title: Failure to recognize nontuberculous mycobacteria leads to misdiagnosis of chronic pulmonary tuberculosis.
abstract: BACKGROUND
  Nontuberculous mycobacterial (NTM) infections cause morbidity worldwide. They are difficult to diagnose in resource-limited regions, and most patients receive empiric treatment for tuberculosis (TB). Our objective here is to evaluate the potential impact of NTM diseases among patients treated presumptively for tuberculosis in Mali.
  
  
  METHODS
  We re-evaluated sputum specimens among patients newly diagnosed with TB (naïve) and those previously treated for TB disease (chronic cases). Sputum microscopy, culture and Mycobacterium tuberculosis drug susceptibility testing were performed. Identification of strains was performed using molecular probes or sequencing of secA1 and/or 16S rRNA genes.
  
  
  RESULTS
  Of 142 patients enrolled, 61 (43%) were clinically classified as chronic cases and 17 (12%) were infected with NTM. Eleven of the 142 (8%) patients had NTM disease alone (8 M. avium, 2 M. simiae and 1 M. palustre). All these 11 were from the chronic TB group, comprising 11/61 (18%) of that group and all were identified as candidates for second line treatment. The remaining 6/17 (35.30%) NTM infected patients had coinfection with M. tuberculosis and all 6 were from the TB treatment naïve group. These 6 were candidates for the standard first line treatment regimen of TB. M. avium was identified in 11 of the 142 (8%) patients, only 3/11 (27.27%) of whom were HIV positive.
  
  
  CONCLUSIONS
  NTM infections should be considered a cause of morbidity in TB endemic environments especially when managing chronic TB cases to limit morbidity and provide appropriate treatment.
authors.affiliation: Project SEREFO-NIAID/University of Bamako Research Collaboration on HIV/TB, Bamako, Mali.
authors.forename: Mamoudou
authors.initials: M
authors.lastname: Maiga
authors.forename: Sophia
authors.initials: S
authors.lastname: Siddiqui
authors.forename: Souleymane
authors.initials: S
authors.lastname: Diallo
authors.forename: Bassirou
authors.initials: B
authors.lastname: Diarra
authors.forename: Brehima
authors.initials: B
authors.lastname: Traoré
authors.forename: Yvonne R
authors.initials: YR
authors.lastname: Shea
authors.forename: Adrian M
authors.initials: AM
authors.lastname: Zelazny
authors.forename: Bindongo P P
authors.initials: BP
authors.lastname: Dembele
authors.forename: Drissa
authors.initials: D
authors.lastname: Goita
authors.forename: Hamadoun
authors.initials: H
authors.lastname: Kassambara
authors.forename: Abdulrahman S
authors.initials: AS
authors.lastname: Hammond
authors.forename: Michael A
authors.initials: MA
authors.lastname: Polis
authors.forename: Anatole
authors.initials: A
authors.lastname: Tounkara
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003951:Diagnostic Errors; D005260:Female; D006679:HIV Seropositivity / Q000175:diagnosis; D006801:Humans; D008297:Male; D008302:Mali; D008875:Middle Aged; D009165:Mycobacterium Infections, Nontuberculous / Q000175:diagnosis*; D009170:Nontuberculous Mycobacteria / Q000302:isolation & purification*; D013183:Sputum / Q000737:chemistry / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D055815:Young Adult