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The challenge of pulmonary nontuberculous mycobacterial infection

  • Bronchiectasis (G Tino, Section Editor)
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Abstract

The incidence of nontuberculous mycobacterial (NTM) lung disease is increasing. Current treatment strategies are largely based on expert opinion. The lack of randomized clinical trials to inform treatment leave clinicians with many questions regarding the most effective and safe regimens. The risk-benefit ratio of therapy is often thought to favor observation given the chronic nature of the disease, multiple long-term antibiotics recommended for therapy, side effects associated with treatment, and perceived lack of efficacious therapies.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. van der Werf MJ, Kodmon C, Katalinic-Jankovic V, Kummik T, Soini H, Richter E, et al. Inventory study of non-tuberculous mycobacteria in the European Union. BMC Infect Dis. 2014;14:62. 2334-14-62.

    Article  PubMed Central  PubMed  Google Scholar 

  2. Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro A, Daley C, Gordin F, et al. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med. 2007;175(4):367–416.

    Article  CAS  PubMed  Google Scholar 

  3. Marras TK, Prevots DR, Jamieson FB, Winthrop KL, MAC Pulmonary Outcomes Group. Opinions differ by expertise in Mycobacterium avium complex disease. Ann Am Thorac Soc. 2014;11(1):17–22.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Falkinham 3rd JO. Surrounded by mycobacteria: nontuberculous mycobacteria in the human environment. J Appl Microbiol. 2009;107(2):356–67.

    Article  CAS  PubMed  Google Scholar 

  5. Adjemian J, Olivier KN, Prevots DR. Nontuberculous mycobacteria among patients with cystic fibrosis in the United States: screening practices and environmental risk. Am J Respir Crit Care Med. 2014;190(5):581–6.

    Article  PubMed  Google Scholar 

  6. Henkle E, Hedberg K, Schafer S, Novosad S, Winthrop KL. Population-based incidence of pulmonary nontuberculous mycobacterial disease in Oregon 2007-2012. Ann Am Thorac Soc. 2015.

  7. Winthrop KL, McNelley E, Kendall B, Marshall-Olson A, Morris C, Cassidy M, et al. Pulmonary nontuberculous mycobacterial disease prevalence and clinical features: an emerging public health disease. Am J Respir Crit Care Med. 2010;182(7):977–82.

    Article  PubMed  Google Scholar 

  8. Prevots DR, Shaw PA, Strickland D, Jackson LA, Raebel MA, Blosky MA, et al. Nontuberculous mycobacterial lung disease prevalence at four integrated health care delivery systems. Am J Respir Crit Care Med. 2010;182(7):970–6.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Andrejak C, Nielsen R, Thomsen VO, Duhaut P, Sorensen HT, Thomsen RW. Chronic respiratory disease, inhaled corticosteroids and risk of non-tuberculous mycobacteriosis. Thorax. 2013;68(3):256–62.

    Article  PubMed  Google Scholar 

  10. Fowler SJ, French J, Screaton NJ, Foweraker J, Condliffe A, Haworth CS, et al. Nontuberculous mycobacteria in bronchiectasis: prevalence and patient characteristics. Eur Respir J. 2006;28(6):1204–10.

    Article  CAS  PubMed  Google Scholar 

  11. McShane PJ, Naureckas ET, Strek ME. Bronchiectasis in a diverse US population: effects of ethnicity on etiology and sputum culture. Chest. 2012;142(1):159–67.

