2026/04/03 by Adriana Rodrigues Barretto, Jose Tadeu Colares Monteiro, José Tadeu Colares Monteiro +8
Medicine · #Diagnosis and treatment of tuberculosis #Mycobacterium research and diagnosis #Tuberculosis Research and Epidemiology
paper · doi:10.1016/j.diagmicrobio.2026.117406
openalex publication_date 2026/04/03 · openalex created_date 2026/04/04 · openalex updated_date 2026/07/16
BACKGROUND: Mycobacterium paraense is an emerging slow-growing mycobacterium (SGM) within the M. simiae complex. While reported globally in environmental sources, its clinical significance remains poorly understood, except in Pará State, Brazil, where it frequently causes non-tuberculous mycobacterial pulmonary disease (NTM-PD). METHODS: We retrospectively studied 13 patients meeting ATS/ERS/ESCMID/IDSA criteria for M. paraense NTM-PD (2000-2018). Identification was confirmed by sequencing 16S rRNA, hsp65, and rpoB genes. Antimicrobial susceptibility testing (AST) used broth microdilution. Treatment outcomes followed the 2018 NTM-NET consensus. RESULTS: M. paraense accounted for 8.9% of NTM-PD cases at our center. Median age was 59 years; 92.3% had underlying bronchiectasis. History of tuberculosis (TB) treatment was common (76.9%), with a median diagnostic lag of 26.5 months. Cavitary lesions were significantly associated with smear positivity (p = 0.045). AST showed broad resistance to rifampicin, ethambutol, streptomycin, and ciprofloxacin, but high susceptibility to clarithromycin and amikacin. Patients received empirical macrolide-based regimens (median duration: 18 months); 81.8% of those completing therapy achieved cure (including microbiological cure). No recurrence was observed during follow-up (up to 46 months). CONCLUSION: M. paraense is a clinically relevant pathogen in the Amazon, frequently misdiagnosed as TB due to cavitary presentation. The high success rate of macrolide-based regimens suggests that strategies for M. avium complex are effective. Enhanced molecular diagnostics are essential to uncover the true global prevalence of this species.