Febrile 122: StAR: Protect the Macrolide! NTM Pulmonary Disease
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Jun 23, 2025 Charles Daley, a leading expert on mycobacterial diseases, Minh-Vu Nguyen, an infectious disease specialist, and Reeti Khare, director of a rare disease lab, dive deep into non-tuberculous mycobacterial pulmonary disease. They discuss the rising incidence of NTM infections, the challenges of accurate diagnosis, and the complexities of mixed infections. Insights on tailored treatment strategies, including the fight against macrolide resistance and new advancements in therapy, provide a hopeful outlook for patient care. Tune in for expert anecdotes and essential monitoring strategies!
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NTM Infection Requires Susceptible Host
- Non-tuberculous mycobacteria (NTM) are environmental organisms commonly inhaled or ingested but only cause disease in susceptible hosts.
- Structural lung disease, especially bronchiectasis, and local immune dysfunction primarily predispose to NTM pulmonary disease.
NTM Diagnosis Requires Strict Criteria
- Diagnose NTM pulmonary disease only with compatible symptoms, suggestive imaging, and repeated positive cultures.
- Avoid overdiagnosis since NTM are everywhere in the environment and can represent contamination or colonization.
NTM Testing Is Slow and Complex
- Understand that NTM cultures take 6-8 weeks due to slow bacterial growth, delaying diagnosis.
- Molecular tests could speed diagnostics but currently lack sensitivity, specificity, and clear interpretation for clinical decision-making.