Diagnosis and Treatment of Nontuberculous Mycobacterial Lung Disease

Abstract

Nontuberculous mycobacteria (NTM) are ubiquitous organisms; their isolation from clinical specimens does not always indicate clinical disease. The incidence of NTM lung diseases has been increasing worldwide. Although the geographic diversity of NTM species is well known, Mycobacterium avium complex (MAC), M. abscessus complex (MABC), and M. kansasii are the most commonly encountered and important etiologic organisms. Two distinct types of NTM lung diseases have been reported, namely fibrocavitary and nodular bronchiectatic forms. For laboratory diagnosis of NTM lung diseases, both liquid and solid media cultures and species-level identification are strongly recommended to enhance growth detection and determine the clinical relevance of isolates. Treatment for NTM lung diseases consists of a multidrug regimen and a long course of therapy, lasting more than 12 months after negative sputum conversion. For MAC lung disease, several new macrolide-based regimens are now recommended. For nodular bronchiectatic forms of MAC lung diseases, an intermittent three-time-weekly regimen produces outcomes similar to those of daily therapy. Treatment of MABC lung disease is very difficult, requiring long-term use of parenteral agents in combination with new macrolides. Treatment outcomes are much better for M. massiliense lung disease than for M. abscessus lung disease. Thus, precise identification of species in MABC infection is needed for the prediction of antibiotic response. Likewise, increased efforts to improve treatment outcomes and develop new agents for NTM lung disease are needed.

Keywords: Mycobacterium abscessus; Mycobacterium avium Complex; Mycobacterium kansasii; Nontuberculous Mycobacteria.

Fig. 1

Two distinct manifestations of nontuberculous mycobacterial lung disease: fibrocavitary and nodular bronchiectatic forms. (A, B) A 56-year-old male with Mycobacterium avium lung disease. The chest radiograph shows cavities in both upper lung fields. The chest CT shows two thin walled cavities in bilateral upper lobes. (C, D) An 83-year-old female with Mycobacterium avium lung disease. The chest radiograph shows multiple nodules in both mid-lung fields. The chest CT shows multiple centrilobular nodules with bronchiectasis in the right middle lobe and the lingular segment of the left upper lobe.