Nontuberculous Mycobacterial Infections in a French Hospital: A 12-Year Retrospective Study

Abstract

BackgroundNontuberculous mycobacteria (NTM) are environmental organisms associated with a range of infections. Reports of NTM epidemiology are mainly focused on pulmonary infections and isolations, and extrapulmonary infections are less frequently described.MethodsWe conducted a retrospective study of NTM infections at the Bordeaux University Hospital, France, between January 2002 and December 2013. We used the microbiologic component of the American Thoracic Society/Infectious Diseases Society of America's pulmonary NTM disease criteria to define cases of pulmonary NTM, and patients with isolates from a normally sterile site were classified as having extrapulmonary disease.ResultsIn our setting, 170 patients were included. Pulmonary cases predominated (54.1%), followed by skin and soft tissue infections (22.9%), disseminated cases (10.6%), lymphadenitis (7.7%), bone and joint infections (2.9%) and the remaining 1.8% catheter-related infections. Overall, 16 NTM species were isolated. Mycobacterium avium (31.8%) and M. intracellulare (20%) were the most common species identified, followed by M. marinum (13.5%), M. kansasii (10.6%), M. xenopi (9.4%), rapidly growing mycobacteria (9.4%) and other slowly growing mycobacteria (5.3%). In general, NTM isolates were largely prevalent in people older than 50 (62.4%); patients aged 1–10 year-old exclusively yielded M. avium from lymph nodes, almost cases having being diagnosed after 2007. Among the 121 patients with complete follow-up, 78 (64.5%), 24 (19.8%), and 19 (15.7%) were cured, experienced relapse, or died, respectively.ConclusionIn our study, extrapulmonary NTM infections represented almost half of cases, consisting mainly in skin and soft tissue infections. The increase lymphadenitis cases in children after 2007 could be linked to the cessation of mandatory BCG vaccination in France. We observed similar cure rates (64%) between pulmonary and extrapulmonary infections.

The first Saudi Arabian national inventory study revealed the upcoming challenges of highly diverse non-tuberculous mycobacterial diseases

“…On the other hand, M . avium also showed a higher (66.7%) clinical relevance, which resembles similar findings from other part of the world [ 3 , 23 , 26 ].…”

“…Moreover, increased frequency of genetic predisposing conditions among the Saudi nationals mainly due to higher rate of consanguinity, increasing rate of different immunosuppressive therapies and various malignancies could be additional risks factors to increase the susceptibility to NTM infections [ 20 – 22 ]. Current data showed, individuals aged above 60 years were under particular risk of NTM infections, similar to studies reported with a higher isolation rate of NTM’s among elderly from Saudi Arabia and rest of the world [ 3 , 12 , 23 ]. Positive HIV cases were very much limited (2.6%) and comparably lower to other countries.…”

Nontuberculous Mycobacteria Strains Isolated from Patients between 2013 and 2017 in Poland. Our Data with Respect to the Global Trends

“…It should be stressed that all authors agreed that patients with NTM infection were older than those with tuberculosis and were usually 60+. Comparable NTM pattern to our current results was also observed in the retrospective study conducted in Bordeaux, France over 12years (2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013) [18]. However, such stable trend among mycobacterial species over the years is not a typical phenomenon.…”

“…chelonae and M. xenopi dominate [17]. Few recent studies from South America have revealed that MAC is generally the most common there, and M. kansasii is also frequent [17][18][19][20][21]. Similarly, MAC is predominant in South Asia and in Queensland, Australia, whereas MAC with M. fortuitum and simiae in the Middle East [22,23].…”

Epidemiological and Clinical Aspects of Pulmonary Mycobacteriosis in Sisak-Moslavina County

“…14 Ekspektativno stajalište motivirano je činjeni cama da je svega 20 -40% plućnih izolata NTM-a pove zano s bolešću, da rezultati testova osjetljivosti pojedinih NTM-a na antibiotike in vitro ne koreliraju s rezultatima in vivo pa se njihovom primjenom ne mogu predvidjeti klinički i bakteriološki odgovor na liječenje, 9,14,15,16 da ne postoji dovoljno kontroliranih studija koje bi se bavile procjenom rizika od progresivne plućne bolesti 17 što će ga bolesnici steći, kao i identifikacijom prediktora smrtnosti kod bolesnika 8 te da je stopa relapsa ili reinfekcije visoka, pogotovo u slučaju infekcije s M. avium. 18,19 Pritom treba posebno naglasiti da je riječ o sporoprogredirajućoj bole sti koja ostavlja dovoljno vremena za temeljitu dijagno stičku obradu svedenu na isključenje drugih bolesti što bi mogle davati slične simptome i radiološke nalaze, pogla vito tuberkulozu i karcinom pluća, kao i bakteriološku analizu dodatnih respiratornih uzoraka. 7 Upravo stoga od luka o započinjanju liječenja treba se temeljiti na objek tivnoj procjeni prednosti i rizika kojima može biti izložen bolesnik koji mora skupu i potencijalno toksičnu antibiot sku terapiju uzimati više od godinu dana.…”