    Article  PubMed  Google Scholar 

  12. Mirsaeidi M, Hadid W, Ericsoussi B, Rodgers D, Sadikot RT. Non-tuberculous mycobacterial disease is common in patients with non-cystic fibrosis bronchiectasis. Int J Infect Dis. 2013;17(11):e1000–4.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Wickremasinghe M, Ozerovitch LJ, Davies G, Wodehouse T, Chadwick MV, Abdallah S, et al. Non-tuberculous mycobacteria in patients with bronchiectasis. Thorax. 2005;60(12):1045–51.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  14. Marras TK, Mendelson D, Marchand-Austin A, May K, Jamieson FB. Pulmonary nontuberculous mycobacterial disease, Ontario, Canada, 1998-2010. Emerg Infect Dis. 2013;19(11):1889–91.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Adjemian J, Olivier KN, Seitz AE, Holland SM, Prevots DR. Prevalence of nontuberculous mycobacterial lung disease in U.S. Medicare beneficiaries. Am J Respir Crit Care Med. 2012;185(8):881–6.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Bodle EE, Cunningham JA, Della-Latta P, Schluger NW, Saiman L. Epidemiology of nontuberculous mycobacteria in patients without HIV infection. New York City. Emerg Infect Dis. 2008;14(3):390–6.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Mirsaeidi M, Machado RF, Garcia JG, Schraufnagel DE. Nontuberculous mycobacterial disease mortality in the United States, 1999-2010: a population-based comparative study. PLoS One. 2014;9(3):e91879.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Feazel LM, Baumgartner LK, Peterson KL, Frank DN, Harris JK, Pace NR. Opportunistic pathogens enriched in showerhead biofilms. Proc Natl Acad Sci U S A. 2009;106(38):16393–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  19. Lee G, Lee KS, Moon JW, Koh WJ, Jeong BH, Jeong YJ, et al. Nodular bronchiectatic Mycobacterium avium complex pulmonary disease. Natural course on serial computed tomographic scans. Ann Am Thorac Soc. 2013;10(4):299–306.

    Article  PubMed  Google Scholar 

  20. Maliwan N, Zvetina JR. Clinical features and follow up of 302 patients with Mycobacterium kansasii pulmonary infection: a 50 year experience. Postgrad Med J. 2005;81(958):530–3.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  21. Reich JM, Johnson RE. Mycobacterium avium complex pulmonary disease presenting as an isolated lingular or middle lobe pattern. The Lady Windermere syndrome. Chest. 1992;101(6):1605–9.

    Article  CAS  PubMed  Google Scholar 

  22. Kim RD, Greenberg DE, Ehrmantraut ME, Guide SV, Ding L, Shea Y, et al. Pulmonary nontuberculous mycobacterial disease: prospective study of a distinct preexisting syndrome. Am J Respir Crit Care Med. 2008;178(10):1066–74.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  23. Chan ED, Iseman MD. Slender, older women appear to be more susceptible to nontuberculous mycobacterial lung disease. Gend Med. 2010;7(1):5–18.

    Article  PubMed  Google Scholar 

  24. Kartalija M, Ovrutsky AR, Bryan CL, Pott GB, Fantuzzi G, Thomas J, et al. Patients with nontuberculous mycobacterial lung disease exhibit unique body and immune phenotypes. Am J Respir Crit Care Med. 2013;187(2):197–205.

    Article  PubMed  Google Scholar 

  25. Griffith DE, Girard WM, Wallace Jr RJ. Clinical features of pulmonary disease caused by rapidly growing mycobacteria. An analysis of 154 patients. Am Rev Respir Dis. 1993;147(5):1271–8.

    Article  CAS  PubMed  Google Scholar 

  26. Carrillo MC, Patsios D, Wagnetz U, Jamieson F, Marras TK. Comparison of the spectrum of radiologic and clinical manifestations of pulmonary disease caused by Mycobacterium avium complex and Mycobacterium xenopi. Can Assoc Radiol J. 2014;65(3):207–13.

    Article  PubMed  Google Scholar 

  27. Ito Y, Hirai T, Maekawa K, Fujita K, Imai S, Tatsumi S, et al. Predictors of 5-year mortality in pulmonary Mycobacterium avium-intracellulare complex disease. Int J Tuberc Lung Dis. 2012;16(3):408–14.

    Article  CAS  PubMed  Google Scholar 

  28. Kobashi Y, Yoshida K, Miyashita N, Niki Y, Oka M. Relationship between clinical efficacy of treatment of pulmonary Mycobacterium avium complex disease and drug-sensitivity testing of Mycobacterium avium complex isolates. J Infect Chemother. 2006;12(4):195–202.

    Article  CAS  PubMed  Google Scholar 

  29. Kobashi Y, Abe M, Mouri K, Obase Y, Kato S, Oka M. Relationship between clinical efficacy for pulmonary MAC and drug-sensitivity test for isolated MAC in a recent 6-year period. J Infect Chemother. 2012;18(4):436–43.

