What Is Nontuberculous Mycobacteria?
Nontuberculous Mycobacteria (NTM) are microorganisms which occur naturally in water and soil. There are over 150 species of NTM, and for most people, coming into contact with them does not pose any risk. However, in some people, NTM can cause lung infections which can be difficult to treat and may lead to permanent damage.
NTM enter the body when they are breathed in along with soil or water particles. They can be found in tap water, steam from bathtubs or dishwater, showerheads, and soil particles form parks or gardens.
Most people are able to clear these microorganisms from their lungs easily, but people who have pre-existing lung conditions or weak immune systems may struggle to do this. In some cases, NTM can interfere with immune cells known as macrophages, and begin to multiply within the body.
Although NTM is not thought to be contagious, it can become chronic and cause permanent lung problems if left untreated. Therefore, early diagnosis is crucial for making a full recovery from NTM infections.
You are more likely to be affected by NTM if you are over 65, have reduced immunity, or suffer from a medical condition including:
- Structural lung disease
- Chronic obstructive pulmonary disease (COPD)
- Cystic fibrosis
- History of lung infections including tuberculosis (TB)
Although NTM most often affects the lungs, in some cases it can also cause infections of the skin and soft tissue.
Nontuberculous Mycobacteria Symptoms
NTM can cause a variety of symptoms. Unfortunately, many of these can be similar to those of pre-existing lung disorders such as bronchiectasis, and people with these conditions may not notice that they have been infected until their symptoms become more severe.
One way to distinguish between the symptoms of NTM and other lung problems is that with NTM, symptoms will gradually get worse over time as the infection progresses.
The symptoms of NTM include:
- Coughing with or without blood
- Shortness of breath
- Reduced appetite or weight loss
- Low-grade fever
- Night sweats
- Swollen lymph glands
If you have any of these symptoms for the first time, or your current symptoms are getting worse, see your physician as soon as possible to get an accurate diagnosis.
Nontuberculous Mycobacteria Diagnosis
In order to diagnose NTM, your physician will take a full medical history including your current symptoms and any pre-existing lung disorders you may have. They will then take a chest x-ray or scan to confirm the presence of a lung infection, followed by a biopsy or blood sample to identify the microorganism that is responsible.
Making an identification is crucial as there are so many different species of NTM and your exact treatment will depend on which one is causing the infection.
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Nontuberculous Mycobacteria Treatment
Some people do not require treatment for NTM as healthy individuals should be able to clear the infection by themselves over time. However, some people do need treatment for this condition, and it is very important to get it right.
NTM is treated with a long course of antibiotics which may last for a year or even longer depending on your situation. It is common to be prescribed a combination of three different types of antibiotic including:
- Azithromycin or clarithromycin
- Rifampicin or rifabutin
When taken properly, these antibiotics can effectively treat most cases of NTM. However, they can also cause side effects such as nausea, vomiting, and diarrhea. Therefore, it is important to pay close attention to your diet while taking these drugs to avoid weight loss and malnutrition. Rifampicin can cause your body fluids (including tears, saliva, urine, and feces) to change color. This side effect can be alarming but is not usually a cause for concern.
Also, these powerful drugs can sometimes cause more serious side effects, and your physician should monitor you closely for the duration of your treatment. It is especially important to observe the following:
- Liver enzymes
- White blood cell count
- Eyesight and hearing
- Neuropathy (nerve pain)
- Kidney function
It is also essential that you take your antibiotics exactly as prescribed and complete the whole course of treatment. If you miss doses or stop taking your antibiotics too early, you risk becoming re-infected by NTM, or worse still, the NTM could become resistant to treatment. This means that the infection will no longer respond to antibiotics, and could become chronic. If this happens, you may have to take medication indefinitely or require surgery to remove part of your lung.
Nontuberculous Mycobacteria Prevention
It is difficult to prevent NTM, as these microorganisms exist in high concentrations throughout our everyday environment. However, there are a few steps you can take to reduce your chances of being infected.
Avoid washing medical equipment or wounds in tap water, and try not to leave sources of standing water around your home. Keep taps and showerheads clean and disinfect them regularly. You may also want to consider avoiding baths or hot tubs as these make you more likely to breathe in steam contaminated with NTM.
These preventative measures are especially important if you are at increased risk of NTM infection due to lung conditions or low immunity. Taking these few simple steps could reduce your chances of becoming sick and having to undergo a long course of NTM treatment in the future.