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Non-tuberculous mycobacteria and the rise of Mycobacterium abscessus

Abstract

Infections caused by non-tuberculous mycobacteria (NTM) are increasing globally and are notoriously difficult to treat due to intrinsic resistance of these bacteria to many common antibiotics. NTM are diverse and ubiquitous in the environment, with only a few species causing serious and often opportunistic infections in humans, including Mycobacterium abscessus. This rapidly growing mycobacterium is one of the most commonly identified NTM species responsible for severe respiratory, skin and mucosal infections in humans. It is often regarded as one of the most antibiotic-resistant mycobacteria, leaving us with few therapeutic options. In this Review, we cover the proposed infection process of M. abscessus, its virulence factors and host interactions and highlight the commonalities and differences of M. abscessus with other NTM species. Finally, we discuss drug resistance mechanisms and future therapeutic options. Taken together, this knowledge is essential to further our understanding of this overlooked and neglected global threat.

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Fig. 1: The M. abscessus infection cycle.
Fig. 2: Glycopeptidolipids and the smooth-to-rough morphotype transition of M. abscessus.
Fig. 3: The type VII secretion system ESX-4 in M. abscessus and other mycobacteria.

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Acknowledgements

The authors thank the members of the L.K team (Montpellier) and the J.-L.H. team (Montigny-le-Bretonneux) for their contribution to the work presented in this Review. The authors are also grateful to the Fondation pour la Recherche Médicale (grant no. DEQ20150331719), the Association Gregory Lemarchal and Vaincre la Mucoviscidose (grants no. RIF20180502320 and no. RIF20170502057), the Labex EpiGenMed ‘Investissements d’Avenir’ programme (grant no. ANR-10-LABX-12-01) and the French National Research Agency (grant no. DIMYVIR ANR-13-BSV3-0007-01).

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Glossary

Cystic fibrosis

A progressive, genetic disease that causes persistent lung infections and limits the ability to breathe.

Bronchiectasis

A disease in which the airways of the lungs become abnormally widened, leading to an excess of mucus that can make the lungs more vulnerable to infection.

Granuloma

An aggregation of immune cells formed during inflammation in different diseases such as mycobacterial infections.

Trophozoites

Protozoans in the early growth stage.

Fomites

Inanimate objects which, when contaminated with infectious agents, can transmit disease to a new host.

Minimum inhibitory concentration

The lowest concentration of a chemical or drug that is able to prevent visible bacterial growth.

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Johansen, M.D., Herrmann, JL. & Kremer, L. Non-tuberculous mycobacteria and the rise of Mycobacterium abscessus. Nat Rev Microbiol 18, 392–407 (2020). https://doi.org/10.1038/s41579-020-0331-1

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