Department of Pediatrics, Children's Hospital Colorado, University of Colorado Denver School of Medicine, 13123 East 16th Avenue, Box B-395, Aurora, CO 80045, USA.
Department of Medicine, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA; Department of Medicine, University of Colorado Denver School of Medicine, 12631 East 17th Avenue, Box 860, Aurora, CO 80045, USA.
Clin Chest Med. 2022 Dec;43(4):697-716. doi: 10.1016/j.ccm.2022.06.010.
Nontuberculous mycobacteria (NTM) are important pathogens, with a longitudinal prevalence of up to 20% within the cystic fibrosis (CF) population. Diagnosis of NTM pulmonary disease in people with CF (pwCF) is challenging, as a majority have NTM infection that is transient or indolent, without evidence of clinical consequence. In addition, the radiographic and clinical manifestations of chronic coinfections with typical CF pathogens can overlap those of NTM, making diagnosis difficult. Comprehensive care of pwCF must be optimized to assess the true clinical impact of NTM and to improve response to treatment. Treatment requires prolonged, multidrug therapy that varies depending on NTM species, resistance pattern, and extent of disease. With a widespread use of highly effective modulator therapy (HEMT), clinical signs and symptoms of NTM disease may be less apparent, and sensitivity of sputum cultures further reduced. The development of a disease-specific approach to the diagnosis and treatment of NTM infection in pwCF is a research priority, as a lifelong strategy is needed for this high-risk population.
非结核分枝杆菌（NTM）是重要的病原体，在囊性纤维化（CF）人群中，其纵向患病率高达 20%。CF 患者（pwCF）中分枝杆菌肺病的诊断具有挑战性，因为大多数患者的 NTM 感染是短暂或惰性的，没有临床后果的证据。此外，典型 CF 病原体的慢性合并感染的放射学和临床表现可能与 NTM 重叠，导致诊断困难。必须优化 pwCF 的综合护理，以评估 NTM 的真正临床影响，并提高对治疗的反应。治疗需要长期、多药物治疗，具体取决于 NTM 物种、耐药模式和疾病程度。随着高效调节剂治疗（HEMT）的广泛应用，NTM 疾病的临床症状可能不太明显，痰培养的敏感性进一步降低。为 pwCF 中 NTM 感染的诊断和治疗制定特定疾病的方法是一个研究重点，因为对于这个高风险人群需要一种终身策略。
