321 Ch 320. Non-Tuberculous Mycobacterial (NTM) Lung Disease

NTM = TB + leprosy 以外的 200+ 種 mycobacteria；main pulmonary pathogens：(1) Mycobacterium avium complex (MAC, M. avium + M. intracellulare + M. chimaera) — 最常見；(2) M. abscessus complex (MABC) — 最棘手；(3) M. kansasii — 像 TB；(4) M. xenopi；(5) M. malmoense；(6) M. simiae；現代 incidence 上升 (HRCT + 老化 + 免疫抑制)；ATS/IDSA 2020 diagnostic criteria：clinical + radiographic + microbiologic (2 positive sputum OR 1 BAL OR 1 tissue biopsy)；MAC treatment：macrolide (azithromycin) + ethambutol + rifampin × 12 months after culture conversion；refractory → add inhaled amikacin (ALIS, Arikayce) (CONVERT trial 2018) — FDA 2018；M. abscessus：multi-drug IV + PO ≥ 12 months (very difficult, often life-long)；M. kansasii：rifampin + isoniazid + ethambutol 9-12 months；Lady Windermere syndrome：tall thin elderly women + right middle lobe / lingula bronchiectasis；2024 trends：bedaquiline + clofazimine for M. abscessus, omadacycline。