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Chronic, persistent and dry cough with periodic mucopurulent discharge, low-grade fever or even fever, night sweats, unplanned weight loss are typical symptoms associated with a little-known respiratory disease called mycobacteriosis. Rare symptoms of mycobacteriosis are shortness of breath and chest pain.
Mycobacteriosis is caused by non-tuberculous mycobacteria (NTM, or “non-tuberculous mycobacteria”, or MOTT, or “mycobacteria other than tuberculousis”), which are very common in our environment, but the disease itself is considered a rare disease. In Poland, about 200 cases of mycobacteriosis are registered annually, mainly among people from the high-risk group, which includes people with weakened immunity and the elderly. Mycobacteria that cause it are responsible for diseases of the lungs, lymph nodes, skin, subcutaneous tissues and peritonitis.
How is it possible to get infected with mycobacteriosis?
Non-tuberculous bacilli can be found in soil and in open water reservoirs. They are also present in tap water, but they are present in small concentrations, therefore they are not dangerous to us. Unfortunately, they also accumulate in tap deposits or on the inside of the shower heads. In these places they create a biofilm and then their concentration can be even 100 times higher than the concentration in water, which is already a threat to health. Research shows that the biofilm formed on tap water spouts in Poland is most often isolated M. kansasii – mycobacteria from the group Mycobacterium avium complex. Therefore, they are the most common cause of mycobacteriosis in our country.
Pathogens can enter our body through the nose and mouth, and then enter the respiratory system along with splashing water drops, which happens when showering. Infection can also occur by inhaling germs with tap water (e.g. in a sauna). Mycobacteria cannot be infected from another person or from an animal.
Mycobacteriosis – risk groups
People suffering from chronic respiratory diseases, such as chronic obstructive pulmonary disease, pneumoconiosis or cystic fibrosis, tuberculosis, allergic bronchopulmonary aspergillosis or bronchiectasis are the most vulnerable to mycobacteriosis. Chest deformities also increase the likelihood of developing the disease, as do gastroesophageal reflux disease and achalasia. People with a weakened immune system, e.g. HIV carriers, people after transplants or struggling with cancer, are also at increased risk. Another group at risk of developing mycobacteriosis are people with chronic diseases such as kidney failure, diabetes and alcoholism. But susceptibility to infection with mycobacteria may also be genetically determined.
Symptoms of mycobacteriosis
When the disease develops, the patient may have a chronic, persistent and dry cough with periodic mucopurulent discharge, low-grade fever or fever, night sweats. Unplanned weight loss is also characteristic. Dyspnoea or chest pain rarely occurs in the course of the disease. In people at increased risk of developing the disease, non-tuberculous bacilli may lead to inflammation of the lymph nodes, as well as skin and soft tissues.
It also happens that after entering the body, non-tuberculous mycobacteria do not give any symptoms. If mycobacteriosis develops, it most often occurs in the form of tuberculosis (despite the fact that it is caused by non-tuberculous mycobacteria), which is the most vulnerable in people with lung lesions. However, before a full-blown disease develops, the ailments are not very specific and are often confused with other respiratory diseases. This is because mycobacteria reproduce very slowly and the disease takes years to develop.
In children, mycobakeriosis most often occurs as a nodal form, in adults – pulmonary.
Diagnosis and treatment of mycobacteriosis
To make a diagnosis for a patient, a chest X-ray should be performed. In the case of the disease, disintegrating infiltrates, nodules and / or lumpy masses are visible. Another important test is the microbiological test, i.e. the culture of sputum or bronchopulmonary lavage. After diagnosing the type of mycobacteria, the doctor selects the appropriate treatment.
Mycobacteria are very resistant to treatment. Therefore, therapy is lengthy and typically must be continued for at least one year after receiving a negative culture. In total, treatment may take up to 2 years. It usually involves the use of several drugs, most often rifampicin, isoniazid and ethambutol.
People who have undergone mycobacteriosis must undergo an X-ray of the lungs once a year after the end of treatment. Patients and convalescents remain under the care of a lung disease clinic, as they are at increased risk of developing pulmonary tuberculosis.