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Park J, Kim D, Son YJ, Ciufolini MA, Clovis S, Han M, Kim LH, Shin SJ, Hwang HJ. Chemical optimization and derivatization of micrococcin p2 to target multiple bacterial infections: new antibiotics from thiopeptides. World J Microbiol Biotechnol 2024; 40:307. [PMID: 39162916 DOI: 10.1007/s11274-024-04109-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Accepted: 08/09/2024] [Indexed: 08/21/2024]
Abstract
Antimicrobial resistance poses a significant threat to humanity, and the development of new antibiotics is urgently needed. Our research has focused on thiopeptide antibiotics such as micrococcin P2 (MP2) and derivatives thereof as new anti-infective agents. Thiopeptides are sulfur-rich, structurally complex substances that exhibit potent activity against Gram-positive pathogens and Mycobacteria species, including clinically resistant strains. The clinical development of thiopeptides has been hampered by the lack of efficient synthetic platforms to conduct detailed structure-activity relationship studies of these natural products. The present contribution touches upon efficient synthetic routes to MP2 that laid the groundwork for clinical translation. The medicinal chemistry campaign on MP2 has been guided by computational molecular dynamic simulations and parallel investigations to improve drug-like properties, such as enhancing the aqueous solubility and optimizing antibacterial activity. Such endeavors have enabled identification of promising lead compounds, AJ-037 and AJ-206, against Mycobacterium avium complex (MAC). Extensive in vitro studies revealed that these compounds exert potent activity against MAC species, a subspecies of non-tuberculous mycobacteria (NTM) that proliferate inside macrophages. Two additional pre-clinical candidates have been identified: AJ-024, for the treatment of Clostridioides difficile infections, and AJ-147, for methicillin-resistant Staphylococcus aureus impetigo. Both compounds compare quite favorably with current first-line treatments. In particular, the ability of AJ-147 to downregulate pro-inflammatory cytokines adds a valuable dimension to its clinical use. In light of above, these new thiopeptide derivatives are well-poised for further clinical development.
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Affiliation(s)
- Jiyun Park
- Department of Microbiology, Institute for Immunology and Immunological Disease, Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - Dahyun Kim
- A&J Science Co., Ltd, 80 Chumbok Ro, Dong Gu, Daegu, 41061, Republic of Korea
| | - Young-Jin Son
- A&J Science Co., Ltd, 80 Chumbok Ro, Dong Gu, Daegu, 41061, Republic of Korea
| | - Marco A Ciufolini
- Department of Chemistry, University of British Columbia, 2036 Main Mall, Vancouver, BC, V6K 1Z1, Canada
| | - Shyaka Clovis
- A&J Science Co., Ltd, 80 Chumbok Ro, Dong Gu, Daegu, 41061, Republic of Korea
| | - Minwoo Han
- New Drug Development Center, Daegu Gyeongbuk Medical Innovation Foundation (K-MEDI hub), 80 Chumbok Ro, Dong Gu, Daegu, 41061, Republic of Korea
| | - Lee-Han Kim
- Department of Microbiology, Institute for Immunology and Immunological Disease, Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - Sung Jae Shin
- Department of Microbiology, Institute for Immunology and Immunological Disease, Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea.
| | - Hee-Jong Hwang
- A&J Science Co., Ltd, 80 Chumbok Ro, Dong Gu, Daegu, 41061, Republic of Korea.
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Wang P, Yang GL, He YF, Shen YH, Hao XH, Liu HP, Shen HB, Wang L, Sha W. Single-cell transcriptomics of blood identified IFIT1 + neutrophil subcluster expansion in NTM-PD patients. Int Immunopharmacol 2024; 137:112412. [PMID: 38901242 DOI: 10.1016/j.intimp.2024.112412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 05/18/2024] [Accepted: 06/02/2024] [Indexed: 06/22/2024]
Abstract
OBJECTIVE Non-tuberculous mycobacterial pulmonary disease (NTM-PD) is caused by an imbalance between pathogens and impaired host immune responses. Mycobacterium avium complex (MAC) and Mycobacterium abscessus (MAB) are the two major pathogens that cause NTM-PD. In this study, we sought to dissect the transcriptomes of peripheral blood immune cells at the single-cell resolution in NTM-PD patients and explore potential clinical markers for NTM-PD diagnosis and treatment. METHODS Peripheral blood samples were collected from six NTM-PD patients, including three MAB-PD patients, three MAC-PD patients, and two healthy controls. We employed single-cell RNA sequencing (scRNA-seq) to define the transcriptomic landscape at a single-cell resolution. A comprehensive scRNA-seq analysis was performed, and flow cytometry was conducted to validate the results of scRNA-seq. RESULTS A total of 27,898 cells were analyzed. Nine T-cells, six mononuclear phagocytes (MPs), and four neutrophil subclusters were defined. During NTM infection, naïve T-cells were reduced, and effector T-cells increased. High cytotoxic activities were shown in T-cells of NTM-PD patients. The proportion of inflammatory and activated MPs subclusters was enriched in NTM-PD patients. Among neutrophil subclusters, an IFIT1+ neutrophil subcluster was expanded in NTM-PD compared to healthy controls. This suggests that IFIT1+ neutrophil subcluster might play an important role in host defense against NTM. Functional enrichment analysis of this subcluster suggested that it is related to interferon response. Cell-cell interaction analysis revealed enhanced CXCL8-CXCR1/2 interactions between the IFIT1+ neutrophil subcluster and NK cells, NKT cells, classical mononuclear phagocytes subcluster 1 (classical Mo1), classical mononuclear phagocytes subcluster 2 (classical Mo2) in NTM-PD patients compared to healthy controls. CONCLUSIONS Our data revealed disease-specific immune cell subclusters and provided potential new targets of NTM-PD. Specific expansion of IFIT1+ neutrophil subclusters and the CXCL8-CXCR1/2 axis may be involved in the pathogenesis of NTM-PD. These insights may have implications for the diagnosis and treatment of NTM-PD.
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Affiliation(s)
- Peng Wang
- Department of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China; Clinic and Research Center of Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200433, China
| | - Guo-Ling Yang
- Department of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China; Clinic and Research Center of Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200433, China
| | - Yi-Fan He
- Department of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China; Clinic and Research Center of Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200433, China
| | - Yan-Heng Shen
- Department of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China; Clinic and Research Center of Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200433, China
| | - Xiao-Hui Hao
- Department of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China; Clinic and Research Center of Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200433, China
| | - Hai-Peng Liu
- Clinical Translation Research Center, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Hong-Bo Shen
- Clinic and Research Center of Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200433, China
| | - Li Wang
- Department of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China; Clinic and Research Center of Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200433, China.
| | - Wei Sha
- Department of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China; Clinic and Research Center of Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200433, China; Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China.
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Campbell AM, Willis K, Parsons E. Forecasting climate-associated non-tuberculous mycobacteria (NTM) infections in the UK using international surveillance data and machine learning. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003262. [PMID: 39159199 PMCID: PMC11332936 DOI: 10.1371/journal.pgph.0003262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 07/17/2024] [Indexed: 08/21/2024]
Abstract
Nontuberculous mycobacteria (NTM) cause skin and lung infections, have high mortality rates, and are resistant to a range of antibiotics and water treatment methods. As NTM reside in environmental reservoirs, they are sensitive to environmental conditions. The suitability of their environmental reservoirs can increase as a result of climate change, subsequently increasing environmental exposure and infection rates. NTM infections are not generally notifiable, including in the UK, but sustained increases have been observed in regions that report NTM infection rates. To assess the burden of NTM infections in the UK under projected climate change, we examined the relationship between climate variables and available NTM surveillance data internationally. Statistically significant increases were found in regions where NTM infections are notifiable, which were positively associated with increased precipitation and temperatures. A random forest regressor was trained using supervised learning from international NTM surveillance data and linked climate variables. The random forest model was applied to UK climate projections, projecting a 6.2% increase in NTM infection rates over the next 10 years, with notable regional variation. Our random forest model predicts that the forecasted impacts of climate change in the UK, including increasing temperatures and frequency of heavy rainfall, will lead to increases in NTM infection rates. Robust surveillance in the future is necessary to increase data available to train models, increasing our predictive power in forecasting climate-associated NTM trends. Our results highlight a novel aspect of how climate change will impact health outcomes in the UK.
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Affiliation(s)
- Amy Marie Campbell
- Global Assessment and Emerging Hazards Division, UK Health Security Agency, London, United Kingdom
| | - Katy Willis
- Global Assessment and Emerging Hazards Division, UK Health Security Agency, London, United Kingdom
| | - Edward Parsons
- Global Assessment and Emerging Hazards Division, UK Health Security Agency, London, United Kingdom
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Deshpande D, Magombedze G, Boorgula GD, Chapagain M, Srivastava S, Gumbo T. Ceftriaxone Efficacy for Mycobacterium avium Complex Lung Disease in the Hollow Fiber and Translation to Sustained Sputum Culture Conversion in Patients. J Infect Dis 2024; 230:e230-e240. [PMID: 38036299 PMCID: PMC11326821 DOI: 10.1093/infdis/jiad545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/17/2023] [Accepted: 11/28/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Only 35.6%-50.8% of patients with Mycobacterium avium complex (MAC) pulmonary disease achieve sustained sputum culture conversion (SSCC) on treatment with the azithromycin-ethambutol-rifabutin standard of care (SOC). We tested the efficacy of ceftriaxone, a β-lactam with a lung-to-serum penetration ratio of 12.18-fold. METHODS We mimicked lung concentration-time profiles of 7 ceftriaxone once-daily doses for 28 days in the hollow fiber system model of intracellular MAC (HFS-MAC). Monte Carlo experiments were used for dose selection. We also compared once-daily ceftriaxone monotherapy to 3-drug SOC against 5 MAC clinical isolates in HFS-MAC using γ (kill) slopes, and translated to SSCC rates. RESULTS Ceftriaxone killed 1.02-3.82 log10 colony-forming units (CFU)/mL, at optimal dose of 2 g once-daily. Ceftriaxone killed all 5 strains below day 0 versus 2 of 5 for SOC. The median γ (95% confidence interval [CI]) was 0.49 (.47-.52) log10 CFU/mL/day for ceftriaxone and 0.38 (.34-.43) log10 CFU/mL/day for SOC. In patients, the SOC was predicted to achieve SSCC rates (CI) of 39.3% (36%-42%) at 6 months. The SOC SSCC was 50% at 8.18 (3.64-27.66) months versus 3.58 (2.20-7.23) months for ceftriaxone, shortening time to SSCC 2.35-fold. CONCLUSIONS Ceftriaxone is a promising agent for creation of short-course chemotherapy.
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Affiliation(s)
| | | | | | - Moti Chapagain
- Department of Cellular and Molecular Biology, School of Medicine, University of Texas Health Science Center at Tyler
| | - Shashikant Srivastava
- Baylor University Medical Center, Dallas
- Department of Medicine, School of Medicine, University of Texas at Tyler
- Department of Cellular and Molecular Biology, School of Medicine, University of Texas Health Science Center at Tyler
| | - Tawanda Gumbo
- Mathematical Modeling and AI Department, Praedicare Inc, Dallas
- Hollow Fiber System and Experimental Therapeutics Laboratories, Praedicare Inc, Dallas, Texas
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Park Y, Hong JW, Ahn E, Gee HY, Kang YA. PARK2 as a susceptibility factor for nontuberculous mycobacterial pulmonary disease. Respir Res 2024; 25:310. [PMID: 39143598 PMCID: PMC11325611 DOI: 10.1186/s12931-024-02946-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 08/07/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND The genetic signatures associated with the susceptibility to nontuberculous mycobacterial pulmonary disease (NTM-PD) are still unknown. In this study, we performed RNA sequencing to explore gene expression profiles and represent characteristic factor in NTM-PD. METHODS Peripheral blood samples were collected from patients with NTM-PD and healthy individuals (controls). Differentially expressed genes (DEGs) were identified by RNA sequencing and subjected to functional enrichment and immune cell deconvolution analyses. RESULTS We enrolled 48 participants, including 26 patients with NTM-PD (median age, 58.0 years; 84.6% female), and 22 healthy controls (median age, 58.5 years; 90.9% female). We identified 21 upregulated and 44 downregulated DEGs in the NTM-PD group compared to those in the control group. NTM infection did not have a significant impact on gene expression in the NTM-PD group compared to the control group, and there were no differences in the proportion of immune cells. However, through gene ontology (GO), gene set enrichment analysis (GSEA), and protein-protein interaction (PPI) analysis, we discovered that PARK2 is a key factor associated with NTM-PD. The PARK2 gene, which is linked to the ubiquitination pathway, was downregulated in the NTM-PD group (fold change, - 1.314, P = 0.047). The expression levels of PARK2 remained unaltered after favorable treatment outcomes, suggesting that the gene is associated with host susceptibility rather than with the outcomes of infection or inflammation. The area under the receiver operating characteristic curve for the PARK2 gene diagnosing NTM-PD was 0.813 (95% confidence interval, 0.694-0.932). CONCLUSION We identified the genetic signatures associated with NTM-PD in a cohort of Korean patients. The PARK2 gene presents as a potential susceptibility factor in NTM-PD .
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Affiliation(s)
- Youngmok Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute for Innovation in Digital Healthcare, Yonsei University, Seoul, Republic of Korea
| | - Ji Won Hong
- Departments of Pharmacology, Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eunsol Ahn
- Division of Vaccine Research, International Tuberculosis Research Center, Seoul, Republic of Korea
| | - Heon Yung Gee
- Departments of Pharmacology, Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul, Republic of Korea.
- Woo Choo Lee Institute for Precision Drug Development, Seoul, Republic of Korea.
| | - Young Ae Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
- Institute of Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Koh J, Kim S, Kim JY, Yim JJ, Kwak N. Immunologic features of nontuberculous mycobacterial pulmonary disease based on spatially resolved whole transcriptomics. BMC Pulm Med 2024; 24:392. [PMID: 39138424 PMCID: PMC11323347 DOI: 10.1186/s12890-024-03207-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 08/07/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND The immunologic features of nontuberculous mycobacterial pulmonary disease (NTM-PD) are largely unclear. This study investigated the immunologic features of NTM-PD using digital spatial profiling techniques. METHODS Lung tissues obtained from six patients with NTM-PD between January 1, 2006, and December 31, 2020, at Seoul National University Hospital were subjected to RNA sequencing. Cores from the peribronchial areas were stained with CD3, CD68, and DNASyto13, and gene expression at the whole-transcriptome level was quantified using PCR amplification and Illumina sequencing. Lung tissues from six patients with bronchiectasis collected during the same period were used as controls. The RNA sequencing results were validated using immunohistochemistry (IHC) in another cohort (30 patients with NTM-PD and 15 patients with bronchiectasis). RESULTS NTM-PD exhibited distinct gene expression patterns in T cells and macrophages. Gene set enrichment analysis revealed that pathways related to antigen presentation and processing were upregulated in NTM-PD, particularly in macrophages. Macrophages were more prevalent and the expression of genes associated with the M1 phenotype (CD40 and CD80) was significantly elevated. Although macrophages were activated in the NTM-PD group T cell activity was unaltered. Notably, expression of the costimulatory molecule CD28 was decreased in NTM-PD. IHC analysis showed that T cells expressing Foxp3 or TIM-3, which facilitate the regulatory functions of T cells, were increased. CONCLUSIONS NTM-PD exhibits distinct immunologic signatures characterized by the activation of macrophages without T cell activation.
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Affiliation(s)
- Jaemoon Koh
- Department of Pathology, Seoul National University Hospital, Seoul, South Korea
- Laboratory of Immune Regulation in Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
| | - Sehui Kim
- Department of Pathology, Seoul National University Hospital, Seoul, South Korea
- Department of Pathology, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Joong-Yub Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 110-744, South Korea
| | - Jae-Joon Yim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 110-744, South Korea
| | - Nakwon Kwak
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 110-744, South Korea.
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Fukushima S, Hagiya H, Okura M, Iio K. Ghost in blood culture. Intern Emerg Med 2024:10.1007/s11739-024-03731-3. [PMID: 39126579 DOI: 10.1007/s11739-024-03731-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Accepted: 07/26/2024] [Indexed: 08/12/2024]
Affiliation(s)
- Shinnosuke Fukushima
- Department of General Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan
- Department of Bacteriology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan
- Department of Infectious Diseases, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Hideharu Hagiya
- Department of Infectious Diseases, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan.
| | - Mami Okura
- Microbiology Division, Clinical Laboratory, Okayama University Hospital, Okayama, Japan
| | - Koji Iio
- Microbiology Division, Clinical Laboratory, Okayama University Hospital, Okayama, Japan
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Yan J, Zheng R, Zhang Z, Shi J, Yan T, Liu H, Li F. Swollen Necrotic Lymphadenitis Infected with Mycobacterium Paracondontium in an AIDS Patient: a Case Report and Literature Review. Infect Drug Resist 2024; 17:3475-3482. [PMID: 39139625 PMCID: PMC11321343 DOI: 10.2147/idr.s473762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 07/31/2024] [Indexed: 08/15/2024] Open
Abstract
Background Non-tuberculous mycobacteria (NTM) are a group of mycobacteria that are commonly found in the environment and can cause disease in humans. The symptoms of NTM infection can be similar to those of tuberculosis, making diagnosis challenging. The morbidity associated with NTM is increasing, and clinical management can be challenging. Case Description This report details the case of a 32-year-old male who was found to have multiple enlarged and partially necrotic lymph nodes in the neck, axilla, mediastinum, and retroperitoneum. The causative agent was rapidly identified as Mycobacterium paracondontium through pathogen-targeted sequencing (tNGS). After two weeks of treatment with azithromycin, moxifloxacin, rifabutin, and amikacin, the patient's uncomfortable symptoms had resolved, and he is currently undergoing further review. Conclusion It is imperative that clinicians remain vigilant for the presence of NTM, particularly those that are rare, given their pervasiveness in the environment. Prompt diagnosis is of paramount importance, and molecular identification techniques represent a crucial tool in this regard. In vitro drug sensitivity testing should be conducted whenever feasible to guarantee the administration of an efficacious treatment regimen.
