Internal Medicine

0521779407-15 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 18:43

NSAIDs Nontuberculous Mycobacterial Infections 1069

follow-up

■patients with dyspepsia whose symptoms do not respond to H2

receptor antagonists or proton pump inhibitors within 1 week should

be endoscoped to look for ulcer or other cause of symptoms

■patients with gastric ulcers should have repeat upper endoscopy

after 8 weeks of treatment to confirm healing (to exclude gastric

cancer)

complications and prognosis

■dyspepsia is not life threatening and is usually responsive to stopping

medications or use of acid reducing drugs as noted above

■ulcers almost always heal with acid reducing drugs but can recur

■ulcer complications (bleeding and perforation) occur in 2% of users

of nonselective NSAIDs per year but can be avoided by using COX-2

specific inhibitors. The risk of dying from a major GI hemorrhage is

5–10%

NONTUBERCULOUS MYCOBACTERIAL INFECTIONS

RICHARD A. JACOBS, MD, PhD

history & physical

History

■Nontuberculous or atypical mycobacteria are a heterogeneous group

of acid-fast bacilli that are ubiquitous in nature.

■Cause disease in normal hosts, immunocompromised pts (especially

HIV) and those with underlying pulmonary disease (bronchiectasis)

■Not transmissible from person to person

■Most species NOT sensitive to usual antituberculous drugs

■Most common pathogens are Mycobacterium avium complex

(MAC), M. kansasii, M. fortuitum, M. chelonae, M. abscessus, M.

marinum, M. scrofulaceum

Signs & Symptoms

■Pulmonary – MAC and M. kansasii most common causes; M. for-

tuitum and M. abscessus less common; presentation insidious with

chronic cough, fatigue, weight loss over months

■Lymphadenitis – in children MAC and M. scrofulaceum most com-

mon causes, with M. tuberculosis less common; in adults M.