1
|
Ugedo J, Tabernero E, Altube L, Leal MV, García JA. Nontuberculous Mycobacteria Isolates in Respiratory Samples and Mycobacterial Pulmonary Disease in an Area of Northern Spain. OPEN RESPIRATORY ARCHIVES 2024; 6:100353. [PMID: 39318829 PMCID: PMC11421231 DOI: 10.1016/j.opresp.2024.100353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 07/16/2024] [Indexed: 09/26/2024] Open
Abstract
Introduction The epidemiology of nontuberculous mycobacteria (NTM) is not well known. In this study, we aimed to determine the incidence of NTM isolates and nontuberculous mycobacterial pulmonary disease (NTM-PD) in five closely located hospitals in an area of northern Spain and analyse differences between them. Material and methods Demographic, microbiological, clinical and radiological data were collected retrospectively from all patients with a NTM isolated from respiratory specimens at five hospitals between 2012 and 2019. Mycobacterium gordonae isolates were excluded. Once the data was collected, it was determined which patients met the NMT-PD criteria. Results 594 patients were included in the study. The mean incidence rate of NTM isolates across all five hospitals in the period studied was 4.15 per 100,000 person-year, while the rate of NTM-PD was 1.2. The annual number of isolates showed an upward trend over this period, but the same did not occur in the number of cases of NTM-PD. The species most frequently isolated were Mycobacterium avium complex (MAC) and Mycobacterium xenopi and those most frequently causing disease were MAC and Mycobacterium kansassi. There were significant differences between the five centres. Conclusions Our results are in line with similar studies in Europe in terms of NTM isolation and NTM-PD incidence and species isolated; however, we do not see the upward trend in NTM-PD rates described elsewhere. The great variability in isolation and disease rates, as well as in species isolated in geographically close areas, underlines, in our opinion, the importance of local environmental factors.
Collapse
Affiliation(s)
- Javier Ugedo
- Department of Respiratory Medicine, San Pedro University Hospital, Logroño, La Rioja, Spain
| | - Eva Tabernero
- Department of Respiratory Medicine, Cruces University Hospital, BioBizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Lander Altube
- Department of Respiratory Medicine, Galdakao University Hospital, Bizkaia, Spain
| | - María Victoria Leal
- Department of Respiratory Medicine, Basurto University Hospital, Bizkaia, Spain
| | | |
Collapse
|
2
|
Kumar K, Loebinger MR. Non-Tuberculous Mycobacterial Pulmonary Disease-Where are we Now? Arch Bronconeumol 2024; 60:609-611. [PMID: 39043478 DOI: 10.1016/j.arbres.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 07/01/2024] [Accepted: 07/02/2024] [Indexed: 07/25/2024]
Affiliation(s)
- Kartik Kumar
- Host Defence Unit, Department of Respiratory Medicine, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Michael R Loebinger
- Host Defence Unit, Department of Respiratory Medicine, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK; National Heart and Lung Institute, Imperial College London, London, UK.
| |
Collapse
|
3
|
Zimenkov D, Atanasova Y, Ushtanit A, Yordanova S, Baykova A, Filippova M, Semenova U, Mokrousov I, Bachiyska E. The Intriguing Pattern of Nontuberculous Mycobacteria in Bulgaria and Description of Mycobacterium bulgaricum sp. nov. Int J Mol Sci 2024; 25:10434. [PMID: 39408759 PMCID: PMC11476446 DOI: 10.3390/ijms251910434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2024] [Revised: 09/24/2024] [Accepted: 09/25/2024] [Indexed: 10/20/2024] Open
Abstract
We investigated the rise of nontuberculous mycobacteria (NTM) infections in Bulgaria, focusing on species identification and distribution from 2018 to 2022. Utilizing advanced diagnostic tools, including the Hain Mycobacterium CM/AS method, Myco-biochip assay, and whole-genome sequencing, the study identifies and characterizes a diverse range of Mycobacterium species from clinical samples. While M. avium, M. gordonae, M. fortuitum, and M. chelonae were dominating, a number of rare species were also found. They include such species as M. marseillense and M. celatum. Moreover, the noticeable prevalence of M. terrae complex species missed by conventional testing was observed. We identified a rare species, highly homologous to previously described strains from Japan; based on genome-genome distance data, we propose its reannotation as a new species. Further, a novel species was identified, which is significantly distinct from its closest neighbor, M. iranicum, with ANI = 87.18%. Based on the SeqCode procedure, we propose to name this new species Mycobacterium bulgaricum sp. nov. Dynamic changes in NTM species prevalence in Bulgaria observed from 2011 to 2022 highlight the emergence of new species and variations tied to environmental and demographic factors. This underscores the importance of accurate species identification and genotyping for understanding NTM epidemiology, informing public health strategies, and enhancing diagnostic accuracy and treatment protocols.
