Nontuberculous Mycobacteria Infection: Source and Treatment

Abstract

This review offers current understanding of the source of nontuberculous mycobacteria (NTM) infections especially in relation to engineered water systems. It provides a summary of current treatment methods and highlights novel treatment options being developed. Nontuberculous mycobacteria (NTM) infections are thought to originate from inhalation or aspiration of NTM from contaminated drinking water. While significant NTM metagenomics analysis and culturing of environmental samples have been performed, the bias of culture independent and dependent techniques along with the ubiquity of NTM organisms in the environment has made connecting the pathogen reservoir and route of transmission difficult. Recent advances in NTM DNA extraction protocols and NTM high-throughput sequencing methods suggest inhalation and aspiration of drinking water remain a critical route of transmission. The development of pulmonary diseases associated with NTM infections is complex. Patients with CF and non-CF bronchiectasis are susceptible to NTM infections, whereas the development of bronchiectasis may be due to long-term exposure to NTM. Source attribution of NTM infections is critical, especially if the source includes engineered water systems such as drinking water distribution networks and clinical and non-clinical premise plumbing. However, source identification requires more work. Current NTM treatment therapies were developed for other indications. New and combined therapies are being developed, but are insufficient to address growing antibiotic resistance and diversity of NTM infections.