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Affiliation(s)
- Jun Yan
- The Second Infectious Disease Department, Xixi Hospital of Hangzhou, Hangzhou, 310023, People’s Republic of China
| | - Rongrong Zheng
- The Second Infectious Disease Department, Xixi Hospital of Hangzhou, Hangzhou, 310023, People’s Republic of China
| | - Zhongdong Zhang
- The Second Infectious Disease Department, Xixi Hospital of Hangzhou, Hangzhou, 310023, People’s Republic of China
| | - Jinchuan Shi
- The Second Infectious Disease Department, Xixi Hospital of Hangzhou, Hangzhou, 310023, People’s Republic of China
| | - Tingbo Yan
- Radiology Department, Xixi Hospital of Hangzhou, Hangzhou, 310023, People’s Republic of China
| | - Hong Liu
- Pathology Department, Xixi Hospital of Hangzhou, Hangzhou, 310023, People’s Republic of China
| | - Feng Li
- The Second Infectious Disease Department, Xixi Hospital of Hangzhou, Hangzhou, 310023, People’s Republic of China
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Calhoun KM, Armantrout E, Poch K, Caceres S, Lovell VK, Jones M, Malcolm KC, Vestal B, Wheeler E, Rysavy N, Manzer J, Aboellail I, Chatterjee D, Nick JA. Prospective Analysis of urINe LAM to Eliminate NTM Sputum Screening (PAINLESS) study: Rationale and trial design for testing urine lipoarabinomannan as a marker of NTM lung infection in cystic fibrosis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.08.08.24311698. [PMID: 39148848 PMCID: PMC11326329 DOI: 10.1101/2024.08.08.24311698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
Background Routine screening for nontuberculous mycobacterial (NTM) lung disease is dependent on sputum cultures. This is particularly challenging in the cystic fibrosis (CF) population due to reduced sputum production and low culture sensitivity. Biomarkers of infection that do not rely on sputum may lead to earlier diagnosis, but validation trials require a unique prospective design. Purpose The rationale of this trial is to investigate the utility of urine lipoarabinomannan (LAM) as a test to identify people with CF with a new positive NTM culture. We hypothesize that urine LAM is a sensitive, non-invasive screening test with a high negative predictive value to identify individuals with a relatively low risk of having positive NTM sputum culture. Study design This is a prospective, single-center, non-randomized observational study in adults with CF, 3 years of negative NTM cultures, and no known history of NTM positive cultures. Patients are followed for two year-long observational periods with the primary endpoint being a positive NTM sputum culture within a year of a positive urine LAM result and a secondary endpoint of a positive NTM sputum culture within 3 years of a positive urine LAM result. Study implementation includes remote consent and sample collection to accommodate changes from the COVID-19 pandemic. Conclusions This report describes the study design of an observational study aimed at using a urine biomarker to assist in the diagnosis of NTM lung infection in pwCF. If successful, urine LAM could be used as an adjunct to traditional sputum cultures for routine NTM screening.
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Affiliation(s)
- Kara M. Calhoun
- Department of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Emily Armantrout
- Department of Medicine, National Jewish Health, Denver, CO, 80206, USA
| | - Katie Poch
- Department of Medicine, National Jewish Health, Denver, CO, 80206, USA
| | - Silvia Caceres
- Department of Medicine, National Jewish Health, Denver, CO, 80206, USA
| | - Valerie K. Lovell
- Department of Medicine, National Jewish Health, Denver, CO, 80206, USA
| | - Marion Jones
- Department of Medicine, National Jewish Health, Denver, CO, 80206, USA
| | | | - Brian Vestal
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, USA
| | - Emily Wheeler
- Department of Medicine, National Jewish Health, Denver, CO, 80206, USA
| | - Noel Rysavy
- Department of Medicine, National Jewish Health, Denver, CO, 80206, USA
| | - Jordan Manzer
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, 1682 Campus Delivery, Fort Collins, CO, USA
| | - Ibrahim Aboellail
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, 1682 Campus Delivery, Fort Collins, CO, USA
| | - Delphi Chatterjee
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, 1682 Campus Delivery, Fort Collins, CO, USA
| | - Jerry A. Nick
- Department of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Medicine, National Jewish Health, Denver, CO, 80206, USA
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Mazzarelli A, Nisii C, Cannas A, Vulcano A, Bartolini B, Turchi F, Butera O, Rossi A, De Giuli C, Massimino C, Stellitano C, Antonelli V, Petriccione I, Girardi E, Gualano G, Palmieri F, Fontana C. The Drug Susceptibility of Non-Tuberculous Mycobacteria (NTM) in a Referral Hospital in Rome from 2018 to 2023. Microorganisms 2024; 12:1615. [PMID: 39203457 PMCID: PMC11356625 DOI: 10.3390/microorganisms12081615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Revised: 08/02/2024] [Accepted: 08/06/2024] [Indexed: 09/03/2024] Open
Abstract
Background: The treatment of non-tuberculous mycobacterial (NTM) infections is challenging because of the difficulty in obtaining phenotypic (pDST) and/or molecular (mDST) drug susceptibility testing and the need of a multi-drug regimen. Objectives: The objective was to describe the in vitro susceptibility patterns of various NTM species through an analysis of susceptibility results obtained on isolates collected between 2018 and 2023. Methods: Species identification and mutations in rrs or rrl genes (mDST) were identified by a line probe assay, while the pDST was performed by broth microdilution and interpreted according to CLSI criteria. Results: We analysed 337 isolates of NTM belonging to 15 species/subspecies. The Mycobacterium avium complex (MAC) was the most common (62%); other species identified included M. gordonae (11%), M. kansasii (5%), the M. abscessus complex (8%), M. chelonae (6%), and M. fortuitum (2%). The results of pDST (claritromycin and amikacin) and mDST (rrl and rrs genes) on 66 NTM strains showed that while wild-type rrl and rrs occurred in 86.3% and 94% strains, respectively, the pDST showed 88% sensitivity for clarithromycin and 57.5% for amikacin. The main incongruity was observed for macrolides. Conclusions: Most NTM are likely to be susceptible to macrolides and aminoglycosides. The molecular identification of resistant genotypes is accurate and strongly recommended for optimal patient management.
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Affiliation(s)
- Antonio Mazzarelli
- Laboratory of Microbiology and Biorepository, National Institute for Infectious Diseases, INMI “Lazzaro Spallanzani”, IRCCS, Via Portuense 292, 00149 Rome, Italy; (A.M.); (A.C.); (A.V.); (B.B.); (F.T.); (O.B.); (A.R.); (C.D.G.); (C.M.) (C.S.); (V.A.); (I.P.); (C.F.)
| | - Carla Nisii
- Laboratory of Microbiology and Biorepository, National Institute for Infectious Diseases, INMI “Lazzaro Spallanzani”, IRCCS, Via Portuense 292, 00149 Rome, Italy; (A.M.); (A.C.); (A.V.); (B.B.); (F.T.); (O.B.); (A.R.); (C.D.G.); (C.M.) (C.S.); (V.A.); (I.P.); (C.F.)
| | - Angela Cannas
- Laboratory of Microbiology and Biorepository, National Institute for Infectious Diseases, INMI “Lazzaro Spallanzani”, IRCCS, Via Portuense 292, 00149 Rome, Italy; (A.M.); (A.C.); (A.V.); (B.B.); (F.T.); (O.B.); (A.R.); (C.D.G.); (C.M.) (C.S.); (V.A.); (I.P.); (C.F.)
| | - Antonella Vulcano
- Laboratory of Microbiology and Biorepository, National Institute for Infectious Diseases, INMI “Lazzaro Spallanzani”, IRCCS, Via Portuense 292, 00149 Rome, Italy; (A.M.); (A.C.); (A.V.); (B.B.); (F.T.); (O.B.); (A.R.); (C.D.G.); (C.M.) (C.S.); (V.A.); (I.P.); (C.F.)
| | - Barbara Bartolini
- Laboratory of Microbiology and Biorepository, National Institute for Infectious Diseases, INMI “Lazzaro Spallanzani”, IRCCS, Via Portuense 292, 00149 Rome, Italy; (A.M.); (A.C.); (A.V.); (B.B.); (F.T.); (O.B.); (A.R.); (C.D.G.); (C.M.) (C.S.); (V.A.); (I.P.); (C.F.)
| | - Federica Turchi
- Laboratory of Microbiology and Biorepository, National Institute for Infectious Diseases, INMI “Lazzaro Spallanzani”, IRCCS, Via Portuense 292, 00149 Rome, Italy; (A.M.); (A.C.); (A.V.); (B.B.); (F.T.); (O.B.); (A.R.); (C.D.G.); (C.M.) (C.S.); (V.A.); (I.P.); (C.F.)
| | - Ornella Butera
- Laboratory of Microbiology and Biorepository, National Institute for Infectious Diseases, INMI “Lazzaro Spallanzani”, IRCCS, Via Portuense 292, 00149 Rome, Italy; (A.M.); (A.C.); (A.V.); (B.B.); (F.T.); (O.B.); (A.R.); (C.D.G.); (C.M.) (C.S.); (V.A.); (I.P.); (C.F.)
| | - Alberto Rossi
- Laboratory of Microbiology and Biorepository, National Institute for Infectious Diseases, INMI “Lazzaro Spallanzani”, IRCCS, Via Portuense 292, 00149 Rome, Italy; (A.M.); (A.C.); (A.V.); (B.B.); (F.T.); (O.B.); (A.R.); (C.D.G.); (C.M.) (C.S.); (V.A.); (I.P.); (C.F.)
| | - Chiara De Giuli
- Laboratory of Microbiology and Biorepository, National Institute for Infectious Diseases, INMI “Lazzaro Spallanzani”, IRCCS, Via Portuense 292, 00149 Rome, Italy; (A.M.); (A.C.); (A.V.); (B.B.); (F.T.); (O.B.); (A.R.); (C.D.G.); (C.M.) (C.S.); (V.A.); (I.P.); (C.F.)
| | - Chiara Massimino
- Laboratory of Microbiology and Biorepository, National Institute for Infectious Diseases, INMI “Lazzaro Spallanzani”, IRCCS, Via Portuense 292, 00149 Rome, Italy; (A.M.); (A.C.); (A.V.); (B.B.); (F.T.); (O.B.); (A.R.); (C.D.G.); (C.M.) (C.S.); (V.A.); (I.P.); (C.F.)
| | - Chiara Stellitano
- Laboratory of Microbiology and Biorepository, National Institute for Infectious Diseases, INMI “Lazzaro Spallanzani”, IRCCS, Via Portuense 292, 00149 Rome, Italy; (A.M.); (A.C.); (A.V.); (B.B.); (F.T.); (O.B.); (A.R.); (C.D.G.); (C.M.) (C.S.); (V.A.); (I.P.); (C.F.)
| | - Valentina Antonelli
- Laboratory of Microbiology and Biorepository, National Institute for Infectious Diseases, INMI “Lazzaro Spallanzani”, IRCCS, Via Portuense 292, 00149 Rome, Italy; (A.M.); (A.C.); (A.V.); (B.B.); (F.T.); (O.B.); (A.R.); (C.D.G.); (C.M.) (C.S.); (V.A.); (I.P.); (C.F.)
| | - Ivano Petriccione
- Laboratory of Microbiology and Biorepository, National Institute for Infectious Diseases, INMI “Lazzaro Spallanzani”, IRCCS, Via Portuense 292, 00149 Rome, Italy; (A.M.); (A.C.); (A.V.); (B.B.); (F.T.); (O.B.); (A.R.); (C.D.G.); (C.M.) (C.S.); (V.A.); (I.P.); (C.F.)
| | - Enrico Girardi
- Scientific Direction, National Institute for Infectious Diseases, INMI “Lazzaro Spallanzani”, IRCCS, 00149 Rome, Italy;
| | - Gina Gualano
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases, INMI “Lazzaro Spallanzani”, IRCCS, 00149 Rome, Italy; (G.G.); (F.P.)
| | - Fabrizio Palmieri
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases, INMI “Lazzaro Spallanzani”, IRCCS, 00149 Rome, Italy; (G.G.); (F.P.)
| | - Carla Fontana
- Laboratory of Microbiology and Biorepository, National Institute for Infectious Diseases, INMI “Lazzaro Spallanzani”, IRCCS, Via Portuense 292, 00149 Rome, Italy; (A.M.); (A.C.); (A.V.); (B.B.); (F.T.); (O.B.); (A.R.); (C.D.G.); (C.M.) (C.S.); (V.A.); (I.P.); (C.F.)
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Raccagni AR, Mori G, de Chaurand VP, Dell'Acqua R, Cirillo DM, Oltolini C, Mazzi B, Scomazzoni F, Castagna A, Guffanti M. Long-term successfull management of recurrent episodes of nontuberculous mycobacterial infection in an apparently healthy Chinese woman. Ann Clin Microbiol Antimicrob 2024; 23:68. [PMID: 39097716 PMCID: PMC11298074 DOI: 10.1186/s12941-024-00732-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 07/29/2024] [Indexed: 08/05/2024] Open
Abstract
BACKGROUND Disseminated non-tuberculous mycobacteria (dNTM) infections are mostly reported among individuals with an underlying congenital or acquired immunodeficiency or receiving immunosuppressive treatment, but are rarely documented in otherwise healthy subjects. CASE PRESENTATION We describe a case of recurrent disseminated mycobacterial infection in an apparently immunocompetent Chinese woman. Mycobacterium szulgai and Mycobacterium avium-complex were identified in distinct episodes. Long-term antimycobacterial therapy was administered given the occurrence of recurrent events when off-treatment. Successful management over more than 10 years and immunologic data are reported. CONCLUSIONS This case-report highlights that dNTM should be suspected also among apparently immunocompetent hosts and that thorough assessment of underling immune-impairments is helpful to define patients' management. Long-term antimycobacterial therapy and close monitoring is required to grant successful outcomes in case of recurrent dNTM infections.
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Affiliation(s)
| | - Giovanni Mori
- Vita-Salute San Raffaele University, Via Stamira D'Ancona 20, Milano, 20127, Italy
| | - Valeria Poletti de Chaurand
- Emerging Bacterial Pathogens Unit, Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Raffaele Dell'Acqua
- Unit of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Daniela Maria Cirillo
- Vita-Salute San Raffaele University, Via Stamira D'Ancona 20, Milano, 20127, Italy
- Emerging Bacterial Pathogens Unit, Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Oltolini
- Unit of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Benedetta Mazzi
- Immunogenetics Laboratory, Department of Immunohematology & Blood Transfusion, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Scomazzoni
- Department of Neuroradiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonella Castagna
- Vita-Salute San Raffaele University, Via Stamira D'Ancona 20, Milano, 20127, Italy
- Unit of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Monica Guffanti
- Unit of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Mitsutome E, Yanagi S, Uchida T, Horiguchi T, Tsubouchi H, Sumiyoshi M, Kitamura A, Oda Y, Ueno H, Yamaguchi H, Miyazaki T. Postprandial hypoglycemia caused by the combination of clarithromycin and rifampicin in a patient with nontuberculous mycobacterial pulmonary disease. J Infect Chemother 2024:S1341-321X(24)00207-1. [PMID: 39097170 DOI: 10.1016/j.jiac.2024.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 07/04/2024] [Accepted: 07/29/2024] [Indexed: 08/05/2024]
Abstract
Most cases of nontuberculous mycobacterial pulmonary disease (NTM-PD) have a progressive clinical course, and initiation of treatment is recommended rather than watchful waiting. The NTM-PD medications are frequently associated with adverse reactions, occasionally serious. Optimization of the methods for monitoring and managing adverse events in NTM-PD treatment is thus an important medical issue. Here we report a first case of postprandial hypoglycemia caused by the combination of clarithromycin (CAM) and rifampicin (RFP) in a patient with NTM-PD. A 73-year-old Japanese woman with NTM-PD was hospitalized for treatment with a combination of oral CAM, RFP, and ethambutol. She took the first doses of antibiotics before breakfast, and 3 h later went into a hypoglycemic state. Postprandial hypoglycemia occurred with high reproducibility and was accompanied by relative insulin excess. Continuous glucose monitoring with or without food and in combination with various patterns of medication revealed that the combination of CAM and RFP specifically induced postprandial hypoglycemia. Shifting the timing of administration of the CAM and RFP combination from morning to before sleep corrected the hypoglycemia and enabled continuation of the antimicrobial treatment. In conclusion, our report suggests the importance of introducing NTM-PD medication under inpatient management in order to closely monitor and early detect postprandial hypoglycemia and other serious adverse events.
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Affiliation(s)
- Eriko Mitsutome
- Division of Respirology Rheumatology Infectious Diseases and Neurology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, 889-1692, Japan
| | - Shigehisa Yanagi
- Division of Respirology Rheumatology Infectious Diseases and Neurology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, 889-1692, Japan.
| | - Taisuke Uchida
- Division of Hematology, Diabetes, and Endocrinology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, 889-1692, Japan
| | - Takanori Horiguchi
- Division of Respirology Rheumatology Infectious Diseases and Neurology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, 889-1692, Japan
| | - Hironobu Tsubouchi
- Division of Respirology Rheumatology Infectious Diseases and Neurology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, 889-1692, Japan
| | - Makoto Sumiyoshi
- Division of Respirology Rheumatology Infectious Diseases and Neurology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, 889-1692, Japan
| | - Akiko Kitamura
- Division of Respirology Rheumatology Infectious Diseases and Neurology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, 889-1692, Japan
| | - Yasuharu Oda
- Division of Respirology Rheumatology Infectious Diseases and Neurology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, 889-1692, Japan
| | - Hiroaki Ueno
- Division of Hematology, Diabetes, and Endocrinology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, 889-1692, Japan
| | - Hideki Yamaguchi
- Division of Hematology, Diabetes, and Endocrinology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, 889-1692, Japan
| | - Taiga Miyazaki
- Division of Respirology Rheumatology Infectious Diseases and Neurology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, 889-1692, Japan
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Andalibi F, Bostanghadiri N, Amirmozafari N, Irajian G, Mirkalantari S. Efficacy and treatment outcome of infected patients with pulmonary Mycobacterium kansasii: A systematic review. J Clin Tuberc Other Mycobact Dis 2024; 36:100463. [PMID: 39139717 PMCID: PMC11321441 DOI: 10.1016/j.jctube.2024.100463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024] Open
Abstract
Background Mycobacterium kansasii (M. kansasii) is a non-tuberculosis bacterium with a highly prevalent that is transferred by aerosols from water and soil resources to the respiratory system. M. kansasii is one of the main species responsible for NTM pulmonary disease. Methods Web of Science, Scopus, and PubMed databases were systematically explored. Relevant articles from 1971 to November 2023 were reviewed. "The inclusion criteria" included patients with M. kansasii infection, treatment follow-up, and treatment outcomes. "The exclusion criteria" were clinical samples from animals, environmental samples, and other laboratory investigations. Results 40 studies, including 1201 patients, were obtained through database search. Using the therapeutic regimens used in different studies, the therapy course for patients with M. kansasii infection ranged from 1 week to 118 months. In this study, the antibiotics prescribed in different treatment regimens for M. kansasii pulmonary infection were as follows: Rifampin, Ethambutol, Isoniazid, Clarithromycin, Streptomycin, and Pyrazinamide. Antibiotic combinations of three or four medicines, including rifampin, ethambutol, and isoniazid with or without streptomycin or pyrazinamide had the most therapeutic effect. Conclusion The initial treatment involves rifampin, ethambutol, isoniazid, and pyridoxine, per the guidelines from the American Thoracic Society (ATS) and the Infectious Diseases Society of America (IDSA). Understanding the treatment plan and its outcomes is crucial for managing and determining the most effective therapy approach.