Collapse
Affiliation(s)
- Danila Zimenkov
- Center for Precision Genome Editing and Genetic Technologies for Biomedicine, Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, 119991 Moscow, Russia; (A.U.); (M.F.); (U.S.)
| | - Yuliana Atanasova
- National Reference Laboratory of Tuberculosis, Department of Microbiology, National Center of Infectious and Parasitic Diseases, 44A General Nikolai Stoletov Boulevard, 1233 Sofia, Bulgaria; (S.Y.); (A.B.); (E.B.)
| | - Anastasia Ushtanit
- Center for Precision Genome Editing and Genetic Technologies for Biomedicine, Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, 119991 Moscow, Russia; (A.U.); (M.F.); (U.S.)
| | - Stanislava Yordanova
- National Reference Laboratory of Tuberculosis, Department of Microbiology, National Center of Infectious and Parasitic Diseases, 44A General Nikolai Stoletov Boulevard, 1233 Sofia, Bulgaria; (S.Y.); (A.B.); (E.B.)
| | - Ana Baykova
- National Reference Laboratory of Tuberculosis, Department of Microbiology, National Center of Infectious and Parasitic Diseases, 44A General Nikolai Stoletov Boulevard, 1233 Sofia, Bulgaria; (S.Y.); (A.B.); (E.B.)
| | - Marina Filippova
- Center for Precision Genome Editing and Genetic Technologies for Biomedicine, Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, 119991 Moscow, Russia; (A.U.); (M.F.); (U.S.)
| | - Uliana Semenova
- Center for Precision Genome Editing and Genetic Technologies for Biomedicine, Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, 119991 Moscow, Russia; (A.U.); (M.F.); (U.S.)
| | - Igor Mokrousov
- Laboratory of Molecular Epidemiology and Evolutionary Genetics, St. Petersburg Pasteur Institute, 197101 St. Petersburg, Russia;
| | - Elizabeta Bachiyska
- National Reference Laboratory of Tuberculosis, Department of Microbiology, National Center of Infectious and Parasitic Diseases, 44A General Nikolai Stoletov Boulevard, 1233 Sofia, Bulgaria; (S.Y.); (A.B.); (E.B.)
| |
Collapse
|
4
|
Marino A, Raddusa MSP, Gussio M, Sangiorgio G, Moscatt V, Libra A, Spampinato S, Bongiorno D, Cacopardo B, Nunnari G. Epidemiological and clinical characteristics of nontuberculous mycobacterial infections: A retrospective female cohort study in an Italian population. IDCases 2024; 37:e02067. [PMID: 39281309 PMCID: PMC11395720 DOI: 10.1016/j.idcr.2024.e02067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 06/23/2024] [Accepted: 08/21/2024] [Indexed: 09/18/2024] Open
Abstract
Objectives This study aims to assess the characteristics and treatment outcomes of patients diagnosed with non-tuberculous mycobacteria (NTM) diseases at the Infectious Diseases Unit of ARNAS Garibaldi Hospital in Catania, Italy, focusing on demographics, clinical features, and treatment effectiveness. Methods We conducted a retrospective observational study of 10 patients diagnosed with NTM diseases between 2019 and 2021. Data was collected from electronic medical records, including demographic information, comorbidities, treatment modalities, and outcomes. The study utilized descriptive statistics to analyze continuous and categorical variables. Treatment regimens were based on individual patient needs, incorporating a combination of antibiotics. Results The median age of the patients was 55.44 years, all female, predominantly suffering from pulmonary NTM diseases. Mycobacterium intracellulare was the most common pathogen. Common comorbidities included COPD, bronchiectasis, GERD, and hypovitaminosis D. Patients showed symptoms like fever, cough, and asthenia. The treatment regimens were diverse, with macrolides, rifampicin, and ethambutol forming the core. Adverse effects were noted in 40 % of patients, including gastrointestinal and neurological disorders. All patients achieved microbiological cure, with 60 % showing clinical improvement and 36 % radiological improvement. Conclusion The study highlights the complexity of diagnosing and treating NTM diseases, emphasizing the need for personalized treatment plans and vigilant monitoring of adverse effects. Despite achieving microbiological cure, challenges remain in achieving complete clinical and radiological resolution. Further research is needed to enhance the understanding and management of NTM diseases, particularly in diverse populations.
