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Nontuberculous mycobacteria infections of the pleura: A systematic review

Keren Bachar1, Tiberiu Shulimzon2, Michael J Segel3

  • 1Institute of Pulmonology, Sheba Tel-HaShomer Medical Center, Ramat Gan, Israel; Medical Corps, Israel Defense Forces, Israel.

Respiratory Medicine
|November 6, 2022
PubMed
Abstract

Insights

Nontuberculous mycobacterial (NTM) pleuritis is rare but serious, affecting diverse patients and often requiring surgery. These NTM pleural infections have a high mortality rate of 24% and significant complications.

Area of Science:

  • Infectious Diseases
  • Pulmonology
  • Microbiology

Background:

  • Nontuberculous mycobacterial (NTM) pleuritis is an uncommon yet severe manifestation of NTM infection.
  • Existing literature consists primarily of case reports and small series, indicating a variable clinical course and high mortality rates.

Approach:

  • A systematic review was conducted, analyzing 206 cases of NTM pleural infections published in PubMed-indexed journals between 1980 and 2021.
  • Data on patient demographics, clinical presentation, microbiological findings, treatment interventions, complications, and outcomes were extracted and analyzed.

Key Points:

  • NTM pleural infections occurred in both immunocompetent and immunosuppressed individuals, with or without chronic lung disease or concurrent pulmonary NTM infection.
  • Mycobacterium avium complex was the most common pathogen (65%).
  • High complication rates included pneumothorax (40%), empyema (16%), and broncho-pleural fistula (16.5%), with a 24% mortality rate.

Conclusions:

  • NTM pleural infections present a significant clinical challenge with a poor prognosis.
  • Effective management often necessitates a combination of anti-NTM chemotherapy, pleural effusion drainage, and surgical interventions.
  • The high incidence of complications underscores the need for prompt diagnosis and aggressive treatment strategies.
Keywords:
Nontuberculous mycobacteriaPleural infectionSystematic review

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