Non-tuberculous Mycobacteria isolated from Pulmonary samples in sub-Saharan Africa - A Systematic Review and Meta Analyses

Abstract

Pulmonary non-tuberculous mycobacterial (NTM) disease epidemiology in sub-Saharan Africa is not as well described as for pulmonary tuberculosis. Earlier reviews of global NTM epidemiology only included subject-level data from one sub-Saharan Africa country. We systematically reviewed the literature and searched PubMed, Embase, Popline, OVID and Africa Wide Information for articles on prevalence and clinical relevance of NTM detection in pulmonary samples in sub-Saharan Africa. We applied the American Thoracic Society/Infectious Disease Society of America criteria to differentiate between colonisation and disease. Only 37 articles from 373 citations met our inclusion criteria. The prevalence of pulmonary NTM colonization was 7.5% (95% CI: 7.2%–7.8%), and 75.0% (2325 of 3096) occurred in males, 16.5% (512 of 3096) in those previously treated for tuberculosis and Mycobacterium avium complex predominated (27.7% [95% CI: 27.2–28.9%]). In seven eligible studies, 27.9% (266 of 952) of participants had pulmonary NTM disease and M. kansasii with a prevalence of 69.2% [95% CI: 63.2–74.7%] was the most common cause of pulmonary NTM disease. NTM species were unidentifiable in 29.2% [2,623 of 8,980] of isolates. In conclusion, pulmonary NTM disease is a neglected and emerging public health disease and enhanced surveillance is required.

Nontuberculous mycobacteria isolated from specimens of pulmonary tuberculosis suspects, Northern Tunisia: 2002-2016

“…The overall PNTM isolation rate of 0.56% in Northern Tunisia was comparable to the rate of 1.05% previously reported among HIV-negative patients from Portugal [14]. However, these rates are low compared to the mean rate of 7.5% estimated for nine sub-Saharan African countries [9], or other regions where the prevalence of NTM isolation from pulmonary samples was ~ 5 to 16 times higher; being 2.62% in China (Shanghai) [15], 3.2% in Iran [16], and 4.1 % to 8% in Brazil [17,18]. Hence, NTM isolation from pulmonary samples in Northern Tunisia occurred very rarely with an overall annual prevalence of 0.17/100 000.…”

Nontuberculous mycobacteria isolated from specimens of pulmonary tuberculosis suspects, Northern Tunisia: 2002-2016

“…The overall PNTM isolation rate of 0.6% in Northern Tunisia was comparable to the rate of 1.0% previously reported among HIV-negative patients from Portugal [14]. However, these rates are low compared to the mean rate of 7.5% estimated for nine sub-Saharan African countries [9], or other regions where the prevalence of NTM isolation from pulmonary samples was ~ 5 to 16 times higher; being 2.6% in China (Shanghai) [15], 3.2% in Iran [16], and 4.1 % to 8.0% in Brazil [17,18]. Hence, NTM isolation from pulmonary samples in Northern Tunisia occurred very rarely with an overall annual prevalence of 0.17/100 000.…”

Evolution of drug resistance in Mycobacterium tuberculosis: a review on the molecular determinants of resistance and implications for personalized care

“…Furthermore, the clinical signs and symptoms of NTM infection are clinically and radiologically indistinguishable from MTB infection, underscoring the need for a reliable molecular-based diagnostic. 21 …”