Nontuberculous Mycobacterial Infections and Pulmonary Disease

Nontuberculous mycobacteria (NTM) are a diverse group of environmental organisms found in water, soil and biofilms that have emerged as significant pulmonary pathogens. Unlike the obligate human-to-human transmission of Mycobacterium tuberculosis, NTM pulmonary disease arises predominantly from inhalation of environmental aerosols. Clinical manifestations range from indolent nodular bronchiectasis in older women to cavitary disease resembling tuberculosis in middle-aged smokers. Key risk factors include underlying structural lung damage, immunosuppression and cystic fibrosis, although rising incidence in ostensibly healthy adults has been reported. Diagnosis demands a combination of radiological imaging, microbiological culture and molecular speciation to distinguish true infection from mere colonisation. Treatment protocols rely on prolonged multidrug regimens tailored to the offending species, yet outcomes are hampered by intrinsic resistance mechanisms and adverse drug effects. Surgical resection may be considered for focal disease unresponsive to chemotherapy. Growing evidence links climatic shifts, expanding tropical zones and ageing populations to the global rise in NTM pulmonary disease. Efforts to characterise host–pathogen interactions, to refine diagnostic accuracy and to develop novel antimicrobials and prevention strategies are central to meeting this emerging public health challenge.

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Nontuberculous Mycobacterial Infections and Pulmonary Disease publication trend

The graph below shows the total number of articles in nontuberculous mycobacterial infections and pulmonary disease across all publications each year (not limited to Nature Index journals).

Technical terms

Nontuberculous mycobacteria (NTM): Environmental Mycobacterium species other than M. tuberculosis that can cause human disease.

Mycobacterium avium complex (MAC): A group of slow-growing NTM species commonly implicated in pulmonary infections.

Bronchiectasis: Irreversible dilation of bronchi leading to impaired mucus clearance and chronic infection.

Biofilm: A structured community of microorganisms enclosed in a self-produced matrix, often adherent to surfaces.

Granuloma: A focal aggregate of immune cells that forms in response to persistent pathogens or antigens.

References

1. Ecological and evolutionary perspectives advance understanding of mycobacterial diseases. The Lancet Microbe (2024).
2. Mycobacterium abscessus Complex Infections in Humans. Emerging Infectious Diseases (2015).
3. The Rise of Non-Tuberculosis Mycobacterial Lung Disease. Frontiers in Immunology (2020).
4. Of tuberculosis and non-tuberculous mycobacterial infections – a comparative analysis of epidemiology, diagnosis and treatment. Journal of Biomedical Science (2020).
5. The Role of Antibiotic-Target-Modifying and Antibiotic-Modifying Enzymes in Mycobacterium abscessus Drug Resistance. Frontiers in Microbiology (2018).
6. General Overview of Nontuberculous Mycobacteria Opportunistic Pathogens: Mycobacterium avium and Mycobacterium abscessus. Journal of Clinical Medicine (2020).
7. Global Environmental Nontuberculous Mycobacteria and Their Contemporaneous Man-Made and Natural Niches. Frontiers in Microbiology (2018).