Does this strange bacteria affect your lungs too? (NTM Lung Disease) Let's talk in detail!

Have you ever heard of a type of bacteria called `Nontuberculous Mycobacteria` (NTM) that causes lung disease? This is a bit rare, meaning it is not a disease that everyone gets. Simply put, this condition called NTM lung disease occurs when these germs called NTM enter our lungs and cause an infection there. Maybe this name is a little new to you, but don't worry, we will talk about this in detail today, in Sinhala that you can understand.

What is this NTM lung disease? Are there types?

Okay, now let's see what this NTM lung disease is, and whether there are different types of it. This is an infection that only affects the lungs. We see two main types of this:

1. Nodular bronchiectasis: This is the most common type of the disease and is relatively mild . Specifically, it is a condition in which small nodules (small lumps) develop in the lungs, causing the bronchi to widen (bronchiectasis). This condition is more common in postmenopausal women (i.e., those who have stopped menstruating) and nonsmokers . Although it is mild, it can cause problems if left untreated.

2. Cavitary NTM lung disease: This is a more severe form of the disease than the previous type. It is characterized by the gradual development of cavities, or holes, in your lung tissue. Think of it as small, hollow spaces in your lungs. As this continues, breathing becomes increasingly difficult and can lead to respiratory failure . This type is more common in smokers, those who have smoked for many years, or those who have other lung diseases, such as emphysema .

So what is this NTM?

Now you might be wondering what kind of bacteria NTM is. `Nontuberculous mycobacteria` (NTM) is a family of bacteria that grow slowly, meaning they don't multiply and grow quickly. They are surprisingly ubiquitous in our environment. For example, these bacteria can be found in soil, water (rivers, streams, even tap water), and dust . Therefore, it is impossible for us to be completely free from them.

Another special thing about these NTM bacteria is that they are resistant to common disinfectants . In addition, these NTM bacteria have an amazing ability to withstand high temperatures that would kill other types of bacteria. This means that they do not die even if you just wash them in hot water.

The severity of this infection, its treatment, and the likelihood of recovery are determined by two main factors. One is the type of bacteria (`strain`) that causes the infection . The other is whether the disease is the previously mentioned `nodular bronchiectatic` or `cavitary` type. Although there are many types of bacteria in the NTM family, there are a few main types that cause lung infections in humans:

• Mycobacterium avium complex (MAC): In countries like the United States, NTM lung diseases are often caused by this group of bacteria.
• Mycobacterium abscessus: This is also a more severe and difficult to treat type.
• `Mycobacterium kansasii`: This is another variant.

Who is more likely to develop NTM lung disease?

Not everyone gets sick from NTM bacteria. However, some people are more likely to get the disease, or are at higher risk . That is, people with certain predisposing conditions can be affected. In particular, if you have other lung diseases, you are more likely to get an NTM lung infection. Here are some things to consider:

• Recurrent pneumonia: Some people get frequent lung infections. This is especially true for people with conditions like `aspirate pneumonia`, where things we breathe in (like food and drink) can get into our lungs and become infected .
• Asthma: This is also a common condition among many people. Asthma makes the airways in the lungs sensitive, making them susceptible to NTM infections.
• Bronchiectasis: This is said to be the main risk factor for developing NTM lung disease. In this, the bronchi ( airways) in the lungs become permanently dilated, widened, and their walls become weak. This makes it easier for mucus to get stuck, creating a good environment for bacteria to grow.
• Chronic obstructive pulmonary disease (COPD): This is a chronic lung disease that is common among smokers.
• Cystic fibrosis: This is a genetic disease. It also causes thick mucus to build up in the lungs, leading to infections.
• Lung cancer: Because the lungs of a person with lung cancer are weak, infections like NTM can easily develop.
• Tuberculosis (TB): People who have previously had tuberculosis and damaged their lungs are also at risk of developing NTM.

In addition, if you are over 65 years of age , or if you have any medical conditions that weaken your immune system (e.g., human immunodeficiency virus (HIV)/AIDS , rheumatoid arthritis (a disease that causes inflammation of the joints) , or Sjögren's syndrome ( a condition that causes dry eyes and mouth), or if you are taking medications that suppress the immune system (e.g., chemotherapy , inhaled corticosteroids for conditions like asthma), you are also at higher risk of developing NTM lung disease.

What are the symptoms of NTM lung disease?

Okay, now let's see what symptoms appear when this NTM lung disease develops. The main symptom that is often seen is a cough . This cough is not just like the cough that comes with a common cold. It is:

• It can be long-term . That means it can last for weeks or months.
• Sometimes, when you cough, you may even bring up a little blood along with the mucus . This is called `hemoptysis` in medical terms.
• The cough can become so severe that you can't sleep at night. You may wake up with a cough while you're sleeping.
• Thick, possibly colored mucus may come out .

