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Nishiuchi Y, Iwamoto T, Maruyama F. Infection Sources of a Common Non-tuberculous Mycobacterial Pathogen, Mycobacterium avium Complex. Front Med (Lausanne) 2017; 4:27. [PMID: 28326308 PMCID: PMC5339636 DOI: 10.3389/fmed.2017.00027] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 02/22/2017] [Indexed: 01/08/2023] Open
Abstract
Numerous studies have revealed a continuous increase in the worldwide incidence and prevalence of non-tuberculous mycobacteria (NTM) diseases, especially pulmonary Mycobacterium avium complex (MAC) diseases. Although it is not clear why NTM diseases have been increasing, one possibility is an increase of mycobacterial infection sources in the environment. Thus, in this review, we focused on the infection sources of pathogenic NTM, especially MAC. The environmental niches for MAC include water, soil, and dust. The formation of aerosols containing NTM arising from shower water, soil, and pool water implies that these niches can be infection sources. Furthermore, genotyping has shown that clinical isolates are identical to environmental ones from household tap water, bathrooms, potting soil, and garden soil. Therefore, to prevent and treat MAC diseases, it is essential to identify the infection sources for these organisms, because patients with these diseases often suffer from reinfections and recurrent infections with them. In the environmental sources, MAC and other NTM organisms can form biofilms, survive within amoebae, and exist in a free-living state. Mycobacterial communities are also likely to occur in these infection sources in households. Water distribution systems are a transmission route from natural water reservoirs to household tap water. Other infection sources include areas with frequent human contact, such as soil and bathrooms, indicating that individuals may carry NTM organisms that concomitantly attach to their household belongings. To explore the mechanisms associated with the global spread of infection and MAC transmission routes, an epidemiological population-wide genotyping survey would be very useful. A good example of the power of genotyping comes from M. avium subsp. hominissuis, where close genetic relatedness was found between isolates of it from European patients and pigs in Japan and Europe, implying global transmission of this bacterium. It is anticipated that whole genome sequencing technologies will improve NTM surveys so that the mechanisms for the global spread of MAC disease will become clearer in the near future. Better understanding of the niches exploited by MAC and its ecology is essential for preventing MAC infections and developing new methods for its effective treatment and elimination.
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Affiliation(s)
- Yukiko Nishiuchi
- Toneyama Institute for Tuberculosis Research, Osaka City University Medical School , Toyonaka , Japan
| | - Tomotada Iwamoto
- Department of Infectious Diseases, Kobe Institute of Health , Kobe , Japan
| | - Fumito Maruyama
- Section of Microbiology, Graduate School of Medicine and Faculty of Medicine, Kyoto University , Kyoto , Japan
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Desikan P, Tiwari K, Panwalkar N, Khaliq S, Chourey M, Varathe R, Mirza SB, Sharma A, Anand S, Pandey M. Public health relevance of non-tuberculous mycobacteria among AFB positive sputa. Germs 2017; 7:10-18. [PMID: 28331837 DOI: 10.18683/germs.2017.1103] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 07/18/2016] [Accepted: 08/23/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND Sputum smear microscopy for acid fast bacilli (AFB) is used by most public health programmes to detect tuberculosis. While most AFB in countries endemic for tuberculosis are Mycobacterium tuberculosis (MTB), some may also be non-tuberculous mycobacteria (NTM). The inability to differentiate NTM from MTB by sputum smear microscopy may lead to erroneous diagnoses of tuberculosis, leading in turn to inappropriate therapy. METHODS This was a retrospective study of consecutive sputum samples received from November 2013 to March 2015 in the Department of Microbiology, Bhopal Memorial Hospital & Research Centre, Bhopal, India. Samples underwent smear microscopy, line probe assay (LPA) for MTB complex, culture, biochemical tests and LPA for NTM. RESULTS Of 4095 sputum samples, 2886 were AFB smear positive (70.5%). Of these, MTB complex was detected in 2611 (90.5%) samples by LPA. Of the remaining 275 samples, 47 grew AFB on culture. Nine strains belonged to the MTB complex. The remaining 38 (1.3%) were NTM, and could be speciated in 26 strains; 14 (53.8 %) were M. abscessus; 10 (38.4%) M. intracellulare, one (3.8%) M. kansasii and one (3.8%) M. fortuitum. The remaining 12 NTM could not be speciated. CONCLUSION NTM were present in at least 1.3% of all smear positive samples. It is important for public health programs to recognize the avoidable burden on logistics, infrastructure and finances caused by this. Detection and quantification of this burden would help design an appropriate strategy for optimal tuberculosis control.
