Non-Tuberculous Mycobacterial Pulmonary Disease identified during community-based screening for Mycobacterium Tuberculosis: a case report

Abstract

There is a rising prevalence of Non-Tuberculous Mycobacterial (NTM) disease in sub-Saharan Africa identified on culture specimens.
However, distinguishing mycobacterial colonisations from infection from identified NTMs on culture in the sub-Saharan Africa
setting remains to be established. A 49-year-old man presented with the cardinal symptoms of tuberculosis (TB) in a community TB
prevalence survey in Blantyre, Malawi. Mycobacteriology was atypical, prompting a line probe assay which revealed Mycobacterium
avium complex (MAC) species.
The epidemiology of Mycobacterium tuberculosis complex (MTBC) is better known than that of NTM. Up-scaling culture and speciation
may be a solution to this gap in knowledge of the burden of disease of NTM. Like most resource-poor settings, TB culture is not
routinely done in the diagnosis and management of TB in Malawi. Furthermore, the treatment of NTM is not analogous to that
of MTBC. The multi-drug regimens used for NTM disease treatment includes a newer macrolide (azithromycin, clarithromycin),
ethambutol, and rifamycin, and require prolonged durations of therapy aimed at facilitating clearance of the mycobacteria and
minimizing the emergence of drug resistance. Clinicians must thus be aware of this rising burden of NTM disease and consider other
diagnostic options to better investigate this disease in patients.