医学
非结核分枝杆菌
疾病
重症监护医学
肺结核
脓肿分枝杆菌
流行病学
病因学
抗生素
耐火材料(行星科学)
肺病
免疫学
内科学
肺
分枝杆菌
病理
物理
微生物学
天体生物学
生物
作者
Steven Cowman,Jakko van Ingen,David E. Griffith,Michael R. Loebinger
出处
期刊:The European respiratory journal
[European Respiratory Society]
日期:2019-06-20
卷期号:54 (1): 1900250-1900250
被引量:154
标识
DOI:10.1183/13993003.00250-2019
摘要
Nontuberculous mycobacterial pulmonary disease (NTM-PD) is a challenging infection which is becoming increasingly prevalent, particularly in the elderly, for reasons which are unknown. While underlying lung disease is a well-established risk factor for NTM-PD, it may also occur in apparently healthy individuals. No single common genetic or immunological defect has been identified in this group, and it is likely that multiple pathways contribute towards host susceptibility to NTM-PD which further interact with environmental and microbiological factors leading to the development of disease.The diagnosis of NTM-PD relies on the integration of clinical, radiological and microbiological results. The clinical course of NTM-PD is heterogeneous, with some patients remaining stable without the need for treatment and others developing refractory disease associated with considerable mortality and morbidity. Treatment regimens are based on the identity of the isolated species, drug sensitivity testing (for some agents) and the severity of disease. Multiple antibiotics are typically required for prolonged periods of time and treatment is frequently poorly tolerated. Surgery may be beneficial in selected cases. In some circumstances cure may not be attainable and there is a pressing need for better regimens to treat refractory and drug-resistant NTM-PD.This review summarises current knowledge on the epidemiology, aetiology and diagnosis of NTM-PD and discusses the treatment of two of the most clinically significant species, the M. avium and M. abscessus complexes, with a focus on refractory disease and novel therapies.
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