Non-tuberculous mycobacterial pulmonary disease (NTM-PD): Epidemiology, diagnosis and multidisciplinary management

Kartik Kumar¹, Aravind Ponnuswamy², Toby Gd Capstick³, Christabelle Chen⁴, Douglas McCabe⁵, Rhys Hurst⁶, Lisa Morrison⁷, Fiona Moore⁷, Matt Gallardo⁸, Jennie Keane⁹, Shirley Harwood¹⁰, Tanya Sinnett¹⁰, Sarah Bryant¹¹, Ronan Breen¹², Onn Min Kon¹³, Marc Lipman¹⁴, Michael R Loebinger¹⁵, Devesh J Dhasmana¹⁶

Affiliations

¹ Host Defence Unit, Department of Respiratory Medicine, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK; National Heart and Lung Institute, Imperial College London, London, UK. Electronic address: https://twitter.com/DrKartikKumar.
² Department of Respiratory Medicine, Royal Liverpool University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK; Chester Medical School, University of Chester, Chester, UK.
³ Pharmacy Department, St James's University Hospital, The Leeds Teaching Hospitals NHS Trust, Leeds, UK. Electronic address: https://twitter.com/tcapper78.
⁴ Pharmacy Department, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK. Electronic address: https://twitter.com/Christab3lleMin.
⁵ Pharmacy Department, Western General Hospital, NHS Lothian, Edinburgh, UK.
⁶ Department of Thoracic Medicine, Royal Papworth Hospital, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK. Electronic address: https://twitter.com/RespPT_rhys.
⁷ West of Scotland Adult Cystic Fibrosis Unit, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK.
⁸ Tuberculosis Service, Royal Sussex County Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, UK.
⁹ Tuberculosis Service, Raphael House, Essex Partnership University NHS Foundation Trust, Rochford, UK.
¹⁰ NTM Patient Care UK.
¹¹ NTM Network UK, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK.
¹² Department of Respiratory Medicine, Forth Valley Royal Hospital, NHS Forth Valley, Larbert, UK.
¹³ National Heart and Lung Institute, Imperial College London, London, UK; Department of Respiratory Medicine, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK. Electronic address: https://twitter.com/onnmin.
¹⁴ Department of Respiratory Medicine, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK; UCL Respiratory, Division of Medicine, University College London, London, UK.
¹⁵ Host Defence Unit, Department of Respiratory Medicine, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK; National Heart and Lung Institute, Imperial College London, London, UK. Electronic address: https://twitter.com/mloebinger.
¹⁶ Department of Respiratory Medicine, Victoria Hospital, NHS Fife, Kirkcaldy, UK; School of Medicine, North Haugh, University of St Andrews, St Andrews, UK. Electronic address: djd5@st-andrews.ac.uk.

PMID: 38387207
PMCID: PMC11024839
DOI: 10.1016/j.clinme.2024.100017

Review

Non-tuberculous mycobacterial pulmonary disease (NTM-PD): Epidemiology, diagnosis and multidisciplinary management

Kartik Kumar et al. Clin Med (Lond). 2024 Jan.

. 2024 Jan;24(1):100017.

doi: 10.1016/j.clinme.2024.100017. Epub 2024 Jan 17.

Authors

Affiliations

¹ Host Defence Unit, Department of Respiratory Medicine, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK; National Heart and Lung Institute, Imperial College London, London, UK. Electronic address: https://twitter.com/DrKartikKumar.
² Department of Respiratory Medicine, Royal Liverpool University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK; Chester Medical School, University of Chester, Chester, UK.
³ Pharmacy Department, St James's University Hospital, The Leeds Teaching Hospitals NHS Trust, Leeds, UK. Electronic address: https://twitter.com/tcapper78.
⁴ Pharmacy Department, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK. Electronic address: https://twitter.com/Christab3lleMin.
⁵ Pharmacy Department, Western General Hospital, NHS Lothian, Edinburgh, UK.
⁶ Department of Thoracic Medicine, Royal Papworth Hospital, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK. Electronic address: https://twitter.com/RespPT_rhys.
⁷ West of Scotland Adult Cystic Fibrosis Unit, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK.
⁸ Tuberculosis Service, Royal Sussex County Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, UK.
⁹ Tuberculosis Service, Raphael House, Essex Partnership University NHS Foundation Trust, Rochford, UK.
¹⁰ NTM Patient Care UK.
¹¹ NTM Network UK, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK.
¹² Department of Respiratory Medicine, Forth Valley Royal Hospital, NHS Forth Valley, Larbert, UK.
¹³ National Heart and Lung Institute, Imperial College London, London, UK; Department of Respiratory Medicine, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK. Electronic address: https://twitter.com/onnmin.
¹⁴ Department of Respiratory Medicine, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK; UCL Respiratory, Division of Medicine, University College London, London, UK.
¹⁵ Host Defence Unit, Department of Respiratory Medicine, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK; National Heart and Lung Institute, Imperial College London, London, UK. Electronic address: https://twitter.com/mloebinger.
¹⁶ Department of Respiratory Medicine, Victoria Hospital, NHS Fife, Kirkcaldy, UK; School of Medicine, North Haugh, University of St Andrews, St Andrews, UK. Electronic address: djd5@st-andrews.ac.uk.

