Nontuberculous mycobacteria

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Template:Seealso Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: MOTT, NTM

Overview

Nontuberculous mycobacteria (NTM), or atypical mycobacteria or mycobacteria other than tuberculosis (MOTT), are mycobacteria which do not cause tuberculosis or Hansen's disease (leprosy).

Introduction

Over the past 25 years, there has been a dramatic increase in the number of NTM cases seen by clinicians across the United States and Canada.

The correct name of NTM is "nontuberculous mycobacteria." There is no such bacteria called "nontuberculosis microbacteria."

See Mycobacterium for more information about this genus and a list of species.

Medical classification

Mycobacteria are a family of small, rod-shaped bacilli that can be classified into 3 main groups for the purpose of diagnosis and treatment:

• Mycobacterium tuberculosis complex which can cause tuberculosis: M. tuberculosis, M. bovis, M. africanum, , M. microti and M. canetti.
• M. leprae which causes Hansen's disease or leprosy.
• Nontuberculous mycobacteria (NTM) are all the other mycobacteria which can cause pulmonary disease resembling tuberculosis, lymphadenitis, skin disease, or disseminated disease. Pulmonary NTM infections include: MAC (mycobacterium avian complex), which includes M. avium and M. intracellulare; faster-growing M. abscessus, M. chelonae, and M. fortuitum; and less common strains such as M. kansasii and M. xenopi.

Unlike TB and leprosy, which are primarily spread by human-to-human contact, NTM is believed to be contracted from the environment, hence its alternative label, "environmental bacteria." NTM is believed to exist naturally in soil and water.

Diagnosis

Epidemiology: typical NTM patient is female, over age 50, caucasian, slender body habitus, negligible history of smoking.

Symptoms: Dry cough which becomes very wet, sometimes blood is coughed up; fever, chills, night sweats; recurrent bronchitis or pneumonia; vague malaise and diminished energy.

Tests: NTM diagnosis requires a high-resolution CT scan of the lungs and Acid Fast Bacilli test of sputum (growth of NTM bacteria will take several weeks or more to occur and sample must be in a cultural media specific to mycobacteria). NTM do not take up a Gram stain (Gram neutral).

Possible Predisposing or Co-existing Conditions: Cystic Fibrosis (including adult onset); Alpha-1 Antitrypsin Deficiency; Primary ciliary diskinesia (Kartagener's Syndrome); GERD; scoliosis; allergies.

References

• American Thoracic Society Guidelines: Diagnosis, Treatment and Prevention of Nontuberculous Mycobacterial Diseases. Am. J. Respiratory and Critical Care Medicine, Vol. 175, pp. 367-417, 2007. [2]

• eMedicine Radiology © - pictures of X-ray and CT scan of various findings of NTM disease:
  • Lung, Nontuberculous Mycobacterial Infections - cavity, volume loss, fibrosis, nodule, bronchiectasis, atelectasis, lymphadenopathy

External links

• The NTM Handbook: A Guide for Patients with Nontuberculosis Mycobacterial Infections Including MAC
• National Jewish Medical and Research Center
• University of Texas, Tyler Health Center
• Stop NonTuberculosis Mycobacterium Now informational website.

Organizations

• NTM Info & Research [3]

"ntminfo.org" is the most comprehensive website explaining Nontuberculous Mycobacterial pulmonary disease. NTM (Nontuberculous Mycobacterial) is also known as Atypical TB or MOTT (Mycobacteria Other Than TB),or MAC (Mycobacteria Avium Complex).