Post by hellodolly on Jul 4, 2023 7:40:34 GMT -5
Studies from North America, Europe, and Asia have all shown increasing NTM disease incidence over the last two decades. Estimated NTM disease prevalence rose from 2.4 cases/100,000 in the early 1980s to 15.2 cases/100,000 in 2013 in the US (36). The prevalence in the elderly population (>65 years) more than doubled from 20 cases/100,000 to 47 cases /100,000 population between 1997 and 2007 (37). Multiple studies in five US states showed NTM positive culture rates increased from 8.2 cases/100,000 in 1994 to 16 cases/100,000 in 2014 (38). Similar figures are recorded in a Canadian study published in 2017 with disease prevalence increasing from 4.65 cases/100,000 in 1998 to 9.08 cases/100,000 in 2010. Laboratory isolation rate increased from 11.4 isolates/100,000 in 1998 to 22.22 isolates/100,000 in 2010 (39). The prevalence of NTM disease in non-cystic fibrosis (NCF) bronchiectasis in the US is estimated as 37% with the most common isolate being MAC (37). Laboratory isolation of NTM are now more common than M. tuberculosis in the US and Canada with an increase of 8.4% annually being documented between 1997 and 2003 (17). A study from the UK showed similar increases with the NTM infection rates more than tripling from 0.9 cases/100,000 in 1995 to 2.9 cases/100,000 in 2006 (40). Similar rates have been documented in Denmark (41) and Germany (42).
Studies in South Korea showed a 62% increase in NTM lung disease from 2002 to 2008 with a marked increase in MABS infection (43). This is in contrast to European studies that show a predominance of MAC infection (44, 45) Numbers from Japan have shown a marked increase in both NTM infection and mortality from 1994 to 2010 (46) while a population-based Chinese study showed an increase in NTM isolation rate from 3 to 8.5% from 2008 to 2012 (47). As NTM disease is not a notifiable disease in most countries, accurate epidemiological data is limited, particularly in countries with low development indices. Nonetheless, an increasing number of NTM cases have been recorded in Brazil, Taiwan and the Middle East (48–52).
Globally, the most common NTM pathogens are the MAC organisms though prevalence varies greatly with geographic region, gender, and age (49). MABS are a significant problem particularly because of very high levels of antibiotic resistance and the disease a growing problem in East Asian countries including Japan, Korea, and Taiwan (53). NTM are also a particularly difficult problem in patients with cystic fibrosis, which is the most common genetics disease in Caucasians, whom are highly prone to MABS infection (40).
Cultures from CF patients have an ~10,000-fold higher NTM prevalence compared with the general population (21). NTM isolation rates in CF vary from 3 to 17% with an increase in median prevalence from 9 to 13% seen in pre- and post-millennial studies (54). Increased prevalence of NTM positive cultures is seen with increasing age (55). Prevalence rates in the Australian adult CF population was 4.1% in a 2001–2014 retrospective study carried out in Queensland (56). Though not as common as other bacterial pathogens, NTM infection was recognized as an important clinical entity in these patients as it was associated with significant deterioration in lung function (57). A geographical variance is seen in NTM species prevalent in the CF population, with MABS and MAC remaining the most common PNTM infections in these regions (54). Genetic mutations in CF patients are associated with PNTM (58).
NTM pathology has been a notifiable disease in Queensland (QLD), Australia since the commencement of the tuberculosis (TB) control programme in the 1960s and is currently a notifiable disease (59, 60). The increase in disease incidence in QLD over the last several decades has been clearly documented. Clinical cases of MAC disease were reported as 0.63 cases/100,000 in 1985, 1.21 cases/100,000 in 1994 and 2.2 cases/100,000 in 1999 (59). Significant NTM species isolation rates then rose from 9.1 cases/100,000 to 13.6 cases/100,000 from 1999 to 2005. In total, 1,171 isolates were reported in 2016 which is almost double the 672 isolates reported for the same period in 2012 (60). An increase in MABS isolates was also seen during this period. Of note, there was a change in the gender distribution from male predominance in 1999 to female predominance in 2005, particularly in the elderly population (59). Overall, a pattern of increasing non-cavitary disease in elderly females at a rate of 2.2–3.2 cases/100,000 population per year has emerged. Similarly, an increase in NTM disease has also been seen in the Northern Territory (NT), Australia from 1989 to 1997 (61). Regarding infection sources, subsequent investigation showed MAC, and MABS were present in household and municipal water sources and shower aerosols in homes (62–64). Projections show cases could more than triple between 2020 and 2040 [up to 6,446 cases a year (CI 15 just in QLD] (Figure 2).
