A narrative review of nontuberculous mycobacterial pulmonary disease: microbiology, epidemiology, diagnosis, and management challenges

Figures & data

Table 1. Potential sources of NTM in natural and artificial water environments.

Natural water environments [13,14]	Artificial water environments
Lakes Rivers Streams Brooks Seawater	Wastewater treatment plants [15] Drinking water pipelines [16] Bottled and municipal water [16] Residential and hospital faucets [17,18] Showerheads [19] Hot tubs [20] Ice machines [21] Humidifiers [5] Heating/ventilation systems [5] Spa foot-baths [22]

Figure 1. Annual prevalence (number of cases per 100,000 persons) of nontuberculous mycobacterial pulmonary disease across different geographies.

^aThe prevalence of pulmonary NTM colonization in apparently healthy and diseased individuals in sub-Saharan Africa was 7.5% based on a meta-analysis that included 37 articles.

Table 2. Summary of NTM species prevalence across different geographies.

NTM species	North America	Europe	Asia	Oceania	Africa	South America
MAC	51–85%	22–82%	34–76%	61–83%	9–58%	20–63%
MAB complex	3–18%	5–9%	7–45%	5–12%	7–16%	7–19%
M. fortuitum	<1–8%	6–63%	2–24%	8–12%	5–8%	4–16%
M. gordonae	12–13%	5–20%	6–9%	2%	1–17%	17%
M. xenopi	1–23%	6–28%	1%	N/A	1%	N/A
M. kansasii	1–5%	5–70%	2–13%	2–20%	3%	3–33%
M. chelonae	N/A	9%	6–30%	3%	N/A	N/A
M. malmoense	N/A	8–37%	N/A	N/A	<1%	N/A
Authors	Hoefsloot, van Ingen et al. 2013 [93]; Prevots and Marras 2015 [11]; Tsai Yunusa et al. 2022 [94]; Zweijpfenning, van Ingen et al. 2018 [95]	Dahl, Laursen et al. 2023 [96]; Hoefsloot, van Ingen et al. 2013 [93]; Prevots and Marras 2015 [11]; Zweijpfenning, van Ingen et al. 2018 [95]	Hoefsloot, van Ingen et al. 2013 [93]; Lee, Kim et al. 2021 [97]; Prevots and Marras 2015 [11]; Ryoo, Shin et al. 2008 [98]; Zweijpfenning, van Ingen et al. 2018 [95]	Hoefsloot, van Ingen et al. 2013 [93]; Prevots and Marras 2015 [11]; Zweijpfenning, van Ingen et al. 2018 [95]; Thomson, Furuya-Kanamori et al. 2020 [40]	Hoefsloot, van Ingen et al. 2013 [93]; Okoi, Anderson et al. 2017 [99]; Zweijpfenning, van Ingen et al. 2018 [95]	Hoefsloot, van Ingen et al. 2013 [93]; Zweijpfenning, van Ingen et al. 2018 [95]

Abbreviations: MAB, Mycobacterium abscessus; MAC, Mycobacterium avium complex.

Table 3. Summary of North American studies assessing the prevalence of NTM-PD.

Population	Time Period	Annual Prevalence^a	Period Prevalence^a	Annual % change in prevalence	Authors
Nationally representative sample of Medicare Part B beneficiaries (≥65 years of age)	1997–2007	20–47 over study period	112	8.2%	Adjemian, Olivier et al. 2012 [36]
Four geographically diverse integrated health care delivery systems in the US (California, Colorado, Pennsylvania, Washington)	2004–2006	5.5 (range: 1.4–6.6)	By age group: <60 years: 1.7; 60–69 years:15; 70–79 years: 30; >80 years: 57	2.7% (1994 to 2006)	Prevots, Shaw et al. 2010 [75]
Oregon surveillance data with laboratory results from Portland, Tri-County Region	2005–2006	5.6	8.6 By age group: ≥50 years: 20.4	N/A	Winthrop, McNelley et al. 2010 [7]
Kaiser Permanente beneficiaries residing in Hawaii	2005–2013	20–44 over study period	122 By age group: 50–64 years: 183; ≥65 years: 696; ≥75 years: 906	6%	Adjemian, Frankland et al. 2017 [83]
Five states with NTM reporting (Missouri, Mississippi, Maryland, Ohio, Wisconsin)	2008–2013	8.7–13.9 over study period	75.8	9.9% By age group: 50 to 80+ years: 11.8%; 0 to 49 years: 8.7%	Donohue and Wymer 2016 [101]
Large US managed care health plan	2008–2015	6.8–11.7 over study period By age group and gender: Women: 9.6–16.8 Men: 3.79–6.45 ≥65 years: 30.3–47.5 <65 years: 2.9–4.1 Medicare plan members: 19.5–43.1	N/A	7.5% (prevalence increased by at least 10% in 39 states)	Winthrop, Marras et al. 2020 [53]

Abbreviations: NTM, nontuberculous mycobacteria.

^aNumber of cases per 100,000 persons.

Figure 2. Nontuberculous mycobacterial antimicrobial targets and resistance mechanisms. Adapted from van der Laan, Snabilie et al. 2022 [228].

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