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

Zhen-Tao Fei, Dan-Ping Zhou, Wei Huang, Ping Liu, Qian-Ping Lu, Hao Li, Yang Yang, Dan Ye, et al. (10 authors)

European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2025-08

Abstract

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&#x2009;+&#x2009;NTM group, 167 in the NTM-only group, and 200 in the TB-only group. Chest pain was more common in the TB&#x2009;+&#x2009;NTM group than the TB-only group (P&#x2009;=&#x2009;0.006). The TB&#x2009;+&#x2009;NTM group exhibited a significantly lower body mass index (19.95&#x2009;&#xb1;&#x2009;3.51) and serum albumin level (36.09&#x2009;&#xb1;&#x2009;4.93&#xa0;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&#x2009;<&#x2009;0.05). Miliary nodules were more frequent in the TB&#x2009;+&#x2009;NTM group (24.2%) compared to the TB-only group (11.0%, P&#x2009;=&#x2009;0.048). A higher proportion of TB&#x2009;+&#x2009;NTM patients were from Central and Western China (P&#x2009;=&#x2009;0.005). Survival analysis showed worse outcomes for the TB&#x2009;+&#x2009;NTM group (P&#x2009;=&#x2009;0.038 vs. NTM-only, P&#x2009;=&#x2009;0.008 vs. TB-only). Cox regression further identified a higher mortality risk in the TB&#x2009;+&#x2009;NTM group (adjusted hazard ratios&#x2009;=&#x2009;2.468, 95% CI: 1.079-5.642, P&#x2009;=&#x2009;0.032).

CONCLUSION: TB&#x2009;+&#x2009;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.

MeSH terms

  • Humans
  • Male
  • Female
  • Retrospective Studies
  • Mycobacterium Infections, Nontuberculous
  • Middle Aged
  • Coinfection
  • China
  • Tuberculosis
  • Adult
  • Aged
  • Nontuberculous Mycobacteria