Source: www.frontiersin.org/articles/10.3389/fimmu.2020.00303/full
Studies in South Korea showed a 62% increase in NTM lung disease from 2002 to 2008 with a marked increase in MABS infection (43). This is in contrast to European studies that show a predominance of MAC infection (44, 45) Numbers from Japan have shown a marked increase in both NTM infection and mortality from 1994 to 2010 (46) while a population-based Chinese study showed an increase in NTM isolation rate from 3 to 8.5% from 2008 to 2012 (47). As NTM disease is not a notifiable disease in most countries, accurate epidemiological data is limited, particularly in countries with low development indices. Nonetheless, an increasing number of NTM cases have been recorded in Brazil, Taiwan and the Middle East (48–52).
Globally, the most common NTM pathogens are the MAC organisms though prevalence varies greatly with geographic region, gender, and age (49). MABS are a significant problem particularly because of very high levels of antibiotic resistance and the disease a growing problem in East Asian countries including Japan, Korea, and Taiwan (53). NTM are also a particularly difficult problem in patients with cystic fibrosis, which is the most common genetics disease in Caucasians, whom are highly prone to MABS infection (40).
Cultures from CF patients have an ~10,000-fold higher NTM prevalence compared with the general population (21). NTM isolation rates in CF vary from 3 to 17% with an increase in median prevalence from 9 to 13% seen in pre- and post-millennial studies (54). Increased prevalence of NTM positive cultures is seen with increasing age (55). Prevalence rates in the Australian adult CF population was 4.1% in a 2001–2014 retrospective study carried out in Queensland (56). Though not as common as other bacterial pathogens, NTM infection was recognized as an important clinical entity in these patients as it was associated with significant deterioration in lung function (57). A geographical variance is seen in NTM species prevalent in the CF population, with MABS and MAC remaining the most common PNTM infections in these regions (54). Genetic mutations in CF patients are associated with PNTM (58).
NTM pathology has been a notifiable disease in Queensland (QLD), Australia since the commencement of the tuberculosis (TB) control programme in the 1960s and is currently a notifiable disease (59, 60). The increase in disease incidence in QLD over the last several decades has been clearly documented. Clinical cases of MAC disease were reported as 0.63 cases/100,000 in 1985, 1.21 cases/100,000 in 1994 and 2.2 cases/100,000 in 1999 (59). Significant NTM species isolation rates then rose from 9.1 cases/100,000 to 13.6 cases/100,000 from 1999 to 2005. In total, 1,171 isolates were reported in 2016 which is almost double the 672 isolates reported for the same period in 2012 (60). An increase in MABS isolates was also seen during this period. Of note, there was a change in the gender distribution from male predominance in 1999 to female predominance in 2005, particularly in the elderly population (59). Overall, a pattern of increasing non-cavitary disease in elderly females at a rate of 2.2–3.2 cases/100,000 population per year has emerged. Similarly, an increase in NTM disease has also been seen in the Northern Territory (NT), Australia from 1989 to 1997 (61). Regarding infection sources, subsequent investigation showed MAC, and MABS were present in household and municipal water sources and shower aerosols in homes (62–64). Projections show cases could more than triple between 2020 and 2040 [up to 6,446 cases a year (CI 15 just in QLD] (Figure 2).
Source: www.frontiersin.org/articles/10.3389/fimmu.2020.00303/full