Collapse
Affiliation(s)
- Andrea Marino
- Department of Clinical and Experimental Medicine, ARNAS Garibaldi Hospital, Unit of Infectious Diseases, University of Catania, 95123 Catania, Italy
| | | | - Maria Gussio
- Department of Clinical and Experimental Medicine, ARNAS Garibaldi Hospital, Unit of Infectious Diseases, University of Catania, 95123 Catania, Italy
| | - Giuseppe Sangiorgio
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy
| | - Vittoria Moscatt
- Department of Clinical and Experimental Medicine, ARNAS Garibaldi Hospital, Unit of Infectious Diseases, University of Catania, 95123 Catania, Italy
| | - Alessandro Libra
- Regional Referral Centre for Rare Lung Disease, University Hospital "Policlinico-San Marco", Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Serena Spampinato
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, 98124 Messina, Italy
| | - Dafne Bongiorno
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy
| | - Bruno Cacopardo
- Department of Clinical and Experimental Medicine, ARNAS Garibaldi Hospital, Unit of Infectious Diseases, University of Catania, 95123 Catania, Italy
| | - Giuseppe Nunnari
- Department of Clinical and Experimental Medicine, ARNAS Garibaldi Hospital, Unit of Infectious Diseases, University of Catania, 95123 Catania, Italy
| |
Collapse
|
5
|
Cai J, Vonder M, Du Y, Pelgrim GJ, Rook M, Kramer G, Groen HJM, Vliegenthart R, de Bock GH. Who is at risk of lung nodules on low-dose CT in a Western country? A population-based approach. Eur Respir J 2024; 63:2301736. [PMID: 38697647 PMCID: PMC11154756 DOI: 10.1183/13993003.01736-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 04/12/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND This population-based study aimed to identify the risk factors for lung nodules in a Western European general population. METHODS We quantified the presence or absence of lung nodules among 12 055 participants of the Dutch population-based ImaLife (Imaging in Lifelines) study (age ≥45 years) who underwent low-dose chest computed tomography. Outcomes included the presence of 1) at least one solid lung nodule (volume ≥30 mm3) and 2) a clinically relevant lung nodule (volume ≥100 mm3). Fully adjusted multivariable logistic regression models were applied overall and stratified by smoking status to identify independent risk factors for the presence of nodules. RESULTS Among the 12 055 participants (44.1% male; median age 60 years; 39.9% never-smokers; 98.7% White), we found lung nodules in 41.8% (5045 out of 12 055) and clinically relevant nodules in 11.4% (1377 out of 12 055); the corresponding figures among never-smokers were 38.8% and 9.5%, respectively. Factors independently associated with increased odds of having any lung nodule included male sex, older age, low educational level, former smoking, asbestos exposure and COPD. Among never-smokers, a family history of lung cancer increased the odds of both lung nodules and clinically relevant nodules. Among former and current smokers, low educational level was positively associated with lung nodules, whereas being overweight was negatively associated. Among current smokers, asbestos exposure and low physical activity were associated with clinically relevant nodules. CONCLUSIONS The study provides a large-scale evaluation of lung nodules and associated risk factors in a Western European general population: lung nodules and clinically relevant nodules were prevalent, and never-smokers with a family history of lung cancer were a non-negligible group.