    Article  CAS  PubMed  Google Scholar 

  30. Brown-Elliott BA, Iakhiaeva E, Griffith DE, Woods GL, Stout JE, Wolfe CR, et al. In vitro activity of amikacin against isolates of Mycobacterium avium complex with proposed MIC breakpoints and finding of a 16S rRNA gene mutation in treated isolates. J Clin Microbiol. 2013;51(10):3389–94.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  31. Kasperbauer SH, De Groote MA. The treatment of rapidly growing mycobacterial infections. Clin Chest Med. 2015;36(1):67–78.

    Article  PubMed  Google Scholar 

  32. Griffith DE, Brown-Elliott BA, Benwill JL, Wallace Jr RJ. Mycobacterium abscessus. "Pleased to meet you, hope you guess my name…". Ann Am Thorac Soc. 2015;12(3):436–9.

    Article  PubMed  Google Scholar 

  33. Nash KA, Brown-Elliott BA, Wallace Jr RJ. A novel gene, erm(41), confers inducible macrolide resistance to clinical isolates of Mycobacterium abscessus but is absent from Mycobacterium chelonae. Antimicrob Agents Chemother. 2009;53(4):1367–76.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  34. Bastian S, Veziris N, Roux AL, Brossier F, Gaillard JL, Jarlier V, et al. Assessment of clarithromycin susceptibility in strains belonging to the Mycobacterium abscessus group by erm(41) and rrl sequencing. Antimicrob Agents Chemother. 2011;55(2):775–81.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  35. Tettelin H, Davidson RM, Agrawal S, Aitken ML, Shallom S, Hasan NA, et al. High-level relatedness among Mycobacterium abscessus subsp. massiliense strains from widely separated outbreaks. Emerg Infect Dis. 2014;20(3):364–71.

    Article  PubMed Central  PubMed  Google Scholar 

  36. Brown-Elliott BA, Vasireddy S, Vasireddy R, Iakhiaeva E, Howard ST, Nash K, et al. Utility of sequencing the erm(41) gene in isolates of Mycobacterium abscessus subsp. abscessus with low and intermediate clarithromycin MICs. J Clin Microbiol. 2015;53(4):1211–5.

    Article  CAS  PubMed  Google Scholar 

  37. Griffith DE. Mycobacterium abscessus subsp abscessus lung disease: 'trouble ahead, trouble behind…'. F1000Prime Rep. 2014;6:107. 107.eCollection 2014.

    Article  PubMed Central  PubMed  Google Scholar 

  38. Broda A, Jebbari H, Beaton K, Mitchell S, Drobniewski F. Comparative drug resistance of Mycobacterium abscessus and M. chelonae isolates from patients with and without cystic fibrosis in the United Kingdom. J Clin Microbiol. 2013;51(1):217–23.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  39. Nash KA, Zhang Y, Brown-Elliott BA, Wallace Jr RJ. Molecular basis of intrinsic macrolide resistance in clinical isolates of Mycobacterium fortuitum. J Antimicrob Chemother. 2005;55(2):170–7.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  40. Swenson JM, Thornsberry C, Silcox VA. Rapidly growing mycobacteria: testing of susceptibility to 34 antimicrobial agents by broth microdilution. Antimicrob Agents Chemother. 1982;22(2):186–92.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  41. Swenson JM, Wallace Jr RJ, Silcox VA, Thornsberry C. Antimicrobial susceptibility of five subgroups of Mycobacterium fortuitum and Mycobacterium chelonae. Antimicrob Agents Chemother. 1985;28(6):807–11.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  42. Andrejak C, Lescure FX, Pukenyte E, Douadi Y, Yazdanpanah Y, Laurans G, et al. Mycobacterium xenopi pulmonary infections: a multicentric retrospective study of 136 cases in north-east France. Thorax. 2009;64(4):291–6.

    Article  CAS  PubMed  Google Scholar 

  43. Field SK, Fisher D, Cowie RL. Mycobacterium avium complex pulmonary disease in patients without HIV infection. Chest. 2004;126(2):566–81.

    Article  PubMed  Google Scholar 

  44. Xu HB, Jiang RH, Li L. Treatment outcomes for Mycobacterium avium complex: a systematic review and meta-analysis. Eur J Clin Microbiol Infect Dis. 2014;33(3):347–58.