PMID: 38387207
PMCID: PMC11024839
DOI: 10.1016/j.clinme.2024.100017

Abstract

Non-tuberculous mycobacteria (NTM) are ubiquitous environmental organisms that can cause significant disease in both immunocompromised and immunocompetent individuals. The incidence of NTM pulmonary disease (NTM-PD) is rising globally. Diagnostic challenges persist and treatment efficacy is variable. This article provides an overview of NTM-PD for clinicians. We discuss how common it is, who is at risk, how it is diagnosed and the multidisciplinary approach to its clinical management.

Keywords: Diagnosis; Epidemiology; Multidisciplinary management; Non-tuberculous mycobacteria; Pulmonary disease.

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Conflict of interest statement

Declaration of competing interest All authors are members of NTM Network UK, which is a network of healthcare professionals, researchers and patients from across the UK who have an interest in infections caused by non-tuberculous mycobacteria. TGDC has received non-financial support from Napp and GSK for attendance at ERS conference; TGDC's employer has received payment for his participation in advisory boards or for providing teaching sessions from AstraZeneca, Chiesi, GSK, Novartis, Boehringer Ingelheim, and Insmed, outside the submitted work. CC received non-financial support from GSK for attendance at ERS; CC's employer has received financial support from AstraZeneca through her grant application; CC received payment for her participation in advisory boards or providing teaching from AstraZeneca, Chiesi, GSK and Insmed, outside the submitted work. RH has received consultancy fees from Insmed, outside the submitted work.

Figures

**Fig 1**
Diagnostic triad for NTM-PD. ^⁎Chest CT is preferrable to a chest pain radiograph; even on CT, there may be no specific radiological features for NTM-PD.

**Fig 2**
Serial cross-sectional chest CT images from an individual with cavitary NTM-PD secondary to *Mycobacterium avium* complex. Note the co-existent emphysema.

**Fig 3**
Serial cross-sectional chest CT images from an individual with nodular NTM-PD secondary to *Mycobacterium avium* complex. Note the associated middle lobe bronchiectasis.

See this image and copyright information in PMC

References

1. Haworth CS, Banks J, Capstick T, et al. British Thoracic Society guidelines for the management of non-tuberculous mycobacterial pulmonary disease (NTM-PD) Thorax. 2017;72:ii1–ii64. - PubMed
1. Shah NM, Davidson JA, Anderson LF, et al. Pulmonary Mycobacterium avium-intracellulare is the main driver of the rise in non-tuberculous mycobacteria incidence in England, Wales and Northern Ireland, 2007–2012. BMC Infect Dis. 2016;16:195. - PMC - PubMed
1. Prevots DR, Marshall JE, Wagner D, Morimoto K. Global epidemiology of nontuberculous mycobacterial pulmonary disease: a review. Clin Chest Med. 2023;44:675–721. - PMC - PubMed
1. Kumar K, Loebinger MR. Nontuberculous mycobacterial pulmonary disease: clinical epidemiologic features, risk factors, and diagnosis: the nontuberculous mycobacterial series. Chest. 2022;161:637–646. - PubMed
1. Hoefsloot W, van Ingen J, Andrejak C, et al. The geographic diversity of nontuberculous mycobacteria isolated from pulmonary samples: an NTM-NET collaborative study. Eur Respir J. 2013;42:1604–1613. - PubMed

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Non-tuberculous mycobacterial pulmonary disease (NTM-PD): Epidemiology, diagnosis and multidisciplinary management

Affiliations

Non-tuberculous mycobacterial pulmonary disease (NTM-PD): Epidemiology, diagnosis and multidisciplinary management

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

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LinkOut - more resources

Full Text Sources