Pediatric Non-Cystic Fibrosis Pulmonary Nontuberculous Mycobacterium Infections: A Global Population Based Study

Marina Bahaa Monir Zakhary Gad El Sayed,1 Dennis Tai,2,* Lucy Yu,3,* Daniel Novak,1 Amrita Dosanjh4 1School of Medicine, University of California Riverside, Riverside, CA, USA; 2Department of Biology, Brown University, Providence, RI, USA; 3School of Public Health, Brown University, Providence, RI, USA; 4Pediatric Respiratory, Affiliated Rady Children’s Hospital, San Diego, CA, USA*These authors contributed equally to this workCorrespondence: Amrita Dosanjh, Pediatric Respiratory, Affiliated Rady Children’s Hospital San Diego, San Diego, CA, USA, Email [email protected]: Nontuberculous mycobacteria (NTM) are Mycobacterial pathogens that cause pulmonary infections among children, particularly those with underlying lung conditions or immunosuppression. Clinical presentations include chronic cough, weight loss, and fatigue. Diagnosis involves clinical assessment, radiographic imaging, and microbiological confirmation, while treatment often requires prolonged, multidrug antibiotic regimens. This study aimed to analyze the epidemiology and clinical outcomes of pulmonary NTM infections in a non-cystic fibrosis pediatric population from four distinct age groups.Methods: A retrospective study as cross-sectional design for data collection from the TriNetX platform, a global electronic health record database. Inclusion criteria targeted pediatric patients aged 0– 18 years with pulmonary NTM, while exclusion criteria included cystic fibrosis, tuberculosis, smoking history, and cutaneous NTM infections. The cohort comprised 109 cases among 0– 2 years (mean age 2 years), 401 cases among 3– 5 years (mean age 4 years), 1,074 cases among 6– 12 years (mean age 9 years), and 760 cases among 13– 18 years (mean age 15 years). Demographics, comorbidities, and inflammatory markers were analyzed. Logistic and binomial regression models were used to evaluate associations between age group and five-year outcomes of pediatric pulmonary NTM, reporting odds ratios (OR), risk ratios (RR), 95% confidence intervals (CI), and p-values.Results: Of the total 2,344 records of pediatric patients examined, the most common comorbidities included malignancies (36%), acute pharyngitis (78%), asthma (46%), unspecified pneumonia (46%), and immunodeficiencies (22%). Female patients represented 53.31% of cases. Key inflammatory markers (eg C-reactive protein (CRP), mean white blood cell count, ferritin) were elevated among older age groups.Conclusion: This study highlights age-specific variations in risk factors, clinical outcomes, and inflammatory responses, offering potential insights for improved diagnosis and management of NTM in children. These results underscore the importance of further research in pediatric cohorts with NTM to better understand its role in pediatric pulmonary conditions and comorbidities.Keywords: non-tuberculous mycobacteria, non-cystic fibrosis, pulmonary, pediatric, NTM-PD