Surgical Lung & Chest Care
From the Thoracic Surgery Team at Columbia University

Nontuberculous Mycobacterial Lung Infections

Nontuberculous mycobacterial (NTM) lung infections are caused by a common type of bacteria called mycobacteria. While these bacteria are usually harmless, they sometimes cause serious lung disease. Treatment options range from antibiotics to surgery for severe cases.

Key Facts

  • Mycobacteria are a diverse group of bacteria that includes over 190 species, the most well-known of which causes tuberculosis. The rest of them are referred to as nontuberculous.
  • Mycobacteria are everywhere: found in soil, water, and animals. Indoor plumbing and water systems are common reservoirs in developed countries. Almost everyone has come into contact with mycobacteria before in their lives, which is harmless for most people. Although NTM lung infections are rare, certain people are at increased risk such as those with underlying lung conditions or weakened immune systems.
  • Symptoms can range from a chronic cough with sputum and trouble breathing to fever and weight loss. In most cases, NTM infections can be treated with antibiotics. For severe cases, surgery may help improve treatment.

Causes

NTM lung infections are caused by breathing in mycobacteria. This type of bacteria is extremely common and can be found in the air, water, and soil, as well as on domestic and wild animals, all over the world. Indoor plumbing and water systems are common reservoirs for the ubiquitous NTM.

Everyone comes in contact with mycobacteria almost every day, but only a small percentage of people are at risk of infection. Factors that can increase this risk include the following:

  • Age
  • Alcohol Dependence
  • Autoimmune disease
  • Cystic fibrosis
  • HIV/AIDS
  • Lung disease, e.g. COPD, bronchiectasis
  • Smoking

Symptoms

A range of symptoms is associated with NTM lung infections. Depending on each person, their health, and the severity of their condition, these symptoms can change.

The following are some common symptoms of NTM lung infections:

  • Chest pain
  • Chronic cough, often with sputum production
  • Fatigue
  • Fever
  • Shortness of breath
  • Weight loss
  • Coughing up blood (hemoptysis)

Over time, these symptoms will get worse and become more persistent if the infection remains untreated.

Diagnosis

Diagnosing an NTM lung infection can be difficult because it can resemble other lung conditions, such as COPD or bronchiectasis. This is why it is important to go to a healthcare provider and get a medical exam as soon as there are any possible symptoms. Left undiagnosed, NTM lung infection can lead to chronic symptoms and irreversible lung damage. .

The following are the most common ways to diagnose an NTM lung infection:

  • Physical Exam: A healthcare provider will perform a physical exam to examine your health, which includes listening to your lungs with a stethoscope. They will also ask about your symptoms, including fever, weight loss, and breathing problems.
  • Imaging Tests: Doctors use these to take detailed images of the chest and lungs to look for any signs of infection. They will usually include either an x-ray or a computerized tomography (CT) scan.
  • Sputum Culture: Sputum is a type of mucus that is coughed up from the lungs. This test examines sputum under a microscope to see if any bacteria are present.

Treatment

There are several ways to treat NTM infections depending on their severity. For some people with mild infections, no treatment may be necessary. For those who have more severe cases and/or underlying conditions, the following treatment options may be necessary:

Antibiotics

This is the most common treatment for NTM infections. Patients will usually take several types of antibiotics at once to reduce the chances of the bacteria becoming resistant to medication. In severe cases, patients may need to take antibiotics once a day for up to 12 months.

The following are some common antibiotics used for NTM infections, usually in combination:

  • Amikacin
  • Azithromycin
  • Clarithromycin
  • Ethambutol
  • Isoniazid
  • Rifampin
  • Streptomycin

Surgery

Oftentimes, NTM infections can be difficult to treat with antibiotics alone. In these cases, surgery may be necessary to remove any diseased lung tissue. Surgeons will typically perform a procedure to remove an isolated area of the lung, called a lobectomy or segmentectomy. When combined with antibiotics, surgery can help increase the chances of eliminating a severe NTM infection.

Outlook

In most cases, NTM infections can be successfully treated. However, the length of time this takes and the amount of lung damage that will remain afterward will depend on several factors, such as when the infection is diagnosed, its severity, and your overall health.

During treatment, your healthcare provider may monitor your progress with additional imaging, blood tests, and sputum tests.

After treating an NTM infection, the best way to reduce the chances of future infection is to address the underlying risk factors that made you vulnerable to infection. This may include the following:

  • Take your prescribed medications, particularly for immune system disorders (i.e. HIV) and lung disorders (i.e. COPD, asthma).
  • Stop smoking. You may improve your chances of quitting with the help of nicotine patches or medications like varenicline or bupropion.
  • Stay up to date with vaccinations, which includes the flu vaccine for all adults and the pneumococcal vaccine (PPSV23) for adults over age 65 or younger with certain conditions or smoking.
  • Exercise, stay hydrated, and maintain a healthy diet.

Next Steps

NTM lung infections can be hard to recognize because the symptoms can be subtle. A comprehensive history and physical examination, imaging, and lab tests are often needed to diagnose NTM lung infection. If you feel like you may be ill, talk to a healthcare provider. With the proper treatment, you can get back to feeling like your regular self.

If you need help for a lung or chest issue, we’re here for you. Call (212) 305-3408 for existing patients, (212) 304-7535 for new patients, or request an appointment online to get started today.

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