Nontuberculous mycobacteria are ubiquitous environmental organisms that have beenudrecognised as a cause of pulmonary infection for over 50 years. Traditionally patientsudhave had underlying risk factors for development of disease; however the proportion ofudapparently immunocompetent patients involved appears to be rising. Not all patientsudculture-positive for mycobacteria will have progressive disease, making the diagnosisuddifficult, though criteria to aid in this process are available. The two main forms ofuddisease are cavitary disease (usually involving the upper lobes) and fibronodularudbronchiectasis (predominantly middle and lingular lobes). For patients with disease,udcombination antibiotic therapy for 12-24 months is generally required for successfuludtreatment, and this may be accompanied by drug intolerances and side effects. Publishedudsuccess rates range from 30-82%. As the progression of disease is variable, for someudpatients, attention to pulmonary hygiene and underlying diseases without immediateudantimycobacterial therapy may be more appropriate. Surgery can be a useful adjunct,udthough is associated with risks. Randomised controlled trials in well described patientsudwould provide stronger evidence-based data to guide therapy of NTM lung diseases, andudthus are much needed.
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