About Extrapulmonary Nontuberculous Mycobacteria (ENTM)

On this page:
About ENTM
Transmission of ENTM
Treatment of ENTM
Tracking ENTM
More about ENTM

About ENTM

• Nontuberculous mycobacteria (NTM) are opportunistic bacteria that are widespread and naturally occur in the environment, especially in soil and water.
• ENTM can cause an extremely broad range of infections that vary depending on the specific NTM species and the person who is infected. Extrapulmonary infections can include:
  • Cervical lymphadenitis, an enlargement of the lymph nodes that predominantly occurs in young children
  • Disseminated infection, which occurs in immunosuppressed patients that requires treatment with long and complicated regimens of antibiotic drugs
  • Opportunistic disease, which occurs as a result of contamination of NTM from the environment or health care equipment and most often seen as an infected skin wound, a soft tissue infection, or a prosthetic joint infection
• The prevalence of human disease caused by ENTM has increased over the last decade. Whether the increase in cases is real or whether more cases are being recognized and diagnosed remains unclear due to a lack of surveillance for ENTM.
• Outbreaks in a variety of health care settings of ENTM have occurred causing serious morbidity and mortality.
  • A widely publicized outbreak due to prosthetic valve endocarditis and other invasive disease caused by M. chimaera. This global outbreak from 2011 to 2016 was traced to contamination of water heater-cooler units used during open-heart surgery. In the United States, half a million patients were exposed and 11 deaths occurred.

Transmission of ENTM

• ENTM infections occur in any body site outside of the lungs, and may result from direct inoculation.
  • Unlike infection with tuberculosis, there is little convincing evidence to suggest that ENTM infections can be transmitted from person-to-person.
• NTM are opportunistic pathogens that have a strong affinity for infecting patients in health care settings.
  • In both hospitals and clinics, NTM can find opportunities to infect immunocompromised patients due to breaches in patients' natural defenses such as medical devices. Healthcare-associated transmission has occurred due to contaminated medical equipment or solutions that contain water.

Treatment of ENTM

• Treatment of ENTM generally requires consultation with a specialist.
• Treatment may involve surgery. NTM are often resistant to many antibiotics. Treatment varies depending on the individual patient infected and the body site of infection. Treatment for many of these infections can require a combination of 2 to 3 antibiotics for a prolonged period of time (months to a year).

Tracking ENTM

• Identification of ENTM requires special laboratory equipment and techniques.
• All labs that have the capability to identify ENTM from a Minnesota resident are required to report to MDH within one working day after the final test result is completed.

More about ENTM

• CDC: Nontuberculous Mycobacteria (NTM) Infections
  NTM overview, symptoms, and more information for clinicians and public health professionals