Non-tuberculous mycobacterial lung disease in general practice
Practice nurses may be the first to notice signs and symptoms of respiratory infections, including non-tuberculous mycobacteria. As it is becoming an increasingly recognised infection, Jacqui White et al explore its epidemiology and impact on chronic lung disease
Non-tuberculous mycobacteria infection is increasingly recognised as a cause of chronic lung disease. This is most often found in people with underlying lung damage, such as chronic obstructive pulmonary disease or bronchiectasis, where it may present as new, worsening or recurrent symptoms. Mycobacterial culture is central to diagnosis, though treatment is generally initiated on the basis of additional compatible symptoms and radiology. The prolonged duration of often poorly-tolerated therapy highlights the importance of patient-centred care and shared decision-making in non-tuberculous mycobacteria management.
Non-tuberculous mycobacteria (NTM) are a diverse group of complex bacteria that are found in environmental sites such as soil and water. They are generally not as pathogenic to humans as the Mycobacterium tuberculosis complex organisms, which result in tuberculosis (TB). For the purposes of classification, they also do not include Mycobacterium leprae, which cause leprosy.
This article will discuss why what was previously regarded as an unimportant and generally harmless organism is now seen as a serious healthcare issue. It will also map out the important role of nurses in the management of NTM-related infection and disease.
There are over 170 different NTM species. This number continues to rise as improvements in diagnostic technology occur, for example the use of mycobacterial whole genome sequencing (where the full or near-complete DNA sequence of a mycobacteria is identified using molecular techniques) to distinguish strains that would have been previously considered the same organism. Also, the greater interest in the field means that researchers are now looking for NTM in a number of different clinical and environmental settings; while clinicians in both primary and secondary care are considering these organisms in diagnostic investigations.
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