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The Management of Lung Disease Caused by Opportunist Mycobacteria

Based on a lecture delivered at the Symposium on Emerging Problems in Respiratory Medicine held in the College on 6 November 1998 Consultant Chest Physician, Llandough Hospital, Cardiff This group of organisms is known by many names, i.e. Mycobacteria Other Than Tuberculosis (MOTT), Nontuberculous Mycobacteria, Atypical Mycobacteria, Anonymous Mycobacteria, Environmental Mycobacteria or Opportunist Mycobacteria. As M. leprae is not included in this grouping, the use of the first two names is inappropriate. The organisms are not atypical of the mycobacterial genus nor are they without name or unknown thus the third and fourth terms are inappropriate. Of the last two names, I prefer Opportunist Mycobacteria because that term better describes their pathological relationships to the human than does the term Environmental Mycobacteria. These organisms are ubiquitous in the environment and are low-grade pathogens. Cross-infection between patients is very rare indeed. Notification to the Public Health Authorities and contact tracing are unnecessary. Clinically, radiologically and on direct smear the organisms are indistinguishable from M. tuberculosis. Diagnosis is based on culture (Löwenstein Jensen or Middlebrook media) and special methods of identification such as temperature range, oxygen preference, sensitivity pattern, pigment production, hydrolysis of Tween 80 and chromatography. DNA probes are available for M. avium, M. intracellulare, M. kansasii and M. gordonae. M. kansasii, M. avium intracellulare (MAC or MAIS), M. malmoense and M. xenopi cause pulmonary disease in humans more than all the other species (Table 1).