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Frontiers in Medicine 2021Non-tuberculous mycobacteria (NTM), specifically complex (MAC), is an increasingly prevalent cause of pulmonary dysfunction. Clofazimine has been shown to be effective...
Non-tuberculous mycobacteria (NTM), specifically complex (MAC), is an increasingly prevalent cause of pulmonary dysfunction. Clofazimine has been shown to be effective for the treatment of complex, but there were no published large-scale analyses comparing clofazimine to non-clofazimine regimens in MAC treatment. The objective of this large-scale meta-analysis was to evaluate patient characteristics and treatment outcomes of individuals diagnosed with MAC and treated with a clofazimine-based regimen. We used Pubmed/Medline, Embase, Web of Science, and the Cochrane Library to search for studies published from January 1, 1990 to February 9, 2020. Two reviewers (SSH and NY) extracted the data from all eligible studies and differences were resolved by consensus. Statistical analyses were performed with STATA (version 14, IC; Stata Corporation, College Station, TX, USA). The pooled success treatment rate with 95% confidence intervals (CI) was assessed using random effect model. The estimated pooled treatment success rates were 56.8% in clofazimine and 67.9% in non-clofazimine groups. Notably, success rates were higher (58.7%) in treatment of HIV patients with disseminated infection. Treatment was more successful in the non-clofazimine group overall. However, HIV patients with disseminated infection had higher treatment response rates than non-HIV patients within the clofazimine group.
PubMed: 33968952
DOI: 10.3389/fmed.2021.638306 -
Respiratory Research Dec 2019Macrolide is a key drug in the treatment of Mycobacterium avium complex pulmonary disease (MAC-PD). Macrolide-resistant MAC is gaining importance, but there are little... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Macrolide is a key drug in the treatment of Mycobacterium avium complex pulmonary disease (MAC-PD). Macrolide-resistant MAC is gaining importance, but there are little data in clinical characteristics and treatment outcomes of macrolide-resistant MAC-PD (MR-MAC-PD).
METHODS
We performed a systematic review and meta-analysis of published studies reporting clinical characteristics and treatment outcomes of patients with MR-MAC-PD. Risk of bias was assessed using the modified Newcastle-Ottawa Scale.
RESULTS
Nine studies (seven retrospective and two prospective) comprising 319 patients were identified through a database search. Around 73% were women, and 52% had the fibrocavitary form. Pooled sputum culture conversion rate after combined multiple antibiotics or surgical resection was 21% (95% confidence interval [CI], 14-30%), and the one-year all-cause mortality was 10% (95% CI, 5-20%). There was no significant difference in treatment outcomes between nodular bronchiectatic and fibrocavitary types.
CONCLUSIONS
Even combination therapy with fluoroquinolone, aminoglycoside, and surgical resection, the treatment outcomes of MR-MAC-PD were poor. The investigation of new treatment modalities is urgent.
Topics: Aged; Anti-Bacterial Agents; Drug Resistance, Bacterial; Drug Therapy, Combination; Female; Humans; Macrolides; Male; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Pneumonectomy; Respiratory Tract Infections; Risk Factors; Treatment Outcome
PubMed: 31852452
DOI: 10.1186/s12931-019-1258-9 -
Germs Mar 2021This study aimed to assess the prevalence of slow growing mycobacteria (SGM) and rapid-growing mycobacteria (RGM) retrieved from hospital water sources in Iran from 2016... (Review)
Review
INTRODUCTION
This study aimed to assess the prevalence of slow growing mycobacteria (SGM) and rapid-growing mycobacteria (RGM) retrieved from hospital water sources in Iran from 2016 to 2020.
METHODS
The review was conducted to get eligible published studies from 1 January 2016 to 25 March 2020 based on PRISMA protocol. A combination of related words from the Medical Subject Heading Terms (MeSH), with (AND, OR) were used to search for published studies reporting the prevalence of nontuberculous mycobacteria (NTM) in Scopus, MEDLINE, Web of Sciences, Google Scholar, and Iranian databases. Then data from the studies were extracted and reported.
