Emergence of Non-tuberculous Mycobacteria Infections in Patients with Drug-Resistant Tuberculosis (DR-TB) During Bedaquiline - Containing Treatment

<i>Introduction:</i> Environmental microorganisms known as non-tuberculous mycobacteria (NTM) are frequently found in soil and water, originating from both natural and man-made sources. All mycobacteria species are included in this group, with the exception of Mycobacterium leprae, which causes leprosy, and Mycobacterium tuberculosis complex, which causes tuberculosis. NTM consists of a diverse array of over 190 distinct species. Mycobacterium avium complex (MAC), which consists of Mycobacterium avium and Mycobacterium intracellulare, is the most common pathogen that causes disease in humans. Mycobacterium abscessus (MAB) is the next most common pathogen. <i>Methods:</i> The centre, Saint Peter’s Specialized Hospital, is the pioneering TB specialized hospital in Ethiopia. Both conventional and molecular drug susceptibility testing were used to diagnose the patients with DR-TB. NTM-infected patients received therapy for their DR-TB using regimens containing bedaquiline, and they were monitored once treatment started. Sputum samples were gathered in order to evaluate the effectiveness of the treatment using mycobacterial culture. We have already come across two NTM cases. <i>Result:</i> Concerns have been raised about the occurrence of nontuberculous mycobacteria (NTM) infections in patients with drug-resistant tuberculosis (DR-TB) using bedaquiline-containing regimens. In a recent study, six cases of NTM infection were documented among patients undergoing treatment with Bedaquiline. The final treatment outcomes for these cases were cured. Bedaquiline is a prospective treatment option for NTM infections because it has shown excellent antibacterial action against a variety of NTM species. However, while effective against extra pulmonary NTM infections; its efficacy in pulmonary infections remains less clear. The increasing incidence of NTM infections in this patient population highlights the need for careful monitoring and potential adjustments in treatment strategies to address the complications arising from these co-infections. <i>Conclusion:</i> These outcomes underscore the complexity of managing co-infections in patients already burdened by DR-TB. It suggest that while Bedaquiline shows promise in treating DR-TB, its role in managing concurrent NTM infections requires careful consideration. The emergence of NTM during treatment may be influenced by factors such as the pharmacokinetics of Bedaquiline and the intrinsic resistance of various NTM species. This situation necessitates ongoing monitoring and potentially revised therapeutic strategies to address these co-infections effectively. As the incidence of NTM infections continues to rise globally, it is crucial for healthcare providers to remain vigilant in identifying and managing these infections in patients undergoing treatment for DR-TB.