Application of Bacteriophages for Mycobacterial Infections, from Diagnosis to Treatment

Abstract

Mycobacterium tuberculosis and other non-tuberculous mycobacteria are responsible for a variety of different infections affecting millions of patients worldwide. Their diagnosis is often problematic and delayed until late in the course of disease, requiring a high index of suspicion and the combined efforts of clinical and laboratory colleagues. Molecular methods, such as PCR platforms, are available, but expensive, and with limited sensitivity in the case of paucibacillary disease. Treatment of mycobacterial infections is also challenging, typically requiring months of multiple and combined antibiotics, with associated side effects and toxicities. The presence of innate and acquired drug resistance further complicates the picture, with dramatic cases without effective treatment options. Bacteriophages (viruses that infect bacteria) have been used for decades in Eastern Europe for the treatment of common bacterial infections, but there is limited clinical experience of their use in mycobacterial infections. More recently, bacteriophages’ clinical utility has been re-visited and their use has been successfully demonstrated both as diagnostic and treatment options. This review will focus specifically on how mycobacteriophages have been used recently in the diagnosis and treatment of different mycobacterial infections, as potential emerging technologies, and as an alternative treatment option.

Mycobacteriophages: From Petri dish to patient

“…ulcerans infections [ 69 , 120 ] and tuberculosis caused by M . tuberculosis [ 71 , 121 – 124 ]. Tuberculosis remains an interesting target but presents a different set of challenges than M .…”

Bacteriophage treatment of disseminated cutaneous Mycobacterium chelonae infection

“…Bacteriophages are organisms that are ubiquitous in the environment with the ability to infect and kill bacterial hosts 16 – 18 . Bacteriophage therapy using a cocktail of multiple phage isolates has been recently successfully used for the treatment of resistant bacterial infections including multidrug-resistant nontuberculous mycobacterial infections in conjunction with traditional antibiotic therapy 14 , 15 , 19 , 20 .…”

Bacteriophages of Mycobacterium tuberculosis, their diversity, and potential therapeutic uses: a review

“…This might characterize an appropriate substitute for PCR tests, particularly in low-income countries, because it depends on only simple microbiological methods. The defect of PA can be an ineffective infection in a significant number of bacteria in the specimen, which can limit from half to four-fifths of the measured CFU, and could be triggered by some reasons; e.g., phage replication does not happen in dormant bacteria [ 49 , 50 ].…”