairam B, MBBS, Atul Gogia, MRCP(UK), Atul Kakar, DNB and S. P. Byotra, MBBS, MD, Sir Ganga Ram Hospital, New Delhi, India

Disclosures:

S. B, None

A. Gogia, None

A. Kakar, None

S. P. Byotra, None

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