Epidemiology of human pulmonary infection with mycobacteria nontuberculous
Section snippets
Skin test studies
Two landmark studies of skin testing helped shape our understanding of the epidemiology of NTM. Between 1943 and 1959, Palmer skin-tested over 22,000 students starting their nursing training in the United States [17]. A complete history of geographic residence and TB exposure was taken to classify subjects by area of origin within the United States and as having had close, intermediate, or no known contact with tuberculosis. Skin tests were considered positive if there was at least 5 mm of
Central and South America
Data on the epidemiology of NTM infection in Central and South America are limited. Barrera surveyed laboratories in Argentina to review mycobacterial isolates and related clinical information between 1982 and 1984 [40]. NTM disease was defined by the presence of symptoms, repeated isolation with quantitative culture, and the lack of response to standard anti-TB therapy. Over three-year study period, the authors found that 3% of all mycobacterial isolates were NTM, and only 6% were classified
Restricted microbiologic studies
Tala and Viljanen published a brief report of the mycobacterial isolates in Finland between 1991 and 1993 [41]. With the aid of national compulsory reporting for all mycobacterial infections, they found NTM rates remaining relatively stable, with a mean annual isolation rate of 6.6/100,000; 55% of isolates were MAC, with rapid growers (M chelonei and M fortuitum) making up 20%, M gordonae 15%, and M malmoense 10%. No data were provided on the clinical significance of these isolates, and the
Restricted microbiologic studies
A number of studies of the epidemiology of NTM have been performed in South Africa. These have generally been limited to select populations, providing accurate population-specific information, but no national averages to generalize to the population as a whole. Two studies reported on the results of mycobacterial studies of sputum cultures from large random samples of South African native peoples [54], [55]. Arabin et al obtained sputum from 1,196 Zulus in Natal, South Africa [54]. No clinical
Studies with clinical correlation
There has been a proliferation of studies on the epidemiology of NTM in Japan over the past two decades. Data for these studies come from patients investigated for suspected mycobacterial disease, who by public health law, are admitted to TB hospitals for investigations. These methods may lead to an underestimate of infection rates and an overestimate of the proportion of patients who have NTM disease rather than colonization, as patients with lower levels of symptoms may not reach medical
Studies with clinical correlation
Mycobacterial epidemiologists in Australia have enjoyed a system of screening for TB that requires reporting of all cases of mycobacterial disease, facilitating several thorough studies of rates of NTM infection and disease. Two studies presenting overlapping data on the epidemiology of NTM in Western Australia between 1959 and 1968 are reviewed together [63], [64]. Data reflected all positive NTM cultures over the study period and were correlated with clinical information. Disease was defined
Risk factors
Reviewing well-defined surveys of NTM infection and disease permits a relatively unbiased assessment of risk factors. These factors, summarized in Table 4, may be divided, in decreasing order of importance, into coexisting medical conditions, living and work environment, and patient demographics. Less well-studied is the magnitude of risk associated with these factors, and whether a factor increases the risk of infection, disease, or both. When available, these data are presented in Table 4,
Summary
A great deal of study has gone into the assessment of the epidemiology of NTM infection and disease in many different parts of the world. Review of the available studies provides insight into the frequency of this clinical problem as well as important limitations in current data. Study methods have varied greatly, undoubtedly leading to differing biases. In general, reported rates of infection and disease are likely underestimates, with the former probably less accurate than the latter, given
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Dr. Marras is a Canadian Institutes for Health Research and Lung Association postdoctoral fellow and University of Toronto Department of Medicine Clinician Scientist trainee.