Abstract
The global spread of non-tuberculous mycobacteria (NTM) may be due to HIV/AIDS and other environmental factors. The symptoms of NTM and tuberculosis (TB) disease are indistinguishable, but their treatments are different. Lack of research on the epidemiology of NTM infections has led to underestimation of its prevalence within TB endemic countries. This study was designed to determine the prevalence and clinical characteristics of pulmonary NTM in Bamako. A cross-sectional study which include 439 suspected cases of pulmonary TB. From 2006 to 2013 a total of 332 (76%) were confirmed to have sputum culture positive for mycobacteria. The prevalence of NTM infection was 9.3% of our study population and 12.3% of culture positive patients. The seroprevalence of HIV in NTM group was 17.1%. Patients who weighed <55 kg and had TB symptoms other than cough were also significantly more likely to have disease due to NTM as compared to those with TB disease who were significantly more likely to have cough and weigh more than 55 kg (OR 0.05 (CI 0.02-0.13) and OR 0.32 (CI 0.11-0.93) respectively). NTM disease burden in Bamako was substantial and diagnostic algorithms for pulmonary disease in TB endemic countries should consider the impact of NTM.
Highlights
Non-tuberculous mycobacteria (NTM) are a major cause of opportunistic infection in immunocompromised hosts
We found that 9.34% (41/439) were non-tuberculous mycobacteria (NTM), 66.29% (291/439) were M. tuberculosis complex and 24.37% (107/439) were sputum culture negative (Fig. 1)
Among those with sputum culture positive, NTM was identified in 12.34% (41/332) and M. tuberculosis complex in 87.66% (291/ 332)
Summary
Non-tuberculous mycobacteria (NTM) are a major cause of opportunistic infection in immunocompromised hosts. Many NTM-infected patients in TB endemic countries, such as Mali, receive unnecessary long treatment with anti-TB drugs that are expensive and toxic [4]. In TB endemic countries, NTM disease was considered to be negligible until more recent reports indicated the impact they may have in the management of patients with TB-like symptoms [4,5,6,7]. Many recent reports revealed that NTM is increasing worldwide [8]. Reasons for this increase is unclear but environmental changes, availability of better detection tools and greater disease awareness are likely contributing factors [8, 9]
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