Collapse
Affiliation(s)
- Jiali Cai
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marleen Vonder
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Yihui Du
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Epidemiology and Health Statistics, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Gert Jan Pelgrim
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Radiology, Medisch Spectrum Twente, University of Twente, Enschede, The Netherlands
| | - Mieneke Rook
- Department of Radiology, Martini Hospital Groningen, Groningen, The Netherlands
| | - Gerdien Kramer
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Radiology, Martini Hospital Groningen, Groningen, The Netherlands
| | - Harry J M Groen
- Department of Pulmonology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Rozemarijn Vliegenthart
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Geertruida H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
6
|
Zweijpfenning SMH, Aarnoutse R, Boeree MJ, Magis-Escurra C, Stemkens R, Geurts B, van Ingen J, Hoefsloot W. Safety and Efficacy of Clofazimine as an Alternative for Rifampicin in Mycobacterium avium Complex Pulmonary Disease Treatment: Outcomes of a Randomized Trial. Chest 2024; 165:1082-1092. [PMID: 38040054 DOI: 10.1016/j.chest.2023.11.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 11/02/2023] [Accepted: 11/06/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Results of retrospective studies have suggested clofazimine as an alternative for rifampicin in the treatment of Mycobacterium avium complex pulmonary disease (MAC-PD). RESEARCH QUESTION Is a treatment regimen consisting of clofazimine-ethambutol-macrolide noninferior to the standard treatment regimen (rifampicin-ethambutol-macrolide) in the treatment of MAC-PD? STUDY DESIGN AND METHODS In this single-center, nonanonymized clinical trial, adult patients with MAC-PD were randomly assigned in a 1:1 ratio to receive rifampicin or clofazimine as adjuncts to an ethambutol-macrolide regimen. The primary outcome was sputum culture conversion following 6 months of treatment. RESULTS Forty patients were assigned to receive either rifampicin (n = 19) or clofazimine (n = 21) in addition to ethambutol and a macrolide. Following 6 months of treatment, both arms showed similar percentages of sputum culture conversion based on an intention-to-treat analysis: 58% (11 of 19) for rifampicin and 62% (13 of 21) for clofazimine. Study discontinuation, mainly due to adverse events, was equal in both arms (26% vs 33%). Based on an on-treatment analysis, sputum culture conversion following 6 months of treatment was 79% in both groups. In the clofazimine arm, diarrhea was more prevalent (76% vs 37%; P = .012), while arthralgia was more frequent in the rifampicin arm (37% vs 5%; P = .011). No difference in the frequency of corrected QT interval prolongation was seen between groups. INTERPRETATION A clofazimine-ethambutol-macrolide regimen showed similar results to the standard rifampicin-ethambutol-macrolide regimen and should be considered in the treatment of MAC-PD. The frequency of adverse events was similar in both arms, but their nature was different. Individual patient characteristics and possible drug-drug interactions should be taken into consideration when choosing an antibiotic regimen for MAC-PD. CLINICAL TRIAL REGISTRATION EudraCT; No.: 2015-003786-28; URL: https://eudract.ema.europa.eu.
Collapse
Affiliation(s)
- Sanne M H Zweijpfenning
- Department of Pulmonary Diseases, TB Expert Center, Research Institute for Medical Innovation, Radboud University Medical Center, Radboudumc Center for Infectious Diseases, Nijmegen, The Netherlands.
