Non-tuberculous mycobacterial infection (NTM)

Non-tuberculous mycobacteria, or NTM, are a group of bacteria that cause rare lung infections. NTM mainly affects people who have damaged lungs or who have a problem with their immune system. These infections are sometimes known as NTM pulmonary disease (NTM-PD).

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If you live with a lung condition and have symptoms of an infection that won’t go away, or are getting worse despite your usual treatment, ask your health care professional to test for NTM.

What is NTM?

Non-tuberculous mycobacteria, or NTM, are a group of bacteria that cause rare lung infections. NTM can cause health problems for people with no pre-existing condition, but it’s more likely to affect people with an underlying lung problem or a weak immune system.

You’re more likely to get NTM infections if you live with a long-term lung condition like:

NTM infections are rare (around 7.6 cases per 100,000 people). Some people can carry the bacteria in their airways without it causing any problems. This means it’s not always necessary to treat NTM even if it’s found in your phlegm.

NTM are part of the same family of bacteria that cause tuberculosis (TB), but NTM bacteria do not cause TB.

Help your lungs fight off infection

The best way to help your lungs fight off an NTM infection is to keep active and to look after yourself. Have a flu jab each year, eat a healthy balanced diet and if you smoke, stop. Take your medication as prescribed and do your chest physiotherapy exercises regularly if you have bronchiectasis or cystic fibrosis. And avoid being around people with chest infections and colds.

Where does NTM come from?

NTM are a family of common bacteria found in water and soil. We all come into contact with NTM bacteria in our daily lives. There are lots of different species of NTM. Some are more likely to cause problems than others.

Can I avoid NTM in soil and water?

No. There’s no clear evidence that things like stopping gardening, not showering, or giving up swimming reduces the risk of getting an NTM infection. Or, of getting infected again if you’ve already been treated.

What are the symptoms of NTM infections?

Symptoms are similar to those of other, more common, lung infections. They may develop slowly. Symptoms include:

  • cough, and coughing up phlegm or blood
  • fever
  • losing weight and loss of appetite
  • feeling very tired
  • increasing shortness of breath
  • night sweats.

Many of these symptoms are the same as the symptoms of lung conditions or infections too. For example, people living with bronchiectasis or COPD may experience a cough, produce phlegm, and feel tired. If the symptoms of your existing lung condition get worse, often this is a flare-up of the condition itself. If you are experiencing prolonged or repeated flare ups of your condition you should speak to your GP, and ask if this could be an NTM infection.

There is no evidence that someone with an NTM infection can pass it on to a healthy person. It is also extremely rare for NTM to be passed between people with existing lung conditions. If you have any type of infection, it’s always a good idea to cough into a tissue, dispose of tissues carefully and keep your hands clean.

How is NTM infection diagnosed?

It can take time to diagnose an NTM infection. You may be asked about your medical history, and you may be asked to do a number of tests:

Even if NTM are found in your phlegm, it doesn’t mean you have NTM lung disease and, you may not require treatment.

If you live with any long-term lung condition, such as COPD, bronchiectasis, or cystic fibrosis, you should ask to see your health care professional if:

  • your symptoms are getting worse despite treatment, or
  • you have a chest infection that does not go away after several courses of antibiotics.

This is because it may be a sign of NTM.

How is NTM infection treated?

Once you have a diagnosis of an NTM infection, you will be closely monitored. NTM infections continue because phlegm gets trapped in the lungs. Chest physiotherapy and regular exercise can help NTM infections go away without treatment.

But you will be given antibiotic treatment if:

  • you continue to have symptoms due to NTM
  • there is evidence of lung damage. For example, a CT scan shows inflammation in the lungs or widening airways.

You will be treated with a combination of several antibiotics. It takes a long time to kill all the NTM bacteria, so you may be treated for a year or two. If you take all your medication as prescribed, the infection should go. However, it is possible to get an NTM infection again.

If you forget or stop taking your NTM medication, the infection may return

This is serious because:

  • if you don’t take your medication regularly the NTM bacteria can become resistant to the antibiotics you were taking, making them much harder to treat
  • you may need to take more medication
  • bacteria can still exist even after samples come back negative
  • you may need to have injections as well as tablets.

What are the side effects of NTM treatment?

The antibiotics used to treat NTM can cause side effects. You may experience different side effects depending on the medication you’re taking. You should always talk to your health care professional if you’re experiencing side effects.

Very common side effects of NTM treatment

If you are taking Rifampicin, more than 1 in 10 people may experience:

  • a change in the colour of your urine, poo, saliva, sweat and tears – usually to a red-orange colour. This is a harmless side effect.

Common side effects of NTM treatment

Around 1 in 100 to 1 in 10 people may experience these side effects. You should contact your health care professional if you experience any of these for more than 48 hours:

  • vomiting
  • nausea (feeling sick)
  • diarrhoea
  • loss of appetite.

Rare side effects of NTM treatment

Around 1 in 10,000 to 1 in 1,000 people may experience these side effects. You should contact your health care professional immediately if you experience any one of these:

  • eyesight problems such as blurry vision or pain in the eyes (this can occur with Ethambutol treatment)
  • rash or itchy skin
  • chills or a fever
  • bruising more easily
  • liver problems such as yellowing skin (jaundice)
  • numbness or tingling in your fingers or toes.

Useful resources

Other useful resources for people living with NTM infections:

  • NTM Patient Care UK - a patient association for people with non-tuberculous mycobacterial (NTM) infections.
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