JRSM > Volume 96, Number 5 > Pp. 255

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Atypical mycobacterial infections

S Venkatesh Karthik   Kalyani V Mulay

Department of Paediatrics, Warrington Hospital, Warrington WA5 1QG
St James's University Hospital, Leeds, UK

Correspondence to: Dr S V Karthik E-mail: svkarthik{at}yahoo.com

Ms Montague and her colleagues (March 2003 JRSM¹) are unsure about the value of chemotherapy in atypical mycobacterial cervical adenitis. They refer to encouraging results with the macrolide clarithromycin, but both primary and secondary resistance to this agent are well recognized. There is evidence that combination therapy with rifabutin or rifampicin alongside clarithromycin has a synergistic effect, particularly against Mycobacterium avium-intracellulare complex.² This not only ensures maximum antimycobacterial activity but also may protect against the development of secondary clarithromycin resistance. Multidrug regimens employing standard antimycobacterials (isoniazid, ethambutol and/or streptomycin) used with the above combination have proven effective in cases of disseminated atypical mycobacterial infections, particularly in patients with AIDS.³ With excision biopsy early diagnosis is feasible with tools such as the polymerase-chain-reaction linked ELISA with mycobacterial DNA probes. The antimicrobial susceptibility of atypical mycobacteria can be assessed rapidly in tissue specimens by use of mycobacteria growth indicator tubes, which also give an indication of minimum inhibitory concentrations.⁴ These tools for rapid diagnosis, not yet widely available, can be helpful in decisions about postoperative chemotherapy.

REFERENCES

1. Montague M, Musheer Hussain SS, Blair RL. Three cases of atypical mycobacterial cervical adenitis. J R Soc Med2003; 96:129 -31[Free Full Text]

2. Ghebremichael S, Svenson SB, Kallenius G, Hoffner SE. Antimycobacterial synergism of clarithromycin and rifabutin. Scand J Infect Dis 1996;28:387 -90[Medline]

3. Correa AG, Starke JR. Nontuberculous mycobacterial disease in children. Semin Respir Infect1996; 11:262 -71[Medline]

4. Piersimoni C, Nista D, Bornigia S, De Sio G. Evaluation of a new method for rapid drug susceptibility testing of Mycobacterium avium complex isolates by using the mycobacteria growth indicator tube. J Clin Microbiol1998; 36:64 -7[Abstract/Free Full Text]

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This Article Full Text (PDF) Send a Quick Comment Alert me when this article is cited Alert me when Quick Comments are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Karthik, S V. Articles by Mulay, K. V Search for Related Content PubMed PubMed Citation Social Bookmarking                      What's this?