Epidemiological profile and follow-up of patients with pulmonary disease by non-tuberculous mycobacteria in Baixada Santista area, São Paulo

Coelho, Andréa Gobetti Vieira; Chiou, Ana Carolina; Pedro, Heloisa da Silveira Paro; Nardi, Susilene Maria Tonelli; Chimara, Erica

doi:10.31744/einstein_journal/2022AO5510

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Sumário

ORIGINAL ARTICLE • Einstein (São Paulo) 20 • 2022 • https://doi.org/10.31744/einstein_journal/2022AO5510 copy

Epidemiological profile and follow-up of patients with pulmonary disease by non-tuberculous mycobacteria in Baixada Santista area, São Paulo

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

To present the frequency and species diversity of non-tuberculous mycobacteria, estimate the prevalence of non-tuberculous mycobacterial pulmonary disease, describe the epidemiological profile, and determine the follow-up of patients with non-tuberculous mycobacterial pulmonary disease living in a region with a high burden of tuberculosis.

Methods

This a retrospective cohort observational study using data records obtained from the Instituto Adolfo Lutz - Santos and from the São Paulo Sistema de Vigilância de Tuberculose do Estado de São Paulo in the period between 2000 and 2009. The studied variables were: socio-demographic characteristics, current and past history of tuberculosis, aspects related to diagnosis, and treatment and associated diseases.

Results

We included 319 non-tuberculous mycobacteria isolates in the study, corresponding to 257 patients. The species Mycobacterium kansasii (28.5%) and Mycobacterium fortuitum (16.6%) presented the higher occurrence. In 10.9% (24) of the patients, there was a criterion for confirming a case of pulmonary disease due to non-tuberculous mycobacteria. In relation to gender and age, male and individuals over 50 years old were the most frequent. Considering the confirmed cases, 47.8% had a past history of tuberculosis.

Conclusion

The lack of information about the cases is evident, since pulmonary disease due to non-tuberculous mycobacteria is not mandatory. The therapeutic regimen according to the identified species is fundamental for success in combating the infections caused by non-tuberculous mycobacteria. Besides that, information about the regional epidemiology of pulmonary disease caused by non-tuberculous mycobacteria and the search for associations with other comorbidities are important to establish the correct treatment. In order to improve surveillance of pulmonary diseases by non-tuberculous mycobacteria, we suggest the implantation of a sentinel surveillance and of population-based studies.

Lung diseases/diagnosis; Lung diseases/epidemiology; Nontuberculous mycobacteria; Opportunistic infections

Identification	Isolated n (%)
M. kansasii	91 (28.5)
M. fortuitum	53 (16.6)
MAC	37 (11.6)
Mycobacterium spp.	30 (9.4)
CLA	14 (4.4)
CRA	11 (3.4)
M. gordonae	10 (3.1)
M. intracellulare/M. chimaera	9 (2.8)
M. abscessus	8 (2.5)
M. peregrinum	8 (2.5)
M. nonchromogenicum	4 (1.3)
CLE	3 (0.9)
CLF	3 (0.9)
M. flavescens	3 (0.9)
M. scrofulaceum	3 (0.9)
M. tuberculosis/M. kansasii	3 (0.9)
M. immunogenum	2 (0.6)
M. intracellulare	2 (0.6)
M. lentiflavum	2 (0.6)
M. szulgai	2 (0.6)
M. terrae	2 (0.6)
M. tuberculosis /MNT	2 (0.6)
M. terrae/M. triviale	2 (0.6)
M. fortuitum/ M. chelonae	2 (0.6)
CRE	1 (0.3)
M. asiaticum	1 (0.3)
M. bohemicum	1 (0.3)
M. celatum	1 (0.3)
M. chelonae	1 (0.3)
M. mucogenicum	1 (0.3)
M. monacense	1 (0.3)
M. mucogenicum	1 (0.3)
M. holsaticum	1 (0.3)
M. shimoidei	1 (0.3)
M. tuberculosis/ M. intracellulare	1 (0.3)
M. tuberculosis/ M. gordonae	1 (0.3)
M. abscessus/ M. peregrinum	1 (0.3)
Total	319 (100.0)

Species	Isolated	n (%)	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009
CLA	14	(4.4)	2	3	2			1	2		1	3
CRA	11	(3.4)			1			1	1		2	6
CLE	3	(0.9)	1					2
CLF	3	(0.9)									3
CRE	1	(0.3)			1
M. kansasii	91	(28.5)	5	4	13	14	10	13	13	4	8	7
M. fortuitum	53	(16.6)	3	3	4	6	3	8	4	2	5	15
MAC	37	(11.6)		2	9	2	4	3	7	4	2	4
Mycobacterium spp.	30	(9.4)				16	14
M. gordonae	10	(3.1)			1				4	2		3
M. abscessus	8	(2.5)				1		3	2	1		1
M. peregrinum	8	(2.5)		1	2		3			1		1
M. nonchromogenicum	4	(1.3)		1	1				1	1
M. flavenscens	3	(0.9)					1		2
M. scrofulaceum	3	(0.9)							1	2
M. immunogenum	2	(0.6)							1			1
M. intracellulare	2	(0.6)						1	1
M. lentiflavum	2	(0.6)						1			1
M. mucogenicum	2	(0.6)							1		1
M. szulgai	2	(0.6)								1		1
M. terrae	2	(0.6)		2
M. asiaticum	1	(0.3)							1
M. bohemicum	1	(0.3)						1
M. celatum	1	(0.3)										1
M. chelonae	1	(0.3)						1
M. monacense	1	(0.3)									1
M. holsaticum	1	(0.3)										1
M. shimoidei	1	(0.3)			1
Mixed culture	21	(6.6)	0	2	4	1	1		1	1	2	9
Total	319	(100)	11 (3.4)	18 (5.6)	39 (12.2)	40 (12.5)	36 (11.3)	35 (11.0)	42 (13.2)	19 (6.0)	26 (8.2)	53 (16.6)

