Abstract
Nontuberculous mycobacteria (NTM) can cause chronic pulmonary infection in susceptible
hosts. Individuals with cystic fibrosis (CF), a multisystem disease predominated by
progressive structural lung disease, are particularly vulnerable. Only recently have
NTM been recognized for their potential to cause lung deterioration in CF patients.
The reported prevalence varies widely from 4 to 40%, significantly more common than
in the general population, but this varies because of multiple factors including inconsistent
screening practices. Mycobacterium abscessus complex and Mycobacterium avium complex are the two most common species recovered. Defining NTM pulmonary disease
in a CF patient can present challenges as it can be difficult to distinguish from
the other potentially pathogenic organisms in the lung microbiome. In general, treatment
regimens do not differ from the non-CF population but the clinician should be aware
of potential interactions with other CF therapies. Recent population-level genomics
has raised serious concern for indirect person-to-person transmission of several dominating
NTM clones worldwide, raising awareness for increase prevention strategies when CF
patients potentially congregate, such as clinic visits. Lung transplantation is controversial
in those with NTM present in sputum culture but the available evidence suggests that
this is not an absolute contraindication.
Keywords
nontuberculous mycobacteria - cystic fibrosis - MAC -
Mycobacterium abscessus
- bronchiectasis - cavitary lung disease
