Nontuberculous Mycobacteria

Author: Prof. Dr. med. Peter Altmeyer

All authors of this article

Last updated on: 19.10.2023

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MOTT; Mycobacteria; Mycobacteria other than tubercle bacilli (MOTT); non-tuberculous; non-tuberculous mycobacteria (NTM); NTM; unclassifiable mycobacteria

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Non-tuberculous mycobacteria (NTM) have been known almost as long as M. tuberculosis itself, but their clinical significance was not recorded until the 1950s.

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The term "nontuberculous mycobacterioses", or "NTM" for short, refers to a heterogeneous group of more than 190 environmental mycobacteria characterized by a wide diversity in terms of their occurrence and adaptation to environmental conditions. The reference to the obligate pathogenic mycobacterial species of tuberculosis and leprosy is reflected in the antipodal naming "nontuberculous mycobacterioses."

NTMs are facultatively humpathogenic and can become clinically relevant as opportunistic pathogens, under certain conditions, some nosocomially, especially in immunocompetent but also in immunocompetent individuals. Some clearly definable dermatological clinical pictures such as "swimming pool granuloma" and "Buruli ulcer" refer to defined pathogens such as M. marinum and M.ulcerans. Other NTM infections are not very characteristic with regard to their clinical-dermatological symptoms, so that their assignment often turns out to be a microbiological incidental finding.

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So far, more than 190 different NTM species have been discovered; more will follow. In addition to the NTMs that could also be detected in environmental samples, there are species, such as M. ulcerans, M. marinum, M. genavense or M. haemophilum, that are clearly more host-specific than other species. For M. genavense, infections of birds have been described. However, there is no evidence of spread outside this host.

Mycobacterium ulcerans, the causative agent of Buruli ulcer, has been diagnosed in over 33 countries worldwide, not only in tropical areas of West Africa but also in areas with temperate non-tropical climates, including Australia and Japan. In temperate Australia, M. ulcerans infections are also known (Bairnsdale ulcer). The pathogen has also been detected in mosquitoes (Aedes camptorhynchus/ Johnson PD et al. 2007).

For M. haemophilum, aquatic reservoirs are considered a likely source of infection.

For M. marinum , fish and seafood. Skin lesions occur at the site of inoculation as granulomatous, usually verrucous plaques or nodules, and also as sporotrichoid arranged cutaneous-subcutaneous nodules if untreated.

M. intermedium: may cause granulomatous dermatitis. Cases have been reported in which M. intermedium was transmitted by contaminated water from hot tubs (Edson RS et al. 2006).


Basically, the non-tuberculous mycobacteria can be divided into:

  • slow growing NTM
  • and
  • fast growing NTM

Furthermore, a subdivision can be made on the basis of their pigment production into:

  • photochromogenic
  • scotochromogenic
  • or unpigmented.

These subdivisions have no major significance for the clinician.


Slow-growing NTM:

The list of clinically important slow-growing nontuberculous mycobacteria (NTM) continues to expand as new species are identified and older ones are recognized as pathogenic. Some NTMs have not been newly discovered but were previously considered virtually nonpathogenic. Previously, many of them were considered contaminants when isolated from clinical specimens. Because they are ubiquitous in nature, many NTMs are isolated from ground or tap water, soil, house dust, domestic and wild animals, and birds. Most infections occur by inhalation or direct inoculation from environmental sources.

* belonging to the M. avium complex

Fast growing NTM: The eponymous characteristic of fast growing mycobacteria is that they show significant growth in less than 7 days at their optimal growth temperature. This statement refers to standard culture conditions only. Fast-growing mycobacteria are clearly resistant to a wide variety of environmental conditions. They are therefore widely distributed (Falkinham 3rd JO 2009).

  • M. abscessus** (after cosmetic procedures, other nosocomial transmissions).
  • M. alvei
  • M. aurum
  • M. boenickei
  • M. brumae
  • M. chelonae**
  • M. confluentis
  • M. elephantis
  • M. fortuitum complex**(M. abscessus, M. fortuitum, M. chelonae).
  • M. goodii (catheter-associated nosocomial infections).
  • M. holsaticum
  • M. immunogenum (clustered after cosmetic procedures, other nosocomial transmissions).
  • M. iranicum sp. nov.
  • M. margeritense
  • M. mucogenicum
  • M. peregrinum
  • M. phocaicum
  • M. septicum (phlegmonous skin infections following cosmetic surgery; pneumonia)
  • M. thermoresistible

** belonging to the M.fortuitum complex

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See also non-tuberculous mycobacterioses. Transmission from person to person does not occur.

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Potentially pathogenic mycobacteria

Saprophytes, rarely pathogenic mycobacteria

M. avium complex

M. kansasii

M. fortuitum complex

M. scrofulaceum

M. xenopi

M. szulgai

M. malmoense

M. simiae

M. marinum

M. ulcerans

M. haemophilum

M. gordonae

M. asiaticum

M. terrae-trivale

M. gastri

M. nonchromogenicum

M. paratuberculosis

M. flavescens

M. thermoresistibile

M. smegmatis

M. vaccae

M. parafortuitum complex

M. phlei

Most common causative agents of cutaneous, subcutaneous and soft tissue infections: M. ulcerans (buruli ulcer), M. marinum (swimming pool granuloma), M. fortuitum, M. chelonei.

Most common pathogens of lymphadenitis: M. scrofulaceum.

Most frequent pathogens of infections of internal organs as well as generalized forms: M. avium complex, M. kansasii.


Please ask your physician for a reliable diagnosis. This website is only meant as a reference.


Last updated on: 19.10.2023