RESULTS
Our study showed that different water sources of hospitals were contaminated with NTMs. The prevalence of RGM isolates in hospital water samples varied between 42.2%-67.5%, and the prevalence of SGM varied between 32.5%-57.7%, respectively. (84.7%), complex(2.8%-56.4%)and (2.8%-56.2%) were the most prevalent NTM species amongst SGM, whereas (2.9%-44.2%), (8%-36.8%) (8%-25.6%) were the most leading NTM isolates among RGM.
CONCLUSIONS
A high prevalence of NTM was reported from hospital environments particularly hospital water sources which can colonize medical devices, solutions, and water used for patients and cause nosocomial infection. Therefore, the hospitals should check the microbiological quality of the water used.
PubMed: 33898346
DOI: 10.18683/germs.2021.1245 -
Frontiers in Genetics 2020Mixed strain infection (MSI) refers to the concurrent infection of a susceptible host with multiple strains of a single pathogenic species. Known to occur in humans and...
Mixed strain infection (MSI) refers to the concurrent infection of a susceptible host with multiple strains of a single pathogenic species. Known to occur in humans and animals, MSIs deserve special consideration when studying transmission dynamics, evolution, and treatment of mycobacterial diseases, notably tuberculosis in humans and paratuberculosis (or Johne's disease) in ruminants. Therefore, a systematic review was conducted to examine how MSIs are defined in the literature, how widespread the phenomenon is across the host species spectrum, and to document common methods used to detect such infections. Our search strategy identified 121 articles reporting MSIs in both humans and animals, the majority (78.5%) of which involved members of the complex, while only a few (21.5%) examined non-tuberculous mycobacteria (NTM). In addition, MSIs exist across various host species, but most reports focused on humans due to the extensive amount of work done on tuberculosis. We reviewed the strain typing methods that allowed for MSI detection and found a few that were commonly employed but were associated with specific challenges. Our review notes the need for standardization, as some highly discriminatory methods are not adapted to distinguish between microevolution of one strain and concurrent infection with multiple strains. Further research is also warranted to examine the prevalence of NTM MSIs in both humans and animals. In addition, it is envisioned that the accurate identification and a better understanding of the distribution of MSIs in the future will lead to important information on the epidemiology and pathophysiology of mycobacterial diseases.
PubMed: 33408740
DOI: 10.3389/fgene.2020.600692 -
Journal of the Formosan Medical... Jun 2020Nontuberculous mycobacteria (NTM) are critical emerging global infectious pathogens. Though NTM can be mere colonizers when isolated from human specimens, NTM are also...
Nontuberculous mycobacteria (NTM) are critical emerging global infectious pathogens. Though NTM can be mere colonizers when isolated from human specimens, NTM are also responsible for diverse human infections. NTM-lung disease (NTM-LD) is the most common human disease entity. The present review aims to provide general insight into NTM-LD epidemiology in Taiwan. In reviewing NTM epidemiology in Taiwan, we discovered three distinguishing features. First, NTM disease incidence has increased in Taiwan over the past decade. Second, the distribution of NTM varies geographically in Taiwan. Mycobacterium avium-intracellulare complex (MAC) is the dominant species in northern Taiwan, whereas Mycobacterium abscessus complex and MAC may be equally dominant in southern Taiwan. Third, researchers in Taiwan have published valuable research investigating NTM among special patient populations, including patients in intensive care units, with ventilator dependency, with pulmonary tuberculosis, and who are infected with specific NTM species. The largest obstacle to clarifying NTM epidemiology in Taiwan may be the lack of routine NTM species identification in laboratories. Increased awareness of NTM diseases and acknowledgment that NTM species identification is crucial and guides clinical management are essential steps for facilitating the identification of NTM species in laboratories.
Topics: Humans; Mycobacterium Infections, Nontuberculous; Mycobacterium abscessus; Mycobacterium avium Complex; Nontuberculous Mycobacteria; Taiwan
PubMed: 32482605
DOI: 10.1016/j.jfma.2020.05.019 -
Le Infezioni in Medicina Sep 2020Mycobacterium xenopi and Non Tuberculous Mycobacteria (NTM) are rare causes of spondylodiscitis (SD). The aim of this study was to highlight the relevance of considering...
