Nontuberculous mycobacteria in non‐HIV patients: epidemiology, treatment and response

Abstract

Recent international guidelines published in 1997 and 1999 have proposed diagnostic and treatment criteria for disease caused by nontuberculous mycobacteria (NTM).In this paper, the epidemiological data, diagnostic criteria, treatment regimens and outcomes from 117 HIV‐negative patients who had a positive culture for NTM between 1995–1999 are reviewed. The authors wished to identify factors associated with improved outcome in these patients.A total of 71 patients were believed to have a clinical disease caused by NTM, as defined by international criteria. A total of 72% patients were found to have had pulmonary disease. There was a rise in infections between 1995–1999, with a peak in infections in 1997. The most striking rise was inMycobacterium aviumintracellulare complex infections (1995: 33% infections; 1996: 36% infections; 1997: 41% infections; 1998: 61% infections; 1999: 57% infections). There was a link between deprivation and number of positive NTM isolates (34.4% isolates occurred in the areas of lowest Carstairs deprivation indexversus20.6% isolates from areas of least deprivation). There was a significant association between appropriate therapy, defined by American Thoracic Society and British Thoracic Society guidelines, and successful outcome (74%) in contrast to those who received inappropriate treatment prior to the publication of these guidelines.Nontuberculous mycobacteria infections remain a significant problem in non‐HIV patients. Adherence to published guidelines may improve patient outcomes.

Mycobacterium noviomagense sp. nov.; clinical relevance evaluated in 17 patients

“…To determine clinical relevance, we examined the medical records of all 17 patients; their baseline characteristics are displayed in Table 1. The predominance of male patients, mean age and history of chronic pulmonary disease are comparable with previous NTM studies (Griffith et al, 2007;Henry et al, 2004). None of the patients had clinical and radiographic features suggestive of mycobacterial lung disease; one was systemically immunocompromised due to HIV co-infection.…”

Micobacterias atípicas en cinco pacientes adultos sin evidencias de inmunosupresión: Construyendo una experiencia

“…Este problema ha sido abordado por al menos dos guías extranjeras que exigen varias muestras positivas junto a alteraciones pulmonares para establecer el diagnóstico de enfermedad pulmonar atribuible y por ende justificar la terapia 2,11 . Dos de nuestros tres casos pulmonares, cumplieron con los criterios de la British Thoracic Society y de la American Thoracic Society publicados el año 1997 para establecer la existencia de enfermedad pulmonar 2 .…”

“…Varios estudios dan cuenta de un aumento de los aislamientos clínicos de este grupo de agentes, especialmente entre la población sin infección por VIH o SIDA en países desarrollados. Por ejemplo, en el Reino Unido se ha observado un incremento en el número de aislamientos desde 0,9 por 100.000 el año 1995 a cifras de 2,9 casos por 100.000 el 2006 1,2 . Este aumento de casos se ha focalizado especialmente en personas a partir de los 65 años e incluye varias especies, especialmente en muestras de origen pulmonar 1 .…”

Nontuberculous Mycobacterial Pulmonary Disease

“…It has been shown in multiple already published studies that geography has a prominent role in the epidemiology of NTM pulmonary disease. Thus, M. xenopi is relatively more common in the south-east and in the west of Europe (Marusic et al, 2009;van Ingen et al, 2008;Hanry et al, 2004;Dailloux et al, 2006) and in Canada (Varadi & Marras, 2009), while M. malmoense is relatively more common in the north of Europe (Abgueguen et al, 2010;Petrini, 2006;Thomsen et al, 2002;Henry et al, 2004).…”

“…Since reporting NTM pulmonary disease to public health departments is not obligatory, the exact number of the infected remains unknown. An increase in the frequency of NTM infections and NTM pulmonary disease has been indicated in a number of worldwide surveys and populationbased studies during the last few decades (AST, 2007;Maras et al, 2007;Iseman & Marras, 2008;Henry et al, 2004;Thomson & Yew, 2009). …”