    Article  CAS  PubMed  Google Scholar 

  45. Wallace Jr RJ, Brown-Elliott BA, McNulty S, Philley JV, Killingley J, Wilson RW, et al. Macrolide/Azalide therapy for nodular/bronchiectatic mycobacterium avium complex lung disease. Chest. 2014;146(2):276–82. Retrospective study of 180 patients with nodular/bronchiectatic MAC pulmonary disease treated with macrolide/azalide therapy via a consistent protocol at a single center. 84% of patients achieved treatment success (sputum conversion without true microbiological relapse). Of those with microbiologic recurrence, 75% were reinfection isolates.

    Article  CAS  PubMed  Google Scholar 

  46. Griffith DE, Brown-Elliott BA, Langsjoen B, Zhang Y, Pan X, Girard W, et al. Clinical and molecular analysis of macrolide resistance in Mycobacterium avium complex lung disease. Am J Respir Crit Care Med. 2006;174(8):928–34.

    Article  CAS  PubMed  Google Scholar 

  47. Jeong BH, Jeon K, Park HY, Kim SY, Lee KS, Huh HJ, et al. Intermittent antibiotic therapy for nodular bronchiectatic Mycobacterium avium complex lung disease. Am J Respir Crit Care Med. 2015;191(1):96–103. This is a retrospective cohort study of 217 patients with noncavitary MAC pulmonary disease treated with daily or TIW therapy (macrolide, ethambutol, and rifampin). They found no difference in outcomes between intermittent and daily therapy.

    Article  CAS  PubMed  Google Scholar 

  48. Miwa S, Shirai M, Toyoshima M, Shirai T, Yasuda K, Yokomura K, et al. Efficacy of clarithromycin and ethambutol for Mycobacterium avium complex pulmonary disease. A preliminary study. Ann Am Thorac Soc. 2014;11(1):23–9. This is a preliminary open-label study of 2-drug (clarithromycin and ethambutol) vs. 3-drug (clarithromycin, ethambutol, and rifampin) for MAC pulmonary disease. They found that 2-drug therapy was not inferior to 3-drug therapy.

    Article  PubMed  Google Scholar 

  49. Choi GE, Shin SJ, Won CJ, Min KN, Oh T, Hahn MY, et al. Macrolide treatment for Mycobacterium abscessus and Mycobacterium massiliense infection and inducible resistance. Am J Respir Crit Care Med. 2012;186(9):917–25.

    Article  CAS  PubMed  Google Scholar 

  50. Maurer FP, Castelberg C, Quiblier C, Bottger EC, Somoskovi A. Erm(41)-dependent inducible resistance to azithromycin and clarithromycin in clinical isolates of Mycobacterium abscessus. J Antimicrob Chemother. 2014;69(6):1559–63.

    Article  CAS  PubMed  Google Scholar 

  51. Jarand J, Levin A, Zhang L, Huitt G, Mitchell JD, Daley CL. Clinical and microbiologic outcomes in patients receiving treatment for Mycobacterium abscessus pulmonary disease. Clin Infect Dis. 2011;52(5):565–71.

    Article  PubMed  Google Scholar 

  52. Koh WJ, Jeon K, Lee NY, Kim BJ, Kook YH, Lee SH, et al. Clinical significance of differentiation of Mycobacterium massiliense from Mycobacterium abscessus. Am J Respir Crit Care Med. 2011;183(3):405–10.

    Article  PubMed  Google Scholar 

  53. Kim HS, Lee KS, Koh WJ, Jeon K, Lee EJ, Kang H, et al. Serial CT findings of Mycobacterium massiliense pulmonary disease compared with Mycobacterium abscessus disease after treatment with antibiotic therapy. Radiology. 2012;263(1):260–70.

    Article  PubMed  Google Scholar 

  54. Novosad S, Polgreen P, Mackey K, Beekmann S, Winthrop K. Treatment of Mycobacterium Abscessus: a case series via the emerging infections network. San Diego: American Thoracic Society; 2014.

    Google Scholar 

  55. Olivier KN, Shaw PA, Glaser TS, Bhattacharyya D, Fleshner M, Brewer CC, et al. Inhaled amikacin for treatment of refractory pulmonary nontuberculous mycobacterial disease. Ann Am Thorac Soc. 2014;11(1):30–5.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  56. Philley JV, Wallace RJ, Jr, Benwill JL, Taskar V, Brown-Elliott BA, Thakkar F, et al. Preliminary results of bedaquiline as salvage therapy for patients with nontuberculous mycobacterial lung disease. Chest. 2015.

