Pathobiology of Mycobacterium fortuitum and NTM biofilms: spotlight on emerging therapeutic horizons.

Rapidly growing nontuberculous mycobacteria (NTM) are emerging pathogens that are well-known entities behind pulmonary, extra-pulmonary, cutaneous, subcutaneous, as well as systemic and disseminated infections. Mycobacterium fortuitum is an important human pathogenic NTM. It is a routine nosocomial contaminant capable of forming resilient biofilms that enhance its resistance to antibiotics and disinfectants and contribute to persistent healthcare-associated infections. Moreover, varying symptoms of M. fortuitum infections, long duration therapeutics, and lack of a standardized drug regimen underscores medical significance of the pathogen. Limited knowledge regarding M. fortuitum pathogenesis, however, entices research investigating M. fortuitum planktonic as well as the biofilm phenotype. The review article aims to gather data about the prevalence and clinical significance of NTM in general, with special emphasis on M. fortuitum. It further delves into the biofilm aspect of the pathogen and examines current therapeutic strategies against NTM infections and diseases. Emerging horizons in NTM therapeutics, including repurposing antitubercular drugs, bacteriophage therapy, photodynamic therapy, and advancements in molecular diagnostic techniques are being explored to combat NTM infections. In addition, innovative treatments specifically targeting NTM biofilms, such as combination therapies, liposomal formulations, thiopeptide antibiotics, monoclonal antibodies, and inhibitors of the DosRS system, are under investigation. The concluding section of the article emphasizes the necessity for future research to delve into molecular mechanisms underlying biofilm formation and maintenance, develop targeted therapies, and refine diagnostic tools to effectively manage and treat NTM infections. Collectively, the information will be helpful to the researchers working on strategies and treatments to combat NTM infections.