Abstract
ABSTRACTObjective To present the frequency and species diversity of non-tuberculous mycobacteria, estimate the prevalence of non-tuberculous mycobacterial pulmonary disease, describe the epidemiological profile, and determine the follow-up of patients with non-tuberculous mycobacterial pulmonary disease living in a region with a high burden of tuberculosis.Methods This a retrospective cohort observational study using data records obtained from the Instituto Adolfo Lutz - Santos and from the São Paulo Sistema de Vigilância de Tuberculose do Estado de São Paulo in the period between 2000 and 2009. The studied variables were: socio-demographic characteristics, current and past history of tuberculosis, aspects related to diagnosis, and treatment and associated diseases.Results We included 319 non-tuberculous mycobacteria isolates in the study, corresponding to 257 patients. The species Mycobacterium kansasii (28.5%) and Mycobacterium fortuitum (16.6%) presented the higher occurrence. In 10.9% (24) of the patients, there was a criterion for confirming a case of pulmonary disease due to non-tuberculous mycobacteria. In relation to gender and age, male and individuals over 50 years old were the most frequent. Considering the confirmed cases, 47.8% had a past history of tuberculosis.Conclusion The lack of information about the cases is evident, since pulmonary disease due to non-tuberculous mycobacteria is not mandatory. The therapeutic regimen according to the identified species is fundamental for success in combating the infections caused by non-tuberculous mycobacteria. Besides that, information about the regional epidemiology of pulmonary disease caused by non-tuberculous mycobacteria and the search for associations with other comorbidities are important to establish the correct treatment. In order to improve surveillance of pulmonary diseases by non-tuberculous mycobacteria, we suggest the implantation of a sentinel surveillance and of population-based studies.
Highlights
Non-tuberculous mycobacteria (NTM) are ubiquitous pathogens with wide distribution in the environment
There are few articles referring to the epidemiology of confirmed cases of non-tuberculous mycobacterial pulmonary disease (NTMPD), especially those relating it to factors such as abandonment of a pulmonary disease by non-tuberculous mycobacteria tuberculosis (PTB) treatment in the past and diseases other than AIDS/HIV.[19]. Marques et al,(20) in the period from 2011 to 2014, evaluated 1,014 patients with pulmonary NTM isolation with respect to meeting the American Thoracic Society (ATS) microbiological criteria and found 44.2% of patients with NTPMD, mainly caused by Mycobacterium kansasii, Mycobacterium abscessus, Mycobacterium intracellulare, Mycobacterium avium and Mycobacterium szulgai
It is important to highlight that, among the potentially pathogenic species, those belonging to the M. avium and M. kansasii complex are the most commonly isolated, and both cause mainly pulmonary infection, the former being frequently responsible for disseminated disease and death in HIV-positive patients.[18,23,29] By analyzing only patients with confirmed cases of NTMPD, our results showed that, if we evaluate the data independently of HIV serology, M. kansasii still remains the most commonly isolated species (37.5%), followed by Mycobacterium avium complex (MAC) (20.8%) and M. fortuitum (12.5%)
Summary
Non-tuberculous mycobacteria (NTM) are ubiquitous pathogens with wide distribution in the environment. In regions of the United States, the prevalence in 2007 was 47 cases/100,000 population.[7,8,9] According to their pathogenicity, NTM can be potentially or rarely pathogenic, or strictly environmental. Pathogenic NTM can cause various localized forms of disease that can affect the lungs, lymph nodes, skin, and joints, as well as take the disseminated form. When untreated, they can prove fatal or leave severe sequelae.[11,12,13]
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