Antibiotic treatments against lung infections by the bacteria Mycobacterium abscessus can improve the outcome of patients with bronchiectasis, according to a new study.
The case study “Eradication Of Mycobacterium Abscessus Pulmonary Infection In A Child With Idiopathic Bronchiectasis” was published in the journal Global Pediatric Health.
Mycobacterium abscessus is greatly associated with lung infection among patients with bronchiectasis, and is an important cause of morbidity among this patient population.
In the study, researchers reported the case of an 8-year-old girl who was treated for an Mycobacterium abscessus infection and improved her bronchiectasis.
The patient had persistent asthma since she was 4 and a history of respiratory infections, including six to eight episodes of bronchitis treated with antibiotics every year, two episodes of pneumonia and a diagnosis of sinusitis. When the child was admitted to the hospital, she presented a persistent daily cough, which was worse in the morning, after exercise and after exposure to smoke. Lung examinations revealed crackles and wheeze sounds as she breathed.
Doctors performed several medical tests and analyses to dismiss the existence of cystic fibrosis, a genetic lung disease closely associated with persistent lung infections. Genetic tests were normal, dismissing the existence of cystic fibrosis. The patient’s spirometry (a measure of lung function) was normal. A chest CT scan suggested the presence of an atypical lung infection and the onset of pneumonia.
Analysis of the bronchoalveolar lavage (the fluid present in the lungs’ bronchi) revealed the presence of the bacteria Streptococcus pneumoniae and M. abscessus. The patient was then administered the antibiotics amoxicillin and clavulanate for 21 days, after which she had less cough and sputum production; an improvement in her lung function also was observed.
However, in the following months, the girl’s respiratory symptoms worsened, the cough returned and her lung function declined. The patient was treated for 14 days with intravenous clindamycin and piperacillin-tazobactam antibiotics for persistent pneumococcal infection. After the treatment, her lung function improved again and there was no sign of bacterial or fungal infections.
One month later, the patient was readmitted to the hospital with a bronchiectasis exacerbation with fever, vomit, increased cough, sputum production, and a declining lung function. She also had infection by M. abscessus. The patient was then given a triple antibiotic therapy, composed of daily intravenous tigecycline (50 mg), daily oral azithromycin (250 mg), and twice-daily inhaled tobramycin (300 mg). The treatment improved the patient’s symptoms and her lung function. The girl was sent home to continue her triple antibiotic therapy for the following months.
Two months later, her lungs had significantly improved and the patient had decreased sputum production and improved lung function. She had no signs of bacterial or fungal infections. After five months, the antibiotic treatment was discontinued and she remained asymptomatic.
“Our case highlights several key points,” the authors wrote in their report. “First, in children with underlying lung pathology, particularly bronchiectasis, presenting with pulmonary exacerbations, a high index of suspicion should be maintained for atypical nontuberculous bacterial infections, including M. abscessus. Second, we present a well-tolerated, effective, novel approach to treatment of M. abscessus in a pediatric patient.”
“Finally, early identification of this pathogen allows for expeditious treatment, improved outcomes, and possible infection eradication for the pediatric patients with Mycobacterium abscessus infection,” the researchers concluded.
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