Healthcare Workers Awareness On Diagnosis And Management Of Non-Tuberculous Mycobacterial Pulmonary Disease

ABSTRACT

Non-tuberculous mycobacteria (NTM) are also referred to as mycobacteria other than

tuberculosis (MOTT). These bacteria are ubiquitous in the environment and their

distribution varies depending on environmental microbial distribution, climate and

weather condition. Transmission occurs by aerosols for example during bathing and

steaming. Over time the numbers of species and burden have been increasing. This

includes saprophytes and emergence of species that cause diseases to human and animals.

In general Mycobacterium avium complex (MAC) has been the most common isolated

group of NTM. These bacteria have commonly been isolated from among patients

presumed to have pulmonary Tuberculosis

Non-tuberculous mycobacteria cause a variety of clinical conditions from localized

infection to disseminated disease. Commonly they have been isolated from patients with

atypical pulmonary TB. This condition is also known as NTM Pulmonary Disease (NTMPD)

and it is clinically similar to TB. NTM-PD cases have remained undiagnosed or

misdiagnosed for TB. This poses a high risk of unsuccessful treatment outcomes and long

hospitalization. Management of NTM requires Healthcare Workers (HCW) with expertise

in the field because despite of long courses of treatment required, treatment regimen also

varies depending on the infecting species. Treatment of Mycobacteria avium Complex

(MAC) and Mycobacteria abscessus Complex (MABC) mostly relies on the use of

macrolides and aminoglycosides.

Problem of NTM-PD is not yet well addressed in Tanzania. Success in detection and

management of cases is largely limited by the level of awareness among HCWs and drug

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susceptibility of circulating species. The current study assessed knowledge gap, identify

circulating NTM species as a single or co-infections with TB and their drug susceptibility.

This study adopted a cross-sectional design. NTM-PD awareness was carried out on

HCWs from Health facilities (HFs) in the four administrative Regions that make the

Northern zone of Tanzania; Tanga, Arusha, Manyara and Kilimanjaro. Four cadres of

HCWs from TB clinics were conveniently interviewed using standardized questionnaire.

These included; clinicians, nurses, laboratory personnel and pharmacists. A list of HCWs

for each cadre in each HF provided the sampling frame for the study. In a situation where

more than one HCWs per cadre met inclusion criteria for survey in a particular HF, simple

random selection was applied.

Analysis of culture positive isolates was carried out at the Central TB Reference

Laboratory. These included sample selection, storage, DNA extraction, speciation, drug

susceptibility testing (DST). Isolates that were positive for para-nitrobenzoic acid (PNB)

and all isolates from Kibong’oto zonal laboratory received between November, 2019 and

August, 2020 were screened for NTMs. GenoLyse® protocol was used to extract DNA

that were stored at – 200C till analysis. DNA amplification was done on the GTQ Cycler

96. Mycobacterium species were identified using GenoType® Mycobacterium CM/AS

and GenoType® NTM-DR protocol. GenoType® NTM-DR was used to determine

mutations that lead to drug resistance.

An average score for awareness on Pulmonary NTM was 24.1% (n=120; 95% CI:

10.5-37.7 STD: = 11.72), for which the highest was 61% and the lowest was 3%.

Only 5 (4%) of all participants had a fair level of awareness (scored 50 to 74%) while all

the remaining had poor level of awareness. A strong relationship was observed between

history of attending training in which NTM was a topic of study and high level of

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awareness (p