Management of opportunist mycobacterial infections: Joint Tuberculosis Committee guidelines 1999
- Subcommittee of the Joint Tuberculosis Committee of the British Thoracic Society*
- Dr I A Campbell
- Received 10 May 1999
- Revision requested 23 July 1999
- Revised 14 October 1999
- Accepted 22 November 1999
Guidelines have been produced for tuberculosis by the British Thoracic Society (BTS),1 2 the American Thoracic Society (ATS),3 the International Union Against Tuberculosis and Lung Disease,4 and the World Health Organisation.5 These, however, deal mainly withMycobacterium tuberculosis complex infections (M tuberculosis,M africanum, and M bovis). With the exception of the ATS guidelines on non-tuberculous mycobacteria,3 these do not address the opportunist mycobacteria (also called atypical mycobacteria, mycobacteria other than tuberculosis (MOTT), non-tuberculous mycobacteria (NTM), or environmental mycobacteria).
The number of isolates of such opportunist mycobacteria has been increasing,6 both in HIV negative and HIV positive individuals. Because of the growing numbers of patients with disease due to infection by these mycobacteria, the wide range of species, the difficulties in both diagnosis and management, and in response to increasing requests for advice on management, the BTS Joint Tuberculosis Committee has reviewed the evidence on management of these infections. On the whole the evidence is not derived from controlled clinical trials as very few have been reported but, where possible, we have graded the evidence according to the criteria in table 1. Sections cover epidemiology, bacteriological aspects, diagnosis and treatment in adults and children, separated where appropriate into sections according to their HIV infection status.
Opportunist mycobacteria can be found throughout the environment and can be isolated from soil, water (including tap water), dust, milk, and various animals and birds.7-10 The significance of an isolate can only be established by considering the type of specimen from which the Mycobacterium was isolated, the number of isolates, the degree of growth, and the identity of the organism. In general, multiple isolates are needed from non-sterile sites to establish disease whereas one positive culture from a sterile site, particularly where …