Nontuberculous mycobacterial lung disease: ecology, microbiology, pathogenesis, and antibiotic resistance mechanisms

Kim, Su‐Young; Han, Se Hee; Kim, Dae Hun; Koh, Won‐Jung

doi:10.23838/pfm.2017.00135

Cited by 8 publications

(5 citation statements)

References 173 publications

(131 reference statements)

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“…Nontuberculous mycobacteria (NTM) are a large group of naturally-occurring mycobacteria, ubiquitous in the environment like soil and water [1–3]. NTM are very diverse organisms, comprising over 170 species with different virulence features [4]. Some species are opportunistic pathogens for human beings, which could cause severe pulmonary and non-pulmonary diseases [2, 5, 6].…”

Section: Introductionmentioning

confidence: 99%

Characterization of non-tuberculous mycobacterial pulmonary disease in Nanjing district of China

Huang

Cai

et al. 2019

BMC Infect Dis

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Background Environmental bacteria, nontuberculous mycobacteria (NTM), are recognized as one of the major human infection pathogens. NTM are prone to be mistaken as multidrug-resistant Mycobacterium tuberculosis and challenge our fight against TB. In addition, treatment of NTM per se is intractable. Remarkably, the distribution of NTM pathogenic species is geographically specific. Thus, it is very important to summarize the prevalent features and clinical symptoms of NTM pulmonary disease. However, In Nanjing district, southeast China, there is no such a report. Methods Through investigating electronic medical records and analyzing data of clinical examination system (Lis), we retrospectively summarized the NTM species from 6012 clinical isolates from May 2017 to August 2018, and analyzed the association between NTM species and clinical symptoms. Results Of 6012 clinical specimens, 1461 (24.3%) could grow in the MGIT 960 broth. Among these positive isolates, 1213 (83%) were M. tuberculosis , 22 (1.5%) were M. bovis , and 226 (15.5%) were NTM. After deducting redundancy, those NTM specimens were confirmed from 154 patients, among which, 87 (56.5%) patients met the full ATS/IDSA NTM disease criteria. The most common etiologic agent was M. intracellulare (70.1%). NTM infection was associated with age, based on which 68.6% male patients and 77.8% female patients were over 50 years old. The older patients were more likely to have hemoptysis, but the younger patients were more likely to manifest chest congestion. Male patients were more likely to have shortness of breath and females were more likely to have hemoptysis. The most common radiographic presentation of NTM pulmonary disease was bronchiectasis, accounting for 39.1%. Remarkably, multiple and thin-walled cavities were outstanding. The most frequent comorbidity of NTM disease was previous tuberculosis (64%), followed by clinical bronchiectasis (19.5%), HIV (19.5%), and 6.9% chronic obstructive pulmonary disease (COPD). There was no association between NTM species and clinical symptoms. Conclusion This study retrospectively investigated the prevalence of NTM pulmonary disease in Nanjing district, southeast China. Similar to Beijing area, north China, M. intracellulare was the major pathogenic NTM species. Clinical symptoms of the disease were not species-specific. Previous TB and HIV infection immensely enhanced risk of NTM disease.

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Section: Introductionmentioning

confidence: 99%

Characterization of non-tuberculous mycobacterial pulmonary disease in Nanjing district of China

Huang

Cai

et al. 2019

BMC Infect Dis

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“…[ 23 ]. In addition, point mutations for aminoglycoside, macrolide, and rifampin resistance have been described for nontuberculous mycobacteria (NTM) [ 25 ]. Point mutations in ampD , whose protein product controls the beta-lactamase AmpC expression, have been described for B. multivorans [ 23 ].…”

Section: Antibiotic Resistance and Tolerancementioning

confidence: 99%

Adaptation and Evolution of Pathogens in the Cystic Fibrosis Lung

Planet

2022

Journal of the Pediatric Infectious Diseases Society

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As opposed to acute respiratory infections, the persistent bacterial infections of the lung that characterize cystic fibrosis (CF) provide ample time for bacteria to evolve and adapt. The process of adaptation is recorded in mutations that accumulate over time in the genomes of the infecting bacteria. Some of these mutations lead to obvious phenotypic differences such as antibiotic resistance or the well-known mucoid phenotype of Pseudomonas aeruginosa. Other mutations may be just as important but harder to detect such as increased mutation rates, cell surface changes, and shifts in metabolism and nutrient acquisition. Remarkably, many of the adaptations occur again and again in different patients, signaling that bacteria are adapting to solve specific challenges in the CF respiratory tract. This parallel evolution even extends across distinct bacterial species. This review addresses the bacterial systems that are known to change in long-term CF infections with a special emphasis on cross-species comparisons. Consideration is given to how adaptation may impact health in CF, and the possible evolutionary mechanisms that lead to the repeated parallel adaptations.

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“…Reduced antibiotic susceptibility is conferred by the relative impermeability of the NTM cell wall, the intracellular localization of the NTM organism, and -for extracellular NTM in the airways -growth in biofilms [10,11]. Intracellular growth and biofilms play important roles in the clinical course of pulmonary mucosal infection by NTM and could explain both the chronic nature of and the difficulty of treating NTM-LD, including infections caused by MAC [6,10,11].…”

Section: Pathogenesismentioning

confidence: 99%

Nontuberculous mycobacterial lung disease caused by Mycobacterium avium complex - disease burden, unmet needs, and advances in treatment developments

Ingen

Obradović

Hassan³

et al. 2021

Expert Review of Respiratory Medicine

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Introduction: Nontuberculous mycobacterial (NTM) lung disease (LD) is the most common clinical manifestation of NTM infection and is a growing health concern. Up to 85% of NTM-LD cases are caused by Mycobacterium avium complex (MAC). Increased awareness of NTM-LD caused by MAC is needed as patients with this disease experience substantial burden and unmet treatment needs. Areas covered: This review provides clinicians and regulatory and healthcare decision makers an overview of the clinical, economic, and humanistic burden of NTM-LD and the unmet treatment needs faced by patients and clinicians. The review focuses on NTM-LD caused by MAC. A summary of the 2020 NTM guidelines specifically for MAC-LD and an overview of novel treatment options, including amikacin liposome inhalation suspension (ALIS) as the first approved therapy for refractory MAC-LD, and investigational drugs in testing phase are provided. Expert opinion: Key advancements in NTM-LD management include recent updates to clinical practice guidelines, approval of ALIS for the treatment of refractory MAC-LD, and ongoing clinical trials of investigational treatments. Yet opportunities still exist to improve patient outcomes, including development of better screening tools, such as reliable and responsive biomarkers to help identify high-risk patients, and addressing unmet treatment needs.

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Nontuberculous mycobacterial lung disease: ecology, microbiology, pathogenesis, and antibiotic resistance mechanisms

Cited by 8 publications

References 173 publications

Characterization of non-tuberculous mycobacterial pulmonary disease in Nanjing district of China

Characterization of non-tuberculous mycobacterial pulmonary disease in Nanjing district of China

Adaptation and Evolution of Pathogens in the Cystic Fibrosis Lung

Nontuberculous mycobacterial lung disease caused by Mycobacterium avium complex - disease burden, unmet needs, and advances in treatment developments

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