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P re f a c e N o n t u b e rc u l o u s Mycobacteria

Gwen A. Huitt, MD, MS

Charles L. Daley, MD

Nontuberculous mycobacteria (NTM) represent over 160 separate species that vary greatly in their ability to cause disease in humans. Epidemiologic data from across the world have documented increasing prevalence of pulmonary NTM infections and, in some areas, prevalence rates are greater than those of tuberculosis. This issue is dedicated to NTM and reviews the pathogenesis, epidemiology, diagnosis, and management of these complex and difficult-to-treat infections. The issue begins with a review of the pathogenesis of NTM infections, highlighting the spectrum of host impairment associated with NTM disease. An extensive review of the epidemiology of NTM infections follows. This article delineates the varying rates of disease and increasing prevalence of NTM pulmonary disease globally. Possible reasons for the increasing prevalence are explored, including exposure to environmental sources and possible steps that can be taken to decrease exposure. Diagnosis of pulmonary NTM infections requires that the clinician integrate clinical, radiographic, and microbiological data but, ultimately, the diagnosis is based on isolation of the organism from the patient. The laboratory diagnosis of NTM is in a state of evolution, transitioning from mostly phenotypic to molecular methods. The next article summarizes available data on techniques for the

microbiological diagnosis of NTM pulmonary disease and provides a framework for the optimal microbiological diagnosis. The first article to address treatment reviews the commonly used drugs for the treatment of NTM infections and approach to monitoring for adverse reactions. The drugs and regimens used will vary depending on the species causing disease. Therefore, treatment is discussed by dividing the reviews into one that reviews the management of rapidly growing mycobacteria and another for slowly growing mycobacteria. NTM infections are increasingly common in some special populations, so we have included reviews of the management of NTM infections in immunocompromised patients and persons with cystic fibrosis. And, finally, in some cases, antimicrobial therapy is insufficient for control and/or cure of the infection. In these cases, surgical resection may be indicated, so we have included an excellent review of the surgical approach to pulmonary NTM infections. We hope this issue is of interest to clinicians, scientists, and patients. To the authors, we owe them thanks for their excellent contributions. To Casey Jackson and the Elsevier staff, we thank you for your support and patience during the long effort to bring this issue to fruition and now publication.

Clin Chest Med - (2014) -–http://dx.doi.org/10.1016/j.ccm.2014.11.006 0272-5231/14/$ – see front matter Ó 2014 Published by Elsevier Inc.

chestmed.theclinics.com

Editors

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Preface We would like to dedicate this issue to the memory of Fern Leitman, a patient, visionary, and leader in the fight against NTM. Gwen A. Huitt, MD, MS Division of Mycobacterial and Respiratory Infections National Jewish Health 1400 Jackson Street Denver, CO 80206, USA

Charles L. Daley, MD Division of Mycobacterial and Respiratory Infections National Jewish Health, Room J304 1400 Jackson Street Denver, CO 80206, USA E-mail addresses: [email protected] (G.A. Huitt) [email protected] (C.L. Daley)

Nontuberculous mycobacteria.

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