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

+90 850 321 50 00

Non-Tuberculous Mycobacterial (NTM) Lung Disease

Pulmonary infection by environmental mycobacteria other than M. tuberculosis (most commonly M. avium complex, M. abscessus, M. kansasii, M. xenopi), increasingly recognized in patients with bronchiectasis, COPD, post-tuberculous lung damage, cystic fibrosis, and immunocompromise.

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 Göğüs Hastalıkları department. Book Appointment →

What is Non-Tuberculous Mycobacterial (NTM) Lung Disease?

Non-tuberculous mycobacteria (NTM) are ubiquitous environmental organisms found in soil, water, biofilms, and aerosols. Over 200 species are described; ~30 cause human disease. The most clinically important pulmonary pathogens are Mycobacterium avium complex (MAC: M. avium, M. intracellulare, M. chimaera), M. abscessus complex, M. kansasii, M. xenopi, and M. malmoense. Unlike M. tuberculosis, NTM is not transmitted person-to-person (rare M. abscessus exception in cystic fibrosis).

Pulmonary NTM has two classic clinical phenotypes: (1) cavitary upper-lobe disease in older men with smoking-related COPD or prior TB, and (2) nodular-bronchiectatic disease (Lady Windermere syndrome) in older non-smoking women with right middle lobe and lingula involvement. Other groups include cystic fibrosis (M. abscessus), HIV/AIDS (disseminated MAC), and hot-tub lung (hypersensitivity pneumonitis to M. avium aerosols).

Diagnosis follows the 2020 ATS/IDSA/ERS/ESCMID guideline: clinical symptoms (cough, fatigue, dyspnea, weight loss, hemoptysis), HRCT findings (nodular-bronchiectatic or cavitary), and microbiologic confirmation (≥ 2 positive sputum cultures of the same NTM species OR ≥ 1 positive BAL/transbronchial biopsy with granulomas). Treatment is species-tailored multidrug therapy for 12 months after culture conversion (typically 18-month total). MAC: azithromycin + ethambutol + rifampin (3-times-weekly for nodular-bronchiectatic; daily + amikacin IV for cavitary or refractory). M. abscessus: amikacin + cefoxitin or imipenem + macrolide (subsp. abscessus often macrolide-resistant via inducible erm gene). Newer agents: amikacin liposome inhalation suspension (ALIS, FDA-approved 2018 for refractory MAC), bedaquiline, clofazimine, omadacycline.

Symptoms

Chronic productive cough with mucoid or mucopurulent sputum
Fatigue, malaise, weight loss, low-grade fevers
Hemoptysis (especially with cavitation or bronchiectasis)
Progressive exertional dyspnea
Recurrent pneumonia or worsening of underlying lung disease
Failure to respond to standard antibiotics
Lady Windermere phenotype: thin, post-menopausal woman with chronic cough, scoliosis, mitral valve prolapse

Risk Factors

Pre-existing bronchiectasis, COPD, prior tuberculosis, cystic fibrosis
Lady Windermere phenotype (older non-smoking women, voluntary cough suppression)
Alpha-1 antitrypsin deficiency, scoliosis, pectus excavatum
Immunocompromise: HIV/AIDS (disseminated MAC), anti-TNF therapy, post-transplant
Hot-tub or shower aerosol exposure (hot-tub lung, M. avium hypersensitivity pneumonitis)
Esophageal motility disorders, GERD with chronic aspiration
Cystic fibrosis (M. abscessus increasingly recognized)

When to See a Doctor?

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

  • Chronic cough > 4–8 weeks with weight loss or fatigue
  • Recurrent pneumonia in same anatomic location
  • Bronchiectasis or cavitary lesions on chest imaging
  • Hemoptysis or worsening sputum production
  • Failure of standard antibiotics for community-acquired pneumonia
  • Underlying CF, immunosuppression, or HIV with respiratory symptoms
  • Hot-tub use with new dyspnea, fever, or interstitial lung disease pattern

Treatment Methods

01
Apply 2020 ATS/IDSA/ERS/ESCMID criteria: clinical, radiographic (HRCT), and microbiologic confirmation
02
MAC nodular-bronchiectatic: azithromycin 500 mg + ethambutol 25 mg/kg + rifampin 600 mg three times weekly for 12 months after culture conversion
03
MAC cavitary or refractory: daily azithromycin + ethambutol + rifampin + amikacin IV (or streptomycin) for first 2–3 months
04
M. abscessus: amikacin IV + cefoxitin or imipenem + macrolide (azithromycin if macrolide-susceptible) intensive 1–2 months, then continuation with oral agents
05
Refractory MAC: add amikacin liposome inhalation suspension (ALIS) — FDA-approved 2018, dosed 590 mg daily inhalation; consider clofazimine, bedaquiline
06
Surgical resection (lobectomy/wedge) for localized cavitary disease, focal recalcitrant infection, hemoptysis
07
Ongoing monitoring: monthly sputum cultures, AST testing of strains, drug levels (amikacin), audiometry (ototoxicity), vision (ethambutol optic neuritis), QTc (clofazimine, bedaquiline, macrolides)

Which Department to Visit?

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

Learn About Göğüs 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.

Non-Tuberculous Mycobacteria

Göğüs Hastalıkları

Non-tuberculous mycobacteria (NTM) are environmental organisms causing pulmonary disease predominantly in hosts with underlying structural lung disease or immunocompromise, with rising incidence globally.

Asthma

Göğüs Hastalıkları

Asthma is characterized by wheezing, coughing and shortness of breath attacks; with proper treatment it can be kept under control.

COPD (Chronic Obstructive Pulmonary Disease)

Göğüs Hastalıkları

COPD is an irreversible lung disease characterized by shortness of breath and chronic cough; quitting smoking slows its progression.

Pneumonia

Göğüs Hastalıkları

Pneumonia presents with high fever, cough and shortness of breath; the vast majority recover with appropriate antibiotic treatment.

Tuberculosis (TB)

Göğüs Hastalıkları

Tuberculosis presents with weeks-to-months of cough, fever, and night sweats; early diagnosis and treatment lead to full recovery.

Pleural Effusion

Göğüs Hastalıkları

Pleural effusion is the accumulation of excess fluid in the pleural space, resulting from imbalances in fluid production and removal, and represents a manifestation of diverse cardiopulmonary, infectious, and malignant disorders.

Pneumothorax

Göğüs Hastalıkları

Pneumothorax is the presence of air in the pleural space resulting in partial or complete lung collapse, classified as spontaneous (primary/secondary), traumatic, or iatrogenic, with tension pneumothorax representing a life-threatening emergency.

Bronchitis (Acute and Chronic)

Göğüs Hastalıkları

Acute bronchitis is mostly viral and resolves spontaneously, while chronic bronchitis is a smoking-related component of COPD.

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.