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CME/MOC

Adult

Mycobacterial Diseases

Non-tuberculous mycobacterium:

Daley CL, Iaccarino JM, Lange C, et al. Treatment of nontuberculous mycobacterial pulmonary disease: An official ATS/ERS/ESCMID/IDSA clinical practice guideline. Clin Infect Dis 2020; 71:905-913. An updated version of the 2007 guidelines with a primary focus on treatment including recommendations for specific organisms. Diagnostic criteria are included in the 2020 update but the 2007 guidelines contain greater detail on aspects of taxonomy, diagnosis, and prevention.
PMID: 17277290

Haworth CS, Banks J, Capstick T, et al. British Thoracic Society guidelines for the management of non-tuberculous mycobacterial pulmonary disease (NTM-PD). Thorax. 2017; 72 (Suppl 2):ii1-ii64. This guideline includes useful recommendations on indications for treatment, susceptibility testing, treatment regimens for various organisms, and monitoring during treatment.
PMID: 29054853
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Griffith DE, Eagle G, Thomson R, et al. Amikacin liposome inhalation suspension for treatment-refractory lung disease caused by Mycobacterium Avium Complex (CONVERT). Am J Respir Crit Care Med 2018; 198: 1559-1569. This randomized, open-label study of patients with persistent sputum culture positivity after 6 months of guideline-based therapy for MAC lung disease demonstrated that addition of inhaled amikacin led to culture conversion in 29% compared to 8.9% with guideline-based therapy alone after an additional six months.
PMID: 30216086

Latent tuberculosis:

Lewinsohn DM, Leonard MK, LoBue PA et al. Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention Clinical Practice Guidelines: Diagnosis of tuberculosis in adults and children. Clin Infect Dis. 2017;64:111-115. Updated ATS/IDSA guidelines focusing on diagnostic testing for latent tuberculosis infection, pulmonary tuberculosis, and extrapulmonary tuberculosis.
PMID: 28052967
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Sterling TR, Njie G, Zenner D, et al. Guidelines for the treatment of latent tuberculosis infection: Recommendations from the National Tuberculosis Controllers Association and CDC, 2020. MMWR, 2020; 69:1-11. The most noteworthy change to the newest latent TB treatment guideline is preferential use of three rifamycin-based regimens of 3-4 month duration over isoniazid monotherapy for 6-9 months.
PMID: 31027539
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Active Tuberculosis- Diagnosis:

Lewinsohn DM, Leonard MK, LoBue PA et al. Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention Clinical Practice Guidelines: Diagnosis of tuberculosis in adults and children. Clin Infect Dis. 2017; 64:111-115. Updated ATS/IDSA guidelines focusing on diagnostic testing for latent tuberculosis infection, pulmonary tuberculosis, and extrapulmonary tuberculosis.
PMID: 28052967
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Conde MB, Loivos AC, Rezende VM, et al. Yield of sputum induction in the diagnosis of pleural tuberculosis. Am J Respir Crit Care Med 2003;167:723-5. Prospective study of 84 patients with pleural tuberculosis found induced sputum culture was helpful in patients with no infiltrate on CXR; 55% of patients with effusion and otherwise clear CXR were culture positive, although only 12% had a rapid diagnosis via positive smears.
PMID: 12598215

Active Tuberculosis- Treatment:

Nahid P, Dorman SE, Alipanah N, et al. Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America clinical practice guidelines: treatment of drug-susceptible tuberculosis. Clin Infect Dis. 2016; 63:853-67. This update to the 2003 guideline focuses primarily on non-drug resistant disease and emphasizes the importance of case management and avoiding excessive delay of ART in HIV-positive patients initiating treatment of active tuberculosis.
PMID: 27621353
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Dorman SE, Nahid P, Kurbatova EV, et al. Four-month rifapentine regimens with or without moxifloxacin for tuberculosis. N Engl J Med. 2021; 384:1705-1718. Large, international RCT found treatment of non-resistent TB with 4 months of rifapentine plus moxifloxacin was non-inferior to standard 6- month, 4-drug therapy.
PMID: 33951360
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