Isolation of non-tuberculous mycobacteria among tuberculosis patients, a study from a tertiary care hospital in Lahore, Pakistan
Abstract Background There is scarce knowledge on the prevalence of diseases caused by non-tuberculous mycobacteria (NTM) in Pakistan. In the absence of culture and identification, acid-fast bacilli (AFB) causing NTM disease are liable to be misinterpreted as tuberculosis (TB). Introduction of nuclei...
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doaj-4a9ace9ea0ff49be8bfd844574ea08b12021-04-25T11:08:45ZengBMCBMC Infectious Diseases1471-23342021-04-012111910.1186/s12879-021-06086-8Isolation of non-tuberculous mycobacteria among tuberculosis patients, a study from a tertiary care hospital in Lahore, PakistanAsifa Karamat0Atiqa Ambreen1Aamira Ishtiaq2Sabira Tahseen3Muhammad Aqeelur Rahman4Tehmina Mustafa5Department of Tuberculosis and Chest Medicine, Gulab Devi HospitalDepartment of Microbiology, Gulab Devi HospitalDepartment of Tuberculosis and Chest Medicine, Gulab Devi HospitalNational Tuberculosis Control Programme and National Tuberculosis Reference LaboratoryDepartment of Tuberculosis and Chest Medicine, Gulab Devi HospitalCentre for International Health, Department of Global Public Health and Primary Care, University of BergenAbstract Background There is scarce knowledge on the prevalence of diseases caused by non-tuberculous mycobacteria (NTM) in Pakistan. In the absence of culture and identification, acid-fast bacilli (AFB) causing NTM disease are liable to be misinterpreted as tuberculosis (TB). Introduction of nucleic acid amplification testing for Mycobacterium tuberculosis complex (MTBC) offers improved diagnostic accuracy, compared with smear microscopy, and also assists in differentiating MTBC from other mycobacteria. This study aimed to investigate the prevalence of NTM among patients investigated for TB and describe NTM disease and treatment outcomes at a tertiary care hospital in Pakistan. Methods This is a retrospective study, data on NTM isolates among culture-positive clinical samples over 4 years (2016–19) was retrieved from laboratory records. Information on clinical specimens processed, AFB smear results, and for the AFB positive isolates, results of species identification for MTBC, and for NTM isolates, results of species characterization and drug susceptibility testing was collected. Additional clinical data including patient characteristics, treatment regimens, and outcomes were collected for patients with NTM disease treated at Gulab Devi Hospital, Lahore. Results During the study period, 12,561 clinical specimens were processed for mycobacterial culture and 3673 (29%) were reported positive for AFB. Among these 3482 (95%) were identified as MTBC and 191 (5%) as NTM. Among NTM, 169 (88%) were isolated from pulmonary and 22 (12%) from extrapulmonary specimens. Results of NTM speciation were available for 60 isolates and included 55% (n = 33) M. avium complex and 25% (n = 15) M. abscesses. Among these patients, complete clinical records were retrieved for 12 patients with pulmonary disease including nine infected with M. avium complex and three with M. abscessus. All 12 patients had a history of poor response to standard first-line anti-TB treatment. Ten patients were cured after 18 months of treatment, whereas, one with M. abscessus infection died and another was lost to follow up. Conclusion In TB endemic areas, NTM can be misdiagnosed as pulmonary TB leading to repeated failed anti-TB treatment and increased morbidity, emphasizing the need for improved diagnosis.https://doi.org/10.1186/s12879-021-06086-8Non-tuberculous mycobacteriaNTM pulmonary diseaseNTM treatmentMycobacterial speciesPulmonary tuberculosisAcid-fast microscopy |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Asifa Karamat Atiqa Ambreen Aamira Ishtiaq Sabira Tahseen Muhammad Aqeelur Rahman Tehmina Mustafa |
spellingShingle |
