Disease Overview

  • Nontuberculous mycobacteria (NTM) are a group of emerging, opportunistic pathogens that are increasingly recognized as a cause of human disease1
  • NTM cause a wide spectrum of human disease, with the most common clinical manifestation being pulmonary disease1
  • NTM pulmonary disease is generally a slowly progressing, chronic condition that is associated with a decline in respiratory function, decreased quality of life, and an increased risk of death2,3
NTM
What are Nontuberculous Mycobacteria?
Types of NTM Infection
NTM Pulmonary Disease

What are Nontuberculous Mycobacteria?

NTM species are mycobacterial species other than those belonging to the Mycobacterium tuberculosis complex and Mycobacterium leprae.4


NTM are ubiquitous in the environment, being present in water sources and soil.1,3 Over 180 NTM species have been identified using molecular identification techniques including whole-genome sequencing.4 Only a small number of species have been reported to cause disease in humans.

NTM infection rates are rising globally, with studies from North America, Europe and Asia reporting increasing prevalence of NTM disease over the last two decades.3,6
 

NTM

Scanning Electron Microscopy Image of Untreated M. abscessus subsp. massiliense Cells

Image from das Neves RC, et al. PLoS ONE. 2016;11(3): e0149729 under the Creative Commons Attribution License (CC BY).5
 

Types of NTM Infection 

NTM can cause a wide spectrum of human disease, from localized skin and soft tissue infection to disseminated disease, often in patients with comorbidities or those who are immunosuppressed.1 Pulmonary disease is the most common clinical manifestation, accounting for roughly 80–90% of all NTM infections.1

NTM Spectrum of Disease in Humans

NTM Spectrum of Disease in Humans

AIDS, acquired human immunodeficiency syndrome
TNFα, tumor necrosis factor alpha 
Figure adapted from Baldwin SL, et al. PLoS Negl Trop Dis. 2019;13(2):e0007083 under the Creative Commons Attribution License (CC BY).7
 

NTM Pulmonary Disease

NTM pulmonary disease is a slowly progressing, chronic disease, often with debilitating outcomes. It disproportionately impacts individuals over 45 years of age, particularly those with preexisting structural lung disease, as well as younger patients with cystic fibrosis.2


NTM pulmonary disease is associated with decreased respiratory function over time and patients often have significantly impaired quality of life, experiencing limitations to several daily activities, as shown below.3,8  The condition is also associated with increased morbidity and mortality rates; when compared with a matched control group and followed for ~3.5 years, all-cause mortality rates were more than double in patients with NTM pulmonary disease.9
 

NTM Pulmonary Disease – Patient Ratings of Limitations to Daily Activities

NTM Disease overview graph

Figure adapted from Shteinberg M, et al. ERJ Open Res. 2021;7(1):00807-2020 under the Creative Commons Attribution License (CC BY).10

Learn about the symptoms and diagnosis of NTM pulmonary disease

References

  1. To K, Cao R, Yegiazaryan A, Owens J, Venketaraman V. General Overview of Nontuberculous Mycobacteria Opportunistic Pathogens: Mycobacterium avium and Mycobacterium abscessus. J Clin Med. 2020;9(8)doi:10.3390/jcm9082541
  2. Varley CD, Winthrop KL. Nontuberculous Mycobacteria: Diagnosis and Therapy. Clin Chest Med. 2022;43(1):89–98. doi:10.1016/j.ccm.2021.11.007
  3. Ratnatunga CN, Lutzky VP, Kupz A, et al. The Rise of Non-Tuberculosis Mycobacterial Lung Disease. Front Immunol. 2020;11:303. doi:10.3389/fimmu.2020.00303
  4. Cowman S, van Ingen J, Griffith DE, Loebinger MR. Non-tuberculous mycobacterial pulmonary disease. Eur Respir J. 2019;54(1)doi:10.1183/13993003.00250–2019
  5. das Neves RC, Trentini MM, de Castro e Silva J, et al. Antimycobacterial Activity of a New Peptide Polydim-I Isolated from Neotropical Social Wasp Polybia dimorpha. PLoS One. 2016;11(3):e0149729. doi:10.1371/journal.pone.0149729
  6. Dahl VN, Mølhave M, Fløe A, et al. Global trends of pulmonary infections with nontuberculous mycobacteria: a systematic review. Int J Infect Dis. 2022;125:–131. doi:10.1016/j.ijid.2022.10.013
  7. Baldwin SL, Larsen SE, Ordway D, Cassell G, Coler RN. The complexities and challenges of preventing and treating nontuberculous mycobacterial diseases. PLoS Negl Trop Dis. 2019;13(2):e0007083. doi:10.1371/journal.pntd.0007083
  8. Mehta M, Marras TK. Impaired health-related quality of life in pulmonary nontuberculous mycobacterial disease. Respir Med. 2011;105(11):1718-25. doi:10.1016/j.rmed.2011.08.004
  9. Marras TK, Vinnard C, Zhang Q, et al. Relative risk of all-cause mortality in patients with nontuberculous mycobacterial lung disease in a US managed care population. Respir Med. 2018;145:80–88. doi:10.1016/j.rmed.2018.10.022
  10. Shteinberg M, Boyd J, Aliberti S, et al. What is important for people with nontuberculous mycobacterial disease? An EMBARC-ELF patient survey. ERJ Open Res. 2021;7(1)doi:10.1183/23120541.00807–2020
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