What is Mycobacterium abscessus Pumonary Disease?
MABS-PD is an emerging complex, infection with no approved treatments. The global prevalence of MABS infections and MABS-PD has seen an unexplained and significant rise over the past 30 years along with the unexplained global spread of highly virulent and antibiotic-resistant MABS clones. During this time MABS has emerged as the 2nd most common and the most severe NTM infection, whose treatment is complicated by high levels of intrinsic and acquired multi-antibiotic resistance. Increased rates of MABS-PD have been observed in people with cystic fibrosis (pwCF) with a cumulative incidence of 100 per 1000 tested in pwCF aged >12 years, and in older adults with other underlying conditions, such as chronic obstructive pulmonary disease (COPD) and bronchiectasis (ranked 2nd and 3rd most common chronic lung disorders globally), immune dysfunction and of growing concern, in previously healthy people. While there may be some ascertainment bias, changes to environmental conditions and climate, increasing urbanisation and water management practices have likely contributed.
MABS-PD is associated with severe morbidity, and high mortality, especially in adolescents with CF. The median age of acquisition in adolescents is 13 years after which end stage lung disease occurs within 13.6 years of acquisition of MABS infection. In the older non-CF population (aged >60 years with COPD or bronchiectasis), the disease is often indolent initially but causes early death in 15% and usually precludes lung transplantation if MABS infection is active. Some people have transient infections without disease, yet a significant proportion develop MABS-PD although how and why this occurs is unknown and complicates decisions around treatment initiation.
