Highlights
- •Nontuberculous mycobacteria infections of the pleura arise in immunocompetent and immunosuppressed patients.
- •The pleural infection does not necessarily co-exist with a nontuberculous mycobacteria pulmonary infection.
- •The prognosis of nontuberculous mycobacteria pleural infection is poor including a high risk of complications.
Abstract
Background
Nontuberculous mycobacterial (NTM) pleuritis is an uncommon manifestation of NTM infection.
Case reports and small case series have shown a variable clinical course and high
mortality rates.
Objective
To describe patients' characteristics, clinical presentation and outcomes of NTM pleural
infections.
Methods
A systematic review of cases of NTM pleural infections published in PubMed-indexed
journals from 1980 to 2021.
Results
A total of 206 cases of NTM pleural infections were found and analyzed. Fifty-eight
percent of cases were males. The mean age was 57.5 yrs (range 9–87 yrs). Forty-three
percent of patients were immunosuppressed, and 43% had a chronic lung disease; thirty-two
percent had neither risk factor. In addition to the pleural infection, 67% of cases
had a concurrent pulmonary NTM infection, and in 18 cases there was another extrapulmonary
site of NTM infection. In 29% of cases the pleural infection was the sole manifestation
of NTM disease. The most common isolated mycobacterium was Mycobacterium avium complex (65%). Fifty-three percent and 26% of patients required pleural effusion
drainage and a surgical intervention, respectively, to treat the infection, in addition
to anti-NTM chemotherapy. Forty percent of patients developed pneumothorax, 16% suffered
from empyema, and 16.5% had broncho-pleural fistula. The reported mortality rate was
24%.
Conclusion
NTM pleural infections may arise in immunocompetent and immunosuppressed patients,
with or without chronic lung disease or concurrent NTM pulmonary infection. These
infections carry a poor prognosis and a high risk of complications requiring surgical
interventions in addition to anti-NTM chemotherapy.
Keywords
Abbreviations:
NTM (nontuberculous mycobacteria), AIDS (acquired immunodeficiency syndrome), PCR (polymerase chain reaction), HIV (human immunodeficiency virus), TB (tuberculosis), INF-ɣ (interferon-gamma), IL-12 (interleukin 12), TNF-α (tumor necrosis factor-alpha)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: October 31, 2022
Accepted:
October 27,
2022
Received in revised form:
September 11,
2022
Received:
April 18,
2022
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
