What are NTM?

Non-Tuberculous Mycobacteria (NTM) constitute a large group of diverse organisms found in a variety of natural environments. These bacteria thrive in both water and soil, and can be found in natural bodies of water, tap water, and even in your shower at home.

NTM are called “non-tuberculous” to distinguish them from the Mycobacterium tuberculosis complex, which causes tuberculosis, a widely recognised serious lung disease. There are over 200 species of NTM identified, each with varying impacts on human health.

Common Identified NTM: What You Need to Know

When it comes to NTM infections in humans, a few species tend to stand out. These species are more likely to cause disease and are commonly encountered in medical settings.

Mycobacterium Avium Complex (MAC)

The Mycobacterium avium complex (MAC) is one of the most common groups of NTM causing disease in humans. It includes three species: Mycobacterium avium, Mycobacterium intracellulare, and Mycobacterium chimaera.

MAC species can cause a range of diseases, from lung infections to disseminated disease, particularly in individuals with weakened immune systems. Lung disease caused by MAC often presents with symptoms like persistent cough, fatigue, and weight loss.

Mycobacterium Kansasii

Mycobacterium kansasii is another NTM species that frequently causes lung disease, especially in people with underlying lung conditions. Similar to MAC, M. kansasii can cause symptoms like cough, shortness of breath, and fatigue.

M. kansasii is unique in that it can cause a disease that closely mimics tuberculosis, leading to challenges in diagnosis. Thankfully, M. kansasii infections usually respond well to treatment.

Mycobacterium Abscessus

Mycobacterium abscessus is known for causing lung disease and skin and soft tissue infections. This species is of particular concern due to its resistance to many antibiotics, which can make treatment challenging.

M. abscessus can cause a variety of symptoms depending on the site of infection. Lung disease caused by M. abscessus may present with a persistent cough, chest pain, and weight loss.

Other NTM Species

There are many other species of NTM that can cause disease in humans, though they tend to do so less frequently. This includes species like Mycobacterium marinum, which is associated with skin and soft tissue infections, often in people who have been in contact with fish or water.

Risks of Non-tuberculous mycobacterial Pulmonary Disease: Who Should Be Concerned?

While NTM is widespread in our environment and we frequently encounter them, not everyone who comes into contact with these bacteria develops non-tuberculous mycobacterium Pulmonary Disease (NTM PD). However, certain groups are at a heightened risk. Let’s delve deeper into understanding who should be more concerned about NTM PD.

Individuals with Pre-existing Lung Conditions

Lung diseases like chronic obstructive pulmonary disease (COPD), bronchiectasis, and cystic fibrosis create structural changes in the lungs that can trap NTM and provide an environment for the bacteria to thrive. The impaired lung function in these individuals can also make it harder for the body to clear the bacteria, leading to an increased risk of developing NTM PD.

Immune-compromised Individuals

Those with weakened immune systems, such as people with HIV/AIDS, organ transplant recipients, or those undergoing chemotherapy, are more susceptible to NTM PD. The weakened immune system struggles to fight off the NTM, allowing the bacteria to multiply and potentially cause disease.

The Elderly

As we age, our immune system becomes less efficient and our lung function decreases, both of which can increase the risk of Non-tuberculous Mycobacterial Pulmonary Disease. Moreover, elderly individuals may have more underlying health conditions that make them vulnerable to these infections.

Environmental Factors

Certain environmental conditions can also increase exposure to NTM and, thus, the risk of NTM PD. NTM thrive in water and soil, so activities like gardening without gloves or inhaling steam from hot tubs can increase exposure to these bacteria. Similarly, living in a damp or mouldy home can provide an ideal environment for NTM to flourish.

Genetic Factors

Recent research suggests there may be genetic factors that make some individuals more susceptible to NTM PD. Certain genetic conditions like cystic fibrosis or alpha-1 antitrypsin deficiency, can predispose individuals to NTM infections. Additionally, certain genetic traits might influence how the immune system responds to NTM, although more research is needed in this area.

Recognising the Signs and Symptoms of Non-Tuberculous Mycobacterial Pulmonary Disease

Recognising the signs and symptoms of Non-Tuberculous Mycobacterial Pulmonary Disease is critical for early diagnosis and treatment. However, NTM PD symptoms can be subtle and similar to other lung conditions, making it a challenge to diagnose. Here’s a deeper look at the main symptoms you should watch out for.

