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Genetic Diversity and Prevalence of Nontuberculous Mycobacteria Isolated from Clinical Samples in Tehran, Iran. Microb Drug Resist 2019; 25:264-270. [PMID: 30256172 DOI: 10.1089/mdr.2018.0150] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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52
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Schiff HF, Jones S, Achaiah A, Pereira A, Stait G, Green B. Clinical relevance of non-tuberculous mycobacteria isolated from respiratory specimens: seven year experience in a UK hospital. Sci Rep 2019; 9:1730. [PMID: 30741969 PMCID: PMC6370870 DOI: 10.1038/s41598-018-37350-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 12/04/2018] [Indexed: 11/13/2022] Open
Abstract
The frequency of isolation of non-tuberculous mycobacteria (NTM) species from respiratory specimens is increasing, however the clinical relevance of such identifications vary by mycobacterial species and geographical location. A retrospective study of 853 NTM isolates from respiratory samples from 386 patients over seven years was performed. Clinical records and radiographic information were examined. Clinical significance was assessed by American Thoracic Society diagnostic criteria. 25% of all patients with respiratory isolates met criteria for non-tuberculous mycobacterial pulmonary disease (NTM-PD). Significant symptoms were weight loss, fever, night sweats, productive cough and haemoptysis. HIV co-infection was a significant risk factor for disease. Cavities, nodules and tree-in-bud were significant radiographic findings. Mycobacterium avium complex (MAC) were the dominant species isolated from this patient cohort. Mycobacterium abscessus (M. abscessus) was the species most likely to cause clinically significant disease and be sputum smear positive, thus warranting particular attention.
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Affiliation(s)
- H F Schiff
- Clinical and Experimental Sciences, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.
- Department of Respiratory Medicine, Queen Alexandra Hospital, Southwick Hill Road, Cosham, Portsmouth, PO6 3LY, UK.
| | - S Jones
- Department of Respiratory Medicine, Queen Alexandra Hospital, Southwick Hill Road, Cosham, Portsmouth, PO6 3LY, UK
| | - A Achaiah
- Department of Respiratory Medicine, Queen Alexandra Hospital, Southwick Hill Road, Cosham, Portsmouth, PO6 3LY, UK
| | - A Pereira
- Department of Respiratory Medicine, Queen Alexandra Hospital, Southwick Hill Road, Cosham, Portsmouth, PO6 3LY, UK
| | - G Stait
- Department of Respiratory Medicine, Queen Alexandra Hospital, Southwick Hill Road, Cosham, Portsmouth, PO6 3LY, UK
| | - B Green
- Department of Respiratory Medicine, Queen Alexandra Hospital, Southwick Hill Road, Cosham, Portsmouth, PO6 3LY, UK
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53
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Sarro YDS, Kone B, Diarra B, Kumar A, Kodio O, Fofana DB, Achenbach CJ, Beavogui AH, Seydi M, Holl JL, Taiwo B, Diallo S, Doumbia S, Murphy RL, McFall SM, Maiga M. Simultaneous diagnosis of tuberculous and non-tuberculous mycobacterial diseases: Time for a better patient management. CLINICAL MICROBIOLOGY AND INFECTIOUS DISEASES 2018; 3:10.15761/CMID.1000144. [PMID: 30613797 PMCID: PMC6319944 DOI: 10.15761/cmid.1000144] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Tuberculosis (TB) is the deadliest infectious disease in the world which disproportionately affects low-and-middle-income countries (LMICs) where diagnostic resources and treatment options are limited. The incidence of pulmonary non-tuberculous mycobacteria (NTM) disease is also rapidly increasing in these regions traditionally dominated by TB infections. This poses significant diagnostic and treatment challenges, since these two diseases are often indistinguishable clinically or by sputum smear microscopy (SSM), the most commonly used TB diagnostic tool in LMICs. Consequently, NTM-infected patients usually receive unnecessary TB treatment for months. TB patients with NTM co-infections may also be treated incorrectly due to inaccurate SSM and Xpert™ MTB/RIF (M. tuberculosis./rifampin) results. These issues complicate the management of patients and contribute to the worsening of the current TB and NTM epidemiological features including development of drug resistant strains. It is therefore critical to develop improved diagnostic tools to accurately distinguish these two different pathogens that have many similar clinical and epidemiological features but have different treatment regimens. In this review, we will discuss limitations with current diagnostic tools and the need to develop novel techniques that can accurately and simultaneously diagnose TB and NTM disease._.
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Affiliation(s)
- Yeya DS Sarro
- University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Bourahima Kone
- University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Bassirou Diarra
- University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | | | - Ousmane Kodio
- University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Djeneba B Fofana
- University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | | | | | | | - Jane L Holl
- Northwestern University, Chicago, Illinois, USA
| | | | - Souleymane Diallo
- University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Seydou Doumbia
- University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | | | | | - Mamoudou Maiga
- University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
- Northwestern University, Chicago, Illinois, USA
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54
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Lu M, Fitzgerald D, Karpelowsky J, Selvadurai H, Pandit C, Robinson P, Marais BJ. Surgery in nontuberculous mycobacteria pulmonary disease. Breathe (Sheff) 2018; 14:288-301. [PMID: 30519295 PMCID: PMC6269180 DOI: 10.1183/20734735.027218] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Medical treatment of pulmonary nontuberculous mycobacteria (NTM) disease has highly variable outcomes. Despite the use of multiple antibiotics, sputum clearance is often difficult to achieve, especially in cases with macrolide resistant NTM infection. Immunocompromised patients and those with structural lung disease are at increased risk, although occurrence in immunocompetent patients without structural lung disease is well recognised. Most pulmonary NTM disease involves Mycobacterium avium complex (MAC), but with enhanced identification multiple species have now been recognised as opportunistic pathogens. The observed increase in NTM disease, especially infection with multidrug-resistant Mycobacterium abscessus complex, is probably multifactorial. Surgery has been used as adjuvant treatment in patients with 1) focal disease that can be removed or 2) bothersome symptoms despite medical treatment that can be ameliorated. Early post-surgical mortality is low, but long-term morbidity and mortality are highly dependent on the degree of lung involvement and the residual lung function, the potency of medical treatment and the type of surgical intervention. In conjunction with antibiotic therapy, reported post-surgical sputum clearance was excellent, although publication bias should be considered. Bronchopleural fistulae were problematic, especially in pneumonectomy cases. Study results support the use of minimal resection surgery, in a carefully selected subgroup of patients with focal disease or persistent symptoms. Educational aims To critically review the literature describing the use of surgery in the treatment of pulmonary disease caused by nontuberculous mycobacteria (NTM).To assess the outcomes and complications observed with different surgical approaches used in the treatment of pulmonary NTM disease.
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Affiliation(s)
- Mimi Lu
- Dept of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, Australia
| | - Dominic Fitzgerald
- Dept of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, Australia.,Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Jonathan Karpelowsky
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, Australia.,Dept of Paediatric Surgery, The Children's Hospital at Westmead, Sydney, Australia
| | - Hiran Selvadurai
- Dept of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, Australia.,Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Chetan Pandit
- Dept of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, Australia.,Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Paul Robinson
- Dept of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, Australia.,Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Ben J Marais
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, Australia.,Dept of Infectious Diseases, The Children's Hospital at Westmead, Sydney, Australia
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55
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Perez-Miranda J, Traversi L, Polverino E. Atypical Mycobacteria in Bronchiectasis. When do we Treat it? Arch Bronconeumol 2018; 55:183-184. [PMID: 30471918 DOI: 10.1016/j.arbres.2018.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 10/09/2018] [Accepted: 10/13/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Javier Perez-Miranda
- Hospital Universitari Vall d'Hebron (HUVH), Institut de Recerca Vall d'Hebron (VHIR), Barcelona, España
| | - Letizia Traversi
- Department of Medicine and Surgery, Respiratory Diseases, Università dell'Insubria, Varese-Como, Italia
| | - Eva Polverino
- Hospital Universitari Vall d'Hebron (HUVH), Institut de Recerca Vall d'Hebron (VHIR), Barcelona, España; Servicio de Neumología, Hospital Universitari Vall d'Hebron (HUVH), CIBER, Barcelona, España.
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56
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Dakić I, Arandjelović I, Savić B, Jovanović S, Tošić M, Kurucin T, Vuković D. Pulmonary isolation and clinical relevance of nontuberculous mycobacteria during nationwide survey in Serbia, 2010-2015. PLoS One 2018; 13:e0207751. [PMID: 30462740 PMCID: PMC6248987 DOI: 10.1371/journal.pone.0207751] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 11/06/2018] [Indexed: 11/19/2022] Open
Abstract
The rates of pulmonary colonization and disease due to nontuberculous mycobacteria (NTM) appear to be increasing globally, but diversity of species recovered as well as clinical relevance of NTM isolates differ considerably by geographic region. The first nationwide study of isolation frequency and clinical significance of NTM in Serbia included all patients with respiratory specimens yielding a positive NTM culture over the six-year period, 2010–2015. We analyzed trends in annual NTM isolation and NTM pulmonary disease (PD) incidence rates, with NTM PD cases defined in accordance with microbiological criteria established by the American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA). 777 pulmonary NTM isolates were collected from 565 patients, of whom 126 (22.3%) met the ATS/IDSA criteria. The annual NTM isolation and NTM PD incidence rates per 100,000 changed over 2010–2015 from 0.9 to 1.6 (p = 0.1746) and from 0.18 to 0.48 (p = f0.0040), respectively. Both isolation and disease rates increased considerably with age, while higher NTM PD rates were also associated with residence in urbanized areas. Diversity of NTM species isolated was shown to be region-specific, with M. xenopi as the most prevalent species (17.3%), and increasing isolation rates of rapid growing mycobacteria (RGM) (p = 0.0072). M. xenopi was also the most common cause of NTM PD (28.6%), followed by RGM (27.8%). With 73% clinically relevant isolates, M. abscessus was identified as the most clinically relevant NTM species. While NTM PD obviously remains a rare disease in Serbia, the overall results justify recognition of NTM as pathogens of rising importance, and require further characterization of their epidemiology in the country.
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Affiliation(s)
- Ivana Dakić
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Irena Arandjelović
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Branislava Savić
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Snežana Jovanović
- Department of Microbiology, Clinical Center of Serbia, Belgrade, Serbia
| | - Mirjana Tošić
- Department of Microbiology, Municipal Institute for Pulmonary Diseases and Tuberculosis, Belgrade, Serbia
| | - Tatjana Kurucin
- Center for Microbiology, Virology and Immunology, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Dragana Vuković
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- * E-mail:
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57
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Pyarali FF, Schweitzer M, Bagley V, Salamo O, Guerrero A, Sharifi A, Campos M, Quartin A, Mirsaeidi M. Increasing Non-tuberculous Mycobacteria Infections in Veterans With COPD and Association With Increased Risk of Mortality. Front Med (Lausanne) 2018; 5:311. [PMID: 30460238 PMCID: PMC6232288 DOI: 10.3389/fmed.2018.00311] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 10/22/2018] [Indexed: 12/23/2022] Open
Abstract
Background: There are limited data on the epidemiology of Non-tuberculous mycobacteria (NTM) infections among patients with COPD, particularly in the veteran population. This study examined the prevalence, incidence, and mortality of pulmonary NTM infections among veterans with COPD population in the United States. Methods: We analyzed nationwide data from Veterans Affairs Hospitals from 2001 to 2015. First, we determined the incidence and prevalence rates and geographic distribution of NTM infections among veterans with COPD and then we evaluated the association between NTM infections with mortality among veterans with COPD. Pulmonary NTM and COPD diagnosis were defined based on charting claims for each condition on ≥2 occasions and ≥30 days apart. COPD diagnoses had to precede diagnosis of NTM. Cox Proportional-Hazards Regression was performed to determine the dependency of survival time of COPD patients with NTM. Results: The incidence and prevalence rates of NTM rose over the study period, with a sharp rise in incidence after 2012. The areas with the highest NTM period prevalence were Puerto Rico (370), followed by Florida (351) and District of Columbia (309) in 100,000 COPD population. Mortality registered for those patients with COPD Patients and NTM infection was 1.43 times higher compared to those that were uninfected. Conclusions: NTM rates have been increasing in veterans with COPD since 2012. NTM infection is associated with increased risk of mortality. This highlights the importance of identifying preventable risk factors associated with NTM infections in subjects with COPD.