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Affiliation(s)
- Fatemeh Andalibi
- Microbial Biotechnology Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Narjess Bostanghadiri
- Microbial Biotechnology Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Nour Amirmozafari
- Microbial Biotechnology Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Irajian
- Microbial Biotechnology Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Shiva Mirkalantari
- Microbial Biotechnology Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Wetzstein N, Dahl VN, Lillebaek T, Lange C. Clinical spectrum and relevance of Mycobacterium malmoense: Systematic review and meta-analysis of 859 patients. J Infect 2024; 89:106203. [PMID: 38906266 DOI: 10.1016/j.jinf.2024.106203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 06/06/2024] [Accepted: 06/11/2024] [Indexed: 06/23/2024]
Abstract
INTRODUCTION The clinical relevance of Mycobacterium malmoense isolation from pulmonary specimens has been considered high compared with other non-tuberculous mycobacteria. In this study, we aimed to analyse all published clinical data of patients with M. malmoense isolation to investigate the clinical spectrum, relevance, and outcomes of infections with this uncommon mycobacterium. METHODS A systematic review of PubMed, Web of Science, Embase, and Scopus was performed to identify all clinical data about M. malmoense. Random effects meta-analyses of proportions were calculated for clinical relevance, treatment success, and mortality, as well as for other clinical characteristics. A logistic regression analysis, investigating predictors of mortality, as well as Kaplan-Meier survival analyses, were performed. RESULTS One hundred and eighty eight patients with individual data from 112 articles and 671 patients with pooled data from 12 articles were included in the meta-analyses. Of patients with individual data, pulmonary infection was the most common manifestation (n = 106/188, 56.4%). One third (n = 61/188, 32.4%) suffered from isolated extra-pulmonary and 21/188 (11.2%) from disseminated disease. In 288 patients with pooled data and pulmonary affection, clinical relevance was high with 68% (95% CI 44-85%) of patients fulfilling criteria for clinical disease. Macrolide and rifamycin-containing regimens were associated with improved survival (adjusted OR 0.12, 95% CI 0.03-0.42, p = 0.002, and 0.23, 95% CI 0.04-0.86, p = 0.03, for lethal events, respectively). CONCLUSION In this study, we provide a detailed clinical description of M. malmoense infections. The pathogen is of high clinical relevance for the individual patient with more than 2 out of 3 patients having relevant disease and >40% of manifestations being extra-pulmonary or disseminated. Macrolide and rifamycin-containing regimens are associated with improved survival.
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Affiliation(s)
- Nils Wetzstein
- Goethe University Frankfurt, University Hospital, Department of Internal Medicine, Infectious Diseases, Frankfurt am Main, Germany; Molecular and Experimental Mycobacteriology, Research Center Borstel, Leibniz Lung Center, Borstel, Germany.
| | - Victor Naestholt Dahl
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark; International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark
| | - Troels Lillebaek
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark; Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Christoph Lange
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany; German Center for Infection Research (DZIF), TTU-TB, Borstel, Germany; Respiratory Medicine and International Health, University of Lübeck, Lübeck, Germany; Baylor College of Medicine and Texas Children´s Hospital, Houston, TX, USA
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Narimisa N, Goodarzi F, Bostanghadiri N, Masjedian Jazi F. Prevalence of antibiotic resistance in clinical isolates of Mycobacterium kansasii: a systematic review and meta-analysis. Expert Rev Anti Infect Ther 2024; 22:669-679. [PMID: 38294514 DOI: 10.1080/14787210.2024.2313051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/30/2023] [Indexed: 02/01/2024]
Abstract
INTRODUCTION The prevalence of diseases caused by non-tuberculous mycobacteria (NTM), including M. kansasii, is increasing, necessitating further information to guide prevention, control, and treatment strategies. AREAS COVERED A comprehensive analysis of articles published until February 2023 was conducted on PubMed, Web of Science, and Scopus databases to investigate antibiotic resistance in M. kansasii species. Stata software version 17 was employed for all analyses. EXPERT OPINION A total of 1647 articles were obtained through database search. After removing duplicates and unrelated studies, 17 cross-sectional studies that examined the breakpoints proposed by CLSI were included. The rates of resistance of M. kansasii to various antibiotics were as follows: clarithromycin (0%), rifampin (1%), amikacin (0%), ciprofloxacin (14%), linezolid (0%), moxifloxacin (0%), rifabutin (1%), doxycycline (96%), and SXT (49%). Our findings underscore the importance of managing and monitoring the use of these antibiotics, as well as the need for further studies to elucidate the exact mechanism of M. kansasii resistance to these antibiotics.
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Affiliation(s)
- Negar Narimisa
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Forough Goodarzi
- Department of Bacteriology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Narjess Bostanghadiri
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Faramarz Masjedian Jazi
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Akazawa N, Itoh N, Ishibana Y, Murakami H, Okumura S. Successful management of surgical site infection caused by Mycobacterium mageritense in a breast cancer patient. J Infect Chemother 2024; 30:800-805. [PMID: 38272263 DOI: 10.1016/j.jiac.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/14/2023] [Accepted: 01/18/2024] [Indexed: 01/27/2024]
Abstract
Mycobacterium mageritense (M. mageritense), a nontuberculous mycobacterium, is classified as a rapidly growing mycobacterium, class IV in the Runyon Classification. This bacterium is found in soil, water, and other habitats. Infections caused by M. mageritense are relatively rare and no treatment protocol has been established. Herein, we report a case of skin and soft tissue infection caused by M. mageritense. A 49-year-old woman underwent surgery for right breast cancer. Four months after surgery, a surgical site infection was found, and M. mageritense was identified in the wound culture using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). Based on the sensitivity results, the patient was treated with levofloxacin and doxycycline for 4 months. In addition to antimicrobial agents, aggressive surgical interventions led to a favorable course of treatment. In conclusion, successful treatment of skin and soft tissue infections with M. mageritense requires surgical intervention whenever possible, aggressive susceptibility testing, and appropriate antimicrobial therapy.
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Affiliation(s)
- Nana Akazawa
- Division of Infectious Diseases, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan.
| | - Naoya Itoh
- Division of Infectious Diseases, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan
| | - Yuichi Ishibana
- Division of Infectious Diseases, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan
| | - Hiromi Murakami
- Division of Infectious Diseases, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan
| | - Seiko Okumura
- Department of Plastic and Reconstructive Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan
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Dettmer S, Heiß-Neumann M, Wege S, Maske H, Ringshausen FC, Joean O, Theissig N, Ewen R, Wacker F, Rademacher J. Evaluation of treatment response with serial CT in patients with non-tuberculous mycobacterial pulmonary disease. Eur Radiol 2024:10.1007/s00330-024-10987-y. [PMID: 39088042 DOI: 10.1007/s00330-024-10987-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 06/05/2024] [Accepted: 07/13/2024] [Indexed: 08/02/2024]
Abstract
OBJECTIVES In patients with non-tuberculous mycobacterial pulmonary disease (NTM-PD), the response to treatment is evaluated based on microbiological, clinical, and radiological data. However, little is known about the dynamics of CT findings. The aim of this study was to evaluate CT changes in NTM-PD in order to define radiological criteria for treatment success. METHODS Retrospective multicenter study (Hannover, Heidelberg, Gauting). Sixty patients with NTM-PD and at least two consecutive CT scans were included. Scoring for NTM-PD was performed by evaluating variables of bronchiectasis, mucus plugging, bronchiolitis, cavities, nodules, and consolidations on an ordinal scale from 0 to 3. Differences between baseline and follow-up were calculated, and patients with/without cultural conversion were compared using the Mann-Whitney U-test. For paired comparison of the two consecutive CT scans the Wilcoxon test was used. RESULTS Comparing patients with and without culture conversion, there were significant differences in temporal changes of bronchiectasis (p < 0.001), cavities (p = 0.006), bronchiolitis (p < 0.001), consolidations (p = 0.004), and total score (p < 0.001). Nodules showed no significant differences between groups (p = 0.060). The Wilcoxon test showed significant differences between both CTs in patients with a microbiological cure for the total score (p < 0.001), cavities (p = 0.005), bronchiolitis (p < 0.001), and consolidations (p = 0.021) with a decrease after microbiological cure, whereas bronchiectasis (p = 0.102) and nodules (p = 0.18) stayed stable. In the case of persistently positive cultures, there was an increase in the total score (p = 0.010) which was attributable to progressive bronchiectasis (p < 0.001). CONCLUSION Cavities, consolidations, and bronchiolitis are useful to assess treatment response, whereas bronchiectasis and nodules may remain stable despite successful treatment. CLINICAL RELEVANCE STATEMENT Cavities, consolidations, and bronchiolitis can assess treatment response whereas bronchiectasis and nodules may remain stable despite successful treatment. In persistently positive cultures, bronchiectasis showed an increase over time indicating that NTM-PD is a progressive chronic disease. KEY POINTS Little is known about CT changes in nontuberculous mycobacteria pulmonary disease (NTM-PD) and criteria to evaluate treatment response. In the case of culture conversion, cavities and bronchiolitis decreased whereas bronchiectasis and nodules remained stable. Cavities and bronchiolitis can evaluate treatment response in NTM, but bronchiectasis and nodules may persist despite successful treatment.
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Affiliation(s)
- Sabine Dettmer
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research (DZL), Hannover, Germany.
| | - Marion Heiß-Neumann
- Department of Pneumology & Infectious Diseases, Asklepios Lung Clinic Munich-Gauting (CPC-M), Gauting, Germany
- Comprehensive Pneumology Center Munich, Member of the German Centre for Lung Research (DZL), Gauting, Germany
| | - Sabine Wege
- Department of Pneumology and Critical Care Medicine, Thoraxklinik at the University Hospital Heidelberg, Heidelberg, Germany
| | - Hannah Maske
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Felix C Ringshausen
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research (DZL), Hannover, Germany
- Department of Respiratory Medicine and Infectious Diseases, Hannover Medical School, Hannover, Germany
- European Reference Network on Rare and Complex Respiratory Diseases (ERN-LUNG), Frankfurt, Germany
| | - Oana Joean
- Department of Respiratory Medicine and Infectious Diseases, Hannover Medical School, Hannover, Germany
| | - Nicole Theissig
- Department of Pneumology and Critical Care Medicine, Thoraxklinik at the University Hospital Heidelberg, Heidelberg, Germany
| | - Raphael Ewen
- Department of Respiratory Medicine and Infectious Diseases, Hannover Medical School, Hannover, Germany
| | - Frank Wacker
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research (DZL), Hannover, Germany
| | - Jessica Rademacher
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research (DZL), Hannover, Germany
- Department of Respiratory Medicine and Infectious Diseases, Hannover Medical School, Hannover, Germany
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68
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Morimoto K, Gallagher JR, Wagner D, Griffith DE, van Ingen J. Real-World Patients' Diagnosis-to-Treatment Journey with Nontuberculous Mycobacterial Pulmonary Disease: A Cross-Sectional Survey. Infect Dis Ther 2024; 13:1907-1920. [PMID: 38985411 PMCID: PMC11266326 DOI: 10.1007/s40121-024-01015-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 06/26/2024] [Indexed: 07/11/2024] Open
Abstract
INTRODUCTION The incidence and prevalence of nontuberculous mycobacterial pulmonary disease (NTM-PD) are increasing globally. Approximately 80% of NTM-PD cases in Japan and five countries within Europe (Eur5; France, Germany, Italy, Spain, and the UK) are caused by Mycobacterium avium complex (MAC). This study describes the clinical decision-making process associated with the management of patients with NTM-PD in Japan and the Eur5. METHODS We analyzed data from a survey conducted between July 2013 and October 2013 among physicians treating patients with NTM-PD in clinical practice to compare the healthcare settings, clinical presentation, and patient management in Japan and the Eur5. RESULTS Overall, 619 physicians (Japan, 173; Eur5, 446) participated in the survey. Most patients in Japan (85%) and the Eur5 (79%) were diagnosed with MAC-PD. Patients were managed generally in hospital-based outpatient clinics (117/173, 68%) in Japan and research/teaching hospitals affiliated with medical schools (140/446, 31%) in the Eur5. The most common reason for delaying treatment was the patient's symptoms not being considered serious enough for treatment (55/128, 43%) in Japan and awaiting results of antimicrobial susceptibility testing (44/151, 29%) in the Eur5. Culture negativity was less commonly achieved after treatment in patients in Japan versus those in the Eur5 (31% [73/238] vs. 70% [300/426], p < 0.0001). In treatment phases that were either completed or discontinued, the primary goal was symptomatic improvement, followed by achieving culture conversion, in both Japan and the Eur5. Overall, 19% (16/85) of physicians in Japan and 43% (220/511) in the Eur5 were "entirely satisfied" with their patients' treatment outcomes. CONCLUSIONS Similarities and differences exist in the healthcare settings, clinical presentation, and management of patients with NTM-PD in Japan and the Eur5. Insufficient consideration of culture status by physicians, delayed treatment initiation, and symptom-based cessation emphasize the need for educational efforts on the guideline-based strategies.
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Affiliation(s)
- Kozo Morimoto
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association, 3-1-24 Matsuyama Kiyose, Tokyo, 204-8522, Japan.
| | | | - Dirk Wagner
- Division of Infectious Diseases, Department of Medicine II, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - David E Griffith
- Division of Mycobacterial and Respiratory Infections, Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Jakko van Ingen
- Radboudumc Center for Infectious Diseases, Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
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Marvin-Peek J, Sasaki K, Kontoyiannis DP, Adachi J, Ohanian M, Takahashi K, Issa GC, Kornblau S, Abbas HA. Nontuberculosis mycobacteria (NTM) infections in patients with leukemia: a single center case series. Front Med (Lausanne) 2024; 11:1402897. [PMID: 39149601 PMCID: PMC11324579 DOI: 10.3389/fmed.2024.1402897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 07/22/2024] [Indexed: 08/17/2024] Open
Abstract
Patients with leukemia experience profound immunosuppression both from their underlying disease as well as chemotherapeutic treatment. Little is known about the prevalence and clinical presentation of nontuberculous mycobacteria (NTM) in this patient population. We identified six cases of NTM infection from 29,743 leukemia patients who had acid-fast bacilli (AFB) cultures. Four cases had bloodstream infections and five had disseminated disease, including one who presented with an unusual case of diffuse cellulitis/myositis. All patients were lymphopenic at time of diagnosis, and two patients ultimately died from their NTM infection. NTM infections are a rare, but potentially life-threatening infection in patients with leukemia. Sending AFB cultures early is important to direct appropriate antimicrobial therapy and allow for future leukemia-directed therapy.
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Affiliation(s)
- Jennifer Marvin-Peek
- Department of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Koji Sasaki
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Dimitrios P Kontoyiannis
- Department of Infectious Disease, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Javier Adachi
- Department of Infectious Disease, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Maro Ohanian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Koichi Takahashi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ghayas C Issa
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Steven Kornblau
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Hussein A Abbas
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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70
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Kuint R, Abutbul A, Fridlender ZG, Laxer U, Berkman N. Is there a role for lung or bronchial biopsies for the diagnosis of mycobacterial pulmonary disease in patients with bronchiectasis? J Clin Tuberc Other Mycobact Dis 2024; 36:100447. [PMID: 38708038 PMCID: PMC11070234 DOI: 10.1016/j.jctube.2024.100447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Abstract
Background Workup of bronchiectasis patients mandates microbiological characterization often being sought via Bronchoscopy. However, whether to perform bronchial or lung biopsies, is unknown, especially for the diagnosis of NTM pulmonary disease. We aimed to assess the current practice and yield of the different bronchoscopic procedures in this setting. Methods Data from an adult cohort with bronchiectasis referred for bronchoscopy for microbiologic sampling was reviewed, including demographics, etiology, imaging and results of the different bronchoscopic procedures performed. Results 127 subjects were analyzed (mean age 61, 56% female). BAL culture was positive in 44%. Frequent pathogens were Hemophilus Influenza (20%), pseudomonas aeruginosa (8%) and Staphylococcus aureus (7%). NTM and tuberculosis were found in 6% and 1.5% respectively. BAL cytology was sent in 125 procedures, EBB was performed in 51 patients (40%) and TBLB in 38 patients (30%). BAL cytology and both EBB and TBB (including tissue cultures) had no benefit over BAL with respect to microbiological diagnosis, including identification of mycobacterial disease. Conclusions In adult subjects with Non-CF bronchiectasis requiring bronchoscopy for microbiological characterization, BAL cytology and lung tissue biopsies were frequently performed but were of minimal additional benefit over BAL culture (including for mycobacterial pulmonary disease), and are most likely futile.
