Risk Factors and Mental Health Status in Patients With Non-Tuberculous Mycobacterial Lung Disease: A Single Center Retrospective Study

Analysis of non-tuberculous mycobacteria types in high tuberculosis endemic areas

BACKGROUND

The incidence of non-tuberculous mycobacteria (NTM) has been rising globally, posing significant challenges for diagnosis and treatment, particularly in regions with high tuberculosis (TB) incidence. This study aims to investigate the epidemiological, demographic, and clinical characteristics of non-tuberculous mycobacterial lung disease (NTM-PD) in areas with a high incidence of TB.

METHOD

This study was conducted at the Affiliated Hospital of Zunyi Medical University from January 2017 to December 2021. A total of 6259 culture-positive specimens were analyzed. Screening was based on acid-fast staining, colony morphology, and p-nitrobenzoic acid detection, which identified 107 suspected NTM strains. Gene sequencing confirmed 51 NTM-positive cases.

RESULTS

The predominant species identified were Mycobacterium abscessus (33.33%) and Mycobacterium intracellulare (27.45%). Several risk factors were associated with higher susceptibility to NTM-PD suspect, including bronchiectasis, low serum albumin levels (< 3.5 g/L), and male gender. The study found that although the isolation rate of NTM remained stable over the five-year period, drug resistance rates for the dominant species were notably high.

CONCLUSIONS

The findings highlight the need for clinicians in TB-endemic areas to carefully distinguish NTM infections from TB. The stable isolation rates of NTM, coupled with the high drug resistance of key species, underscore the importance of accurate diagnosis and tailored treatment strategies to manage NTM-PD effectively.

Gender differences in the relationship between mental health and academic performance among undergraduate students at a medical school in Shanghai: a cross-sectional study

BACKGROUND

Epidemiological studies indicate that 12% to 50% of university students suffer from one or more common mental health problems, which may be linked to academic performance. However, most current studies provide associations between only a single mental disorder and college students' academic performance, with inconsistent results, and do not consider gender differences. The objective of this study was to analyze the mental health status across various dimensions among male and female college students and to explore the impact of gender on the relationship between mental health status and academic performance.

METHODS

This study used a cross-sectional design conducted at an undergraduate medical school in Shanghai, China. Data were collected from undergraduate students in the 2020-2021 academic year, with a total of 6923 students (2153 males and 4770 females) completing the survey. The SCL-90 scale was used to screen for mental health problems. Data on student academic performance were obtained from school records. Logistic regression were used to examine the association between mental health status and academic performance.

RESULTS

The overall positive rate for the mental health status of the participants was 41.2%, with 39.6% for males and 41.9% for females. Among female students, those with positive mental health were more likely to underperform academically (aOR = 1.183, 95% CI: 1.035-1.353, p < 0.05). As the severity of symptoms in the factors of somatization (SOM), interpersonal sensitivity (INTS), depression (DEPR), paranoid ideation (PARI), psychoticism (PSY), and sleep and diet (ADD) increases, the likelihood of poor academic performance also increases in females. However, mental health status among male students is not related to academic performance (aOR = 1.138, 95% CI: 0.950-1.364, p > 0.05).

CONCLUSIONS

The poor mental health status of female college students was significantly correlated with a higher likelihood of poor academic performance, and there was a dose-dependent relationship between the six factors of the SCL-90 and academic performance. In contrast, no similar results were observed among male students.

Illness cognition, illness perception and related factors in patients with lymphangioleiomyomatosis

PURPOSE

To explore the self-perceived illness cognition and perception status, as well as the relevant factors among lymphangioleiomyomatosis (LAM) patients.

METHODS

A web-based questionnaire survey was conducted in September 2023. A total of 121 LAM patients participated (including 16 patients with TSC-LAM), and the survey collected general demographic information, responses to a disease cognition questionnaire, and a simplified disease perception questionnaire.

