Diagnostik und Therapie der nichttuberkulösen Mykobakteriosen - Substanzielle Unterschiede zur Tuberkulose!

Abstract

Non-tuberculous mycobacterioses differ substantially from infections with M. tuberculosis complex in regard to both clinical presentation and treatment. In persons infected with HIV the pathogenic organism is almost always M. avium complex, which leads to various pulmonary diseases with specific characteristics and disseminated courses. In patients not infected with HIV, a number of factors that reduce local resistance and certain systemic conditions increase the risk of the infection's reaching a degree of severity requiring treatment. Since these factors are associated with a wide variety of clinical presentations and treatment is species-specific, assessment needs to be individualised for almost all patients. In contrast to the treatment of tuberculosis, in non-tuberculous mycobacterioses the extent to which the treatment can be based on in vitro resistance tests is limited. Clinicians therefore have to draw on their previous clinical experience and the few existing controlled studies, at least initially. In view of the high rate of recurrence compared to tuberculosis, surgical removal of local risk factors (bronchiectasis, bullae, post-specific changes) and thus the mycobacterial infection itself should be considered in all cases.