The information on this website is not intended for diagnosis or treatment. Please consult your physician for health concerns.

+90 850 321 50 00

Atypical (Nontuberculous) Mycobacterial Infection

Pulmonary, lymphatic, skin, and disseminated infections caused by environmental nontuberculous mycobacteria.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Internal Medicine department. Book Appointment →

What is Atypical (Nontuberculous) Mycobacterial Infection?

Nontuberculous mycobacteria (NTM), also called atypical mycobacteria, are environmental acid-fast bacilli distinct from M. tuberculosis complex and M. leprae. The Mycobacterium avium complex (MAC) — including M. avium, M. intracellulare, and M. chimaera — is the most clinically relevant, followed by M. kansasii, M. xenopi, M. abscessus complex, M. fortuitum, M. chelonae, and M. marinum.

Pulmonary NTM disease most commonly affects elderly women with bronchiectasis (Lady Windermere syndrome) or men with COPD or prior tuberculosis. Cervical lymphadenitis is common in children. Skin and soft tissue infections follow trauma or contaminated water exposure. Disseminated disease occurs in advanced HIV (CD4 below 50) or immunosuppressed transplant recipients.

Diagnosis of pulmonary disease requires ATS/IDSA criteria: clinical (compatible symptoms and radiology) plus microbiologic (two positive sputum cultures, one positive bronchial wash, or positive biopsy with granuloma). Drug susceptibility testing guides therapy: macrolide-based for MAC, rifampin-isoniazid-ethambutol for M. kansasii, parenteral combination for M. abscessus. Treatment lasts at least 12 months after culture conversion.

Symptoms

Chronic productive cough
Hemoptysis
Fatigue, low-grade fever
Weight loss, night sweats
Dyspnea
Chronic sinusitis
Cervical lymphadenopathy in children (often unilateral)
Persistent skin nodules or ulcers
Fish tank granuloma (M. marinum)
Hot tub lung (hypersensitivity pneumonitis)
Sinopulmonary infections in cystic fibrosis
Disseminated symptoms in HIV: fever, weight loss, anemia, hepatosplenomegaly
Bone or joint infection (osteomyelitis)
Skin tracts after cosmetic procedures (M. abscessus)
Cardiac symptoms in M. chimaera (heater-cooler exposure)

Risk Factors

Bronchiectasis (any cause)
COPD, smoking
Prior tuberculosis
Cystic fibrosis
Alpha-1-antitrypsin deficiency
GERD with chronic aspiration
Immunodeficiency (HIV CD4 below 50, IFN-gamma autoantibody)
Solid organ or stem cell transplant
TNF-alpha inhibitor therapy
Older age, female sex (Lady Windermere)
Tall, slender body habitus
Hot tub or shower exposure (hypersensitivity)
Fish tank or marine exposure (M. marinum)
Cosmetic surgery, tattoos, pedicures
Hospital water systems (M. chimaera, M. abscessus)
Cardiac surgery with heater-cooler units (M. chimaera)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Chronic cough not improving with standard therapy
  • Persistent cervical lymphadenopathy in child
  • Skin nodule after fish tank or aquatic exposure
  • Recurrent abscess after cosmetic procedure
  • Fever and weight loss in advanced HIV
  • Bronchiectasis with chronic sputum production
  • Hot tub use with persistent dyspnea
  • Recent cardiac surgery with prolonged fever
  • Smear-positive AFB but PCR negative for TB

Treatment Methods

01
Pulmonary or infectious disease specialist referral
02
Sputum AFB smear, mycobacterial culture, NAAT (negative for TB), MALDI-TOF for species identification
03
HRCT chest: nodular bronchiectatic vs cavitary patterns
04
Lymph node or biopsy culture if extrapulmonary
05
Drug susceptibility testing for clarithromycin (MAC), amikacin, rifampin
06
MAC pulmonary nodular bronchiectatic: 3-times-weekly clarithromycin or azithromycin plus rifampin plus ethambutol
07
MAC cavitary or severe: daily macrolide plus rifampin plus ethambutol plus IV amikacin or streptomycin (initial 2-3 months)
08
Continue therapy 12 months after culture conversion
09
M. kansasii: rifampin plus isoniazid plus ethambutol for 12 months
10
M. abscessus: macrolide (if susceptible) plus IV amikacin plus imipenem or cefoxitin for 4-6 months, then oral combination
11
M. marinum: clarithromycin plus rifampin or doxycycline for 3-4 months
12
Hot tub lung: discontinue exposure, short steroid course, consider antimicrobials
13
Lymphadenitis (children): surgical excision often curative
14
Disseminated MAC in HIV: macrolide plus ethambutol plus rifabutin, until CD4 sustained over 100
15
ART optimization in HIV
16
Surgical resection for localized cavitary pulmonary disease (selected)
17
Monitor for hepatotoxicity, ototoxicity (macrolides, aminoglycosides), uveitis (rifabutin)
18
Pulmonary rehabilitation, nutrition optimization
19
Treat coexisting bronchiectasis, GERD
20
Prophylaxis: azithromycin in HIV CD4 below 50
21
Public health investigation for hospital outbreaks
22
Long-term follow-up for relapse

Which Department to Visit?

You can visit our Enfeksiyon Hastalıkları department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About Enfeksiyon Hastalıkları Department

Let us help you

You can make an appointment with our specialists or contact us for your concerns.

Book AppointmentContact Us

Related Health Topics

Other articles from the same department you may want to explore.

Flu (Influenza)

Enfeksiyon Hastalıkları

Influenza is a seasonal contagious respiratory disease caused by influenza viruses; it presents with high fever, muscle pain, and severe fatigue.

COVID-19

Enfeksiyon Hastalıkları

COVID-19 is a contagious disease caused by the SARS-CoV-2 coronavirus with a wide clinical spectrum ranging from asymptomatic to severe pneumonia.

Upper Respiratory Tract Infection

Enfeksiyon Hastalıkları

Upper respiratory tract infections are diseases that include common cold, pharyngitis, sinusitis, and laryngitis, often of viral origin and self-limited.

Urinary Tract Infection

Enfeksiyon Hastalıkları

Urinary tract infections are common bacterial infections most often caused by Escherichia coli, presenting with burning and frequent urination.

Hepatitis A (HAV)

Enfeksiyon Hastalıkları

Hepatitis A is an acute, self-limited liver infection transmitted via the fecal-oral route causing acute hepatitis without chronicity; supportive care suffices in most cases, while vaccination prevents outbreaks and post-exposure prophylaxis within 2 weeks is effective.

Hepatitis B

Enfeksiyon Hastalıkları

Hepatitis B is a contagious infection caused by HBV virus transmitted via blood, sexual intercourse, and mother-to-child, that can become chronic and progress to cirrhosis and liver cancer.

Hepatitis C

Enfeksiyon Hastalıkları

Hepatitis C is a liver disease caused by HCV virus transmitted mainly by blood; the rate of chronicity is high, but cure is possible with new antiviral drugs.

HIV/AIDS Information

Enfeksiyon Hastalıkları

HIV is a virus that targets the immune system; if untreated, it progresses to AIDS. With modern antiretroviral therapy, HIV-positive individuals can lead healthy, long lives.

Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.