Persistent Cough

A persistent, chronic cough is a hallmark symptom of NTM PD. This cough can be dry or produce mucus (a condition known as a productive cough). While coughing can be a symptom of many respiratory conditions, a lingering cough that doesn’t improve over time can suggest a more serious issue like NTM PD.

Fatigue and Weakness

Individuals with NTM PD often report a pervasive sense of tiredness or weakness. This isn’t the usual end-of-day fatigue that everyone experiences. It’s a profound and persistent lack of energy that can hinder everyday activities and isn’t relieved by rest.

Unexplained Weight Loss

Unexpected weight loss without any changes in diet or exercise can be a sign of NTM PD. This weight loss might be accompanied by a loss of appetite.

Fever and Night Sweats

Low-grade fever, along with night sweats, can be a sign of NTM PD. Fever is the body’s way of fighting off an infection, and night sweats can be a response to fever.

Chest Discomfort

Chest discomfort or pain can occur in some people with NTM PD. This discomfort can vary, from a general ache to sharp pain, and can be a result of the infection in the lungs.


Haemoptysis, or coughing up blood, is a more severe symptom of NTM PD. While it can be alarming, it’s important to remember that it’s a symptom, not a disease in itself, and immediate medical attention should be sought.


Shortness of breath, especially during physical activities, can also be a symptom of NTM PD. This happens because the infection can affect the lung’s ability to exchange oxygen and carbon dioxide effectively.

It’s vital to remember that these symptoms can vary significantly from person to person, and they can also be signs of other respiratory conditions. So, if you or a loved one experience any of these symptoms, especially if you fall into a high-risk group, it’s essential to seek medical attention promptly. Early recognition of these signs and symptoms, coupled with appropriate medical care, can lead to better management and outcomes for individuals with NTM PD.

Diagnosis of NTM PD: What to Expect

Diagnosing Non-Tuberculous Mycobacterial Pulmonary Disease can be complex due to the subtle and non-specific nature of its symptoms. However, a combination of clinical signs, imaging tests and microbiological cultures can lead to an accurate diagnosis. Let’s explore what to expect when you’re being tested for NTM PD.

Clinical Evaluation

Your healthcare professional will first conduct a thorough clinical evaluation. This includes a review of your medical history, any pre-existing conditions you may have, and a physical examination. This provides an overview of your overall health and helps identify any risk factors for NTM PD.

Radiographic Imaging

Chest radiography is often the first imaging test done when NTM PD is suspected. It can show abnormalities or changes in the structure of your lungs, indicative of an infection. However, because NTM PD can look similar to other lung conditions on an X-ray, further imaging is usually necessary.

A high-resolution computed tomography (HRCT) scan provides a more detailed view of the lungs. It can identify specific patterns that are characteristic of NTM PD, such as nodules or bronchiectasis.

Microbiological Cultures

While imaging tests can suggest NTM PD, a definitive diagnosis requires identification of the NTM species from your sputum (mucus coughed up from the lungs) or tissue samples. This is achieved through microbiological cultures, where your sample is allowed to grow in a lab to identify the specific NTM species causing the disease.

Generally, two or more positive cultures are required for a diagnosis, due to the ubiquity of NTM in the environment and the risk of contamination.

Pulmonary Function Tests

Pulmonary function tests (PFTs) may be used to assess the extent of lung damage and how well your lungs are functioning. This involves a series of breathing tests to measure lung capacity, airflow, and oxygen exchange.


In some cases, if sputum cultures are negative but there’s a strong suspicion of NTM PD, a bronchoscopy may be performed. This procedure involves inserting a flexible tube with a light and camera down the throat to examine the airways and collect lung samples.

Navigating the Treatment of Non-Tuberculous Mycobacterial Pulmonary Disease

Once Non-Tuberculous Mycobacterial Pulmonary Disease (NTM PD) has been diagnosed, a treatment plan tailored to the individual’s specific condition will be put into place. The mainstay of treatment is a combination of antibiotics that work together to effectively combat the NTM. Let’s delve deeper into understanding the key aspects of NTM PD treatment.

Antibiotic Treatment

The primary treatment for NTM PD involves a combination of antibiotics. The exact antibiotics used depend on the specific NTM species causing the disease. For instance, Mycobacterium avium complex (MAC), the most common cause of NTM PD, is typically treated with a three-drug regimen of azithromycin or clarithromycin, rifampicin, and ethambutol.

