Video The Mandate for Individualized Care in Persons with NTM Lung Disease and Limited Options Play Pause Volume Quality 1080P 720P 576P Fullscreen Captions Transcript Chapters Slides The Mandate for Individualized Care in Persons with NTM Lung Disease and Limited Options Overview CLICK HERE FOR CME CREDIT Back to Symposium My name is Christoph Lange. I'm the medical director of the Research Center Borstel in Germany, and it is a pleasure to invite you to this live webinar on best practice advances in frontline management to optimize clinical outcomes in non-tuberculous mycobacterial lung disease. This is a CME certified Sing cast symposium which is jointly provided by UMASS Chan Medical School and CME Educational Resources. There's commercial support by an educational grant from the company INSET. It is my great pleasure to introduce the distinguished faculty to you, Professor Stefano Aliberti from Italy. He is professor at the Humanitas University and respiratory consultant, chief of the respiratory unit at Humanitas Research Hospital in Milan, Italy. And Professor David Griffith, who is professor of medicine at the National Jewish Health in Denver, Colorado in the USA. My name is Christophe Lange. I'm the medical director of the Research Center Borsel in Germany and professor for respiratory medicine and international health at the University of Lubeck in Germany. Please allow me to introduce you to the subject, the mandate for individualized care in persons with MTM lung disease and limited treatment options. Mycobacteria are a fascinating group of organisms. They are more there are more than 200 different species and subspecies of mycobacteria identified. Some of them occur commonly and cause diseases like mycobacteria tuberculosis, the most common cause of death by a single. Um, microorganism that is known on Earth. The second most common mycobacterial disease is uh leprosy caused by mycobacterium leprae and mycobacterium lepromatosis, also seen here on the family tree of mycobacteria. This tree starts down here with rapid growers and goes all the way here to the mycobacteria from the mycobacterium avium complex. The clinical manifestation of non-tuberculosis mycobacteria um can be basically twofold. It can be nodular bronchiectstatic disease. You see here several nodules in the um computer tomography of the thorax, and you see also here bronchiectasis. The other form is fibrocavitary disease causing cavities and fibrosis, and both nodular bronchiectic and fibrocavitary disease can occur simultaneously in a patient. There's no way to distinguish a pulmonary disease caused by non-tuberculose mycobacterium from pulmonary disease caused by tuberculosis. In the past decades, the scientific interest in non-tuberculous mycobacteria diseases has dramatically increased now with around 350 publications listed in PubMed per year. There's also probably an increased incidence in some countries as you can see here from the example of Denmark. With increased uh definitive and possible um or increased definite uh diseases, also, uh, increased possible diseases over the last decade caused by non-tuberculosis mycobacterial disease. So they are emerging pathogens and in some countries, there is now more. The more diseases notified by non-tuberculous mycobacteria than by tuberculosis. This accounts for several countries in the European Union, for example. Not everybody gets non-tuberculosis mycobacterial disease, but there is uh a prominent risk factors, and the most common risk factors are bronchiectasis and post or past pulmonary tuberculosis. Other pulmonary diseases that are risk factors are COPD, primoorosis, silicosis, or cystic fibrosis, but they all are not as prominent as bronchiectasis and past pulmonary TB. Also inhative corticosteroids, advanced age, diabetes mellitus, alcohol use disorders, cigarette smoking, warm climate, and living in coastal areas increases the risk for the development of non-tuberculous mycobacteria pulmonary disease. In a group of international colleagues who found consensus last year on when to screen for non-tuberculos mycobacterial pulmonary disease, we concluded that those who have non-cystic fibrosis bronchiectasis should especially be undergoing evaluations if they could have. uh, in not only infection but disease caused by non-tuberculosis mycobacteria and also those individuals with persistent cough should be under or should undergo diagnosis if they could have non-tuberculose mycobacterial pulmonary disease. How is the diagnosis made? This is made based on three different pillars. The one is clinical symptoms, respiratory symptoms, and exclusion of another disease that is sometimes difficult. Imaging that is compatible with non-tuberculous mycobacterial disease, so either nodular bronchiectstatic or fibro cavitary disease or both. And 3rd, mycobacteriological conformation. Either by two positive sputum cultures or one positive uh culture from bronchoalveolar lavage or histology plus one culture biopsy or sputum from the same uh species. There are also other criteria already uh formulated in 1981 by Emmanuel Wolinsky, one of the um uh forefathers of the, the groundbreaking um scientists in the area of non-tuberculose mycobacterial pulmonary diseases. Um, and the Wolinsky criteria are very plausible criteria. They say if acid habacili are visible, there's so many bacteria that it's probably disease. If you repeatedly isolate the same organism, then this is probably disease. If you isolate an organism from a sterile source, let's say a pleural effusion, then it is um usually disease. Also, pathogenic species like Mycobacterium cansasi, favor disease, whereas others like Mycobacterium gordonna almost never cause disease. And finding of non-tuberculosis mycobacteria in individuals with immunodeficiencies increases the risk for disease. Current guidelines are based on the consensus by the ATS, ERS, ESMIT, and IDSA and they only include four different organisms, Mycobacterium Avium complex, Mycobacterium canasi, Mycobacterium enopi, and mycobacterium abscessor. And for mycobacterium avium complex, the recommendations azithromycin, ethambuyrivampicin for mycobacterium enoppi, azithromycin ethembuyrivampicin or fluluquinolone for mycobacterium cansasi, revampicin isonia and fembuto, and for mycobacterium abscessor, the treatment should be based on drug susceptibility testing and very often includes oral and IV therapy. For the less common mycobacteria that are causing pulmonary disease like Keloni, fortuitum, yavenza, godone, malmo andysemia and sulgae, there are also evidence-based guidelines published by the same authors. So at present for all the organisms causing non-tuberculous mycobacterial disease that commonly and less commonly occur apart from the really rare ones, we for the first time in history have evidence-based guidelines. How to manage um individuals that are affected. It is now my great pleasure to introduce as the next speaker. Professor Stefano Aliberti, who is the professor in respiratory medicine at Humanitas University in Milan, Italy, Chief of the respiratory unit and at the Humanitas Research Hospital in Milan, and he also chairs the Italian registry on non-tuberculos Mycobacteria. He is followed by Professor David Griffith, who is professor of medicine at the National Jewish Health in Denver, Colorado. And my name is Christoph Lange, and I'm the medical director of the Research Center Borsel in Germany and Professor of respiratory medicine and International Health at the University of Lubeck. Published Created by Related Presenters Professor Christoph Lange, MD - Program Chair Medical Director/Clinical DirectorResearch Center BorstelBorstel, Germany
