Molecular characterization of E. coli, Shigella and Vibrio cholerae collected from an Urban River in Johannesburg, South Africa

Discussion: The case highlights the complexities of treating patients with advanced HIV disease and opportunistic infections, particularly NTM mixtures.Challenges in NTM mixture treatment include uncertainties in selecting multi-drug regimens, treatment duration, patient tolerance, relapse frequency, and susceptibility testing.LPAs could potentially overlook subpopulations in NTM mixtures, as shown in previous research.In this regard, nextgeneration sequencing and metagenomics have demonstrated superiority over DNA-DNA hybridization platforms (LPAs) in identifying NTM mixtures, suggesting their integration into diagnostic algorithms.The potential role of liposomal amikacin in mixed NTM disease warrants further investigation and could have been considered in this case.However, its use in patients with NTM and a subsequent diagnosis of PML remains debatable due to the condition's poor prognosis.Finally, the high mortality associated with PML raises questions about withdrawing antibiotic treatment and transitioning to supportive palliative care.Conclusion: Overall, the case highlights the need for comprehensive diagnostic approaches and personalized treatment strategies to address the complexities of NTM mixture disease, especially in immunocompromised and critically ill patients, with a focus on improving patient outcomes and quality of life.