| | - Rob Aarnoutse
- Department of Pharmacy, Research Institute for Medical Innovation, Radboud University Medical Center, Radboudumc Center for Infectious Diseases, Nijmegen, The Netherlands
| | - Martin J Boeree
- Department of Pulmonary Diseases, TB Expert Center, Research Institute for Medical Innovation, Radboud University Medical Center, Radboudumc Center for Infectious Diseases, Nijmegen, The Netherlands
| | - Cecile Magis-Escurra
- Department of Pulmonary Diseases, TB Expert Center, Research Institute for Medical Innovation, Radboud University Medical Center, Radboudumc Center for Infectious Diseases, Nijmegen, The Netherlands
| | - Ralf Stemkens
- Department of Pharmacy, Research Institute for Medical Innovation, Radboud University Medical Center, Radboudumc Center for Infectious Diseases, Nijmegen, The Netherlands
| | - Bram Geurts
- Department of Radiology, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jakko van Ingen
- Department of Medical Microbiology, Research Institute for Medical Innovation, Radboud University Medical Center, Radboudumc Center for Infectious Diseases, Nijmegen, The Netherlands
| | - Wouter Hoefsloot
- Department of Pulmonary Diseases, TB Expert Center, Research Institute for Medical Innovation, Radboud University Medical Center, Radboudumc Center for Infectious Diseases, Nijmegen, The Netherlands
| |
Collapse
|
7
|
Prevots DR, Marshall JE, Wagner D, Morimoto K. Global Epidemiology of Nontuberculous Mycobacterial Pulmonary Disease: A Review. Clin Chest Med 2023; 44:675-721. [PMID: 37890910 PMCID: PMC10625169 DOI: 10.1016/j.ccm.2023.08.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
Nontuberculous mycobacterial (NTM) isolation and pulmonary disease (NTM-PD) have continued to increase in most regions of the world, driven mainly by Mycobacterium avium. Single-center studies also support increasing trends as well as a persistent burden of undiagnosed NTM among persons suspected of having tuberculosis (TB), in countries with moderate-to-high TB prevalence. Cumulative exposure to water and soil presents an increased risk to susceptible hosts, and trace metals in water supply are recently recognized risk factors. Establishing standard case definitions for subnational and national surveillance systems with mandatory notification of NTM-PD are needed to allow comparisons within and across countries and regions.
Collapse
Affiliation(s)
- D Rebecca Prevots
- Epidemiology and Population Studies Unit, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 5601 Fishers Lane, Bethesda, MD 20852, USA.
| | - Julia E Marshall
- Epidemiology and Population Studies Unit, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 5601 Fishers Lane, Bethesda, MD 20852, USA
| | - Dirk Wagner
- Division of Infectious Diseases, Department of Internal Medicine II, Medical Center- University of Freiburg, Faculty of Medicine, Hugstetter Street. 55, Freiburg b106, Germany
| | - Kozo Morimoto
- Division of Clinical Research, Fukujuji Hospital, Japan Anti-Tuberculosis Association (JATA), 3-1-24, Matsuyama, Kiyose, Tokyo, Japan
| |
Collapse
|
8
|
Liu Q, Du J, An H, Li X, Guo D, Li J, Gong W, Liang J. Clinical characteristics of patients with non-tuberculous mycobacterial pulmonary disease: a seven-year follow-up study conducted in a certain tertiary hospital in Beijing. Front Cell Infect Microbiol 2023; 13:1205225. [PMID: 37424783 PMCID: PMC10325861 DOI: 10.3389/fcimb.2023.1205225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/05/2023] [Indexed: 07/11/2023] Open
Abstract
Background The incidence of non-tuberculous mycobacterial pulmonary disease (NTM-PD) has increased in recent years. However, the clinical and immunologic characteristics of NTM-PD patients have received little attention. Methods NTM strains, clinical symptoms, underlying diseases, lung CT findings, lymphocyte subsets, and drug susceptibility tests (DSTs) of NTM-PD patients were investigated. Then, the counts of immune cells of NTM-PD patients and their correlation were evaluated using principal component analysis (PCA) and correlation analysis. Results 135 NTM-PD patients and 30 healthy controls (HCs) were enrolled from 2015 to 2021 in a certain tertiary hospital in Beijing. The number of NTM-PD patients increased every year, and Mycobacterium intracellulare (M. intracellulare), M. abscessus, M. avium, and M. kansasii were the major pathogens of NTM-PD. The main clinical symptoms of NTM-PD patients were cough and sputum production, and the primary lung CT findings were thin-walled cavity, bronchiectasis, and nodules. In addition, we identified 23 clinical isolates from 87 NTM-PD patients with strain records. The DST showed that almost all of M. abscessus and M. avium and more than half of the M. intracellulare and M. avium complex groups were resistant to anti-tuberculosis drugs tested in this study. M. xenopi was resistant to all aminoglycosides. M. kansasii was 100% resistant to kanamycin, capreomycin, amikacin, and para-aminosalicylic acid, and sensitive to streptomycin, ethambutol, levofloxacin, azithromycin, and rifamycin. Compared to other drugs, low resistance to rifabutin and azithromycin was observed among NTM-PD isolates. Furthermore, the absolute counts of innate and adaptive immune cells in NTM-PD patients were significantly lower than those in HCs. PCA and correlation analysis revealed that total T, CD4+, and CD8+ T lymphocytes played an essential role in the protective immunity of NTM-PD patients, and there was a robust positive correlation between them. Conclusion The incidence of NTM-PD increased annually in Beijing. Individuals with bronchiectasis and COPD have been shown to be highly susceptible to NTM-PD. NTM-PD patients is characterized by compromised immune function, non-specific clinical symptoms, high drug resistance, thin-walled cavity damage on imaging, as well as significantly reduced numbers of both innate and adaptive immune cells.
