A group of wounds and conditions caused by Mycobacterium bacteria is called nontuberculous mycobacteria (NTM) infections. The exceptions are bacteria that cause tuberculosis and leprosy (Hansen’s disease). NTM infections often affect the lungs, skin, bones, lymph nodes, and other organs in the body. One of the most common causes of these infections is M. avium complex (MAC). Commonly, healthcare professionals treat NTM infections with antibiotics.
Furthermore, NTMs are found in dust, soil, and water. While these bacteria affect the lungs, they can also infect other parts of the body. NTM infections can be localized (limited to one part of the body) or disseminated (infect multiple parts of the body). However, such infections outside of the lungs are very rare in people who do not have weakened immune systems.
Symptoms
In most cases, people with NTM infections experience the following symptoms. Check some general symptoms below:
- Extreme tiredness (fatigue)
- Fever
- Weight loss
- Swollen lymph nodes
Sometimes, people may experience different symptoms because it depends on where they are infected. For example:
- NTM skin infection may cause pain, redness, swelling, sores, ulcers, or rash
- NTM musculoskeletal infection can cause joint stiffness and pain
- NTM lung infection often causes cough and dyspnea (shortness of breath)
Immediately contact your healthcare professional if any of the previous symptoms occur.
Causes and Risk Factors
Most people develop NTM infections due to M. avium complex (MAC), but they may also happen due to other mycobacterial types. For example:
- kansasii
- abscessus complex
- xenopi and others
Usually, this bacterium is found in the environment, including soil, water, and dust. Check below some ways in which people get infected with this bacterium:
- Bathing, showering, or drinking water that contains NTM
- Inhaling mycobacteria from the environment (especially if you already have a lung disease)
- Medical devices (such as a central venous line or surgical tools)
- Needles that are used for injecting medical and nonmedical drugs or for tattooing
After exposure to NTM, it may take some time to experience symptoms. That’s why most people do not know they are infected. While most NTMs do not spread from one person to another, in rare cases, these infections are contagious.
Anyone can develop NTM infections, but doctors have identified some factors that may make you more likely to develop them. For example:
- Underlying lung diseases (these include cystic fibrosis, bronchiectasis, asthma, and emphysema)
- Central venous lines, breathing or feeding tubes, or another device that goes into the body
- You are administering immunosuppressants
- Have HIV infection, cancer, or another disorder that weakens your immune system
In addition, women with a low BMI and certain disorders, including GERD (gastroesophageal reflux disease), scoliosis, pectus excavatum, or mitral valve prolapse, are at increased risk of developing pulmonary NTM infections (also known as Lady Windermere syndrome).
What Happens if NTM Infections Are Left Untreated?
Sometimes, people with these infections may also experience some complications, especially if they develop a severe form or leave it untreated. Check some of them below:
- Lung damage that may lead to the formation of cavities, abscesses, and lung scarring (fibrosis)
- Pleural problems (including pleurisy and pleural effusion)
- Respiratory failure
- Hemoptysis
- Chronic cough and mucus
- Lymphadenopathy (swollen and infected lymph nodes)
- Non-healing wounds
- Disseminated disease – This is a widespread infection, particularly in immunocompromised people, that negatively affects the liver, spleen, and other organs
- Gastrointestinal problems
- Liver problems
- Nerve damage
- Skin scars
This article does not contain a full list of complications, but you can consult with your healthcare provider about ways to reduce the risk or even prevent them.
How to Prevent Nontuberculous Mycobacteria Infections?
Usually, people do not get sick when they come in contact with this bacterium, but if they have an existing lung disease or weakened immune system, NTM infections can occur. Check below some places that you should avoid:
- Hot tubs (particularly in enclosed areas)
- Working with soil (especially potting soil)
- Avoid tattoos
- Do not inhale sprayers that produce a fine mist
Diagnosis
Doctors often start the diagnosis of NTM infections with a physical examination to check for abnormalities linked to the infection. Thereafter, they may also ask some questions about your symptoms and medical history to gather more information about your disease. However, to confirm or rule out NTM infections, physicians often perform a culture test to look for mycobacteria in the blood, tissue, or sputum (mucus coughed up from the lungs). In some cases, physicians may perform additional tests and procedures, but it depends on your symptoms. Examples include:
- Chest X-rays
- Bronchoscopy
- CT (computerized tomography) scans
- Acid-fast bacilli test
- Biopsy – In more severe cases, doctors may take a small sample of the affected tissue for testing
The only way to know if you are infected is to visit a doctor because the symptoms of NTM infections are very similar to other illnesses.
Treatment
In most cases, people get a prescription for a combination of antibiotics that are taken for up to 12 months to clear these infections. It is very important to administer medicines exactly as prescribed by your doctor. Otherwise, the infection may return, and it often becomes more difficult to treat. Check below some antibiotic types that are prescribed by doctors for people with NTM infections:
- Clarithromycin
- Ethambutol
- Amikacin liposome suspension for inhalation (ALIS)
Furthermore, some people may experience some adverse reactions to antibiotics, especially if they are used for long periods. Check some of them below:
- Hearing loss (deafness)
- Long QT syndrome
- Vision changes
- Liver or kidney damage
If any of the previous side effects occur, immediately call 911 or go to the nearest emergency room (ER).
Frequently Asked Questions
When should I go to the ER?
If any of the following symptoms occur, immediately go to the nearest emergency room (ER). For example:
- Trouble breathing
- Confusion
- Disorientation
- Fever over 103 degrees F (40 degrees C)
- A wound or surgical site that does not heal
- Severe adverse reactions to antibiotics
What is the most common NTM infection?
One of the most common types of NTM infection in the U.S. is Mycobacterium avium complex (MAC). However, people may develop other types too. For more details, discuss it with your doctor.
Does NTM ever go away?
It is important to understand that NTM infections do not go away on their own. That’s why you should visit a doctor as soon as symptoms occur. Without treatment, it may lead to serious and even life-threatening complications. If you have additional questions, ask your healthcare professional.
