Atypical tuberculosis is caused by non-tuberculous mycobacteria (NTM) and is difficult to diagnose. It affects people with compromised immune systems and is increasingly seen in postmenopausal women. Antibiotic resistance is common, and treatment can involve years of multiple antibiotics with serious side effects. Proper identification of the particular type of Mycobacterium is crucial for effective treatment.
Atypical tuberculosis is a form of tuberculosis-like lung disease caused by non-tuberculous mycobacteria (NTM). These are bacteria of the Mycobacterium family which are not the causal agent of tuberculosis, Mycobacterium tuberculosis complex or leprosy. There are a number of other species in this family that individuals are exposed to on a daily basis. Atypical tuberculosis generally affects people with compromised immune systems and is increasingly seen in postmenopausal women. The disorder is extremely difficult to diagnose, and treatment can involve years of multiple antibiotics that can have serious side effects.
Another term for this disorder is mycobacteria other than tuberculosis (MOTT), or environmental mycobacteria. This group of bacteria is unusual in having a thick cell wall made up of materials that make them resistant to most antibiotics and disinfectant measures. Mycobacteria can generally survive harsh conditions and are found throughout the environment in streams, marshes and even chlorinated water. Organisms do not spread from one individual to another, but are acquired from the environment through drinking, respiration or contact with soil.
Symptoms are similar to those of standard TB and include cough, fever, weight loss, lack of appetite, low energy levels, bloody sputum, and night sweats. Of a number of species that can cause this ailment, one of the most prevalent is a group of bacterial species that can be found in birds, such as chickens. This is the Mycobacterium avium complex, or MAC. Infection with this group is a common side effect for patients with cystic fibrosis or HIV infection. It is unclear why the incidence of the disease is increasing in postmenopausal women.
Diagnosing atypical tuberculosis involves culture of mycobacteria from sputum and can take weeks to months. In the past, only a few hospitals and research laboratories had the expertise to identify the affected species using traditional diagnostic methods once the microbes had been cultured. Recombinant DNA techniques have expanded the ability to identify particular species. Sequence differences in nucleic acids are currently a common way of delineating the different types of mycobacteria.
Proper identification of the particular type of Mycobacterium infecting a person is crucial. Not all species cause disease. Doctors don’t want to subject patients to the rigors of treatment unnecessarily. The strong antibiotics used to treat NTM infections often have drastic side effects.
Antibiotic resistance is very common among these types of bacteria. Species vary in their susceptibility to a particular antibiotic. Identifying the particular Mycobacterium found in a person’s lung allows the appropriate combination of antibiotics to be used in the treatment of atypical tuberculosis. Typically a combination of three to five different antibiotics is needed and may need to be taken for up to two years to cure this disorder.
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