Nontuberculous mycobacterial pulmonary disease

PURPOSE OF REVIEWPulmonary disease caused by nontuberculous mycobacteria is occurring with greater frequency, and previously unrecognized manifestations of nontuberculous mycobacteria are being identified. Paralleling this increase, improvements in laboratory techniques now allow for more precise identification of nontuberculous mycobacteria and recognition of new species. Consequently, clinicians are more often confronted with diagnostic and therapeutic challenges relevant to the care of patients with nontuberculous mycobacterial lung disease. RECENT FINDINGSIn response to this burgeoning clinical need, the American Thoracic Society and Infectious Disease Society of America jointly published an updated consensus statement on nontuberculous mycobacterial pulmonary disease in 2007. This document, in conjunction with original investigations in the field, has advanced our understanding of the pathogenesis of nontuberculous mycobacterial lung disease, its clinical manifestations, and the efficacy of medical and surgical therapy. SUMMARYThe present article will review our current understanding of nontuberculous mycobacterial pulmonary disease with particular emphasis on pathogenesis, diagnosis, and therapeutic decision making. Areas of clinical controversy in which current data are inadequate to guide our decision making will be highlighted.