Global Epidemiology of Nontuberculous Mycobacterial Pulmonary Disease: A Review

Abstract

Nontuberculous mycobacterial (NTM) isolation and pulmonary disease (NTM-PD) have continued to increase in most regions of the world, driven mainly by Mycobacterium avium. Single-center studies also support increasing trends as well as a persistent burden of undiagnosed NTM among persons suspected of having tuberculosis (TB), in countries with moderate-to-high TB prevalence. Cumulative exposure to water and soil presents an increased risk to susceptible hosts, and trace metals in water supply are recently recognized risk factors. Establishing standard case definitions for subnational and national surveillance systems with mandatory notification of NTM-PD are needed to allow comparisons within and across countries and regions.

Keywords: Epidemiology; Exposome; Global; Mycobacterium abscessus; Mycobacterium avium; Nontuberculous mycobacteria; Pulmonary disease.

Figure 1.

NTM exosome framework. Adapted from The exposome: a new paradigm to study the impact of environment on health, Vrijheid M., 69, 876–8, 2014 with permission from BMJ Publishing Group Ltd.

Figure 2.

a. Forest plot of annual change of NTM infection per 100,000 persons/year. From Dahl VN, Mølhave M, Fløe A, et al. Global trends of pulmonary infections with nontuberculous mycobacteria: a systematic review. Int J Infect Dis. Oct 13 2022;125:120–131. doi:10.1016/j.ijid.2022.10.013; with permission. (Figure 3 in original) b. Forest plot of annual change of NTM disease per 100,000 persons/year (Dahl et al., 2022); with permission. (Figure 6 in original)

Figure 2.

a. Forest plot of annual change of NTM infection per 100,000 persons/year. From Dahl VN, Mølhave M, Fløe A, et al. Global trends of pulmonary infections with nontuberculous mycobacteria: a systematic review. Int J Infect Dis. Oct 13 2022;125:120–131. doi:10.1016/j.ijid.2022.10.013; with permission. (Figure 3 in original) b. Forest plot of annual change of NTM disease per 100,000 persons/year (Dahl et al., 2022); with permission. (Figure 6 in original)

Figure 3.

Annual incidence of NTM-PD in national U.S. health insurance plan (Optum EHR database) 2008–2015. Reprinted with permission of the American Thoracic Society. Copyright © 2023 American Thoracic Society. All rights reserved. Cite: Winthrop KL, Marras TK, Adjemian J, Zhang H, Wang P, Zhang Q./2020/Incidence and Prevalence of Nontuberculous Mycobacterial Lung Disease in a Large U.S. Managed Care Health Plan, 2008–2015/Ann Am Thorac Soc./17/178–185. Annals of the American Thoracic Society is an official journal of the American Thoracic Society. (Figure 2 in original)

Figure 4.

Incidence of NTM-PD in France by treatment status from 2010–2017. From Veziris N, Andréjak C, Bouée S, Emery C, Obradovic M, Chiron R. Non-tuberculous mycobacterial pulmonary diseases in France: an 8 years nationwide study. BMC Infect Dis. Nov 17 2021;21(1):1165. doi:10.1186/s12879-021-06825-x; with permission. (Figure 1 in original)

Figure 5

a. Annual prevalence per 100,000 of NTM-PD in the Netherlands by database (2012–2019). From Schildkraut JA, Zweijpfenning SMH, Nap M, et al. The epidemiology of nontuberculous mycobacterial pulmonary disease in the Netherlands. ERJ Open Res. Jul 2021;7(3)doi:10.1183/23120541.00207-2021; with permission. 5b. Mean prevalence per 100,000 (2012–2019) of NTM-PD by database (Schildkraut et al., 2021); with permission. (Figure 1 in original). Reproduced with permission of the ERS 2023. ERJ Open Res 7: 00207–2021; DOI: 10.1183/23120541.00207-2021 Published 12 July 2021.

Figure 5

a. Annual prevalence per 100,000 of NTM-PD in the Netherlands by database (2012–2019). From Schildkraut JA, Zweijpfenning SMH, Nap M, et al. The epidemiology of nontuberculous mycobacterial pulmonary disease in the Netherlands. ERJ Open Res. Jul 2021;7(3)doi:10.1183/23120541.00207-2021; with permission. 5b. Mean prevalence per 100,000 (2012–2019) of NTM-PD by database (Schildkraut et al., 2021); with permission. (Figure 1 in original). Reproduced with permission of the ERS 2023. ERJ Open Res 7: 00207–2021; DOI: 10.1183/23120541.00207-2021 Published 12 July 2021.

Figure 6

a. Age-adjusted incidence of NTM infection per 100,000 population by sex (2003–2016). From Park SC, Kang MJ, Han CH, et al. Prevalence, incidence, and mortality of nontuberculous mycobacterial infection in Korea: a nationwide population-based study. BMC Pulm Med. Aug 1 2019;19(1):140. doi:10.1186/s12890-019-0901-z; with permission. 6b. Incidence of NTM infection per 100,000 population by age group (2003–2016) (Park et al., 2019); with permission. (Figure 2 in original)

Figure 6

a. Age-adjusted incidence of NTM infection per 100,000 population by sex (2003–2016). From Park SC, Kang MJ, Han CH, et al. Prevalence, incidence, and mortality of nontuberculous mycobacterial infection in Korea: a nationwide population-based study. BMC Pulm Med. Aug 1 2019;19(1):140. doi:10.1186/s12890-019-0901-z; with permission. 6b. Incidence of NTM infection per 100,000 population by age group (2003–2016) (Park et al., 2019); with permission. (Figure 2 in original)

Figure 7.

a. Incidence of M. intracellulare-PD per 100,000 population in 344 medical regions of Japan (2011–2013). From Morimoto K, Ato M, Hasegawa N, Mitarai S. Population-Based Distribution of Mycobacterium avium and Mycobacterium intracellulare in Japan. Microbiology Research. 2021;12(3):739–743; with permission. 7b. Incidence of M. avium-PD per 100,000 population in 344 medical regions of Japan (2011–2013) (Morimoto et al., 2021); with permission. (Figure 1 in original)

Figure 7.

a. Incidence of M. intracellulare-PD per 100,000 population in 344 medical regions of Japan (2011–2013). From Morimoto K, Ato M, Hasegawa N, Mitarai S. Population-Based Distribution of Mycobacterium avium and Mycobacterium intracellulare in Japan. Microbiology Research. 2021;12(3):739–743; with permission. 7b. Incidence of M. avium-PD per 100,000 population in 344 medical regions of Japan (2011–2013) (Morimoto et al., 2021); with permission. (Figure 1 in original)