NONTUBERCULOUS MYCOBACTERIAL DISEASE

These naturally-occurring organisms found in soil and water.

NTM lung infection occurs when a person inhales the organism from their environment.

  • Most people do not become ill; for some susceptible individuals, a slowly progressive and destructive disease can occur.
    • Can become chronic and require ongoing treatment. Some patients, however, do not require treatment for their less severe infections.
    • Treatment of NTM requires antibiotics for 1 to 2 years.

Risk factors for the disease:

  • Age: Older individuals more susceptible.
  • Lung disease i.e. COPD or brochiectasis
  • Slender Caucasian women
  • Weak immune system: Due to certain conditions that alter the immune system i.e. Sjogren’s disease and rheumatoid arthritis; Certain drugs, such as steroids, may affect the immune system as well.
  • Esophageal disorders: Acid reflux (GERD) and other disorders of the esophagus can increase the risk of NTM lung disease due to spillage of gastric contents into the lung.
  • Environment: Exposure to NTM in our environment can result in infection. High-risk sources include indoor hot tubs and pools and exposure to soil.

The symptom can vary from no symptoms to severe cough, fatigue, and weight loss.

The more severe the infection, the higher the likelihood of the manifestation of symptoms.

Symptoms of NTM lung disease can be divided into two categories: lung symptoms and body symptoms.

Most common respiratory symptoms:

  • Cough that won’t go away
  • Coughing up blood (hemoptysis)
  • Shortness of breath during activity

Other symptoms:

  • Fatigue
  • Low-grade fever
  • Night sweats
  • Weight loss

DIAGNOSIS

  • Physician may do/request:
    • History & Physical Exam
    • Other Additional tests such as:
      • Computed tomography (CT) scan
      • Sputum culture

 

RECOMMENDED MEDICATIONS

NTM are relatively resistant to antibiotics and can become more resistant if only one antibiotic is used to treat the infection.

  • Effective treatment requires two to three drugs: the exact drug and combination of drugs depending on the NTM species involved, how bad the infection is, and results of drug susceptibility testing. Treatment should continue until the respiratory culture results have been negative for at least 12 months.
    • MAC and M kansasii (most common causes): three drugs given either 3 days a week or daily, depending on the severity of disease.
    • M abscessus: One or two IV drugs with oral and sometimes inhaled antibiotics for several months.
      • more complicated and associated with poorer treatment outcomes compared with MAC and M kansasii.

Surgery may be required for removal of the most damaged lung parts.

  • Should be considered after consultation with related experts.

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