Risk Factors and Characteristics of Nontuberculous Mycobacterial Infections

Yıl 2025, Cilt: 8 Sayı: 3, 207 - 213, 30.09.2025

Efraim Güzel , Oya Baydar Toprak

Öz

Aim: Infections caused by nontuberculous Mycobacterium (NTM) are extremely prevalent in nature and challenging to identify and treat. Thus, the purpose of this study was to examine the clinical characteristics and risk factors of NTM.
Methods: The present investigation was carried out using 5-year retrospective data in a tertiary university hospital. The study comprised 29 individuals with radiological and clinical signs of NTM infection that were confirmed by microbiological testing. These patients' clinical, laboratory, radiological, and sociodemographic information was documented.
Results: The patients' average age was 58.31 ± 14.31 years, and 62.1% of them were men. Cough, weakness, and fever were the most prevalent symptoms, and hypertension and chronic lung disease were the most prevalent comorbidities. M. Kansasii, M. Fortuitum, and M. Abscessus were the most commonly isolated NTM species. HIV, treatment type, and treatment duration were determined to be the most significant factors influencing treatment response (p=0.018, p=0.002, p=0.001, respectively). Two (6.9%) of our patients passed away during the follow-up period, and it was discovered that a high sedimentation rate, a high Charlson comorbidity index score, and a lengthy interval between the onset of symptoms and diagnosis were all linked to death (p=0.010, p=0.002, and p=0.000, respectively).
Conclusion: NTM lung disease should be established, contamination should be ruled out, and if the pathogen is found, species-specific and sufficient treatment should be given to patients with NTM risk factors and relevant clinical, radiologic, and laboratory results.

Anahtar Kelimeler

nontuberculous mycobacterium , infections , risk factors , mortality , treatment

Nontüberküloz Mikobakteriyel Enfeksiyonların Risk Faktörleri ve Özellikleri

Öz

Giriş ve Amaç: Tüberküloz dışı mikobakterilerin (NTM) neden olduğu enfeksiyonlar doğada oldukça yaygın olup tanımlanması ve tedavisi zordur. Bu çalışmanın amacı NTM'nin klinik özelliklerini ve risk faktörlerini incelemektir.
Gereç ve Yöntemler: Bu araştırma, üçüncü basamak bir üniversite hastanesinde 5 yıllık retrospektif veriler kullanılarak gerçekleştirilmiştir. Çalışma, NTM enfeksiyonunun radyolojik ve klinik bulguları olan ve mikrobiyolojik testlerle doğrulanan 29 kişiyi kapsamaktadır. Bu hastaların klinik, laboratuvar, radyolojik ve sosyodemografik bilgileri kayıt altına alınmış ve analizler yapılmıştır.
Bulgular: Hastaların yaş ortalaması 58.31 ± 14.31 yıldı ve %62.1'i erkekti. Öksürük, halsizlik ve ateş en sık görülen semptomlar, hipertansiyon ve kronik akciğer hastalığı ise en sık görülen komorbiditelerdi. M. Kansasii, M. Fortuitum ve M. Abscessus en sık izole edilen NTM türleriydi. HIV, tedavi tipi ve tedavi süresi tedavi yanıtını etkileyen en önemli faktörler olarak belirlenmiştir (sırasıyla p=0.018, p=0.002, p=0.001). Hastalarımızın ikisi (%6,9) takip süresi içinde vefat etmiş ve yüksek sedimantasyon hızı, yüksek Charlson komorbidite indeksi skoru ve semptomların başlangıcı ile tanı arasındaki sürenin uzun olmasının ölümle bağlantılı olduğu görülmüştür (sırasıyla p=0,010, p=0,002 ve p=0,000).
Tartışma ve Sonuç: NTM risk faktörleri ve ilgili klinik, radyolojik ve laboratuvar sonuçları olan hastalarda NTM akciğer hastalığı tespit edilmeli, kontaminasyon ekarte edilmeli ve patojen bulunursa türe özgü ve yeterli tedavi verilmelidir.