Characteristics	Mycobacterium kansasii n=9 n (%)	Mycobacterium fortuitum n=3 n (%)	MAC* n=5 n (%)	Other species n=7 n (%)	Total n=24 n (%)
Sex
Women	1 (11.1)	1 (33.3)	2 (40.0)	1 (14.3)	5 (20.8)
Men	8 (88.9)	2 (66.7)	3 (60.0)	6 (85.7)	19 (79.2)
Age group, years
15-25	0	0	1 (20.0)	1 (14.3)	2 (8.3)
26-30	0	1 (33.3)	0	1 (14.3)	2 (8.3)
31-35	1 (11.1)	0	1 (20.0)	1 (14.3)	3 (12.5)
236-40	2 (22.2)	0	1 (20.0)	0	3 (12.5)
41-45	1 (11.1)	0	0	0	1 (4.2)
46-50	1 (11.1)	1 (33.3)	1 (20.0)	0	3 (12.6)
50 or more	4 (44.4)	1 (33.3)	1 (20.0)	4 (57.1)	10 (41.7)
HIV infection
No	8 (88.9)	2 (66.7)	1 (20.0)	4 (57.1)	15 (62.5)
Yes	1 (11.1)	1 (33.3)	4 (80.0)	3 (42.9)	9 (37.5)
Diabetes
No	5 (55.6)	1 (33.3)	2 (40.0)	3 (42.9)	11 (458.)
Yes	1 (11.1)	1 (33.3)	0	0	2 (8.3)
SI	3 (33.3)	1 (33.3)	3 (60.0)	4 (57.1)	11 (45.8)
Past TB*
No	4 (44.4)	1 (33.3)	4 (80.0)	3 (50.0)	12 (52.2)
Yes	5 (55.6)	2 (66.7)	1 (20.0)	3 (50.0)	11 (47.8)
Outcome past TB
Cure	3 (33.3)	1 (33.3)	1 (20.0)	2 (28.6)	7 (29.2)
Abandonment	0	0	0	0	0
Failure	0	0	0	0	0
SI	6 (66.7)	2 (66.7)	4 (80.0)	5 (71.4)	17 (70.8)
Supervised treatment
Yes	6 (22.2)	1 (33.3)	4 (80.0)	2 (28.6)	13 (37.5)
No	2 (66.7)	1 (33.3)	0	2 (28.6)	5 (37.5)
SI	1 (11.1)	1 (33.3)	1 (20.0)	3 (42.9)	6 (25.0)
Treatment regimen
RHZ	4 (50.0)	1 (50.0)	4 (80.0)	3 (75.0)	12 (63.2)
2RHZE	3 (37.5)	1 (50.0)	1 (20.0)	0	5 (26.3)
Other drugs	1 (12.5)	0	0	1 (33.3)	2 (10.5)
Current outcome
Cure	3 (33.3)	2 (66.7)	2 (40.0)	4 (57.1)	11 (45.8)
Dropout	0	0	0	0	0
Death TB	0	0	0	0	0
TB/HIV death	0	0	1 (20.0)	0	1 (4.2)
Failure	0	0	0	0	0
Change of diagnosis	6 (66.7)	1 (33.3)	1 (20.0)	1 (14.3)	9 (37.5)
Transfer	0	0	1 (20.0)	1 (14.3)	2 (8.3)
SI	0	0	0	1 (14.3)	1 (4.2)

Year	Prevalence of isolates*	Prevalence of confirmed cases*
2000	0.9 (n=10)	0.1 (n=1)
2001	1.5 (n=16)	0.2 (n=2)
2002	3.3 (n=34)	0.3 (n=3)
2003	3.4 (n=32)	0.5 (n=6)
2004	3.0 (n=26)	0.5 (n=7)
2005	2.9 (n=25)	0.3 (n=5)
2006	3.5 (n=35)	0.4 (n=4)
2007	1.6 (n=14)	0.3 (n=3)
2008	2.2 (n=20)	0.3 (n=4)
2009	4.4 (n=45)	0.3 (n=4)
Total	n=257	n=39

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[1] Corresponding author: Heloisa da Silveira Paro Pedro Instituto Adolfo Lutz Rua Alberto Sufredine Bertoni, 2.325 - Vila Maceno Zip code: 15060-020 - São José do Rio Preto, SP, Brazil Phone: (55 17) 3224-2602, branch line 717 E-mail: heloisa.paro@gmail.com