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due to overlapping symptoms&#44; signs&#44; and radiological findings&#46; Moreover&#44; the treatment of these infections constitutes an additional burden for patients&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">3</span></a> We report the first 2 cases of pediatric CF patients with lung infection caused by <span class="elsevierStyleItalic">Mycobacterium lentiflavum</span> &#40;<span class="elsevierStyleItalic">M&#46; lentiflavum</span>&#41;&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Our first case was a boy with CF with typical symptoms&#44; 2 CFTR gene mutations &#40;c&#46;1521&#95;1523delCTTT&#47;1820&#95;1903del&#41;&#44; and 100 and 84<span class="elsevierStyleHsp" style=""></span>mmol&#47;l chloride in sweat tests&#46; He was chronically colonized with oxacillin-sensitive <span class="elsevierStyleItalic">Staphylococcus aureus</span> and <span class="elsevierStyleItalic">Haemophilus influenzae</span> with intermittent <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span> infection&#46; At the age of 13 years&#44; he experienced an increase in respiratory secretions&#44; lung function decline&#44; and weight loss&#46; He was treated with ciprofloxacin&#44; but showed no clinical improvement&#46; Lung high-resolution computed tomography &#40;HRCT&#41; showed increased bronchiectasis with a tree-in-bud image and acinar nodules &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#46; After obtaining 2 sputum cultures positive for <span class="elsevierStyleItalic">M&#46; lentiflavum</span>&#44; the patient began treatment with clarithromycin &#40;500<span class="elsevierStyleHsp" style=""></span>mg&#47;12<span class="elsevierStyleHsp" style=""></span>h&#41;&#44; cycloserine &#40;500<span class="elsevierStyleHsp" style=""></span>mg&#47;24<span class="elsevierStyleHsp" style=""></span>h&#41;&#44; and ethambutol &#40;500<span class="elsevierStyleHsp" style=""></span>mg&#47;24<span class="elsevierStyleHsp" style=""></span>h&#41; for 6 months&#44; resulting in eradication of the pathogen&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Our second patient was an 11-year-old girl with a diagnosis of CF who presented persistent chronic cough&#44; 102<span class="elsevierStyleHsp" style=""></span>mmol&#47;l chloride in 2 sweat tests&#44; and 2 CFTR mutations &#40;c&#46;&#91;1521&#95;1523delCTT&#47;c&#46;1000C&#62;T&#41;&#46; She had intermittent colonization with oxacillin-sensitive <span class="elsevierStyleItalic">S&#46; aureus</span>&#46; The patient presented a slight increase in cough and worsening lung function&#44; which coincided with the isolation of <span class="elsevierStyleItalic">M&#46; lentiflavum</span> in 2 sputum samples&#46; Lung HRCT showed pulmonary nodules and increased bronchiectasis &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46; After 6 months of oral clarithromycin &#40;500<span class="elsevierStyleHsp" style=""></span>mg&#47;12<span class="elsevierStyleHsp" style=""></span>h&#41;&#44; cycloserine 500<span class="elsevierStyleHsp" style=""></span>mg&#47;12<span class="elsevierStyleHsp" style=""></span>h&#44; ethambutol &#40;500<span class="elsevierStyleHsp" style=""></span>mg&#47;24<span class="elsevierStyleHsp" style=""></span>h&#41;&#44; and nebulized amikacin&#44; the patient&#39;s clinical and spirometric progress was good&#44; and <span class="elsevierStyleItalic">M&#46; lentiflavum</span> was eradicated&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In recent years&#44; we have witnessed an increase in survival in CF for multiple reasons&#44; including early diagnosis with neonatal screening&#44; better nutritional support&#44; earlier and more aggressive interventions for respiratory infections&#44; multidisciplinary management&#44; follow-up in reference units&#44; and the development of cystic fibrosis transmembrane conductance regulators&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">1</span></a> Changes are also being observed in the epidemiology of pathogens associated with lung infections&#44; with the emergence of microorganisms with a significant clinical impact that complicate the management of these patients and significantly affect lung function by perpetuating the vicious circle of inflammation and infection&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">4</span></a> One of these emerging pathogens is NTMB&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">2</span></a> These microorganisms are widely distributed in the environment&#44; and the generally accepted mechanism of transmission is aerosolization&#44;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">2&#44;5</span></a> although