The disease caused by Non-Tuberculous Mycobacteria (NTM) is a little-known pathology whose prevalence is increasing significantly, making it an emerging public health challenge.

There are several names by which this disease is called in the scientific literature:

• Atypical tuberculosis (atypical TB)
• Mycobacterial other than tuberculosis (MOTT) infection
• Mycobacterium avium complex (MAC)
• Environmental Mycobacteria (EM)

What are the nontuberculous mycobacteria?

There are more than 180 species of nontuberculous mycobacteria (NTM). These are naturally occurring environmental organisms found in water, soil, food, and animals. They may be present in secretions and body surfaces.

They are agents that cause opportunistic infections in humans.

Who gets NTM lung disease?

NTM lung disease is a less well-known pathology than tuberculosis (TB). It is known that people who have previously suffered lung infections, or who suffer from diseases such as COPD (Chronic Obstructive Pulmonary Disease), cystic fibrosis, alpha-1-antitrypsin deficiency or primary ciliary dyskinesia are more susceptible to this type of infection.

People with autoimmune problems, such as rheumatoid arthritis or Sjogren's disease, or on immunosuppressive treatment are also at higher risk of becoming infected.

This infection can affect the bones, skin, soft tissues, and especially the lungs.

Each MNT can give rise to a different disease, as summarized in the following table:

How I know contracts?

NTM microorganisms are in the environment, including in water (both in water from natural sources and in treated tap water) and in soil. Doctors and scientists believe that some patients become infected with NTM by inhaling the mycobacterium that is aerosolized in showers, kitchen sink sprayers, indoor pools, hot tubs, or ice machines. of the refrigerators. Some patients can get an NTM infection from breathing in naturally occurring mycobacteria in potting soil, through activities such as gardening. Many doctors and scientists believe that NTM lung infection is not only due to exposure to the bacteria in the environment, but also to the vulnerability of the host: some people are more predisposed to infection than others.

Is it a contagious disease?

No. NTMs are not considered transferable from one person to another. However, patients with certain comorbidities, such as cystic fibrosis (CF), may be vulnerable to transmitting certain infections to one another, and it is uncertain whether NTM infection is one of these. For this reason, CF patients should take extra precautions when in close environments with each other.

How is it diagnosed?

Often, NTM infection is misdiagnosed. Unfortunately, this can delay initial diagnosis until after the patient has had recurrent infections and further lung damage as a result. This can make treatment more difficult because previous use of monotherapy may have created some resistance to the drug. Recurrent infections and associated inflammation may have resulted in further damage to the respiratory tract.

Diagnosis of NTM infection involves the following:

1. Sputum smear and culture: Acid fast bacilli (AFB) smear and culture are the basic laboratory tests to identify mycobacteria.
2. Chest computed tomography (CT): A CT scan (or computed tomography) is a three-dimensional image generated by a large series of two-dimensional x-ray images. Chest radiographs alone allow rudimentary identification of pulmonary conditions. A CT scan provides the doctor with a detailed picture of the extent and location of the disease, and is an important diagnostic tool. The diagnosis of NTM infection and its follow-up usually require a noncontrast high-resolution CT scan.

• Medical history: Knowing about illnesses that you and your blood relatives have had, including childhood illnesses, can help your doctor better understand why certain underlying lung conditions exist.

Common symptoms of NTM infection

Patients with NTM infections often have some or even all of the following symptoms:

1. Cough: you can cough up sputum or not. NTM lung disease can cause you to cough up blood (this is called “hemoptysis”).
2. 2. Night sweats, fever: You may have a low fever. The feeling of fever and sweating is usually more prominent at night.
3. Loss of weight and appetite: It is common to lose weight, so it is important to be aware of these changes.
4. 4. Lack of energy: Many patients perceive a variable, though often profound, feeling of fatigue.
5. feeling short of breath
6. Wheezing or wheezing in the chest when breathing
7. Chest pain around the lung area

Management of NTM

To properly manage NTM it is necessary to carry out specific treatment and control measures that require your collaboration to be effective.

