Seminars in respiratory and critical care medicine
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Semin Respir Crit Care Med · Feb 2013
Management of nontuberculous mycobacterial (NTM) lung disease.
Nontuberculous mycobacterial (NTM) lung diseases present formidable obstacles to successful management, especially when compared with tuberculosis, beginning with diagnosis and extending through treatment. Factors peculiar to NTM disease such as extensive microbial resistance mechanisms and difficult to interpret, even misleading, in vitro drug susceptibility patterns are just two of the multiple and frustrating clinical management challenges. ⋯ In spite of these difficulties, the majority of NTM lung disease patients are still treated successfully. Because the prevalence of NTM is rising, it is increasingly necessary for clinicians to understand those unique aspects of NTM lung disease diagnosis and treatment that differ from tuberculosis and that contribute to limited treatment options.
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The nontuberculous mycobacteria (NTM) are typically environmental organisms residing in soil and water. Although generally of low pathogenicity to humans, NTM can cause a wide array of clinical diseases; pulmonary disease is most frequent, followed by lymphadenitis in children, skin disease by M. marinum (particularly in fish tank fanciers), and other extrapulmonary or disseminated infections in severely immunocompromised patients. Of the >140 NTM species reported in the literature, 25 species have been strongly associated with NTM diseases; the remainder are environmental organisms rarely encountered in clinical samples. ⋯ Because of limited sensitivity and specificity of symptoms, radiology, and direct microscopy of clinical samples, culture remains the gold standard. Yet culture is time consuming and demands the use of multiple media types and incubation temperatures to optimize the yield. Outside of reference centers, such elaborate culture algorithms are scarce.
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Semin Respir Crit Care Med · Feb 2013
Ecology of nontuberculous mycobacteria--where do human infections come from?
Nontuberculous mycobacteria (NTM) are environmental, opportunistic human pathogens whose reservoirs include peat-rich potting soil and drinking water in buildings and households. In fact, humans are likely surrounded by NTM. ⋯ These include avoiding inhalation of dusts from peat-rich potting soil and aerosols from showers, hot tubs, and humidifiers. A riskanalysis of the presence of NTM in drinking water has not been initiated because the virulence of independent isolates of even single NTM species (e.g., Mycobacterium avium) is quite broad, and virulence determinants have not been identified.