Methods to reduce environmental nontuberculous mycobacteria exposure: revisiting the recent literature

The incidence and prevalence of nontuberculous mycobacterial (NTM) lung disease (LD) cases are rising, with diagnosis and treatment proving difficult. With the preponderance of viable NTM in both natural and engineered environments, the understood route of human infection is through environmental exposures. In an effort to decrease the occurrence of NTM LD, methods to reduce environmental NTM exposures are of great interest to people with infection and the clinical community. In 2013, coauthor Falkinham summarized methods known at the time to reduce exposure to LD-causing Mycobacterium avium. The objective of this current review was to perform an updated PubMed, Web of Science, and Google Scholar literature search spanning 2014-2025 for newly reported methods and newer studies that expand on known mitigation strategies. In total, 31 articles were found. Among these new reports that posed new or improved methods to reduce environmental NTM exposure, risk assessment remains limited underscoring the need for more research in this area. We propose a feasible solution may be to revisit the "healthy home" concept and to consider the engineered environmental microbiome interactions when designing future homes.