In addition to this cough, other symptoms may occur. Not everyone will have all of these symptoms, but you may have some of these:

• Chest pain: You may feel a pain in your chest when you breathe or cough.
• Excessive tiredness/fatigue: Not just tiredness, but a feeling of being helpless no matter what you do.
• Anorexia: Loss of desire to eat.
• Low-grade fever with malaise: Not a high fever, but the body temperature remains high.
• Night sweats: You wake up sweating all over your body while you are sleeping.
• Frequent respiratory infections: Pneumonia-like illnesses occur every few months.
• Difficulty breathing (dyspnea): Difficulty breathing even with mild exertion or when climbing stairs.
• Unexplained weight loss: Suddenly losing weight without dieting.
• Wheezing sound when breathing: A whistling sound is heard from the chest.

The most important thing is to definitely see a doctor for advice if you have these symptoms, especially a persistent cough.

Is NTM lung disease contagious?

This is a question that many people ask and want to know. In fact, NTM bacteria are not usually transmitted from one person to another. This means that if you talk to someone who has NTM pneumonia or drink from a cup they used, you will not get it. Therefore, it is currently accepted that this is not a contagious disease .

However, there is one thing. Among people with the genetic disease ``cystic fibrosis``, some infections (researchers are still investigating whether these NTM infections are also among them) have been rarely spread. However, among the general population, there is no reason to fear the spread of NTM lung disease.

How is NTM lung disease accurately diagnosed?

As we mentioned earlier, diagnosing NTM lung disease can be challenging because its symptoms are non-specific. That is, they are very similar to those of other, more common lung diseases (e.g., pneumonia, tuberculosis, bronchitis).

To make a diagnosis, at least three things must be met:

1. Presence of symptoms: Symptoms like the previously mentioned cough and difficulty breathing.

2. Changes in a chest X-ray or CT scan: These tests look for nodules, cavities, or bronchiectasis in the lungs.

3. Growth of NTM bacteria in a sputum sample: The sputum that you cough up (which may be mixed with saliva) is taken and tested in a laboratory to see if NTM bacteria are present and growing in it.

If you have an infection, finding out exactly which strain of NTM bacteria is causing it is essential for treatment.

Some of the tests done for this are:

• Physical examination: The doctor will ask about your symptoms and listen to your chest with a stethoscope.
• Imaging studies: Chest X-ray or CT scan to assess changes in lung tissue. A CT scan can provide a clearer picture than an X-ray.
• Sputum culture: This is the most important test. First thing in the morning, before brushing your teeth, you will need to cough up a large amount of sputum and put it in a special bottle. To increase the accuracy of the test, you will need to give the sample for several days (usually at least three days). Sometimes, if you are unable to cough up sputum properly, your doctor may take a sample from the smaller airways in your lungs using a procedure called a bronchoscopy . The specialist will then examine the sample under a microscope and culture the bacteria.
• Lung biopsy: This is not done for everyone. If a clear conclusion cannot be reached from the sputum test or other tests, or if there is a suspicion of another disease, a small piece of tissue is taken from the lung and examined.

What else do you need to know about NTM tests?

There is something else important to know about NTM testing. Many people can have NTM lung disease for years before they are diagnosed. Because symptoms come on slowly, some people don't realize it. The longer you have the disease, the more damage to your lungs and the higher your risk of complications.

If you are already being treated for another lung condition (e.g. asthma, COPD), but your symptoms (such as cough, shortness of breath) are getting worse, you may benefit from being tested for NTM infection. Be sure to tell your doctor about this.

The best care for this disease comes from doctors who have specialized knowledge and experience in this disease. For example , pulmonologists and infectious disease doctors .

How is NTM lung disease treated?

Okay, now let's talk about the treatment for this. The treatment that's right for you depends on a few things. These include the type of NTM bacteria that's causing your infection, what type of NTM lung disease you have (nodular bronchiectatic or cavitary) , and your overall health history and current health status .

Usually, the main treatment for this is antibiotics . But this is not just a medicine that you take for seven or eight days and then stop. These antibiotics have to be taken continuously for several months, sometimes a year or even longer . Often, it is not just one antibiotic, but two or three types of antibiotics that have to be taken together .

In severe cases of the disease, meaning that the lungs have been severely damaged and cavities have formed, surgery may sometimes be needed to remove the infected lung tissue. However, this is not done for everyone. If antibiotics do not control your disease well, or if you cannot tolerate the side effects of antibiotics, doctors are more likely to consider surgery. People with Mycobacterium avium complex (MAC) infection can sometimes bleed from the lungs due to this infection. In such cases, surgery may be needed to stop the bleeding.

Are there any side effects of NTM treatment?

