Our studies show that microaerophilic conditions promote the growth of Mycobacterium genavense in semisolid medium. The growth of M. genavense at 2.5 or 5% oxygen was superior to that obtained at 21% oxygen in BACTEC primary cultures (Middlebrook 7H12, pH 6.0, without additives). By using nondecontaminated specimens, it was possible to detect growth with very small inocula (25 bacilli/ml) of 12 different M. genavense strains (from nude mice) within 6 weeks of incubation under low oxygen tension; conversely, with 21% oxygen, no growth of 8 of 12 (66.7%) M. genavense strains was detected (growth index, <10). The same beneficial effect of 2.5 or 5% oxygen was observed in primary cultures of a decontaminated clinical specimen. Low oxygen tension (2.5 or 5%) is recommended for the primary isolation of M. genavense. Microaerophilic cultivation of other atypical mycobacteria, especially slow-growing (e.g., Mycobacterium avium) and difficult-to-grow (e.g., Mycobacterium ulcerans) species, is discussed.