evidence is emerging on transmission between humans&#44; underlining the importance of strict adherence to protocols for the control of cross-infection&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">2</span></a> They can cause chronic lung infection&#44; particularly in subjects with pre-existing inflammatory lung disease&#44; such as our patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">2&#44;5</span></a> The incidence increases with age&#44;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">6</span></a> and the real prevalence&#44; as defined by the American Thoracic Society&#44; is not fully determined&#44; although it is estimated to be between 4&#37; and 14&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleItalic">Mycobacterium avium complex</span> and <span class="elsevierStyleItalic">Mycobacterium abscessus</span> are the most frequently isolated NTMB&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">7&#44;8</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">M&#46; lentiflavum</span> is a slow-growing&#44; pigmented&#44; scotocromogenic NTMB&#44; first described in 1996&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">7&#8211;9</span></a> It grows at 25&#8211;37<span class="elsevierStyleHsp" style=""></span>&#176;C&#44; forming colonies measuring 1&#8211;2<span class="elsevierStyleHsp" style=""></span>mm in diameter&#44; with bright yellow pigmentation&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">7&#44;8&#44;10</span></a> It rarely causes human infection&#59; the most common form of presentation in children is cervical lymphadenitis&#44;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">7&#44;8&#44;11&#44;12</span></a> although infections have also been described in immunocompromised patients&#44;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">7&#44;8&#44;11&#44;12</span></a> and evidence is growing of cases of chronic lung disease in immunocompetent patients&#44;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">7&#44;12</span></a> such as the ones discussed here&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Because <span class="elsevierStyleItalic">M&#46; lentiflavum</span> is an environmental microorganism&#44; the clinical significance of lung infection caused by this bacterium in immunocompetent patients has been questioned&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">7&#44;8&#44;10&#44;13</span></a> In our patients&#44; the diagnosis of <span class="elsevierStyleItalic">M&#46; lentiflavum</span> infection was made according to the criteria of the latest consensus of the European Society and American CF Foundation for the diagnosis of NTMB in CT patients&#46; Specifically&#44; both patients presented symptoms of respiratory exacerbation not attributable to other microorganisms or other causes&#44; radiological worsening&#44; and 2 sputum cultures positive for <span class="elsevierStyleItalic">M&#46; lentiflavum</span>&#46; These data were supported by the clear radiological&#44; spirometric&#44; and nutritional improvement and negative cultures obtained after the treatment&#46; Given the clinical impact of infection by this pathogen on the lung disease of our patients&#44; we suggest that <span class="elsevierStyleItalic">M&#46; lentiflavum</span> is not always a simple contaminant&#44; and we believe that it is essential to identify it in CF patients&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">9</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The biochemical characteristics of this microorganism make it difficult to identify&#44;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">9</span></a> as additional nucleic acid studies are required for its characterization&#58; hsp-65 gene amplification&#44; digestion with restriction enzymes and 16S rRNA amplification&#44; with subsequent sequencing of a hypervariable region within the gene&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">9</span></a> The optimal therapeutic regimen has not been determined&#44;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">10</span></a> but it is important to bear in mind that this micro-organism is resistant to most antituberculosis agents&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">12</span></a> Combinations of clarithromycin or azithromycin plus rifampicin&#44; rifabutin or ethambutol<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">9</span></a> are commonly used&#46; Strains that are sensitive to amikacin&#44; ciprofloxacin&#44; cycloserine&#44; canamycin&#44; or ofloxacin have been identified&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">12</span></a> In