About Nontuberculous Mycobacteria (NTM) Infections

Overview

Nontuberculous mycobacteria (NTM) are bacteria (germs) found in soil, dust and water. NTM do not include M. tuberculosis (the cause of tuberculosis) or M. leprae (the cause of leprosy).

Anyone can get an NTM infection but people with underlying lung disease or weakened immune systems are at increased risk. Health departments and healthcare facilities play an important role in preventing NTM infections.

Types and strains

There are more than 190 recognized species (types) of NTM. Some cause disease in humans.

Signs and symptoms

Symptoms of NTM infection depend on the site of infection but can include:

• Blood in the sputum
• Cough
• Decreased appetite
• Fever
• Loss of energy
• Night sweats
• Rashes
• Shortness of breath
• Weight loss

NTM commonly causes infections in:

• Lungs
• Skin and soft tissue (typically from surgery, trauma, injection, etc.)
• Areas in/on the body with medical devices
• Lymph nodes (common in children)
• Blood or other usually sterile locations in the body (more common in patients with weakened immune systems or invasive medical devices or after procedures)

Exposure risks

Exposure to NTM can happen through contaminated water sources in many places, such as:

• Natural water sources (e.g., rivers and streams).
• Municipal water sources (e.g., water that people drink or shower in).
• Shower heads and sink faucets.
• Hydrotherapy equipment, such as jetted therapy baths.
• Ice machines.
• Decorative fountains and water features.

Settings with increased risk include:

• Tattoo parlors.
• Nail salons.
• Hot tubs or spas.
• Healthcare settings.

NTM outbreaks typically happen in healthcare settings if procedures expose patients to contaminated water.

Who is at risk

Anyone can get an NTM infection. People who already have a lung disease or weakened immune systems are at increased risk.

Lung infections most commonly occur in patients who already have a lung disease such as:

• Cystic fibrosis
• Bronchiectasis
• Emphysema

How it spreads

NTM can live in water or surfaces in moist environments, such as inside pipes that carry water through buildings. When water contaminated with NTM aerosolizes (turns into a fine mist or spray), like the steam from your shower head or a hot tub, people inhale the bacteria.

NTM can cause infections in sites where people received surgery or injections.

NTM infections don't typically spread person to person.

Prevention

Healthcare facilities should develop an effective water management program to prevent healthcare-associated infections caused by NTM.

Public health departments can support NTM prevention and outbreak response.

Treatment and recovery

• Treatment typically requires consultation with an infectious disease or pulmonary specialist.
• NTM are resistant to many antibiotics, making infections more difficult to treat.
• Treatment varies but often requires a combination of 2 to 3 antibiotics for 6 months to a year or longer.

Related conditions

Mycobacterium abscessus is a group of environmental mycobacteria also found in water, soil and dust.

What CDC is doing

• Tracking NTM infections through the Emerging Infections Program.
• Working closely with health departments, other federal agencies, healthcare providers and patients to prevent infections caused by NTM.

Resources

• Nontuberculous Mycobacteria NTM Overview (National Jewish Health)