RESULTS

LAM patients have a higher level of negative illness cognition and a lower level of positive illness cognition, specifically characterized by helplessness (15.74 ± 4.68 points), acceptance (16.00 ± 3.28 points), and perceived benefits (16.92 ± 3.86 points). Single-factor analysis of variance found significant correlations between cultural level, age, family average monthly income, use of rapamycin, use of home oxygen therapy, hospitalization frequency, disease duration, severity of respiratory distress, activity limitation, and the helplessness score of LAM patients (p ≤ 0.05); the number of children was significantly associated with acceptance scores of LAM patients (p ≤ 0.05); and whether surgery had been performed was significantly associated with acceptance and perceived benefits scores of LAM patients (p ≤ 0.05). Disease duration and activity limitation entered the regression equation for helplessness dimension, while whether surgery had been performed entered the regression equation for perceived benefits dimension, but no factor entered the regression equation for acceptance dimension. Applying the same analysis to disease perception, we found that the average score of the Illness Perception Questionnaire was 45.43 ± 8.97, with lower scores in the reverse-scored items of individual control, treatment, and understanding.

CONCLUSIONS

LAM patients exhibit higher levels of helplessness, particularly among those with longer disease duration and greater activity limitations, leading to a more negative perception of the disease. Additionally, patients who have undergone surgical procedures tend to perceive fewer benefits. Furthermore, there is a significant correlation between illness perception and factors such as rapamycin usage, home oxygen therapy, disease duration and activity limitations caused by LAM. This indicates that clinical healthcare providers should pay more attention to LAM patients and their associated groups, providing both informational and psychological support.

Prevalence of Chronic Obstructive Pulmonary Disease in Patients with Nontuberculous Mycobacterial Pulmonary Disease: A Systemic Review and Meta-Analysis

BACKGROUND/OBJECTIVES

Nontuberculous mycobacterial pulmonary disease (NTM-PD) is an important comorbidity of COPD. Although many studies have reported an association between COPD and NTM-PD, no clear estimate of the prevalence of COPD and its effects on survival times in patients with NTM-PD is available. This study aimed to investigate the prevalence of COPD and its impact on survival in patients with NTM-PD.

METHODS

All studies reporting the prevalence of COPD in patients with NTM between 1952 and 2021 were searched using PubMed in May 2023. The inclusion criteria were studies about patients with NTM and COPD. A random-effects meta-analysis was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

RESULTS

The pooled overall prevalence of COPD in patients with NTM-PD was 28% (95% confidence interval [CI], 22-35). Patients with NTM-PD were six times more likely to have COPD than those without NTM-PD (pooled odds ratio [OR], 6.26; 95% CI, 3.37-11.65). Male patients with NTM-PD had a four-fold higher risk of COPD than females (OR, 3.81; 95% CI, 1.18-12.35). The co-existence of COPD and NTM-PD was significantly associated with an increased risk of mortality compared with NTM-PD without COPD (OR, 3.65; 95% CI, 1.28-10.40).

CONCLUSIONS

COPD is common in patients with NTM-PD, and patients with NTM-PD had a six-fold increase in the odds of having COPD than those without NTM-PD. The presence of COPD and NTM-PD had a significant negative effect on survival. These findings may support the need to assess the presence of COPD in patients with NTM-PD and the potential negative effects associated with the co-existence of COPD and NTM-PD.

Drugs for treating infections caused by non-tubercular mycobacteria: a narrative review from the study group on mycobacteria of the Italian Society of Infectious Diseases and Tropical Medicine

BACKGROUND

Non-tuberculous mycobacteria (NTM) are generally free-living organism, widely distributed in the environment, with sporadic potential to infect. In recent years, there has been a significant increase in the global incidence of NTM-related disease, spanning across all continents and an increased mortality after the diagnosis has been reported. The decisions on whether to treat or not and which drugs to use are complex and require a multidisciplinary approach as well as patients' involvement in the decision process.

METHODS AND RESULTS

This review aims at describing the drugs used for treating NTM-associated diseases emphasizing the efficacy, tolerability, optimization strategies as well as possible drugs that might be used in case of intolerance or resistance. We also reviewed data on newer compounds highlighting the lack of randomised clinical trials for many drugs but also encouraging preliminary data for others. We also focused on non-pharmacological interventions that need to be adopted during care of individuals with NTM-associated diseases CONCLUSIONS: Despite insufficient efficacy and poor tolerability this review emphasizes the improvement in patients' care and the needs for future studies in the field of anti-NTM treatments.

