title: [Pulmonary infection with Mycobacterium malmoense. Difficulties in diagnosis and treatment].
abstract: BACKGROUND
  Pulmonary infection due to Mycobacterium malmoense can be difficult to diagnose. These difficulties can be responsible for a delay in the implementation of optimal treatment. Moreover, the treatment is not standardized.
  
  
  METHODS
  We report the case of a 56-year-old patient who developed a Mycobacterium malmoense pulmonary infection whose diagnosis was delayed due to initial suspicion of pulmonary Mycobacterium tuberculosis infection. Once the diagnosis was confirmed, the patient was treated empirically with rifampicin, ethambutol, and clarithromycin for 12 months after culture conversion, giving a total of 15 months. The clinical and radiological outcomes were favorable.
  
  
  CONCLUSIONS
  This clinical case highlights the difficulties of diagnosing pulmonary atypical mycobacterial infection according to the American Thoracic Society criteria, particularly Mycobacterium malmoense, a non-tuberculous mycobacterium (NTM) quite uncommon in France. Currently, there are new diagnostic techniques such as GenoType Mycobacteria Direct®. The second issue is the poorly standardized treatment of this NTM and many others, that are based on the recommendations of the British Thoracic Society. A national register has been set up by the MycoMed network, based essentially on the work of microbiologists but this register is unfortunately not exhaustive.
  
  
  CONCLUSIONS
  A more systematic reporting strategy could allow cohort studies and therefore provide us with data on the most efficient drugs in the treatment of the rarest NTM infections.
authors.affiliation: CHRU de Nancy, bâtiment des spécialités médicales Philippe Cantion, rue du Morvan, 54511 Vandoeuvre-les-Nancy cedex, France. Electronic address: d.huet@chru-nancy.fr.
authors.forename: D
authors.initials: D
authors.lastname: Huet
authors.affiliation: Service de pneumologie, hôpital Robert-Schuman, 57070 Vantoux, France.
authors.forename: B
authors.initials: B
authors.lastname: Godbert
authors.affiliation: Service de pneumologie, hôpital Robert-Schuman, 57070 Vantoux, France.
authors.forename: J
authors.initials: J
authors.lastname: Hermann
authors.affiliation: Service de pneumologie, hôpital Robert-Schuman, 57070 Vantoux, France.
authors.forename: J-M
authors.initials: JM
authors.lastname: Zordan
authors.affiliation: CHRU de Nancy, bâtiment des spécialités médicales Philippe Cantion, rue du Morvan, 54511 Vandoeuvre-les-Nancy cedex, France.
authors.forename: F
authors.initials: F
authors.lastname: Chabot
authors.affiliation: Service de pneumologie et de réanimation respiratoire, CHU Sud, 80080 Amiens, France.
authors.forename: C
authors.initials: C
authors.lastname: Andréjak
mesh_terms: D017291:Clarithromycin / Q000008:administration & dosage; D003937:Diagnosis, Differential; D004977:Ethambutol / Q000008:administration & dosage; D006801:Humans; D008171:Lung Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D009165:Mycobacterium Infections, Nontuberculous / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D009170:Nontuberculous Mycobacteria / Q000302:isolation & purification*; D012141:Respiratory Tract Infections / Q000175:diagnosis* / Q000188:drug therapy; D012293:Rifampin / Q000008:administration & dosage; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis
chemical_list: D004977:Ethambutol; D017291:Clarithromycin; D012293:Rifampin
keywords: Diagnosis; Diagnostic; Infection respiratoire basse; Lower tract pulmonary infection; Mycobacterium malmoense; Traitement; Treatment