Pulmonary disease caused by nontuberculous mycobacteria

Expert Rev Respir Med. 2012 Dec;6(6):597-612; quiz 613. doi: 10.1586/ers.12.58.

Abstract

The propensity of various nontuberculous mycobacteria to cause lung disease varies widely and is conditioned by host factors; infection is believed to occur from environmental sources. Nontuberculous mycobacteria pulmonary disease (PNTM) is increasing worldwide and Mycobacterium avium complex is the most common cause. PNTM usually occurs in one of three prototypical forms: hypersensitivity pneumonitis, cavitary tuberculosis-like disease or nodular bronchiectasis. PNTM has been linked in some patients to genetic variants of the cystic fibrosis transmembrane conductance regulator gene and a distinct patient phenotype. Interactions between PNTM and other comorbidities are also increasingly appreciated. Guidelines for diagnosis, emphasizing chest imaging and microbiology, have been published; speciation using molecular techniques is critical for accuracy and for treatment decisions. Clinical trials are lacking to inform treatment for many species and experience with M. avium complex and several others species serves as a guide instead. Use of multiple drugs for a period of at least 12 months following sputum conversion is the norm for most species. In vitro drug susceptibility results for many drugs may not correlate with clinical outcomes and such testing should be done on a selective basis.

Publication types

  • Review

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Comorbidity
  • Drug Resistance, Bacterial
  • Drug Therapy, Combination
  • Humans
  • Immunocompromised Host
  • Lung / diagnostic imaging
  • Lung Diseases / diagnosis
  • Lung Diseases / drug therapy
  • Lung Diseases / microbiology*
  • Mycobacterium Infections, Nontuberculous / complications*
  • Mycobacterium Infections, Nontuberculous / diagnosis
  • Mycobacterium Infections, Nontuberculous / drug therapy
  • Mycobacterium Infections, Nontuberculous / epidemiology
  • Opportunistic Infections / drug therapy
  • Opportunistic Infections / microbiology
  • Practice Guidelines as Topic
  • Retreatment
  • Specimen Handling
  • Tomography, X-Ray Computed
  • Treatment Failure

Substances

  • Anti-Bacterial Agents