Collapse
Affiliation(s)
- Qi Liu
- Senior Department of Tuberculosis, The 8th Medical Center of PLA General Hospital, Beijing, China
- Hebei North University, Zhangjiakou, Hebei, China
| | - Jingli Du
- Senior Department of Tuberculosis, The 8th Medical Center of PLA General Hospital, Beijing, China
| | - Huiru An
- Senior Department of Tuberculosis, The 8th Medical Center of PLA General Hospital, Beijing, China
| | - Xianan Li
- Senior Department of Tuberculosis, The 8th Medical Center of PLA General Hospital, Beijing, China
| | - Donglin Guo
- Senior Department of Tuberculosis, The 8th Medical Center of PLA General Hospital, Beijing, China
| | - Jiebai Li
- Senior Department of Tuberculosis, The 8th Medical Center of PLA General Hospital, Beijing, China
| | - Wenping Gong
- Senior Department of Tuberculosis, The 8th Medical Center of PLA General Hospital, Beijing, China
| | - Jianqin Liang
- Senior Department of Tuberculosis, The 8th Medical Center of PLA General Hospital, Beijing, China
| |
Collapse
|
9
|
Jarchow-MacDonald A, Smith M, Seagar AL, Russell CD, Claxton P, Laurenson IF, Moncayo-Nieto OL. Changing Incidence and Characteristics of Nontuberculous Mycobacterial Infections in Scotland and Comparison With Mycobacterium tuberculosis Complex Incidence (2011 to 2019). Open Forum Infect Dis 2022; 10:ofac665. [PMID: 36726549 PMCID: PMC9879710 DOI: 10.1093/ofid/ofac665] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
Background An increase in infections with nontuberculous mycobacteria (NTM) has been noted globally, and their incidence has overtaken that of Mycobacterium tuberculosis complex (MTBc) in many countries. Using data from a national reference laboratory, we aimed to determine if this trend could be observed in Scotland. Methods We undertook a retrospective review of all NTM isolates received by the Scottish Mycobacteria Reference Laboratory (SMRL) over 9 years from 2011 to 2019 inclusive. Clinical episodes were defined as per 2017 British Thoracic Society and 2020 American Thoracic Society/European Respiratory Society/European Society of Clinical Microbiology and Infectious Diseases/Infectious Diseases Society of America NTM guidelines. These rates were compared with Scottish tuberculosis rates over the same period. Results Of 8552 NTM isolates from 4586 patients in 2011 to 2019, 7739 (90.5%) were considered clinically relevant. These represented 2409 episodes of NTM infection, with M. avium, M. intracellulare, and M. abscessus complex being most common. A total of 1953 (81.1%) were pulmonary NTM infection episodes from 1470 patients and 456 extrapulmonary episodes from 370 patients. We estimated a rise in incidence from 3.4 to 6.5 per 100 000 person-years (2011-2019 inclusive), with an increase in NTM incidence over MTBc incidence in Scotland by 2017. Conclusions The incidence of NTM infection in Scotland has overtaken MTBc incidence. NTM infection leads to a costly health care burden, possibly as much as UK£1.47 million (US$ and €1.73 million) annually. We recommend standardization of isolate referral with clinical surveillance and implementation of agreed standards of care delivered through multidisciplinary teams. This would improve diagnosis and patient management as well as assessment of diagnostics and novel treatments through clinical trials.
