"Highlights from Doctor Radio broadcast June 25, 2013 hosted by Dr. Frank Adams, with guests Dr. Joe Falkinham of Virginia Tech and Philip Leitman, co-founder of NTM Info & Research. The two main topics of discussion were NTM “hot spots” throughout the country, including one in Philadelphia, PA, and the recent New York Times Magazine article on NTM lung disease.
NTMs are ideally adapted to household and drinking water, as they are resistant to water treatments such as chlorination, as well as to hot water unless the temperature of that water is at or above 131° F (55 C°). NTMs stick to the insides of pipes in the biofilm and grow there. About 70% of water and household systems in the United States and Canada have NTMs in them. The thick cell walls make it more resistant to most antibiotics, which is why there is a smaller selection to choose from, and why it is so important to use a regimen of multiple antibiotics as opposed to just one.
A number of people in the population are vulnerable to NTM infection. Education of doctors is needed so they more easily recognize symptoms, order the correct tests, and administer the correct treatments.
There are a number of possible causes of the “hot spots” that are occurring around the country. A recent paper by Dr. Rebecca Prevots at the National Institutes of Health identifies some of these areas with higher numbers of NTM lung disease patients, as well as some with lower numbers."
"Currently a company is conducting a clinical trial of a new inhaled form of Amikacin, a medication used frequently to treat NTM lung disease. Hopefully the results will demonstrate that inhalation results in the drug staying in the lungs longer, which increases its efficacy, while not being absorbed into the patient’s system as much. This clinical trial is currently enrolling patients"
"A caller asked whether NTM can cause a positive test result on a conventional TB skin test. The result would not be positive, but there would likely be some skin reaction to the test, as mycobacteria (which include TB as well as NTMs) share some similar proteins in their cell walls. The test reaction area would be small for NTM, as opposed to a larger area for TB. This differential can also be helpful in diagnosing NTM (along with the standard of high-resolution CT scan without contrast and a sputum sample culture), and there is currently a clinical study underway to test the sensitivity of a TB skin test. (Click here for more information on how you can enroll in this study, which is not time-intensive or difficult.)
Sinus washes can be helpful but MUST be done with sterile water. Tap water is NOT sterile. Distilled water is NOT sterile. You can buy sterilized saline solution for nasal rinses in drug stores, or you can use water that you have sterilized by boiling it for at least 10 minutes at a rolling boil, then let it cool sufficiently before using it. You can also boil the wash bottle to sterilize that as well.
Doctors often see NTM cultures with fungal infections; one can occur as an opportunistic infection as a result of the other, and a fungal infection can cause damage which makes one more susceptible to NTM infection. Like NTMs, fungi tend to grow slowly and are resistant to a number of standard antibiotics.
Advancements in treatment of NTM often are the result of medications which have been developed for other uses, but are effective against NTM as well. In the last five to ten years, doctors have found different combinations of various medications which can be effective, and it often is based on the patient’s individual response. Another area in which we are slowly making progress is the education of medical professionals, which helps bring about earlier diagnosis and treatment."
"NTMs double in growth once a day, which is slow for bacteria, and this is why it can take anywhere between a week and four weeks to grow out a culture to identify the NTM. This is why the diagnosis can take more time, but a patient can begin treatment and the treatment can be adjusted once the diagnosis is confirmed by the lab results.
Household water can be a significant source of exposure through aerosols (mist or steam). Currently there is no commercial, regulatory or water treatment lab which will conduct these tests, and because NTMs are so prevalent in the water supply, it is not necessary. Instead, patients should take precautions to avoid exposure, and patients who have had NTM lung infections will remain susceptible to them.
There is a water filter coming onto the market now for use in homes, and this filter does remove NTMs from the water. Refer back soon for more information.
Symptoms of NTM lung infection include a chronic cough (which may or may not produce sputum), night sweats, weight loss, low-grade fever, change in pulmonary function, and two or more lower respiratory infections in a single year. If you are at risk and have a chronic cough and other symptoms, ask your doctor if you could have NTM.
The show’s host, Dr. Adams, noted that one of the most significant changes to his pulmonary medicine practice has been the reduction of TB cases to the point where he does not really treat it anymore, but at the same time, there has been a big increase in the number of NTM patients he has treated."
"In Philadelphia, a study initiated by Dr. Leah Lande and her colleagues at Lankenau Medical Center found that in their cluster of patients, there was unusually high susceptibility among older, slender women and men (though more women than men). Though the risk of infection increases with age, we are also seeing quite a few patients in their 30’s and some children as well. Clusters are also being found in other areas of the country.
Co-morbidities and human behavior play a big role in susceptibility to NTM lung disease including the use of certain types of drugs for treatments of other conditions, such as Rheumatoid Arthritis. Such medications suppress the immune system.
COPD is a term which encompasses a number of lung issues including bronchiectasis, emphysema and others. Bronchiectasis is damage to the bronchial walls in the lungs, and an NTM infection can cause such damage. There is much discussion among experts about which comes first, the NTM infection or the bronchiectasis?
Regarding the New York Times Magazine article, it was good to see NTM lung disease getting media coverage, but the suggestion that the treatment is worse than the disease, is misleading. NTM Info & Research received a lot of feedback, and many people were upset by the article.
As a result, Philip Leitman communicated directly with the article’s author, Dr. Lisa Sanders. The article was meant to be educational, but it demonstrated how things can go wrong if the treatment described in the article were to be followed, as it could lead to many more sick patients with worse outcomes. (Click here to read the article.)"