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Affiliation(s)
- Rottem Kuint
- Institute of Pulmonary Medicine, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Avraham Abutbul
- Institute of Pulmonary Medicine, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Zvi G. Fridlender
- Institute of Pulmonary Medicine, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Uri Laxer
- Institute of Pulmonary Medicine, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Neville Berkman
- Institute of Pulmonary Medicine, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel
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71
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Liao W, Wang X, Wang Y, Ma P, Chen K, Ge L, Yang X, Zeng S, Gao W, Zhang S, Wang H, Jia X, Luo T. Noncanonical mutations in ribosome nascent peptide exit tunnel confer clarithromycin resistance in Mycobacterium abscessus complex. Int J Antimicrob Agents 2024; 64:107223. [PMID: 38810940 DOI: 10.1016/j.ijantimicag.2024.107223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 05/04/2024] [Accepted: 05/20/2024] [Indexed: 05/31/2024]
Abstract
OBJECTIVES Mycobacterium abscessus is a non-tuberculous mycobacterial pathogen that causes pulmonary and skin infections globally. Clarithromycin plays a pivotal role in treating M. abscessus infections, with resistance often leading to treatment failure. While canonical mutations in the 23S rRNA residue 2270/2271 are recognized as the primary mechanism for acquired clarithromycin resistance, resistant isolates lacking these mutations have been widely reported. This study aims to identify new mechanisms of clarithromycin resistance in M. abscessus. METHODS We selected spontaneous resistant mutants derived from two parental strains characterized by erm(41) T28 and C28 sequevars, respectively. Whole-genome sequencing was performed on mutants lacking the 23S rRNA 2270/2271 mutations. Site-directed mutagenesis was used to confirm the resistance phenotypes of newly identified mutations. Bioinformatic analysis of publicly available genomes was conducted to evaluate the presence of these mutations in clinical isolates. The spatial localization of these mutations in the ribosome was analyzed to investigate potential mechanisms of resistance. RESULTS A total of 135 resistant mutants were selected from the parental strains. Sequencing of the 78 mutants lacking the 23S rRNA 2270/2271 mutations identified mutations within the peptidyl-transferase center and hairpin loops 35, 49, and 74 of the 23S rRNA. These noncanonical mutations were identified in 57 of 1875 genomes of clinical isolates. Thirteen representative mutations were introduced into the bacterial genome, and their contributions to macrolide resistance were confirmed. The newly identified mutations all localized at the entrance of the nascent peptide exit tunnel, potentially contributing to resistance by disrupting the macrolide binding pocket. CONCLUSION Several noncanonical 23S rRNA mutations conferring clarithromycin resistance were identified. These mutations enhance our understanding of macrolide resistance in M. abscessus and could serve as important markers for diagnosing clarithromycin resistance.
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Affiliation(s)
- Wei Liao
- Department of Pathogen Biology, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, China; High Altitude Health Science Research Centre of Tibet University, Medical College of Tibet University, Lhasa, China
| | - Xinyan Wang
- Genomics Center of Core Facilities, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Wang
- Department of Pathogen Biology, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, China
| | - Pengjiao Ma
- Department of Biochemistry and Molecular Biology, College of Basic Medical Science, Army Medical University, Chongqing, China
| | - Ken Chen
- Department of Pathogen Biology, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, China
| | - Liang Ge
- Department of Pathogen Biology, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, China
| | - Xiaoyan Yang
- Department of Pathogen Biology, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, China
| | - Shushu Zeng
- Department of Pathogen Biology, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, China
| | - Wenfeng Gao
- Sichuan Center for Disease Control and Prevention, Chengdu, China
| | - Shu Zhang
- Sichuan Center for Disease Control and Prevention, Chengdu, China
| | - Hongren Wang
- Department of Pathogen Biology, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, China
| | - Xu Jia
- Non-coding RNA and Drug Discovery Key Laboratory of Sichuan Province, Chengdu Medical College, Chengdu, China
| | - Tao Luo
- Department of Pathogen Biology, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, China.
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Bertuccio F, Baio N, Montini S, Ferroni V, Chino V, Pisanu L, Russo M, Giana I, Cascina A, Conio V, Primiceri C, Stella G, Corsico A. Adjuvant surgical treatment of non-tuberculous mycobacterial lung disease in chronic thromboembolic pulmonary hypertension: A first case report. J Clin Tuberc Other Mycobact Dis 2024; 36:100462. [PMID: 39050410 PMCID: PMC11268100 DOI: 10.1016/j.jctube.2024.100462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024] Open
Abstract
Pulmonary hypertension (PH) is not considered a known risk factor for non-tuberculous mycobacterial lung disease (NTM-LD), despite that many studies state that incidence is almost equal to other chronic lung diseases. Current standard of care for NTM-LD consists in multidrug antibiotic regimen for several months. However, it results in negative culture conversion in a minority of cases. Therefore, when feasible an adjuvant surgical approach is indicated. In this case report we highlight the importance of multidisciplinary team discussion in providing the best therapeutic strategy in presence of significant comorbidities like chronic thromboembolic pulmonary hypertension.
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Affiliation(s)
- F.R. Bertuccio
- Cardiothoracic and Vascular Department, Unit of Respiratory Disease, IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
- Department of Internal Medicine and Pharmacology, University of Pavia, Pavia 27100, Italy
| | - N. Baio
- Cardiothoracic and Vascular Department, Unit of Respiratory Disease, IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
- Department of Internal Medicine and Pharmacology, University of Pavia, Pavia 27100, Italy
| | - S. Montini
- Department of Internal Medicine and Pharmacology, University of Pavia, Pavia 27100, Italy
| | - V. Ferroni
- Cardiothoracic and Vascular Department, Unit of Respiratory Disease, IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
- Department of Internal Medicine and Pharmacology, University of Pavia, Pavia 27100, Italy
| | - V. Chino
- Cardiothoracic and Vascular Department, Unit of Respiratory Disease, IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
- Department of Internal Medicine and Pharmacology, University of Pavia, Pavia 27100, Italy
| | - L. Pisanu
- Cardiothoracic and Vascular Department, Unit of Respiratory Disease, IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
- Department of Internal Medicine and Pharmacology, University of Pavia, Pavia 27100, Italy
| | - M. Russo
- Department of Internal Medicine and Pharmacology, University of Pavia, Pavia 27100, Italy
| | - I. Giana
- Department of Internal Medicine and Pharmacology, University of Pavia, Pavia 27100, Italy
| | - A. Cascina
- Cardiothoracic and Vascular Department, Unit of Respiratory Disease, IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
- Department of Internal Medicine and Pharmacology, University of Pavia, Pavia 27100, Italy
| | - V. Conio
- Cardiothoracic and Vascular Department, Unit of Respiratory Disease, IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
- Department of Internal Medicine and Pharmacology, University of Pavia, Pavia 27100, Italy
| | - C. Primiceri
- Department of Thoracic Surgery, Azienda Ospedaliera Santi Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - G.M. Stella
- Cardiothoracic and Vascular Department, Unit of Respiratory Disease, IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
- Department of Internal Medicine and Pharmacology, University of Pavia, Pavia 27100, Italy
| | - A.G. Corsico
- Cardiothoracic and Vascular Department, Unit of Respiratory Disease, IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
- Department of Internal Medicine and Pharmacology, University of Pavia, Pavia 27100, Italy
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Khilnani GC, Tiwari P, Mittal S, Kulkarni AP, Chaudhry D, Zirpe KG, Todi SK, Mohan A, Hegde A, Jagiasi BG, Krishna B, Rodrigues C, Govil D, Pal D, Divatia JV, Sengar M, Gupta M, Desai M, Rungta N, Prayag PS, Bhattacharya PK, Samavedam S, Dixit SB, Sharma S, Bandopadhyay S, Kola VR, Deswal V, Mehta Y, Singh YP, Myatra SN. Guidelines for Antibiotics Prescription in Critically Ill Patients. Indian J Crit Care Med 2024; 28:S104-S216. [PMID: 39234229 PMCID: PMC11369928 DOI: 10.5005/jp-journals-10071-24677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 03/20/2024] [Indexed: 09/06/2024] Open
Abstract
How to cite this article: Khilnani GC, Tiwari P, Mittal S, Kulkarni AP, Chaudhry D, Zirpe KG, et al. Guidelines for Antibiotics Prescription in Critically Ill Patients. Indian J Crit Care Med 2024;28(S2):S104-S216.
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Affiliation(s)
- Gopi C Khilnani
- Department of Pulmonary, Critical Care and Sleep Medicine, PSRI Hospital, New Delhi, India
| | - Pawan Tiwari
- Department of Pulmonary, Critical Care and Sleep Medicine, AIIMS, New Delhi, India
| | - Saurabh Mittal
- Department of Pulmonary, Critical Care and Sleep Medicine, AIIMS, New Delhi, India
| | - Atul P Kulkarni
- Division of Critical Care Medicine, Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Dhruva Chaudhry
- Department of Pulmonary and Critical Care Medicine, University of Health Sciences, Rohtak, Haryana, India
| | - Kapil G Zirpe
- Department of Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | - Subhash K Todi
- Department of Critical Care, AMRI Hospital, Kolkata, West Bengal, India
| | - Anant Mohan
- Department of Pulmonary, Critical Care and Sleep Medicine, AIIMS, New Delhi, India
| | - Ashit Hegde
- Department of Medicine & Critical Care, P D Hinduja National Hospital, Mumbai, India
| | - Bharat G Jagiasi
- Department of Critical Care, Kokilaben Dhirubhai Ambani Hospital, Navi Mumbai, Maharashtra, India
| | - Bhuvana Krishna
- Department of Critical Care Medicine, St John's Medical College and Hospital, Bengaluru, India
| | - Camila Rodrigues
- Department of Microbiology, P D Hinduja National Hospital, Mumbai, India
| | - Deepak Govil
- Department of Critical Care and Anesthesia, Medanta – The Medicity, GuruGram, Haryana, India
| | - Divya Pal
- Department of Critical Care and Anesthesia, Medanta – The Medicity, GuruGram, Haryana, India
| | - Jigeeshu V Divatia
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Manju Sengar
- Department of Medical Oncology, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Mansi Gupta
- Department of Pulmonary Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Mukesh Desai
- Department of Immunology, Pediatric Hematology and Oncology Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Narendra Rungta
- Department of Critical Care & Anaesthesiology, Rajasthan Hospital, Jaipur, India
| | - Parikshit S Prayag
- Department of Transplant Infectious Diseases, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
| | - Pradip K Bhattacharya
- Department of Critical Care Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Srinivas Samavedam
- Department of Critical Care, Ramdev Rao Hospital, Hyderabad, Telangana, India
| | - Subhal B Dixit
- Department of Critical Care, Sanjeevan and MJM Hospital, Pune, Maharashtra, India
| | - Sudivya Sharma
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Susruta Bandopadhyay
- Department of Critical Care, AMRI Hospitals Salt Lake, Kolkata, West Bengal, India
| | - Venkat R Kola
- Department of Critical Care Medicine, Yashoda Hospitals, Hyderabad, Telangana, India
| | - Vikas Deswal
- Consultant, Infectious Diseases, Medanta - The Medicity, Gurugram, Haryana, India
| | - Yatin Mehta
- Department of Critical Care and Anesthesia, Medanta – The Medicity, GuruGram, Haryana, India
| | - Yogendra P Singh
- Department of Critical Care, Max Super Speciality Hospital, Patparganj, New Delhi, India
| | - Sheila N Myatra
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Wang PH, Shu CC, Sheu CC, Chang CL, Hsieh MH, Hsu WH, Chen MT, Ou WF, Wei YF, Yang TM, Lan CC, Wang CY, Lin CB, Lin MS, Wang YT, Lin CH, Liu SF, Cheng MH, Chen YF, Cheng WC, Peng CK, Chan MC, Chen CY, Jao LY, Wang YH, Chen CJ, Chen SP, Tsai YH, Cheng SL, Lin HC, Chien JY, Wang HC. Clinical Predictors of Nontuberculous Mycobacteria Lung Disease and Coisolates of Potential Pathogenic Microorganisms in Noncystic Fibrosis Bronchiectasis. Open Forum Infect Dis 2024; 11:ofae427. [PMID: 39145140 PMCID: PMC11322833 DOI: 10.1093/ofid/ofae427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 07/17/2024] [Indexed: 08/16/2024] Open
Abstract
Background In bronchiectasis, nontuberculous mycobacteria (NTM) lung disease (NTM-LD) is a well-known coexisting infection. However, microorganism coisolates and clinical NTM-LD predictors are poorly studied. Methods Patients with bronchiectasis diagnosed by means of computed tomography between January 2017 and June 2020 were screened, using the date of computed tomography as the index date. Those with a major bronchiectasis diagnosis in ≥2 follow-up visits after the index date were enrolled in the study, and NTM-LD occurrence and its association with pneumonia and hospitalization within 1 year were analyzed. Results Of the 2717 participants, 79 (2.9%) had NTM-LD diagnosed. The factors associated with NTM-LD included hemoptysis, postinfectious bronchiectasis, a tree-in-bud score ≥2, a modified Reiff score ≥4, and chronic obstructive pulmonary disease (adjusted odds ratios, 1.80, 2.36, 1.78, 2.95, and 0.51, respectively). Compared with patients in the non-NTM group, those with NTM-LD had higher rates of hospitalization (15.9% vs 32.9%; P < .001) and pneumonia (9.8% vs 20.3%; P = .003). Pseudomonas aeruginosa was the most common microorganism in those with NTM-LD and those in the non-NTM group (10.1% vs 7.8%; P = .40). However, compared with those in the non-NTM group, Acinetobacter baumannii and Escherichia coli were more prevalent in patients with NTM-LD (0.7% vs 3.8% [P = .03%] and 1.0% vs 3.8% [P = .05], respectively). Conclusions Postinfectious bronchiectasis with hemoptysis, higher radiological involvement, and a tree-in-bud pattern were associated with NTM-LD risk. The rate of A baumannii and E coli coisolation was higher in bronchiectasis populations with NTM-LD.
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Affiliation(s)
- Ping-Huai Wang
- Division of Thoracic Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chin-Chung Shu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chau-Chyun Sheu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chia-Ling Chang
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Meng-Heng Hsieh
- Department of Thoracic Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wu-Huei Hsu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung City, Taiwan
- Critical Medical Center, China Medical University Hospital, Taichung, Taiwan
| | - Ming-Tsung Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Fan Ou
- Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung City, Taiwan
| | - Yu-Feng Wei
- Department of Internal Medicine, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Tsung-Ming Yang
- Division of Pulmonary and Critical Care Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chou-Chin Lan
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan, Republic of China
| | - Cheng-Yi Wang
- Department of Internal Medicine, Cardinal Tien Hospital and School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Chih-Bin Lin
- Division of Pulmonary Medicine, Department of Internal Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- School of Medicine, Tzu-Chi University, Hualien, Taiwan
| | - Ming-Shian Lin
- Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi City, Taiwan
| | - Yao-Tung Wang
- Division of Pulmonary Medicine, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Ching-Hsiung Lin
- Department of Internal Medicine, Division of Chest Medicine, Changhua Christian Hospital, Changhua, Taiwan
- Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung, Taiwan
- PhD Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan
- Department of Recreation and Holistic Wellness, MingDao University, Changhua, Taiwan
| | - Shih-Feng Liu
- Division of Pulmonary & Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
- Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Meng-Hsuan Cheng
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Respiratory Therapy, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yen-Fu Chen
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin branch, Yun-Lin, Taiwan
- Thoracic Medicine Center, Department of Medicine and Surgery, National Taiwan University Hospital Yun-Lin branch, Yun-Lin, Taiwan
| | - Wen-Chien Cheng
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung City, Taiwan
| | - Chung-Kan Peng
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Department of Medical Planning, Medical Affairs Bureau Ministry of National Defense, Taipei City, Taiwan
| | - Ming-Cheng Chan
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung City, Taiwan
- School of Post Baccalaureate Medicine, College of Medicine National Chung Hsing University, Taichung City, Taiwan
| | - Ching-Yi Chen
- Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Lun-Yu Jao
- School of Medicine, Tzu-Chi University, Hualien, Taiwan, Republic of China
| | - Ya-Hui Wang
- Medical Research Center, Cardinal Tien Hospital and School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Chi-Jui Chen
- Division of Pulmonary Medicine, Department of Internal Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Shih-Pin Chen
- Division of Pulmonary Medicine, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Yi-Hsuan Tsai
- Division of Pulmonary & Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
- Department of Pulmonary Medicine, Lee's Clinic, Pingtung, Taiwan
| | - Shih-Lung Cheng
- Division of Thoracic Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Chemical Engineering and Materials Science, Yuan-Ze University, Taoyuan City, Taiwan
| | - Horng-Chyuan Lin
- Department of Thoracic Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Respiratory Therapy, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
| | - Jung-Yien Chien
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hao-Chien Wang
- College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Medicine National Taiwan University Cancer Center, National Taiwan University College of Medicine, Taipei, Taiwan
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Long BQ, Long Q, Lai MY, Yang L, You FR, Guo HW. Mycobacterium marinum cutanous infection misdiagnosed as sporotrichosis in a patient with systemic lupus erythematosus: A case report. Heliyon 2024; 10:e34444. [PMID: 39113973 PMCID: PMC11305167 DOI: 10.1016/j.heliyon.2024.e34444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 06/17/2024] [Accepted: 07/09/2024] [Indexed: 08/10/2024] Open
Abstract
Mycobacterium marinum(M. marinum ), a slow-growing bacterium in freshwater and seawater, can cause cutanous and extracutaneous infections. A fisher-woman with systemic lupus erythematosus (SLE) presented with chronic polymorphic rashes in a lymphangitic pattern was initially misdiagnosed as sporotrichosis. The final diagnosis of M. marinum and Candida dubliniensis co-infection was confirmed based on the skin histopathology, pustule culture, MetaCAP sequencing and effective antibiotic combination treatments.
