Non-tuberculous Mycobacteria isolated from Pulmonary samples in sub-Saharan Africa - A Systematic Review and Meta Analyses

Abstract

Pulmonary non-tuberculous mycobacterial (NTM) disease epidemiology in sub-Saharan Africa is not as well described as for pulmonary tuberculosis. Earlier reviews of global NTM epidemiology only included subject-level data from one sub-Saharan Africa country. We systematically reviewed the literature and searched PubMed, Embase, Popline, OVID and Africa Wide Information for articles on prevalence and clinical relevance of NTM detection in pulmonary samples in sub-Saharan Africa. We applied the American Thoracic Society/Infectious Disease Society of America criteria to differentiate between colonisation and disease. Only 37 articles from 373 citations met our inclusion criteria. The prevalence of pulmonary NTM colonization was 7.5% (95% CI: 7.2%-7.8%), and 75.0% (2325 of 3096) occurred in males, 16.5% (512 of 3096) in those previously treated for tuberculosis and Mycobacterium avium complex predominated (27.7% [95% CI: 27.2-28.9%]). In seven eligible studies, 27.9% (266 of 952) of participants had pulmonary NTM disease and M. kansasii with a prevalence of 69.2% [95% CI: 63.2-74.7%] was the most common cause of pulmonary NTM disease. NTM species were unidentifiable in 29.2% [2,623 of 8,980] of isolates. In conclusion, pulmonary NTM disease is a neglected and emerging public health disease and enhanced surveillance is required.

Figure 1

Flow chart of literature search and article selection criteria.

Figure 2

The distribution of the top four non-tuberculous mycobacteria species identified from pulmonary samples in Mali (HIV 1.4%), Ghana (HIV prevalence 1.3), Nigeria (HIV 3.1%), Uganda (HIV 7.1%), Kenya (HIV 5.9%), Tanzania (HIV 4.7%), Zambia (HIV 12.9%), and Republic of South Arica (HIV 19.2%), without considering clinical relevance. Data compiled from refs^{,,,,,–,–,–}. HIV prevalence compiled from ref..

Figure 3

Non-tuberculous mycobacteria species causing pulmonary disease (based on ATS/ISDA criteria) found in respiratory specimens in sub-Saharan Africa. Data compiled from refs^,,,,,,.