Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Clinician Investigator Program, University of British Columbia, Suite 200 City Square East Tower South, 555 West 12th Avenue, Vancouver, British Columbia V5Z 3X7, Canada.
Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Respirology, University Health Network, Toronto, Ontario, Canada; Division of Respiratory Medicine, West Park Healthcare Centre, 82 Buttonwood Avenue, Toronto, Ontario M6M 2J5, Canada.
Clin Chest Med. 2023 Dec;44(4):799-813. doi: 10.1016/j.ccm.2023.06.011. Epub 2023 Aug 14.
Nontuberculous mycobacterial pulmonary disease caused by the less common nontuberculous mycobacteria have distinct features depending on the species. Diagnostic evaluation follows the established criteria for all nontuberculous mycobacteria, but with certain qualifications given species-specific and regional differences in pathogenicity. Clinicians should first institute nonpharmacologic management and evaluate clinical, radiologic, and microbiologic factors in the decision regarding antimycobacterial therapy. Treatment is challenging, and evidence-based recommendations are limited for most species. Drug susceptibility testing is used to help with regimen selection; however, this approach is imperfect given the uncertain correlation between in vitro activity and clinical response for most drugs.
非结核分枝杆菌肺病由较少见的非结核分枝杆菌引起，其特征因菌种而异。诊断评估遵循所有非结核分枝杆菌的既定标准，但鉴于致病性在菌种和地区间存在差异，也有某些特定的限定条件。临床医生应首先进行非药物治疗，并在决定是否使用抗分枝杆菌治疗时评估临床、影像学和微生物学因素。治疗具有挑战性，而且大多数菌种的推荐方案都基于有限的证据。药敏试验用于帮助选择治疗方案；然而，由于大多数药物的体外活性与临床反应之间的相关性不确定，这种方法并不完美。
