Nontuberculous mycobacteria in Middle East: Current situation and future challenges

Abstract

Nontuberculous mycobacteria (NTM) are a diverse group of bacterial species that are distributed in the environment. Many of these environmental bacteria can cause disease in humans. The identification of NTM in environmental sources is important for both clinical and epidemiological purposes. In this study, the distribution of NTM species from environmental and clinical samples in the Middle East was reviewed. In order to provide an overview of NTM, as well as recent epidemiological trends, all studies addressing NTM in the Middle East from 1984 to 2014 were reviewed. A total of 96 articles were found, in which 1751 NTM strains were isolated and 1084 of which were obtained from clinical samples, 619 from environmental samples and 48 were cited by case reports. Mycobacterium fortuitum was the most common rapid growing mycobacteria (RGM) isolated from both clinical (269 out of 447 RGM; 60.1%) and environmental (135 out of 289 RGM; 46.7%) samples. Mycobacterium avium complex (MAC) was the most common slow growing mycobacteria (SGM) isolated from clinical samples (140 out of 637 SGM; 21.9%). An increasing trend in NTM isolation from the Middle East was noted over the last 5years. This review demonstrates the increasing concern regarding NTM disease in the Middle East, emphasizing the need for regional collaboration and coordination in order to respond appropriately.

Nontuberculous Mycobacteria in Saudi Arabia and Gulf Countries: A Review

“…One explanation of this huge difference in the burden of NTM diversity in Saudi Arabia and the rest of Gulf region could be due to a better clinical coverage of NTM in Saudi Arabia compared to the small sample size reported from Kuwait and Oman (14 and 13 clinical isolates, resp.). In line with this explanation, similar diversity trend noted from Saudi Arabia has been also reported from neighbors of the GCC countries, constituting other regions of the Middle East, with various extents, such as that reported from Iran (12 species of NTM) and Turkey (18 species of NTM) [28, 29, 33]. Alternatively, Saudi Arabia might be under higher vulnerability to NTM exposure and infection when compared with other GCC countries.…”

“…M. avium complex and M. kansasii were found in Saudi Arabia with the uppermost number of reported clinical isolates compared to Kuwait and Oman (Table 1). In fact, the diversity burden of M. avium complex and M. kansasii exceeds the Gulf region and covers most regions of the Middle East with a clinical rate of 12.9% and 9.4%, respectively [14, 17–19, 22–29]. …”

Nontuberculosis mycobacterial infections at a specialized tuberculosis treatment centre in the Republic of Korea

“…Misdiagnosis or delayed diagnosis of NTM, due to similarity in clinical presentation to Tb, can result in inappropriate isolation with psychosocial stress [15] and serious morbidity and mortality [3]. Traditional culture methods, which take up to 6 weeks, may be required in order to differentiate the Tb and NTM [21].…”

“…Reporting NTM infections to public health authorities is not mandatory, as opposed to reporting of Tb, in most regions of the world. Therefore, precise epidemiological and surveillance data are lacking [1, 3]. This has limited our knowledge and understanding of the impact of NTM infections on public health [3], leading to human infections by mycobacterial persistence and dissemination within healthcare units [4].…”

“…Therefore, precise epidemiological and surveillance data are lacking [1, 3]. This has limited our knowledge and understanding of the impact of NTM infections on public health [3], leading to human infections by mycobacterial persistence and dissemination within healthcare units [4]. Understanding the trends and true prevalence of NTM is a major priority for optimizing infection control programmes and resources [5].…”