PURPOSE
Mycobacterium xenopi and Non Tuberculous Mycobacteria (NTM) are rare causes of spondylodiscitis (SD). The aim of this study was to highlight the relevance of considering these pathogens in differential diagnosis of slow growing SD, obtaining the correct diagnosis and evaluating the key points of management and therapy approach.
METHODS
A case of surgically treated Mycobacterium xenopi SD is reported. A systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed. The research was conducted on MEDLINE, PubMed and Scopus using as search-terms "vertebral", "spinal", "infection", "spondylodiscitis", "discitis", "osteomyelitis", "atypical", "nontuberculous", "mycobacterium".
RESULTS
After the screening of 444 titles and abstracts, 113 papers were considered eligible for the full-text analysis. Seventy-seven studies that met inclusion criteria were finally included in the review. Overall, including our report, 91 patients affected by NTM SD were analyzed in this systematic review Conclusion: This review highlights the rarity of spinal infections due to NTM and the difficulty of their management. A tailored approach with prolonged antibiotic therapy, eventually associated with surgery in selected cases were suggested for the treatment of NTM infections.
Topics: Discitis; Female; Humans; Middle Aged; Mycobacterium Infections, Nontuberculous
PubMed: 32920580
DOI: No ID Found -
FEMS Microbiology Reviews Jan 2022Understanding the interactions of ecosystems, humans and pathogens is important for disease risk estimation. This is particularly true for neglected and newly emerging...
Understanding the interactions of ecosystems, humans and pathogens is important for disease risk estimation. This is particularly true for neglected and newly emerging diseases where modes and efficiencies of transmission leading to epidemics are not well understood. Using a model for other emerging diseases, the neglected tropical skin disease Buruli ulcer (BU), we systematically review the literature on transmission of the etiologic agent, Mycobacterium ulcerans (MU), within a One Health/EcoHealth framework and against Hill's nine criteria and Koch's postulates for making strong inference in disease systems. Using this strong inference approach, we advocate a null hypothesis for MU transmission and other understudied disease systems. The null should be tested against alternative vector or host roles in pathogen transmission to better inform disease management. We propose a re-evaluation of what is necessary to identify and confirm hosts, reservoirs and vectors associated with environmental pathogen replication, dispersal and transmission; critically review alternative environmental sources of MU that may be important for transmission, including invertebrate and vertebrate species, plants and biofilms on aquatic substrates; and conclude with placing BU within the context of other neglected and emerging infectious diseases with intricate ecological relationships that lead to disease in humans, wildlife and domestic animals.
Topics: Animals; Buruli Ulcer; Ecosystem; Humans; Mycobacterium ulcerans; Plants
PubMed: 34468735
DOI: 10.1093/femsre/fuab045 -
The International Journal of... Feb 2020Non-tuberculous mycobacteria (NTM) have evolved as an emerging group of pathogens globally. Due to the pitfalls in identification, the majority of them are not familiar... (Meta-Analysis)
Meta-Analysis
Non-tuberculous mycobacteria (NTM) have evolved as an emerging group of pathogens globally. Due to the pitfalls in identification, the majority of them are not familiar or remain 'rare' to clinicians and microbiologists. In available literatures, a consolidated global data analysis is non-existent on rarely encountered NTM. A systematic review and meta-analysis have been carried out on 100 rare NTM species, which are possibly identified only by DNA sequencing methods, to establish their global epidemiology, emergence and clinical relevance. Articles published in English from 1956 to 2018 reporting rare NTM species were searched in MEDLINE, Scopus, Ovid and Embase. A total of 447 articles matched the selection criteria, and 1670 rare NTM cases were identified from 52 countries. The majority of the incidences were reported from North America (33.4%), followed by Europe (23.8%) and Asia (20.8%). Of 100 species, 43 were defined as emerging species, with 1351 (80.9%) new incidence cases globally. In total, 87 species caused clinically relevant pulmonary and extrapulmonary diseases. Interestingly, some NTM species showed significant geographic predominance, such as to South Korea, to Japan; and to the United States and to Saudi Arabia. Rare NTM species mainly caused pulmonary infection (67.1%), while extrapulmonary infections generally comprised mycobacteremia and skin/soft tissue infections. In conclusion, the majority of rarely encountered NTM species are now well-established pathogens with valid clinical implications. The emergence of these rare pathogens warrants immediate local and international follow-ups. Their increasing clinical and pathological significance should not be disregarded.