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Affiliation(s)
- Fahim F Pyarali
- Section of Pulmonary Medicine, Miami VA Healthcare System, Miami, FL, United States.,Division of Pulmonary and Critical Care, University of Miami, Miami, FL, United States
| | - Michael Schweitzer
- Section of Pulmonary Medicine, Miami VA Healthcare System, Miami, FL, United States
| | - Valeria Bagley
- Section of Pulmonary Medicine, Miami VA Healthcare System, Miami, FL, United States
| | - Oriana Salamo
- Section of Pulmonary Medicine, Miami VA Healthcare System, Miami, FL, United States
| | - Andrea Guerrero
- Section of Pulmonary Medicine, Miami VA Healthcare System, Miami, FL, United States.,Division of Pulmonary and Critical Care, University of Miami, Miami, FL, United States
| | - Arash Sharifi
- Rosenstiel School of Marine and Atmospheric Science at the University of Miami, Miami, FL, United States
| | - Michael Campos
- Section of Pulmonary Medicine, Miami VA Healthcare System, Miami, FL, United States.,Division of Pulmonary and Critical Care, University of Miami, Miami, FL, United States
| | - Andrew Quartin
- Section of Pulmonary Medicine, Miami VA Healthcare System, Miami, FL, United States.,Division of Pulmonary and Critical Care, University of Miami, Miami, FL, United States
| | - Mehdi Mirsaeidi
- Section of Pulmonary Medicine, Miami VA Healthcare System, Miami, FL, United States.,Division of Pulmonary and Critical Care, University of Miami, Miami, FL, United States
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58
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Ustinova VV, Smirnova TG, Sochivko DG, Varlamov DA, Larionova EE, Andreevskaya SN, Andrievskaya IY, Kiseleva EA, Chernousova LN, Ergeshov A. New assay to diagnose and differentiate between Mycobacterium tuberculosis complex and nontuberculous mycobacteria. Tuberculosis (Edinb) 2018; 114:17-23. [PMID: 30711153 DOI: 10.1016/j.tube.2018.10.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 10/02/2018] [Accepted: 10/07/2018] [Indexed: 11/29/2022]
Abstract
The purpose of the present study was to create a real-time PCR test system allowing simultaneous detection of nontuberculous mycobacteria (NTM) and Mycobacterium tuberculosis complex (MTBC) both in culture and sputum. NTM cultures (18 strains, 18 species), MTBC cultures (16 strains, 2 species) and non-mycobacterial microorganisms from the collection of the Central Research TB Institute (CTRI) were used for the preliminary evaluation of the test system. 301 NTM cultures from patients with mycobacteriosis were used to assess the sensitivity of the developed test system. Clinical respiratory samples (sputum) from 104 patients with mycobacteriosis, 3627 patients with tuberculosis and 118 patients with other lung diseases were used for diagnostic sensitivity and specificity testing. The specificity and sensitivity of the assay for MTBC was found to be 100% both in culture and sputum samples; for NTM, the specificity was 100% in culture and sputum, the sensitivity reached 100% in culture and 73.1% in sputum samples. Positive predictive value (PPV) and negative predictive value (NPV) of the assay for culture were both 100%, for clinical material 100% and 80.8%, respectively. The limit of detection at the probability of detection 95% (LoD95%) was estimated to be 16 cfu/ml for M. tuberculosis H37RV and 1200 cfu/ml for M. avium.
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Affiliation(s)
- Vera V Ustinova
- Microbiology Department, Central Tuberculosis Research Institute RAMS, Moscow, Russia.
| | - Tatiana G Smirnova
- Microbiology Department, Central Tuberculosis Research Institute RAMS, Moscow, Russia
| | | | - Dmitry A Varlamov
- All-Russia Research Institute of Agricultural Biotechnology, Moscow, Russia
| | - Elena E Larionova
- Microbiology Department, Central Tuberculosis Research Institute RAMS, Moscow, Russia
| | - Sofya N Andreevskaya
- Microbiology Department, Central Tuberculosis Research Institute RAMS, Moscow, Russia
| | - Irina Yu Andrievskaya
- Microbiology Department, Central Tuberculosis Research Institute RAMS, Moscow, Russia
| | - Ekaterina A Kiseleva
- Microbiology Department, Central Tuberculosis Research Institute RAMS, Moscow, Russia
| | - Larisa N Chernousova
- Microbiology Department, Central Tuberculosis Research Institute RAMS, Moscow, Russia
| | - Atadzhan Ergeshov
- Microbiology Department, Central Tuberculosis Research Institute RAMS, Moscow, Russia
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59
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Performance of Vitek MS v3.0 for Identification of Mycobacterium Species from Patient Samples by Use of Automated Liquid Medium Systems. J Clin Microbiol 2018; 56:JCM.00219-18. [PMID: 29875193 DOI: 10.1128/jcm.00219-18] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 05/31/2018] [Indexed: 12/27/2022] Open
Abstract
The accuracy and robustness of the Vitek MS v3.0 matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry (MS) system was evaluated by identifying mycobacteria from automated liquid-medium systems using patient samples. This is the first report to demonstrate that proteins within the liquid medium, its supplements, and decontamination reagents for nonsterile patient samples do not generate misidentification or false-positive results by use of the Vitek MS v3.0 system. Prior to testing with patient samples, a seeded-culture study was conducted to challenge the accuracy of the Vitek MS system at identifying mycobacteria from liquid medium by mimicking a clinical workflow. Seventy-seven Mycobacterium strains representing 21 species, seeded in simulated sputum, were decontaminated, inoculated into BacT/Alert MP liquid culture medium, incubated until positivity, and identified using the Vitek MS system. A total of 383 liquid cultures were tested, of which 379 (99%) were identified correctly to the species/complex/group level, 4 (1%) gave a "no-identification" result, and no misidentifications were observed. Following the simulated-sputum study, a total of 73 smear-positive liquid-medium cultures detected using BD BBL MGIT and VersaTREK Myco liquid media were identified by the Vitek MS system. Sixty-four cultures (87.7%) were correctly identified to the species/complex/group level; 7 (9.6%) resulted in no identification; and 2 (2.7%) were misidentified at the species level. These results indicate that the Vitek MS v3.0 system is an accurate tool for routine diagnostics of Mycobacterium species isolated from liquid cultures.
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60
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Brode SK, Marchand-Austin A, Jamieson FB, Marras TK. Pulmonary versus Nonpulmonary Nontuberculous Mycobacteria, Ontario, Canada. Emerg Infect Dis 2018; 23:1898-1901. [PMID: 29048292 PMCID: PMC5652412 DOI: 10.3201/eid2311.170959] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
In Ontario, Canada, during 1998–2010, nontuberculous mycobacteria (NTM) from pulmonary sites comprised 96% of species/patient combinations isolated; annual rates of isolation and cases increased steadily. NTM isolates from nonpulmonary sites comprised 4% of species/patient combinations; annual rates and cases were temporally stable. NTM increases were driven exclusively by pulmonary isolates and disease.
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61
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Adjemian J, Daniel-Wayman S, Ricotta E, Prevots DR. Epidemiology of Nontuberculous Mycobacteriosis. Semin Respir Crit Care Med 2018; 39:325-335. [PMID: 30071547 PMCID: PMC11037020 DOI: 10.1055/s-0038-1651491] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Annual prevalence estimates for pulmonary nontuberculous mycobacterial (PNTM) disease in the contiguous United States range from 1.4 to 13.9 per 100,000 persons, while one study found an annual prevalence of up to 44 per 100,000 persons in Hawaii. PNTM prevalence varies by region, sex, and race/ethnicity, with higher prevalence among women and persons of Asian ancestry, as well as in the Southern United States and Hawaii. Studies consistently indicate that PNTM prevalence is increasing, with estimates ranging from 2.5 to 8% per year. Most PNTM disease is associated with Mycobacterium avium complex (MAC), although the proportion of disease attributed to MAC varies by region. Host factors identified as influencing disease risk include structural lung disease, immunomodulatory medication, as well as variants in connective tissue, mucociliary clearance, and immune genes. Environmental variables including measures of atmospheric moisture and concentrations of certain soil factors have also been shown to correlate with higher PNTM prevalence. Prevalence of extrapulmonary NTM disease is lower, stable, and associated with different risk factors, including primary immune deficiencies or HIV infection.
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Affiliation(s)
- Jennifer Adjemian
- Epidemiology Unit, Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
- Commissioned Corps, United States Public Health Service, Rockville, Maryland
| | - Shelby Daniel-Wayman
- Epidemiology Unit, Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Emily Ricotta
- Epidemiology Unit, Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - D. Rebecca Prevots
- Epidemiology Unit, Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
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62
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Profiling non-tuberculous mycobacteria in an Asian setting: characteristics and clinical outcomes of hospitalized patients in Singapore. BMC Pulm Med 2018; 18:85. [PMID: 29788943 PMCID: PMC5964916 DOI: 10.1186/s12890-018-0637-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 04/25/2018] [Indexed: 01/15/2023] Open
Abstract
Background Non-tuberculous mycobacteria (NTM) infection is an increasing problem worldwide. The epidemiology of NTM in most Asian countries is unknown. This study investigated the epidemiology, and clinical profile of inpatients in whom NTM was isolated from various anatomical sites in a Singaporean population attending a major tertiary referral centre. Methods Demographic profile, clinical data, and characteristics of patients hospitalized with NTM isolates at a major tertiary hospital over two-year period were prospectively assessed (2011–2012). Data collected included patient demographics, ethnicity, smoking status, co-morbidities, NTM species, intensive care unit (ICU) treatment, and mortality. Results A total of 485 patients (62.1% male) with 560 hospital admissions were analysed. The median patient age was 70 years. Thirteen different NTM species were isolated from this cohort. Mycobacterium abscessus (M. abscessus) (38.4%) was most frequently isolated followed by Mycobacterium fortuitum (M. fortuitum) (16.6%), Mycobacterium avium complex (MAC) (16.3%), Mycobacterium kansasii (M. kansasii) (15.4%), and Mycobacterium gordonae (M. gordonae) (6.8%). Most (91%) NTM was isolated from the respiratory tract. The three most common non-pulmonary sites were; blood (2.7%), skin wounds and abscesses (2.1%), and gastric aspirates (1.1%). A third (34.4%) of the study population had prior pulmonary tuberculosis (PTB). There was a significant association between isolated NTM species, and patient age (p = 0.0002). Eleven (2.2%) patients received intensive care unit (ICU) treatment during the study period and all cause mortality within 1 year of the study was 16.9% (n = 82). Of these, 72 (87.8%) patients died of pulmonary causes. Conclusions The profile of NTM species in Singapore is unique. M. abscessus is the commonest NTM isolated, with a higher prevalence in males, and in the elderly. High NTM prevalence is associated with high rates of prior PTB in our cohort.
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63
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Scasso F, Ferrari G, DE Vincentiis GC, Arosio A, Bottero S, Carretti M, Ciardo A, Cocuzza S, Colombo A, Conti B, Cordone A, DE Ciccio M, Delehaye E, Della Vecchia L, DE Macina I, Dentone C, DI Mauro P, Dorati R, Fazio R, Ferrari A, Ferrea G, Giannantonio S, Genta I, Giuliani M, Lucidi D, Maiolino L, Marini G, Marsella P, Meucci D, Modena T, Montemurri B, Odone A, Palma S, Panatta ML, Piemonte M, Pisani P, Pisani S, Prioglio L, Scorpecci A, Scotto DI Santillo L, Serra A, Signorelli C, Sitzia E, Tropiano ML, Trozzi M, Tucci FM, Vezzosi L, Viaggi B. Emerging and re-emerging infectious disease in otorhinolaryngology. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2018; 38:S1-S106. [PMID: 29967548 PMCID: PMC6056203 DOI: 10.14639/0392-100x-suppl.1-38-2018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARY Emerging and re-emerging infectious disease in otorhinolaryngology (ENT) are an area of growing epidemiological and clinical interest. The aim of this section is to comprehensively report on the epidemiology of key infectious disease in otorhinolaryngology, reporting on their burden at the national and international level, expanding of the need of promoting and implementing preventive interventions, and the rationale of applying evidence-based, effective and cost- effective diagnostic, curative and preventive approaches. In particular, we focus on i) ENT viral infections (HIV, Epstein-Barr virus, Human Papilloma virus), retrieving the available evidence on their oncogenic potential; ii) typical and atypical mycobacteria infections; iii) non-specific granulomatous lymphadenopathy; iv) emerging paediatric ENT infectious diseases and the prevention of their complications; v) the growing burden of antimicrobial resistance in ENT and the strategies for its control in different clinical settings. We conclude by outlining knowledge gaps and action needed in ENT infectious diseases research and clinical practice and we make references to economic analysis in the field of ENT infectious diseases prevention and care.
