Department of Molecular Medicine, Jamia Hamdard Institute of Molecular Medicine, Jamia Hamdard (Deemed-to-be-University), New Delhi, India.
Indian J Med Res. 2020 Sep;152(3):185-226. doi: 10.4103/ijmr.IJMR_902_20.
Non-tuberculous mycobacteria (NTM) are ubiquitously present in the environment, but NTM diseases occur infrequently. NTM are generally considered to be less virulent than Mycobacterium tuberculosis, however, these organisms can cause diseases in both immunocompromised and immunocompetent hosts. As compared to tuberculosis, person-to-person transmission does not occur except with M. abscessus NTM species among cystic fibrosis patients. Lung is the most commonly involved organ, and the NTM-pulmonary disease (NTM-PD) occurs frequently in patients with pre-existing lung disease. NTM may also present as localized disease involving extrapulmonary sites such as lymph nodes, skin and soft tissues and rarely bones. Disseminated NTM disease is rare and occurs in individuals with congenital or acquired immune defects such as HIV/AIDS. Rapid molecular tests are now available for confirmation of NTM diagnosis at species and subspecies level. Drug susceptibility testing (DST) is not routinely done except in non-responsive disease due to slowly growing mycobacteria ( M. avium complex, M. kansasii) or infection due to rapidly growing mycobacteria, especially M. abscessus. While the decision to treat the patients with NTM-PD is made carefully, the treatment is given for 12 months after sputum culture conversion. Additional measures include pulmonary rehabilitation and correction of malnutrition. Treatment response in NTM-PD is variable and depends on isolated NTM species and severity of the underlying PD. Surgery is reserved for patients with localized disease with good pulmonary functions. Future research should focus on the development and validation of non-culture-based rapid diagnostic tests for early diagnosis and discovery of newer drugs with greater efficacy and lesser toxicity than the available ones.
非结核分枝杆菌（NTM）广泛存在于环境中，但 NTM 病的发病率较低。NTM 通常被认为比结核分枝杆菌的毒力低，但这些病原体可引起免疫功能低下和免疫功能正常宿主的疾病。与肺结核不同，除囊性纤维化患者中的脓肿分枝杆菌 NTM 种属外，人与人之间不会发生传播。肺部是最常受累的器官，NTM-肺部疾病（NTM-PD）在患有先前存在肺部疾病的患者中经常发生。NTM 也可能表现为局部疾病，涉及肺外部位，如淋巴结、皮肤和软组织，很少累及骨骼。播散性 NTM 病罕见，发生于先天性或获得性免疫缺陷个体，如 HIV/AIDS。目前可快速进行分子检测以在种属和亚种水平上确认 NTM 诊断。除因生长缓慢的分枝杆菌（鸟分枝杆菌复合体、堪萨斯分枝杆菌）或因快速生长的分枝杆菌（尤其是脓肿分枝杆菌）引起的非耐药性疾病外，通常不进行药敏试验（DST）。虽然治疗 NTM-PD 患者的决策需要仔细考虑，但在痰培养转为阴性后仍需治疗 12 个月。其他措施包括肺康复和纠正营养不良。NTM-PD 的治疗反应各不相同，取决于分离出的 NTM 种属和基础 PD 的严重程度。对于肺功能良好的局限性疾病患者，保留手术治疗。未来的研究应侧重于开发和验证非培养快速诊断检测方法，以便早期诊断和发现比现有药物疗效更好、毒性更小的新药。