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Affiliation(s)
- Bo-quan Long
- Dermatology Department of The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524003, China
| | - Qi Long
- Dermatology Department of The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524003, China
| | - Mei-yan Lai
- Dermatology Department of The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524003, China
| | - Lan Yang
- Dermatology Department of The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524003, China
| | - Fu-rong You
- Dermatology Department of The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524003, China
| | - Hong-wei Guo
- Dermatology Department of The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524003, China
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76
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Harper LJ, Farver CF, Yadav R, Culver DA. A framework for exclusion of alternative diagnoses in sarcoidosis. J Autoimmun 2024:103288. [PMID: 39084998 DOI: 10.1016/j.jaut.2024.103288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 07/02/2024] [Accepted: 07/13/2024] [Indexed: 08/02/2024]
Abstract
Sarcoidosis is a multisystem granulomatous syndrome that arises from a persistent immune response to a triggering antigen(s). There is no "gold standard" test or algorithm for the diagnosis of sarcoidosis, making the diagnosis one of exclusion. The presentation of the disease varies substantially between individuals, in both the number of organs involved, and the manifestations seen in individual organs. These qualities dictate that health care providers diagnosing sarcoidosis must consider a wide range of possible alternative diagnoses, from across a range of presentations and medical specialties (infectious, inflammatory, cardiac, neurologic). Current guideline-based diagnosis of sarcoidosis recommends fulfillment of three criteria: 1) compatible clinical presentation and/or imaging 2) demonstration of granulomatous inflammation by biopsy (when possible) and, 3) exclusion of alternative causes, but do not provide guidance on standardized strategies for exclusion of alternative diagnoses. In this review, we provide a summary of the most common differential diagnoses for sarcoidosis involvement of lung, eye, skin, central nervous system, heart, liver, and kidney. We then propose a framework for testing to exclude alternative diagnoses based on pretest probability of sarcoidosis, defined as high (typical findings with sarcoidosis involvement confirmed in another organ), moderate (typical findings in a single organ), or low (atypical/findings suggesting of an alternative diagnosis). This work highlights the need for informed and careful exclusion of alternative diagnoses in sarcoidosis.
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Affiliation(s)
- Logan J Harper
- Department of Pulmonary and Critical Care Medicine, Integrated Hospital Care Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Carol F Farver
- Department of Pathology, Cleveland Clinic, Cleveland, OH, USA
| | - Ruchi Yadav
- Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Daniel A Culver
- Department of Pulmonary and Critical Care Medicine, Integrated Hospital Care Institute, Cleveland Clinic, Cleveland, OH, USA
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77
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Hu Y, Li T, Liu W, Zhu D, Feng X, Chen Y, Zheng H. Prevalence and antimicrobial susceptibility pattern of Mycobacterium abscessus complex isolates in Chongqing, Southwest China. Heliyon 2024; 10:e34546. [PMID: 39113955 PMCID: PMC11305262 DOI: 10.1016/j.heliyon.2024.e34546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 07/10/2024] [Accepted: 07/11/2024] [Indexed: 08/10/2024] Open
Abstract
Objectives To investigate the prevalence of Mycobacterium abscessus complex (MABC), drug resistance characteristics, and the relationship between clarithromycin (CLA) susceptibility and MABC genotype in Chongqing, China. Methods A total of 434 NTM patient isolates were collected between October 2018 and October 2019. Isolates confirmed to be non-tuberculous mycobacteria (NTM) were tested for minimal inhibitory concentrations of antimicrobial agents. In addition, rrl and erm(41) gene sequences were used to analyze the acquired macrolide resistance and inducible macrolide resistance. Results Overall, 17 different NTM species were detected, of which M. abscessus (22.6 %, 91/403) was most prevalent. Amikacin, CLA, azithromycin and cefoxitin exhibited potent activities against MABC organisms, but no significant differences were observed in drug resistance rates between M. abscessus and M. massiliense (P > 0.05). On day 3 of culture, the acquired resistance rate against CLA was 7.4 % (9/121). Of 41 MABC isolates with inducible CLA resistant, 95.1 % (39/41) isolates belonged to the erm(41) T28 sequevar, while the remaining 4.9 % (2/41) possessed the M. massiliense genotype. All erm(41) C28 sequevar isolates were sensitive to CLA on day3 and day 14 of culture. Meanwhile, of the 5 erm(41) T28 isolates with acquired resistance, all possessed rrl 2058/2059 mutations, including 3 isolates with A2058C mutation and 2 isolates with A2059G mutation. While 2 of the 4 M. massiliense isolates with acquired resistance possessed the A2059G mutation, and one isolate possessed the A2058G mutation. Conclusion Erm(41) and rrl gene could serve as useful markers for predicting macrolide susceptibility of MABC complex isolates.
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Affiliation(s)
- Yan Hu
- Tuberculosis Reference Laboratory, Chongqing Tuberculosis Control Institute, 400050, China
| | - Tongxin Li
- Department of Clinical Laboratory, Chongqing Public Health Medical Center, Chongqing, 400036, China
| | - Wenguo Liu
- Tuberculosis Reference Laboratory, Chongqing Tuberculosis Control Institute, 400050, China
| | - Damian Zhu
- Tuberculosis Reference Laboratory, Chongqing Tuberculosis Control Institute, 400050, China
| | - Xin Feng
- Tuberculosis Reference Laboratory, Chongqing Tuberculosis Control Institute, 400050, China
| | - Yaokai Chen
- Department of Infectious Diseases, Chongqing Public Health Medical Center, Chongqjing, 400036, China
| | - Huiwen Zheng
- Laboratory of Respiratory Diseases, Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, National Center for Children’s Health, 100045, China
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Evans I, Weimann A, Baird T, Haworth C, Floto A. Mycobacterium abscessus treatment outcomes in cystic fibrosis: A single centre experience. J Cyst Fibros 2024:S1569-1993(24)00801-4. [PMID: 39068106 DOI: 10.1016/j.jcf.2024.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 07/22/2024] [Accepted: 07/22/2024] [Indexed: 07/30/2024]
Affiliation(s)
- Ieuan Evans
- Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia; Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.
| | - Aaron Weimann
- Molecular Immunity Unit, Department of Medicine, University of Cambridge, Cambridge, UK; Heart Lung Research Institute, University of Cambridge, Cambridge, UK
| | - Timothy Baird
- Department of Thoracic Medicine, Sunshine Coast University Hospital, Queensland, Australia
| | - Charles Haworth
- Cambridge Centre for Lung Infection (CCLI), Royal Papworth Hospital, Cambridge, UK; Heart Lung Research Institute, University of Cambridge, Cambridge, UK
| | - Andres Floto
- Molecular Immunity Unit, Department of Medicine, University of Cambridge, Cambridge, UK; Cambridge Centre for Lung Infection (CCLI), Royal Papworth Hospital, Cambridge, UK; Heart Lung Research Institute, University of Cambridge, Cambridge, UK
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79
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López-Medrano F, Carver PL, Rutjanawech S, Aranha-Camargo LF, Fernandes R, Belga S, Daniels SA, Mueller NJ, Burkhard S, Theodoropoulos NM, Postma DF, van Duijn PJ, Arnaiz de Las Revillas F, Pérez Del Molino-Bernal C, Hand J, Lowe A, Bodro M, Vanino E, Fernández-Cruz A, Ramos-Martínez A, Makek MJ, Bou Mjahed R, Manuel O, Kamar N, Calvo-Cano A, Rueda-Carrasco L, Muñoz P, Álvarez-Uría A, Pérez-Recio S, Sabé N, Rodríguez-Álvarez R, Silva JT, Mularoni A, Vidal E, Alonso-Titos J, Del Rosal T, Classen AY, Goss CW, Agarwal M, Mejía-Chew C. Clinical Management and Outcomes of Nontuberculous Mycobacterial Infections in Solid Organ Transplant Recipients: A Multinational Case-control Study. Transplantation 2024:00007890-990000000-00830. [PMID: 39049076 DOI: 10.1097/tp.0000000000005156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
BACKGROUND The management and outcomes of nontuberculous mycobacterial (NTM) infections in solid organ transplant (SOT) recipients are poorly characterized. We aimed to describe the management and 1-y mortality of these patients. METHODS Retrospective, multinational, 1:2 matched case-control study included SOT recipients aged 12 y old or older diagnosed with NTM infection between January 1, 2008, and December 31, 2018. Controls were matched on transplanted organs, NTM treatment center, and posttransplant survival at least equal to the time to NTM diagnosis. The primary aim was 1-y mortality after NTM diagnosis. Differences between cases and controls were compared using the log-rank test, and Cox regression models were used to identify factors associated with mortality at 12 mo among cases. RESULTS In 85 patients and 169 controls, the median age at the time of SOT was 54 y (interquartile range, 40-62 y), 59% were men, and the lungs were the most common site of infection after SOT (57.6%). One-year mortality was significantly higher in cases than in controls (20% versus 3%; P < 0.001), and higher mortality was associated with lung transplantation (hazard ratio 3.27; 95% confidence interval [1.1-9.77]; P = 0.034). Median time (interquartile range) from diagnosis to treatment initiation (20 [4-42] versus 11 [3-21] d) or the reduction of net immunosuppression (36% versus 45%, hazard ratio 1.35 [95% CI, 0.41-4.43], P = 0.618) did not differ between survivors and those who died. CONCLUSIONS NTM disease in SOT recipients is associated with a higher mortality risk, especially among lung transplant recipients. Time to NTM treatment and reduction in net immunosuppression were not associated with mortality.
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Affiliation(s)
- Francisco López-Medrano
- Unit of Infectious Diseases, University Hospital 12 de Octubre, Instituto de Investigación del Hospital 12 de Octubre (imas12), School of Medicine, Universidad Complutense, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC; CB21/13/00009), Instituto de Salud Carlos III, Madrid, Spain
| | - Peggy L Carver
- Department of Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI
| | - Sasinuch Rutjanawech
- Department of Infectious Diseases, Washington University School of Medicine, St. Louis, MO
| | - Luis F Aranha-Camargo
- Department of Infectious Diseases, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Ruan Fernandes
- Department of Infectious Diseases, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Sara Belga
- Department of Infectious Diseases, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada
| | - Shay-Anne Daniels
- Department of Infectious Diseases, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada
| | - Nicolas J Mueller
- Department of Infectious Diseases, University Hospital Zurich, Zurich, Switzerland
| | - Sara Burkhard
- Department of Infectious Diseases, University Hospital Zurich, Zurich, Switzerland
| | - Nicole M Theodoropoulos
- Department of Infectious Diseases, University of Massachusetts Chan Medical School, Worcester, MA
| | - Douwe F Postma
- Department of Internal Medicine and Infectious Diseases, Groningen, the Netherlands
| | - Pleun J van Duijn
- Certe Laboratory for Infectious Diseases, Department of Clinical Microbiology, Groningen, the Netherlands
| | - Francisco Arnaiz de Las Revillas
- Infectious Diseases and Microbiology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Cantabria, Spain
- CIBERINFEC (CB21/13/00068), ISCIII, Madrid, Spain
| | - Concepción Pérez Del Molino-Bernal
- Infectious Diseases and Microbiology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Cantabria, Spain
- CIBERINFEC (CB21/13/00068), ISCIII, Madrid, Spain
| | - Jonathan Hand
- Department of Infectious Diseases, Ochsner Medical Center, New Orleans, LA
| | - Adam Lowe
- Department of Infectious Diseases, Ochsner Medical Center, New Orleans, LA
| | - Marta Bodro
- Department of Infectious Diseases, Hospital Clinic Barcelona, Barcelona, Spain
| | - Elisa Vanino
- Infectious Diseases Unit, IRCCS Policlinico Sant'Orsola, University of Bologna, Bologna, Italy
- Infectious Diseases Unit, Ravenna Hospital, AUSL Romagna, Ravenna, Italy
| | - Ana Fernández-Cruz
- Department of Infectious Diseases, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Antonio Ramos-Martínez
- Department of Infectious Diseases, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Mateja Jankovic Makek
- Department of Infectious Diseases, School of Medicine, University of Zagreb, University Hospital Center Zagreb, Zagreb, Croatia
| | - Ribal Bou Mjahed
- Department of Infectious Diseases, School of Medicine, University of Zagreb, University Hospital Center Zagreb, Zagreb, Croatia
| | - Oriol Manuel
- Department of Infectious Diseases, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Nassim Kamar
- Department of Nephrology and Organs Transplantation, Toulouse Rangueil University, INSERM UMR 1291, Toulouse Institute for Infectious and Inflammatory Disease (Infinity), Paul Sabatier University, Toulouse, France
| | - Antonia Calvo-Cano
- Infectious Disease Department, University Hospital Badajoz, Badajoz, Spain
| | | | - Patricia Muñoz
- Departamento de Medicina, Hospital Gregorio Marañón, Biomedical Research Institute Gregorio Marañon (IiSGM), CIBERES, Universidad Complutense, Madrid, Spain
| | - Ana Álvarez-Uría
- Departamento de Medicina, Hospital Gregorio Marañón, Biomedical Research Institute Gregorio Marañon (IiSGM), CIBERES, Universidad Complutense, Madrid, Spain
| | - Sandra Pérez-Recio
- Tuberculosis Unit, Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge, Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Núria Sabé
- Tuberculosis Unit, Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge, Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - José Tiago Silva
- Unit of Infectious Diseases, University Hospital 12 de Octubre, Instituto de Investigación del Hospital 12 de Octubre (imas12), School of Medicine, Universidad Complutense, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC; CB21/13/00009), Instituto de Salud Carlos III, Madrid, Spain
| | - Alessandra Mularoni
- Department of Infectious Diseases, IRCC-ISMETT, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy
| | - Elisa Vidal
- Department of Infectious Diseases, Reina Sofía University Hospital, Córdoba, Spain
| | - Juana Alonso-Titos
- Department of Nephrology, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Teresa Del Rosal
- Department of Pediatrics, Hospital Universitario La Paz, Madrid, Spain
| | - Annika Y Classen
- Department I for Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany
| | - Charles W Goss
- Department of Infectious Diseases, Washington University School of Medicine, St. Louis, MO
| | - Mansi Agarwal
- Department of Infectious Diseases, Washington University School of Medicine, St. Louis, MO
| | - Carlos Mejía-Chew
- Department of Infectious Diseases, Washington University School of Medicine, St. Louis, MO
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Shaw TD, Krasnodembskaya AD, Schroeder GN, Doherty DF, Silva JD, Tandel SM, Su Y, Butler D, Ingram RJ, O'Kane CM. Human mesenchymal stromal cells inhibit Mycobacterium avium replication in clinically relevant models of lung infection. Thorax 2024; 79:778-787. [PMID: 38508718 PMCID: PMC11287638 DOI: 10.1136/thorax-2023-220819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 02/27/2024] [Indexed: 03/22/2024]
Abstract
INTRODUCTION Novel therapeutic strategies are urgently needed for Mycobacterium avium complex pulmonary disease (MAC-PD). Human mesenchymal stromal cells (MSCs) can directly inhibit MAC growth, but their effect on intracellular bacilli is unknown. We investigated the ability of human MSCs to reduce bacterial replication and inflammation in MAC-infected macrophages and in a murine model of MAC-PD. METHODS Human monocyte-derived macrophages (MDMs) were infected with M. avium Chester strain and treated with human bone marrow-derived MSCs. Intracellular and extracellular colony-forming units (CFUs) were counted at 72 hours. Six-week-old female balb/c mice were infected by nebulisation of M. avium Chester. Mice were treated with 1×106 intravenous human MSCs or saline control at 21 and 28 days post-infection. Lungs, liver and spleen were harvested 42 days post-infection for bacterial counts. Cytokines were quantified by ELISA. RESULTS MSCs reduced intracellular bacteria in MDMs over 72 hours (median 35% reduction, p=0.027). MSC treatment increased extracellular concentrations of prostaglandin E2 (PGE2) (median 10.1-fold rise, p=0.002) and reduced tumour necrosis factor-α (median 28% reduction, p=0.025). Blocking MSC PGE2 production by cyclo-oxygenase-2 (COX-2) inhibition with celecoxib abrogated the antimicrobial effect, while this was restored by adding exogenous PGE2. MSC-treated mice had lower pulmonary CFUs (median 18% reduction, p=0.012), but no significant change in spleen or liver CFUs compared with controls. CONCLUSION MSCs can modulate inflammation and reduce intracellular M. avium growth in human macrophages via COX-2/PGE2 signalling and inhibit pulmonary bacterial replication in a murine model of chronic MAC-PD.
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Affiliation(s)
- Timothy D Shaw
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University, Belfast, UK
| | | | - Gunnar N Schroeder
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University, Belfast, UK
| | - Declan F Doherty
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University, Belfast, UK
| | - Johnatas Dutra Silva
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University, Belfast, UK
| | - Shikha M Tandel
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University, Belfast, UK
| | - Yue Su
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University, Belfast, UK
| | - David Butler
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University, Belfast, UK
| | - Rebecca J Ingram
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University, Belfast, UK
| | - Cecilia M O'Kane
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University, Belfast, UK
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81
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Ren H, Xiao Y, Tang B, Shi Y, Zeng Z, Qiu X, Ding Y, Xiao R. The Price of Beauty: A Literature Review on Non-Tuberculous Mycobacteria Infection After Cosmetic Procedures. Aesthet Surg J 2024; 44:NP574-NP584. [PMID: 38591553 DOI: 10.1093/asj/sjae076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 03/22/2024] [Accepted: 03/26/2024] [Indexed: 04/10/2024] Open
Abstract
Non-tuberculous mycobacteria (NTM) infection of the skin and soft tissues is a complication of cosmetic procedures. The incidence of cutaneous NTM infections has increased significantly as aesthetic operations have become more commonplace. With the rise of cosmetic tourism, the geographic expansion of NTM infections is a major concern. Due to the unique pathogenesis of NTM infections, diagnosis and treatment remain significant challenges for clinicians. Clinical management relies on a combination of antibiotic therapy with drug susceptibility testing and appropriate surgical debridement. Some new drugs, photodynamic therapy, and bacteriophage therapy have been developed in recent years, and may improve the aesthetic outcomes. This review summarizes the cosmetic procedures prone to NTM infections in recent years and their clinical features. We propose a 2-stage treatment procedure, including a hospitalization phase and a follow-up phase. We aim to increase the alertness of clinicians to NTM infections for timely detection and treatment. LEVEL OF EVIDENCE: 3
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82
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Lin WH, Yao C, Mei L, Wang DP, Bao XD, Liu SS. Screening, epidemic trends and drug sensitivity analysis of nontuberculous mycobacteria in a local area of China. Am J Transl Res 2024; 16:3298-3305. [PMID: 39114690 PMCID: PMC11301460 DOI: 10.62347/majy5046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 07/02/2024] [Indexed: 08/10/2024]
Abstract
OBJECTIVE To analyze the isolation rate, prevalence trends, species distribution, and drug sensitivity of non-tuberculous mycobacteria (NTM) in Anhui Province, providing a reference for diagnosis and treatment strategies. METHODS Specimens from suspected mycobacterial infection patients at Anhui Chest Hospital (including outpatients and inpatients) from January 2021 to December 2023 were cultured. Identified NTM strains were analyzed for species distribution and drug sensitivity. RESULTS Of 10,519 mycobacteria strains cultured, 1,589 were NTM (15.11%). The top four species were Mycobacterium intracellulare (75.36%), Mycobacterium abscessus (11.78%), Mycobacterium kansasii (7.09%), and Mycobacterium avium (2.85%). NTM strains showed high sensitivity to amikacin and clarithromycin (≥90%) and significant sensitivity to rifabutin, moxifloxacin, and rifampicin (89.03%-79.61%). They exhibited high resistance to imipenem/cilastatin, sulfamethoxazole, minocycline, and doxycycline (≥95%). CONCLUSION NTM isolation rates in Anhui have remained stable, with the predominant species being M. intracellulare, M. kansasii, M. abscessus, and M. avium. NTM strains are highly sensitive to amikacin, clarithromycin, rifabutin, moxifloxacin, and rifampicin. These findings can guide diagnosis, treatment strategies, and drug selection for NTM disease in Anhui Province.
