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Recent Advances in Chest Medicine |

Pulmonary Disease Due to Nontuberculous MycobacteriaPulmonary Disease From Nontuberculous Mycobacteria: Current State and New Insights

Pamela J. McShane, MD; Jeffrey Glassroth, MD
Author and Funding Information

From the National Heart, Lung, and Blood Institute (Dr McShane), National Institutes of Health, Bethesda, MD; and Biological Sciences Division (Dr Glassroth), The University of Chicago, Chicago, IL.

CORRESPONDENCE TO: Pamela J. McShane, MD, National Heart, Lung, and Blood Institute, National Institutes of Health, Bldg 10, Room 6-3154, Bethesda, MD 20892; e-mail: pamelamcshane@hotmail.com


Drs McShane and Glassroth contributed equally to this manuscript.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;148(6):1517-1527. doi:10.1378/chest.15-0458
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Since pulmonary nontuberculous mycobacteria (PNTM) lung disease was last reviewed in CHEST in 2008, new information has emerged spanning multiple domains, including epidemiology, transmission and pathogenesis, clinical presentation, diagnosis, and treatment. The overall prevalence of PNTM is increasing, and in the United States, areas of highest prevalence are clustered in distinct geographic locations with common environmental and socioeconomic factors. Although the accepted paradigm for transmission continues to be inhalation from the environment, provocative reports suggest that person-to-person transmission may occur. A panoply of host factors have been investigated in an effort to elucidate why infection from this bacteria develops in ostensibly immunocompetent patients, and there has been clarification that immunocompetent patients exhibit different histopathology from immunocompromised patients with nontuberculous mycobacteria infection. It is now evident that Mycobacterium abscessus, an increasingly prevalent cause of PNTM lung disease, can be classified into three separate subspecies with differing genetic susceptibility or resistance to macrolides. Recent publications also raise the possibility of improved control of PNTM through enhanced adherence to current treatment guidelines as well as new approaches to treatment and even prevention. These and other recent developments and insights that may inform our approach to PNTM lung disease are reviewed and discussed.

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