  57. Winthrop KL, Ku JH, Marras TK, Griffith DE, Daley CL, Olivier KN, et al. The tolerability of linezolid in the treatment of nontuberculous mycobacterial disease. Eur Respir J. 2015;45(4):1177–9.

    Article  CAS  PubMed  Google Scholar 

  58. Davis KK, Kao PN, Jacobs SS, Ruoss SJ. Aerosolized amikacin for treatment of pulmonary Mycobacterium avium infections: an observational case series. BMC Pulm Med. 2007;7:2.

    Article  PubMed Central  PubMed  Google Scholar 

  59. Biller J, Eagle G, McGinnis JP, Micioni L, Daley C, Winthrop KL, et al. Efficacy of Liposomal amikacin for inhalation (LAI) in achieving nontuberculous mycobacteria (NTM) culture negativity in patients whose lung infection is refractory to guideline-based therapy. Denver: American Thoracic Society; 2015.

    Google Scholar 

  60. Ruoss S, Eagle G, McGinnis J, Micioni L, Daley C, Winthrop, KL, et al. Analysis of functional exercise capacity (via the six-minute walk test [6MWT]) and culture negativity in patients with nontuberculous mycobacteria (NTM) lung infection refractory to guideline-based therapy treated with liposomal amikacin for inhalation (LAI). Denver: American Thoracic Society; 2015.

  61. Padayatchi N, Gopal M, Naidoo R, Werner L, Naidoo K, Master I, et al. Clofazimine in the treatment of extensively drug-resistant tuberculosis with HIV coinfection in South Africa: a retrospective cohort study. J Antimicrob Chemother. 2014;69(11):3103–7.

    Article  CAS  PubMed  Google Scholar 

  62. Nunn AJ, Rusen ID, Van Deun A, Torrea G, Phillips PP, Chiang CY, et al. Evaluation of a standardized treatment regimen of anti-tuberculosis drugs for patients with multi-drug-resistant tuberculosis (STREAM): study protocol for a randomized controlled trial. Trials. 2014;15:353. 6215-15-353.

    Article  PubMed Central  PubMed  Google Scholar 

  63. Wallace Jr RJ, Nash DR, Steele LC, Steingrube V. Susceptibility testing of slowly growing mycobacteria by a microdilution MIC method with 7H9 broth. J Clin Microbiol. 1986;24(6):976–81.

    CAS  PubMed Central  PubMed  Google Scholar 

  64. Shen GH, Wu BD, Hu ST, Lin CF, Wu KM, Chen JH. High efficacy of clofazimine and its synergistic effect with amikacin against rapidly growing mycobacteria. Int J Antimicrob Agents. 2010;35(4):400–4.

    Article  CAS  PubMed  Google Scholar 

  65. van Ingen J, Totten SE, Helstrom NK, Heifets LB, Boeree MJ, Daley CL. In vitro synergy between clofazimine and amikacin in treatment of nontuberculous mycobacterial disease. Antimicrob Agents Chemother. 2012;56(12):6324–7.

    Article  PubMed Central  PubMed  Google Scholar 

  66. Vaidya P, O'Shaughnessy E, Mauer R, Rodgers A, Dillon-Parker M, Almario EN, et al. Clofazimine use in patient with mycobacterial infections under single patient investigational new drug (SPIND). San Diego: Infectious Disease Society of America; 2012.

    Google Scholar 

  67. Field SK, Cowie RL. Treatment of Mycobacterium avium-intracellulare complex lung disease with a macrolide, ethambutol, and clofazimine. Chest. 2003;124(4):1482–6.

    Article  CAS  PubMed  Google Scholar 

  68. Jo KW, Kim S, Lee JY, Lee SD, Kim WS, Kim DS, et al. Treatment outcomes of refractory MAC pulmonary disease treated with drugs with unclear efficacy. J Infect Chemother. 2014;20(10):602–6.

