Non-tuberculous mycobacterial pulmonary disease

Abstract

Nontuberculous mycobacterial pulmonary disease (NTM-PD) is a challenging infection which is becoming increasingly prevalent, particularly in the elderly, for reasons which are unknown. While underlying lung disease is a well-established risk factor for NTM-PD, it may also occur in apparently healthy individuals. No single common genetic or immunological defect has been identified in this group, and it is likely that multiple pathways contribute towards host susceptibility to NTM-PD which further interact with environmental and microbiological factors leading to the development of disease.The diagnosis of NTM-PD relies on the integration of clinical, radiological and microbiological results. The clinical course of NTM-PD is heterogeneous, with some patients remaining stable without the need for treatment and others developing refractory disease associated with considerable mortality and morbidity. Treatment regimens are based on the identity of the isolated species, drug sensitivity testing (for some agents) and the severity of disease. Multiple antibiotics are typically required for prolonged periods of time and treatment is frequently poorly tolerated. Surgery may be beneficial in selected cases. In some circumstances cure may not be attainable and there is a pressing need for better regimens to treat refractory and drug-resistant NTM-PD.This review summarises current knowledge on the epidemiology, aetiology and diagnosis of NTM-PD and discusses the treatment of two of the most clinically significant species, theM. aviumandM. abscessuscomplexes, with a focus on refractory disease and novel therapies.

The Peroxisome Proliferator-Activated Receptor α- Agonist Gemfibrozil Promotes Defense Against Mycobacterium abscessus Infections

“…Understanding host-pathogen interactions and the underlying mechanisms is vital for the development of new therapeutics against NTM infection [1,39,40]. Recent studies on the roles of the innate and acquired immune system in NTM infection have suggested that multiple pathways/factors contribute to the pathogenesis of Mabc infection and host protective immunity [1,40]. In this study, we found that activation of PPARα induced an antimicrobial response to Mabc infection in vitro and in vivo.…”

“…Mabc, a rapidly growing NTM, causes serious pulmonary infections in both immunocompetent and immunocompromised individuals [1,36,37]. Within the Mabc complex, Mabc (sensu stricto) is a clinically important species because it is the most drug-resistant NTM and is associated with a high rate of treatment failure [37,38].…”

“…Within the Mabc complex, Mabc (sensu stricto) is a clinically important species because it is the most drug-resistant NTM and is associated with a high rate of treatment failure [37,38]. Understanding host-pathogen interactions and the underlying mechanisms is vital for the development of new therapeutics against NTM infection [1,39,40]. Recent studies on the roles of the innate and acquired immune system in NTM infection have suggested that multiple pathways/factors contribute to the pathogenesis of Mabc infection and host protective immunity [1,40].…”

“…The incidence of nontuberculous mycobacterial (NTM) infection is increasing worldwide, not only in immunocompromised patients, but also in healthy individuals [1][2][3][4]. However, little is known about the host factors that influence the pathogenesis of NTM infection [1,3,4]. Mycobacterium abscessus (Mabc), a rapidly growing NTM species, lives in natural environments such as water and soil, and causes pulmonary, cutaneous, and other opportunistic infectious diseases [3,5].…”

Infecções por micobactérias não tuberculosas no Hospital Nereu Ramos, centro de referência em Santa Catarina

“…O risco de infecções disseminadas que caracterizam pacientes imunocomprometidos é bem conhecido, mas também podem acontecer com acometimento mais localizado, como por exemplo em linfonodos, pele e tecidos subcutâneos, bem como ossos e articulações, que também são alvos importantes da infecção por MNT. As infecções por MNT são um importante causa de morbidade e mortalidade, muitas vezes sob a forma de doença pulmonar progressiva 3 . Vários estudos realizados em diferentes partes do mundo indicam que as infecções por MNT são um problema emergente de saúde global.…”