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Affiliation(s)
- F Scasso
- SOC Otorinolaringoiatria, ASL 3 Genovese, Ospedale P.A. Micone, Genova, Italy
| | - G Ferrari
- SOC Otorinolaringoiatria, ASL 5 Genovese, Ospedale P.A. Levante Ligure, La Spezia, Italy
| | - G C DE Vincentiis
- UOC Otorinolaringoiatria, Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italy
| | - A Arosio
- Clinica Otorinolaringoiatria, Ospedale Macchi, ASST Settelaghi, Varese, Italy
| | - S Bottero
- UOC Chirurgia delle Vie Aeree, Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italy
| | - M Carretti
- UOC Otorinolaringoiatria, Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italy
| | - A Ciardo
- SOC Otorinolaringoiatria, ASL 5 Genovese, Ospedale P.A. Levante Ligure, La Spezia, Italy
| | - S Cocuzza
- Clinica di Otorinolaringoiatria, Università degli Studi di Catania, Catania, Italy
| | - A Colombo
- SOC Otorinolaringoiatria, Ospedale Cardinal Massaia, Asti, Italy
| | - B Conti
- Dipartimento di Scienze del Farmaco, Università degli Studi di Pavia, Pavia, Italy
| | - A Cordone
- SOC Otorinolaringoiatria, ASL 3 Genovese, Ospedale P.A. Micone, Genova, Italy
| | - M DE Ciccio
- SOC Otorinolaringoiatria, ASL 5 Genovese, Ospedale P.A. Levante Ligure, La Spezia, Italy
| | - E Delehaye
- SOC Otorinolaringoiatria, ASL 5 Genovese, Ospedale P.A. Levante Ligure, La Spezia, Italy
| | - L Della Vecchia
- Clinica Otorinolaringoiatria, Ospedale Macchi, ASST Settelaghi, Varese, Italy
| | - I DE Macina
- SOC Malattie Infettive, ASL 1 Imperiese, Ospedale di Sanremo, Italy
| | - C Dentone
- SOC Malattie Infettive, ASL 1 Imperiese, Ospedale di Sanremo, Italy
| | - P DI Mauro
- Clinica di Otorinolaringoiatria, Università degli Studi di Catania, Catania, Italy
| | - R Dorati
- Dipartimento di Scienze del Farmaco, Università degli Studi di Pavia, Pavia, Italy
| | - R Fazio
- SOC Otorinolaringoiatria, ASL 5 Genovese, Ospedale P.A. Levante Ligure, La Spezia, Italy
| | - A Ferrari
- Direzione Sanitaria, AOU Parma, Italy
| | - G Ferrea
- SOC Malattie Infettive, ASL 1 Imperiese, Ospedale di Sanremo, Italy
| | - S Giannantonio
- UOC Audiologia e Otochirurgia, Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italy
| | - I Genta
- Dipartimento di Scienze del Farmaco, Università degli Studi di Pavia, Pavia, Italy
| | - M Giuliani
- UOC Otorinolaringoiatria, Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italy
| | - D Lucidi
- UOC Audiologia e Otochirurgia, Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italy
| | - L Maiolino
- Clinica di Otorinolaringoiatria, Università degli Studi di Catania, Catania, Italy
| | - G Marini
- UOC Otorinolaringoiatria, Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italy
| | - P Marsella
- UOC Audiologia e Otochirurgia, Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italy
| | - D Meucci
- UOC Chirurgia delle Vie Aeree, Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italy
| | - T Modena
- Dipartimento di Scienze del Farmaco, Università degli Studi di Pavia, Pavia, Italy
| | - B Montemurri
- UOC Audiologia e Otochirurgia, Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italy
| | - A Odone
- Facoltà di Medicina e Chirurgia, Università Vita-Salute San Raffaele, Milano, Italy
| | - S Palma
- SOC Otorinolaringoiatria, Azienda Sanitaria Universitaria di Udine (ASUIUD), Italy
| | - M L Panatta
- UOC Otorinolaringoiatria, Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italy
| | - M Piemonte
- SOC Otorinolaringoiatria, Azienda Sanitaria Universitaria di Udine (ASUIUD), Italy
| | - P Pisani
- SOC Otorinolaringoiatria, Ospedale Cardinal Massaia, Asti, Italy
| | - S Pisani
- Dipartimento di Scienze del Farmaco, Università degli Studi di Pavia, Pavia, Italy
| | - L Prioglio
- SOC Otorinolaringoiatria, ASL 3 Genovese, Ospedale P.A. Micone, Genova, Italy
| | - A Scorpecci
- UOC Audiologia e Otochirurgia, Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italy
| | | | - A Serra
- Clinica di Otorinolaringoiatria, Università degli Studi di Catania, Catania, Italy
| | - C Signorelli
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Parma, Italy; Facoltà di Medicina e Chirurgia, Università Vita-Salute San Raffaele, Milano, Italy
| | - E Sitzia
- UOC Otorinolaringoiatria, Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italy
| | - M L Tropiano
- UOC Chirurgia delle Vie Aeree, Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italy
| | - M Trozzi
- UOC Chirurgia delle Vie Aeree, Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italy
| | - F M Tucci
- UOS Chirurgia Cervicale ORL, Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italy
| | - L Vezzosi
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Parma, Italy; Dipartimento di Medicina Sperimentale, Università degli Studi della Campania Luigi Vanvitelli, Napoli, Italy
| | - B Viaggi
- SOC Neuroanestesia e Rianimazione, A.O.U. Careggi, Firenze, Italy
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Kobayashi T, Tsuyuguchi K, Arai T, Tsuji T, Maekura T, Kurahara Y, Sugimoto C, Minomo S, Nakao K, Tokura S, Sasaki Y, Hayashi S, Inoue Y, Suzuki K. Change in lung function in never-smokers with nontuberculous mycobacterial lung disease: A retrospective study. J Clin Tuberc Other Mycobact Dis 2018; 11:17-21. [PMID: 31720386 PMCID: PMC6830135 DOI: 10.1016/j.jctube.2018.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 02/02/2018] [Accepted: 02/05/2018] [Indexed: 11/16/2022] Open
Abstract
Purpose Never-smokers account for a large proportion of subjects in general population studies on nontuberculous mycobacteria lung disease (NTM-LD). However, the influence of NTM infection on the lung function of never-smokers has not yet been evaluated. The aim of this study was to determine how NTM-LD impairs the lung function in never-smokers, and whether there are an association between successful NTM-LD treatment in radiologic outcomes and improvement in lung function of never-smokers with NTM-LD or not. Methods We performed a retrospective study of patients (1) who have never smoked during their lifetime; (2) with at least two respiratory specimens from sputum, one bronchial washing sample, or one lung tissue that were culture positive for the same NTM species; and (3) who underwent at least two pulmonary function tests. We enrolled healthy never-smokers as the control group. Results In 22 never-smokers with NTM-LD, the median forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) at baseline was lower than those in 9 healthy never-smokers [1800 vs 2080 ml (p = 0.23) and 2230 vs 2620 ml (p = 0.06)], respectively. The median change in FEV1 in never-smokers with NTM-LD was lower than that in healthy never-smokers [−70 vs 20 ml per year (p = 0.07), respectively]. On univariate analysis, baseline %-predicted FEV1 in never-smokers with NTM-LD was associated with changes in FVC (p = 0.026) and FEV1 (p = 0.013). Anti-NTM treatment was administered for at least 1 year in 19 patients (86.4%). The relationship between worsening chest CT findings and rapid progressive decline in both FVC (p = 0.66) and FEV1 (p = 0.23) were not significant. Conclusion Never-smokers with NTM-LD showed lung function decline. There was no association between successful NTM-LD treatment in radiologic outcomes and improvement in lung function of never-smokers.
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Affiliation(s)
- Takehiko Kobayashi
- Department of Internal Medicine, National Hospital Organization, Kinki-Chuo Chest Medical Center, Sakai City, Osaka, Japan
| | - Kazunari Tsuyuguchi
- Department of Infectious Diseases, Clinical Research Center, National Hospital Organization, Kinki-Chuo Chest Medical Center, 1180 Nagasone-cho, Kita-Ku, Sakai City, Osaka 591-8555, Japan
| | - Toru Arai
- Clinical Research Center, National Hospital Organization, Kinki-Chuo Chest Medical Center, Sakai City, Osaka, Japan
| | - Taisuke Tsuji
- Department of Internal Medicine, National Hospital Organization, Kinki-Chuo Chest Medical Center, Sakai City, Osaka, Japan
| | - Toshiya Maekura
- Department of Internal Medicine, National Hospital Organization, Kinki-Chuo Chest Medical Center, Sakai City, Osaka, Japan
| | - Yu Kurahara
- Department of Internal Medicine, National Hospital Organization, Kinki-Chuo Chest Medical Center, Sakai City, Osaka, Japan
| | - Chikatoshi Sugimoto
- Clinical Research Center, National Hospital Organization, Kinki-Chuo Chest Medical Center, Sakai City, Osaka, Japan
| | - Shojiro Minomo
- Department of Internal Medicine, National Hospital Organization, Kinki-Chuo Chest Medical Center, Sakai City, Osaka, Japan
| | - Keiko Nakao
- Department of Internal Medicine, National Hospital Organization, Kinki-Chuo Chest Medical Center, Sakai City, Osaka, Japan
| | - Sayoko Tokura
- Department of Internal Medicine, National Hospital Organization, Kinki-Chuo Chest Medical Center, Sakai City, Osaka, Japan
| | - Yumiko Sasaki
- Department of Internal Medicine, National Hospital Organization, Kinki-Chuo Chest Medical Center, Sakai City, Osaka, Japan.,Department of Infectious Diseases, Clinical Research Center, National Hospital Organization, Kinki-Chuo Chest Medical Center, 1180 Nagasone-cho, Kita-Ku, Sakai City, Osaka 591-8555, Japan
| | - Seiji Hayashi
- Department of Internal Medicine, National Hospital Organization, Kinki-Chuo Chest Medical Center, Sakai City, Osaka, Japan
| | - Yoshikazu Inoue
- Clinical Research Center, National Hospital Organization, Kinki-Chuo Chest Medical Center, Sakai City, Osaka, Japan
| | - Katsuhiro Suzuki
- Department of Internal Medicine, National Hospital Organization, Kinki-Chuo Chest Medical Center, Sakai City, Osaka, Japan
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65
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Matsuyama M, Martins AJ, Shallom S, Kamenyeva O, Kashyap A, Sampaio EP, Kabat J, Olivier KN, Zelazny AM, Tsang JS, Holland SM. Transcriptional Response of Respiratory Epithelium to Nontuberculous Mycobacteria. Am J Respir Cell Mol Biol 2018; 58:241-252. [PMID: 28915071 DOI: 10.1165/rcmb.2017-0218oc] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The incidence of pulmonary nontuberculous mycobacteria (NTM) disease is increasing, but host responses in respiratory epithelium infected with NTM are not fully understood. In this work, we aimed to identify infection-relevant gene expression signatures of NTM infection of the respiratory epithelium. We infected air-liquid interface (ALI) primary respiratory epithelial cell cultures with Mycobacterium avium subsp. avium (MAC) or Mycobacterium abscessus subsp. abscessus (MAB). We used cells from four different donors to obtain generalizable data. Differentiated respiratory epithelial cells at the ALI were infected with MAC or MAB at a multiplicity of infection of 100:1 or 1,000:1, and RNA sequencing was performed at Days 1 and 3 after infection. In response to infection, we found down-regulation of ciliary genes but upregulation of genes associated with cytokines/chemokines, such as IL-32, and cholesterol biosynthesis. Inflammatory response genes tended to be more upregulated by MAB than by MAC infection. Primary respiratory epithelial cell infection with NTM at the ALI identified ciliary function, cholesterol biosynthesis, and cytokine/chemokine production as major host responses to infection. Some of these pathways may be amenable to therapeutic manipulation.
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Affiliation(s)
| | - Andrew J Martins
- 2 Systems Genomics and Bioinformatics Unit, Laboratory of Systems Biology, and
| | - Shamira Shallom
- 3 Microbiology Service, Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland; and
| | - Olena Kamenyeva
- 4 Biological Imaging Section, Research Technology Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | | | | | - Juraj Kabat
- 4 Biological Imaging Section, Research Technology Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Kenneth N Olivier
- 5 Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Adrian M Zelazny
- 3 Microbiology Service, Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland; and
| | - John S Tsang
- 2 Systems Genomics and Bioinformatics Unit, Laboratory of Systems Biology, and
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66
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Adjemian J, Frankland TB, Daida YG, Honda JR, Olivier KN, Zelazny A, Honda S, Prevots DR. Epidemiology of Nontuberculous Mycobacterial Lung Disease and Tuberculosis, Hawaii, USA. Emerg Infect Dis 2018; 23:439-447. [PMID: 28221128 PMCID: PMC5382761 DOI: 10.3201/eid2303.161827] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Previous studies found Hawaiians and Asian-Americans/Pacific Islanders to be independently at increased risk for nontuberculous mycobacterial pulmonary disease (NTMPD) and tuberculosis (TB). To better understand NTM infection and TB risk patterns in Hawaii, USA, we evaluated data on a cohort of patients in Hawaii for 2005–2013. Period prevalence of NTMPD was highest among Japanese, Chinese, and Vietnamese patients (>300/100,000 persons) and lowest among Native Hawaiians and Other Pacific Islanders (50/100,000). Japanese patients were twice as likely as all other racial/ethnic groups to have Mycobacterium abscessus isolated (adjusted odds ratio 2.0, 95% CI 1.2–3.2) but were not at increased risk for infection with other mycobacteria species. In contrast, incidence of TB was stable and was lowest among Japanese patients (no cases) and highest among Filipino, Korean, and Vietnamese patients (>50/100,000). Substantial differences exist in the epidemiology of NTMPD by race/ethnicity, suggesting behavioral and biologic factors that affect disease susceptibility.
