Nontuberculous Mycobacteria in Saudi Arabia and Gulf Countries: A Review

Abstract

Nontuberculous Mycobacteria (NTM) are causing growing health problems worldwide. This is indicated by an increasing amount of scientific reports showing not only well-identified species reemerging but also emergence of new species. The emergence and reemergence of NTM are particularly worrying in developing countries due to scarce published data and improper identification. Here we aimed to examine the main epidemiological aspects and diagnostic challenges associated with NTM in countries of the Gulf Cooperation Council (GCC) and compare these findings to the international arena findings. Data revealed that countries of the GCC are largely dominated by rapidly growing mycobacteria species such as M. fortuitum (29%) and M. abscessus (17%) with high rate of definitive respiratory diseases. On the other hand, most of the developed countries are dominated by slowly growing mycobacteria such as MAC, M. kansasii, and M. gordonae. More efforts are needed, however, to gain insights into NTM issues in countries of the GCC.

Figure 1

Clinical diversity of NTM in the Gulf countries. Illustrating the clinical diversity of NTM in three different GCC countries: Saudi Arabia, Kuwait, and Oman. The ∗∗ sign is designated for species reported from Saudi Arabia, Kuwait, and Oman. The ∗ sign, however, indicates that a species is reported from two GCC countries (Saudi Arabia and Oman or Saudi Arabia and Kuwait). Species shown in this figure with (no sign) are only reported from one GCC country. References [–21].

Figure 2

Worldwide geographical distribution of NTM. Showing summarized data of NTM identified from human clinical specimens in different geographical settings [–, –42, 96].

Figure 3

Environmental isolates reported from Saudi Arabia, Iraq, and Turkey. Illustrating the environmental diversity of NTM in Saudi Arabia, Iraq, and Turkey. Species' names and their relevant environmental percentages are also illustrated. References [, , –58].