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Affiliation(s)
- Prabha Desikan
- MD, Department of Microbiology, Bhopal Memorial Hospital and Research Centre, Raisen Bypass Road, Karond, Bhopal, 462038, India
| | - Karuna Tiwari
- MD, Department of Microbiology, Bhopal Memorial Hospital and Research Centre, Raisen Bypass Road, Karond, Bhopal, 462038, India
| | - Nikita Panwalkar
- MSc, Department of Microbiology, Bhopal Memorial Hospital and Research Centre, Raisen Bypass Road, Karond, Bhopal, 462038, India
| | - Saima Khaliq
- MSc, Department of Microbiology, Bhopal Memorial Hospital and Research Centre, Raisen Bypass Road, Karond, Bhopal, 462038, India
| | - Manju Chourey
- BSc, Department of Microbiology, Bhopal Memorial Hospital and Research Centre, Raisen Bypass Road, Karond, Bhopal, 462038, India
| | - Reeta Varathe
- MSc, Department of Microbiology, Bhopal Memorial Hospital and Research Centre, Raisen Bypass Road, Karond, Bhopal, 462038, India
| | - Shaina Beg Mirza
- MSc, Department of Microbiology, Bhopal Memorial Hospital and Research Centre, Raisen Bypass Road, Karond, Bhopal, 462038,India
| | - Arun Sharma
- MSc, Department of Microbiology, Bhopal Memorial Hospital and Research Centre, Raisen Bypass Road, Karond, Bhopal, 462038, India
| | - Sridhar Anand
- PhD, Consultant Microbiologist, World Health Organization, Central TB Division, Ministry of Health & Family Welfare (Government of India), Nirman Bhawan, 523 'C' Wing, New Delhi, 110 011, India
| | - Manoj Pandey
- MS, Department of Oncology, Bhopal Memorial Hospital and Research Centre, Raisen Bypass Road, Karond, Bhopal, 462038, India.MSc, Department of Microbiology, St. John's Medical College Hospital, Bengaluru, Karnataka, India
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López-Varela E, L. García-Basteiro A, Augusto OJ, Fraile O, Bulo H, Ira T, Gondo K, van Ingen J, Naniche D, Sacarlal J, Alonso PL. High Rates of Non-Tuberculous Mycobacteria Isolation in Mozambican Children with Presumptive Tuberculosis. PLoS One 2017; 12:e0169757. [PMID: 28095429 PMCID: PMC5240942 DOI: 10.1371/journal.pone.0169757] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 12/21/2016] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Non-tuberculous mycobacteria (NTM) can cause disease which can be clinically and radiologically undistinguishable from tuberculosis (TB), posing a diagnostic and therapeutic challenge in high TB settings. We aim to describe the prevalence of NTM isolation and its clinical characteristics in children from rural Mozambique. METHODS This study was part of a community TB incidence study in children <3 years of age. Gastric aspirate and induced sputum sampling were performed in all presumptive TB cases and processed for smear testing using fluorochrome staining and LED Microscopy, liquid and solid culture, and molecular identification by GenoType® Mycobacterium CM/AS assays. RESULTS NTM were isolated in 26.3% (204/775) of children. The most prevalent NTM species was M. intracellulare (N = 128), followed by M. scrofulaceum (N = 35) and M. fortuitum (N = 9). Children with NTM were significantly less symptomatic and less likely to present with an abnormal chest radiograph than those with M. tuberculosis. NTM were present in 21.6% of follow-up samples and 25 children had the same species isolated from ≥2 separate samples. All were considered clinically insignificant and none received specific treatment. Children with NTM isolates had equal all cause mortality and likelihood of TB treatment as those with negative culture although they were less likely to have TB ruled out. CONCLUSIONS NTM isolation is frequent in presumptive TB cases but was not clinically significant in this patient cohort. However, it can contribute to TB misdiagnosis. Further studies are needed to understand the epidemiology and the clinical significance of NTM in children.
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Affiliation(s)
- Elisa López-Varela
- Centro de Investigação em Saude de Manhiça (CISM), Maputo, Mozambique
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Alberto L. García-Basteiro
- Centro de Investigação em Saude de Manhiça (CISM), Maputo, Mozambique
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam, The Netherlands
| | | | - Oscar Fraile
- Centro de Investigação em Saude de Manhiça (CISM), Maputo, Mozambique
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Helder Bulo
- Centro de Investigação em Saude de Manhiça (CISM), Maputo, Mozambique
| | - Tasmiya Ira
- Centro de Investigação em Saude de Manhiça (CISM), Maputo, Mozambique
| | - Kizito Gondo
- Centro de Investigação em Saude de Manhiça (CISM), Maputo, Mozambique
| | - Jakko van Ingen
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Denise Naniche
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Jahit Sacarlal
- Centro de Investigação em Saude de Manhiça (CISM), Maputo, Mozambique
- Departamento de Microbiologia, Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Pedro L. Alonso
- Centro de Investigação em Saude de Manhiça (CISM), Maputo, Mozambique
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
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Thirunavukkarasu S, Plain KM, de Silva K, Marais BJ, Whittington RJ. Applying the One Health Concept to Mycobacterial Research - Overcoming Parochialism. Zoonoses Public Health 2017; 64:401-422. [PMID: 28084673 DOI: 10.1111/zph.12334] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Indexed: 12/27/2022]
Abstract
Mycobacterial infections remain a public health problem. Historically important, globally ubiquitous and with a wide host range, we are still struggling to control mycobacterial infections in humans and animals. While previous reviews have focused on individual mycobacterial infections in either humans or animals, a comprehensive review of the zoonotic aspect of mycobacteria in the context of the One Health initiative is lacking. With the purpose of providing a concise and comprehensive resource, we have collated literature to address the zoonotic potential of different mycobacterial species and elaborate on the necessity for an inter-sectorial approach to attain a new vision to combat mycobacterial infections.
