two have remained culture positive, despite the
antibiotic therapy, suggesting thatM. abscessus
is a new scary bacterial nightmare.
Similar therapeutic results are observed with
lung mycobacterioses caused byMycobacterium
aviumcomplex. In these patients, radiological
regression takes place while on therapy,
associated with a decrease in cultivation positiv-
ity. However, reinfection occurs after a time,
suggesting an insufficient antibiotic control.
Wallace et al. ( 2014 ) have argued that reinfec-
tion, and not antibiotic resistance, is the major
cause treatment failure. These authors achieved
preliminary cure, i.e., sputum conversion without
true microbiologic relapse, in 84 % of patients.
Nonetheless, microbiologic recurrence occurred
in 48 % of these patients after therapy comple-
tion, due to reinfection isolates (75 %) and true
relapse isolates (25 %).
7 Conclusions
Non-tuberculous mycobacteria represent a rela-
tively rare clinical and laboratory finding, but the
frequency of lung infections caused by these
bacteria has been steadily rising in Slovakia dur-
ing in recent years. A crucial task for clinicians is
to rationally evaluate the clinical significance of
detected mycobacterial agents in relation to the
disease symptomatology, especially in assessing
the colonization of the respiratory tract in
patients with residual lesions after tuberculosis
or bronchiectasis.
From the microbiologic standpoint, heteroge-
neity of microbes requires sophisticated and
rapid laboratory techniques. Since current phar-
macological therapy of mycobacterioses is prob-
lematic and it often fails to reach the long-term
eradication of pathogens, it is necessary to ferret
out new drugs or treatment and dosage regimens
for successful therapy of these infections, partic-
ularly serious in immunocompromised patients.
Conflicts of Interest The authors declare no conflicts of
interest in relation to this article.
ReferencesAndrejcak C, Nielsen RB, Thomsen V, Duhaut P,
Sørensen HT, Thomsen RW (2013) Chronic respira-
tory disease, inhaled corticosteroids and risk of
nontuberculous mycobacteriosis. Thorax 68:256–262
CLSI (2011) Susceptibility testing ofMycobacteria,
Nocardiaeand other aerobic actinomycetes; approved
standard, 2nd edn. Clinical and Laboratory Standard
Institute, Wayne
Griffith DE, Aksamit T, Brown-Elliot BA, Catabzaro A,
Daley C, Gordin F, Holland SM, Horsburgh R,
Huitt G, Iademarco MF, Iseman M, Olivier K,
Ruoss S, Von Reyn CF, Wallce RJ Jr, Winthrop K,
on behalf of the ATS Mycobacterial Diseases
Subcomittee (2007) An official ATS/IDSA statement:
diagnosis, tratment and prevention of nontuberculous
mycobacterial diseases. Am J Respir Crit Care
175:367–416
Iseman MD, Marras TK (2008) The importance of
nontuberculous mycobacterial disease. Am J Respir
Crit Care Med 178:999–1000
Jarlier V, Nikaido H (1994) Mycobacterial cell wall:
structure and role in natural resistance to antibiotics.
FEMS Microbiol Lett 123:11–18
Koh WJ, Jeon K, Lee NY, Kim BJ, Kook YH, Lee SH,
Park YK, Kim CK, Shin SJ, Huitt GA, Daley CL,
Kwon OJ (2011) Clinical significance of differentia-
tion ofMycobacterium massiliensefromMycobacte-
rium abscessus. Am J Respir Crit Care Med
183:405–410
Lalande V, Barbut F, Varnerot A, Febvre M, Nesa D,
Wadel S, Vincent V, Petit JC (2001) Pseudo-outbreak
ofMycobacterium gordonaeassociated with water
from refrigerated fountains. J Hosp Infect 48:76–79
Porvaznik I, Mokry J, Solovic I (2014) Drug resistance to
anti-tuberculotics in children – three years status in
Slovakia. Acta Med Martiniana 13:18–22
Porvaznik I, Mokry J, Solovic I (2015) Classical against
molecular-genetic methods for susceptibility testing
of antituberculotics. Adv Exp Med Biol 4:15–22
Runyon EH (1959) Anonymous mycobacteria in pulmo-
nary disease. Med Clin North Am 43:273–290
van Ingen J, Boeree MJ, van Soolingen D, Iseman MD,
Heifets LB, Daley CL (2012a) Are phylogenetic posi-
tion, virulence, drug susceptibility and in vivo
response to treatment in mycobacteria interrelated?
Infect Genet Evol 12:832–837
van Ingen J, Boeree MJ, van Soolingen D, Mouton JW
(2012b) Resistance mechanisms and drug susceptibil-
ity testing of nontuberculous mycobacteria. Drug
Resist Updat 15:149–161
van Ingen J, Egelund EF, Levin A, Totten SE, Boeree MJ,
Mouton JW, Aarnoutse RE, Heifets LB, Peloquin CA,
Daley CL (2012c) The pharmacokinetics and pharma-
codynamics of pulmonary Mycobacterium avium
complex disease treatment. Am J Respir Crit Care
Med 186:559–56524 I. Porvaznik et al.