Pulmonary Nontuberculous Mycobacterial Disease: New Insights into Risk Factors for Susceptibility, Epidemiology, and Approaches to Management in Immunocompetent and Immunocompromised Patients
- 162 Downloads
Nontuberculous mycobacteria (NTM) are ubiquitous in the environment and cause a wide range of diseases in humans. Pulmonary involvement, the most common disease manifestation of NTM infection, is being increasingly encountered in clinical settings. In addition, specific phenotypic and genetic characteristics of persons predisposed to contract pulmonary NTM disease are now beginning to be recognized. Prior to treatment, patients should meet clinical and microbiologic criteria for NTM disease. Treatment involves prolonged courses of antibiotics in various combination regimens that are often discontinued because of serious side effects. In some cases, complete cure of pulmonary disease is difficult to achieve. Rather, clinical improvement may be a more feasible goal. Surgical treatment is warranted for select patients.
KeywordsNontuberculous mycobacteria Bronchiectasis Mycobacterium avium complex Mycobacterium abscessus Mycobacterium kansasii Cystic fibrosis
This work was supported by the Intramural Research Program of the National Institute of Allergy and Infectious Diseases, National Institutes of Health.
The views expressed in this article are those of the authors and do not necessarily reflect those of the US Department of Health and Human Services.
Papers of particular interest, published recently, have been highlighted as: •Of importance ••Of major importance
- 1.•• Griffith DC, Aksamit T, Brown-Elliott BA, et al.: An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med 2007, 175:367–416. This article provides the most up-to-date official guidelines for the diagnosis and management of pulmonary infections caused by nontuberculous mycobacteria endorsed by the American Thoracic Society and the Infectious Diseases Society of America.Google Scholar
- 5.Edwards LB, Acquaviva FA, Livesay VT, et al.: An atlas of sensitivity to tuberculin, PPD-B, and histoplasmin in the United States. Am Rev Respir Dis 1969, 99(Suppl):1–132.Google Scholar
- 6.Kirschner R, Parker B, Falkinham J: Epidemiology of infection by nontuberculous mycobacteria: Mycobacterium avium, Mycobacterium intracellulare, and Mycobacterium scrofulaceum in acid, brown-water swamps of the Southeastern United States and their association with environmental variables. Am Rev Respir Dis 1992, 145:271–275.PubMedGoogle Scholar
- 14.• Kim RD, Greenberg DE, Ehrmantraut ME, et al.: Pulmonary nontuberculous mycobacterial disease: prospective study of a distinct preexisting syndrome. Am J Respir Crit Care Med 2008, 178:1066–1074. This article provides an excellent study of the phenotypic characteristics of women without underlying pulmonary disease who develop pulmonary nontuberculous mycobacterial disease.Google Scholar
- 15.Colombo RE, Hill SC, Claypool RJ, et al.: Familial clustering of pulmonary nontuberculous mycobacterial disease. Chest 2009, Epub ahead of print..Google Scholar
- 17.•• Colombo RE, Olivier KN: Diagnosis and treatment of infections caused by rapidly growing mycobacteria. Semin Respir Crit Care Med 2008, 29:577–588. This article provides a review of the spectrum of disease and management of infection due to rapidly growing mycobacteria, especially Mycobacterium abscessus.Google Scholar
- 22.Research Committee of the British Thoracic Society: Pulmonary disease caused by Mycobacterium avium-intracellulare in HIV-negative patients: five-year follow-up of patients receiving standardized treatment. Int J Tuberc Lung Dis 2002, 6:628–634.Google Scholar
- 30.Jeon K, Jung Kwon O, Lee NY, et al.: Antibiotic treatment of Mycobacterium abscessus lung disease: a retrospective analysis of 65 patients. Am J Respir Crit Care Med 2009, 180:896–902.Google Scholar