Pulmonary diseases caused by non-tuberculous mycobacteria

Pulmonary disease due to non-tuberculous mycobacteria (NTM) is an emerging infection, mainly in regions with a decreasing prevalence of tuberculosis (TB). Patients with existing pulmonary diseases (e.g. cystic fibrosis, chronic obstructive pulmonary disease (COPD) and/or bronchiectasis), or patients with local or systemic immunosuppression are at risk of developing NTM lung disease. Disease manifestations can be: fibrocavitary, resembling TB; nodular/bronchiectatic, usually in elderly lean, nonsmoking female patients; or hypersensitivitylike after exposure to contaminated water. Since the clinical relevance of pulmonary NTM isolates differs significantly between NTM species, correct laboratory identification of NTM isolates is important to guide treatment decisions and drug-susceptibility testing (DST) efforts. Diagnosis requires the application of clinical and microbiological criteria according to published American Thoracic Society (ATS)/Infectious Diseases Society of America (IDSA) guidelines. Treatment decisions need to be individualised; long-term antibiotic therapy may be combined with surgical resection of affected portions of the lung.