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Rapid identification of mycobacteria from positive MGIT broths of primary cultures by MALDI-TOF mass spectrometry. PLoS One 2018; 13:e0192291. [PMID: 29394275 PMCID: PMC5796708 DOI: 10.1371/journal.pone.0192291] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 01/22/2018] [Indexed: 02/06/2023] Open
Abstract
Background Rapid identification of mycobacteria is important for timely treatment and the implementation of public health measures. The MGIT system ensures rapid detection of mycobacteria, but identification is usually delayed by days to weeks due to further subculture on solid medium. Matrix-assisted laser desorption time-of-flight mass spectrometry (MALDI-TOF MS) was demonstrated to effectively identify mycobacteria isolates subcultured from solid or liquid media. Reports of identification directly from MGIT broths of both sterile and non-sterile clinical specimens, omitting the subculture step, were limited and not satisfactory before. Our identification method dramatically shortened delay from detection to identification of mycobacteria. Methodology We assessed the performance of the Vitek MS IVD version 3.0 for direct identification of NTM and M.tuberculosis from primary MGIT cultures, and assessed two sample preparation methods. Results Direct identification of NTM from positive MGIT broths, using MALDI-TOF VITEK MS with IVD v.3.0, generated high rates of acceptable results reaching 96.4% (80/83), and up to 100% (83/83) for sample preparations including a 0.1% SDS washing step. The sensitivity of VITEK MS to identify M.tuberculosis from MGIT tubes was 58/72 (80.6%), when using immunochromatography (ICA) test as gold standard. A characteristic colony clumping, wool-like appearance was observed in 48, and all 58 (100%) were correctly identified as M.tuberculosis using MALDI-TOF. The detection rate of M.tuberculosis complex was low (10/24, 41.6%) in the 24 MGIT tubes that was polymicrobial. Our method significantly reduced both the reagent cost and turnaround time. Conclusions Based on a simplified protocol, we showed that MALDI-TOF MS can be used for rapid identification of NTM directly from primary MGIT cultures within the routine clinical laboratory workflow. However, we recommend an initial ICA test to screen for M.tuberculosis complex, due to a low identification rate of M. tuberculosis in the presence of polymicrobial cultures using MALDI-TOF.
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Practice Guidelines for Clinical Microbiology Laboratories: Mycobacteria. Clin Microbiol Rev 2018; 31:31/2/e00038-17. [PMID: 29386234 DOI: 10.1128/cmr.00038-17] [Citation(s) in RCA: 146] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Mycobacteria are the causative organisms for diseases such as tuberculosis (TB), leprosy, Buruli ulcer, and pulmonary nontuberculous mycobacterial disease, to name the most important ones. In 2015, globally, almost 10 million people developed TB, and almost half a million patients suffered from its multidrug-resistant form. In 2016, a total of 9,287 new TB cases were reported in the United States. In 2015, there were 174,608 new case of leprosy worldwide. India, Brazil, and Indonesia reported the most leprosy cases. In 2015, the World Health Organization reported 2,037 new cases of Buruli ulcer, with most cases being reported in Africa. Pulmonary nontuberculous mycobacterial disease is an emerging public health challenge. The U.S. National Institutes of Health reported an increase from 20 to 47 cases/100,000 persons (or 8.2% per year) of pulmonary nontuberculous mycobacterial disease among adults aged 65 years or older throughout the United States, with 181,037 national annual cases estimated in 2014. This review describes contemporary methods for the laboratory diagnosis of mycobacterial diseases. Furthermore, the review considers the ever-changing health care delivery system and stresses the laboratory's need to adjust and embrace molecular technologies to provide shorter turnaround times and a higher quality of care for the patients who we serve.
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Abstract
In Queensland, Australia, all cases of mycobacterial infection (tuberculosis [TB] and nontuberculous mycobacteria [NTM]) are notifiable under the Queensland Public Health Act (2005). This process originally emerged to avoid NTM confounding with notification of cases of TB, but has facilitated awareness of the increasing incidence and changing epidemiology of NTM. Although initially not a public health priority, the notification process has facilitated research that has led to an appreciation of both public health and environmental health issues associated with these pathogens. When reports of NTM infections were low in frequency, reporting was managed largely by clinicians specializing in TB. However, as reports of NTM isolates surpassed those for TB, the workload associated with clinical reporting exceeded resources. The Communicable Diseases Branch transitioned to digital reporting of laboratory isolates of mycobacteria, thereby enabling weekly and quarterly reporting of data, and generation of more detailed annual reports. The reports now include species and geographic distributions by health service district, allowing identification of clusters requiring further investigation and systematic reviews of different species. With ecological and climate change, the distribution and virulence of these emerging pathogens are evolving. Evidence of transmission of highly virulent and antibiotic-resistant clones of Mycobacterium abscessus among patients with cystic fibrosis internationally heightens the need for timely reporting to public health authorities. Ongoing systematic monitoring by public health authorities will be crucial to our understanding of NTM diseases.
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A novel liquid media mycobacteria extraction method for MALDI-TOF MS identification using VITEK® MS. J Microbiol Methods 2017; 144:128-133. [PMID: 29158151 DOI: 10.1016/j.mimet.2017.11.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 10/30/2017] [Accepted: 11/16/2017] [Indexed: 11/22/2022]
Abstract
A low-cost identification method that can be performed directly from a positive liquid medium culture is needed for the diagnosis of mycobacterial infections. Here, we describe a novel, cost-effective, and validated method that allows for direct and rapid identification of mycobacteria from a positive liquid culture using VITEK® MS with a total process duration under 45min. From a liquid mycobacteria culture a 3.0mL aliquot is removed 24-72h post positivity and centrifuged to create a pellet. After decanting, the tube is blotted dry, the pellet is re-suspended in 0.5mL of 70% ethanol and then transferred into a 2.0mL tube containing glass beads. Mycobacteria are disrupted mechanically followed by a 10min. incubation at room temperature to complete inactivation. Inactivated material is pelleted by centrifugation and then re-suspended in 10μL of 70% formic acid and 10μL of acetonitrile. After centrifugation, 1μL of supernatant (protein extract) is deposited onto target slide, allowed to dry, and then 1μL CHCA matrix is added. A seeded study was conducted to demonstrate the reliability of the method, a total of 251 culture samples obtained from automated culture systems (BacT/ALERT® MP bottles, BACTEC MGIT™ 960 tubes, and VersaTREK® Myco bottles), were tested and resulted in 98.8% correct identification. Reproducibility was shown by testing three organisms across three reagent lots, between four laboratory technicians, over the course of five days for three liquid media systems resulting in a total of 180 deposits with an overall correct identification of 98.9% with the remaining results giving no identification. Additional studies were performed including comparison of different mechanical disruption techniques, stability of frozen extracts, and stability of slide deposits to allow for flexibility in a routine clinical workflow. The described method proved to be safe while providing consistent and reproducible results for different species of mycobacteria and is compatible with the three most widely used liquid media medium detection systems.
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71
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Lim DH, Kim YG, Shim TS, Jo KW, Ghang B, Ahn SM, Hong S, Lee CK, Yoo B. Nontuberculous mycobacterial infection in rheumatoid arthritis patients: a single-center experience in South Korea. Korean J Intern Med 2017; 32:1090-1097. [PMID: 28063416 PMCID: PMC5668388 DOI: 10.3904/kjim.2015.357] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 12/08/2015] [Accepted: 12/14/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND/AIMS Nontuberculous mycobacteria (NTM) infection has been increasing worldwide in both general population and immunocompromised patients, which has also been reported in rheumatoid arthritis (RA) patients. This study aimed to identify the incidence and clinical characteristics of NTM infection in RA patients living in tuberculosis (TB) infection endemic area. METHODS We performed a retrospective analysis of NTM infection cases in our RA registry at a tertiary referral center from January 1995 to December 2013. The clinical features of them were compared to those of 52 TB infection patients from same registry. RESULTS Among 1,397 patients with RA, NTM infection was newly developed in 26 patients and the incidence of NTM infection was 164.8 per 100,000 patient-years. The Mycobacterium avium complex was the most frequent isolate (76.9%). None of the NTM infections had extrapulmonary involvement, which was rather common in TB infection (26.9%). Patients with NTM infection were older, received higher cumulative steroid doses, and had higher rates of past TB infection history and concomitant interstitial lung disease (ILD) than cases with TB infection. CONCLUSIONS In South Korea, NTM infection is not rare in RA patients, and infection rates are growing. Physicians should be cautious about NTM infection in patients with a history of TB infection or concomitant ILD, even living in TB endemic area.
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Affiliation(s)
- Doo-Ho Lim
- Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong-Gil Kim
- Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Correspondence to Yong-Gil Kim, M.D. Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea Tel: +82-2-3010-3279 Fax: +82-2-3010-6969 E-mail:
| | - Tae Sun Shim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung-Wook Jo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byeongzu Ghang
- Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Soo Min Ahn
- Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seokchan Hong
- Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang-Keun Lee
- Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Bin Yoo
- Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Inhibition of Adherence of Mycobacterium avium to Plumbing Surface Biofilms of Methylobacterium spp. Pathogens 2017; 6:pathogens6030042. [PMID: 28906463 PMCID: PMC5617999 DOI: 10.3390/pathogens6030042] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 09/06/2017] [Accepted: 09/11/2017] [Indexed: 11/21/2022] Open
Abstract
Both Mycobacterium spp. and Methylobacterium spp. are opportunistic premise plumbing pathogens that are found on pipe surfaces in households. However, examination of data published in prior microbiological surveys indicates that Methylobacterium spp. and Mycobacterium spp. tend not to coexist in the same household plumbing biofilms. That evidence led us to test the hypothesis that Methylobacterium spp. in biofilms could inhibit the adherence of Mycobacterium avium. Measurements of adherence of M. avium cells to stainless steel coupons using both culture and PCR-based methods showed that the presence of Methylobacterium spp. biofilms substantially reduced M. avium adherence and vice versa. That inhibition of M. avium adherence was not reduced by UV-irradiation, cyanide/azide exposure, or autoclaving of the Methylobacterium spp. biofilms. Further, there was no evidence of the production of anti-mycobacterial compounds by biofilm-grown Methylobacterium spp. cells. The results add to understanding of the role of microbial interactions in biofilms as a driving force in the proliferation or inhibition of opportunistic pathogens in premise plumbing, and provide a potential new avenue by which M. avium exposures may be reduced for at-risk individuals.
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Cadelis G, Ducrot R, Bourdin A, Rastogi N. Predictive factors for a one-year improvement in nontuberculous mycobacterial pulmonary disease: An 11-year retrospective and multicenter study. PLoS Negl Trop Dis 2017; 11:e0005841. [PMID: 28787454 PMCID: PMC5560745 DOI: 10.1371/journal.pntd.0005841] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 08/17/2017] [Accepted: 07/29/2017] [Indexed: 11/19/2022] Open
Abstract
Background Nontuberculous mycobacterial pulmonary disease (NTM-PD) has become an emerging infectious disease and is responsible for more deaths than tuberculosis in industrialized countries. NTM-PD mortality remains high in some series reportedly ranging from 25% to 40% at five years and often due to unfavorable evolution of NTM-PD despite established treatment. The purpose of our study was to search for early factors that could predict the favorable or unfavorable evolution of NTM-PD at the first year of treatment. Methods In this retrospective and multicenter study, we selected 119 patients based on clinical, radiological and microbiological data from 2002 to 2012 from three French university hospitals (Guadeloupe, Martinique, Montpellier) with definite (meeting the criteria of the American Thoracic Society and the Infectious Disease Society of America in 2007; ATS/IDSA) or probable (one positive sputum culture) NTM-PD. We compared two patient groups: those who improved at one year (clinical symptoms, radiological lesions and microbiology data) and those who did not improve at one year. The data were analyzed for all patients as well as for subgroups by gender, HIV-positive patients, and Mycobacterium avium complex (MAC) infection. Results The average patient age was 50 years ± 19.4; 58% had respiratory comorbidities, 24% were HIV positive and 19% had cystic fibrosis. Coughing concerned 66% of patients and bronchiectasis concerned 45%. The most frequently isolated NTM were MAC (46%). 57% (n = 68) of patients met the ATS criteria and improved status concerned 38.6% (n = 46). The improvement factors at one year of NTM-PD were associated with the duration of ethambutol treatment: (Odds ratio adjusted [ORa]: 2.24, 95% Confidence interval [CI]; 2.11–3.41), HIV-positive status: (ORa: 3.23, 95% CI; 1.27–8.45), and male gender: (ORa: 2.34, 95% CI; 1.26–8.16). For the group with NTM-PD due to MAC, improvement was associated with the duration of macrolide treatment (ORa: 3.27, 95% CI; 1.88–7.30) and an age <50 years (ORa: 1.88, 95% CI; 1.55–8.50). Conclusion In this retrospective multicenter study, improvement at one year in patients with definite or probable NTM-PD was associated with the duration of ethambutol treatment, HIV-positive status and male gender. For the group of patients infected with MAC, improvement was associated with the duration of macrolide treatment and an age <50 years. Identifying predictors of improvement at one year of NTM-PD is expected to optimize the management of the disease in its early stages. Early predictive factors for a favorable development of nontuberculous mycobacterial pulmonary disease (NTM-PD) are important to improve management due to the high mortality of this infection at 5 years. The purpose of this study was to search for early factors that could predict at the first year, the favorable or unfavorable evolution of NTM-PD. This multicenter and retrospective study shows the importance of the duration of use of certain antibiotics (e.g. ethambutol and macrolides) in combination with other drugs in the one-year improvement of patients with NTM-PD. It also confirms the favorable prognosis at one year of NTM-PD patients with HIV-positive status. Identifying predictors of improvement at one year of NTM-PD is expected to optimize prognosis of the disease in its early stages.
