Recommendations of the German Central Committee against Tuberculosis (DZK) and the German Respiratory Society (DGP) for the Diagnosis and Treatment of Non-tuberculous Mycobacterioses

Abstract

Non-tuberculous mycobacterioses comprise a group of diseases caused by mycobacteria which do not belong to the Mycobacterium (M.) tuberculosis-complex and are not ascribed to M. leprae. These mycobacteria are characterized by a broad variety as to environmental distribution and adaptation. Some of the species may cause specific diseases, especially in patients with underlying immunosuppressive diseases, chronic pulmonary diseases or genetic predisposition, respectively. Worldwide, a rising prevalence and significance of non-tuberculous mycobacterioses is recognized. The present recommendations summarise current aspects of epidemiology, pathogenesis, clinical aspects, diagnostics - especially microbiological methods including susceptibility testing -, and specific treatment for the most relevant species. Diagnosis and treatment of non-tuberculous mycobacterioses during childhood and in HIV-infected individuals are described in separate chapters.

Nontuberculous mycobacterial pulmonary disease: an increasing burden with substantial costs

“…A more recent nationally representative survey of physicians in five European countries (France, Germany, Italy, Spain and the UK) and Japan allowed intercountry comparisons of infecting species and comorbidities, as well as comparisons of diagnostic methods, disease severity and treatment practices [20]. Consistent with prior reports, the European patients with NTM PD (table 2, figure 2) [12] were more likely to be male, current or former smokers and have chronic obstructive pulmonary disease (COPD) (33%), whereas Japanese patients were more likely to be female (65%) and less likely than European patients to have COPD (13%) [20].…”

“…Species identification results were received from 20 182 patients from 62 laboratories in 30 countries [11], representing national or subnational reference laboratories. Based on these data, the predominant species showed marked differences across continents: MAC predominated in Australia and North America (table 1), whereas M. xenopi was quite common in Europe, and was the third most frequently isolated species after MAC and M. gordonae [11] (which is generally regarded as nonpathogenic [12]). Within Europe, M. xenopi was more frequently isolated in Southern than Northern Europe [11].…”

“…To this end, initiating NTM infection notification could be considered as part of the public health system and integrated into existing laboratory-based electronic notification systems for tuberculosis, where feasible. These notifications could be supplemented by continued analysis of linked healthcare claims data from different countries to understand the clinical features of NTM PD, including data that had been mostly lacking up to now on the course and outcome of the disease with or without treatment [12], and its cost. DIEL et al [21] have shown us the way forward.…”

Burden of non-tuberculous mycobacterial pulmonary disease in Germany

“…International guidelines (e.g. those described in references [6] and [7]) recommend long-term multidrug treatment until patients achieve 12 consecutive months of negative sputum cultures,. The most recommended treatments mostly comprise a macrolide, rifampicin, and ethambutol, modified according to the phenotypic resistance patterns of the causative strains, if necessary.…”

“…The diagnosis of NTM disease requires the combination of a patient's symptoms, radiographic findings and microbiological criteria, e.g. two or more sputum cultures for well-described respiratory pathogens such as Mycobacterium avium complex, M. kansasii or M. abscessus [6,7]. Because NTM-PD is debilitating in the long term due to lung damage, the need for treatment should be carefully evaluated and it is recommended that patients receive a pathogen-adapted treatment with a multidrug regimen over a period of at least 12 months after sputum culture conversion [6,8].…”