Collapse
Affiliation(s)
- Anna Jarchow-MacDonald
- Correspondence: Anna A. Jarchow-MacDonald, MD, MSc, DTMH, Scottish Mycobacteria Reference Laboratory, NHS Lothian Directorate of Laboratory Medicine, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK (). Dr. Olga-Lucia Moncayo-Nieto, MD, FRCPath, PhD, Scottish Mycobacteria Reference Laboratory, NHS Lothian Directorate of Laboratory Medicine, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK ()
| | - Michael Smith
- Scottish Mycobacteria Reference Laboratory, NHS Lothian Directorate of Laboratory Medicine, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Amie-Louise Seagar
- Scottish Mycobacteria Reference Laboratory, NHS Lothian Directorate of Laboratory Medicine, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Clark D Russell
- Queen's Medical Research Institute, University of Edinburgh Centre for Inflammation Research, Edinburgh, United Kingdom
| | - Pauline Claxton
- Scottish Mycobacteria Reference Laboratory, NHS Lothian Directorate of Laboratory Medicine, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Ian F Laurenson
- Scottish Mycobacteria Reference Laboratory, NHS Lothian Directorate of Laboratory Medicine, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | | |
Collapse
|
10
|
Zimenkov D. Variability of Mycobacterium avium Complex Isolates Drug Susceptibility Testing by Broth Microdilution. Antibiotics (Basel) 2022; 11:1756. [PMID: 36551413 PMCID: PMC9774755 DOI: 10.3390/antibiotics11121756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 11/30/2022] [Accepted: 11/30/2022] [Indexed: 12/09/2022] Open
Abstract
Non-tuberculous mycobacteria are widely distributed in environments and are capable of infecting humans, particularly those with a compromised immune system. The most prevalent species that cause nontuberculous mycobacterial lung diseases are slow-growing bacteria from the Mycobacterium avium complex (MAC), mainly M. avium or M. intracellulare. The key treatment of MAC infections includes macrolides, ethambutol, and rifampicin; however, the therapy outcomes are unsatisfactory. Phenotypic drug susceptibility testing is a conditional recommendation prior to treatment, and critical concentrations for clarithromycin, amikacin, moxifloxacin, and linezolid have been established. In this review, data from studies on the determination of MIC of clinical isolates using the broth microdilution method were summarized. A significant variation in the MIC distributions from different studies was found. The main reasons could impact the findings: insufficient reproducibility of the phenotypic testing and variation in species lineages identified in different laboratories, which could have various intrinsic susceptibility to drugs. For most of the drugs analyzed, the MICs are too high, which could undermine the treatment efficiency. Further improvement of treatment outcomes demands the validation of microbiological resistance criteria together with the identification of molecular mechanisms of resistance.
Collapse
Affiliation(s)
- Danila Zimenkov
- Center for Precision Genome Editing and Genetic Technologies for Biomedicine, Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, 119991 Moscow, Russia
| |
Collapse
|
11
|
Global trends of pulmonary infections with nontuberculous mycobacteria: a systematic review. Int J Infect Dis 2022; 125:120-131. [PMID: 36244600 DOI: 10.1016/j.ijid.2022.10.013] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/21/2022] [Accepted: 10/07/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To describe the global trends of pulmonary nontuberculous mycobacteria (NTM) infection and disease. METHODS A systematic review of studies including culture-based NTM data over time. Studies reporting on pulmonary NTM infection and/or disease were included. Information on the use of guideline-based criteria for disease were collected, in which, infection is defined as the absence of symptoms and radiological findings compatible with NTM pulmonary disease. The trends of change for incidence/prevalence were evaluated using linear regressions, and the corresponding pooled estimates were calculated. RESULTS Most studies reported increasing pulmonary NTM infection (82.1%) and disease (66.7%) trends. The overall annual rate of change for NTM infection and disease per 100,000 persons/year was 4.0% (95% confidence interval [CI]: 3.2-4.8) and 4.1% (95% CI: 3.2-5.0), respectively. For absolute numbers of NTM infection and disease, the overall annual change was 2.0 (95% CI: 1.6-2.3) and 0.5 (95% CI: 0.3-0.7), respectively. An increasing trend was also seen for Mycobacterium avium complex infection (n = 15/19, 78.9%) and disease (n = 10/12, 83.9%) and for Mycobacterium abscessus complex (n = 15/23, 65.2%) infection (n = 11/17, 64.7%) but less so for disease (n = 2/8, 25.0%). CONCLUSION Our data indicate an overall increase in NTM worldwide for both infection and disease. The explanation to this phenomenon warrants further investigation.
