First Case Reports of Nontuberculous Mycobacterial (NTM) Lung Disease in Ecuador: Important Lessons to Learn

Abstract

Nontuberculous mycobacteria (NTM) lung infections are often misdiagnosed as tuberculosis, which can lead to ineffective antibiotic treatments. In this report, we present three cases of NTM lung infections in Ecuador that were initially diagnosed and treated as tuberculosis based on the results of sputum smear microscopy. The patients, all male, included two immunocompetent individuals and one HIV-positive subject. Unfortunately, sputum culture was not initiated until late in the course of the disease and the cause of the lung infection, Mycobacterium avium complex (MAC), was only identified after the patients had either passed away or were lost to follow-up. These cases are the first documented cases of NTM lung infections in the English medical literature from Ecuador. We emphasize the importance of accurate diagnosis of NTM infections by culture and identification to species level. Sputum smear staining alone cannot differentiate between mycobacterial species, which can lead to misidentification and ineffective treatments. Additionally, reporting NTM pulmonary disease as a notifiable disease to national TB control programs is recommended to obtain accurate prevalence data. These data are critical in determining the importance of this public health problem and the necessary actions needed to address it.

Rapid and accurate identification and differentiation of Mycobacterium tuberculosis and non-tuberculous mycobacteria using PCR kits available in a high-burden setting

“…According to one of those reports from 2022, the overall annual rate of change for NTM infection and disease per 100,000 persons/year was 4.0 and 4.1%, respectively ( 16 , 17 ). Although no prevalence studies for NTM in Ecuador have ever been done, there are some recent case reports of pulmonary plastic surgery-associated infections caused by NTM ( 18 , 19 ).…”

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“…The first documented cases of NTMB pulmonary infections in the English medical literature from Ecuador were reported by Echeverria et al (2023). In Denmark (Dahl et al, 2023), the incidence rate fluctuated from 1.3 (2013) to 2.5 (2021) per 100 thousand people.…”