DEAR EDITOR:

The study by Monteiro et al.(1) on clinical aspects in patients with pulmonary infection caused by mycobacteria of the Mycobacterium abscessus complex (MABSC) in the Brazilian Amazon is very interesting. The authors concluded that the "treatment response of pulmonary disease caused by MABSC was less favorable than that of pulmonary disease caused by other nontuberculous mycobacteria." We would like to share ideas on this observation. In our setting, Indochina, the similar high prevalence of mycobacterium pulmonary infection is also observed. MABSC complex has become a new interesting emerging infection. The poor response to the standard anti-mycobacterial therapy is also observable.(2,3) The failure of treatment is usually related to late diagnosis and previous antibiotic treatment due to the lack of standard microbiological testing to confirm the specificity of the pathogen. This situation seems to be similar to that reported by Monteiro et al.(1); most of the patients receive antibiotic treatment before having the final diagnosis of MABSC. In addition, the availability of drugs of choice against MABSC (such as imipenem) is limited in large tertiary hospitals that cannot correspond to the increased incidence of the problem in a community hospital. The possible new paradigm against the emergence of MABSC might be the early diagnosis by specific confirmation of mycobacterial isolates and financial support for the availability of highly effective antibiotic treatment in community hospitals.

REFERENCES

1. Monteiro JTC, Lima KVB, Barretto AR, Furlaneto IP, Gonçalves GM, Costa ARFD, et al. Clinical aspects in patients with pulmonary infection caused by mycobacteria of the Mycobacterium abscessus complex, in the Brazilian Amazon. J Bras Pneumol. 2018;44(2):93-98. https://doi.org/10.1590/s1806-37562016000000378
2. Phowthongkum P, Prasanthai V, Udomsantisook N, Suankratay C. Rapidly growing mycobacteria in King Chulalongkorn Memorial Hospital and review of the literature in Thailand. J Med Assoc Thai. 2005;88(8):1153-62.
3. Sungkanuparph S, Sathapatayavongs B, Pracharktam R. Infections with rapidly grow-ing mycobacteria: report of 20 cases. Int J Infect Dis. 2003;7(3):198-205. https://doi.org/10.1016/S1201-9712(03)90052-X