Management of nontuberculous mycobacterial infection in the elderly

Abstract

The incidence of nontuberculous mycobacteria (NTM) has increased over the last decades. Elderly people are more susceptible to NTM and experience increased morbidities. NTM incidence is expected to rise due to an increasing elderly population at least up to 2050. Given the importance of NTM infection in the elderly, an increasing interest exists in studying NTM characteristics in the aged population. In this review, we summarize the characteristics of NTM infection among elderly patients. We focus on epidemiology, clinical presentation, and treatment options of NTM in this age group. We highlight the differences in the diagnosis and treatment between rapid and slow growing mycobacterial infections. The current recommendation for treatment of NTM is discussed. We debate if in vitro susceptibility testing has a role in the treatment of NTM. Drug-drug interaction between antibiotics used to treat NTM and other medications, particularly warfarin, is another important issue that we discuss. Finally, we review the prognosis of NTM disease in elderly patients.

Keywords: Elderly; NTM; Nontuberculous mycobacterium; Treatment.

Conflict of interest statement

Conflict of interests

The authors have no conflicts of interests to declare related to this manuscript.

Copyright © 2014 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

Figures

Figure 1

Illustration of risk factors for NTM disease. Immune defects include HIV/AIDS, immunosuppressant such as TNF-a inhibitors, chemotherapy agents and radiotherapy.

Image 1

The chest X-ray shows diffuse interstitial fibrotic-type opacities throughout both lungs. There are ill-defined somewhat nodular appearing densities with a hint of cavitation in them on the right side, particularly in the apical segment of the lower lobe. Mild scoliosis is notable.

Image 3

The representative image of chest CT scan shows that multiple small airways opacities are scattered in the right upper lobe, superior right lower lobe, and right middle lobe. Small areas of bronchiectasis are present in the right upper lobe. The largest area of cystic bronchiectasis/small cavity formation measures approximately 1 centimeter and it is present in the posterior right upper lobe.