Mycobacterial infections

Red flags

Consider urgent referral for patients with the following:

  • Active TB bacilli in sputum (this is a public health risk)
  • Significant SOB
  • Abnormal CXR (new changes)
  • Pleural effusion
  • Cavitation on CXR
  • Immunosupression (drug related or due to other disease (HIV)
  • Spreading ulcer

Features that may lead to more urgent categorisation

  • All new cases of infections involving mycobacteria will be category 1

The common mycobacterial infections are caused by:

  • Mycobacterium tuberculosis
  • Mycobacterium avium intracellularae

There are also atypical mycobacterial infections which are involved in ulcerating skin infections and occasionally in pulmonary infections.

  • M. fortitum
  • M. chelonae
  • M. abscessus
  • M. marinum
  • M. ulcerans
  • Rare organisms include
    • Mycobacterim leprae
    • Mycobacterium bovis

Other important information for referring practitioners

Lifestyle changes

  • Adopt healthy lifestyle, good nutrition
  • Encourage smoking cessation

Medical management

  • All cases of TB should be managed by a specialist as it is essential that treatment regimens are adhered to. This is to prevent the development of resistance.
  • Treat any associated conditions leading to immunosuppression
  • Monitor side effects and interactions of any anti tuberculous medication
  • Drugs used to treat mycobacterial infections are:
    • Classical TB (pulmonary or extrapulmonary)
      • Rifampicin
      • Isoniazid
      • Pyrazimamide
      • Ethambutol
      • Moxifloxacin
    • Atypical
      • Clarithromycin
      • Rifampicin
      • Ethambutol
      • Cefoxitin

Referral requirements

A referral may be rejected without the following information.

  • Presence of any red flags
  • Timeline and duration of symptoms
  • Suspected source of infection
  • Presence of immunosuppression and cause
  • Current medication list and allergies
  • Any relevant co-morbidities
  • If has been treated before by specialist include last 2-3 specialist letters
  • Relevant examination findings
  • Investigations:
    • CXR
    • CT chest if abnormal CXR
    • Sputum microscopy and culture and mycobacterial culture and ZN staining
    • FBC, E/LFT, ESR, CRP
    • MSU microscopy and culture
    • Quantiferon gold assay
    • HIV serology

Out of catchment

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander
  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can’t order, or the patient can’t afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary
  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use
  • Full name (including aliases)
  • Date of birth
  • Residential and postal address
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander
  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature
  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)
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