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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Tuberculosis &#40;TB&#41; is a disease well known for its morbidity and mortality&#46; It infects millions of people every year and&#44; along with the human immunodeficiency virus &#40;HIV&#41;&#44; is one of the leading causes of death worldwide&#46; The incidence of TB has gradually declined in industrialized countries&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In recent years&#44; non-tuberculous mycobacteria &#40;NTM&#41; have taken on new importance&#44; with an increase in the number of isolates in microbiology departments&#44; accounting for 30&#37;&#8211;50&#37; of the total mycobacteria&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">NTM are a heterogeneous group of bacteria&#44; widely distributed in nature&#44; that can cause various infections in humans&#44; most frequently pulmonary&#59; NTM usually occurs in patients with predisposing factors for disease progression&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Geographical distribution varies widely&#44; depending on the microorganism&#8217;s ability to survive under certain environmental conditions and the capability of local laboratories to isolate and identify these strains&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The definition&#44; diagnosis&#44; and management of NTM infections have been governed since 2007 by the guidelines of the American Thoracic Society&#47;Infectious Diseases Society of America&#46; The epidemiology of the more than 170 species of NTM described is unknown&#44; because identification and sensitivity testing are not performed in all microbiology laboratories&#44; and these infections are not notifiable diseases in most countries&#46; The number of NTM infections appears to be increasing in many parts of the world&#46; In the United States&#44; we know that the number of cases of NTM infections is higher than that of TB&#46; Despite this&#44; research in this area still lags far behind TB&#44; and many issues remain unclarified&#46; It is still unclear why some NTM are pathogenic and others are not&#44; and which environmental or host factors might favor infection&#44; while the natural history of the disease and the best diagnostic and therapeutic procedures remain undetermined&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The epidemiological relationship between <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span> complex &#40;MTC&#41; and NTM infections is not yet well understood&#46; Some studies suggest that evidence of local increases in NTM infection rates coincide with the decrease in MTC infection rates&#46; The first hypothesis approaches the question from an immunological point of view&#44; citing a phenomenon of cross-reactivity and immune defects favoring NTM disease&#44; but it has not been possible to demonstrate why both diseases appear in geographically different populations&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The second hypothesis is that these entities are unrelated&#44; but have a common link&#58; an improved quality of life is associated with a decrease in MTC infection&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Factors related to the increase in NTM have been described&#44; including centralized water supplies&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> the use of showers that promotes respiratory exposure by aerosol transmission of NTM present in water&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> some diagnostic and therapeutic procedures &#40;bronchoscopies&#44; dialysis fluids&#44; especially <span class="elsevierStyleItalic">Mycobacterium chimaera</span> associated with extracorporeal membrane oxygenation for cardiac support&#41;&#44; and cosmetic applications &#40;mesotherapy&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;9</span></a> Finally&#44; it has been proposed that there may be no relationship and the phenomenon is due to a multifactorial process&#58; improved quality of life&#44; increased research and improved diagnostic tests for NTM&#44; an aging population &#40;involving a larger population with structural lung diseases&#44; tumors&#44; HIV&#44; diabetes mellitus and renal failure&#41; and changes in NTM virulence&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The management of both diseases differs from a clinical&#44; microbiological&#44; and public health point of view&#46; The diagnosis of TB in a baciliferous patient involves culture of the patient&#8217;s respiratory sample and a contact study&#44; an approach that carries both economic and social costs&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> These measures are not necessary in NTM disease&#44; although precautions must be taken in the case of <span class="elsevierStyleItalic">Mycobacterium abscessus</span> in patients with cystic fibrosis&#44; &#40;grade B in the 2017 British Thoracic Society recommendations&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Treatment of mycobacterial diseases has been significantly complicated by increased resistance to the few available antibiotics&#46; In the case of NTM&#44; fewer new drugs are in development than for TB&#44; and those that are&#44; are mostly based on the reformulation or repositioning of other older drugs&#59; some active drugs are also being tested against TB &#40;bedaquiline&#44; inhaled liposomal amikacin&#44; ceftazidime-avibactam&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Microbiological techniques are designed to optimize the detection of MTC and specific studies are only conducted in NTM cases selected for their clinical relevance&#46; The diagnostic possibilities of most microbiology departments have increased with the availability of new technologies&#46; Molecular diagnostic techniques are useful for rapidly differentiating between NTM and MTC diseases when the sputum smear reveals the presence of acid-alcohol-fast bacilli&#44; as culture could take up to 45 days&#46; MALDI-TOF mass spectrometry assists in the correct identification of these microorganisms&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;15</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Knowledge of the epidemiological situation of NTM disease and its associated clinical factors is crucial to address this public health challenge&#44; and to facilitate early diagnosis and treatment and increase the microbiological yield&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> To improve this knowledge&#44; we would need to perform molecular studies to differentiate NTM from MTC in baciliferous patients&#44; refer all clinically relevant strains to reference laboratories for correct identification and sensitivity studies&#44; and notify clinically relevant cases to the public health authorities&#46;</p></span>"
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Editorial
Non-tuberculous mycobacteria: beyond the magic mountain
Micobacterias no tuberculosas, más allá de la montaña mágica
Gema Barbeito-Castiñeiras
Corresponding author
, María Amparo Coira-Nieto, María Luisa Pérez del Molino-Bernal
Microbiology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
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    "titulo" => "Non-tuberculous mycobacteria&#58; beyond the magic mountain"
