Current and future management of non-tuberculous mycobacterial pulmonary disease (NTM-PD) in the UK

Abstract

A rising number of non-tuberculous mycobacterial (NTM) isolates are being identified in UK clinical practice. There are many uncertainties around the management of non-tuberculous mycobacterial pulmonary disease (NTM-PD), including its epidemiology, diagnosis, treatment and prevention. Regional variations in how patients with NTM-PD are managed reflects the lack of standardised pathways in the UK. Service optimisation and multidisciplinary working can improve the quality of care for patients with NTM-PD, including (1) better identification of patients at risk of NTM-PD and modification of risk factors where applicable; (2) standardisation of reference laboratory testing to offer clinicians access to accurate and prompt information on NTM species and drug sensitivities; (3) development of recognised specialist NTM nursing care; (4) standardisation of NTM-PD imaging strategies for monitoring of treatment and disease progression; (5) establishment of a hub-and-spoke model of care, including clear referral and management pathways, dedicated NTM-PD multidisciplinary teams, and long-term patient follow-up; (6) formation of clinical networks to link experts who manage diseases associated with NTM; (7) enabling patients to access relevant support groups that can provide information and support for their condition; and (8) development of NTM research groups to allow patient participation in clinical trials and to facilitate professional education.

Keywords: bacterial infection; bronchiectasis; imaging/CT MRI; immunodeficiency; infection control; opportunist lung infections; rare lung diseases; respiratory Infection.

Figure 1

Radiological imaging features typical of NTM lung infection. (A) Fibrocavitatory NTM-PD in a patient who has M. kansasii. Axial CT image shows a cavity in the apex of the left upper lobe with adjacent satellite nodules. (B) Nodular–bronchiectatic NTM-PD. CT image from a 75-year-old female patient with MAC. Axial CT image at the carina shows bronchiectasis and bronchial wall thickening in the posterior segment of the right upper lobe (arrow) with additional scattered areas of peripheral bronchiectasis, mucus plugging and centrilobular nodularity in the left upper (arrowhead) and lower lobes. (C) Nodular–bronchiectatic NTM-PD in a patient with variant cystic fibrosis who has grown MAC and M. abscessus. Axial CT image just below the carina shows widespread bronchiectasis and bronchial wall thickening with centrilobular nodules in the right lower lobe. Peripheral mucus plugging is a more common finding in NTM-PD and air bubbles or lucency is often seen within the mucus (arrow). There is an ancillary finding of air trapping causing lucent areas of lung. (D) Nodular–bronchiectatic NTM-PD in a patient who has MAC. There is more severe bronchiectasis in the middle lobe, which is cystic and varicose in appearance (circle). There are ancillary findings of chest wall deformity with volume loss in the right hemithorax and little chest wall body fat. Reproduced by the kind permission of Dr Joanne Cleverley and Dr Besma Musaddaq of the Department of Radiology, Royal Free Hospital, London, UK. CT, computerised tomography; MAC, Mycobacterium avium complex; NTM, non-tuberculous mycobacteria; NTM-PD, non-tuberculous mycobacterial pulmonary disease.