Centers of Excellence

The Lung Center

Tuberculosis and Nontuberculous Mycobacterial Disease

Tuberculosis (TB) is a chronic bacterial disease infecting the lungs, kidneys, spine and/or brain. TB is an airborne mycobacterium that can be spread from person to person, such as when an infected person coughs or sneezes. It can also cause an infection after a period of latency in a person who was infected at an earlier time. Without treatment, TB can cause serious complications in other parts of the body or even be fatal. Treatment requires months of adherence to several antibiotics, but most cases can be cured. Drug-resistant TB is much more difficult to cure and treatment takes much longer (nine to 18 months). Brigham and Women’s Hospital (BWH) works with the Massachusetts Department of Public Health, which subsidizes all diagnostic tests and treatment. Surgery is used for diagnosis and to treat complications of TB. Lung resection surgical approaches include thoracotomy and video assisted thoracic surgery (VATS). For surgical treatment to be most effective, it must be preceded and followed by extensive antibacterial therapy.

Nontuberculous mycobacterial disease (NTM) is a general term for a group of lung infections caused by exposure to mycobacteria found in soil and water. The mycobacteria causing these diseases exclude those that cause tuberculosis and leprosy. NTM most commonly affects people with weakened immune systems due to other lung diseases, but otherwise healthy individuals with no prior history of lung disease may also be affected. If left untreated, the disease can become chronic and require ongoing treatment.

Despite medical and surgical advances, TB remains a global epidemic and its presentation requires an aggressive, coordinated approach. The Lung Center at BWH provides high quality multidisciplinary care and research in the area of TB and NTM treatment. Pulmonologists, thoracic surgeons and infectious disease physicians who specialize in TB and NTM collaborate with other specialists throughout BWH to provide patients with a highly informed diagnosis and a cohesive treatment plan.

Tuberculosis and Nontuberculous Mycobacterial Disease Topics

Risk Factors for Tuberculosis and Nontuberculous Mycobacterial Disease

Tuberculosis and nontuberculous mycobacterial disease affect people of all ages, genders, races and income levels. The following groups face a greater risk:

  • People who live or work with others who have TB, including hospital staff
  • People from countries where TB is prevalent
  • People who abuse alcohol or use intravenous drugs
  • People who smoke
  • Homeless people
  • Young children and the elderly
  • People without access to health care
  • People in group settings, such as nursing homes

Patients with weakened immune systems are particularly susceptible to both TB and nontuberculous mycobacterial disease. Some conditions that weaken the immune system and/or damage the lung structure include:

Causes of Tuberculosis and Nontuberculous Mycobacterial Disease

The tuberculosis bacterium is spread through the air when an infected person sneezes, speaks, coughs, sings or laughs. TB is unlikely to be spread by coming into contact with items that an infected person has touched. Many people are infected with the main TB bacterium, Mycobacterium tuberculosis, without ever developing TB. However, TB organisms can more easily overcome the body’s defenses in people with weak immune systems and cause an active disease.

Unlike TB, nontuberculous mycobacterial disease is not considered contagious. Most cases of exposure to environmental sources of NTM do not result in infection. In some people, particularly those with weakened immune systems or damaged lungs, the NTM organisms infect the airways and lung tissue. This creates inflammation in the respiratory system that will progressively worsen without treatment.

Symptoms of Tuberculosis and Nontuberculous Mycobacterial Disease

Tuberculosis consists of three stages: exposure, latent TB infection (when the patient does not yet exhibit symptoms of the disease) and TB disease (when the person has signs and symptoms of an active infection). The symptoms of active TB or NTM may progress slowly and resemble those of other lung conditions or medical conditions. It is important that you contact your physician for a diagnosis early, as leaving the condition untreated may cause severe damage to the lungs or respiratory failure. Symptoms include:

  • A persistent cough
  • Coughing blood or sputum
  • Chest pain
  • High fever
  • Chills or night sweats
  • Shortness of breath (dyspnea)
  • Loss of energy and exhaustion
  • Loss of appetite and unintended weight loss
  • Poor growth in children
Diagnosis of Tuberculosis and Nontuberculous Mycobacterial Disease

To diagnose tuberculosis or nontuberculous mycobacterial disease, your physician will carefully review your medical history and conduct a full physical examination. He or she may also order additional tests, including:

A nontuberculous mycobacterial disease diagnosis can be more challenging than that of TB, as your physician will need to determine the specific disorder to create a treatment plan.

Treatment for Tuberculosis and Nontuberculous Mycobacterial Disease

Your physician will create a tailored treatment plan depending on the type and extent of the disease, your overall health and your age. Treatment plans typically include short-term hospitalization and medication. If TB is not treated early or treatment is not followed, surgery may be required to address resulting lung damage.

Lifestyle changes

In both TB and NTM, patients are encouraged to quit smoking, increase fluid intake, and get plenty of rest.

In NTM, patients are advised to prevent re-infection from the environment by:

  • Avoiding hot tubs
  • Using specialized filtration systems in household plumbing
  • Displaying caution regarding environmental exposure to tap water and soil, particularly by using only filtered water in humidifiers and air purification machines

Medications

Your health provider may proscribe a combination of antibiotics for six months or longer to kill off the mycobacteria causing your disease. Antibiotics include:

Surgery

While most patients with tuberculosis and nontuberculous mycobacterial disease do not require surgery, it may be necessary if complications occur. Possible interventions include:

  • Chest tubes may be used to drain infected fluid around the lungs
  • Chest physiotherapy may be used to optimize bronchial hygiene
  • Surgical Resection:
  • Surgery may be done through minimally invasive incisions, though more often thoracotomy is required:
  • Video-assisted thoracic surgery (VATS), a minimally invasive procedure that involves the insertion of a thoracoscope (small camera) and surgical instruments into small incisions in the chest to remove damaged parts of the lung
  • Thoracotomy, which involves an incision to open the chest and view the lungs to remove lung tissue damaged by TB or NTM
What You Should Expect

A multidisciplinary team will work with you every step of the way, from diagnosis through evaluation, to create a cohesive and comprehensive treatment plan. Our unique approach features same-day consultations with multiple specialists and fosters seamless, expert care. Your medical condition will be closely monitored and managed to promote optimal lung functioning and an improved quality of life.

If you require surgery, you will meet with your health care team first for pre-operative information and tests. On the day of your surgery, you will receive care from surgeons, anesthesiologists and nurses who specialize in thoracic surgery and interventional pulmonary procedures. After surgery, you will recover in our designated thoracic post-surgical care unit where you will receive comprehensive care by an experienced surgical and nursing staff.

Multidisciplinary Care

Tuberculosis and nontuberculous mycobacterial disease patients benefit from the wide range of specialists at The Lung Center, including thoracic surgeons, infectious disease specialists, pulmonologists and imaging experts. This collaboration ensures comprehensive diagnosis and targeted treatment for patients.

Any recommended surgery or procedure will be performed by an experienced, board-certified surgeon, in collaboration with the treatment team including nurses and physician assistants, all of whom specialize in taking care of patients with TB and NTM.

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