The growing impact of nontuberculous mycobacteria: A multidisciplinary review of ecology, pathogenesis, diagnosis, and treatment

Abstract

Nontuberculous mycobacteria (NTM) are emerging pathogens responsible for a growing spectrum of diseases, particularly in individuals with underlying lung disorders or immune suppression. Once considered primarily environmental saprophytes, NTM are now recognized as important causes of pulmonary, cutaneous, lymphatic, and disseminated infections. With more than 200 species identified and regional variations in prevalence, their diagnosis and management present significant clinical and microbiological challenges. The lack of standardized reporting systems and overlapping features with tuberculosis complicate epidemiological understanding and case identification.

This review provides an updated and integrated overview of NTM-associated diseases, emphasizing diagnostic advancements, environmental sources, mechanisms of transmission, host immunity, genetic susceptibility, and therapeutic options. Special attention is given to molecular diagnostic techniques, species-level identification strategies, and the role of gene sequencing in differentiating NTM species. We also highlight the limitations of conventional methods, discuss antimicrobial resistance mechanisms, and summarize current treatment guidelines.

By synthesizing current knowledge across microbiology, clinical medicine, and public health, this review aims to support a multidisciplinary approach to NTM diagnosis and management and address the pressing need for increased awareness, better surveillance, and targeted research on this under-recognized group of pathogens.