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Evaluation and management of patients with pulmonary nontuberculous mycobacterial infections
1Duke University Medical Center, Division of Infectious Diseases and International Health, Box 3306, Department of Medicine, Durham, NC 27710, USA. stout002@mc.duke.edu
Abstract:
Nontuberculous mycobacteria (NTM) are emerging pathogens increasingly associated with chronic pulmonary disease. NTM are environmental saprophytes found in soil, dust and water and, unlike Mycobacterium tuberculosis, NTM are not transmitted from person to person. Pulmonary disease caused by NTM is a particular problem in older people without underlying immune compromise. The diagnosis of NTM pulmonary disease usually requires either multiple respiratory cultures that grow NTM or heavy growth of NTM from a single bronchoscopy or lung-biopsy specimen. High resolution computed tomography is the most useful radiographic study for diagnosis and to determine the extent of disease. Treatment includes multiple medications with activity against the particular NTM species, as single-drug therapy is likely to select for resistant organisms. Data demonstrating the effectiveness of specific drug regimens for NTM pulmonary disease are limited. Clarithromycin and azithromycin form the backbone of most treatment regimens because these drugs are active against many NTM species. Drug tolerability and cost are the major barriers to successful treatment of NTM pulmonary disease. Adjunctive therapies, including mucus clearance techniques and appetite stimulants, are unproven but may be of value in management of NTM pulmonary disease. Multicenter, randomized trials of macrolide-based therapies are sorely needed to determine the safest and most effective treatments for NTM pulmonary disease.
Insights
Nontuberculous mycobacteria (NTM) cause chronic lung disease, especially in older adults. Effective treatment requires multiple drugs, but data on optimal regimens for NTM pulmonary disease is limited.
Area of Science:
- Pulmonology
- Infectious Diseases
- Microbiology
Background:
- Nontuberculous mycobacteria (NTM) are environmental pathogens causing emerging chronic pulmonary disease.
- NTM infections are not person-to-person transmissible and primarily affect older individuals without compromised immunity.
- Diagnosis relies on microbiological cultures and imaging, with high-resolution CT being crucial for assessing disease extent.
Purpose of the Study:
- To review the current understanding of NTM pulmonary disease.
- To highlight diagnostic challenges and treatment strategies.
- To identify gaps in knowledge regarding effective therapeutic regimens.
Main Methods:
- Literature review of NTM pulmonary disease diagnosis and treatment.
- Analysis of diagnostic criteria including microbiological cultures and high-resolution CT.
- Evaluation of current treatment guidelines and drug efficacy data.
Main Results:
- NTM pulmonary disease diagnosis requires definitive microbiological evidence.
- High-resolution CT is essential for staging and evaluating disease progression.
- Macrolide-based multidrug regimens are standard, though data on specific efficacy is limited; drug tolerability and cost are significant challenges.
Conclusions:
- Pulmonary disease caused by NTM is a growing concern, particularly in the elderly.
- Effective management necessitates combination antibiotic therapy, but evidence supporting specific regimens is scarce.
- Multicenter, randomized trials are needed to establish optimal, safe, and cost-effective macrolide-based treatments for NTM pulmonary disease.
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