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Affiliation(s)
- S Thirunavukkarasu
- Faculty of Veterinary Science, School of Life and Environmental Sciences, University of Sydney, Sydney, NSW, Australia.,Boise Veterans Affairs Medical Center, Boise, ID, USA
| | - K M Plain
- Faculty of Veterinary Science, School of Life and Environmental Sciences, University of Sydney, Sydney, NSW, Australia
| | - K de Silva
- Faculty of Veterinary Science, School of Life and Environmental Sciences, University of Sydney, Sydney, NSW, Australia
| | - B J Marais
- Marie Bashir Institute for Infectious Diseases and Biosecurity and the Centre for Research Excellence in Emerging Infections, University of Sydney, Sydney, NSW, Australia
| | - R J Whittington
- Faculty of Veterinary Science, School of Life and Environmental Sciences, University of Sydney, Sydney, NSW, Australia
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HIV/AIDS-Related Problems in Low- and Middle-Income Countries. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00099-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Yılmaz N, Uçar EY, Sağlam L. Mycobacterium Tuberculosis and Nontuberculous Mycobacteria Coinfection of the Lungs. Turk Thorac J 2017; 18:23-26. [PMID: 29404154 DOI: 10.5152/turkthoracj.2017.16034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 10/06/2016] [Indexed: 01/15/2023]
Abstract
Tuberculosis is highly prevalent in our country and nontuberculous mycobacteria (NTM) are frequently found in respiratory specimens recently. A 65-year-old woman was admitted with complaints of fever, cough, weight loss, and hemoptysis. On the patient's chest radiography an upper lobe cavity in both lungs and consolidation was detected. Acid-fast bacilli 4+ were observed in smear of sputum and culture results M. intracellulare and M. tuberculosis were observed together. The patient's treatment was arranged. Through this case, we want to emphasize that tuberculosis and nontuberculous mycobacterial disease can coexist.
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Affiliation(s)
- Nafiye Yılmaz
- Department of Pulmonary Diseases, Ataturk University School of Medicine, Erzurum, Turkey
| | - Elif Yılmazel Uçar
- Department of Pulmonary Diseases, Ataturk University School of Medicine, Erzurum, Turkey
| | - Leyla Sağlam
- Department of Pulmonary Diseases, Ataturk University School of Medicine, Erzurum, Turkey
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Wang MS, Wang JL, Wang XF. The performance of interferon-gamma release assay in nontuberculous mycobacterial diseases: a retrospective study in China. BMC Pulm Med 2016; 16:163. [PMID: 27887611 PMCID: PMC5124224 DOI: 10.1186/s12890-016-0320-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 11/13/2016] [Indexed: 11/10/2022] Open
Abstract
Background The interferon-gamma release assay (IGRA) is more specific than the tuberculin skin test to discriminate between tuberculosis (TB) and nontuberculous mycobacterial (NTM) diseases. Here we performed a retrospective study to evaluate the performance of the T-SPOT.TB in patients with NTM diseases. Methods Between March, 2013 and Nov, 2015, a total of 58 patients with NTM diseases had a T-SPOT.TB performed were enrolled, 30 patients had definite NTM diseases, 28 had probable diseases. Their clinicopathological characteristics were reviewed and analyzed. Cultures for mycobacteria were performed. The indirect proportion method with Löwenstein–Jensen (L-J) medium was used for first-line drug susceptibility test. T-SPOT.TB assay was performed according to the manufacturer’s instructions. Data were expressed as mean ± standard deviation (continuous variables) and as numbers and percentages (categorical variables). The χ2 test was used for comparisons between proportions. Results The average age was 51.8 ± 16.1 years (range 10 to 77 years), 58.6% (34/58) were male. 16.4% (9/55) were TB-PCR positive. 34 (58.6%) isolates were Mycobacterium intracellulare, ten (17.2%) were Mycobacterium chelonae and seven (12.1%) were Mycobacterium fortuitum. Fifty-two (89.7%) patients were NTM lung disease, five (8.6%) were pleural disease, and one (1.7%) lymphadenitis. The total positivity of T-SPOT.TB was 53.4% (31/58) among the whole group (probable and definite). For probable cases, the T-SPOT.TB assay was positive in 53.5% (15/28); for definite cases, 16 (53.3%) of 30 definite cases were positive. There was no statistical difference in the positivity rate between them (P < 0.01). Conclusions In the study, we showed that a significant portion of NTM diseases were T-SPOT.TB positive in China. Although T-SPOT.TB is useful diagnostic method for differentiating TB from NTM diseases, in China, the IGRA assay show limited value in the discrimination. In addition, further research is needed to investigate the association between TB infection and treatment for NTM patients.
