19/06/2025
Pulmonary Non-Tuberculous Mycobacterial (NTM) Disease
for Lungs | Dr Arjun Bhatnager DM Pulmonology, Kanpur
𧫠What is NTM?
Non-tuberculous mycobacteria (NTM) are a group of environmental mycobacteria found in soil, water, and dust. Unlike TB, they are not contagious but can infect lungs, especially in patients with preexisting lung diseases.
π Epidemiology
β’ Globally rising incidence, especially in developed countries.
β’ In India, NTM often goes undetected or misdiagnosed as drug-resistant TB.
β’ Common in elderly, COPD, bronchiectasis, or immunocompromised individuals.
π Symptoms
Often mimics TB but is chronic and subtle:
β’ Persistent cough (often with sputum)
β’ Breathlessness
β’ Low-grade fever or night sweats
β’ Weight loss
β’ Fatigue
π§ͺ Diagnosis
β’ Chest X-ray or HRCT shows nodules, bronchiectasis, or cavitary lesions
β’ Sputum AFB smear and culture positive for NTM (e.g., Mycobacterium avium complex, M. abscessus)
β’ Molecular PCR tests or line-probe assays help differentiate from TB
β’ Diagnosis requires multiple positive cultures and clinical correlation
π Treatment
β’ Long-term, combination antibiotic therapy for 12β18 months
β’ Common drugs: macrolides (azithromycin/clarithromycin), ethambutol, rifampicin, amikacin
β’ Monitoring for drug side effects and resistance is essential
β’ Severe or refractory cases may need surgical resection
β Common Mistakes & Misdiagnosis
β’ Mistaken for multi-drug-resistant TB (MDR-TB)
β’ Patients often treated incorrectly with TB drugs alone
β’ Delayed diagnosis leads to lung damage and poor outcomes
π Outcome
β’ With early diagnosis and adherence, most patients respond well
β’ Cure rates vary by species, immune status, and lung condition
β’ Relapse is common if treatment is not completed
π Scientific References
β’ ATS/IDSA Guidelines 2020
β’ Indian Journal of Tuberculosis 2023
β’ ERS Monograph on NTM Lung Disease 2022
Awareness Saves Lungs. Consult Early.
