Epidemiology of and risk factors for extrapulmonary nontuberculous mycobacterial infections in Northeast Thailand

Abstract

BackgroundNontuberculous mycobacterial (NTM) infection is increasing worldwide. Current epidemiological data and knowledge of risk factors for this disease are limited. We investigated the trends in and risk of NTM infection in Northeast Thailand during 2012–2016.MethodsPatient demographics, infection site(s), and underlying disease or conditions from 530 suspected cases of NTM infections were retrieved from medical records, reviewed and analyzed. A diagnosis of true NTM infection was accepted in 150 cases. Risk factor analyses were done for extrapulmonary NTM infections compared to pulmonary NTM infections and for Mycobacterium abscessus compared to members of the Mycobacterium avium complex (MAC). Trend analysis among NTM species causing NTM infections was performed.ResultsThe most common species of NTMs causing extrapulmonary (n = 114) and pulmonary (n = 36) NTM infections in Northeast Thailand were M. abscessus (25.4% of extrapulmonary infected cases and 27.8% of pulmonary cases) followed by MAC (14.9% of extrapulmonary and 13.9% of pulmonary cases). Presence of anti-IFN-γ autoantibodies was the major risk factor for extrapulmonary (odds ratio (OR) = 20.75, 95%CI [2.70–159.24]) compared to pulmonary NTM infection. M. abscessus infection was less likely (OR = 0.17; 95%CI [0.04–0.80]) to be found in patients with HIV infection than was MAC infection. The prevalence of NTM infection, especially M. abscessus, in Northeast Thailand has recently increased. Extrapulmonary NTM and complicated NTM infections have increased in concordance with the recent trend of increasing frequency of anti-IFN-γ autoantibodies in the population.ConclusionsM. abscessus was the commonest NTM pathogen followed by MAC. The prevalence of NTM infections and anti-IFN-γ are showing an upward trend. Autoimmune disease due to anti-IFN-γ is the major risk factor for extrapulmonary NTM infection in Northeast Thailand.

Retrospective analysis of patients with non-tuberculous mycobacteria from a primary hospital in Southeast China

“…The patients with NTM infection more likely showed defect in signal transduction of IFN-γ/IL-12 axis, especially in patients with disseminated NTM diseases 14 . Besides, the patients with NTM infection commonly express high levels of anti-IFN-γ autoantibodies and suffer from recurrent infection 15,16 . www.nature.com/scientificreports www.nature.com/scientificreports/ NTM was more likely to infect older females as reported previously 1,17,18 ; this may suggest that estrogen has a protective role against NTM 18 .…”

Evaluation of plasma anti-GPL-core IgA and IgG for diagnosis of disseminated non-tuberculous mycobacteria infection

“…Non-tuberculous mycobacteria (NTM) are poorly pathogenic for humans but they can cause infection in people with underlying conditions [1]. The prevalence of opportunistic infections with NTM in pre-disposed hosts has been increasing worldwide [2][3][4][5]. Infection with NTM can be localized or disseminated and have different clinical manifestations [6].…”

Nontuberculous Mycobacteria – Clinical and Laboratory Diagnosis: Experiences from a TB Endemic Country

“…A case of extrapulmonary NTM infection was defined as having >1 isolate from skin/soft tissue (wound, abscess, tissue or exit catheter); disseminated sites (blood, bone marrow, cerebrospinal fluid, pericardial fluid or peritoneal fluid); lymph node; joint (synovial tissue or joint fluid); or other sites (urine, eye, sinus or nasopharyngeal) [ 17 , 18 ].…”