Nontuberculous Mycobacteria (NTM) Infections: Symptoms, Risks, and Care
Updated: 3 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 31, 2026
Quick Answer: What are NTM Infections?
Nontuberculous mycobacteria (NTM) infections are illnesses caused by Mycobacterium bacteria other than those causing tuberculosis and leprosy. These bacteria live in dust, soil and water, and most people exposed do not become ill, but those with weakened immunity or lung disease are susceptible. NTM lung disease is the most common form. Unlike tuberculosis, they rarely spread between people. [1]
What the research says
About 1 in 5 people with NTM lung disease died in pooled studies. A meta-analysis of 41 studies (10,452 patients) found an overall all-cause mortality of 20% (95% CI 17–24%). Older age, prior tuberculosis, lung cavities, smear-positive sputum, anemia, and high CRP were linked to higher mortality or disease progression (Hwang et al., Sci Rep, 2023). [5]
Side effects of NTM treatment are common. A systematic review of 36 prospective studies (1,784 patients in nonrandomized studies and 1,511 in randomized trials) found adverse drug reactions in 59% (95% CI 39–78%), stopping of a drug in 15%, and ADR-related death in 2% (Kim et al., Ann Am Thorac Soc, 2026). [6]
Surgery can help carefully selected patients. In a meta-analysis of 15 studies (1,071 patients), sputum cultures turned negative after surgery in 93% (95% CI 87–97%), infection returned in 9% over a median follow-up of 34 months, and 17% had complications (Kim et al., Chest, 2023). [7]
Key Takeaways: NTM at a Glance
Feature | Details |
Primary Cause | M. avium complex (MAC) and other environmental mycobacteria. |
Common Sources | Soil, dust, and water (including household taps and hot tubs). |
Main Symptoms | Fever, fatigue, weight loss, and persistent cough. |
Primary Risk Factors | Lung disease (e.g., cystic fibrosis), HIV, and immunosuppressants. |
Diagnosis | Sputum or tissue cultures, X-rays, and CT scans. |
Treatment | Multi-antibiotic regimen, typically lasting 12 months or longer. |
What are nontuberculous mycobacteria (NTM) infections?
NTM are environmental organisms that exist in a wide variety of habitats. Because they are so widespread, most humans are frequently exposed to them without any ill effects. When an infection does occur, it is often classified by its location in the body. While the lungs are the primary target, NTM can also cause localized infections in the skin, soft tissues, lymph nodes, and bones. In severe cases, particularly in those with advanced immune deficiency, the infection can become disseminated, spreading to multiple organs through the bloodstream.
What are the symptoms of NTM infections?
Symptoms of an NTM infection vary significantly based on the area of the body affected. However, several general symptoms are common across many types of the disease.
General Symptoms
Location-Specific Symptoms
Infection Site | Common Signs |
Lungs | Chronic cough (sometimes with blood), shortness of breath, chest pain. |
Skin | Redness, swelling, pain, ulcers, or a persistent rash. |
Musculoskeletal | Joint pain, stiffness, and swelling in the affected area. |
What causes NTM infections, and who is at risk?
The most common culprit in NTM infections is the M. avium complex (MAC), though other species like M. kansasii and M. abscessus are also significant. Transmission occurs through environmental contact, such as inhaling mist from a shower or hot tub, drinking contaminated water, or through soil contact. It can also be introduced through medical procedures involving contaminated surgical tools, feeding tubes, or needles used for tattoos.
Who is at Risk?
While anyone can theoretically contract an NTM infection, certain groups are at a much higher risk:
Individuals with Lung Disease: Those with cystic fibrosis, bronchiectasis, asthma, or emphysema are more susceptible to pulmonary NTM. [1]
Immunocompromised Patients: People living with HIV, cancer, or those taking immunosuppressive medications. [1]
Lady Windermere Syndrome: A specific risk group consisting of women with a low body mass index (BMI) and structural conditions like scoliosis or pectus excavatum. [1]
Medical Device Users: Those with central venous lines, breathing tubes, or feeding tubes. [1]
How are NTM infections diagnosed?
Diagnosing an NTM infection can be challenging because the symptoms often mimic other more common illnesses. Healthcare providers must rule out other infections and use specific tests to confirm the presence of mycobacteria.
Cultures: The gold standard for diagnosis involves growing the bacteria from samples of sputum, blood, or tissue.
