British Thoracic Society guidelines for the management of non-tuberculous mycobacterial pulmonary disease (NTM-PD)
The term non-tuberculous mycobacteria (NTM) refers to mycobacterial species other than the Mycobacterium tuberculosis complex (M. bovis, M. africanum, M. microti, M. canetti, M. caprae, M. pinnipedii, M suricattae and M. mungi) and those organisms causing leprosy (M. leprae and M. lepromatosis).
NTM are ubiquitous environmental organisms mostly found in soil and water and cause lung, sinus, lymph node, joint, CNS, and catheter-related and disseminated infections in susceptible individuals.1
NTM can cause progressive inflammatory lung damage, a condition termed ‘NTM pulmonary disease’ (NTM-PD; described in section 5). However NTM can also transiently,
intermittently or permanently reside within the lungs of individuals without causing NTM-PD, representing asymptomatic infection and creating considerable difficulties in deciding who and when to treat.
Since the publication of the British Thoracic Society (BTS) Guideline on the ‘Management of opportunistic mycobacterial infections’ in 2000, our understanding of the epidemiology, microbiology and management of non-tuberculous mycobacterial-pulmonary disease (NTM-PD) has advanced.3 The incidence and prevalence of NTM-PD are increasing and are most likely explained by improved clinician awareness and enhanced detection methods, as well as a variety of changing environmental, mycobacterial and host factors. Technological advances in molecular microbiology have revolutionised our understanding of NTM taxonomy, and it is now appreciated that species and subspecies often differ in their pathogenicity and treatment response. While there remains a dearth of contemporary randomised controlled trial data to inform practice, the Guideline Development Group has sought to combine the best available evidence with clinical experience to create a pragmatic management guideline.
This guideline is aimed at healthcare practitioners who are involved in the care of individuals with NTM-PD, which will include hospital specialists in respiratory medicine, infectious diseases, paediatrics, microbiology immunology and radiology.