J Korean Med Assoc.  2006 Sep;49(9):806-816. 10.5124/jkma.2006.49.9.806.

Nontuberculous Mycobacterial Lung Disease

• Koh WJ
• Kwon OJ

• KMID: 2137821
• DOI: http://doi.org/10.5124/jkma.2006.49.9.806

Abstract

As the prevalence of tuberculosis declines, the proportion of mycobacterial lung disease due to nontuberculous mycobacteria (NTM) is increasing worldwide. In Korea, M. avium complex and M. abscessus account for most of the pathogens encountered, whilst M. kansasii is a relatively uncommon cause of NTM pulmonary diseases. NTM pulmonary disease is highly complex in terms of its clinical presentation and management. Because its clinical features are indistinguishable from those of pulmonary tuberculosis and NTMs are ubiquitous in the environment, the isolation and identification of causative organisms are mandatory for diagnosis, and some specific diagnostic criteria have been proposed. The treatment of NTM pulmonary disease depends on the infecting species, but decisions concerning the institution of treatment are far from being easy. It requires the use of multiple drugs for 18 to 24 months. Thus, the treatment is expensive, often has significant side effects, and is frequently not curative. Therefore, clinicians should be confident that there is a sufficient clinical evidence to warrant prolonged, multidrug treatment regimens. In all situations, outcomes can be best optimized only when the clinicians, radiologists, and laboratories work cooperatively. The purpose of this article is to review the common presentations, diagnosis and treatment of the NTM that most commonly cause lung disease in Korea.

Keyword

Atypical mycobacteria; Mycobacterium avium complex; Lung diseases

MeSH Terms

Diagnosis
Korea
Lung Diseases*
Lung*
Mycobacterium avium Complex
Nontuberculous Mycobacteria
Prevalence
Tuberculosis
Tuberculosis, Pulmonary

Figure

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  Figure 1 M. intracellulare pulmonary disease of the upper lobe cavitary form in a 56-year-old man. Chest radiograph shows cavitary consolidation in the right upper lobe.

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  Figure 2 M. intracellulare pulmonary disease of the nodular bronchiectatic form in a 67-year-old woman. Chest radiograph shows a multifocal patchy distribution of small nodular clusters in both lungs. Transaxial lung window CT images (2.5mm section thickness, 70mA) show small centrilobular nodules and bronchiectasis in the both lungs, especially in the right middle lobe and in the lingular division of the left upper lobe.

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  Figure 3 M. abscessus pulmonary disease in a 60-year-old woman. Chest radiograph shows multifocal patchy areas of small nodular clusters in both lungs. Transaxial lung window CT images (2.5mm section thickness, 70 mA) show bronchiectasis and small centrilobular nodules or tree-in-bud opacities in the both lungs, especially in the right middle lobe. Also note bronchiolitis of small centrilobular nodules and tree-in-bud opacities in both lower lobes.

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