Collapse
|
12
|
van der Laan R, Snabilié A, Obradovic M. Meeting the challenges of NTM-PD from the perspective of the organism and the disease process: innovations in drug development and delivery. Respir Res 2022; 23:376. [PMID: 36566170 PMCID: PMC9789522 DOI: 10.1186/s12931-022-02299-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 12/15/2022] [Indexed: 12/25/2022] Open
Abstract
Non-tuberculous mycobacterial pulmonary disease (NTM-PD) poses a substantial patient, healthcare, and economic burden. Managing NTM-PD remains challenging, and factors contributing to this include morphological, species, and patient characteristics as well as the treatment itself. This narrative review focusses on the challenges of NTM-PD from the perspective of the organism and the disease process. Morphological characteristics of non-tuberculous mycobacteria (NTM), antimicrobial resistance mechanisms, and an ability to evade host defences reduce NTM susceptibility to many antibiotics. Resistance to antibiotics, particularly macrolides, is of concern, and is associated with high mortality rates in patients with NTM-PD. New therapies are desperately needed to overcome these hurdles and improve treatment outcomes in NTM-PD. Amikacin liposome inhalation suspension (ALIS) is the first therapy specifically developed to treat refractory NTM-PD caused by Mycobacterium avium complex (MAC) and is approved in the US, EU and Japan. It provides targeted delivery to the lung and effective penetration of macrophages and biofilms and has demonstrated efficacy in treating refractory MAC pulmonary disease (MAC-PD) in the Phase III CONVERT study. Several other therapies are currently being developed including vaccination, bacteriophage therapy, and optimising host defences. Newly developed antibiotics have shown potential activity against NTM-PD and include benzimidazole, delamanid, and pretomanid. Antibiotics commonly used to treat other infections have also been repurposed for NTM-PD, including clofazimine and bedaquiline. Data from larger-scale studies are needed to determine the potential of many of these therapies for treating NTM-PD.
Collapse
|
13
|
van Ingen J, Obradovic M, Hassan M, Lesher B, Hart E, Chatterjee A, Daley CL. Nontuberculous mycobacterial lung disease caused by Mycobacterium avium complex - disease burden, unmet needs, and advances in treatment developments. Expert Rev Respir Med 2021; 15:1387-1401. [PMID: 34612115 DOI: 10.1080/17476348.2021.1987891] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Nontuberculous mycobacterial (NTM) lung disease (LD) is the most common clinical manifestation of NTM infection and is a growing health concern. Up to 85% of NTM-LD cases are caused by Mycobacterium avium complex (MAC). Increased awareness of NTM-LD caused by MAC is needed as patients with this disease experience substantial burden and unmet treatment needs. AREAS COVERED This review provides clinicians and regulatory and healthcare decision makers an overview of the clinical, economic, and humanistic burden of NTM-LD and the unmet treatment needs faced by patients and clinicians. The review focuses on NTM-LD caused by MAC. A summary of the 2020 NTM guidelines specifically for MAC-LD and an overview of novel treatment options, including amikacin liposome inhalation suspension (ALIS) as the first approved therapy for refractory MAC-LD, and investigational drugs in testing phase are provided. EXPERT OPINION Key advancements in NTM-LD management include recent updates to clinical practice guidelines, approval of ALIS for the treatment of refractory MAC-LD, and ongoing clinical trials of investigational treatments. Yet opportunities still exist to improve patient outcomes, including development of better screening tools, such as reliable and responsive biomarkers to help identify high-risk patients, and addressing unmet treatment needs.
Collapse
Affiliation(s)
- Jakko van Ingen
- Radboudumc Center for Infectious Diseases, Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | | | | | | | - Charles L Daley
- Department of Medicine, National Jewish Health, Denver, Co, and the University of Colorado School of Medicine, Aurora, CO, US
| |
Collapse
|