Symptoms of Nontuberculous Mycobacterial Disease (NTM)
The most common symptoms of nontuberculous mycobacterial (NTM) disease include chronic or recurring cough, sputum production, fatigue, malaise, dyspnea, fever, hemoptysis, chest pain, and weight loss. 1
Respiratory Symptoms
NTM disease primarily manifests as pulmonary disease, with the following respiratory symptoms:
- Chronic cough: Present in virtually all patients with NTM pulmonary disease
- Sputum production: Common in patients with bronchiectasis
- Dyspnea: Especially in patients with underlying lung disease
- Hemoptysis: Can occur in more advanced disease
- Chest pain: Variable presentation
Systemic Symptoms
Constitutional symptoms become more prevalent as NTM disease progresses:
- Fatigue and malaise: Common complaints that impact quality of life
- Fever: May be intermittent or low-grade
- Weight loss: More common in advanced disease
- Night sweats: Similar to tuberculosis presentation
Physical Examination Findings
Physical findings reflect the underlying pulmonary pathology:
- Rhonchi, crackles, wheezes, and squeaks on chest auscultation
- Signs of underlying lung diseases (bronchiectasis, COPD)
Special Patient Populations
Nodular/Bronchiectatic MAC Disease
Patients with nodular/bronchiectatic Mycobacterium avium complex (MAC) disease often present with:
- Predominantly female patients (often postmenopausal)
- Characteristic body morphotype:
- Thin body habitus
- Scoliosis in some cases
- Pectus excavatum
- Mitral valve prolapse may be present 1
Radiographic Findings
Two main patterns are observed:
Fibrocavitary disease:
- Thin-walled cavities with less surrounding parenchymal opacity
- Less bronchogenic but more contiguous spread
- More marked pleural involvement
Nodular/bronchiectatic disease:
- Abnormalities primarily in mid and lower lung fields
- Multifocal bronchiectasis (present in up to 90% of patients)
- Nodular opacities 1
Disease Progression
Symptoms typically worsen over time if untreated:
- Early disease may present with minimal symptoms
- Advanced disease shows more constitutional symptoms and respiratory compromise
- Progressive deterioration in pulmonary function
Differential Considerations
It's important to note that NTM symptoms overlap with other respiratory conditions:
- Tuberculosis (more acute onset, often with night sweats)
- Chronic bacterial bronchitis
- Bronchiectasis from other causes
- COPD exacerbations
Clinical Pitfalls and Caveats
- Symptoms are nonspecific and can be attributed to underlying lung diseases
- Diagnosis requires correlation of symptoms with radiographic findings and microbiological confirmation
- Symptoms alone are insufficient for diagnosis
- Delayed diagnosis is common due to symptom overlap with other respiratory conditions
- Patients with nodular/bronchiectatic disease may have more indolent symptoms compared to those with fibrocavitary disease
NTM disease should be considered in patients with chronic respiratory symptoms that persist despite conventional treatments, especially in those with risk factors such as underlying lung disease or characteristic body morphotype.