Imaging: Chest X-rays and CT scans are used to look for lung cavities, nodules, or scarring. [1]
Bronchoscopy: A procedure where a thin tube is inserted into the lungs to collect mucus or tissue samples. [1]
Biopsy: Removing a small piece of skin or bone tissue for laboratory analysis.
Acid-Fast Bacilli (AFB) Test: A specialized laboratory test used to identify mycobacteria under a microscope. [1]
How are NTM infections managed and treated?
Treating NTM infections requires a dedicated, long-term approach. Because these bacteria are naturally resistant to many standard antibiotics, a combination of medications is necessary to prevent the bacteria from developing further resistance.
Antibiotic Regimen: Patients typically take a combination of at least three antibiotics, often azithromycin or clarithromycin with ethambutol and rifampin, usually for at least 12 months after sputum cultures turn negative.
Surgery: In cases where the infection has caused significant tissue damage or abscesses, surgical removal of the affected area may be required.
Pulmonary Support: For lung infections, breathing exercises and treatments are used to help clear bacteria-laden mucus from the airways. [1]
Monitoring: Regular check-ups are essential to monitor for side effects of long-term antibiotic use, which can include hearing loss, vision changes, and liver or kidney issues. [1]
Conclusion
Nontuberculous mycobacteria (NTM) infections represent a complex group of environmental diseases that require careful diagnosis and persistent treatment. While the road to recovery can be long, early intervention and a strict adherence to medication protocols significantly improve the outlook. For those at high risk, simple environmental precautions can play a vital role in preventing infection and maintaining long-term health.
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Frequently Asked Questions
What does NTM stand for?
It stands for Nontuberculous Mycobacteria.
Is NTM the same as tuberculosis?
No, they are different species of bacteria, and NTM is generally not contagious.
Where is NTM found in the environment?
It is naturally found in soil, dust, and both tap and natural water sources.
Can I catch NTM from another person?
It is extremely rare for NTM to spread from person to person.
What is the most common NTM infection?
NTM lung disease is the most frequent form of the infection.
What is MAC?
MAC stands for M. avium complex, the most common group of NTM bacteria.
Who is most likely to get an NTM infection?
People with existing lung disease or weakened immune systems.
What are the first signs of NTM lung disease?
A persistent cough, fatigue, and shortness of breath.
Can NTM affect the skin?
Yes, it can cause redness, swelling, and ulcers on the skin.
Is weight loss a symptom of NTM?
Yes, unintentional weight loss is a common general symptom.
How is NTM diagnosed?
Through cultures of sputum, blood, or tissue, along with imaging tests.
What is an AFB test?
A lab test that looks for mycobacteria in samples using a special staining technique.
Why does treatment take so long?
NTM bacteria grow slowly and are naturally resistant to many antibiotics.
How long does NTM treatment usually last?
Typically 12 months or longer to ensure the infection is completely cleared.
Are there side effects to NTM antibiotics?
Yes, long-term use can affect hearing, vision, and liver or kidney function.
Can NTM be treated with just one antibiotic?
No, a combination of 2-3 drugs is required to prevent antibiotic resistance.
What is Lady Windermere Syndrome?
A specific type of NTM lung infection seen in certain groups of women.
Can children get NTM infections?
Yes, children often present with swollen lymph nodes in the neck.
Can NTM infections come back?
Yes, recurrence is possible even after successful treatment.
Is NTM found in showerheads?
Yes, NTM can colonize showerheads and be inhaled in the mist.
Should I avoid hot tubs if I have lung disease?
Yes, hot tubs are a known source of NTM exposure.
Can NTM be caused by tattoos?
Yes, if contaminated ink or non-sterile needles are used.
What is a lung cavity?
A hole or hollow space in the lung tissue caused by infection.
What is bronchiectasis?
A condition where the lungs' airways become damaged and widened.
Can NTM cause joint pain?
Yes, if the infection spreads to the musculoskeletal system.
Is surgery always necessary for NTM?
No, it is usually reserved for severe cases with significant tissue damage.
What is ALIS?
An inhaled form of the antibiotic Amikacin used for lung infections.
Does NTM cause a fever?
Yes, persistent low-grade fevers are common.
Can NTM be found in potting soil?
Yes, it is common in soil and dust.
Should I wear a mask when gardening?
High-risk individuals may be advised to wear a mask to avoid inhaling dust.
Is NTM lung disease fatal?
It can be serious, with a 5-year mortality rate between 13% and 45% for lung infections.
What is disseminated NTM?