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Affiliation(s)
- Wen-Hong Lin
- Department of Tuberculosis, Anhui Chest HospitalHefei, Anhui, P. R. China
| | - Chao Yao
- Department of Tuberculosis, Anhui Chest HospitalHefei, Anhui, P. R. China
| | - Lin Mei
- Department of Tuberculosis, Anhui Chest HospitalHefei, Anhui, P. R. China
| | - Dong-Ping Wang
- Department of Laboratory, Anhui Chest HospitalHefei, Anhui, P. R. China
| | - Xun-Di Bao
- Department of Laboratory, Anhui Chest HospitalHefei, Anhui, P. R. China
| | - Sheng-Sheng Liu
- Department of Tuberculosis, Anhui Chest HospitalHefei, Anhui, P. R. China
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Frajman A, Izhakian S, Mekiten O, Hadar O, Lichtenstadt A, Hajaj C, Shchori S, Heching M, Rosengarten D, Kramer MR. Phenotypical characteristics of nontuberculous mycobacterial infection in patients with bronchiectasis. Respir Res 2024; 25:278. [PMID: 39010067 PMCID: PMC11251292 DOI: 10.1186/s12931-024-02904-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Accepted: 07/03/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND The global mortality and morbidity rates of bronchiectasis patients due to nontuberculous mycobacteria (NTM) pulmonary infection are on a concerning upward trend. The aims of this study to identify the phenotype of NTM-positive individuals with bronchiectasis. METHODS A retrospective single-center observational study was conducted in adult patients with bronchiectasis who underwent bronchoscopy in 2007-2020. Clinical, laboratory, pulmonary function, and radiological data were compared between patients with a positive or negative NTM culture. RESULTS Compared to the NTM-negative group (n=677), the NTM-positive group (n=94) was characterized (P ≤0.05 for all) by older age, greater proportion of females, and higher rates of gastroesophageal reflux disease and muco-active medication use; lower body mass index, serum albumin level, and lymphocyte and eosinophil counts; lower values of forced expiratory volume in one second, forced vital capacity, and their ratio, and lower diffusing lung capacity for carbon monoxide; higher rates of bronchiectasis in both lungs and upper lobes and higher number of involved lobes; and more exacerbations in the year prior bronchoscopy. On multivariate analysis, older age (OR 1.05, 95% CI 1.02-1.07, P=0.001), lower body mass index (OR 1.16, 95% CI 1.16-1.07, P <0.001), and increased number of involved lobes (OR 1.26, 95% CI 1.01-1.44, P=0.04) were associated with NTM infection. CONCLUSIONS Patients with bronchiectasis and NTM pulmonary infection are more likely to be older and female with more severe clinical, laboratory, pulmonary function, and radiological parameters than those without NTM infection. This phenotype can be used for screening patients with suspected NTM disease.
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Affiliation(s)
- Assaf Frajman
- Pulmonary Institute, Rabin Medical Center - Beilinson Hospital, 39 Jabotinksy St, Petach Tikva, 4941492, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801, Israel
| | - Shimon Izhakian
- Pulmonary Institute, Rabin Medical Center - Beilinson Hospital, 39 Jabotinksy St, Petach Tikva, 4941492, Israel.
- Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801, Israel.
| | - Ori Mekiten
- Pulmonary Institute, Rabin Medical Center - Beilinson Hospital, 39 Jabotinksy St, Petach Tikva, 4941492, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801, Israel
| | - Ori Hadar
- Pulmonary Institute, Rabin Medical Center - Beilinson Hospital, 39 Jabotinksy St, Petach Tikva, 4941492, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801, Israel
| | - Ariel Lichtenstadt
- The Adelson School of Medicine, Ariel University, Ariel, 4076414, Israel
| | - Chen Hajaj
- Industrial Engineering and Management, Ariel University, Ariel, 40700, Israel
| | - Shon Shchori
- Industrial Engineering and Management, Ariel University, Ariel, 40700, Israel
| | - Moshe Heching
- Pulmonary Institute, Rabin Medical Center - Beilinson Hospital, 39 Jabotinksy St, Petach Tikva, 4941492, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801, Israel
| | - Dror Rosengarten
- Pulmonary Institute, Rabin Medical Center - Beilinson Hospital, 39 Jabotinksy St, Petach Tikva, 4941492, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801, Israel
| | - Mordechai R Kramer
- Pulmonary Institute, Rabin Medical Center - Beilinson Hospital, 39 Jabotinksy St, Petach Tikva, 4941492, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801, Israel
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84
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Becken B, Dousa KM, Johnson JL, Holland SM, Bonomo RA. Dual β-lactam for treatment of pulmonary Mycobacterium abscessus in a child. Antimicrob Agents Chemother 2024; 68:e0031924. [PMID: 38757973 PMCID: PMC11232406 DOI: 10.1128/aac.00319-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 04/18/2024] [Indexed: 05/18/2024] Open
Abstract
Treatment of Mycobacterium abscessus infection presents significant challenges, exacerbated by the emergence of macrolide-resistant strains that necessitate the use of multiple antimicrobials in combination and carry the potential for significant toxic effects. Select dual beta-lactam combinations, with or without beta-lactamase inhibitors, have been shown to be highly active in vitro. Herein, we describe a 6-year-old child with underlying mild bilateral lower lobe cylindrical bronchiectatic lung disease who developed pulmonary Mycobacterium abscessus infection and was treated with a multi-drug regimen including two β-lactam antibiotics, achieving both early clinical and microbiological cure. This case highlights the potential benefit of dual β-lactam therapy for the treatment of drug-resistant Mycobacterium abscessus infection.
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Affiliation(s)
- Bradford Becken
- Division of Pediatric Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Khalid M. Dousa
- Department of Internal Medicine and Infectious Diseases, Louis Stokes Cleveland VA Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - John L. Johnson
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Steven M. Holland
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Robert A. Bonomo
- Department of Internal Medicine and Infectious Diseases, Louis Stokes Cleveland VA Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Internal Medicine, CWRU-Cleveland VAMC Center for Antimicrobial Resistance and Epidemiology (Case VA CARES), Cleveland, Ohio, USA
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85
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Li Y, Feng Y, Li D, Shi D, Chen G. A Rapid PCR-Based Diagnostic Method for Skin Infection with Mycobacterium marinum. Infect Drug Resist 2024; 17:2833-2851. [PMID: 39005849 PMCID: PMC11246082 DOI: 10.2147/idr.s463798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 06/29/2024] [Indexed: 07/16/2024] Open
Abstract
Objective The increasing incidence of chronic skin infections caused by Mycobacterium marinum, coupled with the time-consuming and low detection rates nature of traditional culture and histological-based diagnostic methods, underscores the need for an expedited approach. The study aims to develop a rapid and efficient method for detecting M. marinum with PCR technology. Methods We designed four pairs of primers based on DNA sequences from GeneBank and prior studies, we utilized both PCR and Real-time PCR to identify M. marinum. Specificity and sensitivity assessments were conducted in vitro by DNAs extracted from M. marinum and other bacterial or fungal cultures. Further validation was performed through the implementation of a mouse skin infection model to optimize and confirm the efficacy of the detection method in both fresh and paraffin-embedded skin tissues. The same PCR testing system was further confirmed with paraffin-embedded skin tissues samples from patients as well. Results The results of the study indicate promising outcomes for the four-pair primers system. It demonstrated 100% sensitivity in detecting M. marinum from purified cultures, including typical strains and nine clinical isolates, while achieving a specificity of 100%. This specificity was evidenced by the absence of PCR products from 12 bacterial species, 12 fungi species, and six other non-tuberculous mycobacterium (NTM) species. In the animal model, the PCR assay exhibited high detection efficacy for both infected fresh tissues and paraffin-embedded tissues, with a slight superiority observed in fresh tissues. However, the PCR assay exhibited high detection efficacy for clinical paraffin-embedded tissues. These findings collectively underscore the robust detection capabilities of our four-pair primers in both in vitro and in vivo settings. Conclusion A sensitive and highly specific rapid detection system has been successfully developed that can be used to detect M. marinum in both infected fresh tissues and paraffin-embedded tissues.
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Affiliation(s)
- Yanan Li
- Department of Dermatology, Affiliated Hospital of Qingdao University, Qingdao, People’s Republic of China
| | - Yahui Feng
- The Laboratory of Medical Mycology, Jining No. 1 People’s Hospital, Jining, Shandong, People’s Republic of China
| | - Dongmei Li
- Department of Microbiology & Immunology, Georgetown University Medical Center, Washington, DC, USA
| | - Dongmei Shi
- The Laboratory of Medical Mycology, Jining No. 1 People’s Hospital, Jining, Shandong, People’s Republic of China
- Department of Dermatology, Jining No.1 People’s Hospital, Jining, Shandong, People’s Republic of China
| | - Guanzhi Chen
- Department of Dermatology, Affiliated Hospital of Qingdao University, Qingdao, People’s Republic of China
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Wetzstein N, Diricks M, Anton TB, Andres S, Kuhns M, Kohl TA, Schwarz C, Lewin A, Kehrmann J, Kahl BC, Schmidt A, Zimmermann S, Jansson MK, Baron SA, Schulthess B, Hogardt M, Friesen I, Niemann S, Wichelhaus TA. Clinical and genomic features of Mycobacterium avium complex: a multi-national European study. Genome Med 2024; 16:86. [PMID: 38982539 PMCID: PMC11232273 DOI: 10.1186/s13073-024-01359-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 06/28/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND The Mycobacterium avium complex (MAC) comprises the most frequent non-tuberculous mycobacteria (NTM) in Central Europe and currently includes twelve species. M. avium (MAV), M. intracellulare subsp. intracellulare (MINT), and M. intracellulare subsp. chimaera (MCH) are clinically most relevant. However, the population structure and genomic landscape of MAC linked with potential pathobiological differences remain little investigated. METHODS Whole genome sequencing (WGS) was performed on a multi-national set of MAC isolates from Germany, France, and Switzerland. Phylogenetic analysis was conducted, as well as plasmids, resistance, and virulence genes predicted from WGS data. Data was set into a global context with publicly available sequences. Finally, detailed clinical characteristics were associated with genomic data in a subset of the cohort. RESULTS Overall, 610 isolates from 465 patients were included. The majority could be assigned to MAV (n = 386), MCH (n = 111), and MINT (n = 77). We demonstrate clustering with less than 12 SNPs distance of isolates obtained from different patients in all major MAC species and the identification of trans-European or even trans-continental clusters when set into relation with 1307 public sequences. However, none of our MCH isolates clustered closely with the heater-cooler unit outbreak strain Zuerich-1. Known plasmids were detected in MAV (325/1076, 30.2%), MINT (62/327, 19.0%), and almost all MCH-isolates (457/463, 98.7%). Predicted resistance to aminoglycosides or macrolides was rare. Overall, there was no direct link between phylogenomic grouping and clinical manifestations, but MCH and MINT were rarely found in patients with extra-pulmonary disease (OR 0.12 95% CI 0.04-0.28, p < 0.001 and OR 0.11 95% CI 0.02-0.4, p = 0.004, respectively) and MCH was negatively associated with fulfillment of the ATS criteria when isolated from respiratory samples (OR 0.28 95% CI 0.09-0.7, p = 0.011). With 14 out of 43 patients with available serial isolates, co-infections or co-colonizations with different strains or even species of the MAC were frequent (32.6%). CONCLUSIONS This study demonstrates clustering and the presence of plasmids in a large proportion of MAC isolates in Europe and in a global context. Future studies need to urgently define potential ways of transmission of MAC isolates and the potential involvement of plasmids in virulence.
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Affiliation(s)
- Nils Wetzstein
- Department of Internal Medicine, Infectious Diseases, Goethe University, University Hospital, Theodor-Stern-Kai 7, FrankfurtFrankfurt Am Main, 60590, Germany.
- Molecular and Experimental Mycobacteriology, Research Center Borstel, Borstel, Germany.
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Borstel, Germany.
| | - Margo Diricks
- Molecular and Experimental Mycobacteriology, Research Center Borstel, Borstel, Germany
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Borstel, Germany
| | - Thomas B Anton
- Department of Internal Medicine, Infectious Diseases, Goethe University, University Hospital, Theodor-Stern-Kai 7, FrankfurtFrankfurt Am Main, 60590, Germany
| | - Sönke Andres
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Borstel, Germany
- National and WHO Supranational Reference Laboratory for Mycobacteria, Research Center Borstel, Leibniz Lung Center, Borstel, Germany
| | - Martin Kuhns
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Borstel, Germany
- National and WHO Supranational Reference Laboratory for Mycobacteria, Research Center Borstel, Leibniz Lung Center, Borstel, Germany
| | - Thomas A Kohl
- Molecular and Experimental Mycobacteriology, Research Center Borstel, Borstel, Germany
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Borstel, Germany
| | - Carsten Schwarz
- Division of Cystic Fibrosis, CF Center Westbrandenburg, Campus Potsdam, Klinikum Potsdam, Potsdam, Germany
| | - Astrid Lewin
- Unit Mycotic and Parasitic Agents and Mycobacteria, Robert Koch Institute, Berlin, Germany
| | - Jan Kehrmann
- Institute of Medical Microbiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Barbara C Kahl
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
| | - Annika Schmidt
- Interfaculty Institute of Microbiology and Infection Medicine Tübingen, Institute for Medical Microbiology and Hygiene, University Hospital Tübingen, Tübingen, Germany
| | - Stefan Zimmermann
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Heidelberg, Germany
| | - Moritz K Jansson
- Institute of Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Rostock, Germany
| | - Sophie A Baron
- Faculté de Médecine Et de Pharmacie, IRD, APHM, Aix Marseille Univ, MEPHI, IHU Méditerranée Infection, Marseille, France
| | - Bettina Schulthess
- National Reference Laboratory for Mycobacteria, Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - Michael Hogardt
- Institute of Medical Microbiology and Infection Control, Goethe University, University Hospital, FrankfurtFrankfurt Am Main, Germany
- German National Consiliary Laboratory On Cystic Fibrosis Bacteriology, Frankfurt Am Main, Germany
| | - Inna Friesen
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Borstel, Germany
- National and WHO Supranational Reference Laboratory for Mycobacteria, Research Center Borstel, Leibniz Lung Center, Borstel, Germany
| | - Stefan Niemann
- Molecular and Experimental Mycobacteriology, Research Center Borstel, Borstel, Germany
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Borstel, Germany
- National and WHO Supranational Reference Laboratory for Mycobacteria, Research Center Borstel, Leibniz Lung Center, Borstel, Germany
| | - Thomas A Wichelhaus
- Institute of Medical Microbiology and Infection Control, Goethe University, University Hospital, FrankfurtFrankfurt Am Main, Germany
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Kim SY, Zo S, Kim DH, Shin SJ, Jhun BW. Single-cell transcriptomics by clinical course of Mycobacterium avium complex pulmonary disease. Sci Rep 2024; 14:15663. [PMID: 38977917 PMCID: PMC11231222 DOI: 10.1038/s41598-024-66523-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 07/02/2024] [Indexed: 07/10/2024] Open
Abstract
Mycobacterium avium complex pulmonary disease (MAC-PD) has a heterogeneous clinical course. However, immune profiles associated with MAC-PD clinical course are limited. We performed single-cell RNA sequencing of peripheral blood mononuclear cells from 21 MAC-PD patients divided into three clinical courses: group A, spontaneous culture conversion; group B, stable disease without antibiotic treatment; and group C, progressive disease with antibiotic treatment. A lower proportion of NK cells and higher proportion of monocytes were noted in group C compared to combined groups A and B. The proportion of classical monocytes was higher in group C compared to groups A and B, while the proportion of non-classical monocytes decreased. EGR1, HSPA1A, HSPA1B, and CD83 were up-regulated in spontaneous culture conversion group A compared to progressive disease group C. Up-regulation of MYOM2 and LILRA4 and down-regulation of MT-ATP8, CD83, and CCL3L1 was found in progressive disease group C. PCBP1, FOS, RGCC, S100B, G0S2, AREG, and LYN were highly expressed in favorable treatment response compared to unfavorable response. Our findings may offer a comprehensive understanding of the host immune profiles that influence a particular MAC-PD clinical course and could suggest an immunological mechanism associated with the disease progression of MAC-PD.
