Epidemiology, clinical presentation, and predictors of outcome in nontuberculous mycobacterial central nervous system infection: a systematic review
Abstract Background CNS manifestations represent an emerging facet of NTM infection with significant mortality. Due to protean presentation and low index of suspicion, many cases are often treated erroneously as tubercular meningitis or fungal infections. Objectives Literature on NTM CNS disease is...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-09-01
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| Series: | Tropical Medicine and Health |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s41182-023-00546-4 |
| _version_ | 1797556402221219840 |
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| author | Durga Shankar Meena Deepak Kumar Vasudha Meena Gopal Krishana Bohra Vibhor Tak Mahendra Kumar Garg |
| author_facet | Durga Shankar Meena Deepak Kumar Vasudha Meena Gopal Krishana Bohra Vibhor Tak Mahendra Kumar Garg |
| author_sort | Durga Shankar Meena |
| collection | DOAJ |
| description | Abstract Background CNS manifestations represent an emerging facet of NTM infection with significant mortality. Due to protean presentation and low index of suspicion, many cases are often treated erroneously as tubercular meningitis or fungal infections. Objectives Literature on NTM CNS disease is scarce, with most available data on pulmonary disease. This systematic review aimed to evaluate the epidemiology, clinical presentation, diagnostic modalities, and predictors of outcome in CNS NTM infection. Methods The literature search was performed in major electronic databases (PubMed, Google Scholar, and Scopus) using keywords “CNS,” “Central nervous system,” “brain abscess,” “meningitis,” “spinal,” “Nontuberculous mycobacteria,” “NTM”. All cases of CNS NTM infection reported between January 1980 and December 2022 were included. Results A total of 77 studies (112 cases) were included in the final analysis. The mean age of all patients was 38 years, with most patients male (62.5%). Mycobacterium avium complex (MAC) was the most common aetiology, followed by M. fortuitum and M. abscessus (34.8%, 21.4% and 15.2%, respectively). The disseminated disease was found in 33% of cases. HIV (33.9%) and neurosurgical hardware (22.3%) were the common risk factors. Intracranial abscess (36.6%) and leptomeningeal enhancement (28%) were the most prevalent findings in neuroimaging. The overall case fatality rate was 37.5%. On multivariate analysis, male gender (adjusted OR 2.4, 95% CI 1.2–7.9) and HIV (adjusted OR 3.7, 95% CI 1.8–6.1) were the independent predictors of mortality). M. fortuitum infection was significantly associated with increased survival (adjusted OR 0.18, 95% CI (0.08–0.45), p value 0.012). Conclusions Current evidence shows the emerging role of rapid-grower NTM in CNS disease. Male gender and HIV positivity were associated with significant mortality, while M fortuitum carries favourable outcomes. |
| first_indexed | 2024-03-10T17:01:22Z |
| format | Article |
| id | doaj.art-dce28547b1c94a39838137a25032ef29 |
| institution | Directory Open Access Journal |
| issn | 1349-4147 |
| language | English |
| last_indexed | 2024-03-10T17:01:22Z |
| publishDate | 2023-09-01 |
| publisher | BMC |
| record_format | Article |
| series | Tropical Medicine and Health |
| spelling | doaj.art-dce28547b1c94a39838137a25032ef292023-11-20T10:58:17ZengBMCTropical Medicine and Health1349-41472023-09-0151111010.1186/s41182-023-00546-4Epidemiology, clinical presentation, and predictors of outcome in nontuberculous mycobacterial central nervous system infection: a systematic reviewDurga Shankar Meena0Deepak Kumar1Vasudha Meena2Gopal Krishana Bohra3Vibhor Tak4Mahendra Kumar Garg5Department of Internal Medicine (Division of Infectious Diseases), All India Institute of Medical SciencesDepartment of Internal Medicine (Division of Infectious Diseases), All India Institute of Medical SciencesDepartment of Pediatrics, Dr. S.N. Medical CollegeDepartment of Internal Medicine (Division of Infectious Diseases), All India Institute of Medical SciencesDepartment of Microbiology, All India Institute of Medical SciencesDepartment of Internal Medicine (Division of Infectious Diseases), All India Institute of Medical SciencesAbstract Background CNS manifestations represent an emerging facet of NTM infection with significant mortality. Due to protean presentation and low index of suspicion, many cases are often treated erroneously as tubercular meningitis or fungal infections. Objectives Literature on NTM CNS disease is scarce, with most available data on pulmonary disease. This systematic review aimed to evaluate the epidemiology, clinical presentation, diagnostic modalities, and predictors of outcome in CNS NTM infection. Methods The literature search was performed in major electronic databases (PubMed, Google Scholar, and Scopus) using keywords “CNS,” “Central nervous system,” “brain abscess,” “meningitis,” “spinal,” “Nontuberculous mycobacteria,” “NTM”. All cases of CNS NTM infection reported between January 1980 and December 2022 were included. Results A total of 77 studies (112 cases) were included in the final analysis. The mean age of all patients was 38 years, with most patients male (62.5%). Mycobacterium avium complex (MAC) was the most common aetiology, followed by M. fortuitum and M. abscessus (34.8%, 21.4% and 15.2%, respectively). The disseminated disease was found in 33% of cases. HIV (33.9%) and neurosurgical hardware (22.3%) were the common risk factors. Intracranial abscess (36.6%) and leptomeningeal enhancement (28%) were the most prevalent findings in neuroimaging. The overall case fatality rate was 37.5%. On multivariate analysis, male gender (adjusted OR 2.4, 95% CI 1.2–7.9) and HIV (adjusted OR 3.7, 95% CI 1.8–6.1) were the independent predictors of mortality). M. fortuitum infection was significantly associated with increased survival (adjusted OR 0.18, 95% CI (0.08–0.45), p value 0.012). Conclusions Current evidence shows the emerging role of rapid-grower NTM in CNS disease. Male gender and HIV positivity were associated with significant mortality, while M fortuitum carries favourable outcomes.https://doi.org/10.1186/s41182-023-00546-4Nontuberculous mycobacteriaNTMCentral nervous systemBrain abscessMeningitis |
| spellingShingle | Durga Shankar Meena Deepak Kumar Vasudha Meena Gopal Krishana Bohra Vibhor Tak Mahendra Kumar Garg Epidemiology, clinical presentation, and predictors of outcome in nontuberculous mycobacterial central nervous system infection: a systematic review Tropical Medicine and Health Nontuberculous mycobacteria NTM Central nervous system Brain abscess Meningitis |
| title | Epidemiology, clinical presentation, and predictors of outcome in nontuberculous mycobacterial central nervous system infection: a systematic review |
| title_full | Epidemiology, clinical presentation, and predictors of outcome in nontuberculous mycobacterial central nervous system infection: a systematic review |
| title_fullStr | Epidemiology, clinical presentation, and predictors of outcome in nontuberculous mycobacterial central nervous system infection: a systematic review |
| title_full_unstemmed | Epidemiology, clinical presentation, and predictors of outcome in nontuberculous mycobacterial central nervous system infection: a systematic review |
| title_short | Epidemiology, clinical presentation, and predictors of outcome in nontuberculous mycobacterial central nervous system infection: a systematic review |
| title_sort | epidemiology clinical presentation and predictors of outcome in nontuberculous mycobacterial central nervous system infection a systematic review |
| topic | Nontuberculous mycobacteria NTM Central nervous system Brain abscess Meningitis |
| url | https://doi.org/10.1186/s41182-023-00546-4 |
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