Non-tuberculous Mycobacteria isolated from Pulmonary samples in sub-Saharan Africa - A Systematic Review and Meta Analyses

Catherine Okoi,Ifedayo M O Adetifa,Sarah N Mulwa,Suzanne T B Anderson,Florian Gehre,Martin Antonio

doi:10.1038/s41598-017-12175-z

Abstract

Pulmonary non-tuberculous mycobacterial (NTM) disease epidemiology in sub-Saharan Africa is not as well described as for pulmonary tuberculosis. Earlier reviews of global NTM epidemiology only included subject-level data from one sub-Saharan Africa country. We systematically reviewed the literature and searched PubMed, Embase, Popline, OVID and Africa Wide Information for articles on prevalence and clinical relevance of NTM detection in pulmonary samples in sub-Saharan Africa. We applied the American Thoracic Society/Infectious Disease Society of America criteria to differentiate between colonisation and disease. Only 37 articles from 373 citations met our inclusion criteria. The prevalence of pulmonary NTM colonization was 7.5% (95% CI: 7.2%–7.8%), and 75.0% (2325 of 3096) occurred in males, 16.5% (512 of 3096) in those previously treated for tuberculosis and Mycobacterium avium complex predominated (27.7% [95% CI: 27.2–28.9%]). In seven eligible studies, 27.9% (266 of 952) of participants had pulmonary NTM disease and M. kansasii with a prevalence of 69.2% [95% CI: 63.2–74.7%] was the most common cause of pulmonary NTM disease. NTM species were unidentifiable in 29.2% [2,623 of 8,980] of isolates. In conclusion, pulmonary NTM disease is a neglected and emerging public health disease and enhanced surveillance is required.

Highlights

Pulmonary non-tuberculous mycobacterial (NTM) disease epidemiology in sub-Saharan Africa is not as well described as for pulmonary tuberculosis
The epidemiology of pulmonary disease caused by Mycobacterium tuberculosis complex (MTBC) - M. tuberculosis, M. bovis, M. africanum, M. canetti, M. microti, M. pinnipedii and M. caprae - is better known than for NTM1
We searched PubMed, EMBASE, POPLINE, OVID and Africa Wide Information electronic databases for publications about pulmonary NTM in sub-Saharan Africa published from January 1, 1940 to October 1, 2016 using the following search terms and strategy: ((((((“nontuberculous mycobacteria”[MeSH Terms] AND “africa south of the sahara”[MeSH Terms]) OR “mycobacterium infections, nontuberculous”[MeSH Terms]) AND “africa south of the sahara”[MeSH Terms]) OR “mycobacterium infections, nontuberculous”[MeSH Terms]) AND “africa south of the sahara”[MeSH Terms]) OR ((“lung”[MeSH Terms] OR “lung”[All Fields] OR “pulmonary”[All Fields]) AND “nontuberculous mycobacteria”[MeSH Terms])) AND “africa south of the sahara”[MeSH Terms] AND ((“1940/01/01”[PDAT]: “2016/10/01”[PDAT]) AND “humans”[MeSH Terms])

Summary

Introduction

Pulmonary non-tuberculous mycobacterial (NTM) disease epidemiology in sub-Saharan Africa is not as well described as for pulmonary tuberculosis. NTM were identified soon after Koch’s identification of M. tuberculosis as the cause of active tuberculosis in 1882, it was not until the 1950s that NTM were recognized to cause human pulmonary disease Given their ubiquitous presence in the environment, it is important to distinguish colonization from active disease following isolation of NTM from pulmonary samples. In response to this challenge, the ATS/IDSA introduced stringent diagnostic criteria with clinical, radiological and microbiological components for diagnosis of pulmonary NTM disease[2]. The clinical and molecular epidemiology of prevalent NTM in low and middle-income countries, endemic for pulmonary tuberculosis, is less known because pulmonary and other disease manifestations caused by NTM pose a diagnostic challenge to microbiologists and clinicians[2,4]. Nodular or cavitary opacities on chest radiograph, or a high-resolution computed tomographic scan that shows multifocal bronchiectasis with multiple small nodules

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