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Clinical and microbiologic criteria for diagnosing nontuberculous mycobacterial pulmonary disease[1]

Clinical and microbiologic criteria for diagnosing nontuberculous mycobacterial pulmonary disease[1]
Clinical and radiologic criteria (all required)
1. Pulmonary or systemic symptoms
and
2. Nodular or cavitary opacities on chest radiograph or bronchiectasis with multiple small nodules on high-resolution computed tomography
and
3. Appropriate exclusion of other diagnoses
Microbiologic criteria (at least one required)*
1. Positive culture results from at least two separate expectorated sputum samples. If the results are nondiagnostic, consider repeat sputum AFB smears and cultures.
or
2. Positive culture result from at least one bronchial wash or lavage.
or
3. Transbronchial or other lung biopsy with mycobacterial histopathologic features (granulomatous inflammation or AFB) and positive culture for NTM; or biopsy showing mycobacterial histopathologic features (granulomatous inflammation or AFB) and one or more sputum or bronchial washings that are culture positive for NTM.
Additional considerations
  • Expert consultation should be obtained when NTM are recovered that are infrequently encountered or that usually represent environmental contamination.
  • Patients who are suspected of having NTM lung disease but do not meet the diagnostic criteria should be followed until the diagnosis is firmly established or excluded.
  • Making the diagnosis of NTM lung disease does not, per se, necessitate the institution of therapy, which is a decision based on potential risks and benefits of therapy for individual patients.
AFB: acid-fast bacilli; NTM: nontuberculous mycobacteria.
​* When 2 positive cultures are obtained, the isolates should be the same NTM species (or subspecies in the case of M. abscessus) in order to meet disease criteria.
Originally reproduced with permission from: Griffith DE, Aksamit T, Brown-Elliott BA, et al. An Official ATS/IDSA Statement: Diagnosis, treatment and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med 2007; 175:367. Copyright © 2007 American Thoracic Society.
Updated with information from:
  1. ​Daley CL, Iaccarino JM, Lange C, et al. Treatment of Nontuberculous Mycobacterial Pulmonary Disease: An Official ATS/ERS/ESCMID/IDSA Clinical Practice Guideline: Executive Summary. Clin Infect Dis 2020; 71:e1.
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