Kevin Winthrop, MD, MPH, explains the diagnosis and management of nontuberculous mycobacterial lung disease through the use of infographics for this CME activity titled “Improving Outcomes for Patients With Nontuberculous Mycobacterial Lung Disease: Navigating the Complexities of Diagnosis and Management.” For the full presentation, monograph, complete CME information, and to apply for credit, please visit us at https://bit.ly/2ypuMNH. CME credit will be available until June 22, 2021.

1. Smoking/
emphysema
(often cavitary)
Evaluating Strategies to Improve the Diagnosis of NTM-LD
• M. avium complex
• M. kansasii
• M. marinum
• M. xenopi
• M. abscessus
• M. chelonae
• M. fortuitum
Most Common NTM1,2
~75%
of NTM disease
is pulmonary
Diagnosis4,5
Risk Factors4
Two Disease Types3,4
Rapid
growers
Slow
growers
Bronchiectatic
Nontuberculous
Mycobacterial
Lung Disease
• Symptoms
• Radiology
• Microbiology
ATS/IDSA Diagnostic
Criteria• Chronic cough
• Hemoptysis
• Weight loss
Suspicion
• Fatigue, malaise
• Fever/chills/
night sweats
Underlying lung
architectural abnormalities
Rates increase
with age
Improving Outcomes for Patients With Nontuberculous Mycobacterial Lung Disease:
Navigating the Complexities of Diagnosis and Management
Full references, accreditation, and disclosure information available at PeerView.com/GRG930

2. Clofazimine
Moxifloxacin
Ciprofloxacin
Linezolid/tedizolid
Bedaquiline
Daily
Rifampin
Ethambutol
Additional drug
Cavities present?
Add amikacin
Consider surgery
Daily
Azithromycin
Rifampin
Ethambutol
3x/week
Azithromycin
Rifampin
Ethambutol
At least yearly
Sputum for AFB analysis
Generally every 3-6 months
Clinical
follow-up
Radiographic
follow-up
Microbiologic
follow-up
Inducible drug
resistance
Drug Resistance10
Mutational
resistance
Follow-Up After MAC Therapy12,27,28
Spontaneous
conversion
of sputum to AFB
culture negative
10%-15%
of pts
Risk/benefit
analysis
Highly
drug-resistant
organisms
Shared
decision-making
Analysis of
microbiologic
recurrences
with >1 positive culture
• Minimum à Species ID
üû
ü ûMacrolide sensitive?
Individualizing Treatment for Patients With NTM-LD Using Novel Approaches and Effective Communication
Factors Influencing Treatment Decision4,6-9
MAC Treatment Algorithm4,11-26
Improving Outcomes for Patients With Nontuberculous Mycobacterial Lung Disease:
Navigating the Complexities of Diagnosis and Management
Full references, accreditation, and disclosure information available at PeerView.com/GRG930