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BMC Medicine

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Open Access 01-12-2016 | Opinion

‘”Why me, why now?” Using clinical immunology and epidemiology to explain who gets nontuberculous mycobacterial infection

Authors: M. Alexandra Lake, Lyn R. Ambrose, Marc C. I. Lipman, David M. Lowe

Published in: BMC Medicine | Issue 1/2016

Abstract

Background

The prevalence of nontuberculous mycobacterial (NTM) disease is rising. An understanding of known risk factors for disease sheds light on the immunological and physical barriers to infection, and how and why they may be overcome. This review focuses on human NTM infection, supported by experimental and in vitro data of relevance to the practising clinician who seeks to understand why their patient has NTM infection and how to further investigate.

Discussion

First, the underlying immune response to NTM disease is examined. Important insights regarding NTM disease susceptibility come from nature's own knockouts, the primary immune deficiency disorders. We summarise the current knowledge surrounding interferon-gamma (IFNγ)-interleukin-12 (IL-12) axis abnormalities, followed by a review of phagocytic defects, T cell lymphopenia and rarer genetic conditions known to predispose to NTM disease. We discuss how these define key immune pathways involved in the host response to NTM. Iatrogenic immunosuppression is also important, and we evaluate the impact of novel biological therapies, as well as bone marrow transplant and chemotherapy for solid organ malignancy, on the epidemiology and presentation of NTM disease, and discuss the host defence dynamics thus revealed. NTM infection and disease in the context of other chronic illnesses including HIV and malnutrition is reviewed. The role of physical barriers to infection is explored. We describe how their compromise through different mechanisms including cystic fibrosis, bronchiectasis and smoking-related lung disease can result in pulmonary NTM colonisation or infection. We also summarise further associations with host factors including body habitus and age.

Summary

We use the presented data to develop an over-arching model that describes human host defences against NTM infection, where they may fail, and how this framework can be applied to investigation in routine clinical practice.

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Title: ‘”Why me, why now?” Using clinical immunology and epidemiology to explain who gets nontuberculous mycobacterial infection
Authors: M. Alexandra Lake
Lyn R. Ambrose
Marc C. I. Lipman
David M. Lowe
Publication date: 01-12-2016
Publisher: BioMed Central
Published in: BMC Medicine / Issue 1/2016
Electronic ISSN: 1741-7015
DOI: https://doi.org/10.1186/s12916-016-0606-6

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Springer Medicine

‘”Why me, why now?” Using clinical immunology and epidemiology to explain who gets nontuberculous mycobacterial infection

Abstract

Background

Discussion

Summary

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Discussion

Summary

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