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Nontuberculous mycobacterial disease in children: A systematic review and meta-analysis
Xiaoyi Jiang1, Yi Xue1, Peixuan Men2
1National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug-resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China.
Insights
Nontuberculous mycobacterial (NTM) disease in children is rising globally. Lymph nodes are the most common site, with Mycobacterium avium complex being the predominant pathogen in pediatric cases.
Area of Science:
- Pediatric infectious diseases
- Microbiology
- Epidemiology
Background:
- Nontuberculous mycobacterial (NTM) disease prevalence is increasing in children worldwide.
- Pediatric NTM disease presents differently than in adults, yet understanding remains limited.
Purpose of the Study:
- To analyze the prevalence, common lesion sites, and species distribution of NTM disease in pediatric populations.
- To provide a comprehensive overview of pediatric NTM epidemiology.
Main Methods:
- Systematic review and meta-analysis of cross-sectional and cohort studies from English and Chinese databases.
- Inclusion criteria: studies reporting NTM species composition and lesion sites in children using recognized identification methods.
- Random effects model used to assess prevalence and lesion sites; heterogeneity analyzed using Cochran's Q and I² statistic.
Main Results:
- Pediatric NTM disease prevalence ranges from 0.6 to 5.36 per 100,000, with Europe showing the highest rates.
- Lymph nodes were the most frequent lesion site (71.1%), followed by lungs (19.3%) and skin/soft tissue (16.6%).
- Mycobacterium avium complex (MAC) was the most common NTM pathogen (54.9%), with Mycobacterium avium being more prevalent than Mycobacterium intracellulare within MAC.
Conclusions:
- Lymph node involvement is most common in pediatric NTM disease.
- Mycobacterium avium is the predominant NTM species identified in children.
- Findings highlight key differences in NTM disease presentation between pediatric and adult patients.
Background:
The prevalence of nontuberculous mycobacterial (NTM) disease in children is increasing worldwide. The clinical manifestations of pediatric NTM patients are significantly different from those of adult patients, but the knowledge of the disease is generally poor.
Methods:
English databases (PubMed, Web of Science, Embase, BIOSIS) and Chinese databases (CNKI, Wanfan, VIP) were searched on October 15th, 2022. All the articles of cross-sectional and cohort studies reporting the species composition and lesion site of the NTM disease in children using well-recognized NTM species identification methods were taken into account. Using a random effects model, we assessed the disease lesion sites and the prevalence of different NTM species in pediatric NTM disease. Sources of heterogeneity were analyzed using Cochran's Q and the I2 statistic. All analyses were performed using CMA V3.0.
Results:
The prevalence rates of NTM disease in children ranged between 0.6 and 5.36/100,000 in different countries, and Europe reported the highest prevalence rate. The most common clinical lesion site was lymph node, accounting for 71.1 % (55.0 %-83.2 %), followed by lung (19.3 %, 9.8%-34.4 %）and then skin and soft tissue (16.6 %,13.5%-20.3 %). Mycobacterium avium complex (MAC) was the most isolated NTM pathogen in children, accounting for 54.9 % (39.4%-69.6 %). Inconsistent with adult patients, Mycobacterium avium accounted for a dominant proportion in MAC than Mycobacterium intracellulare.
Conclusions:
The lymph node was the most affected organ in pediatric NTM disease, while Mycobacterium avium was the most isolated pathogenic species in children.
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