Socio-Economic and Environmental Factors Related to Spatial Differences in Human Non-Tuberculous Mycobacterial Diseases in the Czech Republic

Abstract

Non-tuberculous mycobacteria (NTM) are ubiquitous environmental bacteria that can induce pulmonary and non-pulmonary diseases in susceptible persons. It is reported that the prevalence of NTM diseases is increasing in developed countries, but this differs by regions and countries. NTM species distribution and the rate of diseases caused by NTM vary widely in the historical territories of Moravia and Silesia (Czech Republic). This epidemiologic study of NTM diseases covers the period 2012–2018, reviews isolates obtained from patients with clinical disease and investigates correlations with related socio-economic and environmental factors. Individual NTM patients were included only once during the studied period and results were presented as incidence rate per year. The most frequently isolated NTM meeting the microbiological and clinical criteria in the study were the Mycobacterium avium-intracellulare complex, followed by Mycobacterium kansasii and Mycobacterium xenopi. A previously described endemic incidence of M. kansasii in the Karviná district and M. xenopi in the Ostrava district was also observed in this study. The incidence of NTM patients in the whole studied territory was 1.10/100,000 inhabitants (1.33/100,000 in men and 0.88/100,000 in women). The annual incidence of lymphadenitis in children (≤5 years of age) was 2.35/100,000 of the population of children during the 7 year period but increased in the year 2018 to 5.95/100,000. The rate of human tuberculosis in the studied area was 1.97/100,000 inhabitants. The incidence of NTM pulmonary diseases correlated with a lower socio-economic status (r = 0.63) and a higher concentration of benzo[a]pyrene pollution in the air (r = 0.64).

Non-Tuberculous Mycobacterial Diseases in Children

“…On the other hand, local risk factors include conditions that cause disruption of the skin barrier and promote NTM colonization (i.e., skin laser cosmetic surgery, LASIK, catheters) or lung disease, such as cystic fibrosis, especially in adolescents, bronchopulmonary aspergillosis or Staphylococcus aureus colonization, bronchiectasis itself, tuberculosis, chronic obstructive pulmonary disease (COPD), asthma, and every condition that alters parenchymal structure and bronchial epithelium integrity (i.e., air pollution in industrial areas causes the production of reactive oxygen species and secondary inflammatory responses in the lung) [9,11,12].…”

Nontuberculous mycobacterial pulmonary disease: an integrated approach beyond antibiotics

“…Living in an urban or in a rural setting has been associated with altered rates and patterns of NTM infection; for example, living in an area of higher population density was associated with M. kansasii infection, whereas M. avium complex has been associated with living in rural areas [9]. A recent epidemiologic study found a correlation between the incidence of NTM-PD and higher air concentration of particulate matter and benzo[a]pyrene, a polycyclic aromatic hydrocarbon, suggesting that airborne pollution in urban and industrial areas represents a potential risk factor for NTM-PD, probably through the production of reactive oxygen species causing airways chronic inflammation and pulmonary tissue damage [10].…”

Mycobacterioses Induced by Mycobacterium abscessus: Case Studies Indicating the Importance of Molecular Analysis for the Identification of Antibiotic Resistance

“…Infections caused by M. a. are, however, recorded only scarcely. Thus, during the years 2012–2018, M. a. was diagnosed according to American Thoracic Society (ATS) Criteria in only four (1.32%) patients with mycobacterioses [ 9 ]. Nevertheless, in light of the global rise of the mycobacterioses induced by M. a.…”