Clinical characteristics of non-tuberculous mycobacterial pulmonary infections in Bamako, Mali

Abstract

SUMMARY The global spread of Nontuberculous Mycobacteria (NTM) may be due to HIV/AIDS and other environmental factors. The symptoms of NTM and tuberculosis (TB) disease are indistinguishable, but their treatments are different. Lack of research on the epidemiology of NTM infections has led to underestimation of its prevalence within TB endemic countries. This study was design to determine the prevalence and clinical characteristics of pulmonary NTM in Bamako. A cross-sectional study which include 439 suspected cases of pulmonary TB. From 2016 to 2013 a total of 332 (76%) were confirmed to have sputum culture positive for Mycobacteria.The prevalence of NTM infection was 9.3% of our study population and 12.3% of culture positive patients.The seroprevalence of HIV in NTM group was 17.1%. Patients who weighed less than 55 kg and had TB symptoms other than cough were also significantly more likely to have disease due to NTM as compared to those with TB diease who were significantly more likely to have cough and weigh more than 55 kg (OR: 0.05 [CI: 0.02 – 0.13] and OR: 0.32 [CI: 0.11–0.93] respectively). NTM disease burden in Bamako was substantial and diagnostic algorithms for pulmonary diseae in TB endemic countries should consider the impact of NTM.

Development and clinical evaluation of a new multiplex PCR assay for a simultaneous diagnosis of tuberculous and nontuberculous mycobacteria

“… [9] Our most recent data from Mali also confirmed a 12% prevalence of NTM in all TB suspects (new and previously treated) seen at the major TB Referral Center at the Point-G Hospital of Bamako. [12] Similar data have been reported from Kenya, Burkina Faso and Nigeria. [39] , [40] , [41] Although it is not understood why MAC and other NTM diseases have been increasing worldwide including traditionally TB endemic setting, [7] environmental changes, aging, HIV/AIDS and use of immunosuppressors are known to be associated factors.…”

“…[9,11] In Mali, we recently reported that NTM infections was identified in 18% of clinically classified chronic TB cases. [9,12] We also reported that 12% of all patients in Mali with presumptive TB are in fact infected with NTM. [9] Nearly 73% of the NTM cases, are caused by Mycobacterium avium complex (MAC).…”

“…[5] Mycobacterium avium complex (MAC) is the most frequently associated with pulmonary disease, causing up to half of NTM cases worldwide. [6][7][8] In developing countries where TB is endemic, our group and others have shown that failure to recognize NTM infections commonly leads to misdiagnosis of lung disease presenting with nonspecific symptoms like coughs, fever and weight loss. [9,10] This results in inappropriate empiric treatment that is lengthy, expensive, toxic, and may result in the development TB drug resistance.…”

“… [5] Mycobacterium avium complex (MAC) is the most frequently associated with pulmonary disease, causing up to half of NTM cases worldwide. [6] , [7] , [8] …”

Pulmonary and Extra-Pulmonary Tuberculosis: Epidemiological and Diagnostic Aspects at Somin&eacute DOLO Hospital in Mopti

“…The sensitivity of the chest X-ray was 31.6% (25/79), having made it possible to find mainly cavitary images and miliaries. In the literature, approximately 36.7% of radiographic images in immunocompetent subjects are generally atypical [12]. This constitutes a limit in the diagnosis of pulmonary forms.…”