Clinics in chest medicine
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Clinics in chest medicine · Mar 2015
ReviewPathogenesis and risk factors for nontuberculous mycobacterial lung disease.
Nontuberculous mycobacteria (NTM) infections are broadly classified as skin and soft tissue infections, isolated lung disease, and visceral or disseminated disease. The degree of underlying immune abnormalities varies between each classification. ⋯ Visceral and disseminated NTM disease invariably occurs in individuals with more severe immunosuppression. Although the focus of this article is to discuss the pathogenesis of NTM lung disease, the risk factors of visceral/disseminated NTM disease are also summarized, as they provide insights into host-defense mechanisms against these organisms.
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Clinics in chest medicine · Mar 2015
ReviewEpidemiology of human pulmonary infection with nontuberculous mycobacteria: a review.
Population-based data have documented a worldwide increase in the prevalence of human nontuberculous mycobacterial (NTM) infections since 2000. Mycobacterium avium complex is predominant in North America and East Asia, whereas in regions within Europe, M kansasii, M xenopi, and M malmoense are more common. ⋯ Clustering of disease within families suggests a heritable genetic predisposition to disease susceptibility. Warm, humid environments with high atmospheric vapor pressure contribute to population risk.
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Nontuberculous mycobacteria (NTM) include over 150 species. The source for human infection is the environment. NTM are normal inhabitants of soil and drinking water. ⋯ Treatment requires multiple antibiotics. NTM patients are innately sensitive to NTM infection, resulting in reinfection. Knowledge of the sources of NTM can reduce exposure to environmental NTM.
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The most common nontuberculous mycobacterial (NTM) lung pathogen, Mycobacterium avium complex (MAC), requires antibiotic treatment regimens that are long and often arduous. M kansasii is the slowly growing NTM pathogen with the most predictably successful treatment outcomes, whereas other slowly growing NTM pathogens such as M xeonpi, M szulgai, and M malmoense are less predictably responsive to antibiotic regimens. M simiae is the most difficult of the common slowly growing NTM pathogens to eradicate. Surgical intervention for slowly growing mycobacterial lung infection has proved beneficial for some patients, but the optimal candidates and timing for surgical intervention remain unknown.
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Clinics in chest medicine · Mar 2015
ReviewSurgical approach to pulmonary nontuberculous mycobacterial infections.
The incidence of pulmonary nontuberculous mycobacterial disease is increasing. Despite aggressive medical therapy, a subset of patients will experience treatment failure or suffer disabling or life-threatening symptoms. ⋯ More data are needed to confirm this approach. For those with nontuberculous mycobacterial infection, treatment in a multidisciplinary setting including surgeons familiar with operative techniques specific to infectious lung disease will improve patient care.