Non-tuberculous mycobacteria are environmental mycobacteria capable of causing disease in both immunocompetent and immunocompromised individuals, with pulmonary involvement being the most common clinical manifestation [1][3].
Disease overview
Bacterial Evidence-backed information EN 5/7 applicable sections · ZH 5/7 applicable sections Updated Oct 23, 2026
Non-tuberculous mycobacteria (NTM) are environmental bacteria that cause disease infrequently, affecting both immunocompromised and immunocompetent hosts. The lungs are the most commonly involved organ, with NTM-pulmonary disease occurring most often in patients with pre-existing lung disease; however, these organisms can also cause localized extrapulmonary disease involving lymph nodes, skin, and soft tissues, or rare disseminated infection in individuals with severe immune defects. Rapid molecular tests enable species-level confirmation, and treatment decisions are made carefully given the variable response and extended duration required [1][2][3].
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Pulmonary disease represents the primary clinical syndrome, frequently occurring in patients with pre-existing structural lung disease such as bronchiectasis. NTM can also present as localized extrapulmonary disease affecting lymph nodes, skin, and soft tissues, or rarely bones. Disseminated disease occurs in individuals with congenital or acquired immune defects and involves multiple organ systems [1][3].
NTM diseases occur infrequently, though isolated pulmonary NTM infection has been increasing in prevalence in individuals without recognised immune dysfunction. At least seven autosomal mutations (IL12B, IL12RB1, ISG15, IFNGR1, IFNGR2, STAT1, IRF8) and two X-linked mutations (IKBKG, CYBB) have been reported to confer susceptibility to disseminated infection, predominantly presenting in childhood. GATA2 deficiency and anti-interferon γ autoantibodies also predispose to disseminated disease, typically in late childhood or adulthood [3].
Person-to-person transmission does not occur, except with M. abscessus among cystic fibrosis patients [1].
Clinical practice guidelines from the American Thoracic Society, European Respiratory Society, European Society of Clinical Microbiology and Infectious Diseases, and Infectious Diseases Society of America provide evidence-based recommendations for treatment of less common NTM species in adult patients without cystic fibrosis or HIV infection [2].
- 1 Sharma SK et al. Epidemiology, diagnosis & treatment of non-tuberculous mycobacterial diseases. Indian J Med Res. 2020 Sep. PMID: 33107481. doi: 10.4103/ijmr.IJMR_902_20. PubMed: https://pubmed.ncbi.nlm.nih.gov/33107481/
- 2 Lange C et al. Consensus management recommendations for less common non-tuberculous mycobacterial pulmonary diseases. Lancet Infect Dis. 2022 Jul. PMID: 35090639. doi: 10.1016/S1473-3099(21)00586-7. PubMed: https://pubmed.ncbi.nlm.nih.gov/35090639/
- 3 Wu UI et al. Host susceptibility to non-tuberculous mycobacterial infections. Lancet Infect Dis. 2015 Aug. PMID: 26049967. doi: 10.1016/S1473-3099(15)00089-4. PubMed: https://pubmed.ncbi.nlm.nih.gov/26049967/
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