Table 2.
Summary of clinical, microbiological, and radiological characteristics of previously reported cases of non-tuberculosis mycobacteria with neurological manifestations.
| Total cases (n = 125) | Slow-growing mycobacteria | Rapidly growing mycobacteria | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Total (n = 85) | MAC (n = 61) | M. kansasii (n = 7) | M. haemophilum (n = 6) | Other (n = 11) | Total (n = 38) | M. abscessus (n = 21) | M. fortuitum (n = 9) | Other (n = 8) | |||
| Age, years, mean ± SD | 43 ± 15 | 43 ± 14 | 41 ± 14 | 42 ± 17 | 49 ± 11 | 47 ± 16 | 45 ± 18 | 48 ± 18 | 47 ± 23 | 37 ± 11 | |
| Sex, male, n (%) | 77 (62) | 59 (69) | 42 (69) | 4 (57) | 5 (83) | 8 (73) | 16 (42)* | 9 (43) | 5 (56) | 2 (25) | |
| Underlying condition | HIV | 59 (47) | 55 (65) | 41 (67) | 5 (71) | 5 (83) | 4 (36) | 2 (5)* | 0 (0) | 1 (11) | 1 (12.5) |
| Neurosurgery/implant | 24 (19) | 3 (4) | 3 (5) | 0 (0) | 0 (0) | 0 (0) | 21 (55)* | 14 (67) | 5 (56) | 2 (25) | |
| Sarcoidosis | 4 (3) | 4 (5) | 4 (7) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | |
| Hematologic malignancy | 4 (3) | 4 (5) | 2 (3) | 0 (0) | 0 (0) | 2 (18) | 0 (0) | 0 (0) | 0 (0) | 1 (12.5) | |
| Immunosuppressive treatment | 6 (5) | 4 (5) | 3 (5) | 0 (0) | 1 (17) | 0 (0) | 2 (5) | 1 (5) | 0 (0) | 0 (0) | |
| Genetic | 2 (2) | 1 (1) | 1 (2) | 0 (0) | 0 (0) | 0 (0) | 1 (3) | 1 (5) | 0 (0) | 0 (0) | |
| Non identified | 26 (21) | 14 (16) | 7 (11) | 2 (29) | 0 (0) | 5 (45)** | 12 (32) | 0 (0) | 3 (33) | 4 (50) | |
| Neurological manifestations | Headache | 79 (63) | 47 (55) | 37 (61) | 4 (57) | 0 (0)** | 6 (54) | 32 (84)* | 19 (90) | 6 (67) | 7 (87.5) |
| Encephalopathy | 61 (49) | 38 (45) | 28 (46) | 3 (43) | 2 (33) | 5 (45) | 22 (58) | 16 (76)*** | 3 (33) | 3 (37.5) | |
| Focal deficit | 41 (33) | 31 (36) | 21 (34) | 2 (29) | 3 (50) | 5 (45) | 9 (24) | 2 (10) | 2 (22) | 5 (62.5)*** | |
| Seizure | 28 (22) | 25 (29) | 22 (36) | 1 (14) | 1 (17) | 1 (9) | 3 (8)* | 1 (5) | 0 (0) | 2 (25) | |
| Meningeal signs | 16 (13) | 6 (7) | 6 (10) | 0 (0) | 0 (0) | 0 (0) | 10 (26)* | 4 (19) | 5 (56)*** | 1 (12.5) | |
| Imaging features | Focal lesions | 55 (44) | 46 (54) | 26 (43) | 6 (86)** | 6 (100)** | 8 (73) | 7 (18)* | 3 (14) | 2 (22) | 2 (25) |
| Single (% of focal) | 22 (40) | 20 (43) | 12 (46) | 3 (50) | 1 (17) | 4 (50) | 2 (29) | 1 (33) | 1 (50) | 0 (0) | |
| Multiple (% of focal) | 33 (60) | 26 (57) | 14 (54) | 3 (50) | 5 (83) | 4 (50) | 5 (71) | 2 (67) | 1 (50) | 2 (100) | |
