Sammanfattning
BACKGROUND: Pulmonary infections with non-tuberculous mycobacteria are regularly encountered in clinical practice. Diagnosis and treatment are challenging, and international guidelines are largely based on experience and case studies. There is a brief and general account of the subject in the Norwegian Institute of Public Health’s tuberculosis guidelines. Other than that, there are no national guidelines on the subject. This article summarises the most recent knowledge on the subject, with the emphasis on diagnosis and treatment.
METHOD: We searched in PubMed, Embase and Cochrane for all reviews and systematic reviews in the period 2007–2017 on non-tuberculous mycobacteria as the cause of pulmonary disease.
RESULTS: When diagnosing and treating pulmonary infections with non-tuberculous mycobacteria, clinical, radiological and microbiological findings must be taken into account before a decision can be made whether treatment is indicated. Identifying the species and any subspecies of a detected mycobacterium and the drug resistance pattern is very important. Treatment consists of a combination of several drugs over a long period, and these frequently have many adverse reactions and drug interactions.
INTERPRETATION: Treatment outcomes for pulmonary infections with non-tuberculous mycobacteria vary. It is important to decide whether the benefit of treatment is expected to outweigh the disadvantages it may entail. For many patients, optimising other treatment of the underlying pulmonary disease will be most important. Patients must be followed up regularly with sputum tests and monitoring of adverse reactions.