Nontuberculous Mycobacterial Meaning, Symptoms, Life Expectancy (original) (raw)

What is nontuberculous mycobacterial (NTM) lung disease?

The isolation and presence of nontuberculous mycobacterial lung disease (NTM) from the lungs do not necessarily indicate an active disease process that needs aggressive treatment. What is more important is to distinguish a temporary colonization of NTM from true infection because true NTM infection can ultimately cause progressive lung disease.

The incidence and prevalence of no-tuberculosis mycobacterial lung disease has increased in recent years likely due to improved methods of diagnosis as well as increased awareness by healthcare professionals.

What are the most common types of NTM?

Nontuberculous mycobacteria are divided into slow-growing and rapid-growing species.

The most common slow-growing species of NTM include:

The most common rapid-growing species of NTM include:

Since the most common group of NTM that cause pulmonary disease in the US are slow growing M. avium complex (MAC), the remainder of this information will focus on this specific group of bacteria, which can lead to significant disease and death.

How do you get Mycobacterium in your lungs?

Nontuberculous mycobacteria (NTM) are a collection of environmental bacteria found widespread throughout the environment, and typically are found in water (for example, marshlands, streams, rivers, and estuaries), soil, or dispersed in the air we breathe. Although related to other mycobacteria that can cause disease, these NTM specifically do not cause tuberculosis or leprosy.

NTM can cause infections in the lungs, sinuses, lymph nodes, joints, and central nervous system. NTM either can infiltrate and live in the lungs without causing symptoms, signs, or any specific lung disease, or it can cause progressive inflammatory lung disease and destruction.

Who gets nontuberculous mycobacterial (NTM) lung disease?

Risk factors for nontuberculous pulmonary disease vary because there are environmental-related risk factors, and risk factors related to specific individuals.

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What are the symptoms of nontuberculous mycobacteria (NTM) lung infections?

The most common symptom of NTM lung disease is a chronic or recurring dry cough, occasionally with sputum. However, most people with NTM lung disease have symptoms that are nonspecific, and can vary greatly from person to person, for example:

As NTM disease progresses, there may be a loss of appetite or weight, fevers, or night sweats.

NTM lung infection often is difficult to diagnose because symptoms are similar to those of other lung diseases such as chronic obstructive pulmonary disease, (COPD) bronchiectasis, or cystic fibrosis.

Is NTM lung disease contagious?

NTM lung infection in humans is predominantly due to environmental exposures so human-to-human or animal-to-human transmission is very rare, unlike other contagious mycobacterial diseases such as tuberculosis and leprosy.

One specific group of individuals who are at a known risk of human-to-human transmission is those with underlying cystic fibrosis. Apart from this specific subset of individuals, there is no evidence of human-to-human contact with any other NTM species.

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How is nontuberculous mycobacterial (NTM) lung disease diagnosed?

To identify nontuberculous mycobacterial pulmonary disease, the patient must meet the following criteria.

Clinical criteria (Both must be met)

Microbiological (One of the following)

One study in Japan showed that 2% of the patients with a single positive culture developed progressive disease compared with 98% of the patients who progressed to extensive lung disease when the individual had one or more positive cultures of NTM. Therefore, it is important to differentiate the mere isolation of bacteria (with no true disease) from actual NTM pulmonary disease.

What are the treatments for nontuberculous mycobacteria (NTM) lung disease?

The decision to start treatment for NTM is influenced by the following:

Treatment of NTM pulmonary disease typically requires a combination of antibiotic therapies depending on the severity of symptoms. A usual regimen consists of between three and five different antibiotics. Individuals with mild to moderate disease typically can be treated with an intermittent regimen of antibiotics daily or three times per week. Severe NTM disease may require daily antibiotic therapy. Moreover, some individuals may need injectable intravenous (IV) medication. If injectable medication is not practical or is contraindicated due to an underlying medical condition or allergy, nebulized medication may be used instead.

Most importantly, monotherapy with a single antibiotic or dual therapy with two antibiotics alone is not used for the treatment of mycobacterial pulmonary disease. The ultimate goal of treatment is a microbiological goal of treating NTM to convert sputum cultures or biopsy-proven cultures from positive to negative.

What are the side effects of nontuberculous mycobacterial (NTM) infection treatment?

Treatment side effects of NTM lung infection typically are side effects from the antibiotics used to treat the infection, examples include:

Isoniazid

ethambutol (Myambutol)

rifampin (Rifadin, Rimactane), rifabutin (Mycobutin)

streptomycin, amikacin (Amikin), tobramycin (Tobi)

azithromycin (Z-Pak), clarithromycin (Biaxin)

ciprofloxacin (CIPRO), moxifloxacin (Avelox)

Sulfonamides

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Can nontuberculous mycobacteria (NTM) disease be cured?

A cure for NTM is possible and long-term success rates of treating this infection can be as high as 86%. If a cure is not possible, treatment may allow for the stabilization of lung disease and the prevention of continued lung destruction. Unfortunately, once underlying lung destruction occurs there is no cure for the structural destruction of the lung itself.

How long does it take to get rid of Mycobacterium?

Treatment success may require the following:

Antibiotic treatment typically continues for a minimum of 12 months after culture conversion treatment success to prevent recurrence. Rarely, surgery may be required to remove a portion of the lung. This type of surgery may be an option for those patients with localized areas of severe pulmonary disease who do not respond to the typical antibiotic regimen.

How long can you live with NTM lung disease?

Overall life expectancy for NTM lung disease can be normal. However, there are certain characteristics, which can be associated with more complications and a higher likelihood of death.

Lung Disease/COPD Resources

What are the complications of nontuberculous mycobacteria (NTM) lung disease?

Can nontuberculous mycobacterial (NTM) lung disease be prevented?

Since NTM are found in soil, water, and air, primary prevention has been difficult, however, there may be a future role for avoidance and prevention for those individuals who are known to be at high risk of acquiring the disease. Currently, there is no consensus on prevention among NTM experts.

Transmission of NTM infections in the healthcare setting can be decreased by avoiding tap water or tap water-derived fluids from being used to clean surgical equipment, IV catheters, or endoscopes. Updated sterilization guidelines should be used based on known exposure patterns. Moreover, some known skin disinfectants can grow NTM and therefore they are avoided on open wounds.

Antibiotic therapy can be used as a preventative measure in a certain group of individuals. Due to the high incidence and severity of disease in certain individuals with HIV infection, preventative therapy for NTM is recommended with a single oral antibiotic as a prophylactic measure.