Yes, this is also an important question. Taking antibiotics for a long time, that is, for months, can cause some side effects . The most common side effects are:

• Vomiting and nausea
• Diarrhea (stomach ache)
• Appetite
• Stomach ache

In addition, some antibiotics (not all) can rarely cause hearing changes (such as decreased hearing), vision changes (such as blurred vision), liver effects, and skin rashes .

Don't worry! Your doctor will inform you about these side effects. Also, during treatment, your blood tests, eyesight tests, and hearing tests will be done regularly to monitor for these side effects.

These problems can make it difficult to carry out daily activities. However, if you are having difficulty continuing your treatment, be sure to tell your doctor. Your doctor may be able to change the dose, prescribe a different medication, or use other ways to manage side effects. Never stop taking antibiotics without talking to your doctor. Doing so can cause the bacteria to become resistant to the medication, which can make your condition worse.

Can NTM lung disease be prevented?

As we mentioned earlier, it's difficult to completely avoid exposure to NTM bacteria because they are so ubiquitous in our environment. However, there are some simple things you can do to reduce your risk of developing an NTM lung infection:

• Practice good hygiene: Washing your hands thoroughly with soap and water regularly can help control the spread of germs like NTM bacteria. It also reduces the chance of developing an infection if you are exposed to the bacteria.
• Get vaccinated: It is essential to get the flu vaccine every year and the pneumonia vaccine as directed by your doctor. Because if you get the flu or pneumonia, recovery from NTM lung disease can be more complicated and your lungs can become even weaker.
• Quit smoking and tobacco products completely: Tobacco use is extremely harmful to the lungs. It greatly increases the risk of lung diseases and infections like NTM. If you are a smoker, quitting is the best thing you can do for your lungs. If you need help with this, talk to a doctor.

What is the future for people with NTM lung disease?

This depends largely on the individual's condition. However, many people, especially those with the `non-cavitary` (non-cavity, meaning no holes in the lungs) type of disease, recover completely. Your chances and speed of recovery depend on factors such as:

• The type of NTM lung disease you have (e.g., nodular bronchiectasis or cavitary?).
• What is the strain of NTM bacteria that caused the infection? (Some strains respond better to treatment than others.)
• Your overall health history (such as other illnesses, immune system, etc.).
• Whether you can tolerate long-term antibiotic treatment (a problem if you have to stop the medication due to side effects).
• You will also receive the correct antibiotic medication, appropriate for your illness and the type of bacteria.
• If you have bronchiectasis, your ability and willingness to do airway clearance treatments (such as exercises to clear mucus) is important.

Important: Even if treatment is successful, some people may have one or more recurrences of NTM lung disease. Therefore, it is very important to be aware of the symptoms and follow your doctor's instructions.

What is important when living with NTM lung disease?

Living with a lung infection caused by NTM bacteria can sometimes be a bit challenging. However, there are some simple, practical things you can do to help you stay as healthy and comfortable as possible:

• Avoid moisture and steam: NTM bacteria thrive in moist environments. Therefore, avoid using hot tubs, spas, and saunas as much as possible. If you are in the kitchen or bathroom, if steam builds up, turn on a `ventilation fan` / `exhaust fan`. When taking a shower, don't leave the water running too long and fill the bathroom with steam.
• Eat a nutritious diet: Keeping your diet balanced and nutritious will give your body the energy and nutrients it needs to fight infections. Include plenty of protein (fish, meat, eggs, milk, nuts), fluids (water, soup, fruit juice), and vegetables and fruits in your diet.
• Do exercises that your doctor recommends: Simple physical activities (such as walking) can loosen mucus in your lungs and make it easier to cough it up. They can also improve your strength and endurance. However, ask your doctor or physical therapist about the exercises that are right for you.
• Wear a face mask if necessary: ​​Since NTM bacteria can live in dust and soil, wearing a face mask when visiting areas such as newly mowed lawns, newly landscaped areas, farms, and dusty environments can help limit ongoing exposure to NTM to some extent.

Let's take this message home.

Okay, so we've talked a lot about NTM lung disease. In conclusion, here are some of the most important things you need to remember:

NTM lung disease is a lung infection caused by a type of bacteria (`Nontuberculous Mycobacteria`) that grows slowly in our environment, such as soil and water. People with other lung diseases (especially `Bronchiectasis`) and those with weakened immune systems are more likely to develop this condition.

It can be challenging to diagnose and treat, as the symptoms are similar to other lung diseases and treatment can take a long time. However, most people make a full recovery with proper medical care and advice.

If you have this disease, or if you think you are at risk of developing it, avoiding humidity, maintaining good hygiene, and, if necessary, wearing a face mask when going outdoors in dusty areas can be very helpful.

The most important thing is that if you have symptoms like a persistent cough, bloody phlegm, shortness of breath, or unexplained weight loss, don't just dismiss it as something random, but see a qualified doctor right away for advice. Don't worry, with proper diagnosis and treatment, this condition can be well controlled. You are not alone, and doctors are there to help you.

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