Some of these measures are:

1. Medication intake: You will probably have to take multiple medications. Take all your medicines daily for as long as needed. Do not stop taking them when you start to feel better. The doctor will tell you when the bacteria have been controlled long enough for you to stop treatment. Do not stop taking any of your medications because if you do, your NTM infection could become resistant to the drugs. These medications can be administered orally (tablets or syrups), intravenously (injected through a line or catheter), or inhaled.
2. 2. Hearing and vision tests: Some of the antibiotics indicated for the treatment of NTM may affect hearing or vision. Frequent evaluation is important to avoid damage.
3. Performing electrocardiograms: Patients with certain heart conditions may be at risk of developing a dangerous irregular heart rhythm when taking certain types of antibiotics. For this reason, it is important to carry out frequent evaluations to make an early diagnosis of these alterations.
4. Drainage of secretions and nasal washings: The techniques of Respiratory physiotherapy intended for drainage of secretions can help keep the lungs clean of infected secretions, which will reduce the amount of antibiotics needed for treatment and the damage that can occur in the bronchi. It is also very important to perform nasal washes correctly to clean the nose and nasal and paranasal sinuses. Check with your specialized physiotherapist to find out how to do it.
5. Maintain good hydration: Patients with NTM disease need an adequate amount of fluids. Fluids are essential to make secretions thinner, which in turn helps you clear mucus from the airways. They also help the kidneys and liver process medications. Try to minimize certain drinks, such as alcoholic beverages and coffee, tea, or any other drink that acts as a diuretic and actually causes dehydration.
6. Exercise: Exercise is important to help maintain and improve overall stamina. Some patients report that the forceful breathing associated with exercise helps clear their lungs. Weight training can also help muscles become more efficient at extracting oxygen from the blood. Exercise is a recommended part of most treatment plans, but you should discuss the amount and type of exercise with your doctor before beginning an exercise regimen.

Rating of the lung involvement

To assess how NTM is affecting the lungs, it is necessary to perform the following tests:

1. X-rays and chest CT: To detect if there are abnormalities that affect the lungs.
2. Pulmonary function tests: To assess how they work and determine if it is safe to perform surgery. These tests are:
   1. Spirometry: Evaluates the amount of air that enters and leaves our lungs after a forced breath, as well as the speed at which it does so.
   2. Plethysmography: It measures the volume of gas in the lungs by means of the pressure changes that occur during respiration.
   3. diffusion capacity: The patient breathes in small amounts of carbon monoxide and the test measures how much carbon monoxide enters the blood. This indicates the ability of the lungs to allow the passage of oxygen into the blood.
   4. Arterial blood gases: A small amount of blood is drawn from one of the small arteries in the body (usually in the wrist) to test the amount of oxygen and carbon dioxide in the blood.
   5. Oximetry: It also measures the level of oxygen in the blood using a pulse oximeter that is attached to the patient's finger for a minute or two.

Surgery

If the lung damage caused by an NTM infection is isolated, or more severe in one area of ​​the lung, surgery to remove this damaged area may be indicated as an adjunct to other treatments.

Not all people are candidates for this treatment and it requires a series of care, both before and after surgery, to avoid complications. If you are a candidate, strictly follow your doctor's instructions.

Prevention

To avoid complications or infection by NTM it is recommended:

• Get vaccinated against the flu and pneumonia.
• Avoid contact with people with a respiratory infection or with items they have touched or used.
• Wash your hands frequently.
• Adequately ventilate bathrooms and other shower or steam areas.
• Clean shower heads and kitchen faucets regularly to remove biofilm that acts as a breeding ground for mycobacteria. After cleaning them, you can also soak them in vinegar to remove calcium buildup.
• Use a water filter to reduce exposure to aquatic pathogens, including mycobacteria, and to act as an immediate barrier against Gram-negative bacteria, fungi, and parasites.
• Increase the temperature of your home's boiler to 55°C to kill mycobacteria in hot water.
• Use humidifiers with caution. If possible, avoid ultrasonic humidifiers and clean the humidifier reservoir frequently. Soak it in undiluted bleach for 30 minutes and rinse it well. Use sterile water in the humidifier.
• Wear a respirator to prevent inhalation of dust particles while working with potting soil or in the garden, and moisten the soil to reduce the amount of particles released into the air.
• Take steps to decrease gastroesophageal reflux disease.

How Can We Support Your Project?

Lovexair Foundation Respiratory Coaches can help people with NTM to understand their disease and manage it effectively. If you have this pathology or are the caregiver of an affected person, you can write to us at tell us@lovexair.com and one of our health professionals will contact you to make an appointment.

Source: https://ntminfo.org/

You can download the informative brochure in Spanish here: https://ntminfo.org/wp-content/uploads/2022/12/Spanish-pamphlet-ntminfo-2019.pdf

References:

https://www.labtestsonline.es/conditions/micobacterias-no-tuberculosas

https://www.elsevier.es/es-revista-enfermedades-infecciosas-microbiologia-clinica-28-articulo-tratamiento-infecciones-producidas-por-micobacterias-S0213005X17303026

https://www.analesdepediatria.org/es-micobacterias-no-tuberculosas-una-infeccion-articulo-S1695403309003920

https://www.medigraphic.com/cgi-bin/new/resumen.cgi?IDARTICULO=100997