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Affiliation(s)
- Mao-Shui Wang
- Department of Lab Medicine, Shandong Provincial Chest Hospital, 46# Lishan Road, Jinan City, 250013, People's Republic of China
| | - Jun-Li Wang
- Center of Clinical Laboratory, Affiliated Hospital of Youjiang Medical College for Nationalities, Baise, China.
| | - Xin-Feng Wang
- Department of Lab Medicine, Shandong Provincial Chest Hospital, 46# Lishan Road, Jinan City, 250013, People's Republic of China.
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Duan H, Han X, Wang Q, Wang J, Wang J, Chu N, Huang H. Clinical Significance of Nontuberculous Mycobacteria Isolated From Respiratory Specimens in a Chinese Tuberculosis Tertiary Care Center. Sci Rep 2016; 6:36299. [PMID: 27808247 PMCID: PMC5093757 DOI: 10.1038/srep36299] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 10/12/2016] [Indexed: 11/09/2022] Open
Abstract
The clinical relevance of non-tuberculous mycobacteria (NTM) has been reported to be different dramatically by species or by regions, however, no such evaluation has been performed in China.A retrospective study was performed in Beijing Chest Hospital. All the NTM strains isolated from respiratory specimens in the past 5 years, and patients' clinical records (symptoms and radiographic information etc.) were investigated. The clinical relevance was evaluated according to the criteria recommended by the American Thoracic society. Totally 232 NTM strains were recruited, among them, M. intracellulare was the dominant species (40.5%), followed by M. abscessus (28.4%). 109 patients, with 185 total isolates, had full clinical records available for review. 84.4% (38/45), 85.7% (24/28%) and 63.6% (7/11) of patients with isolation of M. intracellulare, M. abscessus and M. kansasii, respectively, were categorized as definite NTM disease. Whereas all the 10 patients with isolation of M. gordonae were defined as unlikely NTM disease. The majority of NTMs isolates yielded from respiratory specimens in Beijing Chest Hospital were clinically significant, and M. intracellulare and M. abscessus was the dominated species of NTM lung disease. NTM lung infections demonstrated some specific chest radiograph characteristics.
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Affiliation(s)
- Hongfei Duan
- Department of Tuberculosis, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China
| | - Xiqin Han
- Department of Tuberculosis, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China
| | - Qingfeng Wang
- Department of Tuberculosis, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China
| | - Jing Wang
- Department of Tuberculosis, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China
| | - Jun Wang
- Department of Tuberculosis, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China
| | - Naihui Chu
- Department of Tuberculosis, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China
| | - Hairong Huang
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China
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Raju RM, Raju SM, Zhao Y, Rubin EJ. Leveraging Advances in Tuberculosis Diagnosis and Treatment to Address Nontuberculous Mycobacterial Disease. Emerg Infect Dis 2016; 22:365-9. [PMID: 26886068 PMCID: PMC4766907 DOI: 10.3201/eid2203.151643] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Recent advances in TB diagnosis and treatment must be considered in the basic scientific research of other mycobacterial diseases. The nontuberculous mycobacteria (NTM), defined as any mycobacterial pathogen other than Mycobacterium tuberculosis or Mycobacterium leprae, are a diverse group of pathogens that collectively cause a substantive but often unappreciated worldwide burden of illness. Although NTMs may cause illness similar to M. tuberculosis, these pathogens generally do not respond to classic tuberculosis (TB) drug regimens, resulting in misdiagnosis and poor treatment, particularly in resource-poor settings. Although a few high-quality epidemiologic surveys have been made on the topic, existing evidence suggests that NTM-associated disease is much more common than previously thought: more common than TB in the industrialized world and likely increasing in prevalence globally. Despite this evidence, these organisms remain markedly understudied, and few international grants support basic science and clinical research. Here we suggest that the considerable efforts in developing new treatments and diagnostics for TB can be harnessed in the fight against NTM-associated illnesses.
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Keerthirathne TP, Magana-Arachchi DN, Madegedara D, Sooriyapathirana SS. Real time PCR for the rapid identification and drug susceptibility of Mycobacteria present in Bronchial washings. BMC Infect Dis 2016; 16:607. [PMID: 27782812 PMCID: PMC5080729 DOI: 10.1186/s12879-016-1943-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 10/19/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Mycobacteria have a spectrum of virulence and different susceptibilities to antibiotics. Distinguishing mycobacterial species is vital as patients with non-tuberculous mycobacterial (NTM) infections present clinical features that are similar to those of patients with tuberculosis. Thus, rapid differentiation of Mycobacterium tuberculosis complex from NTM is critical to administer appropriate treatment. Hence the aim of the study was to rapid identification of mycobacterial species present in bronchial washings using multiplex real time Polymerase Chain Reaction (PCR) and to determine the drug susceptibility in identified mycobacterial species. METHODS Sputum smear negative bronchoscopy specimens (n = 150) were collected for a period of one year, from patients attending the General Hospital Kandy, Sri Lanka. The specimens were processed with modified Petroff's method and were cultured on Löwenstein- Jensen medium. DNA, extracted from the mycobacterial isolates were subjected to a SYBR green mediated real time multiplex, PCR assay with primers specific for the M. tuberculosis complex, M. avium complex, M. chelonae-M.abscessus group and M. fortuitum group. DNA sequencing was performed for the species confirmation, by targeting the 16S rRNA gene and the drug susceptibility testing was performed for the molecularly identified isolates of M. tuberculosis and NTM. RESULTS The optimized SYBR Green mediated multiplex real-time PCR assay was able to identify the presence of genus Mycobacterium in 25 out of 26 AFB positive isolates, two M. tuberculosis complex, three M. avium complex and two isolates belonging to M. chelonae-M. abscessus group. DNA sequencing confirmed the presence of M. tuberculosis, M. chelonae-M. abscessus, M. intracellulare, M. avium, Rhodococcus sp. and M. celatum. Remaining isolates were identified as Mycobacterium sp. All the NTM isolates were sensitive to amikacin and seven were resistant to ciproflaxacin. Twenty two of the NTM isolates and the isolate Rhodococcus was resistant to clarithromycin. The two isolates of M. tuberculosis were sensitive to all first line anti tuberculosis drugs. CONCLUSION The optimized SYBR Green mediated multiplex real time PCR assay could be an effective tool for the rapid differentiation of pathogenic M. tuberculosis complex from the opportunistic nontuberculous mycobacteria and also it confirmed the presence of NTM in 15.3 % of the study population.
