Clinical characteristics and outcomes of tuberculosis and non-tuberculous mycobacteria infections: a population-based study of concurrent and sequential infections.

BACKGROUND

Co-infection with Tuberculosis (TB) and non-tuberculous mycobacteria (NTM) poses significant diagnostic and therapeutic challenges. This study investigates the demographic, clinical, and survival characteristics of these patients.

METHODS

This retrospective study included patients diagnosed with TB, NTM, or TB + NTM co-infection at the Shanghai Public Health Clinical Center (2019-2022). Clinical, imaging, and survival data were collected and analyzed.

RESULTS

A total of 400 patients were included: 33 in the TB + NTM group, 167 in the NTM-only group, and 200 in the TB-only group. Chest pain was more common in the TB + NTM group than the TB-only group (P = 0.006). The TB + NTM group exhibited a significantly lower body mass index (19.95 ± 3.51) and serum albumin level (36.09 ± 4.93 g/l), as well as a higher prevalence of hilar lymphadenopathy (45.5%) and cavitary lesions (39.4%), compared to the TB-only or NTM-only groups (P < 0.05). Miliary nodules were more frequent in the TB + NTM group (24.2%) compared to the TB-only group (11.0%, P = 0.048). A higher proportion of TB + NTM patients were from Central and Western China (P = 0.005). Survival analysis showed worse outcomes for the TB + NTM group (P = 0.038 vs. NTM-only, P = 0.008 vs. TB-only). Cox regression further identified a higher mortality risk in the TB + NTM group (adjusted hazard ratios = 2.468, 95% CI: 1.079-5.642, P = 0.032).

CONCLUSION

TB + NTM co-infection is associated with distinct clinical features and worse survival outcomes, emphasizing the need for early diagnosis and tailored treatment.

CLINICAL TRIAL NUMBER: Not applicable.