Nontuberculous Mycobacteria Infections in Immunosuppressed Hosts

Diseases and therapies that reduce cell-mediated immunity increase the risk of non-tuberculous mycobacterial (NTM) disease. Extrapulmonary NTM disease, including disseminated, skin, and catheter-related disease, is more common in immunosuppressed than immunocompetent patients. Mycobacterium avium complex remains the most common cause of NTM infection, but rapid growers including Mycobacterium abscessus, Mycobacterium chelonae, and Mycobacterium fortuitum play an important role in skin and catheter-related infections. With the exception of antibiotic prophylaxis for AIDS patients, the prevention of NTM remains difficult. Management is complicated, involving restoration of immune function and removal of catheters in addition to treatment with species-specific antibiotics per current guidelines.