Features of the diagnosis and treatment of nontuberculous mycobacterial lung disease caused by M. avium and M. abscessus in outpatient settings (a clinical case)

A case study of a 71-year-old patient with non-tuberculous mycobacteriosis (NTML) of the lungs is presented, caused by a combination of two types of non-tuberculosis mycobacteria: M. avium and M. abscessus. The aim is to demonstrate the complexity of the diagnosis and therapy of NTML in outpatient settings, as well as the need for repeated cultural studies, species typing and determination of sensitivity to biomaterial drugs. Materials and methods : clinical and biochemical blood tests, general sputum and VC analysis, examination of the function of external respiration, computed tomography of the chest organs, fibrobronchoscopy, cultural examination of bronchial flushes in liquid medium (Middlebrook 7H9M7H9) in the automated BACTEC MGIT 960 (Bactec 960) system, cytological examination were performed and the detection of acid-resistant mycobacteria (ARM) in the flushes of their bronchi, ECG and echocardiography. Results: in January 2023, the patient was diagnosed with nontuberculous mycobacterium (NTML) caused by Mycobacterium avium, which was sensitive to macrolides, aminoglycosides, and fluoroquinolones. After three months of antibacterial treatment, cultures from the bronchi on liquid medium did not detect any non-tuberculosis mycobacteria. The antibacterial treatment was stopped. However, in January 2024, the patient experienced a relapse of the illness (associated with a viral infection) and Mycobacterium abscessus was detected in the bronchial cultures, requiring a repeat course of antibacterial medication. Conclusions: this clinical case highlights the key points regarding the specific aspects of the diagnosis and treatment process for NTML in an outpatient setting.