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Affiliation(s)
- Su-Young Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sungmin Zo
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Dae Hun Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sung Jae Shin
- Department of Microbiology, Institute for Immunology and Immunological Disease, Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul, South Korea
| | - Byung Woo Jhun
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
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Anh NK, Phat NK, Thu NQ, Tien NTN, Eunsu C, Kim HS, Nguyen DN, Kim DH, Long NP, Oh JY. Discovery of urinary biosignatures for tuberculosis and nontuberculous mycobacteria classification using metabolomics and machine learning. Sci Rep 2024; 14:15312. [PMID: 38961191 PMCID: PMC11222504 DOI: 10.1038/s41598-024-66113-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 06/27/2024] [Indexed: 07/05/2024] Open
Abstract
Nontuberculous mycobacteria (NTM) infection diagnosis remains a challenge due to its overlapping clinical symptoms with tuberculosis (TB), leading to inappropriate treatment. Herein, we employed noninvasive metabolic phenotyping coupled with comprehensive statistical modeling to discover potential biomarkers for the differential diagnosis of NTM infection versus TB. Urine samples from 19 NTM and 35 TB patients were collected, and untargeted metabolomics was performed using rapid liquid chromatography-mass spectrometry. The urine metabolome was analyzed using a combination of univariate and multivariate statistical approaches, incorporating machine learning. Univariate analysis revealed significant alterations in amino acids, especially tryptophan metabolism, in NTM infection compared to TB. Specifically, NTM infection was associated with upregulated levels of methionine but downregulated levels of glutarate, valine, 3-hydroxyanthranilate, and tryptophan. Five machine learning models were used to classify NTM and TB. Notably, the random forest model demonstrated excellent performance [area under the receiver operating characteristic (ROC) curve greater than 0.8] in distinguishing NTM from TB. Six potential biomarkers for NTM infection diagnosis, including methionine, valine, glutarate, 3-hydroxyanthranilate, corticosterone, and indole-3-carboxyaldehyde, were revealed from univariate ROC analysis and machine learning models. Altogether, our study suggested new noninvasive biomarkers and laid a foundation for applying machine learning to NTM differential diagnosis.
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Affiliation(s)
- Nguyen Ky Anh
- Department of Pharmacology and PharmacoGenomics Research Center, Inje University College of Medicine, Busan, 47392, Republic of Korea
- Faculty of Pharmacy, Ton Duc Thang University, Ho Chi Minh City, Vietnam
| | - Nguyen Ky Phat
- Department of Pharmacology and PharmacoGenomics Research Center, Inje University College of Medicine, Busan, 47392, Republic of Korea
| | - Nguyen Quang Thu
- Department of Pharmacology and PharmacoGenomics Research Center, Inje University College of Medicine, Busan, 47392, Republic of Korea
| | - Nguyen Tran Nam Tien
- Department of Pharmacology and PharmacoGenomics Research Center, Inje University College of Medicine, Busan, 47392, Republic of Korea
| | - Cho Eunsu
- Department of Pharmacology and PharmacoGenomics Research Center, Inje University College of Medicine, Busan, 47392, Republic of Korea
| | - Ho-Sook Kim
- Department of Pharmacology and PharmacoGenomics Research Center, Inje University College of Medicine, Busan, 47392, Republic of Korea
| | - Duc Ninh Nguyen
- Section for Comparative Pediatrics and Nutrition, Department of Veterinary and Animal Sciences, University of Copenhagen, 1870, Frederiksberg, Denmark
| | - Dong Hyun Kim
- Department of Pharmacology and PharmacoGenomics Research Center, Inje University College of Medicine, Busan, 47392, Republic of Korea
| | - Nguyen Phuoc Long
- Department of Pharmacology and PharmacoGenomics Research Center, Inje University College of Medicine, Busan, 47392, Republic of Korea.
| | - Jee Youn Oh
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Seoul, 08308, Republic of Korea.
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Njagi LN, Kaguthi G, Mecha JO, Hawn TR, Nduba V. Attenuated tuberculin skin test responses associated with Mycobacterium intracellulare sputum colonization in an adolescent TB prevalence survey in Western Kenya. Tuberculosis (Edinb) 2024; 147:102514. [PMID: 38723342 PMCID: PMC11168861 DOI: 10.1016/j.tube.2024.102514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 04/16/2024] [Accepted: 05/03/2024] [Indexed: 05/26/2024]
Abstract
INTRODUCTION Exposure to Non-tuberculous Mycobacteria (NTM) varies regionally and may partly explain the disparate outcomes of BCG vaccination and tuberculosis (TB) susceptibility. METHODS We examined NTM sputum colonization, associations with clinical characteristics, and tuberculin skin test (TST) responses in an adolescent TB prevalence survey. RESULTS Among 5004 adolescents screened, 2281 (45.5 %) were evaluated further. TB and NTM prevalence rates were 0.3 % and 8.0 %, respectively. Among 418 NTM isolates, 103 were unidentifiable, and 315 (75 %) comprised 15 species, the most frequent being M. intracellulare (MAC) (108, 26 %), M. scrofulaceum (96, 23 %) and M. fortuitum (51, 12 %). "NTM colonized" adolescents had less frequent chronic cough and night sweats (adjusted odds ratio [aOR] 0.62, 95 % confidence interval [CI] 0.44-0.87and aOR 0.61, CI 0.42-0.89 respectively), and lower TST induration (median 11 mm (interquartile range [IQR] 0-16) vs 13 mm (IQR 6-17; p = 0.006)) when compared to "NTM not colonized" participants. MAC, but not M. scrofulaceum or M. fortuitum, was associated with decreased TST induration (median 7.5 mm (IQR 0-15) vs 13 mm (IQR 6-17) among "MAC colonized" vs "not colonized", p = 0.001). CONCLUSION We observed high NTM prevalence rates with species-specific associations with TST induration, consistent with a model of species-dependent heterologous immunity among mycobacteria.
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Affiliation(s)
- Lilian N Njagi
- Kenya Medical Research Institute, Centre for Respiratory Diseases Research (CRDR), PO Box 47855-00100, Nairobi, Kenya.
| | - Grace Kaguthi
- Kenya Medical Research Institute, Centre for Respiratory Diseases Research (CRDR), PO Box 47855-00100, Nairobi, Kenya.
| | - Jared O Mecha
- Department of Clinical Medicine and Therapeutics, Faculty of Health Sciences, University of Nairobi School of Medicine, PO Box 19676 - 00202, Nairobi, Kenya.
| | - Thomas R Hawn
- Department of Medicine, University of Washington, Seattle, WA, 98195, United States.
| | - Videlis Nduba
- Kenya Medical Research Institute, Centre for Respiratory Diseases Research (CRDR), PO Box 47855-00100, Nairobi, Kenya.
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90
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Yagi A, Fujiwara M, Sato M, Abe Y, Uchida R. New liposidomycin congeners produced by Streptomyces sp. TMPU-20A065, anti-Mycobacterium avium complex agents with therapeutic efficacy in a silkworm infection model. J Antibiot (Tokyo) 2024; 77:412-421. [PMID: 38720140 PMCID: PMC11208132 DOI: 10.1038/s41429-024-00724-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 03/18/2024] [Accepted: 03/26/2024] [Indexed: 06/28/2024]
Abstract
Three new liposidomycin congeners (1, 2, and 4), together with 14 known liposidomycins (3 and 5-17), were isolated from the culture broth of Streptomyces sp. TMPU-20A065 as anti-Mycobacterium avium complex agents. The structures of liposidomycins were elucidated by spectroscopic analyses, including NMR and MS. Compounds 1, 2, and 4 belong to type-I liposidomycin-containing sulfate groups and methylglutaric acid, each with a different acyl side chain in the structure. Compounds 1-17 exhibited in vitro anti-M. avium and M. intracellulare activities with MIC values ranging between 2.0 and 64 μg ml-1. Furthermore, 1-17 exerted potent therapeutic effects in an in vivo-mimic silkworm infection model with ED50 values ranging between 0.12 and 3.7 μg larva-1 g-1.
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Affiliation(s)
- Akiho Yagi
- Division of Natural Product Chemistry, Faculty of Pharmaceutical Sciences, Tohoku Medical and Pharmaceutical University, 4-4-1 Komatsushima, Aoba-ku, Sendai, Miyagi, 981-8558, Japan.
| | - Mayu Fujiwara
- Division of Natural Product Chemistry, Faculty of Pharmaceutical Sciences, Tohoku Medical and Pharmaceutical University, 4-4-1 Komatsushima, Aoba-ku, Sendai, Miyagi, 981-8558, Japan
| | - Mayu Sato
- Division of Natural Product Chemistry, Faculty of Pharmaceutical Sciences, Tohoku Medical and Pharmaceutical University, 4-4-1 Komatsushima, Aoba-ku, Sendai, Miyagi, 981-8558, Japan
| | - Yuzu Abe
- Division of Natural Product Chemistry, Faculty of Pharmaceutical Sciences, Tohoku Medical and Pharmaceutical University, 4-4-1 Komatsushima, Aoba-ku, Sendai, Miyagi, 981-8558, Japan
| | - Ryuji Uchida
- Division of Natural Product Chemistry, Faculty of Pharmaceutical Sciences, Tohoku Medical and Pharmaceutical University, 4-4-1 Komatsushima, Aoba-ku, Sendai, Miyagi, 981-8558, Japan.
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91
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Lee G, Kim S, Chang S, Sohn H, Kang YA, Park Y. Epidemiological Characteristics of Nontuberculous Mycobacterial Pulmonary Disease in South Korea: A Meta-analysis of Individual Participant Data. Tuberc Respir Dis (Seoul) 2024; 87:386-397. [PMID: 38590075 PMCID: PMC11222092 DOI: 10.4046/trd.2023.0193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/29/2024] [Accepted: 04/07/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Despite the global increase in nontuberculous mycobacterial pulmonary disease (NTM-PD), clinical characteristics show geographical variations. We investigated the clinical characteristics of patients with NTM-PD in South Korea. METHODS We systematically reviewed articles concerning patients with NTM-PD in South Korea until February 2022. Individual participant data, regardless of treatment, were collected using a standard case report form. RESULTS Data of 6,489 patients from 11 hospitals between 2002 and 2019 were analyzed. The mean age was 61.5±11.7 years, of whom 57.7% were women. Mycobacterium avium (41.4%) and Mycobacterium intracellulare (38.4%) comprised most of the causative species, followed by Mycobacterium abscessus subspecies abscessus (8.6%) and M. abscessus subspecies massiliense (7.8%). Bronchiectasis (59.4%) was the most common pulmonary comorbidity. Although reported cases of NTM-PD increased over the years, the proportions of causative species and radiologic forms remained similar. Distinct clinical characteristics were observed according to age and sex. Men were older at the time of diagnosis (median 63.8 years vs. 59.9 years, p<0.001), and had more cavitary lesions than women (38.8% vs. 21.0%, p<0.001). The older group (≥65 years) had higher proportions of patients with body mass index <18.5 kg/m2 (27.4% vs. 18.6%, p<0.001) and cavitary lesions (29.9% vs. 27.6%, p=0.009) than the younger group. CONCLUSION We conducted a meta-analysis of the clinical characteristics of patients with NTM-PD in South Korea, and found age- and sex-related differences in disease- specific severity. Further investigation would enhance our comprehension of the nature of the disease, and inherited and acquired host factors.
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Affiliation(s)
- Geunin Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sol Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Shihwan Chang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hojoon Sohn
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young Ae Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute of Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Youngmok Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute for Innovation in Digital Healthcare, Yonsei University, Seoul, Republic of Korea
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92
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Choi S, Lee JM, Kim KES, Park JH, Kim LH, Park J, Jeon Y, Jhun BW, Kim SY, Hong JJ, Shin SJ. Protein-energy restriction-induced lipid metabolism disruption causes stable-to-progressive disease shift in Mycobacterium avium-infected female mice. EBioMedicine 2024; 105:105198. [PMID: 38889480 PMCID: PMC11237864 DOI: 10.1016/j.ebiom.2024.105198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 05/27/2024] [Accepted: 05/30/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Disease susceptibility and progression of Mycobacterium avium complex pulmonary disease (MAC-PD) is associated with multiple factors, including low body mass index (BMI). However, the specific impact of low BMI on MAC-PD progression remains poorly understood. This study aims to examine the progression of MAC-PD in the context of low BMI, utilising a disease-resistant mouse model. METHODS We employed a MAC infection-resistant female A/J mouse model to compare the progression of MAC-PD under two dietary conditions: one group was fed a standard protein diet, representing protein-energy unrestricted conditions, and the other was fed a low protein diet (LPD), representing protein-energy restriction. FINDINGS Our results reveal that protein-energy restriction significantly exacerbates MAC-PD progression by disrupting lipid metabolism. Mice fed an LPD showed elevated fatty acid levels and related gene expressions in lung tissues, similar to findings of increased fatty acids in the serum of patients who exhibited the MAC-PD progression. These mice also exhibited increased CD36 expression and lipid accumulation in macrophages upon MAC infection. In vitro experiments emphasised the crucial role of CD36-mediated palmitic acid uptake in bacterial proliferation. Importantly, in vivo studies demonstrated that administering anti-CD36 antibody to LPD-fed A/J mice reduced macrophage lipid accumulation and impeded bacterial growth, resulting in remarkable slowing disease progression. INTERPRETATION Our findings indicate that the metabolic status of host immune cells critically influences MAC-PD progression. This study highlights the potential of adequate nutrient intake in preventing MAC-PD progression, suggesting that targeting CD36-mediated pathways might be a host-directed therapeutic strategy to managing MAC infection. FUNDING This research was funded by the National Research Foundation of Korea, the Korea Research Institute of Bioscience and Biotechnology, and the Korea National Institute of Health.
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Affiliation(s)
- Sangwon Choi
- Department of Microbiology, Institute for Immunology and Immunological Disease, Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul, 03722, South Korea
| | - Ju Mi Lee
- Department of Microbiology, Institute for Immunology and Immunological Disease, Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul, 03722, South Korea
| | - Keu Eun San Kim
- Department of Microbiology, Institute for Immunology and Immunological Disease, Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul, 03722, South Korea
| | - Ji-Hae Park
- Department of Microbiology, Institute for Immunology and Immunological Disease, Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul, 03722, South Korea
| | - Lee-Han Kim
- Department of Microbiology, Institute for Immunology and Immunological Disease, Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul, 03722, South Korea
| | - Jiyun Park
- Department of Microbiology, Institute for Immunology and Immunological Disease, Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul, 03722, South Korea
| | - Yaerin Jeon
- Department of Microbiology, Institute for Immunology and Immunological Disease, Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul, 03722, South Korea
| | - Byung Woo Jhun
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, South Korea
| | - Su-Young Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, South Korea
| | - Jung Joo Hong
- National Primate Research Center, Korea Research Institute of Bioscience and Biotechnology, Cheongju, 28116, South Korea; KRIBB School of Bioscience, Korea University of Science & Technology (UST), Daejeon, 34113, South Korea
| | - Sung Jae Shin
- Department of Microbiology, Institute for Immunology and Immunological Disease, Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul, 03722, South Korea.
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93
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Pieters ALP, van der Veer T, Meerburg JJ, Andrinopoulou ER, van der Eerden MM, Ciet P, Aliberti S, Burgel PR, Crichton ML, Shoemark A, Goeminne PC, Shteinberg M, Loebinger MR, Haworth CS, Blasi F, Tiddens HAWM, Caudri D, Chalmers JD. Structural Lung Disease and Clinical Phenotype in Bronchiectasis Patients: The EMBARC CT Study. Am J Respir Crit Care Med 2024; 210:87-96. [PMID: 38635862 DOI: 10.1164/rccm.202311-2109oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 04/18/2024] [Indexed: 04/20/2024] Open
Abstract
Rationale: Chest computed tomography (CT) scans are essential to diagnose and monitor bronchiectasis (BE). To date, few quantitative data are available about the nature and extent of structural lung abnormalities (SLAs) on CT scans of patients with BE. Objectives: To investigate SLAs on CT scans of patients with BE and the relationship of SLAs to clinical features using the EMBARC (European Multicenter Bronchiectasis Audit and Research Collaboration) registry. Methods: CT scans from patients with BE included in the EMBARC registry were analyzed using the validated Bronchiectasis Scoring Technique for CT (BEST-CT). The subscores of this instrument are expressed as percentages of total lung volume. The items scored are atelectasis/consolidation, BE with and without mucus plugging (MP), airway wall thickening, MP, ground-glass opacities, bullae, airways, and parenchyma. Four composite scores were calculated: total BE (i.e., BE with and without MP), total MP (i.e., BE with MP plus MP alone), total inflammatory changes (i.e., atelectasis/consolidation plus total MP plus ground-glass opacities), and total disease (i.e., all items but airways and parenchyma). Measurements and Main Results: CT scans of 524 patients with BE were analyzed. Mean subscores were 4.6 (range, 2.3-7.7) for total BE, 4.2 (1.2-8.1) for total MP, 8.3 (3.5-16.7) for total inflammatory changes, and 14.9 (9.1-25.9) for total disease. BE associated with primary ciliary dyskinesia was associated with more SLAs, whereas chronic obstructive pulmonary disease was associated with fewer SLAs. Lower FEV1, longer disease duration, Pseudomonas aeruginosa and nontuberculous mycobacterial infections, and severe exacerbations were all independently associated with worse SLAs. Conclusions: The type and extent of SLAs in patients with BE are highly heterogeneous. Strong relationships between radiological disease and clinical features suggest that CT analysis may be a useful tool for clinical phenotyping.
