All About Nontuberculosis Mycobacteria (NTM) Infections

NTM is a group of bacteria found in soil, water, and dust. There are more than 190 species of NTM, but the most common ones include:

Mycobacterium abscessus

M. abscessus is a rapidly growing species that can cause skin infections and lung disease. It’s often resistant to antibiotics.

Mycobacterium avium complex (MAC)

MAC consists of many species, including Mycobacterium avium and Mycobacterium intracellulare. MAC can cause lung infections in people with weakened immune systems or chronic lung diseases such as cystic fibrosis or chronic obstructive pulmonary disease (COPD).

Mycobacterium kansasii

M. kansasii is a slow-growing species that usually causes lung infections in people with weakened immune systems or chronic lung diseases such as bronchiectasis or COPD.

NTM can enter your lungs if you breathe next to contaminated water, soil, or dust. In essence, everyone can breathe in NTM. Most of the time, they do not cause infections, but some people are at greater risk.

NTM infections can affect anyone, but specific people are more likely to develop the infection. You may be at higher risk if you:

• have an autoimmune disorder, like rheumatoid arthritis
• have an immunodeficiency disorder, like HIV
• are taking immune-suppressing medications
• have a damaged lung from diseases such as cystic fibrosis, bronchiectasis, or COPD
• are in postmenopause
• are over 65 years old
• use an internal medical device, such as a ventilator or catheter

Common symptoms of NTM infections include:

• chronic cough with mucus and, later, blood
• fatigue
• weight loss
• night sweats
• loss of appetite
• shortness of breath
• chest pain
• recurring respiratory infections

Seek emergency medical care if you have any severe symptoms, such as chest pain or trouble breathing.

NTM infections can be challenging to diagnose because they grow slowly and can show similar symptoms to other lung diseases. Because of this, doctors have to use various methods to diagnose them.

First, a doctor will perform a physical exam and ask about your medical history. They may also order lab tests. These tests may include:

• sputum culture, to identify the type of NTM in your lungs
• bronchoscopy, which involves inserting a thin tube with a camera into your lungs to look for signs of infection
• imaging, such as X-ray or CT scan, to help detect lung changes due to NTM infections
• tissue biopsy, to confirm an NTM diagnosis and determine the most effective treatment

Treatment for an NTM infection depends on its type and severity. It may require therapy for up to a year or even longer, especially if your doctor finds it difficult to treat.

Generally, a doctor will prescribe a combination of three to four antibiotics, such as:

• macrolides (azithromycin, clarithromycin)
• rifamycins (rifampin, rifabutin)
• aminoglycosides (streptomycin, tobramycin)
• fluoroquinolones (moxifloxacin, ciprofloxacin)
• ethambutol
• imipenem
• linezolid

Taking multiple antibiotics can help reduce the chances of the infection becoming resistant to one of the antibiotics.

You may need surgery if tissues or organs become infected.

The outlook for people with NTM infections is generally positive. However, it depends on the severity of the infection and whether it affects other organs.

For example, according to a 2022 review, the 5-year all-cause mortality rate for people with lung disease from NTM ranges from 13–45%, which was double that of people who did not have an NTM infection.

Another 2021 Dutch study of more than 183,000 participants with NTM states that the 14-year survival rate is over 77%. However, this goes down to 57% if the participant also has tuberculosis.

Consider speaking with a doctor immediately if you notice symptoms, such as coughing up blood, shortness of breath, chest pain, or fever that lasts more than a few days. The earlier you get a diagnosis and treatment, the better your chances of avoiding serious complications.

The best way to prevent NTM infections is to practice good hygiene and avoid contact with contaminated water or soil. Ensure all your taps and water appliances are installed and working correctly, as these can be sources of NTM infection. You may also want to avoid swimming in untreated water or improperly chlorinated pools.

If your plumbing at home can sustain long durations of boiling water, consider setting your water heating above 176°F (80°C) and running every tap for at least 20 minutes. Doing this occasionally can help destroy any of the NTM in the piping systems, at the disadvantage of water waste and increased electrical costs.

Also, consider talking with a doctor about medications that may increase your risk of developing an NTM infection.

Here are some frequently asked questions about NTM.

Are nontuberculosis mycobacteria infections curable?

Yes, NTM infections can be cured with a combination of antibiotics and other treatments. However, they are not easy to treat and may require a long period of antibiotic treatment.

Are NTM diseases fatal?

Not all NTM diseases are fatal, but some can cause severe illness and even death if left untreated. It is vital to seek medical attention as soon as possible if you experience symptoms of an NTM infection.

Are NTM diseases hereditary?

NTM diseases cannot be passed from human to human, nor can they be passed on genetically. However, your genetics may increase your risk of contracting an NTM infection.

NTM infections can be challenging to diagnose and treat. However, a cure is possible, especially if the infection is detected early and you follow your doctor’s suggestions.