Abstract
The nontuberculous mycobacteria (NTM) are typically environmental organisms residing
in soil and water. Although generally of low pathogenicity to humans, NTM can cause
a wide array of clinical diseases; pulmonary disease is most frequent, followed by
lymphadenitis in children, skin disease by M. marinum (particularly in fish tank fanciers), and other extrapulmonary or disseminated infections
in severely immunocompromised patients. Of the >140 NTM species reported in the literature,
25 species have been strongly associated with NTM diseases; the remainder are environmental
organisms rarely encountered in clinical samples. Correct species identification is
very important because NTM species differ in their clinical relevance. Further, NTM
differ strongly in their growth rate, temperature tolerance, and drug susceptibility.
The diagnosis of NTM disease is complex and requires good communication between clinicians,
radiologists, and microbiologists. Isolation of M. kansasii and (in northwestern Europe) M. malmoense from pulmonary specimens usually indicates disease, whereas Mycobacterium gordonae and, to a lesser extent, M. simiae or M. chelonae are typically contaminants rather than causative agents of true disease. Mycobacterium avium complex (MAC), M. xenopi, and M. abscessus form an intermediate category between these two extremes. This review covers the
clinical and laboratory diagnosis of NTM diseases and particularities for the different
disease types and patient populations. Because of limited sensitivity and specificity
of symptoms, radiology, and direct microscopy of clinical samples, culture remains
the gold standard. Yet culture is time consuming and demands the use of multiple media
types and incubation temperatures to optimize the yield. Outside of reference centers,
such elaborate culture algorithms are scarce.
Keywords
nontuberculous mycobacteria - diagnosis - laboratory techniques