our cases&#44; eradication was achieved after 6 months of oral treatment with clarithromycin&#44; cycloserine&#44; and nebulized amikacin&#44; and tolerance was good&#46; Ophthalmological and audiometric studies are unchanged&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">To conclude&#44; we propose the inclusion of <span class="elsevierStyleItalic">M&#46; lentiflavum</span> in the growing list of NTMB that cause lung disease in both immunocompromised and immunocompetent patients&#46; It is essential to correctly identify this pathogen using specific molecular tools&#44; and to determine its sensitivity profile&#44; given the high rate of antimicrobial resistance&#46; Clinical trials and&#47;or studies are needed to clarify its real prevalence&#44; to identify risk factors related with this infection&#44; and to study the clinical impact in patients with chronic lung disease&#44; specifically in CF&#46; These steps will help improve diagnostic strategies and will support therapeutic decisions with consistent scientific evidence&#44; in order to improve control of the infection and avoid the lung function decline associated with this pathogen&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Moreno Ortega M&#44; Quintana Gallego E&#44; Carrasco Hern&#225;ndez L&#44; P&#233;rez Borrego E&#44; Delgado Pecell&#237;n I&#46; <span class="elsevierStyleItalic">Mycobacterium lentiflavum</span> en pacientes con fibrosis qu&#237;stica&#58; &#191;colonizante o patog&#233;nico&#63; Arch Bronconeumol&#46; 2018&#59;54&#58;639&#8211;640&#46;</p>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Lung CTs of 2 patients with a diagnosis of <span class="elsevierStyleItalic">M&#46; lentiflavum</span> infection&#46; Both patients revealed a clear tree-in-bud image &#40;arrows&#41; with acinar nodules &#40;&#916;&#41;&#44; mainly in the right upper lobes&#46;</p>"
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Scientific Letter
Mycobacterium lentiflavum in Cystic Fibrosis Subjects. A Colonizer or a True Pathogen?
Mycobacterium lentiflavum en pacientes con fibrosis quística: ¿colonizante o patogénico?
María Moreno Ortegaa,b,
Corresponding author
bebarrabaja@gmail.com

Corresponding author.
, Esther Quintana Gallegob,c, Laura Carrasco Hernándezb,c, Esther Pérez Borregoa, Isabel Delgado Pecellínb,c
a Unidad de Pediatría y áreas específicas, Hospital Universitario Virgen del Rocío, Sevilla, Spain
b Unidad de Fibrosis Quística, Hospital Universitario Virgen del Rocío, Sevilla, Spain
c Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain
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due to overlapping symptoms&#44; signs&#44; and radiological findings&#46; Moreover&#44; the treatment of these infections constitutes an additional burden for patients&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">3</span></a> We report the first 2 cases of pediatric CF patients with lung infection caused by <span class="elsevierStyleItalic">Mycobacterium lentiflavum</span> &#40;<span class="elsevierStyleItalic">M&#46; lentiflavum</span>&#41;&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Our first case was a boy with CF with typical symptoms&#44; 2 CFTR gene mutations &#40;c&#46;1521&#95;1523delCTTT&#47;1820&#95;1903del&#41;&#44; and 100 and 84<span class="elsevierStyleHsp" style=""></span>mmol&#47;l chloride in sweat tests&#46; He was chronically colonized with oxacillin-sensitive <span class="elsevierStyleItalic">Staphylococcus aureus</span> and <span class="elsevierStyleItalic">Haemophilus influenzae</span> with intermittent <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span> infection&#46; At the age of 13 years&#44; he experienced an increase in respiratory secretions&#44; lung function decline&#44; and weight loss&#46; He was treated with ciprofloxacin&#44; but showed no clinical improvement&#46; Lung high-resolution computed tomography &#40;HRCT&#41; showed increased bronchiectasis with a tree-in-bud image and acinar nodules &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#46; After obtaining 2 sputum cultures positive for <span class="elsevierStyleItalic">M&#46; lentiflavum</span>&#44; the patient began treatment with clarithromycin &#40;500<span class="elsevierStyleHsp" style=""></span>mg&#47;12<span class="elsevierStyleHsp" style=""></span>h&#41;&#44; cycloserine &#40;500<span class="elsevierStyleHsp" style=""></span>mg&#47;24<span class="elsevierStyleHsp" style=""></span>h&#41;&#44; and ethambutol &#40;500<span class="elsevierStyleHsp" style=""></span>mg&#47;24<span class="elsevierStyleHsp" style=""></span>h&#41; for 6 months&#44; resulting in eradication