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Goswami B, Narang P, Mishra PS, Narang R, Narang U, Mendiratta DK. Drug susceptibility of rapid and slow growing non-tuberculous mycobacteria isolated from symptomatics for pulmonary tuberculosis, Central India. Indian J Med Microbiol 2016; 34:442-447. [DOI: 10.4103/0255-0857.195375] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Dziedzinska R, Makovcova J, Kaevska M, Slany M, Babak V, Moravkova M. Nontuberculous Mycobacteria on Ready-to-Eat, Raw and Frozen Fruits and Vegetables. J Food Prot 2016; 79:1452-6. [PMID: 27497136 DOI: 10.4315/0362-028x.jfp-16-030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The consumption of fruits and vegetables is increasing worldwide because of the positive impact of these foods on human health. Ready-to-eat, raw whole, and frozen fruits and vegetables were purchased from markets and examined for the presence of nontuberculous mycobacteria (NTM) using culture, real-time PCR (qPCR), and sequencing. Using qPCR, Mycobacterium sp. at 10(0) to 10(4) ge/g (genome equivalents per gram) was found in almost all of the 178 samples; members of the M. avium complex were found only sporadically. Culture and sequencing revealed the presence of 22 viable NTM isolates in 17 samples. In addition to NTM commonly found in the environment, several rarely described isolates of viable NTM were recovered. The presence of Mycobacterium shigaense, which has been previously isolated only from human patients, was found in lettuce, the first time that this species has been found in an environmental sample. Mycobacterium parmense, Mycobacterium palustre, and Mycobacterium llatzerense, which have been previously isolated from human patients and occasionally from soil and water, were recovered from leafy green vegetables. Strawberries and cut salad mixes contained Mycobacterium algericum, Mycobacterium fallax, and Mycobacterium minnesotense. NTM are primarily nonpathogenic. However, consumption of fruits or vegetables contaminated with NTM could represent a health risk for immunocompromised people, children, and the elderly.
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Affiliation(s)
- Radka Dziedzinska
- Department of Food and Feed Safety, Veterinary Research Institute, 621 00 Brno, Czech Republic
| | - Jitka Makovcova
- Department of Food and Feed Safety, Veterinary Research Institute, 621 00 Brno, Czech Republic
| | - Marija Kaevska
- Department of Food and Feed Safety, Veterinary Research Institute, 621 00 Brno, Czech Republic
| | - Michal Slany
- Department of Food and Feed Safety, Veterinary Research Institute, 621 00 Brno, Czech Republic
| | - Vladimir Babak
- Department of Food and Feed Safety, Veterinary Research Institute, 621 00 Brno, Czech Republic
| | - Monika Moravkova
- Department of Food and Feed Safety, Veterinary Research Institute, 621 00 Brno, Czech Republic.
