Diagnosis and treatment of lung infection with nontuberculous mycobacteria
Diagnosis and treatment of lung infection with nontuberculous mycobacteria
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DOI：
10.1097/mcp.0b013e3283292679
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发表时间：
2009-05-01
影响因子：
3.3
通讯作者：
Ottenhoff, Tom H. M.
中科院分区：
文献类型：
--
作者：
Arend, Sandra M.;van Soolingen, Dick;Ottenhoff, Tom H. M.
综述目的非结核分枝杆菌 (NTM) 引起的肺部感染的诊断频率不断增加，部分原因是高危人群不断增加，但也是由于认识和诊断设施的提高。本综述总结了有关 NTM 肺部感染的流行病学、临床、诊断和治疗方面的最新文献。最近的发现由于分子技术的广泛使用，已知引起 NTM 感染的物种数量有所增加。公认的危险因素的数量也在增加，包括新发现的遗传性免疫疾病和新型免疫调节药物（例如肿瘤坏死因子-α拮抗剂）。 NTM 肺部感染的诊断标准已修订，但是否治疗患者的决定仍然需要仔细的个体评估，并考虑 NTM 物种、疾病程度、一般状况和潜在疾病。治疗方面尚未取得重大突破。 NTM 感染的抗生素治疗因许多潜在有效药物所需的长持续时间和不良毒性特征而变得复杂，而除两种药物-NTM 物种组合外，体外敏感性和体内有效性之间存在不确定的相关性。新型抗生素在治疗 NTM 感染中的作用仍不确定。总结 关于 NTM 肺部感染的治疗仍有很多未知之处。为了提供最佳护理，应以 2007 年美国胸科学会/美国传染病学会声明中提供的建议为起点，寻求专家咨询的门槛应较低。
Purpose of reviewPulmonary infections caused by nontuberculous mycobacteria (NTM) are diagnosed with increasing frequency, in part due to growing at-risk populations but also as a result of improved awareness and diagnostic facilities. This review summarizes recent literature regarding epidemiological, clinical, diagnostic and therapeutic aspects of NTM lung infections.Recent findingsThe number of species known to cause NTM infections has increased due to the extended use of molecular techniques. The number of recognized risk factors, including newly discovered inherited immunological disorders and novel types of immunomodulating drugs such as antagonists of tumor necrosis factor-alpha is also growing. Revised diagnostic criteria for NTM lung infection are available but the decision whether to treat a patient remains a matter of careful individual evaluation taking into account the NTM species, extent of disease, general condition and underlying disorders. No major breakthrough has been made with regard to treatment. Antibiotic treatment of NTM infection is complicated by the necessary long duration and the adverse toxicity profile of many of the potentially effective drugs while there is an uncertain correlation between in-vitro susceptibility and in-vivo effectiveness except for two drug-NTM species combinations. The role for novel antibiotics in the treatment of NTM infection is still uncertain.Summary Much remains unknown regarding treatment of NTM lung infections. In order to provide optimal care, the recommendations provided in the 2007 American Thoracic Society/Infectious Diseases Society of America statement should be taken as a starting point and there should be a low threshold to seek expert consultation.