Nontuberculous Mycobacteria Infections at a Provincial Reference Hospital, Cambodia.

Maryline Bonnet,Wing-Wai Yew,Jean-Philippe Dousset,Cathy Hewison,Seiha Heng,Sylvain Godreuil,Chandara Sok,Yati Pho,Kim Chamroeun San,William Brant,Elisa Ardizzoni,Northan Hurtado,Khun Kim Eam

doi:10.3201/eid2307.170060

Abstract

Prevalence of nontuberculous mycobacteria (NTM) disease is poorly documented in countries with high prevalence of tuberculosis (TB). We describe prevalence, risk factors, and TB program implications for NTM isolates and disease in Cambodia. A prospective cohort of 1,183 patients with presumptive TB underwent epidemiologic, clinical, radiologic, and microbiologic evaluation, including >12-months of follow-up for patients with NTM isolates. Prevalence of NTM isolates was 10.8% and of disease was 0.9%; 217 (18.3%) patients had TB. Of 197 smear-positive patients, 171 (86.8%) had TB confirmed (167 by culture and 4 by Xpert MTB/RIF assay only) and 11 (5.6%) had NTM isolates. HIV infection and past TB were independently associated with having NTM isolates. Improved detection of NTM isolates in Cambodia might require more systematic use of mycobacterial culture and the use of Xpert MTB/RIF to confirm smear-positive TB cases, especially in patients with HIV infection or a history of TB.

Highlights

IntroductionDetection of nontuberculous mycobacteria (NTM) isolates has increased worldwide, a trend that might be attributed to several factors, including a surge of HIV infections in the past 2 decades, a better understanding of the clinical and pathological relationship between host and pathogen, improved detection methods, increased natural or artificial environmental exposure (i.e., tap water in developing countries), population aging, and improved survival of patients with structural lung diseases [8,9,10,11,12,13,14,15]
The prevalence of nontuberculous mycobacteria (NTM) isolates was 10.8%; prevalence of NTM lung disease was 0.9%
TB history, HIV infection, and previous hospitalizations for respiratory disease were associated with a diagnosis of NTM lung disease compared with TB

Summary

Introduction

Detection of NTM isolates has increased worldwide, a trend that might be attributed to several factors, including a surge of HIV infections in the past 2 decades, a better understanding of the clinical and pathological relationship between host and pathogen, improved detection methods, increased natural or artificial environmental exposure (i.e., tap water in developing countries), population aging, and improved survival of patients with structural lung diseases [8,9,10,11,12,13,14,15]. Because mycobacterial culture laboratories are lacking in limited-resource countries, the burden of NTM infection is often poorly documented in areas with a high tuberculosis (TB) prevalence. This observation is true in Asia, where no population-based studies have been conducted to document the epidemiology of NTM pulmonary isolates and NTM lung disease [4]. The effect of NTM isolates on TB case management needs to be further explored in countries with high TB prevalence

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