| Hydrocephalus | 5 (4) | 4 (5) | 1 (2) | 0 (0) | 0 (0) | 3 (27)** | 1 (2) | 1 (5) | 0 (0) | 0 (0) | |
| Other organ involvement | Disseminated | 22 (18) | 17 (20) | 12 (20) | 2 (29) | 1 (17) | 2 (18) | 5 (13) | 3 (14) | 1 (11) | 1 (12.5) |
| Pulmonary | 8 (6) | 4 (5) | 1 (2) | 3 (43) | 0 (0) | 0 (0) | 3 (8) | 1 (5) | 2 (22) | 0 (0) | |
| Othera | 5 (4) | 2 (2) | 0 (0) | 0 (0) | 1 (17) | 1 (9) | 3 (8) | 0 (0) | 0 (0) | 2 (25) | |
| Microbiological diagnosis | CSF | 65 (52) | 42 (49) | 35 (57) | 0 (0) | 0 (0) | 7 (64) | 21 (55) | 8 (38)*** | 7 (78) | 6 (75) |
| Culture (% of CSF) | 56 (86) | 37 (88) | 33 (94) | 0 (0) | 0 (0) | 4 (57)** | 17 (81) | 8 (100) | 5 (71) | 4 (67) | |
| Molecularb (% of CSF) | 9 (14) | 5 (12) | 2 (6) | 0 (0) | 0 (0) | 3 (43)** | 4 (19) | 0 (0) | 2 (29) | 2 (33) | |
| AFB-stain pos rate (%) | 9 (14) | 2 (5) | 1 (3) | 0 (0) | 0 (0) | 1 (14) | 7 (33)* | 6 (75)*** | 1 (14) | 0 (0) | |
| CNS tissue | 38 (30) | 33 (39) | 19 (31) | 4 (57) | 6 (100) | 4 (36) | 5 (13)* | 2 (10) | 1 (11) | 2 (25) | |
| Culture (% of tissue) | 25 (66) | 23 (70) | 13 (68) | 4 (57) | 3 (50) | 3 (75) | 2 (40) | 1 (50) | 0 (0) | 1 (50) | |
| Molecularb (% of CSF) | 13 (34) | 10 (30) | 6 (32) | 0 (0) | 3 (50) | 1 (25) | 3 (60) | 1 (50) | 1 (100) | 1 (50) | |
| AFB-stain pos rate (%) | 26 (68) | 25 (76) | 15 (79) | 3 (75) | 5 (83) | 2 (50) | 1 (20) | 1 (50) | 0 (0) | 0 (0) | |
| Other tissue culturec | 9 (7) | 8 (9) | 5 (8) | 3 (43)** | 0 (0) | 0 (0) | 1 (3) | 0 (0) | 1 (11) | 0 (0) | |
| Unspecified CNS source | 13 (10) | 2 (2) | 2 (3) | 0 (0) | 0 (0) | 0 (0) | 11 (29) | 11 (52) | 0 (0) | 0 (0) | |
| Antimicrobial regimen | Fluoroquinolone | 31 (25) | 13 (15) | 7 (11) | 1 (14) | 2 (33) | 3 (27) | 17 (45)* | 11 (52) | 4 (44) | 2 (25) |
| Ciprofloxacin | 13 (10) | 9 (10) | 5 (8) | 1 (14) | 1 (17) | 2 (18) | 4 (11) | 1 (5) | 3 (33) | 0 (0) | |
| Levofloxacin | 7 (6) | 1 (1) | 0 (0) | 0 (0) | 1 (17) | 0 (0) | 6 (16)* | 4 (19) | 1 (11) | 1 (12.5) | |
| Moxifloxacin | 10 (8) | 2 (2) | 1 (2) | 0 (0) | 0 (0) | 1 (9) | 7 (18)* | 6 (29) | 0 (0) | 1 (12.5) | |
| Macrolide | 53 (42) | 26 (31) | 18 (30) | 0 (0) | 3 (50) | 5 (45) | 26 (68)* | 19 (90)*** | 3 (33) | 4 (50) | |
| Azithromycin | 11 (9) | 7 (8) | 5 (8) | 0 (0) | 2 (33) | 0 (0) | 3 (8) | 2 (10) | 3 (33) | 1 (12.5) | |
| Clarithromycin | 42 (34) | 19 (22) | 13 (21) | 0 (0) | 1 (17) | 5 (45) | 23 (61)* | 17 (81)*** | 0 (0) | 3 (37.5) | |
