Zusammenfassung
Nichttuberkulöse Mykobakterien (NTM) stellen eine Gruppe biologisch diverser, ubiquitär vorkommender und von Natur aus multiresistenter fakultativ pathogener Bakterien dar. Aktuelle Daten legen eine weltweit zunehmende klinische Relevanz und ein Infektionsrisiko für suszeptible Individuen über Oberflächen und Aerosole nahe. Da diese Personen häufig eine prädisponierende chronische Lungenerkrankung, z. B. Bronchiektasen, eine chronisch-obstruktive Lungenerkrankung oder eine Mukoviszidose, aufweisen, die sich mit der unspezifischen Symptomatik einer NTM-Lungenerkrankung überschneidet, wird die korrekte Diagnose basierend auf klinischen, radiologischen und mikrobiologischen Kriterien oft erst mit großer zeitlicher Verzögerung gestellt. Die Therapie der NTM-Lungenerkrankung ist anspruchsvoller als die Therapie der Lungentuberkulose, da sie in der Regel langwieriger, toxischer und teurer ist und bedeutend häufiger versagt. Die Wahl der antimikrobiellen Kombinationstherapie richtet sich nach patienten- und pathogenseitigen Faktoren und sollte sich an den nationalen und internationalen Empfehlungen orientieren. Da Nebenwirkungen regelhaft auftreten, sollten diese antizipiert und engmaschig überwacht werden. Bei Infektionen durch seltene NTM-Spezies und bei schweren oder refraktären Verläufen sollte ein interdisziplinäres Vorgehen unter Einbeziehung von Infektiologen und erfahrenen Thoraxchirurgen angestrebt und der Patient an ein spezialisiertes Zentrum überwiesen werden.
Abstract
Nontuberculous mycobacteria (NTM) are a group of biologically diverse, ubiquitous and naturally multi-drug resistant bacteria with facultative pathogenicity. Recent data suggest that their clinical significance is increasing worldwide and that susceptible individuals may be at risk for infection via contaminated surfaces and aerosols. These individuals often have a predisposition for chronic respiratory diseases, e. g. bronchiectasis, chronic obstructive pulmonary disease (COPD) and cystic fibrosis and these conditions frequently share the same unspecific signs and symptoms with NTM pulmonary disease (NTM-PD). As a consequence, the diagnosis of NTM-PD, which is established based on clinical, radiological and microbiological criteria, is often delayed. Treating NTM-PD is more demanding than treating pulmonary tuberculosis as therapy is generally more tedious, toxic and expensive as well as being prone to failure. Patient and pathogen-specific factors guide the choice of an appropriate antimicrobial combination regimen, which should comply with national and international recommendations. Adverse events are common, should be anticipated and closely monitored. If infections with infrequently encountered mycobacterial species and severe or refractory disease occur, an interdisciplinary approach should be used, involving infectious disease specialists, experienced thoracic surgeons and referral to an NTM specialist center.
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F.C. Ringshausen gibt an, Forschungsunterstützung (Drittmittel) von Bayer HealthCare, Grifols und Insmed Deutschland zu erhalten; er gibt ferner an, Vortragshonorare bzw. Honorare für Beratertätigkeiten von AstraZeneca, Bayer HealthCare, Brahms/Thermo Fisher Scientific, Cellestis/Qiagen, Forest Laboratories, Grifols und Insmed Deutschland sowie Reisekostenunterstützung bzw. Unterstützung für Patientenveranstaltungen von Abbott, Chiesi, Gilead, Pfizer, OxyCare, Novartis, Heinen + Löwenstein, MSD, InfectoPharm und Bayer HealthCare erhalten zu haben. J. Rademacher gibt an, Vortragshonorare bzw. Honorare für Beratertätigkeiten von Bayer HealthCare, Grifols, Novartis, OmniaMed World of Education, AstraZeneca und Insmed Deutschland erhalten zu haben.
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Ringshausen, F.C., Rademacher, J. Lungenerkrankung durch nichttuberkulöse Mykobakterien. Internist 57, 142–152 (2016). https://doi.org/10.1007/s00108-015-0014-6
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DOI: https://doi.org/10.1007/s00108-015-0014-6