Nqwata Lamla, Pasipanodya Jotam G, Black Marianne, Feldman Charles
Department of Internal Medicine, University of Witwatersrand, Johannesburg 2193, South Africa.
Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
Diagnostics (Basel). 2024 Nov 27;14(23):2682. doi: 10.3390/diagnostics14232682.
BACKGROUND/OBJECTIVES: In sub-Saharan Africa, there is paucity of data regarding non-tuberculous mycobacterial (NTM) infections, leading to underappreciation of disease burden. Consequently, fewer resources are allocated, leading to potential adverse outcomes. This study examines long-term mortality and risk factors of South African patients with positive NTM samples.
We conducted a retrospective analysis of clinical isolates of NTMs between 1 January 2010 and 30 June 2017. We retrieved and thoroughly reviewed the corresponding medical records of patients treated at Charlotte Maxeke Johannesburg Academic Hospital. Outcomes were compared between patients who underwent different therapy regimens, including macrolide-based regimens and 'watchful waiting'.
A total of 123 patients were followed for a median of 1 year (interquartile range [IQR], 0.5-4.5). The median age was 39 years (IQR, 31-51) with male predominance, 58%. The common comorbid conditions were HIV (encountered in 78%) and previous TB (58%). Pulmonary disease due to complex (MAC-PD) was found in 74% of patients, in 5%, and in 4%. The mortality relative risk for patients on initial macrolide-containing therapy was 0.54 (95% confidence interval [CI], 0.22-1.36), = 0.194, while that for macrolide-free antimicrobials was 1.38 (95% CI, 0.57-3.34), = 0.471. The adjusted hazard rate for mortality with low CD4 counts < 50 cells/mm was 2.79 (95%, 1.20-6.50), while that for unknown CD4 counts was 4.01 (95% CI, 1.17-13.77), compared to CD4 counts > 50 cells/mm.
Among HIV patients, NTM-PD predominated, and not disseminated disease. MAC-PD was the most common infection. Low CD4 counts was a significant risk factor for early death, while sex, NTM species, macrolide therapy, and previous TB were not.
背景/目的：在撒哈拉以南非洲地区，关于非结核分枝杆菌（NTM）感染的数据匮乏，导致对疾病负担认识不足。因此，分配的资源较少，可能会导致不良后果。本研究调查了NTM样本呈阳性的南非患者的长期死亡率及危险因素。
我们对2010年1月1日至2017年6月30日期间NTM的临床分离株进行了回顾性分析。我们检索并全面审查了在夏洛特·马克西克约翰内斯堡学术医院接受治疗的患者的相应病历。对接受不同治疗方案（包括基于大环内酯类的方案和“观察等待”）的患者的结局进行了比较。
共对123例患者进行了中位时间为1年的随访（四分位间距[IQR]，0.5 - 4.5）。中位年龄为39岁（IQR，31 - 51），男性占主导，为58%。常见的合并症为HIV（78%）和既往结核病（58%）。74%的患者患有复杂性肺部疾病（MAC - PD），5%患有播散性疾病，4%患有其他疾病。初始接受含大环内酯类治疗的患者的死亡相对风险为0.54（95%置信区间[CI]，0.22 - 1.36），P = 0.194，而接受不含大环内酯类抗菌药物治疗的患者的死亡相对风险为1.38（95% CI，0.57 - 3.34），P = 0.471。CD4细胞计数<50个细胞/mm³时的校正死亡风险率为2.79（95%，1.20 - 6.50），与CD4细胞计数>50个细胞/mm³相比，CD4细胞计数未知时的校正死亡风险率为4.0l（95% CI，1.17 - 13.77）。
在HIV患者中，NTM - PD占主导，而非播散性疾病。MAC - PD是最常见的感染类型。低CD4细胞计数是早期死亡的重要危险因素，而性别、NTM菌种、大环内酯类治疗及既往结核病则不是。
