Phenotyping Nontuberculous Mycobacterial Lung Disease: Comparative Analysis of Clinical and Imaging Features in a TB-Endemic Setting

Objective To systematically analyze clinical features and imaging characteristics of nontuberculous mycobacterial pulmonary disease (NTM-PD) patients in a tuberculosis specialty setting, establishing diagnostic and management references. Methods We conducted a retrospective analysis of 204 NTM-PD cases admitted to our tuberculosis department from January 2018 to December 2023, evaluating clinical manifestations, mycobacterial speciation, and radiological patterns. Results The cohort comprised 118 males and 86 females (mean age 65.34 ± 13.23 years), predominantly rural residents (63.24%). Common comorbidities included previous pulmonary tuberculosis (58.33%), chronic obstructive pulmonary disease (41.67%), and bronchiectasis (36.76%). Primary clinical manifestations were productive cough (78.92%), dyspnea (25.98%), and hemoptysis (24.5%). Mycobacterium avium complex (MAC) accounted for 59.80% of isolates, followed by Mycobacterium abscessus (MABS) (16.67%). Radiological analysis revealed right upper lobe (86.54%) and left upper lobe (82.69%) predominance, with multilobar involvement (≥3 lobes) in 73.08% cases. Characteristic imaging features included nodular opacities, pleural thickening (63.46%), cavitary lesions (54.81%), and bronchiectasis (51.92%). Conclusion NTM-PD primarily affects elderly populations with chronic respiratory symptoms, demonstrating extensive pulmonary involvement across multiple lobes. The disease exhibits characteristic radiological triad of nodules, cavitations, and bronchiectasis, with MAC being the predominant pathogen in this cohort.