Non-Tuberculous Mycobacterial Infections in Cystic Fibrosis

Non-tuberculous mycobacteria (NTM) are widely found in water and soil and exhibit high levels of constitutive and acquired multi-drug resistance. There has been an unexplained increase worldwide in the prevalence of NTM infections over the past 30 years. The diagnosis of NTM pulmonary disease in people with cystic fibrosis (CF) is based upon clinical, radiological, and microbiological criteria. Not everyone with positive NTM respiratory cultures develop pulmonary disease, and some have transiently positive cultures. The diagnosis of NTM pulmonary disease in CF is challenging as the radiographic and clinical manifestations of chronic co-infections with typical CF pathogens can overlap. General CF care must be optimized to assess the impact of positive cultures and improve treatment responses. Treatment is reserved for those with pulmonary disease and requires a complex combination of antimicrobial agents for at least 12 months. Current treatment may have considerable short- and long-term toxicity, with variable rates of successful microbiological clearance. The costs and treatment burden of NTM infections are high and developing evidence for better management for these difficult-to-treat infections remains a priority. It remains unclear how infection and pulmonary disease with NTM will be impacted by widespread and earlier use of CF modulator therapy.