Current challenges in diagnosing and treating nontuberculous mycobacterial pulmonary disease
Patients with pulmonary disease caused by nontuberculous mycobacteria typically present with chronic cough and fatigue, sometimes with hemoptysis and weight loss as well. High-resolution CT is the most helpful radiographic study; it typically shows pulmonary nodules with adjacent bronchiectasis. Obtaining multiple sputum specimens for acid-fast staining and mycobacterial culture is an important part of the diagnostic workup. The diagnosis should be clearly established before treatment is initiated. Traditional regimens include isoniazid, rifampin, and ethambutol. More recent therapies include azithromycin, clarithromycin, rifabutin, and the newer fluoroquinolones. Surgical resection remains an option for patients with relatively localized disease who have a suboptimal response to medical therapy.
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