• Tuberculosis and Respiratory Diseases
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• v.80 no.2
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• pp.153-158
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• 2017

Background: Recently, increased levels of high-mobility group box 1 protein (HMGB1) have been identified in various inflammatory conditions and infections. However, no studies have evaluated the HMGB1 level in nontuberculous mycobacterial (NTM) lung disease, and compared it to mycobacterial lung disease. Methods: A total of 60 patients newly diagnosed with NTM lung disease, 44 culture-positive pulmonary tuberculosis (TB) patients, and 34 healthy controls, were included in this study. The serum HMGB1 concentrations were quantified using HMGB1 enzyme-linked immunosorbent assay kits. Results: Serum HMGB1 level in patients with pulmonary TB or NTM lung disease, was significantly lower than that of the healthy controls. In addition, the serum HMGB1 level in TB patients was significantly lower than patients with NTM lung disease. However, the levels in NTM patient subgroups did not differ according to the causative species, disease progression, and disease phenotype. Conclusion: Although low levels of serum HMGB1 has the potential to be a marker of mycobacterial lung disease, these levels were unable to differentiate disease progression and disease phenotype in NTM lung diseases.

• Tuberculosis and Respiratory Diseases
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• v.72 no.3
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• pp.275-283
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• 2012

Background: Healthy individuals who develop nontuberculous mycobacteria (NTM) lung disease are likely to have specific susceptibility factors which can lead to a NTM infection. The aim of the present study was to investigate the mechanism underlying innate immune responses, including the role of mitogen-activated protein kinase (MAPK), in Mycobacterium abscessus lung disease. Methods: Extracellular signal-regulated kinase (ERK1/2) and p38 MAPK expression in monocytes from peripheral blood mononuclear cells were measured by Western blot analysis after stimulation by Mycobacterium avium in five patients with M. abscessus lung disease and seven healthy controls. A M. avium-induced cytokine assay was performed after inhibition of ERK1/2 and p38 MAPK pathways. Results: Mycobacterium avium induced p38 and ERK1/2 expression in monocytes from healthy controls and subsequently upregulated tumor necrosis factor (TNF)-${\alpha}$, interleukin (IL)-6, and IL-10 production. In monocytes from patients with M. abscessus lung disease, however, induction of p38 and ERK1/2 expression, and the production of TNF-${\alpha}$, IL-6, and IL-10 were significantly lower. Conclusion: Decreased activity of MAPK and cytokine secretion in monocytes from patients with M. abscessus lung disease may provide an explanation regarding host susceptibility to these uncommon infections.

• The Journal of Internal Korean Medicine
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• v.41 no.5
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• pp.856-867
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• 2020

Objectives: The purpose of this case study was to report the effect of Korean Medicine treatment on a patient diagnosed with nontuberculous mycobacterial lung disease. Methods: A 61-year-old female patient with nontuberculous mycobacterial lung disease was admitted to the clinic from October 15th, 2018 to November 7th, 2018. The patient was treated using Korean medical treatments of Jinhae-tang-gami, Ssanghwa-tang-gami, Haeyeol-tang, Jinhae-tang plus Ssanghwa-tang-gami, and Jinhae-tang plus Bojungikgi-tang-gami. We evaluated the improvement of symptoms by a numeric rating scale (NRS) score, C-reactive protein (CRP) levels, erythrocyte sedimentation rate (ESR), and body temperature. Results: After Korean medicine treatment, the patient's cough and sputum amounts were decreased as measured by the NRS score. CRP levels and ESR were also decreased and fever was relieved. Conclusion: This study suggested that Korean medicine treatment might be effective in treating patients diagnosed with nontuberculous mycobacterial lung disease.

• Tuberculosis and Respiratory Diseases
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• v.77 no.4
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• pp.161-166
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• 2014

Since tuberculosis (TB) remains a major global health concern and the incidence of multi-drug resistant (MDR)-TB is increasing globally, new modalities for the detection of TB and drug resistant TB are needed to improve TB control. The Xpert MTB/RIF test can be a valuable new tool for early detection of TB and rifampicin resistance, with a high sensitivity and specificity. Late-generation fluoroquinolones, levofloxacin, and moxifloxacin, which are the principal drugs for the treatment of MDR-TB, show equally high efficacy and safety. Systemic steroids may reduce the overall TB mortality attributable to all forms of TB across all organ systems, although inhaled corticosteroids can increase the risk of TB development. Although fixed dose combinations were expected to reduce the risk of drug resistance and increase drug compliance, a recent meta-analysis found that they might actually increase the risk of relapse and treatment failure. Regarding treatment duration, patients with cavitation and culture positivity at 2 months of TB treatment may require more than 6 months of standard treatment. New anti-TB drugs, such as linezolid, bedaquiline, and delamanid, could improve the outcomes in drug-resistant TB. Nontuberculous mycobacterial lung disease has typical clinical and immunological phenotypes. Mycobacterial genotyping may predict disease progression, and whole genome sequencing may reveal the transmission of Mycobacterium abscessus. In refractory Mycobacterium avium complex lung disease, a moxifloxacin-containing regimen was expected to improve the treatment outcome.

• Journal of the Korean Society of Radiology
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• v.82 no.4
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• pp.838-850
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• 2021

The incidence and prevalence of nontuberculous mycobacterial pulmonary disease (NTM-PD) is increasing worldwide, including in Korea, and the clinical importance of NTM-PD is also rapidly increasing. The diagnosis and management of NTM-PD is difficult. Radiologic evidence is mandatory to diagnose NTM-PD, and the radiologic findings may be the first evidence of the disease in many patients. Traditionally, NTM-PD demonstrates two different radiologic forms: fibrocavitary and nodular bronchiectatic. However, the disease also shows non-specific and a wide spectrum of radiologic features. Radiologists must be aware of the radiologic features of NTM-PD and should include them in the differential diagnosis. This review focuses on the epidemiology in Korea, diagnostic criteria, and radiological features of NTM-PD for radiologists.

