Occurrence of Nontuberculous Mycobacterial Pulmonary Infection in an Endemic Area of Tuberculosis

Ana Roberta Fusco Da Costa,Karla Valéria Batista Lima,Emilyn Costa Conceição,Lúcia Helena Messias Sales,Jeann Ricardo Da Costa Bahia,Adriana Rodrigues Barretto,João Soares Felicio,Maria Luiza Lopes,Joseph O Falkinham

doi:10.1371/journal.pntd.0002340

Ana Roberta Fusco Da Costa, Karla Valéria Batista Lima + Show 7 more

Open Access

https://doi.org/10.1371/journal.pntd.0002340

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Abstract

The majority of investigations of the epidemiology of nontuberculous mycobacteria (NTM) have focused on highly developed nations with a low prevalence of tuberculosis. In contrast, the Para state of north Brazil represents an area of high tuberculosis prevalence and increasing NTM incidence. Toward the goal of understanding the dynamics of infection by all Mycobacterium species, we report patient characteristics and the identification of NTM strains isolated from sputum samples from patients that were residents of Para, a state in the Amazon region, Northern of Brazil, over the period January 2010 through December 2011 (2 years). The 29 NTM patients comprised 13.5% of positive mycobacterial cultures over the 2-year period. A major risk factor for NTM pulmonary disease was previous tuberculosis (76%). Further, the average age of NTM patients (52 years) was significantly higher than that of tuberculosis patients (39 years) and more were female (72.4% vs. 37.4%). Unlike other Brazilian states, NTM pulmonary patients in Para were infected with a different spectrum of mycobacteria; primarily the rapidly growing Mycobacterium massiliense and Mycobacterium simiae complex.

Highlights

Nontuberculous mycobacteria (NTM) are environmental opportunistic pathogens that are natural inhabitants of soil [1] and drinking water [2], [3]
Fisherman and others exposed to fish are at risk for skin infections caused by Mycobacterium marinum infection [5] and children from 18 months to 5 years of age are at risk for cervical lymphadenitis caused more typically by M. avium [6]
All patients were initially diagnosed as having pulmonary tuberculosis (M. tuberculosis) based on sputum smear microscopy for acid-fast bacilli (AFB) and had suffered a treatment failure

Summary

Introduction

Nontuberculous mycobacteria (NTM) are environmental opportunistic pathogens that are natural inhabitants of soil [1] and drinking water [2], [3]. Humans and their agronomic animals are literally surrounded by nontuberculous mycobacteria [4]. Several case reports and studies on the prevalence of pulmonary disease caused by NTM in North America, Europe and Japan have been published during recent years [7], [8], [9], [10], [11]. This study documents the occurrence and diversity of species of NTM that cause pulmonary disease in a region representative of those in the world with high infection rates by M. tuberculosis

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