of the pathogen&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Our second patient was an 11-year-old girl with a diagnosis of CF who presented persistent chronic cough&#44; 102<span class="elsevierStyleHsp" style=""></span>mmol&#47;l chloride in 2 sweat tests&#44; and 2 CFTR mutations &#40;c&#46;&#91;1521&#95;1523delCTT&#47;c&#46;1000C&#62;T&#41;&#46; She had intermittent colonization with oxacillin-sensitive <span class="elsevierStyleItalic">S&#46; aureus</span>&#46; The patient presented a slight increase in cough and worsening lung function&#44; which coincided with the isolation of <span class="elsevierStyleItalic">M&#46; lentiflavum</span> in 2 sputum samples&#46; Lung HRCT showed pulmonary nodules and increased bronchiectasis &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46; After 6 months of oral clarithromycin &#40;500<span class="elsevierStyleHsp" style=""></span>mg&#47;12<span class="elsevierStyleHsp" style=""></span>h&#41;&#44; cycloserine 500<span class="elsevierStyleHsp" style=""></span>mg&#47;12<span class="elsevierStyleHsp" style=""></span>h&#44; ethambutol &#40;500<span class="elsevierStyleHsp" style=""></span>mg&#47;24<span class="elsevierStyleHsp" style=""></span>h&#41;&#44; and nebulized amikacin&#44; the patient&#39;s clinical and spirometric progress was good&#44; and <span class="elsevierStyleItalic">M&#46; lentiflavum</span> was eradicated&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In recent years&#44; we have witnessed an increase in survival in CF for multiple reasons&#44; including early diagnosis with neonatal screening&#44; better nutritional support&#44; earlier and more aggressive interventions for respiratory infections&#44; multidisciplinary management&#44; follow-up in reference units&#44; and the development of cystic fibrosis transmembrane conductance regulators&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">1</span></a> Changes are also being observed in the epidemiology of pathogens associated with lung infections&#44; with the emergence of microorganisms with a significant clinical impact that complicate the management of these patients and significantly affect lung function by perpetuating the vicious circle of inflammation and infection&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">4</span></a> One of these emerging pathogens is NTMB&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">2</span></a> These microorganisms are widely distributed in the environment&#44; and the generally accepted mechanism of transmission is aerosolization&#44;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">2&#44;5</span></a> although evidence is emerging on transmission between humans&#44; underlining the importance of strict adherence to protocols for the control of cross-infection&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">2</span></a> They can cause chronic lung infection&#44; particularly in subjects with pre-existing inflammatory lung disease&#44; such as our patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">2&#44;5</span></a> The incidence increases with age&#44;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">6</span></a> and the real prevalence&#44; as defined by the American Thoracic Society&#44; is not fully determined&#44; although it is estimated to be between 4&#37; and 14&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleItalic">Mycobacterium avium complex</span> and <span class="elsevierStyleItalic">Mycobacterium abscessus</span> are the most frequently isolated NTMB&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">7&#44;8</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">M&#46; lentiflavum</span> is a slow-growing&#44; pigmented&#44; scotocromogenic NTMB&#44; first described in 1996&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">7&#8211;9</span></a> It grows at 25&#8211;37<span class="elsevierStyleHsp" style=""></span>&#176;C&#44; forming colonies measuring 1&#8211;2<span class="elsevierStyleHsp" style=""></span>mm in diameter&#44; with bright yellow pigmentation&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">7&#44;8&#44;10</span></a> It rarely causes human infection&#59; the most common form of presentation in children is cervical lymphadenitis&#44;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">7&#44;8&#44;11&#44;12</span></a> although infections have also been described in immunocompromised patients&#44;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">7&#44;8&#44;11&#44;12</span></a> and evidence is growing of cases of chronic lung disease in immunocompetent patients&#44;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">7&#44;12</span></a> such