Abstract
The incidence and number of deaths from non-tuberculous mycobacterial (NTM) disease have been steadily increasing globally. These lesser known “cousins” of Mycobacterium tuberculosis (TB) were once thought to be harmless environmental saprophytics and only dangerous to individuals with defective lung structure or the immunosuppressed. However, NTM are now commonly infecting seemingly immune competent children and adults at increasing rates through pulmonary infection. This is of concern as the pathology of NTM is difficult to treat. Indeed, NTM have become extremely antibiotic resistant, and now have been found to be internationally dispersed through person-to-person contact. The reasons behind this NTM increase are only beginning to be elucidated. Solutions to the problem are needed given NTM disease is more common in the tropics. Importantly, 40% of the world's population live in the tropics and due to climate change, the Tropics are expanding which will increase NTM infection regions. This review catalogs the global and economic disease burden, at risk populations, treatment options, host-bacterial interaction, immune dynamics, recent developments and research priorities for NTM disease.
Highlights
Non-tuberculous mycobacteria (NTM) are ubiquitous, free living, environmental saprophytic organisms known to occupy water systems, soil, and vegetation
First described in the late nineteenth century, decades passed before human non-tuberculous mycobacterial (NTM) infection was identified [2]
Patients with acquired immunodeficiency syndromes including AIDS and hematological malignancies, hairy cell leukemia in particular, are identified as susceptible to NTM infection [22]. The latter groups of patients usually develop disseminated NTM infection (DNTM) rather than isolated pulmonary NTM infection (PNTM) which is seen in patients with structural lung disease and are considered a separate risk group (Figure 1)
Summary
Non-tuberculous mycobacteria (NTM) are ubiquitous, free living, environmental saprophytic organisms known to occupy water systems, soil, and vegetation. Patients with acquired immunodeficiency syndromes including AIDS and hematological malignancies, hairy cell leukemia in particular, are identified as susceptible to NTM infection [22] The latter groups of patients usually develop disseminated NTM infection (DNTM) rather than isolated pulmonary NTM infection (PNTM) which is seen in patients with structural lung disease and are considered a separate risk group (Figure 1). A hi-dimensional flow analysis between individuals at risk and not at risk of MABS disease revealed immune exhaustion in T cells (CTLA-4) may be playing a role [98] These finding is similar to studies performed in MAC infection [93, 95].
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