Duration of Treatment

The duration of antibiotic treatment for NTM PD is generally long, often lasting 18 to 24 months. In some cases, treatment may need to continue even longer. It’s important to note that even after symptoms have improved, the full course of treatment is required to ensure all the bacteria are cleared from the body and to reduce the risk of disease recurrence.

Treatment Monitoring

During treatment, regular check-ups will be necessary to monitor how well the treatment is working and to manage any potential side effects of the medications. This typically involves chest imaging, sputum cultures, and blood tests.

When to Stop Treatment

The decision to stop treatment is usually based on both clinical and microbiological improvement. Clinical improvement means that your symptoms have significantly improved or resolved. Microbiological improvement means that the bacteria can no longer be cultured from your sputum. Generally, treatment continues until you have had negative sputum cultures for at least 12 months.

Dealing with Drug Resistance

In some cases, the bacteria may become resistant to the antibiotics used for treatment, making them less effective. If this occurs, your doctor may need to adjust your treatment regimen. It’s essential to take your medications exactly as prescribed to minimise the risk of developing drug resistance.


In rare cases, if drug treatment is not effective, or if there are complications such as severe haemoptysis (coughing up blood), surgical treatment may be considered. This usually involves removing the part of the lung affected by the NTM infection.

It’s important to remember that treatment for NTM PD can be a long and challenging journey. It requires patience, persistence, and close collaboration with your healthcare team. Keep them informed of any changes in your symptoms or any side effects you experience. With the right treatment and support, people with NTM PD can manage their disease and continue to lead fulfilling lives.

Living with NTM PD: A Manageable Condition

Being diagnosed with Non-Tuberculous Mycobacterial Pulmonary Disease (NTM PD) can feel overwhelming. However, with the right approach and support, living with this condition can be managed effectively. Here’s a closer look at how to navigate daily life with NTM PD.

Treatment Adherence

Adherence to your prescribed treatment regimen is crucial. This includes taking your medications as instructed by your healthcare provider, even if you’re feeling better. Stopping treatment prematurely or skipping doses can lead to relapse or drug resistance, making the bacteria harder to treat.

Airway Clearance Techniques

Airway clearance techniques (ACTs) are physical methods designed to help people with lung conditions, like NTM PD, clear mucus from their airways. This is important because mucus can trap NTM and other bacteria, contributing to inflammation and infection. By clearing the airways, ACTs can help improve lung function and reduce the risk of infection.

There are many types of ACTs, ranging from simple techniques like controlled coughing and deep breathing exercises, to more specialised techniques like chest physiotherapy, postural drainage, and use of devices that generate vibrations or positive pressure. The right technique for you will depend on your specific condition, abilities, and preferences, so be sure to discuss this with your healthcare provider.

Hypertonic Saline

Hypertonic saline is a saltwater solution that is more concentrated than the fluids in your body. When inhaled as an aerosol, hypertonic saline works by drawing more water into the airways. This water thins the mucus, making it easier to cough up.

This can be particularly beneficial for individuals with NTM PD, as it aids in clearing the bacteria-filled mucus from the lungs. In addition, removing excess mucus can help improve breathing and reduce the frequency of lung infections.

It’s important to note that while hypertonic saline is generally safe, it can sometimes cause side effects like coughing or tightness in the chest, particularly when first starting the treatment. Always use hypertonic saline under the guidance of your healthcare provider, who can help adjust the concentration or suggest other strategies to manage any side effects.

Healthy Lifestyle Choices

Maintaining a healthy lifestyle can help manage NTM PD and enhance your overall wellbeing. This includes:

Emotional and Mental Wellbeing

Living with a chronic condition like NTM PD can be stressful and may impact your mental health. Seek support from loved ones, patient support groups, or mental health professionals to help navigate these challenges. Mindfulness, meditation, and other stress management techniques can also be beneficial. You may find It helpful to speak to other patients with NTM PD for support and can contact NTM Patient Care UK.

Preventing Cross Infection

NTM PD isn’t contagious in the traditional sense, but the bacteria that cause it are common in our environment. As such, it’s a good idea to minimise your exposure to potential sources of NTM, like soil, hot tubs, and steam from showers.

Individualised Approach

Remember that everyone’s experience with NTM PD is unique. What works for one person may not work for another. It’s important to work closely with your healthcare provider to develop a treatment and management plan that suits your specific needs.

Living with NTM PD can present challenges, but with careful management, it’s possible to maintain a high quality of life. By taking an active role in your health and healthcare, you can effectively manage NTM PD and embrace life beyond your diagnosis.


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