| Rifamycins | 39 (31) | 35 (41) | 19 (31) | 6 (86)** | 3 (50) | 7 (64)** | 3 (8)* | 0 (0) | 1 (11) | 2 (25) | |
| Rifampicin | 27 (22) | 24 (28) | 12 (20) | 5 (71)** | 2 (33) | 5 (45) | 3 (8) | 0 (0) | 1 (11) | 2 (25) | |
| Rifabutin | 12 (10) | 11 (13) | 7 (11) | 1 (14) | 1 (17) | 2 (18) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | |
| Ethambutol | 38 (30) | 36 (42) | 20 (32) | 6 (86)** | 2 (33) | 8 (73)** | 1 (3)* | 0 (0) | 0 (0) | 1 (12.5) | |
| Isoniazid | 16 (13) | 15 (18) | 3 (5) | 6 (86)** | 1 (17) | 5 (45)** | 1 (3)* | 0 (0) | 0 (0) | 1 (12.5) | |
| Other | |||||||||||
| TMP/SMX | 6 (5) | 1 (1) | 1 (2) | 0 (0) | 0 (0) | 0 (0) | 5 (13)* | 2 (10) | 1 (11) | 2 (25) | |
| Carbapenem | 10 (8) | 2 (2) | 1 (2) | 0 (0) | 1 (17) | 0 (0) | 8 (21)* | 7 (33) | 1 (11) | 0 (0) | |
| Amikacin | 25 (20) | 6 (7) | 5 (8) | 0 (0) | 0 (0) | 1 (9) | 19 (50)* | 13 (62) | 3 (33) | 3 (37.5) | |
| Clofazimine | 4 (3) | 4 (5) | 3 (5) | 0 (0) | 1 (17) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | |
| Pyrazinamide | 6 (5) | 5 (6) | 2 (3) | 0 (0) | 1 (17) | 2 (18) | 1 (3) | 0 (0) | 0 (0) | 1 (12.5) | |
| Clinical/radiological response to regimen | Complete resolution | 32 (26) | 21 (24) | 15 (25) | 2 (29) | 1 (17) | 3 (27) | 11 (29) | 1 (5) | 5 (56)*** | 3 (37.5) |
| Improvement | 18 (14) | 14 (16) | 7 (11) | 4 (57)** | 0 (0) | 3 (27) | 3 (8) | 3 (14) | 1 (11) | 1 (12.5) | |
| Worsening | 31 (25) | 18 (21) | 8 (13) | 1 (14) | 4 (67)** | 5 (45) | 12 (32) | 6 (29) | 3 (33) | 3 (37.5) | |
| Not specified | 44 (35) | 32 (38) | 31 (51) | 0 (0) | 1 (17) | 0 (0) | 12 (32) | 11 (52) | 0 (0) | 1 (12.5) | |
| Survival | 62 (50) | 41 (48) | 32 (52) | 3 (43) | 1 (17)** | 5 (45) | 21 (55) | 10 (48) | 6 (67) | 5 (62.5) | |
*Significantly different compared to slow-growing mycobacteria (p < 0.05). **Significantly different compared to other subgroups of slow-growing mycobacteria (p < 0.05). ***Significantly different compared to other subgroups of rapidly growing mycobacteria (p < 0.05). aOther organ involvement – hepatic (n = 2), spleen (n = 1), and joints (n = 2). bMolecular – PCR (polymerase chain reaction) or rRNAseq (ribosomal ribonucleic acid sequencing). cOther tissue culture – sputum (n = 4), blood (n = 4), and bone (n = 1). AFB, acid fast bacillus; CNS, central nervous system; CSF, cerebrospinal fluid; M, mycobacterium; MAC, Mycobacterium avium complex; pos, positivity; SD, standard deviation; TMP/SMX, trimethoprim-sulfamethoxazole.