PDF(Pubmed)
Abstract：
In sub-Saharan African (SSA) countries endemic for tuberculosis (TB), previous TB is a significant risk factor for non-tuberculous mycobacterial pulmonary disease (NTM-PD). The deployment of GeneXpert MTB/RIF in pulmonary TB diagnostic work-up regularly identifies symptomatic patients with a positive smear microscopy but negative GeneXpert, indicative of NTM presence. This scoping review outlines recent evidence for NTM-PD diagnosis and management in SSA.
The review\'s objective was to outline the risk factors, available diagnostics, management options and outcomes of NTM-PD in high-burden TB settings in SSA using the population-concept-context framework.
We searched existing literature from PubMed, Web of Science, African Journals Online, Google Scholar and grey literature. Studies published between January 2005 and December 2022 were retained. Data were extracted into Rayyan software and Mendeley and summarised using Excel.
We identified 785 potential articles, of which 105 were included in the full-text review, with 7 papers retained. Included articles used international criteria for diagnosing NTM-PD. Multiple papers were excluded due to non-application of the criteria, suggesting challenging application in the SSA setting. Identified risk factors include previous TB, smoking and mining. Most commonly, chest radiography and not CT was used for the radiological diagnosis of PD, which may miss early changes related to NTM-PD. Molecular methods for NTM species identification were employed in research settings, usually at referral centres, but were unavailable for routine care. Most studies did not report a standardised approach to treatment and they were not offered treatment for the specific disease, marking a lack of guidance in treatment decision-making. When treatment was provided, the outcome was often not reported due to the lack of implementation of standardised outcome definitions.
These outlined challenges present a unique opportunity for researchers to undertake further studies in NTM-PD and proffer solutions more applicable to SSA.
The review\'s objective was to outline the risk factors, available diagnostics, management options and outcomes of NTM-PD in high-burden TB settings in SSA using the population-concept-context framework.
We searched existing literature from PubMed, Web of Science, African Journals Online, Google Scholar and grey literature. Studies published between January 2005 and December 2022 were retained. Data were extracted into Rayyan software and Mendeley and summarised using Excel.
We identified 785 potential articles, of which 105 were included in the full-text review, with 7 papers retained. Included articles used international criteria for diagnosing NTM-PD. Multiple papers were excluded due to non-application of the criteria, suggesting challenging application in the SSA setting. Identified risk factors include previous TB, smoking and mining. Most commonly, chest radiography and not CT was used for the radiological diagnosis of PD, which may miss early changes related to NTM-PD. Molecular methods for NTM species identification were employed in research settings, usually at referral centres, but were unavailable for routine care. Most studies did not report a standardised approach to treatment and they were not offered treatment for the specific disease, marking a lack of guidance in treatment decision-making. When treatment was provided, the outcome was often not reported due to the lack of implementation of standardised outcome definitions.
These outlined challenges present a unique opportunity for researchers to undertake further studies in NTM-PD and proffer solutions more applicable to SSA.
摘要：
背景：在撒哈拉以南非洲（SSA）结核病（TB）流行的国家，既往结核病是非结核性分枝杆菌肺病（NTM-PD）的重要危险因素。GeneXpertMTB/RIF在肺结核诊断检查中的部署会定期识别涂片镜检阳性但GeneXpert阴性的症状患者，表示存在NTM。本范围审查概述了SSA中NTM-PD诊断和管理的最新证据。
目的：本综述的目的是概述风险因素，可用的诊断,使用人口概念上下文框架在SSA高负担结核病设置中NTM-PD的管理选择和结果。
方法：我们搜索了PubMed的现有文献，WebofScience,非洲在线期刊，谷歌学者和灰色文学。保留了2005年1月至2022年12月之间发表的研究。将数据提取到Rayyan软件和Mendeley中并使用Excel进行汇总。
结果：我们确定了785篇潜在文章，其中105个被列入全文审查，保留了7篇论文。纳入的文章使用了诊断NTM-PD的国际标准。由于不适用标准，多篇论文被排除在外，建议在SSA设置中具有挑战性的应用。确定的风险因素包括以前的结核病，吸烟和采矿。最常见的是,胸部X线摄影而不是CT用于PD的放射学诊断，这可能会错过与NTM-PD相关的早期变化。在研究环境中采用了NTM物种鉴定的分子方法，通常在转诊中心，但无法进行常规护理。大多数研究没有报告标准化的治疗方法，也没有为特定疾病提供治疗，标志着治疗决策缺乏指导。当提供治疗时，由于缺乏标准化结果定义的实施,结果通常未报告.
结论：这些概述的挑战为研究人员提供了一个独特的机会，可以对NTM-PD进行进一步研究，并提供更适用于SSA的解决方案。
目的：本综述的目的是概述风险因素，可用的诊断,使用人口概念上下文框架在SSA高负担结核病设置中NTM-PD的管理选择和结果。
方法：我们搜索了PubMed的现有文献，WebofScience,非洲在线期刊，谷歌学者和灰色文学。保留了2005年1月至2022年12月之间发表的研究。将数据提取到Rayyan软件和Mendeley中并使用Excel进行汇总。
结果：我们确定了785篇潜在文章，其中105个被列入全文审查，保留了7篇论文。纳入的文章使用了诊断NTM-PD的国际标准。由于不适用标准，多篇论文被排除在外，建议在SSA设置中具有挑战性的应用。确定的风险因素包括以前的结核病，吸烟和采矿。最常见的是,胸部X线摄影而不是CT用于PD的放射学诊断，这可能会错过与NTM-PD相关的早期变化。在研究环境中采用了NTM物种鉴定的分子方法，通常在转诊中心，但无法进行常规护理。大多数研究没有报告标准化的治疗方法，也没有为特定疾病提供治疗，标志着治疗决策缺乏指导。当提供治疗时，由于缺乏标准化结果定义的实施,结果通常未报告.
结论：这些概述的挑战为研究人员提供了一个独特的机会，可以对NTM-PD进行进一步研究，并提供更适用于SSA的解决方案。