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Kang HK, Jeong BH, Lee H, Park HY, Jeon K, Huh HJ, Ki CS, Lee NY, Koh WJ. Clinical significance of smear positivity for acid-fast bacilli after ≥5 months of treatment in patients with drug-susceptible pulmonary tuberculosis. Medicine (Baltimore) 2016; 95:e4540. [PMID: 27495111 PMCID: PMC4979865 DOI: 10.1097/md.0000000000004540] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Patients with pulmonary tuberculosis (TB) with acid-fast bacilli (AFB)-positive sputum smear at 5 months or later during treatment are considered to be cases of treatment failure according to World Health Organization guidelines. This study evaluated the proportion, clinical characteristics, and significance of positive sputum smears after ≥5 months of standard treatment in patients with drug-susceptible pulmonary TB.This was a retrospective cohort study of 1611 patients with culture-confirmed drug-susceptible pulmonary TB who received standard anti-TB treatment from January 2009 to February 2014. Forty-one patients (2.5%) who were smear-positive after ≥5 months of treatment and 123 age- and sex-matched control patients were evaluated.Among the 41 smear-positive patients, culture of the sputum specimens yielded Mycobacterium tuberculosis (MTB) in 1 patient (2.4%), nontuberculous mycobacteria (NTM) in 7 (17.1%), and no growth in the remaining 33 patients (80.5%). Treatment was successfully completed in 40 patients (97.6%) with prolongation of the continuation phase regimens without change to second-line anti-TB treatment. In patients with smear positivity after ≥5 months of treatment compared with controls, cavitation on chest radiographs (53.7% vs. 25.2%, P = 0.001), bilateral involvement (51.2% vs. 30.1%, P = 0.01) and combined pleural effusion (26.8% vs. 10.6%, P = 0.01) were found more frequently at the time of treatment initiation, and paradoxical response occurred more commonly (19.5% vs. 3.3%, P = 0.002) during treatment.Smear-positive sputum after ≥5 months of standard anti-TB treatment was mainly because of nonviable MTB bacilli or NTM in patients with drug-susceptible pulmonary TB. AFB smear alone should not be used to assess treatment failure and careful examination of microbiologic status, including culture and drug susceptibility testing, is needed before making changes to retreatment regimens or empirical second-line anti-TB regimens in these patients.
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Affiliation(s)
- Hyung Koo Kang
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Ilsan Paik Hospital, Inje University School of Medicine, Goyang, Gyeonggi
| | - Byeong-Ho Jeong
- Department of Medicine, Division of Pulmonary and Critical Care Medicine
| | - Hyun Lee
- Department of Medicine, Division of Pulmonary and Critical Care Medicine
| | - Hye Yun Park
- Department of Medicine, Division of Pulmonary and Critical Care Medicine
| | - Kyeongman Jeon
- Department of Medicine, Division of Pulmonary and Critical Care Medicine
| | - Hee Jae Huh
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Chang-Seok Ki
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Nam Yong Lee
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Won-Jung Koh
- Department of Medicine, Division of Pulmonary and Critical Care Medicine
- Correspondence: Won-Jung Koh, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, South Korea (e-mail: )
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64
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Riello FN, Brígido RTS, Araújo S, Moreira TA, Goulart LR, Goulart IMB. Diagnosis of mycobacterial infections based on acid-fast bacilli test and bacterial growth time and implications on treatment and disease outcome. BMC Infect Dis 2016; 16:142. [PMID: 27039183 PMCID: PMC4818481 DOI: 10.1186/s12879-016-1474-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 03/17/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The establishment of therapeutic regimens for mycobacteriosis depends on the accurate identification of Mycobacterium species, and misdiagnosis can result in inappropriate treatment and increased mortality of patients. Differential diagnosis among Mycobacterium species has been made by conventional phenotypic and biochemical tests after a long culture period. Specialized molecular diagnostics of mycobacteria allows rapid detection and species identification; however, such tests are not available in public health programs. Our aim was to demonstrate the clinical implications of erroneous diagnosis by performing molecular genotyping of mycobacterial infections in patients that were diagnosed based on symptoms, culture and bacilloscopy. METHODS Culture samples of mycobacterial infections from 55 patients clinically diagnosed as tuberculosis in 2013 and 2014, based on conventional methods, were identified by PCR -RFLP and results are discussed. RESULTS We have confirmed 35 (63.6%) positive samples as M. tuberculosis, but 18 (32.7%) were identified as non-tuberculous mycobacteria (M. avium type 1, M. avium type 2, M. kansasii type 1 type 1, M. mucogenicum, M. chelonae, M. terrae type 3, and 1 unknown RFLP pattern) and two were negative. Regarding clinical diagnosis, 61.8% (34/55) was classified as pulmonary tuberculosis. It is important to emphasize that 36.4% (20/55) of samples were misdiagnosed by conventional methods, and 11 (61.1%) of the HIV positive patients (18/55) were NTM-coinfected. CONCLUSION The identification of species in mycobacterial infections is essential for correct diagnosis and choice of treatment regimen, and misdiagnosis by conventional tools can lead to chronic disease, increased resistance and death.
