Epidemiology, diagnosis & treatment of non-tuberculous mycobacterial diseases.
Epidemiology, diagnosis & treatment of non-tuberculous mycobacterial diseases.
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DOI：
10.4103/ijmr.ijmr_902_20
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发表时间：
2020-09
期刊：
影响因子：
--
通讯作者：
Upadhyay V
中科院分区：
文献类型：
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作者：
Sharma SK;Upadhyay V
非结核分枝杆菌（NTM）普遍存在于环境中，但NTM疾病很少发生。NTM通常被认为比结核分枝杆菌毒力低，然而，这些生物体可在免疫功能低下和免疫功能正常的宿主中引起疾病。与结核病相比，除了结核杆菌外，不会发生人际传播。囊性纤维化患者中的NTM物种。肺是最常见的受累器官，而NTM-PD常发生于已有肺部疾病的患者。NTM也可能表现为局限性疾病，累及肺外部位，如淋巴结、皮肤和软组织，很少累及骨骼。播散性NTM疾病是罕见的，发生在患有先天性或获得性免疫缺陷（如HIV/AIDS）的个体中。目前，快速分子检测可用于在物种和亚种水平上确认NTM诊断。药物敏感性试验（DST）不是常规的，除非是由于缓慢生长的分枝杆菌（M。avium complex，M. kansasii）或由于快速生长的分支杆菌（尤其是M.脓肿。虽然治疗NTM-PD患者的决定是谨慎的，但在痰培养转换后给予治疗12个月。其他措施包括肺康复和纠正营养不良。NTM-PD的治疗反应是可变的，取决于孤立的NTM种类和基础PD的严重程度。只有肺功能良好的局限性疾病患者才需要手术治疗。未来的研究应侧重于开发和验证基于非培养的快速诊断测试，用于早期诊断和发现比现有药物疗效更高、毒性更小的新药。
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.