Yaoju Tan1, Yunfeng Deng2, Xiaofeng Yan3, Fangchao Liu4, Yunhong Tan5, Quan Wang6, Xundi Bao7, Jianhua Pan8, Xiaolu Luo9, Yanhong Yu10, Xiaoli Cui11, Guangfu Liao12, Chunmei Ke13, Ping Xu14, Xiaofei Li15, Chunlei Zhang16, Xiangyang Yao17, Ye Xu18, Tongxin Li3, Biyi Su1, Zhenhua Chen5, Ruiying Ma6, Yue Jiang7, Xiaohua Ma8, Dewu Bi9, Jinghong Ma10, Han Yang11, Xuezheng Li2, Liusheng Tang12, Yongmin Yu13, Yufeng Wang19, Huafeng Song14, Hongwei Liu15, Meiling Wu16, Yinghui Yang17, Zhongtan Xue19, Liang Li20, Qingge Li21, Yu Pang22. 1. Department of Clinical Laboratory, Guangzhou Chest Hospital, Guangzhou, China. 2. Katharine Hsu International Research Center of Human Infectious Diseases, Shandong Provincial Chest Hospital, Shandong University, Jinan, China. 3. Central Laboratory, Chongqing Public Health Medical Center, Chongqing, China. 4. Department of Bacteriology and Immunology, Beijing Key Laboratory on Drug-Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis & Thoracic Tumor Research Institute, Beijing, China. 5. Department of Clinical Laboratory, Hunan Chest Hospital, Changsha, China. 6. Department of Clinical Laboratory, The Eighth Affiliated Hospital of Xinjiang Medical University, Urumqi, China. 7. Department of Clinical Laboratory, Anhui Chest Hospital, Hefei, China. 8. Department of Clinical Laboratory, Changsha Central Hospital, Changsha, China. 9. Department of Clinical Laboratory, Affiliated Infectious Disease Hospital of Nanning, Guangxi Medical University, Nanning, China. 10. Department of Clinical Laboratory, Shenyang Tenth People's Hospital, Shenyang, China. 11. Department of Clinical Laboratory, Xi'an Chest Hospital, Xi'an, China. 12. Department of Clinical Laboratory, Guangxi Zhuang Autonomous Region Longtan Hospital, Liuzhou, China. 13. Department of Clinical Laboratory, Henan Provincial Infectious Diseases Hospital, Zhengzhou, China. 14. Department of Clinical Laboratory, The Fifth People's Hospital of Suzhou, Suzhou, China. 15. Department of Clinical Laboratory, The Third People's Hospital of Kunming, Kunming, China. 16. Department of Clinical Laboratory, Harbin Chest Hospital, Harbin, China. 17. Department of Clinical Laboratory, The First Affiliated Hospital of Xiamen University, Xiamen, China. 18. Engineering Research Centre of Molecular Diagnostics of the Ministry of Education, School of Life Sciences, Xiamen University, Xiamen, China. 19. Department of Bacteriology and Immunology, Beijing Key Laboratory on Drug-Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis & Thoracic Tumor Research Institute, Beijing, China; Department of Laboratory Quality Control, Innovation Alliance on Tuberculosis Diagnosis and Treatment (Beijing), Beijing, China. 20. Clinical Center on Tuberculosis Control, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis & Thoracic Tumor Research Institute, Beijing, China. Electronic address: liliang69@tb123.org. 21. Engineering Research Centre of Molecular Diagnostics of the Ministry of Education, School of Life Sciences, Xiamen University, Xiamen, China. Electronic address: qgli@xmu.edu.cn. 22. Department of Bacteriology and Immunology, Beijing Key Laboratory on Drug-Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis & Thoracic Tumor Research Institute, Beijing, China; Department of Laboratory Quality Control, Innovation Alliance on Tuberculosis Diagnosis and Treatment (Beijing), Beijing, China. Electronic address: pangyupound@163.com.
Abstract
BACKGROUND: We aimed to address the knowledge gap that exists regarding the epidemiological, demographic, and clinical characteristics of nontuberculous mycobacterial pulmonary diseases (NTM-PDs) among smear-positive patients with symptoms suggestive of pulmonary tuberculosis (PTB) in China. METHODS: Prospective and national surveillance of NTM-PD was performed from 17 hospitals within the China Nontuberculous Mycobacteria Surveillance Study (CNTMS). Patients were eligible for inclusion if they had positive smears during hospitalization. Sputum specimens were collected for molecular species identification. RESULTS: 6,766 patients with valid results were included, consisting of 6,236 (92.2%) with PTB, 458 (6.8%) with NTM-PD, and 72 (1.0%) with colonization. The proportion of NTM-PD in PTB patients exhibited significant geographic diversity, ranging from 3.2% in the northwest to 9.2% in the south. The most prevalent species was Mycobacterium intracellulare, followed by Mycobacterium abscessus complex. Females, elderly people, and patients with bronchiectasis or COPD are at high risk for developing NTM-PD, while patients with diabetes have a lower risk of NTM-PD when compared with non-diabetic patients. Regarding clinical symptoms, lower rates of persistent cough and weight loss were noted in NTM-PD patients than in PTB patients. CONCLUSIONS: Approximately one-fifteenth of PTB patients are afflicted with nontuberculous mycobacterial infections in China. The prevalence of NTM shows geographic diversity across the country, and it showed a gradual increase from north to south and from west to east. NTM-PD patients are prone to exhibit less severe clinical symptoms than PTB patients, highlighting the importance of raising awareness of NTM diseases to improve decision making on how to best screen, diagnose, and treat NTM in TB-endemic settings.
BACKGROUND: We aimed to address the knowledge gap that exists regarding the epidemiological, demographic, and clinical characteristics of nontuberculous mycobacterial pulmonary diseases (NTM-PDs) among smear-positive patients with symptoms suggestive of pulmonary tuberculosis (PTB) in China. METHODS: Prospective and national surveillance of NTM-PD was performed from 17 hospitals within the China Nontuberculous Mycobacteria Surveillance Study (CNTMS). Patients were eligible for inclusion if they had positive smears during hospitalization. Sputum specimens were collected for molecular species identification. RESULTS: 6,766 patients with valid results were included, consisting of 6,236 (92.2%) with PTB, 458 (6.8%) with NTM-PD, and 72 (1.0%) with colonization. The proportion of NTM-PD in PTB patients exhibited significant geographic diversity, ranging from 3.2% in the northwest to 9.2% in the south. The most prevalent species was Mycobacterium intracellulare, followed by Mycobacterium abscessus complex. Females, elderly people, and patients with bronchiectasis or COPD are at high risk for developing NTM-PD, while patients with diabetes have a lower risk of NTM-PD when compared with non-diabeticpatients. Regarding clinical symptoms, lower rates of persistent cough and weight loss were noted in NTM-PD patients than in PTB patients. CONCLUSIONS: Approximately one-fifteenth of PTB patients are afflicted with nontuberculous mycobacterial infections in China. The prevalence of NTM shows geographic diversity across the country, and it showed a gradual increase from north to south and from west to east. NTM-PD patients are prone to exhibit less severe clinical symptoms than PTB patients, highlighting the importance of raising awareness of NTM diseases to improve decision making on how to best screen, diagnose, and treat NTM in TB-endemic settings.