Clinical, Immunological, and Microbiological Aspects of Nontuberculous Mycobacterium (NTM)
DOI:
https://doi.org/10.36497/3rsgyg73Keywords:
Cell-mediated immunity, diagnosis, nontuberculous mycobacterium-lung disease (NTM-LD), susceptibility host, treatmentAbstract
Nontuberculous mycobacteria (NTM) refer to all mycobacterial species except Mycobacterium (M.) tuberculosis complex and M. leprae complex. These bacteria are acid-fast. The bacteria are environmental bacteria that act opportunistically in humans. The infection can lead to disease, primarily affecting the lungs in susceptible hosts. Risk factors for NTM infection include defects in the body's defence mechanisms, changes in lung structure, and immune system abnormalities, which can be congenital or acquired. The bacteria possess pathogen-associated molecular patterns (PAMPs) and cell wall components that differ from those of Mycobacterium tuberculosis (M. tuberculosis), one of which is the glycopeptidolipid (GPL) component. Different species have distinct cell wall components, enabling them to modulate the immune system in various ways by interacting with multiple pathogen recognition receptors, including toll-like receptors and fibronectin. The cell-mediated immune response plays a role in the response to NTM infection. Alveolar macrophages, as the first line of defence, release interleukin (IL)-12, activating the T-helper-1 (Th1) axis and natural killer (NK) cells, followed by the release of tumour necrosis factor- α (TNF-α), interferon (IFN)-γ, and IL-17. The clinical symptoms of NTM lung disease (NTM-LD) are similar to those of Mycobacterium tuberculosis (M. tuberculosis). Two radiological findings are commonly observed: fibro-cavitary lesions and nodular bronchiectasis. Diagnosis must meet clinical, radiological, and microbiological criteria. The decision to start therapy should consider host factors, clinical conditions, and species type. The treatment approach involves multi-drug therapy and long-term administration, depending on species, disease extent, drug susceptibility testing results, and comorbidities.
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References
1. Dahl VN, Mølhave M, Fløe A, van Ingen J, Schön T, Lillebaek T, et al. Global trends of pulmonary infections with nontuberculous mycobacteria: A systematic review. IJID. 2022;125:120–31.
2. Pereira AC, Ramos B, Reis AC, Cunha M V. Non-tuberculous mycobacteria: Molecular and physiological bases of virulence and adaptation to ecological niches. Microorganisms. 2020;8(9):1380.
3. Sharma S, Upadhyay V. Epidemiology, diagnosis & treatment of non-tuberculous mycobacterial diseases. Indian J Med Res. 2020;152(3):185–226.
4. Honda JR, Alper S, Bai X, Chan ED. Acquired and genetic host susceptibility factors and microbial pathogenic factors that predispose to nontuberculous mycobacterial infections. Curr Opin Immunol. 2018;54:66–73.
5. Cruz-Aguilar M, Castillo-Rodal AI, Arredondo-Hernández R, López-Vidal Y. Non-tuberculous mycobacteria immunopathogenesis: Closer than they appear. a prime of innate immunity trade-off and NTM ways into virulence. Scand J Immunol. 2021;94(2):e13035.
6. Dohál M, Porvazník I, Krivošová M, Solovič I, Mokrý J. Epidemiology of non-tuberculous mycobacterial diseases in Slovakia during the years 2016–2021. Respir Physiol Neurobiol. 2023;314:104090.
7. Saptawati L, Kusumo H, Suryawati B. Prevalence of non-tuberculous mycobacteria (NTM) in Surakarta, Indonesia: Higher than expected. KLS. 2019;4(12):132–8.
8. Saptawati L, Primaningtyas W, Dirgahayu P, Sutanto YS, Wasita B, Suryawati B, et al. Characteristics of clinical isolates of nontuberculous mycobacteria in Java-Indonesia: A multicenter study. PLoS Negl Trop Dis. 2022;16(12):e0011007.
9. Shu CC, Wu MF, Pan SW, Wu TS, Lai HC, Lin MC. Host immune response against environmental nontuberculous mycobacteria and the risk populations of nontuberculous mycobacterial lung disease. J Formos Med Assoc. 2020;119(Suppl 1):S13-22.
10. Chancharoenthana W, Kamolratanakul S, Rotcheewaphan S, Leelahavanichkul A, Schultz MJ. Recent advances in immunopathogenesis and clinical practice: Mastering the challenge-managing of non-tuberculous mycobacteria. Front Immunol. 2025;16:1554544.
11. World Health Organization. Non-tuberculous Mycobacterium: background document for the WHO guidelines for drinking-water quality. World Health Organization. Geneva: World Health Organization; 2025.
12. Johansen MD, Herrmann JL, Kremer L. Non-tuberculous mycobacteria and the rise of Mycobacterium abscessus. Nat Rev Microbiol. 2020;18(7):392–407.
13. Daley CL, Iaccarino JM, Lange C, Cambau E, Wallace RJ, Andrejak C, et al. Treatment of nontuberculous mycobacterial pulmonary disease: An official ats/ers/escmid/idsa clinical practice guideline. Clin Infect Dis. 2020;56(1):2000535.
14. Wu UI, Holland SM. Host susceptibility to non-tuberculous mycobacterial infections. Lancet Infect Dis. 2015;15(8):968–80.
15. Ledda RE, Balbi M, Milone F, Ciuni A, Silva M, Sverzellati N, et al. Imaging in non-cystic fibrosis bronchiectasis and current limitations. BJR Open. 2021;3(1):20210026.
16. Roden L, Görlich D, Omran H, Peters G, Große-Onnebrink J, Kahl BC. A retrospective analysis of the pathogens in the airways of patients with primary ciliary dyskinesia. Respir Med. 2019;156:69–77.
17. Kumar K, Ponnuswamy A, Capstick TG, Chen C, McCabe D, Hurst R, et al. Non-tuberculous mycobacterial pulmonary disease (NTM-PD): Epidemiology, diagnosis and multidisciplinary management. Clin Med (Lond). 2024;24(1):100017.
18. Opperman CJ, Singh S, Goosen W, Cox H, Warren R, Esmail A. Incorporating direct molecular diagnostics in management algorithms for nontuberculous mycobacteria: Is it high time? IJID Regions. 2024;10:140–5.
19. Kurz SG, Zha BS, Herman DD, Holt MR, Daley CL, Ruminjo JK, et al. Summary for clinicians: 2020 clinical practice guideline summary for the treatment of nontuberculous mycobacterial pulmonary disease. Ann Am Thorac Soc. 2020;17(9):1033–9.
20. Haworth CS, Banks J, Capstick T, Fisher AJ, Gorsuch T, Laurenson IF, et al. British Thoracic Society guidelines for the management of non-tuberculous mycobacterial pulmonary disease (NTM-PD). Thorax. 2017;72(Suppl 2):ii1-64.
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