Nontuberculous mycobacteria in cystic fibrosis.
Nontuberculous mycobacteria (NTM) are widely distributed in our modern environment. Therefore, it is not surprising that these organisms are commonly present in sputum from cystic fibrosis (CF) patients. In the setting of CF lung disease, the significance of NTM in respiratory secretions is a major diagnostic challenge. The usual signs, symptoms, and radiographic features of NTM disease are also characteristic of CF lung disease; thus it is difficult to determine whether the NTM are a saprophytic contaminant or an active pathogen. Although many CF patients appear to tolerate the presence of the NTM without clear evidence of disease, some suffer accelerated progression of lung disease that cannot be solely attributed to CF and appear to benefit from antimycobacterial treatment. Standard CF care should be reemphasized in patients with NTM infection, especially aggressive bronchial hygiene. Specific guidelines for antimycobacterial therapy in CF patients have not been determined, and potential complications of treatment are significant. Hence, patients offered antimycobacterial treatment must be selected carefully. An initial approach to treatment of CF patients is based on guidelines developed for the general population.
Nick
Jerry A
JA
Division of Pulmonary Science and Critical Care Medicine, University of Colorado School of Medicine, Denver, Colorado, USA. nickj@njc.org