Respiratory physicians are highlighting the urgent need for large-scale trials evaluating strategies for the management of nontuberculous mycobacteria (NTM) infection in children with cystic fibrosis (CF).
The call came with new UK research showing that diagnosis and treatment of NTM infection remain challenging with no guarantee of success, particularly for Mycobacterium abscessus complex (MABS), which is linked with a more rapid decline in lung function compared with other pathogens.
The research team investigated current approaches to diagnosis, management and consequences of NTM treatment in a multicentre cohort of children with CF in the UK. They looked at data from 11 CF specialist centres from 70 patients less than 17 years old, treated for NTM infection between 2006 and 2017.
The retrospective analysis, published in Archives of Disease in Childhood, revealed that older age and previous diagnosis of allergic bronchopulmonary aspergillosis were all significantly associated with NTM infection in the patient cohort.
The symptoms most likely to be reported when NTM was first detected were increased cough (66%), increased sputum (39%), breathlessness (20%) and systemic symptoms (predominantly weight loss, 16%).
Importantly, 20% of patients were reported to be asymptomatic, which, coupled with the fact that lung function was also found to be significantly lower at diagnosis, “highlight the potential importance of early detection of NTM using proactive screening,” the researchers noted.
With regard to diagnosis, in 56% of patients NTM was detected as part of screening when asymptomatic, in 27% following respiratory symptoms and in 17% as part of routine screening of patients who had respiratory symptoms.