Full text loading...
Chapter 35 : Nontuberculous Mycobacteria—Introduction
Nucleic acid probes are available for the most frequently seen mycobacterial species, Mycobacterium tuberculosis complex, M. avium complex, M. kansasii, and M. gordonae. It has seemed as if there is an increase in nontuberculous mycobacteria (NTM) disease in the United States and other developed countries in recent years, but it has not been clear whether this is a true increase or just better detection. Early on, pulmonary NTM infections seemed to occur mainly in persons who had previous structural lung disease, such as chronic obstructive pulmonary disease, tuberculosis, histoplasmosis, or other causes of bronchiectasis. A more recent cause of immune-suppressiontriggered NTM lung diseases (and NTM disease generally) has been the introduction of biologic agents, especially tumor necrosis factor alpha inhibitor. The 2007 ATS/IDSA Statement includes a section in which the authors conclude that "more fundamental information is needed to improve understanding in essentially all areas of NTM disease". A combination of clinical, radiologic, and bacteriologic features has been suggested for diagnosis of true pulmonary NTM disease. Evaluation should include, beside appropriate history and physical, chest imaging using high-resolution computed tomography (HRCT), unless there is obvious cavitation by chest X ray. If possible, NTM should be identified at the species level. Patients suspected of having NTM disease should be monitored closely until the diagnosis is made or excluded.
Key Concept Ranking
- Tumor Necrosis Factor alpha