Growing from common ground: nontuberculous mycobacteria and bronchiectasis

Area of Science:

• Pulmonology
• Infectious Diseases
• Microbiology

Background:

• Bronchiectasis and nontuberculous mycobacteria (NTM) share a complex relationship, with NTM potentially causing or resulting from bronchiectatic disease.
• Nontuberculous mycobacteria pulmonary disease (NTM-PD) is increasingly recognized in patients with bronchiectasis.

Purpose of the Study:

• To review the diagnostic approaches, risk factors, and treatment strategies for NTM-PD in the context of bronchiectasis.
• To highlight the challenges and future directions in managing this intertwined condition.

Main Methods:

• This narrative review synthesizes current literature on the diagnosis and management of bronchiectasis and NTM-PD.
• It examines clinical, radiological, and microbiological diagnostic criteria.
• It discusses current and emerging treatment strategies, including antimicrobial and host-directed therapies.

Main Results:

• NTM-PD diagnosis requires integrated clinical, radiological, and microbiological findings.
• Mycobacterium avium complex and Mycobacterium abscessus are common NTM species in bronchiectasis.
• Current guideline-based treatments for NTM-PD are lengthy and often yield unsatisfactory outcomes.
• Novel therapeutic strategies, including rifampicin-free regimens, clofazimine, inhaled antibiotics, and host-directed therapies, are under investigation.

Conclusions:

• Effective management of NTM-PD in bronchiectasis necessitates a multidisciplinary, personalized approach.
• Optimizing supportive care, pathogen-directed, and host-directed strategies is crucial.
• Further research into the host-mycobacterial interplay is essential for developing improved treatment strategies.