Chest
Recent Advances in Chest MedicinePulmonary Disease Due to Nontuberculous Mycobacteria
Section snippets
Epidemiology and Pathogenesis
NTM are commonly occurring organisms and have been recovered in many parts of the world and from a variety of environmental reservoirs including fresh and salt water, soil, and biofilms.2 The mode(s) of transmission of NTM to humans has not been defined, although person-to-person transmission is thought not to occur or to be very uncommon, at least in immune-competent hosts. Isolation techniques used for limiting the spread of M tuberculosis are, therefore, not applied to NTM. Because NTM are
Clinical Presentation
Based largely on experience with several species, particularly MAC, in immunocompetent persons, NTM disease in the chest most commonly presents in one of three “prototypical” forms21: a tuberculosis-like pattern classically involving the upper lobes of older men with substantial smoking histories and COPD22; nodular bronchiectasis, often occurring in slender older women nonsmokers including some with skeletal deformities23 and typically presenting with cough2425; and hypersensitivity
Diagnosis
Whereas upper lobe, cavitary tuberculosis-like NTM disease generally presents little diagnostic difficulty other than excluding tuberculosis, nodular bronchiectatic disease is more subtle. Indeed, NTM have often been considered as colonizing areas of slowly progressive disease. Histologic evidence of NTM tissue invasion and reaction, however, suggest “benign” colonization is less likely than previously thought.3536 Because skin test antigens specific for NTM species are not readily available
Treatment
Some years ago, a practical classification presented by Bailey55 discussed grouping mycobacteria as either easy or hard to treat; M kansasii typified the former group, and MAC described the latter. Intervening years and, particularly, the availability of newer macrolides/azilides have changed the situation, but in relative terms it is still correct that some NTM are relatively straightforward in their treatment, while others are extremely difficult to cure. Some general principles also bear
ACKNOWLEDGMENT
The author wishes to acknowledge and thank Meredith Ryan for assistance in the preparation of this article.
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The author has no conflicts of interest to disclose.