What Is NTM & Are You at Risk?

Nontuberculous mycobacterial disease (NTM) is a mysterious infection with a variety of treatments. Are you at risk for this infectious disease?

Transcript

Shannon Kasperbauer, MD:
Nontuberculous mycobacteria are organisms that are naturally a part of our environment. They're usually found in the water, in the soil and there are many different species. There are particular individuals who are more vulnerable. Studies show that those individuals that are older, so typically over 65, tend to have higher rates of NTM lung disease. Women, for some reason, are more often seen struggling with this disease than men in the US, but that's different in different parts of the world and anyone with underlying structural airway disease.

The symptoms of NTM, are nonspecific. Patients can have cough. They can have sputum production. Sometimes patients will have fatigue associated with this chronic infection. In other patients, they might notice shortness of breath, fevers. In severe cases, patients might even describe coughing up blood as one of their symptoms. NTM infections are diagnosed based on three criteria. The first is having imaging that looks consistent with this kind of infection. The second is in a patient that has symptoms and then the third criteria in the guidelines is to meet the microbiologic definition. Particularly, your doctor needs to send this for mycobacterial cultures, not just routine cultures. In general, patients have had symptoms for quite a long time before they're diagnosed because they're often misdiagnosed as having something else. We know of many patients who've had this disease for years before they're diagnosed.

NTM infections, interestingly, because these are many different species, are treated differently. I'll focus on the most common one that makes up about 80% of what we see and that's MAC. in that infection, most of the time, we can treat with oral medications, but the difference with this germ versus other infections that we're all used to hearing about like strep and staph infection are that the treatment course is very long. It requires three different antibiotics for anywhere between 12 and 24 months. Treatment certainly can be successful in the majority of patients, but it really requires the knowledge of the provider, and understanding of side effects and how to manage those.