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Affiliation(s)
- Angelina L P Pieters
- Department of Radiology and Nuclear Medicine
- Department of Pediatrics, Division of Respiratory Medicine and Allergy, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Jennifer J Meerburg
- Department of Radiology and Nuclear Medicine
- Department of Pediatrics, Division of Respiratory Medicine and Allergy, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Eleni-Rosalina Andrinopoulou
- Department of Biostatistics, and
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Pierluigi Ciet
- Department of Radiology and Nuclear Medicine
- Department of Pediatrics, Division of Respiratory Medicine and Allergy, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Radiology, University of Cagliari, Cagliari, Italy
| | - Stefano Aliberti
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico Humanitas Research Hospital, Respiratory Unit, Milan, Italy
| | - Pierre-Regis Burgel
- Institut Cochin, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Paris, France
| | - Megan L Crichton
- School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - Amelia Shoemark
- School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - Pieter C Goeminne
- Department of Respiratory Medicine, AZ Nikolaas, Sint-Niklaas, Belgium
| | | | - Michael R Loebinger
- Host Defence Unit, Royal Brompton Hospital, National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Charles S Haworth
- Cambridge Centre for Lung Infection, Royal Papworth Hospital, Cambridge, United Kingdom
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; and
- Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Cà'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Harm A W M Tiddens
- Department of Radiology and Nuclear Medicine
- Department of Pediatrics, Division of Respiratory Medicine and Allergy, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Daan Caudri
- Department of Radiology and Nuclear Medicine
- Department of Pediatrics, Division of Respiratory Medicine and Allergy, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - James D Chalmers
- School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, United Kingdom
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94
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Santos A, Carneiro S, Silva A, Gomes JP, Macedo R. Nontuberculous Mycobacteria in Portugal: Trends from the last decade. Pulmonology 2024; 30:337-343. [PMID: 35219623 DOI: 10.1016/j.pulmoe.2022.01.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Nontuberculous mycobacteria (NTM) are opportunistic human pathogens found in the environment. The transmission seems to be associated with inhalation of aerosol droplets, ingestion or trauma events. Recent studies indicate that NTM disease is increasing worldwide, however, the true clinical impact of NTM infections is difficult to determine due to challenges in discriminating between disease and colonization as they are ubiquitous in the environment. In addition, understanding the epidemiology of NTM is difficult and has not yet been established. In this work, we used a country NTM representative collection from the National Reference Laboratory for Tuberculosis (NRL-TB) of the National Institute of Health (INSA), to characterize the circulation trends of NTM species in Portugal and the most affected regions, contributing to a better understanding of the NTM epidemiology. MATERIAL AND METHODS We conducted a nationwide retrospective study where all individuals with positive NTM cultures at the NRL-TB of the INSA from 2014 to December 2020 were included. Positive cultures were identified using GenoType Mycobacterium CM/AS® (Hain Lifescience) according to manufacturer's instructions, or hsp65 DNA sequencing as previously described. Social-demographic data from patients were also analyzed and patients classified into 3 groups according only to microbiological data, "definite NTM disease", "NTM colonization" and, "possible NTM disease". RESULTS In the period 2014-2020, the NRL-TB performed 50397 cultures. Among these, 1118 cultures were NTM positive retrieved from 944. Most of our cases were in patients whose mean age was 64±15.9 years, and no significant differences between gender was observed, although more frequent in male patients. Overall, from the 944 cases, we were able to identified 93 "definite NTM disease" cases and 79 "possible NTM disease". Mycobacterium avium complex (MAC) (40,8%), Mycobacterium abscessus-chelonae complex (MABC) (9,6%) and Mycobacterium fortuitum (6,3%) were responsible for most of the infections. The geographical distribution of NTM cases varied significantly and was possible to observe that was independent of population density. The region were most cases occurred was Lisbon Metropolitan Area (31,9%), followed by North (25,3%) and Centre (24,4%), however North region has the highest number of "definite NTM disease" cases (n=33). CONCLUSIONS This is the first national wide epidemiological study on this subject, contributing to a better understanding of NTM dynamics in Portugal. MAC was the NTM species responsible for the majority of infections and, LMA the region with the highest number of cases. It was also possible to conclude that the number of NTM isolates is independent of the demography of the region.
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Affiliation(s)
- A Santos
- National Reference Laboratory for Mycobacteria, Dept of Infectious Diseases, National Institute of Health, Lisbon, Portugal
| | - S Carneiro
- National Reference Laboratory for Mycobacteria, Dept of Infectious Diseases, National Institute of Health, Lisbon, Portugal; Department of Life Sciences, NOVA School of Science and Technology, NOVA University Lisbon, Caparica, Portugal
| | - A Silva
- National Reference Laboratory for Mycobacteria, Dept of Infectious Diseases, National Institute of Health, Porto, Portugal
| | - J P Gomes
- Bioinformtics Unit, National Institute of Health, Lisbon, Portugal
| | - R Macedo
- National Reference Laboratory for Mycobacteria, Dept of Infectious Diseases, National Institute of Health, Lisbon, Portugal.
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95
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Van Braeckel E, Bosteels C. Growing from common ground: nontuberculous mycobacteria and bronchiectasis. Eur Respir Rev 2024; 33:240058. [PMID: 38960614 PMCID: PMC11220627 DOI: 10.1183/16000617.0058-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 05/28/2024] [Indexed: 07/05/2024] Open
Abstract
Bronchiectasis and nontuberculous mycobacteria (NTM) are intricately intertwined, with NTM capable of being both a cause and consequence of bronchiectatic disease. This narrative review focuses on the common ground of bronchiectasis and NTM pulmonary disease (NTM-PD) in terms of diagnostic approach, underlying risk factors and treatment strategies. NTM-PD diagnosis relies on a combination of clinical, radiological and microbiological criteria. Although their epidemiology is complicated by detection and reporting biases, the prevalence and pathogenicity of NTM species vary geographically, with Mycobacterium avium complex and Mycobacterium abscessus subspecies most frequently isolated in bronchiectasis-associated NTM-PD. Diagnosis of nodular bronchiectatic NTM-PD should prompt investigation of host factors, including disorders of mucociliary clearance, connective tissue diseases and immunodeficiencies, either genetic or acquired. Treatment of NTM-PD in bronchiectasis involves a multidisciplinary approach and considers the (sub)species involved, disease severity and comorbidities. Current guideline-based antimicrobial treatment of NTM-PD is considered long, cumbersome and unsatisfying in terms of outcomes. Novel treatment regimens and strategies are being explored, including rifampicin-free regimens and inclusion of clofazimine and inhaled antibiotics. Host-directed therapies, such as immunomodulators and cytokine-based therapies, might enhance antimycobacterial immune responses. Optimising supportive care, as well as pathogen- and host-directed strategies, is crucial, highlighting the need for personalised approaches tailored to individual patient needs. Further research is warranted to elucidate the complex interplay between host and mycobacterial factors, informing more effective management strategies.
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Affiliation(s)
- Eva Van Braeckel
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
- Respiratory Infection and Defense Lab (RIDL), Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- European Reference Network on rare respiratory diseases (ERN-LUNG)
| | - Cédric Bosteels
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
- Respiratory Infection and Defense Lab (RIDL), Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- European Reference Network on rare respiratory diseases (ERN-LUNG)
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96
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Kang N, Jhun BW. Long-term Outcomes of Adjunctive Lung Resection for Nontuberculous Mycobacteria Pulmonary Disease. Open Forum Infect Dis 2024; 11:ofae345. [PMID: 38966854 PMCID: PMC11222975 DOI: 10.1093/ofid/ofae345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 06/18/2024] [Indexed: 07/06/2024] Open
Abstract
Background Adjunctive lung resection is recommended for select patients with nontuberculous mycobacteria (NTM) pulmonary disease (PD). However, data are limited on long-term recurrence rates in patients infected with major pathogens, including Mycobacterium avium complex (MAC) and Mycobacterium abscessus (MABC). Methods In this prospective observational study, we retrospectively analyzed data from 125 patients with MAC-PD (n = 90) or MABC-PD (n = 35) who underwent adjunctive lung resection. We evaluated microbiological response, postoperative complications, recurrence, and all-cause mortality over a median 80-month follow-up. Results Persistent culture positivity (64%) was the most common indication for surgery, followed by hemoptysis, recurrent pneumonia, or radiologic deterioration. Postoperative complications occurred in 18 (14%) patients, with no surgery-related deaths. Treatment outcomes did not significantly differ between the MAC- and MABC-PD groups. Cure with culture conversion was achieved in 112 (90%) patients. Recurrence occurred in 37 (33%) of 112 patients, of which 18 (49%) cases were attributed to reinfection by different NTM species or subspecies. The MAC group had higher recurrence rates than the MABC group (Kaplan-Meier curve, log-rank test, P = .043) and was significantly associated with recurrence in the multivariable analysis (adjusted hazard ratio, 2.71; 95% CI, 1.23-5.99). However, mortality was higher in the MABC-PD group than the MAC-PD group (7/35 vs 4/90, P = .006). Conclusions Adjunctive lung resection with antibiotics helps to reduce bacterial burden and manage symptoms in patients with NTM-PD. However, it does not prevent recurrence, which is mostly caused by reinfection.
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Affiliation(s)
- Noeul Kang
- Division of Allergy, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Byung Woo Jhun
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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97
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Vahabi MM, Bostancı A, Taşbakan SE, Karaarslan I, Çavuşoğlu C, Taşbakan M. Tuberculosis or Nontuberculosis? A Case of Mycobacterial Skin Infection. Int J Mycobacteriol 2024; 13:351-353. [PMID: 39277899 DOI: 10.4103/ijmy.ijmy_211_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 08/25/2024] [Indexed: 09/17/2024] Open
Abstract
Bacteria other than Mycobacterium tuberculosis and Mycobacterium leprae are known as nontuberculous mycobacteria (NTM), and the frequency of clinically symptomatic forms is increasing day by day. Mycobacterium fortuitum, a rapidly reproducing NTM, causes various clinical signs such as skin soft-tissue infection, surgical site infection, and disseminated infection in immunosuppressed patients. Although progress can be made in terms of diagnosis when growth is detected in culture, it is quite difficult to distinguish between infection and contamination. There is no place for antituberculosis treatment in the treatment of M. fortuitum. Antibiotics such as quinolones, trimethoprim-sulfamethoxazole, linezolid, doxycycline, clarithromycin, azithromycin, imipenem, tigecycline, linezolid, and amikacin are recommended at least in dual combination therapy. In this case presentation, the diagnosis and treatment of a 2-year skin soft-tissue infection with M. fortuitum growth in culture will be discussed.
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MESH Headings
- Humans
- Mycobacterium Infections, Nontuberculous/microbiology
- Mycobacterium Infections, Nontuberculous/drug therapy
- Mycobacterium Infections, Nontuberculous/diagnosis
- Mycobacterium fortuitum/isolation & purification
- Male
- Tuberculosis, Cutaneous/diagnosis
- Tuberculosis, Cutaneous/drug therapy
- Tuberculosis, Cutaneous/microbiology
- Anti-Bacterial Agents/therapeutic use
- Skin Diseases, Bacterial/microbiology
- Skin Diseases, Bacterial/drug therapy
- Skin Diseases, Bacterial/diagnosis
- Diagnosis, Differential
- Tuberculosis/drug therapy
- Tuberculosis/microbiology
- Tuberculosis/diagnosis
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Affiliation(s)
- Merve Mert Vahabi
- Department of Infectious Diseases and Clinical Microbiology, İzmir, Turkey
| | - Aylin Bostancı
- Department of Dermatology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Selin Ece Taşbakan
- Department of Faculty of Medicine, İzmir Ekonomi University, İzmir, Turkey
| | - Işıl Karaarslan
- Department of Dermatology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Cengiz Çavuşoğlu
- Department of Microbiology, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Meltem Taşbakan
- Department of Infectious Diseases and Clinical Microbiology, İzmir, Turkey
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98
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Sun JM, Li J, Xu XH. Successful management of Mycobacterium abscessus pneumonia in a 53-day-old immunocompetent infant. Diagn Microbiol Infect Dis 2024; 109:116296. [PMID: 38640607 DOI: 10.1016/j.diagmicrobio.2024.116296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 03/28/2024] [Accepted: 03/30/2024] [Indexed: 04/21/2024]
Abstract
Pulmonary infection due to Mycobacterium abscessus complex (MABC) usually occurs in children with underlying risk factors including cystic fibrosis (CF), chronic lung disease, and immunocompromised status, but rarely in immunocompetent children without underlying lung disease, especially in infants. We present a case of MABC pulmonary disease (MABC-PD) in an otherwise healthy 53-day-old male infant with one week of cough and respiratory distress. Computed tomography showed multiple masses across both lungs. Isolated mycobacteria from his bronchoalveolar lavage fluid were identified as MABC. We describe our complete evaluation, including immunodeficiency evaluation incorporating whole exome sequencing and our therapeutic process given complicated susceptibility pattern of the M. abscessus isolate, and review literature for MABC-PD in immunocompetent children. The infant was successfully treated through prolonged treatment with parenteral Amikacin, Cefoxitin, Linezolid, and Clarithromycin, combined with inhaled Amikacin.
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Affiliation(s)
- Jing-Min Sun
- Department of Pediatric Intensive Care Unit, The First Affiliated Hospital of Anhui Medical University, 18th Floor of Medicine and Medical Tech Building, 218 Jixi Road, Hefei 230022, Anhui, China.
| | - Jing Li
- Department of Pediatric Intensive Care Unit, The First Affiliated Hospital of Anhui Medical University, 18th Floor of Medicine and Medical Tech Building, 218 Jixi Road, Hefei 230022, Anhui, China.
| | - Xi-Hai Xu
- Department of Infectious Diseases, The First Affiliated Hospital of Anhui Medical University, Infectious Diseases Ward Building, 218 Jixi Road, Hefei 230022, Anhui, China.
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99
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Boorgula GD, Gumbo T, Singh S, McShane PJ, Philley JV, Srivastava S. Omadacycline drug susceptibility testing for non-tuberculous mycobacteria using oxyrase to overcome challenges with drug degradation. Tuberculosis (Edinb) 2024; 147:102519. [PMID: 38754247 PMCID: PMC11345947 DOI: 10.1016/j.tube.2024.102519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 05/01/2024] [Accepted: 05/12/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Drug susceptibility testing (DST) protocol of omadacycline against non-tuberculous mycobacteria has not yet been established. We developed a method to accurately determine MIC omadacycline MIC against Mycobacterium abscessus (Mab), Mycobacterium avium-complex (MAC), and Mycobacterium kansasii (Mkn). METHODS First, we identified the oxyrase concentration not affecting Mab, MAC, and Mkn growth followed by omadacycline MIC experiments with and without oxyrase using reference and clinical strains. RESULTS Oxyrase 0.5 % (v/v) stabilized omadacycline in the culture medium. The median omadacycline MIC was 1 mg/L for Mab and 8 mg/L for Mkn. For MAC, the median omadacycline MIC was 2 mg/L for M. avium, 256 mg/L for M. intracellulare, and 4 mg/L for M. chimaera (p < 0.0001). Wilcoxon matched-pairs signed rank test revealed statistically lower MICs with oxyrase for all MAC subspecies (p < 0.0001), all Mab subspecies (p < 0.0001), and Mkn (p = 0.0002). The decrease in MICs with oxyrase was 17/18 of Mab, 14/19 of Mkn, 8/8 of M. avium, 4/5 M. chimera, but only 11/18 of M. intracellulare (p < 0.013). CONCLUSION Use of 0.5 % oxyrase could be a potential solution to reliable and reproducible omadacycline MIC of Mab. However, oxyrase demonstrated a variable effect in reducing MICs against MAC and Mkn.
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Affiliation(s)
- Gunavanthi D Boorgula
- Department of Medicine, University of Texas at Tyler School of Medicine, Tyler, TX, USA
| | - Tawanda Gumbo
- Mathematical Modeling and AI Department, Praedicare Inc., Dallas, TX, USA; Hollow Fiber System & Experimental Therapeutics Laboratories, Wet Lab Systems, Praedicare Inc., Dallas, TX, USA.
| | - Sanjay Singh
- Department of Medicine, University of Texas at Tyler School of Medicine, Tyler, TX, USA
| | - Pamela J McShane
- Department of Medicine, Section of Pulmonary and Critical Care, University of Texas at Tyler School of Medicine, Tyler, TX, USA
| | - Julie V Philley
- Department of Medicine, Section of Pulmonary and Critical Care, University of Texas at Tyler School of Medicine, Tyler, TX, USA
| | - Shashikant Srivastava
- Department of Medicine, University of Texas at Tyler School of Medicine, Tyler, TX, USA; Department of Cellular and Molecular Biology, University of Texas Health Science Centre at Tyler, Tyler, TX, USA.
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100
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Vogiatzoglou AI, Hadji Μitrova M, Papadaki E, Sionidou M, Nikopoulou A, Kontos F, Papaventsis D, Papavasileiou A, Manika K. Combination of Imipenem-Cilastatin-Relebactam and Amoxicillin in the Antibiotic Regimen in Two Cases of Mycobacterium abscessus Lung Infection. Cureus 2024; 16:e65112. [PMID: 39171000 PMCID: PMC11338295 DOI: 10.7759/cureus.65112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2024] [Indexed: 08/23/2024] Open
Abstract
Mycobacterium abscessus is a difficult-to-treat, multidrug-resistant human pathogen. Relebactam has been shown to inhibit M. abscessus β-lactamase (BLAMab) and increase the activity of imipenem and amoxicillin. We present two cases of lung infection due to M. abscessus, one caused by M. abscessussubsp. massiliense and the other by subsp. abscessus. Both strains showed moderate sensitivity to imipenem, and the second strain was also resistant to macrolides. A multidrug antibiotic regimen was administered in both cases, which included imipenem/cilastatin/relebactam adjusted to the estimated glomerular filtration rate (eGFR) and amoxicillin for three months. The regimen was well tolerated and both patients improved both clinically and radiologically after the first phase of treatment. The results of our patients indicate that the combination of imipenem/cilastatin/relebactam and amoxicillin could be used in the future in difficult infections by M. abscessus.
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Affiliation(s)
- Anastasios I Vogiatzoglou
- Pulmonology and Tuberculosis Department, General Hospital of Thessaloniki "Georgios Papanikolaou", Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Maria Hadji Μitrova
- Pulmonology and Tuberculosis Department, General Hospital of Thessaloniki "Georgios Papanikolaou", Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Eleni Papadaki
- Pulmonology and Tuberculosis Department, General Hospital of Thessaloniki "Georgios Papanikolaou", Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Maria Sionidou
- Pulmonology and Tuberculosis Department, General Hospital of Thessaloniki "Georgios Papanikolaou", Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Anna Nikopoulou
- Internal Medicine Department, General Hospital of Thessaloniki "Georgios Papanikolaou", Thessaloniki, GRC
| | - Fanοurios Kontos
- Laboratory of Clinical Microbiology, University General Hospital of Athens "Attikon", Athens, GRC
| | - Dimitrios Papaventsis
- Microbiology, National Reference Laboratory for Mycobacteria, General Hospital of Thoracic Diseases of Athens "Sotiria", Athens, GRC
| | - Apostolos Papavasileiou
- Antituberculosis Department - Multidrug-Resistant Tuberculosis Unit, General Hospital of Thoracic Diseases of Athens "Sotiria", Athens, GRC
| | - Katerina Manika
- Pulmonology and Tuberculosis Department, General Hospital of Thessaloniki "Georgios Papanikolaou", Aristotle University of Thessaloniki, Thessaloniki, GRC
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