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.