Diagnosis and management of nontuberculous mycobacterial lung infections

The diagnosis and management of nontuberculous mycobacterial (NTM) lung infection remains difficult even among experienced clinicians. Both the incidence and prevalence are likely expected to rise with an aging population. Careful assessment of clinical, radiologic, and microbiologic studies is warranted before initiating therapy, which is often complicated by significant drug side effects and limited sputum conversion rates. Indications to treat are best based on a number of factors, including specific NTM species, NTM lung-infection-associated symptoms, advanced bronchiectatic or cavitary disease, expected tolerance of therapy, and related comorbidities. Surgical resection of localized disease or refractory infection may warrant consideration, but should be done by an experienced surgeon and mycobacterial program. Increased awareness and treatment of NTM lung infection in recent years is likely due to earlier recognition and improved treatment strategies, though the approach to the NTM lung infection patient most often involves chronic lung disease management. NTM lung infection is perhaps is best characterized as a treatable lung infection, even without universally curable outcomes.