    Article  CAS  PubMed  Google Scholar 

  69. Wallace Jr RJ, Dukart G, Brown-Elliott BA, Griffith DE, Scerpella EG, Marshall B. Clinical experience in 52 patients with tigecycline-containing regimens for salvage treatment of Mycobacterium abscessus and Mycobacterium chelonae infections. J Antimicrob Chemother. 2014;69(7):1945–53.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  70. Koh WJ, Hong G, Kim SY, Jeong BH, Park HY, Jeon K, et al. Treatment of refractory Mycobacterium avium complex lung disease with a moxifloxacin-containing regimen. Antimicrob Agents Chemother. 2013;57(5):2281–5.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  71. Mitchell JD. Surgical approach to pulmonary nontuberculous mycobacterial infections. Clin Chest Med. 2015;36(1):117–22.

    Article  PubMed  Google Scholar 

  72. Shiraishi Y, Katsuragi N, Kita H, Hyogotani A, Saito MH, Shimoda K. Adjuvant surgical treatment of nontuberculous mycobacterial lung disease. Ann Thorac Surg. 2013;96(1):287–91.

    Article  PubMed  Google Scholar 

  73. Kang HK, Park HY, Kim D, Jeong BH, Jeon K, Cho JH, et al. Treatment outcomes of adjuvant resectional surgery for nontuberculous mycobacterial lung disease. BMC Infect Dis. 2015;15(1):76. 015-0823-1.

    Article  PubMed Central  PubMed  Google Scholar 

  74. Mitchell JD, Yu JA, Bishop A, Weyant MJ, Pomerantz M. Thoracoscopic lobectomy and segmentectomy for infectious lung disease. Ann Thorac Surg. 2012;93(4):1033–9. discussion 1039-40.

    Article  PubMed  Google Scholar 

  75. Koh WJ, Jeong BH, Jeon K, Lee SY, Shin SJ. Therapeutic drug monitoring in the treatment of Mycobacterium avium complex lung disease. Am J Respir Crit Care Med. 2012;186(8):797–802.

    Article  CAS  PubMed  Google Scholar 

  76. van Ingen J, Egelund EF, Levin A, Totten SE, Boeree MJ, Mouton JW, et al. The pharmacokinetics and pharmacodynamics of pulmonary Mycobacterium avium complex disease treatment. Am J Respir Crit Care Med. 2012;186(6):559–65.

    Article  PubMed  Google Scholar 

  77. Adjemian J, Prevots DR, Gallagher J, Heap K, Gupta R, Griffith D. Lack of adherence to evidence-based treatment guidelines for nontuberculous mycobacterial lung disease. Ann Am Thorac Soc. 2014;11(1):9–16.

    Article  PubMed Central  PubMed  Google Scholar 

  78. ClinicalTrials.gov [Internet]. National Institutes of Health [cited May 30, 2015]. Available from: https://clinicaltrials.gov/.

  79. Ballarino GJ, Olivier KN, Claypool RJ, Holland SM, Prevots DR. Pulmonary nontuberculous mycobacterial infections: antibiotic treatment and associated costs. Respir Med. 2009;103(10):1448–55.

    Article  PubMed Central  PubMed  Google Scholar 

  80. Mirsaeidi M, Allen M, Ebrahimi G, Schraufngel D. National hospital costs for pulmonary mycobacterial diseases in the US from 2001 to 2012. Denver: American Thoracic Society; 2015. p. 2015.

    Google Scholar 

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Conflict of Interest

The authors declare that this work has been supported by a National Institutes of Health training grant [2T32HL083808-06] to [SAN].

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Authors and Affiliations

  1. Pulmonary & Critical Care Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, UHN 67, Portland, OR, 97239, USA

    Shannon Novosad

  2. Oregon Public Health Division, Oregon Health Authority, 800 NE Oregon Street, Suite 1105, Portland, OR, 97232, USA

    Emily Henkle

  3. Department of Medicine, Division of Infectious Diseases, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, L457, Portland, OR, 97239, USA

    Kevin L. Winthrop

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  1. Shannon Novosad
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Correspondence to Shannon Novosad.

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Novosad, S., Henkle, E. & Winthrop, K.L. The challenge of pulmonary nontuberculous mycobacterial infection. Curr Pulmonol Rep 4, 152–161 (2015). https://doi.org/10.1007/s13665-015-0119-3

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