Epidemiology, clinical presentation, and predictors of outcome in nontuberculous mycobacterial central nervous system infection: a systematic review

Abstract

Background CNS manifestations represent an emerging facet of NTM infection with significant mortality. Due to protean presentation and low index of suspicion, many cases are often treated erroneously as tubercular meningitis or fungal infections. Objectives Literature on NTM CNS disease is scarce, with most available data on pulmonary disease. This systematic review aimed to evaluate the epidemiology, clinical presentation, diagnostic modalities, and predictors of outcome in CNS NTM infection. Methods The literature search was performed in major electronic databases (PubMed, Google Scholar, and Scopus) using keywords “CNS,” “Central nervous system,” “brain abscess,” “meningitis,” “spinal,” “Nontuberculous mycobacteria,” “NTM”. All cases of CNS NTM infection reported between January 1980 and December 2022 were included. Results A total of 77 studies (112 cases) were included in the final analysis. The mean age of all patients was 38 years, with most patients male (62.5%). Mycobacterium avium complex (MAC) was the most common aetiology, followed by M. fortuitum and M. abscessus (34.8%, 21.4% and 15.2%, respectively). The disseminated disease was found in 33% of cases. HIV (33.9%) and neurosurgical hardware (22.3%) were the common risk factors. Intracranial abscess (36.6%) and leptomeningeal enhancement (28%) were the most prevalent findings in neuroimaging. The overall case fatality rate was 37.5%. On multivariate analysis, male gender (adjusted OR 2.4, 95% CI 1.2–7.9) and HIV (adjusted OR 3.7, 95% CI 1.8–6.1) were the independent predictors of mortality). M. fortuitum infection was significantly associated with increased survival (adjusted OR 0.18, 95% CI (0.08–0.45), p value 0.012). Conclusions Current evidence shows the emerging role of rapid-grower NTM in CNS disease. Male gender and HIV positivity were associated with significant mortality, while M fortuitum carries favourable outcomes.

Disseminated mycobacterium genavense infection with central nervous system involvement in an HIV patient: a case report and literature review

“…The NTM infection has a poor prognosis, with a mortality rate estimated at 32–39.3% among HIV patients [ 5 , 12 ], which illustrates the pathogen’s invasiveness and ineffective treatment methods. A recent systematic review of NTM CNS infections reported a 37.5% case fatality rate; although this review did not include any M. genavense cases [ 32 ].…”

Intracranial infection caused by Mycobacterium rhodesiae with specific imaging findings and good response to medication: a case report and literature review

“…In our review of the literature, cases span from the 1960s to the present. By the end of December 2023, there were 114 cases of intracranial NTM infection reported or summarized in the literature (5,6,(8)(9)(10)(11)(12)(13)(14)(15)(16)(21)(22)(23)(24)(25)(26)(27). Antonia Flor et al reported two cases and identified 50 cases of NTM meningitis in the English-language literature before 1994 (8).…”

“…In general, patients with Mycobacterium fortuitum infection tend to have a lower death rate and may exhibit less drug resistance when compared to those with Mycobacterium abscessus (5). Previous literature also indicated that a high CSF protein level is a risk factor for poor outcomes (27). However, further exploration and data accumulation is required to know whether intracranial infection caused by Mycobacterium rhodesiae could have a better outcome and exhibit less drug resistance as compared to other species.…”

Difficulty in diagnosing intracranial infection caused by Mycobacterium avium in an AIDS patient: case report and review of the literature

“…Mycobacterium avium complex (MAC) was the most common etiology, followed by M. fortuitum and M. abscesses (34.8%, 21.4%, and 15.2%, respectively). The overall case fatality rate was 37.5% [ 2 ]. Since the prevalence of acquired immunodeficiency syndrome (AIDS), NTM infection has increased [ 3 ].…”