Before the advent of HIV, which led to an increased awareness of Mycobacterium avium complex disease, followed by the first prospective comparison studies on treatment regimens 1, 2, the topic of nontuberculous mycobacterial disease was a true example of Aristotelian science. Previously, only a few experts worldwide had compiled empirical data and disseminated knowledge on the subject, which was based upon meticulous observations in small series or case studies from the 1950s onwards 3. These studies demonstrated the manifold particularities of M. avium complex disease and others as compared with tuberculosis, and also showed how even nontuberculous mycobacterial lung diseases alone, quite apart from manifestations in other organs, appear in widely varying forms. To this day, an ever increasing number of reports on uncommon or recently detected and potentially pathogenic species with strange names deepen the impression that we are dealing with an intricate matter. In 1979, Wolinsky 4 published his legendary review on nontuberculous mycobacteria (NTM) and associated diseases, which is still worth reading and citing: “The pathogenesis of adult pulmonary disease is obscure. Does it represent primary infection after inhalation of aerosolized infected droplet nuclei that then localize and proliferate in specific areas of damaged lung? Or is it a reactivation of dormant bacilli that had been acquired previously?” 4. Meanwhile, the history of HIV especially, and the growing number of patients with transplants, have helped in understanding the role, and some mechanisms, of systemic immunosuppression as an important factor in the development of both disseminated and pulmonary disease. Have we, however, deepened our understanding of the pathophysiology of localised lung disease in non-HIV patients, this being a key issue? Focusing on treatment, in 1985 another pioneer in the field of tuberculosis and nontuberculous mycobacterial diseases, Karl Ludwig Radenbach (1918–1986), wrote: “Clinically, treatment cannot …
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