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Affiliation(s)
- Gilbert Cadelis
- Department of Pulmonary Medicine, University Hospital of Pointe-à-Pitre, Pointe-à-Pitre, Guadeloupe, France
- * E-mail:
| | - Rodolphe Ducrot
- Department of Pulmonary Medicine, University Hospital of La Reunion, Saint Pierre, La Reunion, France
| | - Arnaud Bourdin
- Department of Respiratory Diseases, University Hospital of Montpellier, Montpellier, France
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France
| | - Nalin Rastogi
- WHO Supranational TB Reference Laboratory, Tuberculosis & Mycobacteria Unit, Institut Pasteur de la Guadeloupe, Abymes, Guadeloupe, France
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Franz ND, Belardinelli JM, Kaminski MA, Dunn LC, Calado Nogueira de Moura V, Blaha MA, Truong DD, Li W, Jackson M, North EJ. Design, synthesis and evaluation of indole-2-carboxamides with pan anti-mycobacterial activity. Bioorg Med Chem 2017; 25:3746-3755. [PMID: 28545813 PMCID: PMC5539987 DOI: 10.1016/j.bmc.2017.05.015] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 05/04/2017] [Accepted: 05/06/2017] [Indexed: 12/22/2022]
Abstract
Current treatment regimens for non-tuberculous mycobacteria (NTM) and tuberculosis (TB) generally require long duration of therapy with multiple drugs, some of which are broad spectrum antibiotics. Despite some advances in antimicrobial compounds, there remains a need in therapy for antibiotics with specific mycobacterial targets. It has been shown that MmpL3 is an essential transporter required for the translocation of mycolic acids to the mycobacterial cell envelope. Here, we synthesized a series of indole-2-carboxamides that inhibit MmpL3 and have potent pan-activity against mycobacterial species. The compounds were tested against several fast and slow-growing Mycobacterium species, including M. abscessus, M. massiliense, M. bolletii, M. chelonae, M. tuberculosis, M. avium, M. xenopi and M. smegmatis. The target of these indole-based compounds makes them selective for mycobacteria, while showing no clinically relevant bactericidal activity against S. aureus or P. aeruginosa. These compounds were tested against THP-1, a human-cell line, and showed minimal in vitro cytotoxicity and good selectivity indices. The data shown and discussed suggest that lead indole-2-carboxamides are strong contenders for further preclinical testing as NTM therapeutics.
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Affiliation(s)
- Nicholas D Franz
- Department of Pharmacy Sciences, Creighton University, 2500 California Plaza, Omaha, NE 68178, USA
| | - Juan Manuel Belardinelli
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO 80523, USA
| | - Michael A Kaminski
- Department of Pharmacy Sciences, Creighton University, 2500 California Plaza, Omaha, NE 68178, USA
| | - Louis C Dunn
- Department of Pharmacy Sciences, Creighton University, 2500 California Plaza, Omaha, NE 68178, USA
| | - Vinicius Calado Nogueira de Moura
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO 80523, USA
| | - Michael A Blaha
- Department of Pharmacy Sciences, Creighton University, 2500 California Plaza, Omaha, NE 68178, USA
| | - Dan D Truong
- Department of Pharmacy Sciences, Creighton University, 2500 California Plaza, Omaha, NE 68178, USA
| | - Wei Li
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO 80523, USA
| | - Mary Jackson
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO 80523, USA
| | - E Jeffrey North
- Department of Pharmacy Sciences, Creighton University, 2500 California Plaza, Omaha, NE 68178, USA.
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Abstract
The incidence of Mycobacterium kansasii varies widely over time and by region, but this organism remains one of the most clinically relevant isolated species of nontuberculous mycobacteria. In contrast to other common nontuberculous mycobacteria, M. kansasii is infrequently isolated from natural water sources or soil. The major reservoir appears to be tap water. Infection is likely acquired through the aerosol route, with low infectivity in regions of endemicity. Human-to-human transmission is thought not to occur. Clinical syndromes and radiological findings of M. kansasii infection are mostly indistinguishable from that of Mycobacterium tuberculosis, thus requiring microbiological confirmation. Disseminated disease is uncommon in HIV-negative patients and usually associated with severe immunosuppression. The majority of patients with M. kansasii pulmonary disease have underlying pulmonary comorbidities, such as smoking, chronic obstructive pulmonary disease, bronchiectasis, and prior or concurrent M. tuberculosis infection. Surveys in Great Britain, however, noted higher rates, with 8 to 9% of M. kansasii infections presenting with extrapulmonary disease. Common sites of extrapulmonary disease include the lymph nodes, skin, and musculoskeletal and genitourinary systems. The specificity of gamma interferon release assays (IGRAs) for M. tuberculosis may be reduced by M. kansasii infection, as M. kansasii encodes CFP-10 and ESAT-6, two antigens targeted by IGRAs. A study conducted to evaluate the therapy in rifampin-resistant disease found that patients with acquired rifampin resistance were treated with daily high-dose ethambutol, isoniazid, sulfamethoxazole, and pyridoxine combined with aminoglycoside therapy. Given the potential toxicities, particularly with aminoglycoside therapy, clarithromycin and/or moxifloxacin therapy could be considered as alternatives.
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Abstract
Despite the ubiqitous nature of Mycobacterium avium complex (MAC) organisms in the environment, relatively few of those who are infected develop disease. Thus, some degree of susceptibility due to either underlying lung disease or immunosuppression is required. The frequency of pulmonary MAC disease is increasing in many areas, and the exact reasons are unknown. Isolation of MAC from a respiratory specimen does not necessarily mean that treatment is required, as the decision to treatment requires the synthesis of clinical, radiographic, and microbiologic information as well as a weighing of the risks and benefits for the individual patient. Successful treatment requires a multipronged approach that includes antibiotics, aggressive pulmonary hygiene, and sometimes resection of the diseased lung. A combination of azithromycin, rifampin, and ethambutol administered three times weekly is recommend for nodular bronchiectatic disease, whereas the same regimen may be used for cavitary disease but administered daily and often with inclusion of a parenteral aminoglycoside. Disseminated MAC (DMAC) is almost exclusively seen in patients with late-stage AIDS and can be treated with a macrolide in combination with ethambutol, with or without rifabutin: the most important intervention in this setting is to gain HIV control with the use of potent antiretroviral therapy. Treatment outcomes for many patients with MAC disease remain suboptimal, so new drugs and treatment regimens are greatly needed. Given the high rate of reinfection after cure, one of the greatest needs is a better understanding of where infection occurs and how this can be prevented.
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Rhoads WJ, Pruden A, Edwards MA. Interactive Effects of Corrosion, Copper, and Chloramines on Legionella and Mycobacteria in Hot Water Plumbing. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2017; 51:7065-7075. [PMID: 28513143 DOI: 10.1021/acs.est.6b05616] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Complexities associated with drinking water plumbing systems can result in undesirable interactions among plumbing components that undermine engineering controls for opportunistic pathogens (OPs). In this study, we examine the effects of plumbing system materials and two commonly applied disinfectants, copper and chloramines, on water chemistry and the growth of Legionella and mycobacteria across a transect of bench- and pilot-scale hot water experiments carried out with the same municipal water supply. We discovered that copper released from corrosion of plumbing materials can initiate evolution of >1100 times more hydrogen (H2) from water heater sacrificial anode rods than does presence of copper dosed as soluble cupric ions. H2 is a favorable electron donor for autotrophs and causes fixation of organic carbon that could serve as a nutrient for OPs. Dosed cupric ions acted as a disinfectant in stratified stagnant pipes, inhibiting culturable Legionella and biofilm formation, but promoted Legionella growth in pipes subject to convective mixing. This difference was presumably due to continuous delivery of nutrients to biofilm on the pipes under convective mixing conditions. Chloramines eliminated culturable Legionella and prevented L. pneumophila from recolonizing biofilms, but M. avium gene numbers increased by 0.14-0.76 logs in the bulk water and were unaffected in the biofilm. This study provides practical confirmation of past discrepancies in the literature regarding the variable effects of copper on Legionella growth, and confirms prior reports of trade-offs between Legionella and mycobacteria if chloramines are applied as secondary disinfectant residual.
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Affiliation(s)
- William J Rhoads
- Department of Civil and Environmental Engineering, Virginia Polytechnic Institute and State University , 418 Durham Hall, Blacksburg, Virginia 24061, United States
| | - Amy Pruden
- Department of Civil and Environmental Engineering, Virginia Polytechnic Institute and State University , 418 Durham Hall, Blacksburg, Virginia 24061, United States
| | - Marc A Edwards
- Department of Civil and Environmental Engineering, Virginia Polytechnic Institute and State University , 418 Durham Hall, Blacksburg, Virginia 24061, United States
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Lyman MM, Grigg C, Kinsey CB, Keckler MS, Moulton-Meissner H, Cooper E, Soe MM, Noble-Wang J, Longenberger A, Walker SR, Miller JR, Perz JF, Perkins KM. Invasive Nontuberculous Mycobacterial Infections among Cardiothoracic Surgical Patients Exposed to Heater-Cooler Devices 1. Emerg Infect Dis 2017; 23:796-805. [PMID: 28418290 PMCID: PMC5403026 DOI: 10.3201/eid2305.161899] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Invasive nontuberculous mycobacteria (NTM) infections may result from a previously unrecognized source of transmission, heater–cooler devices (HCDs) used during cardiac surgery. In July 2015, the Pennsylvania Department of Health notified the Centers for Disease Control and Prevention (CDC) about a cluster of NTM infections among cardiothoracic surgical patients at 1 hospital. We conducted a case–control study to identify exposures causing infection, examining 11 case-patients and 48 control-patients. Eight (73%) case-patients had a clinical specimen identified as Mycobacterium avium complex (MAC). HCD exposure was associated with increased odds of invasive NTM infection; laboratory testing identified patient isolates and HCD samples as closely related strains of M. chimaera, a MAC species. This investigation confirmed a large US outbreak of invasive MAC infections in a previously unaffected patient population and suggested transmission occurred by aerosolization from HCDs. Recommendations have been issued for enhanced surveillance to identify potential infections associated with HCDs and measures to mitigate transmission risk.
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Epidemiology and Outcomes of Nontuberculous Mycobacterial Infections in Solid Organ Transplant Recipients at a Midwestern Center. Transplantation 2017; 100:1073-8. [PMID: 26950719 DOI: 10.1097/tp.0000000000001123] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Nontuberculous mycobacterial (NTM) infections have the potential to affect outcomes in solid organ transplant (SOT) recipients. METHODS Retrospective cohort of adults who underwent SOT at a Midwestern hospital between January 1, 2004, and December 31, 2013. NTM-infected patients had at least 1 positive culture for NTM posttransplant. NTM disease was defined by 1) American Thoracic Society/Infectious Disease Society of America criteria for respiratory specimens or 2) NTM cultured from a sterile site with a compatible clinical syndrome. The remaining NTM infected patients were classified as colonized. Cox regression analysis was used to determine the association of NTM with mortality among lung transplant recipients. RESULTS Of 3338 SOT recipients, 50 (1.5%) had NTM infection during a median 1038 days (range, 165-3706) follow-up posttransplant. Forty-three patients (86%) with NTM infection were lung transplant recipients; 18 of 43 (41.8%) were treated for NTM and 6 (13.9%) met disease criteria. Isolation of the same species on multiple occasions was associated with treatment among the colonized lung transplant recipients (8/12 [67%] vs 3/25 [12%] who were not treated, P = 0.014). NTM infection was not associated with increased mortality in lung transplant recipients (9/43 [20.9%] in infected died versus 161/510 [31.6%] in uninfected, age-adjusted hazard ratio, 0.56; 95% confidence interval, 0.2-1.1; P = 0.091). Three of 6 lung transplant recipients with NTM disease died compared with 6 of 37 colonized (hazard ratio, 7.0; 95% confidence interval, 1.5-31.5; P = 0.003). CONCLUSIONS Among SOT patients, NTM were most frequently identified from lung transplant recipients. NTM infection was not associated with increased mortality, although NTM disease was associated with increased mortality compared with colonization in lung transplant recipients.
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80
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Wang HY, Uh Y, Kim S, Lee H. Performance of the Quantamatrix Multiplexed Assay Platform system for the differentiation and identification of Mycobacterium species. J Med Microbiol 2017; 66:777-787. [PMID: 28604333 DOI: 10.1099/jmm.0.000495] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The purpose of this study was to evaluate the usefulness of a new diagnostic multiplexed bead-based bioassay (Quantamatrix Multiplexed Assay Platform; QMAP) system with shape-encoded silica microparticles for the rapid and accurate detection and identification of 23 mycobacterial species/groups, including Mycobacterium tuberculosis complex (MTBC). METHODOLOGY A total of 295 mycobacterial clinical isolates cultured from respiratory specimens were used for identification of MTBC and non-tuberculous mycobacteria (NTM) using the QMAP system and the results were confirmed with PCR-restriction fragment length polymorphism (RFLP) analysis of the rpoB gene, rpoB sequence analysis and PCR-reverse blot hybridization assay (REBA).Results/Key findings. The Mycobacterium genus-specific probe of the QMAP system was positive for all 46 Mycobacterium reference strains and negative for 59 non-Mycobacterium strains. Based on 295 liquid culture-positive samples, both the culture-based conventional identification method and the QMAP system identified each 212 and 81 isolates as MTB and NTM species. The concordance rates for the identification of NTM species between the QMAP system and molecular assays were 92.8 % (77/83), 97.6 % (81/83) and 100 % (83/83) for PCR-RFLP, the rpoB sequence analysis and PCR-REBA, respectively. CONCLUSION The QMAP system yielded rapid, highly sensitive and specific results for the identification of MTBC and NTM and accurately discriminated between NTM species within 3 h.
