What are Nontuberculous Mycobacteria (NTM)?
Nontuberculous mycobacteria are a diverse group of bacteria found naturally in the environment, particularly in soil and water. Unlike their well-known relatives, Mycobacterium tuberculosis (which causes tuberculosis) and Mycobacterium leprae (which causes leprosy), NTM are not typically spread from person to person. Instead, they infect individuals through environmental exposure.
Where Are NTM Found?
NTM are ubiquitous and can be found in various environmental sources such as water (both natural and man-made), soil, and dust. Common locations include:
- Showerheads and sink faucets
- Hydrotherapy equipment
- Ice machines
- Decorative fountains
- Hot tubs and spas
These bacteria thrive in moist environments, making water systems a significant reservoir for NTM. The bacteria can form biofilms on surfaces, allowing them to persist in these environments despite disinfection efforts.
How Does Nontuberculous Mycobacteria Transmission Occur to Humans?
Transmission of NTM to humans primarily occurs through inhalation of aerosolised water droplets or dust particles containing the bacteria. Activities that produce aerosols, such as showering, using hot tubs, or undergoing certain medical procedures, can facilitate this transmission. Additionally, NTM can enter the body through open wounds or surgical sites.
Risk Factors for NTM Infections
While anyone can be exposed to NTM, not everyone develops an infection. Certain individuals are at higher risk, including:
- People with underlying lung diseases such as bronchiectasis, cystic fibrosis (CF), or chronic obstructive pulmonary disease (COPD)
- Individuals with weakened immune systems
- Elderly people
- Those who have had recent surgeries or medical procedures involving water-based equipment
Environments Likely to Increase Nontuberculous Mycobacteria Transmission
Certain environments are more likely to increase the risk of NTM exposure and subsequent infection. These include:
- Healthcare settings, especially where medical equipment that uses water is involved
- Residential buildings with complex plumbing systems
- Recreational facilities such as swimming pools, hot tubs, and spas
- Tattoo parlours and nail salons, where water-based equipment is used
Human-to-Human Transmission
Unlike tuberculosis, human-to-human transmission of NTM is rare. Most cases are acquired from environmental sources rather than through contact with infected individuals. However, in healthcare settings, there have been instances where inadequate sterilisation of medical equipment has led to outbreaks.
NTM and Cystic Fibrosis (CF) or Non-CF Bronchiectasis
Patients with cystic fibrosis (CF) and non-CF bronchiectasis are particularly vulnerable to NTM infections due to their underlying lung conditions. NTM infections in these patients can exacerbate their respiratory symptoms and complicate their overall health management. It is crucial for these patients to be monitored regularly, and healthcare providers should be vigilant about potential NTM infections.
How to Prevent NTM Acquisition
Preventing NTM infections involves several strategies aimed at reducing exposure to environmental sources of the bacteria:
- Water Management Programmes: Implementing and maintaining water management programmes in healthcare facilities can help reduce the risk of NTM infections. This includes regular monitoring and cleaning of water systems.
- Avoiding High-Risk Activities: Individuals at higher risk should avoid activities that generate aerosols, such as using hot tubs or being in environments where water is aerosolised.
- Protecting Vulnerable Individuals: For those with underlying lung conditions, taking extra precautions such as using filters in showerheads and avoiding exposure to dust and soil can be beneficial.
- Proper Sterilisation: Ensuring that medical and cosmetic equipment that uses water is properly sterilised to prevent contamination.
Conclusion
Nontuberculous mycobacteria are a significant cause of lung infections, particularly in individuals with pre-existing lung conditions and compromised immune systems. Understanding where NTM are found, how they are transmitted, and the risk factors involved can help in taking appropriate preventive measures. While human-to-human transmission is rare, environmental exposure remains the primary concern. By following recommended prevention strategies, the risk of NTM infections can be significantly reduced.
GET IN TOUCH
Schedule a Visit with Dr Ricardo Jose
Disclaimer: The information provided in this article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your healthcare provider with any questions you may have regarding a medical condition or treatment