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        "titulo" => "Micobacterias no tuberculosas&#44; m&#225;s all&#225; de la monta&#241;a m&#225;gica"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Tuberculosis &#40;TB&#41; is a disease well known for its morbidity and mortality&#46; It infects millions of people every year and&#44; along with the human immunodeficiency virus &#40;HIV&#41;&#44; is one of the leading causes of death worldwide&#46; The incidence of TB has gradually declined in industrialized countries&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In recent years&#44; non-tuberculous mycobacteria &#40;NTM&#41; have taken on new importance&#44; with an increase in the number of isolates in microbiology departments&#44; accounting for 30&#37;&#8211;50&#37; of the total mycobacteria&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">NTM are a heterogeneous group of bacteria&#44; widely distributed in nature&#44; that can cause various infections in humans&#44; most frequently pulmonary&#59; NTM usually occurs in patients with predisposing factors for disease progression&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Geographical distribution varies widely&#44; depending on the microorganism&#8217;s ability to survive under certain environmental conditions and the capability of local laboratories to isolate and identify these strains&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The definition&#44; diagnosis&#44; and management of NTM infections have been governed since 2007 by the guidelines of the American Thoracic Society&#47;Infectious Diseases Society of America&#46; The epidemiology of the more than 170 species of NTM described is unknown&#44; because identification and sensitivity testing are not performed in all microbiology laboratories&#44; and these infections are not notifiable diseases in most countries&#46; The number of NTM infections appears to be increasing in many parts of the world&#46; In the United States&#44; we know that the number of cases of NTM infections is higher than that of TB&#46; Despite this&#44; research in this area still lags far behind TB&#44; and many issues remain unclarified&#46; It is still unclear why some NTM are pathogenic and others are not&#44; and which environmental or host factors might favor infection&#44; while the natural history of the disease and the best diagnostic and therapeutic procedures remain undetermined&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The epidemiological relationship between <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span> complex &#40;MTC&#41; and NTM infections is not yet well understood&#46; Some studies suggest that evidence of local increases in NTM infection rates coincide with the decrease in MTC infection rates&#46; The first hypothesis approaches the question from an immunological point of view&#44; citing a phenomenon of cross-reactivity and immune defects favoring NTM disease&#44; but it has not been possible to demonstrate why both diseases appear in geographically different populations&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The second hypothesis is that these entities are unrelated&#44; but have a common link&#58; an improved quality of life is associated with a decrease in MTC infection&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Factors related to the increase in NTM have been described&#44; including centralized water supplies&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> the use of showers that promotes respiratory exposure by aerosol transmission of NTM present in water&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> some diagnostic and therapeutic procedures &#40;bronchoscopies&#44; dialysis fluids&#44; especially <span class="elsevierStyleItalic">Mycobacterium chimaera</span> associated with extracorporeal membrane oxygenation for cardiac support&#41;&#44; and cosmetic applications &#40;mesotherapy&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;9</span></a> Finally&#44; it has been proposed that there may be no relationship and the phenomenon is due to a multifactorial process&#58; improved quality of life&#44; increased research and improved diagnostic tests for NTM&#44; an aging population &#40;involving a larger population with structural lung diseases&#44; tumors&#44; HIV&#44; diabetes mellitus and renal failure&#41; and changes in NTM virulence&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The management of both diseases differs from a clinical&#44; microbiological&#44; and public health point of view&#46; The diagnosis of TB in a baciliferous patient involves culture of the patient&#8217;s respiratory sample and a contact study&#44; an approach that carries both economic and social costs&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> These measures are not necessary in NTM disease&#44; although precautions must be taken in the case of <span class="elsevierStyleItalic">Mycobacterium abscessus</span> in patients with cystic fibrosis&#44; &#40;grade B in the 2017 British Thoracic Society recommendations&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Treatment of mycobacterial diseases has been significantly complicated by increased resistance to the few available antibiotics&#46; In the case of NTM&#44; fewer new drugs are in development than for TB&#44; and those that are&#44; are mostly based on the reformulation or repositioning of other older drugs&#59; some active drugs are also being tested against TB &#40;bedaquiline&#44; inhaled liposomal amikacin&#44; ceftazidime-avibactam&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Microbiological techniques are designed to optimize the detection of MTC and specific studies are only conducted in NTM cases selected for their clinical relevance&#46; The diagnostic possibilities of most microbiology departments have increased with the availability of new technologies&#46; Molecular diagnostic techniques are useful for rapidly differentiating between NTM and MTC diseases when the sputum smear reveals the presence of acid-alcohol-fast bacilli&#44; as culture could take up to 45 days&#46; MALDI-TOF mass spectrometry assists in the correct identification of these microorganisms&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;15</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Knowledge of the epidemiological situation of NTM disease and its associated clinical factors is crucial to address this public health challenge&#44; and to facilitate early diagnosis and treatment and increase the microbiological yield&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> To improve this knowledge&#44; we would need to perform molecular studies to differentiate NTM from MTC in baciliferous patients&#44; refer all clinically relevant strains to reference laboratories for correct identification and sensitivity studies&#44; and notify clinically relevant cases to the public health authorities&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Barbeito-Casti&#241;eiras G&#44; Coira-Nieto MA&#44; P&#233;rez del Molino-Bernal ML&#46; Micobacterias no tuberculosas&#44; m&#225;s all&#225; de la monta&#241;a m&#225;gica&#46; Arch Bronconeumol&#46; 2021&#59;57&#58;156&#8211;157&#46;</p>"
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Article information
ISSN: 15792129
Original language: English
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