J Korean Med Sci.  2024 May;39(20):e167. 10.3346/jkms.2024.39.e167.

Clinical Characteristics and Treatment Outcomes of Pulmonary Diseases Caused by Coinfections With Multiple Nontuberculous Mycobacterial Species

• Kim S
• Woo AL
• Yong SH
• Leem AY
• Lee SH
• Lee SH
• Kim SY
• Chung K
• Kim EY
• Jung JY
• Kang YA
• Park MS
• Kim YS
• Park Y

• KMID: 2556284
• DOI: http://doi.org/10.3346/jkms.2024.39.e167

Abstract

Background
Coinfections with multiple nontuberculous mycobacterial (NTM) species have not been widely studied. We aimed to evaluate the clinical characteristics and treatment outcomes in patients with NTM-pulmonary disease (PD) caused by coinfection with multiple NTM species.
Methods
We retrospectively reviewed patients with NTM-PD at a tertiary referral hospital in Korea between March 2012 and December 2018. Coinfection was defined as two or more species of NTM pathogens isolated from the same respiratory specimen or different specimens within three months.
Results
Among 1,009 patients with NTM-PD, 147 (14.6%) NTM coinfections were observed (average age 64.7 years, 69.4% women). NTM species were identified more frequently (median 6 vs. 3 times, P < 0.001) in the coinfection group than in the single species group, and follow-up duration was also longer in the coinfection group (median 44.9 vs. 27.1 months, P < 0.001). Mycobacterium avium complex (MAC) and M. abscessus and M. massiliense (MAB) were the dominant combinations (n = 71, 48.3%). For patients treated for over six months in the MAC plus MAB group (n = 31), sputum culture conversion and microbiological cure were achieved in 67.7% and 41.9% of patients, respectively. We divided the MAC plus MAB coinfection group into three subgroups according to the target mycobacteria; however, no statistical differences were found in the treatment outcomes.
Conclusion
In NTM-PD cases, a significant number of multiple NTM species coinfections occurred. Proper identification of all cultured NTM species through follow-up is necessary to detect multispecies coinfections. Further research is needed to understand the nature of NTM-PD in such cases.

Keyword

Coinfection; Mycobacterium avium Complex; Mycobacterium abscessus; Lung Diseases

Figure

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  Fig. 1 Study population.NTM = nontuberculous mycobacterial, MAC = Mycobacterium avium complex (M. avium and M. intracellulare), MAB = M. abscessus and M. massiliense.

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  Fig. 2 Combinations of mycobacteria in MAC plus MAB coinfection group (n = 71). Only the nontuberculous mycobacterial species that met the diagnostic criteria are displayed.MAC = Mycobacterium avium complex (M. avium and M. intracellulare), MAB = M. abscessus and M. massiliense.

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