as the ones discussed here&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Because <span class="elsevierStyleItalic">M&#46; lentiflavum</span> is an environmental microorganism&#44; the clinical significance of lung infection caused by this bacterium in immunocompetent patients has been questioned&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">7&#44;8&#44;10&#44;13</span></a> In our patients&#44; the diagnosis of <span class="elsevierStyleItalic">M&#46; lentiflavum</span> infection was made according to the criteria of the latest consensus of the European Society and American CF Foundation for the diagnosis of NTMB in CT patients&#46; Specifically&#44; both patients presented symptoms of respiratory exacerbation not attributable to other microorganisms or other causes&#44; radiological worsening&#44; and 2 sputum cultures positive for <span class="elsevierStyleItalic">M&#46; lentiflavum</span>&#46; These data were supported by the clear radiological&#44; spirometric&#44; and nutritional improvement and negative cultures obtained after the treatment&#46; Given the clinical impact of infection by this pathogen on the lung disease of our patients&#44; we suggest that <span class="elsevierStyleItalic">M&#46; lentiflavum</span> is not always a simple contaminant&#44; and we believe that it is essential to identify it in CF patients&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">9</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The biochemical characteristics of this microorganism make it difficult to identify&#44;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">9</span></a> as additional nucleic acid studies are required for its characterization&#58; hsp-65 gene amplification&#44; digestion with restriction enzymes and 16S rRNA amplification&#44; with subsequent sequencing of a hypervariable region within the gene&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">9</span></a> The optimal therapeutic regimen has not been determined&#44;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">10</span></a> but it is important to bear in mind that this micro-organism is resistant to most antituberculosis agents&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">12</span></a> Combinations of clarithromycin or azithromycin plus rifampicin&#44; rifabutin or ethambutol<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">9</span></a> are commonly used&#46; Strains that are sensitive to amikacin&#44; ciprofloxacin&#44; cycloserine&#44; canamycin&#44; or ofloxacin have been identified&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">12</span></a> In our cases&#44; eradication was achieved after 6 months of oral treatment with clarithromycin&#44; cycloserine&#44; and nebulized amikacin&#44; and tolerance was good&#46; Ophthalmological and audiometric studies are unchanged&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">To conclude&#44; we propose the inclusion of <span class="elsevierStyleItalic">M&#46; lentiflavum</span> in the growing list of NTMB that cause lung disease in both immunocompromised and immunocompetent patients&#46; It is essential to correctly identify this pathogen using specific molecular tools&#44; and to determine its sensitivity profile&#44; given the high rate of antimicrobial resistance&#46; Clinical trials and&#47;or studies are needed to clarify its real prevalence&#44; to identify risk factors related with this infection&#44; and to study the clinical impact in patients with chronic lung disease&#44; specifically in CF&#46; These steps will help improve diagnostic strategies and will support therapeutic decisions with consistent scientific evidence&#44; in order to improve control of the infection and avoid the lung function decline associated with this pathogen&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Moreno Ortega M&#44; Quintana Gallego E&#44; Carrasco Hern&#225;ndez L&#44; P&#233;rez Borrego E&#44; Delgado Pecell&#237;n I&#46; <span class="elsevierStyleItalic">Mycobacterium lentiflavum</span> en pacientes con fibrosis qu&#237;stica&#58; &#191;colonizante o patog&#233;nico&#63; Arch Bronconeumol&#46; 2018&#59;54&#58;639&#8211;640&#46;</p>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Lung CTs of 2 patients with a diagnosis of <span class="elsevierStyleItalic">M&#46; lentiflavum</span> infection&#46; Both patients revealed a clear tree-in-bud image &#40;arrows&#41; with acinar nodules &#40;&#916;&#41;&#44; mainly in the right upper lobes&#46;</p>"
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Article information
ISSN: 15792129
Original language: English
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