Topics: Asia; Europe; Humans; Japan; Mycobacterium Infections, Nontuberculous; Nontuberculous Mycobacteria; North America; Republic of Korea; Saudi Arabia
PubMed: 32127107
DOI: 10.5588/ijtld.19.0194 -
Chest Apr 2023The burden of nontuberculous mycobacterial pulmonary disease (NTM-PD) is increasing worldwide. Amidst the poor treatment success of antibiotic therapy, adjunctive... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The burden of nontuberculous mycobacterial pulmonary disease (NTM-PD) is increasing worldwide. Amidst the poor treatment success of antibiotic therapy, adjunctive surgery is gaining attention; however, discrepancies in reported outcomes exist.
RESEARCH QUESTION
What are the treatment outcomes and complications of patients with NTM-PD undergoing adjunctive surgery?
STUDY DESIGN AND METHODS
The MEDLINE, Embase, and Cochrane databases were searched for eligible studies before January 2022. Studies reporting the outcomes of adjunctive surgery in adult patients who satisfied the diagnostic criteria for NTM-PD were included. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines. Data were extracted by two independent observers. Estimates of proportion were pooled using a random-effects model. Sputum mycobacterial culture negative conversion, recurrence, complications, and in-hospital mortality after surgery were primary outcomes that had been set before data collection began. Heterogeneity was evaluated by using the I statistic, and publication bias was assessed by using funnel plots and the Egger test.
RESULTS
Fifteen of the 2,739 screened studies, with 1,071 patients, were assessed. The weighted proportion of postoperative sputum culture negative conversion was 93% (95% CI, 87%-97%), and recurrence was 9% (95% CI, 6%-14%) for a median follow-up of 34 months. The proportion of patients who experienced postoperative complications was 17% (95% CI, 13%-23%), and in-hospital mortality was 0% (95% CI, 0%-2%). Studies that performed multilobar lung resection in > 30% of the study population showed comparable rates of complications with studies that did not.
INTERPRETATION
Adjunctive surgery is an effective therapeutic option with acceptable rates of complications for selected patients with NTM-PD.
TRIAL REGISTRY
PROSPERO; No.: CRD42022310663; URL: https://www.crd.york.ac.uk/prospero/.
Topics: Adult; Humans; Mycobacterium Infections, Nontuberculous; Databases, Factual; Hospital Mortality; Lung; Lung Diseases; Nontuberculous Mycobacteria; Retrospective Studies
PubMed: 36208713
DOI: 10.1016/j.chest.2022.09.037 -
Journal of Cardiac Surgery May 2020Left ventricular assist devices (LVADs) are integral for the management of medically refractory heart failure, and LVAD infections are common following device placement....
Left ventricular assist devices (LVADs) are integral for the management of medically refractory heart failure, and LVAD infections are common following device placement. Most infections are caused by Staphylococcal spp. and Gram-negative enteric bacteria but nontuberculous mycobacterial (NTM) infections have been reported. We present the second-ever reported case of a driveline infection caused by Mycobacterium fortuitum in a 75-year-old male with a continuous-flow LVAD. After receiving meropenem, azithromycin, and ciprofloxacin, he underwent device exchange and ultimately died after failing to recover neurologically. Management of NTM infections presents a clinical challenge due to the propensity for rapidly growing mycobacterial species to form biofilms and the possibility of negative cultures delaying diagnosis. To address the literature gap surrounding NTM infections in LVAD patients, we performed a systematic review and present all previously reported cases.
Topics: Aged; Anti-Bacterial Agents; Azithromycin; Ciprofloxacin; Device Removal; Fatal Outcome; Heart Failure; Heart-Assist Devices; Humans; Male; Meropenem; Mycobacterium Infections, Nontuberculous; Mycobacterium fortuitum; Prosthesis-Related Infections
PubMed: 32253770
DOI: 10.1111/jocs.14530