Treatable traits and challenges in the clinical management of non-tuberculous mycobacteria lung disease in people with cystic fibrosis

INTRODUCTION

Over the last ten years an increasing prevalence and incidence of non-tuberculous mycobacteria (NTM) has been reported among patients with cystic fibrosis (CF) Viviani (J Cyst Fibros, 15(5):619-623, 2016). NTM pulmonary disease has been associated with negative clinical outcomes and often requires pharmacological treatment. Although specific guidelines help clinicians in the process of diagnosis and clinical management, the focus on the multidimensional assessment of concomitant problems is still scarce.

MAIN BODY

This review aims to identify the treatable traits of NTM pulmonary disease in people with CF and discuss the importance of a multidisciplinary approach in order to detect and manage all the clinical and behavioral aspects of the disease. The multidisciplinary complexity of NTM pulmonary disease in CF requires careful management of respiratory and extra-respiratory, including control of comorbidities, drug interactions and behavioral factors as adherence to therapies.

CONCLUSIONS

The treatable trait strategy can help to optimize clinical management through systematic assessment of all the aspects of the disease, providing a holistic treatment for such a multi-systemic and complex condition.

Anxiety and depression among patients with non-tuberculous mycobacterial disease in Shanghai: a cross-sectional study

Objective

To understand the mental health status and its influencing factors among patients with non-tuberculous mycobacterial disease and to provide a reference for medical staff to formulate scientific and feasible intervention strategies.

Methods

A total of 114 patients diagnosed with non-tuberculous mycobacillosis during hospitalization in the Department of Infection from September 2020 to April 2021 were selected as the research participants. Participants' mental health status and related factors were evaluated using a self-made general patient information questionnaire, self-rating Anxiety Scale (SAS), and self-rating Depression Scale (SDS).

Results

Among 114 patients with non-tuberculous mycosis, 61 (53.51%) exhibited depressive symptoms, and the SDS score was 51.15 ± 13.04, which was higher than the national norm of 41.88 ± 10.57 (p < 0.05); further, 39 patients (34.21%) showed anxiety symptoms, and the SAS score was 45.75 ± 10.81, which was significantly higher than the national norm of 29.78 ± 10.07 (p < 0.05). Body mass index and monthly household income had significant effects on depression in patients with non-tuberculous mycobacterial disease (p < 0.05). Educational level had a significant effect on the anxiety state of patients with non-tuberculous mycobacterial disease (p < 0.05).

Conclusion

Patients with non-tuberculous mycobacterial disease are prone to depression and anxiety. Nurses should pay attention to it in clinical work for the timely identification of and intervention for anxiety and depression and intervene.

Omadacycline for management of Mycobacterium abscessus infections: a review of its effectiveness, place in therapy, and considerations for use

The Mycobacterium abscessus complex (MABC) is a group of acid-fast, rapidly dividing non-tuberculous mycobacteria (NTM) that include a number of clinically important subspecies, including M. abscessus, M. bolletii, and M. massiliense. These organisms are prevalent in the environment and are primarily associated with human pulmonary or skin and skin structure infections (SSSI) but may cause more deep-seeded disseminated infections and bacteremia in the immunocompromised. Importantly, these NTM are resistant to most first-line anti-tuberculous agents and, due to intrinsic or acquired resistance, exhibit exceedingly low, variable, and geographically distinct susceptibilities to commonly used antibacterial agents including older tetracyclines, macrolides, aminoglycosides, cephalosporins, carbapenems, and sulfamethoxazole-trimethoprim. Omadacycline is a novel third-generation member of the tetracycline family of antibacterials that has recently been demonstrated to have potent anti-NTM effects and clinical efficacy against MABC, including M. abscessus. The purpose of this review is to present a comprehensive and up-to-date assessment on the body of literature on the role of omadacycline for M. abscessus infections. Specifically, the in vitro and in vivo microbiology, mechanisms of action, mechanisms of resistance, clinical pharmacokinetics, clinical efficacy, adverse effects, dosage and administration, and place in therapy of omadacycline in management of M. abscessus infections will be detailed.