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Affiliation(s)
- Hye-Young Wang
- Optipharm, Inc., Wonju Eco Environmental Technology Center, Wonju, Gangwon, 26493, Republic of Korea
| | - Young Uh
- Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju, Gangwon, 26426, Republic of Korea
| | - Seoyong Kim
- Department of Biomedical Laboratory Science, College of Health Sciences, Yonsei University, Wonju, Gangwon, 26493, Republic of Korea
| | - Hyeyoung Lee
- Department of Biomedical Laboratory Science, College of Health Sciences, Yonsei University, Wonju, Gangwon, 26493, Republic of Korea
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Wang HY, Uh Y, Kim S, Shim TS, Lee H. Evaluation of the Quantamatrix Multiplexed Assay Platform system for simultaneous detection of Mycobacterium tuberculosis and the rifampicin resistance gene using cultured mycobacteria. Int J Infect Dis 2017. [PMID: 28627431 DOI: 10.1016/j.ijid.2017.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The differentiation of Mycobacterium tuberculosis complex (MTBC) from non-tuberculous mycobacteria (NTM) is of primary importance for infection control and the selection of anti-tuberculosis drugs. Up to date data on rifampicin (RIF)-resistant tuberculosis (TB) is essential for the early management of multidrug-resistant TB. The aim of this study was to evaluate the usefulness of a newly developed multiplexed, bead-based bioassay (Quantamatrix Multiplexed Assay Platform, QMAP) for the rapid differentiation of 23 Mycobacterium species including MTBC and RIF-resistant strains. METHODS A total of 314 clinical Mycobacterium isolates cultured from respiratory specimens were used in this study. RESULTS The sensitivity and specificity of the QMAP system for Mycobacterium species were 100% (95% CI 99.15-100%, p<0.0001) and 97.8% (95% CI 91.86-99.87%, p<0.0001), respectively. The results of conventional drug susceptibility testing and the QMAP Dual-ID assay were completely concordant for all clinical isolates (100%, 95% CI 98.56-100%). Out of 223 M. tuberculosis (MTB) isolates, 196 were pan-susceptible and 27 were resistant to RIF according to QMAP results. All of the mutations in the RIF resistance-determining region detected by the QMAP system were confirmed by rpoB sequence analysis and a REBA MTB-Rifa reverse blot hybridization assay. The majority of the mutations (n=26, 96.3%), including those missing wild-type probe signals, were located in three codons (529-534, 524-529, and 514-520), and 17 (65.4%) of these mutations were detected by three mutation probes (531TTG, 526TAC, and 516GTC). CONCLUSIONS The entire QMAP system assay takes about 3h to complete, while results from the culture-based conventional method can take up to 48-72h. Although improvements to the QMAP system are needed for direct respiratory specimens, it may be useful for rapid screening, not only to identify and accurately discriminate MTBC from NTM, but also to identify RIF-resistant MTB strains in positive culture samples.
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Affiliation(s)
- Hye-Young Wang
- Optipharm, Inc., Wonju Eco Environmental Technology Center, Wonju, Gangwon, 26493, Republic of Korea
| | - Young Uh
- Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju, Gangwon, 26426, Republic of Korea.
| | - Seoyong Kim
- Department of Biomedical Laboratory Science, College of Health Sciences, Yonsei University, Wonju, Gangwon, 26493, Republic of Korea
| | - Tae-Sun Shim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, 05535, Republic of Korea
| | - Hyeyoung Lee
- Department of Biomedical Laboratory Science, College of Health Sciences, Yonsei University, Wonju, Gangwon, 26493, Republic of Korea.
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82
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Kim C, Park SH, Oh SY, Kim SS, Jo KW, Shim TS, Kim MY. Comparison of chest CT findings in nontuberculous mycobacterial diseases vs. Mycobacterium tuberculosis lung disease in HIV-negative patients with cavities. PLoS One 2017; 12:e0174240. [PMID: 28346488 PMCID: PMC5367717 DOI: 10.1371/journal.pone.0174240] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 03/06/2017] [Indexed: 11/19/2022] Open
Abstract
Objectives This article focuses on the differences between CT findings of HIV-negative patients who have cavities with nontuberculous mycobacteria (NTM) disease and those with Mycobacterium tuberculosis infections (TB). Methods We retrospectively reviewed 128 NTM disease patients (79 males and 49 females) with cavities in chest CT, matched for age and gender with 128 TB patients in the same period. Sputum cultures of all patients were positive for pathogens. Two independent chest radiologists evaluated the characteristics of the largest cavity and related factors. Results Interobserver agreement was excellent (κ value, 0.853–0.938). Cavity walls in NTM disease were significantly thinner (6.9±4 mm vs 10.9±6 mm, P<0.001) and more even (the ratio of thickness, 2.6±1 vs 3.7±2, P<0.001) than those in TB. The thickening of adjacent pleura next to the cavity was also significantly thicker in NTM than TB (P<0.001). However, in the multivariate analysis, thickening of adjacent pleura was the only significant factor among the representative cavity findings (Odds ratio [OR], 6.49; P<0.001). In addition, ill-defined tree-in-bud nodules (OR, 8.82; P<0.001), number of non-cavitary nodules (≥10mm) (OR, 0.72; P = 0.003), and bronchiectasis in the RUL (OR, 5.3; P = 0.002) were significantly associated ancillary findings with NTM disease in the multivariate analysis. Conclusions The major cavities in NTM disease generally have thinner and more even walls than those in TB. When cavities are associated with adjacent pleural thickening, ill-defined satellite tree-in-bud nodules, or fewer non-cavitary nodules ≥10 mm, these CT findings are highly suggestive of NTM disease rather than TB.
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Affiliation(s)
- Cherry Kim
- Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
- Department of Radiology, Ansan Hospital, Korea University College of Medicine, Danwon-gu, Ansan-si, Gyeonggi, Korea
| | - So Hee Park
- Pulmonary and Critical Care Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Sang Young Oh
- Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sung-Soo Kim
- Department of Healthcare Management, Cheongju University, Cheongju, Korea
| | - Kyung-Wook Jo
- Division of pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Tae Sun Shim
- Division of pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Mi Young Kim
- Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
- * E-mail:
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83
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Alcaide F, Peña MJ, Pérez-Risco D, Camprubi D, Gonzalez-Luquero L, Grijota-Camino MD, Dorca J, Santin M. Increasing isolation of rapidly growing mycobacteria in a low-incidence setting of environmental mycobacteria, 1994-2015. Eur J Clin Microbiol Infect Dis 2017; 36:1425-1432. [PMID: 28321580 DOI: 10.1007/s10096-017-2949-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 02/23/2017] [Indexed: 11/25/2022]
Abstract
To determine trends in incidence and clinical relevance of rapidly growing mycobacteria (RGM) in a low-prevalence region of non-tuberculous mycobacteria. We retrospectively identified all patients with RGM-positive cultures between January 1994 and December 2015. Trends in incidence, clinical significance, and outcomes were assessed. One hundred and forty patients had RGM-positive cultures (116 respiratory and 24 extra-respiratory sources). The incidence of RGM isolates increased steadily from 2003 (0.34 per 100,000) to 2015 (1.73 per 100,000), with an average annual increase of 8.3%. Thirty-two patients (22.9%) had clinical disease, which trended to cluster in the second half of the study period. A positive acid-fast bacilli smear (odds ratio [OR] 97.7, 95 % CI 13.8-689.4), the presence of extra-respiratory isolates (OR 19.4, 95 % CI 5.2-72.7), and female gender (OR 5.9, 95 % CI 1.9-19.1) were independently associated with clinical disease. Cure rates were 73.3 and 87.5% for pulmonary and extra-pulmonary disease respectively. Although the burden of disease remains low, the presence of RGM isolates is increasing in our geographical setting. Whether this rise will be sustained over time and will coincide with an increase in clinical disease, or whether it is merely a cycle in the poorly understood epidemiological behaviour of environmental mycobacteria, will be seen in the near future.
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Affiliation(s)
- F Alcaide
- Service of Microbiology, Bellvitge University Hospital-IDIBELL, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
- University of Barcelona, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - M J Peña
- Service of Microbiology, Bellvitge University Hospital-IDIBELL, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - D Pérez-Risco
- Service of Microbiology, Bellvitge University Hospital-IDIBELL, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - D Camprubi
- Service of Infectious Diseases, Bellvitge University Hospital-IDIBELL, University of Barcelona, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - L Gonzalez-Luquero
- Service of Infectious Diseases, Bellvitge University Hospital-IDIBELL, University of Barcelona, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - M D Grijota-Camino
- Service of Infectious Diseases, Bellvitge University Hospital-IDIBELL, University of Barcelona, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - J Dorca
- Service of Pneumology, Bellvitge University Hospital-IDIBELL, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
- University of Barcelona, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - M Santin
- Service of Infectious Diseases, Bellvitge University Hospital-IDIBELL, University of Barcelona, 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
- University of Barcelona, 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
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Hossain MS, Azad AK, Chowdhury PA, Wakayama M. Computational Identification and Characterization of a Promiscuous T-Cell Epitope on the Extracellular Protein 85B of Mycobacterium spp. for Peptide-Based Subunit Vaccine Design. BIOMED RESEARCH INTERNATIONAL 2017; 2017:4826030. [PMID: 28401156 PMCID: PMC5376426 DOI: 10.1155/2017/4826030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 01/25/2017] [Accepted: 02/26/2017] [Indexed: 12/20/2022]
Abstract
Tuberculosis (TB) is a reemerging disease that remains as a leading cause of morbidity and mortality in humans. To identify and characterize a T-cell epitope suitable for vaccine design, we have utilized the Vaxign server to assess all antigenic proteins of Mycobacterium spp. recorded to date in the Protegen database. We found that the extracellular protein 85B displayed the most robust antigenicity among the proteins identified. Computational tools for identifying T-cell epitopes predicted an epitope, 181-QQFIYAGSLSALLDP-195, that could bind to at least 13 major histocompatibility complexes, revealing the promiscuous nature of the epitope. Molecular docking simulation demonstrated that the epitope could bind to the binding groove of MHC II and MHC I molecules by several hydrogen bonds. Molecular docking analysis further revealed that the epitope had a distinctive binding pattern to all DRB1 and A and B series of MHC molecules and presented almost no polymorphism in its binding site. Moreover, using "Allele Frequency Database," we checked the frequency of HLA alleles in the worldwide population and found a higher frequency of both class I and II HLA alleles in individuals living in TB-endemic regions. Our results indicate that the identified peptide might be a universal candidate to produce an efficient epitope-based vaccine for TB.
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Affiliation(s)
- Md. Saddam Hossain
- Department of Biotechnology, Faculty of Life Sciences, Ritsumeikan University, Kusatsu, Shiga 525-8577, Japan
- Department of Genetic Engineering & Biotechnology, Shahjalal University of Science and Technology, Sylhet 3114, Bangladesh
| | - Abul Kalam Azad
- Department of Genetic Engineering & Biotechnology, Shahjalal University of Science and Technology, Sylhet 3114, Bangladesh
| | | | - Mamoru Wakayama
- Department of Biotechnology, Faculty of Life Sciences, Ritsumeikan University, Kusatsu, Shiga 525-8577, Japan
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85
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Pang Y, Tan Y, Chen J, Li Y, Zheng H, Song Y, Zhao Y. Diversity of nontuberculous mycobacteria in eastern and southern China: a cross-sectional study. Eur Respir J 2017; 49:49/3/1601429. [PMID: 28275172 DOI: 10.1183/13993003.01429-2016] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 11/23/2016] [Indexed: 01/22/2023]
Affiliation(s)
- Yu Pang
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.,These authors contributed equally
| | - Yaoju Tan
- Dept of Clinical Laboratory, Guangzhou Chest Hospital, Guangzhou, China.,These authors contributed equally
| | - Jin Chen
- Dept of Clinical Laboratory, Shanghai Pulmonary Hospital, Shanghai, China.,These authors contributed equally
| | - Yanming Li
- Dept of Respiratory and Critical Care Medicine, Beijing Hospital, Beijing, China.,These authors contributed equally
| | - Huiwen Zheng
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yuanyuan Song
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yanlin Zhao
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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86
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Nontuberculous Mycobacteria in Saudi Arabia and Gulf Countries: A Review. Can Respir J 2017; 2017:5035932. [PMID: 28348502 PMCID: PMC5350348 DOI: 10.1155/2017/5035932] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 01/05/2017] [Accepted: 02/01/2017] [Indexed: 01/15/2023] Open
Abstract
Nontuberculous Mycobacteria (NTM) are causing growing health problems worldwide. This is indicated by an increasing amount of scientific reports showing not only well-identified species reemerging but also emergence of new species. The emergence and reemergence of NTM are particularly worrying in developing countries due to scarce published data and improper identification. Here we aimed to examine the main epidemiological aspects and diagnostic challenges associated with NTM in countries of the Gulf Cooperation Council (GCC) and compare these findings to the international arena findings. Data revealed that countries of the GCC are largely dominated by rapidly growing mycobacteria species such as M. fortuitum (29%) and M. abscessus (17%) with high rate of definitive respiratory diseases. On the other hand, most of the developed countries are dominated by slowly growing mycobacteria such as MAC, M. kansasii, and M. gordonae. More efforts are needed, however, to gain insights into NTM issues in countries of the GCC.
