Simultaneous diagnosis of tuberculous and non-tuberculous mycobacterial diseases: Time for a better patient management

Abstract

Tuberculosis (TB) is the deadliest infectious disease in the world which disproportionately affects low-and-middle-income countries (LMICs) where diagnostic resources and treatment options are limited. The incidence of pulmonary non-tuberculous mycobacteria (NTM) disease is also rapidly increasing in these regions traditionally dominated by TB infections. This poses significant diagnostic and treatment challenges, since these two diseases are often indistinguishable clinically or by sputum smear microscopy (SSM), the most commonly used TB diagnostic tool in LMICs. Consequently, NTM-infected patients usually receive unnecessary TB treatment for months. TB patients with NTM co-infections may also be treated incorrectly due to inaccurate SSM and Xpert™ MTB/RIF (M. tuberculosis./rifampin) results. These issues complicate the management of patients and contribute to the worsening of the current TB and NTM epidemiological features including development of drug resistant strains. It is therefore critical to develop improved diagnostic tools to accurately distinguish these two different pathogens that have many similar clinical and epidemiological features but have different treatment regimens. In this review, we will discuss limitations with current diagnostic tools and the need to develop novel techniques that can accurately and simultaneously diagnose TB and NTM disease._

Significance of isolating non‐tuberculous mycobacterial organisms in infertile women with tubal disease: an observational study

“…23 Reports from the literature as well as our findings suggest the need for increased clinical awareness as to the possibility of co-existing MTB and NTM infections.…”

“…These are two different pathogens that have many similar clinical and epidemiological features but that have different treatment regimens. 23…”

Trends in the Prevalence and Antibiotic Resistance of Non-tuberculous Mycobacteria in Mainland China, 2000–2019: Systematic Review and Meta-Analysis

“…NTM are generally environmental bacteria, so it is reasonable that specific environmental factors relating to soil, water, and temperature can affect the distribution of NTM species and the risk of NTM disease, leading to specific geographic characteristics and time variation. Research showed that MAC was the most common species worldwide, accounting for 34–61% of all NTM isolates ( 19 ), followed by M. gordonae, M. xenopi , and M. kansasii , and M. fortuitum was the most common rapid mycobacterial grower ( 20 ). Regional analyses showed that M. kansasii was the most common species in Slovakia and Poland, M. xenopi in Central, Southern, and Western Europe, M. malmoense in Northern Europe, and M. abscessus complex in North America, Taiwan, Australia, and South Korea ( 19 , 21 ).…”

Epidemiology, diagnosis & treatment of non-tuberculous mycobacterial diseases

“…In high tuberculosis (TB)-burden countries, diagnosis of NTM is rarely made because of lack of awareness among healthcare providers about the NTM diseases and poor access to adequate laboratory resources including mycobacterial culture and molecular methods for identification or speciation 10 . In these resource-limited settings, there is a heavy reliance on smear microscopy for the diagnosis of TB, and the diagnosis of NTM is frequently missed and these patients are empirically treated as drug-sensitive and -resistant TB 11 .…”