Asifa Karamat Atiqa Ambreen Aamira Ishtiaq Sabira Tahseen Muhammad Aqeelur Rahman Tehmina Mustafa Isolation of non-tuberculous mycobacteria among tuberculosis patients, a study from a tertiary care hospital in Lahore, Pakistan BMC Infectious Diseases Non-tuberculous mycobacteria NTM pulmonary disease NTM treatment Mycobacterial species Pulmonary tuberculosis Acid-fast microscopy |
author_facet |
Asifa Karamat Atiqa Ambreen Aamira Ishtiaq Sabira Tahseen Muhammad Aqeelur Rahman Tehmina Mustafa |
author_sort |
Asifa Karamat |
title |
Isolation of non-tuberculous mycobacteria among tuberculosis patients, a study from a tertiary care hospital in Lahore, Pakistan |
title_short |
Isolation of non-tuberculous mycobacteria among tuberculosis patients, a study from a tertiary care hospital in Lahore, Pakistan |
title_full |
Isolation of non-tuberculous mycobacteria among tuberculosis patients, a study from a tertiary care hospital in Lahore, Pakistan |
title_fullStr |
Isolation of non-tuberculous mycobacteria among tuberculosis patients, a study from a tertiary care hospital in Lahore, Pakistan |
title_full_unstemmed |
Isolation of non-tuberculous mycobacteria among tuberculosis patients, a study from a tertiary care hospital in Lahore, Pakistan |
title_sort |
isolation of non-tuberculous mycobacteria among tuberculosis patients, a study from a tertiary care hospital in lahore, pakistan |
publisher |
BMC |
series |
BMC Infectious Diseases |
issn |
1471-2334 |
publishDate |
2021-04-01 |
description |
Abstract Background There is scarce knowledge on the prevalence of diseases caused by non-tuberculous mycobacteria (NTM) in Pakistan. In the absence of culture and identification, acid-fast bacilli (AFB) causing NTM disease are liable to be misinterpreted as tuberculosis (TB). Introduction of nucleic acid amplification testing for Mycobacterium tuberculosis complex (MTBC) offers improved diagnostic accuracy, compared with smear microscopy, and also assists in differentiating MTBC from other mycobacteria. This study aimed to investigate the prevalence of NTM among patients investigated for TB and describe NTM disease and treatment outcomes at a tertiary care hospital in Pakistan. Methods This is a retrospective study, data on NTM isolates among culture-positive clinical samples over 4 years (2016–19) was retrieved from laboratory records. Information on clinical specimens processed, AFB smear results, and for the AFB positive isolates, results of species identification for MTBC, and for NTM isolates, results of species characterization and drug susceptibility testing was collected. Additional clinical data including patient characteristics, treatment regimens, and outcomes were collected for patients with NTM disease treated at Gulab Devi Hospital, Lahore. Results During the study period, 12,561 clinical specimens were processed for mycobacterial culture and 3673 (29%) were reported positive for AFB. Among these 3482 (95%) were identified as MTBC and 191 (5%) as NTM. Among NTM, 169 (88%) were isolated from pulmonary and 22 (12%) from extrapulmonary specimens. Results of NTM speciation were available for 60 isolates and included 55% (n = 33) M. avium complex and 25% (n = 15) M. abscesses. Among these patients, complete clinical records were retrieved for 12 patients with pulmonary disease including nine infected with M. avium complex and three with M. abscessus. All 12 patients had a history of poor response to standard first-line anti-TB treatment. Ten patients were cured after 18 months of treatment, whereas, one with M. abscessus infection died and another was lost to follow up. Conclusion In TB endemic areas, NTM can be misdiagnosed as pulmonary TB leading to repeated failed anti-TB treatment and increased morbidity, emphasizing the need for improved diagnosis. |
topic |
Non-tuberculous mycobacteria NTM pulmonary disease NTM treatment Mycobacterial species Pulmonary tuberculosis Acid-fast microscopy |
url |
https://doi.org/10.1186/s12879-021-06086-8 |
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