University of Texas Health Sciences Center, Tyler, 11937 U.S. Hwy 271, Tyler, Texas, USA.
Curr Opin Infect Dis. 2010 Apr;23(2):185-90. doi: 10.1097/QCO.0b013e328336ead6.
There is increasing awareness that nontuberculous mycobacteria (NTM) lung diseases are becoming more prevalent. Nontuberculous mycobacterial diseases could legitimately be seen as an emerging public-health threat.
Nontuberculous mycobacterial lung disease associated radiographically with nodules and bronchiectasis occurs primarily in women. These patients are associated with a specific morphotype, including low BMI, tall stature, scoliosis, pectus excavatum and mitral valve prolapse. The pathophysiologic link between these findings and the development of bronchiectasis and NTM disease remains unclear. As with tuberculosis, the tumor-necrosis factor alpha (TNF-alpha) blockers also predispose to NTM infection that can be severe. The most frustrating aspect of NTM therapy remains the generally poor correlation between in-vitro antibiotic susceptibility and in-vivo response to antimicrobials. A possible insight into this phenomenon is the recent discovery of an inducible macrolide resistance (erm) gene in Mycobacterium fortuitum and Mycobacterium abscessus. This gene can produce in-vivo resistance without resulting in a 'resistant' MIC for macrolides.
The NTM pose an increasing problem for clinicians and are associated with significant obstacles that thwart successful treatment of NTM disease. Continued progress in the areas of disease pathogenesis and therapy will improve the outlook for these patients.
人们越来越意识到非结核分枝杆菌（NTM）肺部疾病越来越普遍。分枝杆菌病可以被视为一种新出现的公共卫生威胁。
与结节和支气管扩张相关的分枝杆菌肺部疾病主要发生在女性中。这些患者与特定的形态类型有关，包括低 BMI、高身材、脊柱侧凸、漏斗胸和二尖瓣脱垂。这些发现与支气管扩张和 NTM 疾病发展之间的病理生理联系尚不清楚。与结核病一样，肿瘤坏死因子-α（TNF-α）阻滞剂也容易导致分枝杆菌感染，且可能很严重。NTM 治疗中最令人沮丧的方面仍然是体外抗生素敏感性与体内对抗微生物药物反应之间通常较差的相关性。最近在偶然分枝杆菌和脓肿分枝杆菌中发现了一种可诱导的大环内酯类耐药（erm）基因，这可能为这一现象提供了一些见解。该基因可产生体内耐药性，而不会导致大环内酯类药物的 MIC 呈“耐药”。
NTM 对临床医生构成了越来越大的问题，并存在严重的障碍，阻碍了 NTM 疾病的成功治疗。在疾病发病机制和治疗领域的持续进展将改善这些患者的前景。