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Affiliation(s)
- Fabiane N. Riello
- />National Reference Center for Sanitary Dermatology and Leprosy (CREDESH) Clinical Hospital Federal University of Uberlândia, Uberlândia, Minas Gerais Brazil
| | - Rebecca T. S. Brígido
- />National Reference Center for Sanitary Dermatology and Leprosy (CREDESH) Clinical Hospital Federal University of Uberlândia, Uberlândia, Minas Gerais Brazil
| | - Sergio Araújo
- />National Reference Center for Sanitary Dermatology and Leprosy (CREDESH) Clinical Hospital Federal University of Uberlândia, Uberlândia, Minas Gerais Brazil
| | - Tomaz A. Moreira
- />Laboratory of Clinical Analysis, Clinics’ Hospital of the Federal University of Uberlândia, Uberlândia, Minas Gerais Brazil
| | - Luiz Ricardo Goulart
- />Federal University of Uberlandia, Institute of Genetics and Biochemistry, Laboratory of Nanobiotechnology, Campus Umuarama, Block 2E, Room 248, CEP 38400-902 Uberlandia, Minas Gerais Brazil
| | - Isabela M. B. Goulart
- />National Reference Center for Sanitary Dermatology and Leprosy (CREDESH) Clinical Hospital Federal University of Uberlândia, Uberlândia, Minas Gerais Brazil
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65
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Stout JE, Koh WJ, Yew WW. Update on pulmonary disease due to non-tuberculous mycobacteria. Int J Infect Dis 2016; 45:123-34. [PMID: 26976549 DOI: 10.1016/j.ijid.2016.03.006] [Citation(s) in RCA: 221] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 03/06/2016] [Accepted: 03/08/2016] [Indexed: 01/01/2023] Open
Abstract
Non-tuberculous mycobacteria (NTM) are emerging worldwide as significant causes of chronic pulmonary infection, posing a number of challenges for both clinicians and researchers. While a number of studies worldwide have described an increasing prevalence of NTM pulmonary disease over time, population-based data are relatively sparse and subject to ascertainment bias. Furthermore, the disease is geographically heterogeneous. While some species are commonly implicated worldwide (Mycobacterium avium complex, Mycobacterium abscessus), others (e.g., Mycobacterium malmoense, Mycobacterium xenopi) are regionally important. Thoracic computed tomography, microbiological testing with identification to the species level, and local epidemiology must all be taken into account to accurately diagnose NTM pulmonary disease. A diagnosis of NTM pulmonary disease does not necessarily imply that treatment is required; a patient-centered approach is essential. When treatment is required, multidrug therapy based on appropriate susceptibility testing for the species in question should be used. New diagnostic and therapeutic modalities are needed to optimize the management of these complicated infections.
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Affiliation(s)
- Jason E Stout
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Box 102359-DUMC, Durham, NC 27710, USA.
| | - Won-Jung Koh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Wing Wai Yew
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China
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66
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Hoza AS, Mfinanga SGM, Rodloff AC, Moser I, König B. Increased isolation of nontuberculous mycobacteria among TB suspects in Northeastern, Tanzania: public health and diagnostic implications for control programmes. BMC Res Notes 2016; 9:109. [PMID: 26887928 PMCID: PMC4756402 DOI: 10.1186/s13104-016-1928-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 02/09/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Non-tuberculous mycobacteria (NTM) are increasingly reported worldwide associated with human disease. Defining the significance of NTM in settings with endemic tuberculosis (TB) requires the discrimination of NTM from TB in suspect patients. Correct and timely identification of NTM will impact both therapy and epidemiology of TB and TB-like diseases. The present study aimed at determining the frequency and diversity of NTM among TB suspects in northeastern Tanzania. METHODS A cross-sectional study was conducted between November 2012 through January 2013. Seven hundred and forty-four sputum samples were collected from 372 TB suspects. Detection was done by using phenotypic, GenoType(®) Mycobacterium CM/AS kits, 16S rRNA and hsp65 gene sequencing for identification of isolates not identified by Hain kits. Binary regression model was used to analyse the predictors of NTM detection. RESULTS The prevalence of NTM was 9.7% of the mycobacterial isolates. Out of 36 patients with confirmed NTM infection, 12 were HIV infected with HIV being a significant predictor of NTM detection (P < 0.001). Co-infection with Mycobacterium tuberculosis (M. tb) was found in five patients. Twenty-eight NTM isolates were identified using GenoType(®) Mycobacterium CM/AS and eight isolates could not be identified. Identified species included M. gordonae and M. interjectum 6 (16.7%), M. intracelullare 4 (11.1%), M. avium spp. and M. fortuitum 2 (5.5%), M. kansasii, M. lentiflavum, M. simiae, M. celatum, M. marinum 1 (2.8%) each. Of isolates not identified to subspecies level, we identified M. kumamotonense (2), M. intracellulare/kansasii, M. intermedium/triplex, M. acapulcensis/flavescens, M. stomatepiae, M. colombiense and M. terrae complex (1) each using 16S rRNA sequencing. Additionally, hsp65 gene sequencing identified M. kumamotonense, M. scrofulaceum/M. avium, M. avium, M. flavescens/novocastrense, M. kumamotonense/hiberniae, M. lentiflavum, M. colombiense/M. avium and M. kumamotonense/terrae/hiberniae (1) each. Results of the 16S rRNA and hsp65 gene sequencing were concordant in three and discordant in five isolates not identified by GenoType(®) Mycobacterium CM/AS. CONCLUSION NTM infections may play a vital role in causing lung disease and impact management of TB in endemic settings. GenoType(®) Mycobacterium CM/AS represents a useful tool to identify clinical NTM infections. However, 16S rRNA gene sequencing should be thought for confirmatory diagnosis of the clinical isolates. Due to the complexity and inconsistence of NTM identification, we recommend diagnosis of NTM infections be centralized by strengthening and setting up quality national and regional infrastructure.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Bacterial Proteins
- Bacterial Typing Techniques
- Chaperonin 60
- Child
- Coinfection
- Communicable Disease Control/organization & administration
- Cross-Sectional Studies
- Diagnosis, Differential
- Female
- HIV/genetics
- HIV Infections/diagnosis
- HIV Infections/epidemiology
- HIV Infections/virology
- Humans
- Male
- Middle Aged
- Mycobacterium Infections, Nontuberculous/diagnosis
- Mycobacterium Infections, Nontuberculous/epidemiology
- Mycobacterium Infections, Nontuberculous/microbiology
- Mycobacterium tuberculosis/genetics
- Mycobacterium tuberculosis/isolation & purification
- Nontuberculous Mycobacteria/genetics
- Nontuberculous Mycobacteria/isolation & purification
- Public Health
- RNA, Ribosomal, 16S/genetics
- Tanzania/epidemiology
- Tuberculosis, Pulmonary/diagnosis
- Tuberculosis, Pulmonary/epidemiology
- Tuberculosis, Pulmonary/microbiology
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Affiliation(s)
- Abubakar S Hoza
- Institute of Medical Microbiology and Epidemiology of Infectious Diseases, University of Leipzig, Liebigstrasse 21, 04103, Leipzig, Germany.