An infection that has spread throughout the entire body.
Can GERD increase NTM risk?
Yes, chronic acid reflux is a known risk factor for pulmonary NTM.
What is an acid-fast bacillus?
A type of bacteria that resists de-staining by acid during laboratory testing.
How does NTM differ from leprosy?
They are caused by different species of Mycobacterium.
Can NTM be found in hospital water?
Yes, it is a known environmental contaminant in many water systems.
What is a sputum culture?
A test where mucus from the lungs is kept in a lab to see if bacteria grow.
Can NTM cause blood in the cough?
Yes, this is a potential symptom of lung involvement.
Is NTM more common in men or women?
Certain forms, like Lady Windermere Syndrome, are more common in women.
Can a feeding tube cause NTM?
Yes, if the device or the site becomes contaminated.
What is pulmonary fibrosis?
Scarring of the lung tissue, which can be a complication of NTM.
Does NTM cause shortness of breath?
Yes, as the infection affects lung function.
Can NTM be treated without antibiotics?
Mild cases may sometimes be monitored without immediate treatment.
What is a CT scan used for in NTM?
To provide detailed images of lung damage that an X-ray might miss.
Can NTM affect the bones?
Yes, though musculoskeletal NTM is less common than lung infection.
What is the genus of NTM?
The genus is Mycobacterium.
Can NTM be inhaled from humidifiers?
Yes, if the water in the humidifier contains the bacteria.
Is NTM a type of fungus?
No, it is a bacterium.
When should I see a doctor for a cough?
If a cough lasts for more than a few weeks or is accompanied by fever and fatigue.
What kind of doctor treats NTM?
Infectious disease specialists and pulmonologists (lung doctors).
Related Reading
Bronchiectasis: The Widened Airways Condition That Makes Mucus Hard to Clear — Explained explains the airway damage that often goes along with NTM lung disease.
Tuberculosis (TB): Symptoms, Causes, Testing, Treatment and Prevention covers tuberculosis, the related mycobacterial infection doctors must rule out.
Sputum Culture: How to Give a Sample, What It Detects and What Results Mean explains the mucus test used to find mycobacteria in the lungs.
Cystic Fibrosis: Symptoms, Causes, Diagnosis, and Treatment (2026 Guide) covers a lung condition that raises the risk of NTM infection.
References
Cleveland Clinic. What Are Nontuberculous Mycobacteria (NTM) Infections? Cleveland Clinic. Last updated February 19, 2024. https://my.clevelandclinic.org/health/diseases/21200-nontuberculous-mycobacteria-infections
American Thoracic Society. What Is Nontuberculous Mycobacteria (NTM) Lung Disease? ATS Patient Education Series. Am J Respir Crit Care Med. 2017;195:P17-P18. Online version updated December 2021. https://www.thoracic.org/patients/patient-resources/resources/ntm.pdf
Cystic Fibrosis Foundation. Nontuberculous Mycobacteria (NTM). Cystic Fibrosis Foundation. Accessed October 18, 2026. https://www.cff.org/managing-cf/nontuberculous-mycobacteria-ntm
Daley CL, Iaccarino JM, Lange C, et al. Treatment of nontuberculous mycobacterial pulmonary disease: an official ATS/ERS/ESCMID/IDSA clinical practice guideline. Clin Infect Dis. 2020;71(4):e1-e36. PMID 32628747. https://doi.org/10.1093/cid/ciaa241
Hwang H, Lee JK, Heo EY, et al. The factors associated with mortality and progressive disease of nontuberculous mycobacterial lung disease: a systematic review and meta-analysis. Sci Rep. 2023;13(1):7348. PMID 37147519. https://doi.org/10.1038/s41598-023-34576-z
Kim J, Oh J, Kang YA, et al. Adverse drug reactions during nontuberculous mycobacterial pulmonary disease treatment: a systematic review and meta-analysis. Ann Am Thorac Soc. 2026;23(2):292-302. PMID 40986804. https://doi.org/10.1513/AnnalsATS.202412-1307OC
Kim JY, Lee HW, Yim JJ, Kwak N. Outcomes of adjunctive surgery in patients with nontuberculous mycobacterial pulmonary disease: a systematic review and meta-analysis. Chest. 2023;163(4):763-777. PMID 36208713. https://doi.org/10.1016/j.chest.2022.09.037
Disclaimer
The information provided in this article is for educational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional for diagnosis and treatment of any medical condition.
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