• Tuberculosis and Respiratory Diseases
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• v.78 no.4
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• pp.412-415
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• 2015

The prevalence of lung diseases caused by nontuberculous mycobacteria (NTM) is increasing worldwide. Unlike pulmonary tuberculosis, endobronchial NTM diseases are very rare with the majority of cases reported in patients with human immunodeficiency virus infection and acquired immune deficiency syndrome. We reported a rare case of endobronchial Mycobacterium avium disease associated with lobar atelectasis in a young immunocompetent patient and reviewed the relevant literature.

• Tuberculosis and Respiratory Diseases
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• v.67 no.3
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• pp.199-204
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• 2009

Background: To examine the recovery rate of nontuberculous mycobacteria (NTM) from respiratory specimens and the clinical course of NTM pulmonary disease at a 700-bed secondary hospital. Methods: This study analyzed the results of 843 acid-fast bacilli (AFB) culture-positive respiratory specimens from 650 subjects collected between May 2003 and April 2008. In addition, the clinical course of NTM pulmonary disease, diagnosed using criteria established by the American Thoracic Society, was examined. Results: There were 67 (7.9%) NTM isolates recovered from 52 (8.0%) subjects. Among the 535 AFB smear-positive specimens, 34 (6.3%) NTM isolates were recovered. There were 33 (10.7%) NTM isolates were recovered from 308 AFB smear-negative specimens. Of 52 subjects with isolated NTM, M. intracellulare was the most common species at 73.1% (n=33), followed by M. kansassi (n=7), M. abscessus (n=2), M. fortuitum (n=2), and M. avium (n=1). Sixteen (30.8%) patients had NTM pulmonary disease and the most common causative organism was M. intracellulare (n=14, 87.5%). Of these, 6 cases attained negative conversion in culture, 4 cases failed to attain negative conversion because of poor cooperation or expiration from complicated underlying lung disease, and 5 cases were transferred to a higher-grade hospital. Conclusion: The recovery rate of NTM from respiratory specimens was relatively low and the most common species was M. intracellulare. Patients with NTM pulmonary disease showed variable clinical outcomes.

• Tuberculosis and Respiratory Diseases
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• v.47 no.6
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• pp.735-746
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• 1999

Background: As the prevalence of nontuberculous mycobacteriosis has been increasing rapidly, there has been recent advance in diagnostic methods and drug therapies for disease. Although the incidence of pulmonary disease caused by nontuberculous mycobacteria(NTM) has been increasing in Korea since 1990, detailed clinical description about the disease were very few. In this study we described the clinical manifestations, radiologic findings, and therapeutic outcomes of nontuberculous mycobacterial pulmonary disease. Methods: Medical records and radiologic findings were retrospectively reviewed in 27 patients who were fulfilled the diagnostic criteria of ATS guideline for NTM pulmonary disease between January of 1990 and August of 1998 in Seoul National University Hospital(SNUH). Results: Of the 27 patients, 15 were male. The mean age was 51.5 yr($\pm$11.9). Twenty patients(74.1%) had preexisting pulmonary diseases. Among them, 19 patients had previous pulmonary tuberculosis. Sixteen patients(59.2%) had cavitary lesions and the majority showed slow progression over 1 yr during follow up period on radiography. Susceptibility test to standard antituberculous drugs showed 100% resistance to INH, 72.2% to RMP, 81.5% to EMB, 92.6% to PZA. The average resistance rate to 2nd-line antituberculous drugs was 66.1%. Among twenty-one patients(77.8%) who received drug therapy over 6 months, 11 subjects were improved and 10 subjects were aggravated. Of six subjects(22.2%) without therapy, 5 patients were aggravated. Presence of cavity and less than 3 sensitive drugs in the regimen were indicators for adverse outcome. Conclusion : The nontuberculous mycobacterial pulmonary diseases in our hospital developed predominantly in older patients with preexistent pulmonary disease. The results of antituberculous drug therapy has been frustrating and disappointing. To improve treatment response, different susceptibility tests and drug regimens for different species of NTM should be performed. Also, diagnostic and therapeutic guidelines of Korea should be made in the recent future.

• Tuberculosis and Respiratory Diseases
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• v.78 no.3
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• pp.293-296
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• 2015

Mycobacterium malmoense is a very rare cause of lung disease in South Korea. We reported the first case of lung disease caused by M. malmoense in an immunocompetent patient. The patient was successfully treated with a 14-month course of antibiotics.

• Tuberculosis and Respiratory Diseases
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• v.76 no.1
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• pp.30-33
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• 2014

We report the first Korean case of lung diseases caused by Mycobacterium abscessus subsp. bolletii in a previously healthy male, except for a previous history of pulmonary tuberculosis and bronchiectasis. All serial isolates are identified as M. abscessus subsp. bolletii by multi-locus sequence analysis based on the hsp65, rpoB, and 16S rRNA fragments. At the genetic level, the isolate has the erm(41) gene with a T28 sequevar, associated with clarithromycin resistance, and no rrl mutation. The isolate is resistant to clarithromycin. Although the symptoms and radiographic findings have improved after combination of antibiotics, the follow-up sputum cultures are persistently positive.