Mycobacterium abscessus

Question

Dear expert team,

a friend of ours has CF and has been colonized with Pseudomonas aeruginosa for quite some time. Now, a mycobacterium abscessus colonization came on top of that. My questions on this:

1. Which health effects can the mycobacterium have?
2. How high is the risk of infection for other patients?
3. What are the sources of transmission?
4. How can the mycobacterium treated most sensibly?

Many thanks in advance for your answer and for this fantastic website.

Answer

Hello,

You are saying that your friend has cystic fibrosis, and her lungs have been colonized with Pseudomonas aeruginosa for a while now and recently also with mycobacterium abscessus. You are asking which health effects this colonization has, how one can contract mycobacteria, whether there is a risk of infection for other people, and about possible therapy options.

Mycobacteria are so-called environmental bacteria; they occur in the water, in the ground, in animals, but also in food. They are transmitted via aerosols, by ingestion of bacteria through the mouth. Human-to-human transmission is not known.

Mycobacterium abscessus belongs to the so-called atypical mycobacteria. These germs are dangerous only for people with a defective immune system. It is known of CF patients that colonization of the respiratory tract can lead to lung damage. This has been observed particularly with mycobacterium abscessus. When infected with this germ, CF patients often react with fever and the germs often also appear in the bloodstream. In CF patients whose immune system is weakened due to lung transplantation and the accompanying treatment, the mycobacteria can spread through the bloodstream into other organs, where they can cause abscesses. Generally, mycobacteria are hard to eliminate once they colonize a CF lung. This is particularly true for mycobacterium abscessus. In case of a fever reaction or a declining lung function of an infected CF patient, an antibiotics therapy according to an antibiogram should be initiated. Usually, an adjunctive therapy with three drugs is necessary. This way, fever reactions can be prevented. Elimination of the germ is successful only very sporadically. Some patients receive long-term therapy from their therapist in order to avoid repeated fever attacks and a rapid worsening of the lungs.

Even though direct human-to-human transmission has not been observed, CF patients infected with mycobacterium abscessus should avoid direct contact with other CF patients, since infection with this germ can lead to a significantly reduced life expectancy.

Kind regards,
Dr. H.-G. Posselt

14.02.2012