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87
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Maselli DJ, Amalakuhan B, Keyt H, Diaz AA. Suspecting non-cystic fibrosis bronchiectasis: What the busy primary care clinician needs to know. Int J Clin Pract 2017; 71:e12924. [PMID: 28238229 PMCID: PMC5396137 DOI: 10.1111/ijcp.12924] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 11/28/2016] [Indexed: 12/30/2022] Open
Abstract
AIMS Non-cystic fibrosis bronchiectasis (NCFB) is a chronic, progressive respiratory disorder characterised by irreversibly and abnormally dilated airways, persistent cough, excessive sputum production and recurrent pulmonary infections. In the last several decades, its prevalence has increased, making it likely to be encountered in the primary care setting. The aim was to review the clinical presentation and diagnosis of NCFB, with an emphasis on the role of computed tomography (CT). METHODS For this review, trials and reports were identified from PubMed/Medline and ClinicalTrials.gov from the US NIH and the Cochrane Register of Controlled Trials. The search used keywords: bronchiectasis, non-cystic fibrosis bronchiectasis, chronic pulmonary infection and computed tomography. No date/language restrictions were used. RESULTS Non-cystic fibrosis bronchiectasis often coexists with other respiratory conditions, such as chronic obstructive pulmonary disease. The prevalence of NCFB is increasing, particularly in women and older individuals, possibly as a result of increased physician awareness and widespread use of CT, which is the gold standard for the diagnosis of NCFB. CT can assist in identifying an underlying cause of NCFB and determining the extent and severity of the disease. DISCUSSION Non-cystic fibrosis bronchiectasis should be suspected in the primary care setting in patients with chronic cough, purulent sputum and frequent respiratory infections that tend to resolve slowly or partially. Early diagnosis and determination of the extent and severity of the disease by CT and other tests are critical to establish therapy to improve quality of life and potentially slow progressive decline of lung function in patients with NCFB.
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Affiliation(s)
- Diego J. Maselli
- Division of Pulmonary Diseases & Critical CareUniversity of Texas Health Science CenterSan AntonioTXUSA
| | - Bravein Amalakuhan
- Division of Pulmonary Diseases & Critical CareUniversity of Texas Health Science CenterSan AntonioTXUSA
| | - Holly Keyt
- Division of Pulmonary Diseases & Critical CareUniversity of Texas Health Science CenterSan AntonioTXUSA
| | - Alejandro A. Diaz
- Division of Pulmonary and Critical Care MedicineBrigham and Women's HospitalHarvard Medical SchoolBostonMAUSA
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88
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Olesen JS, Wang M, Wejse C. Mycobacterium chelonae hand infection after steroid injection in a patient with rheumatoid arthritis receiving long-term linezolid therapy. BMJ Case Rep 2017; 2017:bcr2016217257. [PMID: 28137898 PMCID: PMC5293961 DOI: 10.1136/bcr-2016-217257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2017] [Indexed: 01/19/2023] Open
Abstract
A 66-year-old multimorbid man with rheumatoid arthritis developed an infection after a steroid injection in the hand. Mycobacterium chelonae was cultured 1-month after presentation. In the mean time, his third finger had been amputated. Further treatment was based on preliminary susceptibility testing and the American Thoracic Society guidelines. No regression of the infection was observed before the addition of linezolid (600 mg×1/day) to a combination antimicrobial therapy also consisting of clarithromycin (500 mg×2/day) and moxifloxacin (400 mg×1/day), even though two methods of susceptibility testing, the E-test and broth microdilution, had shown susceptibility to other antimicrobial drugs. The healing was complete 12 months after presentation. There were no serious side effects observed with the use of linezolid in reduced dosage of 600 mg×1/day for a duration of 9 months.
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Affiliation(s)
- Jens Steen Olesen
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus N, Denmark
| | - Mikala Wang
- Department of Microbiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Christian Wejse
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus N, Denmark
- Department of Public Health, Center for Global Health, Aarhus University, Aarhus, Denmark
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89
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Collantes J, Solari FB, Rigouts L. Rapid Detection of Mycobacterium tuberculosis Strains Resistant to Isoniazid and/or Rifampicin: Standardization of Multiplex Polymerase Chain Reaction Analysis. Am J Trop Med Hyg 2016; 95:1257-1264. [DOI: 10.4269/ajtmh.16-0120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 08/25/2016] [Indexed: 11/07/2022] Open
Affiliation(s)
- Jimena Collantes
- Instituto de Medicina Tropical Alexander von Humboldt, Lima, Peru
- Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Francesca Barletta Solari
- Universidad Peruana Cayetano Heredia, Lima, Peru
- Instituto de Medicina Tropical Alexander von Humboldt, Lima, Peru
| | - Leen Rigouts
- University of Antwerp, Belgium
- Institute of Tropical Medicine, Antwerp, Belgium
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90
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Non-tuberculous mycobacteria: epidemiological pattern in a reference laboratory and risk factors associated with pulmonary disease. Epidemiol Infect 2016; 145:515-522. [PMID: 27804902 DOI: 10.1017/s0950268816002521] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
The diseases caused by non-tuberculous mycobacteria (NTM), in both AIDS and non-AIDS populations, are increasingly recognized worldwide. Although the American Thoracic Society published the guidelines for diagnosis of NTM pulmonary disease (NTM-PD), the diagnosis is still difficult. In the first part of the study, we collected data on NTM isolates in the Mycobacteriology Laboratory of Careggi Hospital (Florence, Italy) and analysed the epidemiological data of NTM isolates. Then, to analyse the risk factors associated to NTM-PD, we studied the presence of ATS/IDSA criteria for NTM-PD in patients who had at least one positive respiratory sample for NTM and were admitted to the Infectious Disease Unit and the Section of Respiratory Medicine. We selected 88 patients with available full clinical data and, according to ATS/IDSA criteria, classified 15 patients (17%) as NTM-PD cases and 73 as colonized patients (83%). When comparing colonized and NTM-PD patients we did not find significant differences of age, gender and comorbidity. We observed that Mycobacterium avium and M. intracellulare were statistically associated with NTM-PD (P = 0·001) whereas M. xenopi was statistically associated with colonization. Although the number of studied patients is limited, our study did not identify risk factors for NTM-PD that could help clinicians to discriminate between colonization and disease. We underline the need of close monitoring of NTM-infected patients until the diagnosis is reasonably excluded. Further larger prospective studies and new biological markers are needed to identify new useful tools for the diagnosis of NTM-PD.
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91
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Yu X, Liu P, Liu G, Zhao L, Hu Y, Wei G, Luo J, Huang H. The prevalence of non-tuberculous mycobacterial infections in mainland China: Systematic review and meta-analysis. J Infect 2016; 73:558-567. [PMID: 27717784 DOI: 10.1016/j.jinf.2016.08.020] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 04/27/2016] [Accepted: 08/29/2016] [Indexed: 11/17/2022]
Abstract
Despite increasing attention towards the non-tuberculous mycobacterial (NTM) diseases, the overall epidemiological information remains unavailable for China. A systematic review and meta-analysis was conducted using data of 105 qualified publications from Chinese mainland. The assay demonstrated that the prevalence of NTM infections among tuberculosis suspects was 6.3% (5.4%-7.4%) in mainland, while the Southeastern region had the highest NTM prevalence at 8.6% (7.1%-10.5%). In Northern China, slow growing mycobacteria (SGM) consistituted 63.7% of all the NTM isolates, while this rate in Southern China was 53.0%. More rapid growing mycobacteria (RGM) were present in southern China than the northern (χ2 = 57.996, P < 0.001). According to the coastal provinces' data (from north to south), the NTM prevalence rate and the number of isolated NTM species increased apparently in accordance with geographic latitude. The information obtained in this assay will facilitate the NTM disease diagnosis and screening policy making in China.
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Affiliation(s)
- Xia Yu
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug-resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China
| | - Pengnian Liu
- Medical Library of Chinese People's Liberation Army, 59th, Middle Section West 4th Ring, Beijing, 100039, China
| | - Guan Liu
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug-resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China
| | - Liping Zhao
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug-resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China
| | - Yanjie Hu
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug-resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China
| | - Guomei Wei
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug-resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China
| | - Jingjing Luo
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug-resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China
| | - Hairong Huang
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug-resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China.
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92
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Máiz L, Girón R, Olveira C, Vendrell M, Nieto R, Martínez-García MA. Prevalence and factors associated with nontuberculous mycobacteria in non-cystic fibrosis bronchiectasis: a multicenter observational study. BMC Infect Dis 2016; 16:437. [PMID: 27549788 PMCID: PMC4994165 DOI: 10.1186/s12879-016-1774-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 08/10/2016] [Indexed: 11/10/2022] Open
Abstract
Background Data on the prevalence of and factors associated with nontuberculous mycobacteria (NTM) in patients with non–cystic fibrosis (CF) bronchiectasis are limited. Our aim was to determine the prevalence and factors associated with isolation of NTM in this population. Methods We performed a multicenter observational study of historical cohorts comprising consecutive patients with non-CF bronchiectasis and at least 2 sputum samples cultured for mycobacteria over a period of 5 years. Results The study population included 218 adult patients (61.9 % women) with a mean (SD) age of 55.7 (16) years and a mean (SD) of 5.1 (3.3) cultures/patient. NTM was isolated from sputum in 18 patients (8.3 %). Of these, 5 patients (28 %) met the American Thoracic Society criteria for NTM disease. Mycobacterium avium complex was the most frequently isolated microorganism (9 patients, 4.1 %). The variables independently associated with isolation of NTM were FVC ≥ 75 % predicted (OR, 4.84; 95 % CI 1.47 to 15.9; p < 0.05), age ≥ 50 years (OR, 4.74; 95 % CI 1.25 to 17.97; p < 0.05), and body mass index (BMI) ≤ 23 kg/m2 (OR, 2.97; 95 % CI 1.03-8.58; p < 0.05). Patients with these three characteristics had a 40 % probability of having at least one isolation of NMT. Conclusions A significant number of patients with non-CF bronchiectasis are positive for the isolation of NTM. M. avium complex is the most frequently isolated mycobacteria. FVC ≥ 75 % predicted, age ≥ 50 years, and a BMI ≤ 23 kg/m2 were independently associated with the presence of NTM in patients with non-CF bronchiectasis.
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Affiliation(s)
- L Máiz
- Pneumology Service, Chronic Bronchial Infection, Cystic Fibrosis and Bronchiectasis Unit, Hospital Universitario Ramón y Cajal, Carretera de Colmenar Km 9,100, 28034, Madrid, Spain.
| | - R Girón
- Pneumology Service, Hospital La Princesa, Institute for Health Research (IP), Hospital Universitario de La Princesa, Madrid, Spain
| | - C Olveira
- Pneumology Service, Hospital Universitario Regional de Málaga, Instituto de Biomedicina de Málaga (IBIMA), Málaga University, Málaga, Spain
| | - M Vendrell
- Bronchiectasis Group (Girona Biomedical Research Institute) IDIBGI, Dr Trueta University Hospital, Girona, Spain; CIBER de Enfermedades Respiratorias (Ciberes CB06/06/0030), Instituto de Salud Carlos III, Madrid, Spain
| | - R Nieto
- Pneumology Service, Chronic Bronchial Infection, Cystic Fibrosis and Bronchiectasis Unit, Hospital Universitario Ramón y Cajal, Carretera de Colmenar Km 9,100, 28034, Madrid, Spain
| | - M A Martínez-García
- Pneumology Service, Hospital Universitario y Politécnico La Fe, CIBERes, CIBER de Enfermedades Respiratorias, Valencia, Spain
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93
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Culture-Independent Detection of Nontuberculous Mycobacteria in Clinical Respiratory Samples. J Clin Microbiol 2016; 54:2395-8. [PMID: 27413194 DOI: 10.1128/jcm.01410-16] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 07/06/2016] [Indexed: 11/20/2022] Open
Abstract
Culture-based detection of nontuberculous Mycobacteria (NTM) in respiratory samples is time consuming and can be subject to overgrowth by nonmycobacterial bacteria. We describe a single-reaction TaqMan quantitative PCR assay for the direct detection of NTM species in clinical samples that is specific, sensitive, and robust.
