Wassilew Nasstasja, Hoffmann Harald, Andrejak Claire, Lange Christoph
Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany.
Respiration. 2016;91(5):386-402. doi: 10.1159/000445906. Epub 2016 May 21.
Non-tuberculous mycobacteria (NTM) include more than 160 ubiquitous, environmental, acid-fast-staining bacterial species, some of which may cause disease in humans. Chronic pulmonary infection is the most common clinical manifestation. Although patients suffering from chronic lung diseases are particularly susceptible to NTM pulmonary disease, many affected patients have no apparent risk factors. Host and pathogen factors leading to NTM pulmonary disease are not well understood and preventive therapies are lacking. NTM isolation and pulmonary disease are reported to rise in frequency in Europe as well as in other parts of the world. Differentiation between contamination, infection, and disease remains challenging. Treatment of NTM pulmonary disease is arduous, lengthy, and costly. Correlations between results of in vitro antibiotic susceptibility testing and clinical treatment outcomes are only evident for the Mycobacterium avium complex, M. kansasii, and some rapidly growing mycobacteria. We describe the epidemiology of NTM pulmonary disease as well as emerging NTM pathogens and their geographical distribution in non-cystic fibrosis patients in Europe. We also review recent innovations for the diagnosis of NTM pulmonary disease, summarize treatment recommendations, and identify future research priorities to improve the management of patients affected by NTM pulmonary disease.
非结核分枝杆菌（NTM）包括160多种普遍存在于环境中的抗酸染色细菌物种，其中一些可能导致人类疾病。慢性肺部感染是最常见的临床表现。虽然患有慢性肺部疾病的患者特别容易患NTM肺病，但许多受影响的患者没有明显的危险因素。导致NTM肺病的宿主和病原体因素尚未完全了解，也缺乏预防性治疗方法。据报道，欧洲以及世界其他地区NTM的分离率和肺病发病率都在上升。区分污染、感染和疾病仍然具有挑战性。NTM肺病的治疗艰巨、漫长且成本高昂。体外抗生素敏感性测试结果与临床治疗结果之间的相关性仅在鸟分枝杆菌复合群、堪萨斯分枝杆菌和一些快速生长的分枝杆菌中明显。我们描述了欧洲非囊性纤维化患者中NTM肺病的流行病学、新兴的NTM病原体及其地理分布。我们还回顾了NTM肺病诊断的最新创新，总结了治疗建议，并确定了未来的研究重点，以改善NTM肺病患者的管理。
