Mycobacterium intracellulare in the CF sputum

Question

Hello dear expert team,
in my sputum (I am nearly 30 years old) Mycobactrium intracellulare has been detected last December for the first time. Since then this bacterium could be found in 2 further tests, so that I can assume a chronic infection. As I have been at another CF Center before and to my knowledge those mycobacterial investigations have never been done there, I assume, that I have this bacterium already for a longer time.
As I am doing very well (FEV1 is at the moment between 84-88% and is unchanged) and as I can do a lot of sports without problems (mountain sport: ski tours, climbing, running, mountain biking…) and I have no complaints, I ask me and you the question, if I should have the Mycobacterium treated at all? The treatment would last for months respectively years and would bring side effects with it.
Wouldn’t it be like this that after at least 4 or 5 months an infection with this bacterium would have lead to a deterioration of the lung function respectively other symptoms would have occurred?
I would be very pleased about an answer.
Best regards,
A female CF patient

Answer

Dear questioner,
you want to know, if the finding of Mycobacterium intracellulare without clinical symptoms should be treated or not.
At this point, we have to state first, that we cannot make a diagnosis via the Internet, cannot make therapeutical recommendations either and cannot make clinical decisions either. However, we can provide information, which should help the questioner to conduct the talk with the physician in charge and to understand problems better and be able to make the right decisions.
In the last years, the meaning of NTM (non-tuberculous Mycobacteria) has increased in lung diseases, as clinical symptoms could indeed be correlated with an NTM infection because of more targeted diagnostic procedures. Among this, lung diseases due to Mycobacterium avium intracellulare complex are a more and more noticed as a clinical problem. On the other side it is estimated, that the finding of NTM in the laboratory is causing only in 20-40% indeed an infection with symptoms in the patient. In the meantime, over 140 different species of NTM have been described and these germs occur everywhere in the environment. The differentiation between a colonization and an infection with NTM is difficult, therefore an individual decision has to be made concerning a NTM-targeted treatment. Regarding the difficult assurance of the diagnosis and a complicated and long-lasting NTM therapy, always the profit and the side effects of such a treatment have to be weighed against in case of the finding of Mycobacterium avium intracellulare complex (literuature: Bös L. Et al, Nontuberculous mycobacteria – a short overview of epidemiology, diagnostics and therapy. Pneumologie 2015; 69:287-294 [article in German]).
In all cases with a favorable and stable course of the illness in case of CF in spite of Mycobacterium avium intracellulare-complex finding it should be decided together with the patient about the therapy. In case of waiting when NTM has been found, microbiological controls for NTM should be done at least once a year and the indication for a targeted NTM therapy should always been newly discussed at the 3 monthly controls in the CF center.
I hope to have helped you with my answer a bit and stay with my best regards,
Yours Dr. med Christina Smaczny

04.07.2016