Pathophysiology of pulmonary nontuberculous mycobacterial (NTM) disease

Matsuyama, Masashi; Matsumura, Sosuke; Nonaka, Mizu; Nakajima, Masayuki; Sakai, Chio; Arai, Naoki; Ueda, Kodai; Hizawa, Nobuyuki

doi:10.1016/j.resinv.2022.12.002

Cited by 5 publications

(1 citation statement)

References 107 publications

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“…Disruption of the IFN-γ/IL-12 axis in HIV patients is the main trigger for disseminated NTM infections. Toll-like receptors (TLRs) on macrophages sense mycobacteria and release cytokines (IL-12 and TNF-α); this stimulates IFN-γ production and Th1 cell differentiation in HIV patients and makes them vulnerable to NTM infections [ 5 ]. Compared to HIV, the incidence of NTM disease in the population is 3.1 to 4.7 per 100,000 person-years [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Epidemiology, clinical presentation, and predictors of outcome in nontuberculous mycobacterial central nervous system infection: a systematic review

Meena,

Kumar,

Meena

et al. 2023

Trop Med Health

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Background CNS manifestations represent an emerging facet of NTM infection with significant mortality. Due to protean presentation and low index of suspicion, many cases are often treated erroneously as tubercular meningitis or fungal infections. Objectives Literature on NTM CNS disease is scarce, with most available data on pulmonary disease. This systematic review aimed to evaluate the epidemiology, clinical presentation, diagnostic modalities, and predictors of outcome in CNS NTM infection. Methods The literature search was performed in major electronic databases (PubMed, Google Scholar, and Scopus) using keywords “CNS,” “Central nervous system,” “brain abscess,” “meningitis,” “spinal,” “Nontuberculous mycobacteria,” “NTM”. All cases of CNS NTM infection reported between January 1980 and December 2022 were included. Results A total of 77 studies (112 cases) were included in the final analysis. The mean age of all patients was 38 years, with most patients male (62.5%). Mycobacterium avium complex (MAC) was the most common aetiology, followed by M. fortuitum and M. abscessus (34.8%, 21.4% and 15.2%, respectively). The disseminated disease was found in 33% of cases. HIV (33.9%) and neurosurgical hardware (22.3%) were the common risk factors. Intracranial abscess (36.6%) and leptomeningeal enhancement (28%) were the most prevalent findings in neuroimaging. The overall case fatality rate was 37.5%. On multivariate analysis, male gender (adjusted OR 2.4, 95% CI 1.2–7.9) and HIV (adjusted OR 3.7, 95% CI 1.8–6.1) were the independent predictors of mortality). M. fortuitum infection was significantly associated with increased survival (adjusted OR 0.18, 95% CI (0.08–0.45), p value 0.012). Conclusions Current evidence shows the emerging role of rapid-grower NTM in CNS disease. Male gender and HIV positivity were associated with significant mortality, while M fortuitum carries favourable outcomes.

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Section: Introductionmentioning

confidence: 99%

Epidemiology, clinical presentation, and predictors of outcome in nontuberculous mycobacterial central nervous system infection: a systematic review

Meena,

Kumar,

Meena

et al. 2023

Trop Med Health

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Immunopathogenesis of Non-Tuberculous Mycobacteria Lung Disease

Lyu

2024

Korean J Med

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In recent years, the incidence and prevalence of non-tuberculous mycobacteria lung disease (NTM-LD) has been increasing worldwide. In Korea, <i>Mycobacterium avium</i> complex (MAC) and <i>Mycobacterium abscessus</i> complex account for most common cause of NTM-LD. It is essential to elucidate the pathophysiology of NTM-LD. The pathophysiology of NTM-LD has not been fully understood, however, it can be divided into bacterial and host-side factor. Among the host factor, innate immunity plays an essential role in the initial host immune response against intracellular non-tuberculous mycobacteria (NTM), and adaptive immunity also has a role. However, the role of these immunity in mycobacterial disease has been mainly studied in tuberculosis, but studies on its role in NTM are limited. In this review, I focus on NTM innate and adaptive immunity, the role of macrophages and neutrophils, and host interaction in NTM infection.

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Nonpharmacological Treatment for Nontuberculous Mycobacterial Pulmonary Disease

Kim

2024

Tuberc Respir Dis

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Nontuberculous mycobacterial pulmonary disease (NTM-PD) results from the exposure of susceptible hosts to a diverse group of environmental mycobacteria. The emphasis on nonpharmacological strategies is motivated by the widespread presence of NTM in various environments, and the inconsistent success rates of pharmacological treatments. Modifiable factors contributing to NTM-PD development include impaired airway clearance, low body mass index, gastroesophageal reflux disease, and exposure to NTM habitats. This suggests that lifestyle and environmental modifications could affect disease development and progression. The review highlights several modalities that can modify the risk factors. Airway clearance techniques, informed by the “gel-on-brush” model of the bronchial epithelium, aim to enhance mucociliary clearance, and have the potential to alleviate symptoms and improve lung function. The impact of nutritional status is also examined, with a lower body mass index linked to an increased risk and progression of NTM-PD, indicating the importance of targeted nutritional support. Additionally, the theoretical and epidemiological links between gastroesophageal reflux disease and NTM-PD advocate careful management of reflux episodes. Understanding the risk of NTM transmission through environmental exposure to contaminated water and soil is also crucial. Strategies to mitigate this risk, including effective water management and minimizing soil contact, are presented as vital preventive measures. The review supports the inclusion of nonpharmacological treatments within a comprehensive NTM-PD management strategy, alongside conventional pharmacological therapies. This integrated approach seeks to improve the overall understanding and handling of NTM-PD.

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Pathophysiology of pulmonary nontuberculous mycobacterial (NTM) disease

Cited by 5 publications

References 107 publications

Epidemiology, clinical presentation, and predictors of outcome in nontuberculous mycobacterial central nervous system infection: a systematic review

Epidemiology, clinical presentation, and predictors of outcome in nontuberculous mycobacterial central nervous system infection: a systematic review

Immunopathogenesis of Non-Tuberculous Mycobacteria Lung Disease

Nonpharmacological Treatment for Nontuberculous Mycobacterial Pulmonary Disease

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