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Review
. 2025 Jan-Dec:19:17534666251323181.
doi: 10.1177/17534666251323181. Epub 2025 Mar 12.

Pulmonary nontuberculous mycobacterial infections among women with cystic fibrosis and non-cystic fibrosis bronchiectasis

Jane E Gross  1 , Morgan C Jones  2 , Ashley Buige  2 , D Rebecca Prevots  3 , Shannon Kasperbauer  4   5
Affiliations
Review

Pulmonary nontuberculous mycobacterial infections among women with cystic fibrosis and non-cystic fibrosis bronchiectasis

Jane E Gross et al. Ther Adv Respir Dis. 2025 Jan-Dec.

Abstract

Nontuberculous mycobacteria (NTM) are ubiquitous, opportunistic pathogens that can cause lung disease in people with non-cystic fibrosis bronchiectasis (NCFB) and cystic fibrosis (CF). The incidence of NTM pulmonary infections and lung disease has continued to increase worldwide over the last decade among both groups. Notably, women with NCFB NTM pulmonary disease (NTM-PD) bear a disproportionate burden with NTM rates increasing in this population as well as having consistently higher incidence of NTM-PD compared to men. In contrast, among people with CF, an overall increased risk among women has not been observed. In the United States, the majority of people with CF are taking highly effective cystic fibrosis transmembrane conductance regulator (CFTR) modulators, and these numbers are increasing worldwide. The long-term impact of CFTR modulator medications on NTM infections is not entirely understood. Guidelines for the screening, diagnosis, and management of NTM-PD exist for people with NCFB and CF, but do not consider unique implications relevant to women. This review highlights aspects of NTM-PD among women with NCFB and CF, including the epidemiology of NTM infection, special considerations for treatment, and unmet research needs relevant to women with NTM-PD.

Keywords: Mycobacterium abscessus; Mycobacterium avium complex (MAC); breastfeeding; cystic fibrosis; epidemiology; non-cystic fibrosis bronchiectasis (NCFB); nontuberculous mycobacterial (NTM) pulmonary disease; pregnancy; women’s health.

Plain language summary

Nontuberculous mycobacterial lung infections in womenNontuberculous mycobacteria (NTM) are bacteria that can cause lung disease in people with non-cystic fibrosis bronchiectasis (NCFB) and cystic fibrosis (CF). The incidence of NTM pulmonary infections and lung disease has continued to increase worldwide over the last decade among both groups. Notably, women with NCFB NTM pulmonary disease (NTM-PD) are more likely than men to get infected with NTM and to get disease. In contrast, among people with CF, women and men are equally likely to get NTM infection and disease. More people with CF across the globe are getting highly effective treatment using CF transmembrane conductance regulator (CFTR) modulators. We don’t understand how these medications will affect the chance of getting NTM infections if people take them for many years. Guidelines for the screening, diagnosis, and management of NTM-PD exist for people with NCFB and CF, but do not consider unique implications relevant to women. This review highlights aspects of NTM-PD among women with NCFB and CF, including the epidemiology of NTM infection, special considerations for treatment, and unmet research needs relevant to women with NTM-PD.

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Figures

Figure 1.
Figure 1.
Average annual incidence of nontuberculous mycobacterial pulmonary disease by sex, Medicare beneficiaries aged > 65 years, 2010–2019, United States. Source: DRP who is a federal employee and the work is in public domain.
Figure 2.
Figure 2.
Annual incidence of nontuberculous mycobacterial pulmonary disease by sex, Medicare beneficiaries aged > 65 years, 2010–2019, United States. Source: DRP who is a federal employee and the work is in public domain.
Figure 3.
Figure 3.
(a) Annual Incidence of Mycobacterium avium complex pulmonary infection by United States (U.S.) region (2010–2019). (b) Annual incidence of Mycobacterium abscessus pulmonary infection by U.S. region (2010–2019). *Significant annual percent change (p < 0.05). Source: DRP who is a federal employee and the work is in public domain.
Figure 4.
Figure 4.
Estimated probability of 5-year mortality in patients with nontuberculous mycobacterial pulmonary disease, according to BACES (body mass index, age, cavity, erythrocyte sedimentation rate, and sex) score. Source: Kim et al. Reprinted with permission of the American Thoracic Society. Copyright © 2024 American Thoracic Society. All rights reserved. DRP who is a federal employee and the work is in public domain.
See this image and copyright information in PMC

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