Post-tuberculosis nontuberculous mycobacterial pulmonary disease: epidemiology and latest advances in diagnosis and treatment

doi:10.19871/j.cnki.xfcrbzz.2026.03.015

Abstract

Abstract: ObjectiveWith the global expansion of the tuberculosis survivor population, post-tuberculous nontuberculous mycobacterial pulmonary disease (post-TB NTM-PD) has become a severe public health challenge. "Post-tuberculous" is defined as a state of secondary NTM pulmonary infection caused by residual pulmonary structural and immune damage after standardized anti-tuberculosis treatment with cure or failure. The global incidence of NTM-PD is rising steadily, in sharp contrast to the declining tuberculosis incidence. In China, NTM-PD shows high prevalence in northeastern and southeastern coastal areas with distinct geographic heterogeneity, and the predominant pathogens are Mycobacterium avium-intracellulare complex (MAC) and Mycobacterium abscessus complex (MABC). Its pathogenesis is associated with residual pulmonary structural damage, local immune dysfunction and NTM biofilm formation. Due to high clinical overlap with tuberculosis recurrence, delayed diagnosis, misdiagnosis and missed diagnosis are prominent, with a median diagnosis time of 21.2 months for delayed patients. This paper reviews its epidemiological characteristics and pathogenesis, and focuses on the application value of HRCT radiomics, mNGS and MALDI-TOF MS in accurate differential diagnosis. In terms of treatment, besides individualized multi-drug combination regimens based on species identification and drug susceptibility testing, it explores the application of novel drugs such as inhaled liposomal amikacin (ALIS) and bedaquiline in refractory cases, and evaluates surgical indications and efficacy. Finally, it emphasizes the importance of multidisciplinary comprehensive management for improving prognosis, and points out the existing challenges such as the popularization of molecular diagnosis. By systematically reviewing the research advances and existing challenges in this field, this review aims to provide a reference for clinicians to enhance early recognition of post-TB NTM-PD and optimize diagnostic and treatment strategies, as well as to identify future research directions.

Key words: Post-tuberculous nontuberculous mycobacterial pulmonary disease, Imaging differentiation, Molecular diagnosis, Comprehensive therapy

CLC Number:

R521
R378.91

Lai Xiaoyu, Chen Xunxun, Liao Qinghua, Wen Wenpei, Wu Yue. Post-tuberculosis nontuberculous mycobacterial pulmonary disease: epidemiology and latest advances in diagnosis and treatment[J]. Electronic Journal of Emerging Infectious Diseases, 2026, 11(3): 81-88.

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