Management of opportunist mycobacterial infections: Joint Tuberculosis Committee Guidelines 1999. Subcommittee of the Joint Tuberculosis Committee of the British Thoracic Society.

Guidelines have been produced for tuberculosis by the British Thoracic Society (BTS), 2 the American Thoracic Society (ATS), the International Union Against Tuberculosis and Lung Disease, and the World Health Organisation. These, however, deal mainly with Mycobacterium tuberculosis complex infections (M tuberculosis, M africanum, and M bovis). With the exception of the ATS guidelines on non-tuberculous mycobacteria, these do not address the opportunist mycobacteria (also called atypical mycobacteria, mycobacteria other than tuberculosis (MOTT), nontuberculous mycobacteria (NTM), or environmental mycobacteria). The number of isolates of such opportunist mycobacteria has been increasing, both in HIV negative and HIV positive individuals. Because of the growing numbers of patients with disease due to infection by these mycobacteria, the wide range of species, the diYculties in both diagnosis and management, and in response to increasing requests for advice on management, the BTS Joint Tuberculosis Committee has reviewed the evidence on management of these infections. On the whole the evidence is not derived from controlled clinical trials as very few have been reported but, where possible, we have graded the evidence according to the criteria in table 1. Sections cover epidemiology, bacteriological aspects, diagnosis and treatment in adults and children, separated where appropriate into sections according to their HIV infection status.