Inventory study of non-tuberculous mycobacteria in the European Union
1 European Centre for Disease Prevention and Control, Stockholm, Sweden
2 National Mycobacterium Reference Laboratory, Croatian National Institute of Public Health, Zagreb, Croatia
3 Department of Mycobacteriology, Tartu University Hospital, Tartu, Estonia
4 National Institute for Health and Welfare, Turku, Finland
5 National Reference Laboratory for Mycobacteria, Forschungszentrum Borstel, Borstel, Germany
6 National Reference Laboratory for Mycobacteria, “Sotiria” Chest Diseases Hospital, Athens, Greece
7 Emerging Bacterial Pathogens Unit, San Raffaele Scientific Institute, Milan, Italy
8 Division de Bactériologie – Parasitologie, Laboratoire National de Santé, Luxembourg, Luxembourg
9 National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
10 National Reference Laboratory for Mycobacteria, University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia
11 International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark
BMC Infectious Diseases 2014, 14:62 doi:10.1186/1471-2334-14-62Published: 6 February 2014
Since non-tuberculous mycobacteria (NTM) disease is not notifiable in most European Union (EU) and European Economic Area (EEA) countries, the epidemiological situation of the >150 NTM species is largely unknown. We aimed to collect data on the frequency of NTM detection and NTM species types in EU/EEA countries.
Officially nominated national tuberculosis reference laboratories of all EU/EEA countries were asked to provide information on: laboratory routines for detection and identification of NTM, including drug sensitivity testing (DST) methods; data on the number and type of NTM species identified; coverage and completeness of the provided data on NTM; type and number of human specimens tested for NTM; and number of specimens tested for Mycobacterium tuberculosis complex and NTM. This information was summarized and the main results are described.
In total, 99 different NTM species were identified with M. avium, M. gordonae, M. xenopi , M. intracellulare, and M. fortuitum identified most frequently. Seven percent of the NTM species could not be identified. NTM was cultured from between 0.4-2.0% of the specimens (data from four countries). The laboratories use culturing methods optimised for M. tuberculosis complex. Identification is mainly carried out by a commercial line probe assay supplemented with sequencing. Most laboratories carried out DST for rapid growers and only at the explicit clinical request for slow growers.
It is likely that the prevalence of NTM is underestimated because diagnostic procedures are not optimized specifically for NTM and isolates may not be referred to the national reference laboratory for identification. Due to the diagnostic challenges and the need to establish the clinical relevance of NTM, we recommend that countries should concentrate detection and identification in only few laboratories.