Pulmonary disease by non-tuberculous mycobacteria – clinical management, unmet needs and future perspectives

Abstract

The number of patients with pulmonary disease caused by non-tuberculous mycobacteria (NTM) is increasing globally. Poor resistance against infections, for example, due to pre-existing lung diseases, immune deficiency and immune-modulating treatment, predisposes the population to developing pulmonary NTM disease. The incidence of pre-existing lung diseases such as chronic obstructive pulmonary disease and bronchiectasis has also increased. NTM disease diagnosis is often delayed due to non-specific symptoms. The therapeutic arsenal is limited and adherence to treatment guidelines is often low since the treatment regimens are complex, lengthy and side effects are common. Thus, current disease management is far from satisfactory and needs to be improved. Areas covered: This review provides an overview of the current knowledge of NTM infections and includes pathogenesis, disease patterns, epidemiology, disease management, unmet needs and future perspectives. Expert commentary: NTM disease is becoming more prevalent, in part with our increased awareness and improved diagnostic methods. However, our understanding of the disease pathogenesis is limited and treatment decisions are challenging, with difficult to employ drug regimens. Optimal management requires collaboration between healthcare providers, patients and expert centers.

The overlap between bronchiectasis and chronic airway diseases: state of the art and future directions

“…Caution is, however, warranted because there are no studies specifically in COPD-bronchiectasis overlap for either macrolide. There are significant concerns around the use of macrolides, including the induction of cardiovascular effects and antibiotic resistance; this is particularly dangerous in nontuberculous mycobacterial infections (reported in up to 10% of COPD patients) owing to the increased risk of treatment failure and mortality [82][83][84].…”

A retrospective study of factors associated with treatment decision for nontuberculous mycobacterial lung disease in adults without altered systemic immunity

“…NTM lung disease is strongly associated with pre-existing pulmonary conditions such as chronic obstructive pulmonary disease (COPD), cystic fibrosis, idiopathic bronchiectasis, prior active tuberculosis or pneumoconiosis [6]. It is also frequently associated with genetic or acquired systemic immune deficiency such as defects in the pathways of inflammatory cytokines interleukin (IL)-12, tumor necrosis factor (TNF)-α or interferon (IFN)-γ, immunosuppressive treatments (including anti-TNF-α therapy or corticosteroids), solid-organ transplantation, or acquired immune deficiency syndrome (AIDS)/human immunodeficiency virus (HIV) infection [1][2][3][4][5][6][7]. However, it may also occur in individuals without recognized severe immune local or systemic deficiency.…”

Therapy for Mycobacterium kansasii Infection: Beyond 2018

“…Mycobacterium kansasii infection is challenging to treat since the course of therapy requires multiple drugs and treatment periods of up to 2 years. Long periods of treatment often give rise to additional problems including patient non-adherence to the treatment plan, expense, and potential drug interactions and/or adverse events ( Larsson et al, 2017 ). There are several antimycobacterial drugs that are effective against tuberculosis and other NTMs that might be better alternatives to the current three drug combination.…”