Respiratory Treatment and Prevention (Advances in Experimental Medicine and Biology)

1. classical TB is widespread worldwide, NTM
   infections are characterized by a distinct
   endemic occurrence;


2. source of infection for humans in classical TB
   is a sick person or an infected animal, while
   NTM reservoirs are present in the
   environment;


3. route of transmission of TB is direct from the
   source of infection, rarely indirect from
   contaminated food, and the transfer mecha-
   nism is known. Transmission routes of most
   NTM diseases represent a problematic issue
   and the mechanism has not yet been ade-
   quately explained yet.

There is a growing body of evidence that the
incidence of NTM lung diseases and associated
hospitalizations are on the rise, mainly in the
regions with a low prevalence of TB (Winthrop
et al. 2010 ). Iseman and Marras ( 2008 ) have
mentioned that new cases of NTM lung disease
reach or even exceed those of pulmonary TB in a
number of industrialized countries. The underly-
ing factors of this changing epidemiology
encompass an increase in the prevalence of sus-
ceptible hosts. The factors include patients
requiring systemic therapy due to a severe dis-
ease, e.g., HIV infection, hematological malig-
nancy, inheritable disorders of immunity,
immunosuppressive drug use including TNF-α
therapy (Winthrop et al. 2009 ), systemic or
inhaled corticosteroid therapy (Andrejcak
et al. 2013 ), pre-existing pulmonary disease
such as cystic fibrosis, or chronic obstructive
pulmonary disease (van Ingen et al.2012c).

3 Diagnosis of NTM Pulmonary
Disease

The American Thoracic Society (ATS) and the
Infectious Diseases Society of America (IDSA)
have recently issued a statement containing a set
of criteria to differentiate an accidental
non-morbid NTM isolation from a real pulmo-
nary disease (Griffith et al. 2007 ):

Clinical Criteria

1. pulmonary symptoms;


2. nodular or cavitary opacities on chest radio-
   graph, or a HRCT scan showing a multifocal
   bronchiectasis with multiple small nodules;


3. appropriate exclusion of other diagnoses.

All three clinical criteria are to be fulfilled to

confirm the diagnosis.

Microbiological Criteria

1. positive cultivation from at least two separate
   expectorated sputum samples;


2. positive cultivation from at least one bron-
   chial wash or lavage;


3. transbronchial or other lung biopsy with
   mycobacterial histopathological features and
   a positive cultivation for NTM, or biopsy
   showing mycobacterial histopathological
   features and a sputum or bronchial washing
   testing positive for NTM.

Only one of the microbiological criteria is

required to confirm the diagnosis.

NTM should be identified at the species level.

In the National Reference Laboratory for

mycobacteria in Vysne Hagy in Slovakia we

have been recently switching from phenotypic

and biochemical analyses to molecular-genetic

methods. Two kinds of tests are in use at present:

(1) Speed-oligo®Mycobacteria (Vircell, Spain)

which enables the identification ofMycobacte-

rium tuberculosiscomplex and other 13 most

frequent NTM and (2) Genotype Mycobacterium

CM/AS (Hain Lifescience, Germany) which

enables the identification of 14 common NTM

and other 16 additional species (Porvaznik

et al. 2015 ; Porvaznik et al. 2014 ).

4 Drug-Susceptibility Testing

(DST)

The role of DST in the choice of suitable drugs

for antimicrobial treatment of NTM disease

Non-Tuberculous Mycobacteria: Classification, Diagnostics, and Therapy 21