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94
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Okano Y, Shinohara T, Imanishi S, Takahashi N, Naito N, Taoka T, Kadota N, Ogushi F. Miliary pulmonary nodules due to Mycobacterium xenopi in a steroid-induced immunocompromised patient successfully treated with chemotherapy: a case report. BMC Pulm Med 2016; 16:92. [PMID: 27287608 PMCID: PMC4902965 DOI: 10.1186/s12890-016-0252-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 06/01/2016] [Indexed: 11/13/2022] Open
Abstract
Background Mycobacterium xenopi-infected patients have a high prevalence of pulmonary cavities and nodules. However, the clinical course for patients with miliary nodules due to M. xenopi has not yet been reported. Case presentation We encountered a case of miliary nodules with gradually worsening coughing and sputum production in a 44-year-old male who had renal dysfunction due to glomerulosclerosis with a decade-long history of steroid therapy. Although we started anti-tuberculosis treatment on clinical suspicion of miliary tuberculosis, cultures of sputum and bronchial lavage were both positive for M. xenopi. The patient was successfully treated with rifampin, ethambutol and clarithromycin, without fibrosis. It was unclear whether the miliary pattern was induced by hematogenous or endobronchial spread of the M. xenopi infection. Conclusion Even when clinical and radiological disease manifestations are similar to those of miliary tuberculosis, M. xenopi infection should be considered in the differential diagnosis of miliary nodules.
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Affiliation(s)
- Yoshio Okano
- Division of Pulmonary Medicine, National Hospital Organization Kochi Hospital, 1-2-25 Asakuranishimachi, Kochi, 780-8077, Japan
| | - Tsutomu Shinohara
- Department of Clinical Investigation, National Hospital Organization Kochi Hospital, 1-2-25 Asakuranishimachi, Kochi, 780-8077, Japan.
| | - Shino Imanishi
- Division of Pulmonary Medicine, National Hospital Organization Kochi Hospital, 1-2-25 Asakuranishimachi, Kochi, 780-8077, Japan
| | - Naoki Takahashi
- Division of Pulmonary Medicine, National Hospital Organization Kochi Hospital, 1-2-25 Asakuranishimachi, Kochi, 780-8077, Japan
| | - Nobuhito Naito
- Division of Pulmonary Medicine, National Hospital Organization Kochi Hospital, 1-2-25 Asakuranishimachi, Kochi, 780-8077, Japan
| | - Takanari Taoka
- Division of Pulmonary Medicine, National Hospital Organization Kochi Hospital, 1-2-25 Asakuranishimachi, Kochi, 780-8077, Japan
| | - Naoki Kadota
- Division of Pulmonary Medicine, National Hospital Organization Kochi Hospital, 1-2-25 Asakuranishimachi, Kochi, 780-8077, Japan
| | - Fumitaka Ogushi
- Division of Pulmonary Medicine, National Hospital Organization Kochi Hospital, 1-2-25 Asakuranishimachi, Kochi, 780-8077, Japan
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95
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Dupont C, Viljoen A, Dubar F, Blaise M, Bernut A, Pawlik A, Bouchier C, Brosch R, Guérardel Y, Lelièvre J, Ballell L, Herrmann JL, Biot C, Kremer L. A new piperidinol derivative targeting mycolic acid transport inMycobacterium abscessus. Mol Microbiol 2016; 101:515-29. [DOI: 10.1111/mmi.13406] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2016] [Indexed: 01/24/2023]
Affiliation(s)
- Christian Dupont
- Centre National de la Recherche Scientifique FRE 3689, Centre d’études d'agents Pathogènes et Biotechnologies pour la Santé, Université de Montpellier; 1919 route de Mende Montpellier 34293 France
- UMR1173, INSERM, Université de Versailles St Quentin; 2 avenue de la Source de la Bièvre 78180 Montigny le Bretonneux France
| | - Albertus Viljoen
- Centre National de la Recherche Scientifique FRE 3689, Centre d’études d'agents Pathogènes et Biotechnologies pour la Santé, Université de Montpellier; 1919 route de Mende Montpellier 34293 France
| | - Faustine Dubar
- Université Lille, CNRS, UMR 8576 - UGSF - Unité de Glycobiologie Structurale et Fonctionnelle; Lille F 59000 France
| | - Mickaël Blaise
- Centre National de la Recherche Scientifique FRE 3689, Centre d’études d'agents Pathogènes et Biotechnologies pour la Santé, Université de Montpellier; 1919 route de Mende Montpellier 34293 France
| | - Audrey Bernut
- Centre National de la Recherche Scientifique FRE 3689, Centre d’études d'agents Pathogènes et Biotechnologies pour la Santé, Université de Montpellier; 1919 route de Mende Montpellier 34293 France
| | - Alexandre Pawlik
- Institut Pasteur, Unité de Pathogénomique Mycobactérienne Intégrée; 25 rue du Dr. Roux Paris 75724 France
| | | | - Roland Brosch
- Institut Pasteur, Unité de Pathogénomique Mycobactérienne Intégrée; 25 rue du Dr. Roux Paris 75724 France
| | - Yann Guérardel
- Université Lille, CNRS, UMR 8576 - UGSF - Unité de Glycobiologie Structurale et Fonctionnelle; Lille F 59000 France
| | - Joël Lelièvre
- Diseases of the Developing World, GlaxoSmithKline Tres Cantos; Madrid 28760 Spain
| | - Lluis Ballell
- Diseases of the Developing World, GlaxoSmithKline Tres Cantos; Madrid 28760 Spain
| | - Jean-Louis Herrmann
- UMR1173, INSERM, Université de Versailles St Quentin; 2 avenue de la Source de la Bièvre 78180 Montigny le Bretonneux France
| | - Christophe Biot
- Université Lille, CNRS, UMR 8576 - UGSF - Unité de Glycobiologie Structurale et Fonctionnelle; Lille F 59000 France
| | - Laurent Kremer
- Centre National de la Recherche Scientifique FRE 3689, Centre d’études d'agents Pathogènes et Biotechnologies pour la Santé, Université de Montpellier; 1919 route de Mende Montpellier 34293 France
- INSERM, CPBS; Montpellier 34293 France
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96
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Wassilew N, Hoffmann H, Andrejak C, Lange C. Pulmonary Disease Caused by Non-Tuberculous Mycobacteria. Respiration 2016; 91:386-402. [PMID: 27207809 DOI: 10.1159/000445906] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 03/31/2016] [Indexed: 11/19/2022] Open
Abstract
Non-tuberculous mycobacteria (NTM) include more than 160 ubiquitous, environmental, acid-fast-staining bacterial species, some of which may cause disease in humans. Chronic pulmonary infection is the most common clinical manifestation. Although patients suffering from chronic lung diseases are particularly susceptible to NTM pulmonary disease, many affected patients have no apparent risk factors. Host and pathogen factors leading to NTM pulmonary disease are not well understood and preventive therapies are lacking. NTM isolation and pulmonary disease are reported to rise in frequency in Europe as well as in other parts of the world. Differentiation between contamination, infection, and disease remains challenging. Treatment of NTM pulmonary disease is arduous, lengthy, and costly. Correlations between results of in vitro antibiotic susceptibility testing and clinical treatment outcomes are only evident for the Mycobacterium avium complex, M. kansasii, and some rapidly growing mycobacteria. We describe the epidemiology of NTM pulmonary disease as well as emerging NTM pathogens and their geographical distribution in non-cystic fibrosis patients in Europe. We also review recent innovations for the diagnosis of NTM pulmonary disease, summarize treatment recommendations, and identify future research priorities to improve the management of patients affected by NTM pulmonary disease.
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Affiliation(s)
- Nasstasja Wassilew
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany
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97
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Jarand J, Davis JP, Cowie RL, Field SK, Fisher DA. Long-term Follow-up of Mycobacterium avium Complex Lung Disease in Patients Treated With Regimens Including Clofazimine and/or Rifampin. Chest 2016; 149:1285-93. [DOI: 10.1378/chest.15-0543] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 10/07/2015] [Accepted: 10/09/2015] [Indexed: 01/15/2023] Open
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98
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Chien JY, Lai CC, Sheng WH, Yu CJ, Hsueh PR. Pulmonary infection and colonization with nontuberculous mycobacteria, Taiwan, 2000-2012. Emerg Infect Dis 2016; 20:1382-5. [PMID: 25062534 PMCID: PMC4111185 DOI: 10.3201/eid2008.131673] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
We analyzed samples from 13,652 patients who had respiratory cultures positive for mycobacteria in Taiwan during 2000–2012 and found that 56.9% were positive for nontuberculous mycobacteria (NTM). Whereas annual prevalence of tuberculosis decreased during the study period, prevalence of NTM disease and colonization increased, particularly among older patients and male patients.
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99
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Yeung MW, Khoo E, Brode SK, Jamieson FB, Kamiya H, Kwong JC, Macdonald L, Marras TK, Morimoto K, Sander B. Health-related quality of life, comorbidities and mortality in pulmonary nontuberculous mycobacterial infections: A systematic review. Respirology 2016; 21:1015-25. [PMID: 27009804 DOI: 10.1111/resp.12767] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 01/25/2016] [Accepted: 01/30/2016] [Indexed: 11/28/2022]
Abstract
Nontuberculous mycobacterial (NTM) infections are increasing in disease frequency worldwide. This systematic review examines health-related quality of life (HRQOL), comorbidities and mortality associated with pulmonary NTM disease. We searched MEDLINE, EMBASE, CINAHL, Scopus Life Sciences, conference proceedings and Google (earliest date available to February 2015) for primary studies. Eligible studies compared populations with and without pulmonary NTM disease in high-income jurisdictions. We excluded studies on HIV/AIDS. All languages were accepted. Two reviewers followed MOOSE and PRISMA reporting guidelines and independently appraised quality using STROBE. All studies were summarized qualitatively regardless of quality. Of 3193 citations screened, we included 17 studies mostly from Taiwan (n = 5) and the USA (n = 4). Two studies assessed HRQOL; one assessed comorbidities, 11 assessed mortality, and three assessed multiple outcomes. Populations with pulmonary NTM reported significantly worse or similar HRQOL than the general population, depending on the instruments used. Some suggested greater prevalence of having bronchiectasis (n = 2) and greater risk of developing pulmonary tuberculosis (n = 1). Most (n = 7) suggested no difference in mortality, although only one was age-matched and gender-matched to the general population. Four suggested NTM populations had higher mortality-two of which compared with the general population and were deemed of high quality, while two compared with non-NTM patients from hospital. High clinical heterogeneity in study design may explain discordant results. Bias assessments and controlling for confounding were carried out poorly. No consistent trends were observed although there is suggestion of an increased health burden from respiratory diseases and increased mortality associated with pulmonary NTM disease.
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Affiliation(s)
| | - Edwin Khoo
- Public Health Ontario, Toronto, Ontario, Canada
| | - Sarah K Brode
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,West Park Healthcare Centre, Toronto, Ontario, Canada.,University Health Network and Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Frances B Jamieson
- Public Health Ontario, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Hiroyuki Kamiya
- Respiratory Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Jeffrey C Kwong
- Public Health Ontario, Toronto, Ontario, Canada.,University Health Network and Mount Sinai Hospital, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Liane Macdonald
- Public Health Ontario, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Theodore K Marras
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,University Health Network and Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Kozo Morimoto
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - Beate Sander
- Public Health Ontario, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation at the University of Toronto, Toronto, Ontario, Canada.,Toronto Health Economics and Technology Assessment (THETA) collaborative, Toronto, Ontario, Canada
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100
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Falkinham JO, Williams MD, Kwait R, Lande L. Methylobacterium spp. as an indicator for the presence or absence of Mycobacterium spp. Int J Mycobacteriol 2016; 5:240-3. [PMID: 27242240 DOI: 10.1016/j.ijmyco.2016.03.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 03/05/2016] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE/BACKGROUND A published survey of bacteria in showerhead biofilm samples revealed that Methylobacterium spp. and Mycobacterium spp. seldom coexisted in biofilms. METHODS To confirm that information, biofilm samples were collected from household plumbing of Mycobacterium avium patients and Methylobacterium spp. and M. avium numbers were measured by direct colony counts. RESULTS The results demonstrated that if Methylobacterium spp. were present, Mycobacterium spp. were absent, and the opposite. CONCLUSION The data demonstrate that microbial populations in biofilms can influence the presence or absence of opportunistic premise plumbing pathogens and, thereby, increase the range of strategies to reduce exposure to waterborne pathogens. Finally, by assessing for the visual presence of methylobacteria as pink pigmentation on showers and shower curtains, homeowners and managers of hospitals and other buildings can quickly determine whether a premise plumbing biofilm sample has mycobacteria with a high degree of assurance.
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Affiliation(s)
| | - Myra D Williams
- Department of Biological Sciences, Virginia Tech, Blacksburg, VA, USA
| | - Rebecca Kwait
- Division of Pulmonary and Critical Care Medicine, Lankenau Medical Center, Lankenau Institute for Medical Research, Wynnewood, PA, USA
| | - Leah Lande
- Division of Pulmonary and Critical Care Medicine, Lankenau Medical Center, Lankenau Institute for Medical Research, Wynnewood, PA, USA
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