Nontuberculous Mycobacteria Week

General Information

NTM Week

There are approximately 200 species of nontuberculous mycobacteria or “NTM” identified thus far, and the number continues to grow. NTM are very common in the environment, living in water, soil and other environmental niches. Many types of NTM can cause disease. Among the most common ones causing disease in humans are those in the Mycobacterium avium complex (MAC) and the Mycobacterium abscessus group, as well as Mycobacterium kansasii.

Most healthy people do not get sick from NTM, but people with weakened immune systems or underlying lung diseases are at greater risk for developing infection. NTM can infect the lung, as well as the lymph nodes, skin and soft tissues, and can cause disseminated disease in people with weakened immune systems. Immune deficiencies associated with NTM infection include HIV infection and immunosuppressive medications (e.g. TNF-alpha inhibitors among others). The most common structural lung diseases associated with NTM lung infections are bronchiectasis, such as from cystic fibrosis (CF), and chronic obstructive pulmonary disease (COPD). NTM infections can also occur in middle-aged and elderly women who are thin and without prior known history of lung disease.

NTM lung disease is diagnosed based on symptoms, imaging findings and microbiological tests on respiratory specimens. NTM disease in the lungs can cause symptoms such as cough that is productive of sputum as well as shortness of breath. Fatigue, fevers, night sweats, and weight loss can also occur, particularly if NTM infection is disseminated elsewhere in the body. Chest radiograph and computed tomography are important in the diagnosis of NTM infection. The patterns of abnormalities such as cavitary versus nodular or bronchiectatic disease can influence treatment decisions and response to therapy. If NTM is found in respiratory secretions, it is not necessarily causing disease. Thus, microiological confirmation of NTM infection requires the growth of NTM on repeated sputum cultures or invasively obtained respiratory samples such as from bronchoscopy.  

Not all NTM disease needs to be treated. Very mild disease may be managed by improving airway clearance of secretions and observation. Because treatment of NTM typically involves 3 or more drugs that can be associated with significant side effects for 12-18 months or even longer, the decision to start therapy is a balance between benefits and risks. The decision to start treatment should be a conversation between a patient and his or her physician or other clinician. Sometimes the infection cannot be fully cured. Surgical resection may be a possible additional therapy in certain select candidates.

NTM infections have been rising in recent years for unclear reasons. Data from research networks studying NTM have improved our understanding of some of the features of NTM although much remains to be learned. Ongoing research on more accurate and rapid diagnostic tests for NTM as well as more effective and less toxic treatment options will hopefully lead to better outcomes for patients in the future.

Four Facts About NTM (Nontuberculous Mycobacteria)

  1. Mycobacteria are found everywhere in the environment including water and soil. People with underlying lung disorders are at greater risk for NTM infections.

  2. Common symptoms include chronic cough, loss of weight, loss of appetite, shortness of breath, lack of energy.

  3. Current estimates place the number of people with NTM lung disease in the United States as high as 180,000, and that number is increasing 8.2% every year.

  4. Nontuberculous mycobacteria are not considered to be communicable person to person.

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