Patient: [Patient Name]
MRN: [Medical Record Number]
Date: [Date of Encounter]
Chief Complaint:
(May be asymptomatic or present with) Cough (productive or non-productive),
shortness of breath, hemoptysis (coughing up blood), fatigue, weight loss
(unintentional).
History of Present Illness:
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Onset, duration, and severity of symptoms.
Risk factors for NTM-PD (e.g., underlying lung disease, immunosuppression,
environmental exposures).
Smoking history (may contribute to underlying lung disease).
Prior treatment for NTM-PD (if any).
Past Medical History:
Underlying lung diseases (e.g., chronic obstructive pulmonary disease
(COPD), bronchiectasis, cystic fibrosis) – increase risk for NTM-PD.
Immunosuppressive conditions (e.g., HIV/AIDS, organ transplantation)
increase risk for NTM-PD.
Prior surgeries (lung surgeries may increase risk for NTM-PD).
Social History:
Occupational exposures (e.g., construction, mining, agriculture)
potential exposure to environmental mycobacteria.
Use of recreational water sources (hot tubs, pools) – potential exposure to
environmental mycobacteria.
Family History:
Not typically relevant for NTM-PD unless there is a familial predisposition
to underlying lung diseases that increase risk.
Physical Exam:
General examination: Assess for vital signs (fever may be present in
active disease), weight loss, signs of respiratory distress.
Chest examination: Listen for abnormal breath sounds (crackles, wheezing)
suggestive of airway obstruction or consolidation.
Laboratory Tests:
Sputum culture (acid-fast bacilli stain and culture): Diagnostic test to
identify NTM species and assess for drug susceptibility. Multiple sputum
samples may be needed.
Complete blood count (CBC): May show mild anemia or elevated white
blood cells (WBCs) in active disease.
Imaging Studies:
Chest X-ray: May show infiltrates or cavities suggestive of infection,
but not specific for NTM-PD.
High-resolution chest CT scan: Provides detailed images of the lungs
and can help identify features suggestive of NTM-PD, such as bronchiectasis
or cavities.
Pulmonary Function Tests (PFTs):
May be performed to assess lung function and severity of underlying lung disease.
Assessment:
Non-tuberculous mycobacterial pulmonary disease (NTM-PD): Suspected based
on clinical presentation (symptoms suggestive of chronic respiratory infection), risk factors, and chest imaging findings. Confirmed by identification
of NTM species on sputum culture.
Specific NTM species: Identification of the specific NTM species is
important for guiding treatment decisions as different species have varying
drug susceptibilities.
Severity of disease: Based on symptoms, lung function, and imaging findings.
Differential Diagnoses:
Consider other causes of chronic cough or respiratory symptoms:
Bacterial pneumonia
Tuberculosis (ruled out by acid-fast bacilli stain)
Bronchiectasis (may co-exist with NTM-PD)
Chronic obstructive pulmonary disease (COPD)
Plan:
Treatment for NTM-PD is typically complex and requires prolonged antibiotic
therapy. Possible elements include:
Multidrug antibiotic therapy: Combination of antibiotics based on
sputum culture and drug susceptibility testing. Treatment can last for
months or even years.
Inhaled medications: Bronchodilators for airway improvement or
mucolytics to thin mucus.
Supportive care: Smoking cessation, pulmonary hygiene techniques,
and nutritional support.
Surgical resection (rare): May be considered in some cases for
localized disease or severe complications.
Prognosis:
The prognosis of NTM-PD varies depending on the specific NTM species,
severity of underlying