[Nontuberculous mycobacteria in sputum : Recommendations for diagnosis and treatment]

Pulmonary diseases caused by nontuberculous mycobacteria (NTM) have increased over the last years and decades in Germany and also worldwide. Because the disease is more frequent in patients with immunodeficiencies and chronic respiratory diseases, e.g. bronchiectasis, advanced chronic obstructive lung disease (COPD) and cystic fibrosis (CF), an infection with mycobacteria should always be considered in this patient group. The detection in sputum alone is not an indication for treatment but the correct diagnosis should be based on the appropriate clinical symptoms as well as radiological and microbiological criteria. The diagnosis is often delayed because the symptoms are unspecific. The treatment of pulmonary NTM disease is difficult and tedious and for these reasons is often prematurely terminated. Adherence of treating physicians to the guidelines is also conspicuously low. Before starting treatment, it is important to carefully define the goals and clarify the risks and benefits of the treatment with the patient. As adverse toxic events can occur during treatment, it should be closely monitored. In the case of an infrequent pathogen or a severe course of the disease, referral to an NTM specialist center should be undertaken.