Anahtar Kelimeler

nontüberküloz mikobakteri , enfeksiyon , risk faktörleri , mortalite , tedavi

Kaynakça

• 1.Johnson MM, Odell JA. Nontuberculous mycobacterial pulmonary infections. J Thorac Dis. 2014;6(3):210-20. [Crossref]
• 2.Bryant JM, Grogono DM, Rodriguez-Rincon D, Everall I, Brown KP, Moreno P, et al. Emergence and spread of a human-transmissible multidrug-resistant nontuberculous mycobacterium. Science. 2016;354(6313):751-7. [Crossref]
• 3.Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro A, Daley C, Gordin F, et al; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med. 2007;175(4):367-416. [Crossref]
• 4.Falkinham JO 3rd. Ecology of nontuberculous mycobacteria--where do human infections come from? Semin Respir Crit Care Med. 2013;34(1):95-102. [Crossref]
• 5.Martínez González S, Cano Cortés A, Sota Yoldi LA, García García JM, Alba Álvarez LM, Palacios Gutiérrez JJ; en representación de la Red de Laboratorios de Microbiología del SESPA. Non-tuberculous mycobacteria. An Emerging Threat? Arch Bronconeumol. 2017;53(10):554-560. [Crossref]
• 6.Matsuyama M, Matsumura S, Nonaka M, Nakajima M, Sakai C, Arai N, et al. Pathophysiology of pulmonary nontuberculous mycobacterial (NTM) disease. Respir Investig. 2023;61(2):135-148. [Crossref]
• 7.Wi YM. Treatment of extrapulmonary nontuberculous mycobacterial diseases. Infect Chemother. 2019;51(3):245-255. [Crossref]
• 8.Wu ML, Aziz DB, Dartois V, Dick T. NTM drug discovery: status, gaps and the way forward. Drug Discov Today. 2018;23(8):1502-19. [Crossref]
• 9.Charlson ME, Carrozzino D, Guidi J, Patierno C. Charlson comorbidity index: A critical review of clinimetric properties. Psychother Psychosom. 2022;91(1):8-35. [Crossref]
• 10.Henkle E, Hedberg K, Schafer S, Novosad S, Winthrop KL. Population-based incidence of pulmonary nontuberculous mycobacterial disease in Oregon 2007 to 2012. Ann Am Thorac Soc. 2015;12(5):642-7. [Crossref]
• 11.Moore JE, Kruijshaar ME, Ormerod LP, Drobniewski F, Abubakar I. Increasing reports of non-tuberculous mycobacteria in England, Wales and Northern Ireland, 1995-2006. BMC Public Health. 2010;10:612. [Crossref]
• 12.Shah NM, Davidson JA, Anderson LF, Lalor MK, Kim J, Thomas HL, et al. Pulmonary Mycobacterium avium-intracellulare is the main driver of the rise in non-tuberculous mycobacteria incidence in England, Wales and Northern Ireland, 2007-2012. BMC Infect Dis 2016;16:195. [Crossref]
• 13.Prevots DR, Shaw PA, Strickland D, Jackson LA, Raebel MA, Blosky MA, et al. Nontuberculous mycobacterial lung disease prevalence at four integrated health care delivery systems. Am J Respir Crit Care Med. 2010;182(7):970-6. [Crossref]
• 14.Okoi C, Anderson ST, Antonio M, Mulwa SN, Gehre F, Adetifa IM. Non-tuberculous Mycobacteria isolated from pulmonary samples in sub-Saharan Africa-a systematic review and meta analyses. Sci Rep 2017;7:12002. [Crossref]
• 15.Maasdorp E, Ghebrekristos Y, Khumalo A, Paul L, Williams MJ. Non-tuberculosis mycobacteria identified by line probe assays in respiratory and non-respiratory samples in South Africa between 2015 and 2019. Tuberculosis (Edinb). 2025;151:102610. [Crossref]
• 16.Henkle E, Winthrop KL. Nontuberculous mycobacteria infections in immunosuppressed hosts. Clin Chest Med. 2015;36(1):91-9. [Crossref]
• 17.Gopalaswamy R, Shanmugam S, Mondal R, Subbian S. Of tuberculosis and non-tuberculous mycobacterial infections - a comparative analysis of epidemiology, diagnosis and treatment. J Biomed Sci. 2020;27(1):74. [Crossref]
• 18.Lipman M, Cleverley J, Fardon T, Musaddaq B, Peckham D, van der Laan R, et al. Current and future management of non-tuberculous mycobacterial pulmonary disease (NTM-PD) in the UK. BMJ Open Respir Res. 2020;7(1):e000591. [Crossref]
• 19.Andalibi F, Bostanghadiri N, Amirmozafari N, Irajian G, Mirkalantari S. Efficacy and treatment outcome of infected patients with pulmonary Mycobacterium kansasii: A systematic review. J Clin Tuberc Other Mycobact Dis. 2024;36:100463. [Crossref]
• 20.Mirsaeidi M, Machado RF, Garcia JG, Schraufnagel DE. Nontuberculous mycobacterial disease mortality in the United States, 1999-2010: a population-based comparative study. PloS one. 2014;9:e91879. [Crossref] 21.Koh WJ. Nontuberculous mycobacteria-overview. Microbiol Spectr. 2017;5(1). [Crossref]
• 22.Andalibi F, Bostanghadiri N, Amirmozafari N, Irajian G, Mirkalantari S. Efficacy and treatment outcome of infected patients with pulmonary Mycobacterium kansasii: A systematic review. J Clin Tuberc Other Mycobact Dis. 2024;36:100463. [Crossref]
• 23.Diel R, Lipman M, Hoefsloot W. High mortality in patients with mycobacterium avium complex lung disease: a systematic review. BMC Infect Dis. 2018;18(1):206. [Crossref]