- Sokoine University of Agriculture, Morogoro, Tanzania.
| | - Sayoki G M Mfinanga
- Muhimbili Centre, National Institute for Medical Research (NIMR), Dar es Salaam, Tanzania.
| | - Arne C Rodloff
- Institute of Medical Microbiology and Epidemiology of Infectious Diseases, University of Leipzig, Liebigstrasse 21, 04103, Leipzig, Germany.
| | - Irmgard Moser
- Federal Research for Animal Health, Friedrich Loeffler Institut, Jena, Germany.
| | - Brigitte König
- Institute of Medical Microbiology and Epidemiology of Infectious Diseases, University of Leipzig, Liebigstrasse 21, 04103, Leipzig, Germany.
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67
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Kipourou M, Manika K, Papavasileiou A, Pitsiou G, Lada M, Ntinapogias E, Kioumis I. Immunomodulatory effect of macrolides: At what cost? Respir Med Case Rep 2016; 17:44-6. [PMID: 27222784 PMCID: PMC4821334 DOI: 10.1016/j.rmcr.2016.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 01/11/2016] [Accepted: 01/12/2016] [Indexed: 11/28/2022] Open
Abstract
We present the case of a 60-year old female patient, with a 10 year history of non-CF bronchiectasis and use of macrolides as maintenance immunomodulatory treatment, who was diagnosed with macrolide-resistant Mycobacterium avium complex lung disease. Macrolides' immunomodulatory effect is appealing for non- CF bronchiectasis patients, hiding a high risk for resistance emergence.
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Affiliation(s)
- Maria Kipourou
- Respiratory Infections Unit, Pulmonary Department, Aristotle University of Thessaloniki, G. Papanikolaou Hospital, Thessaloniki, Greece; Pulmonary Department, 424 General Military Hospital, Thessaloniki, Greece
| | - Katerina Manika
- Respiratory Infections Unit, Pulmonary Department, Aristotle University of Thessaloniki, G. Papanikolaou Hospital, Thessaloniki, Greece
| | | | - Georgia Pitsiou
- Respiratory Failure Unit, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Martha Lada
- Respiratory Infections Unit, Pulmonary Department, Aristotle University of Thessaloniki, G. Papanikolaou Hospital, Thessaloniki, Greece
| | | | - Ioannis Kioumis
- Respiratory Infections Unit, Pulmonary Department, Aristotle University of Thessaloniki, G. Papanikolaou Hospital, Thessaloniki, Greece
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68
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Bradley P, Gordon NC, Walker TM, Dunn L, Heys S, Huang B, Earle S, Pankhurst LJ, Anson L, de Cesare M, Piazza P, Votintseva AA, Golubchik T, Wilson DJ, Wyllie DH, Diel R, Niemann S, Feuerriegel S, Kohl TA, Ismail N, Omar SV, Smith EG, Buck D, McVean G, Walker AS, Peto TEA, Crook DW, Iqbal Z. Rapid antibiotic-resistance predictions from genome sequence data for Staphylococcus aureus and Mycobacterium tuberculosis. Nat Commun 2015; 6:10063. [PMID: 26686880 PMCID: PMC4703848 DOI: 10.1038/ncomms10063] [Citation(s) in RCA: 366] [Impact Index Per Article: 40.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 10/28/2015] [Indexed: 01/14/2023] Open
Abstract
The rise of antibiotic-resistant bacteria has led to an urgent need for rapid detection of drug resistance in clinical samples, and improvements in global surveillance. Here we show how de Bruijn graph representation of bacterial diversity can be used to identify species and resistance profiles of clinical isolates. We implement this method for Staphylococcus aureus and Mycobacterium tuberculosis in a software package ('Mykrobe predictor') that takes raw sequence data as input, and generates a clinician-friendly report within 3 minutes on a laptop. For S. aureus, the error rates of our method are comparable to gold-standard phenotypic methods, with sensitivity/specificity of 99.1%/99.6% across 12 antibiotics (using an independent validation set, n=470). For M. tuberculosis, our method predicts resistance with sensitivity/specificity of 82.6%/98.5% (independent validation set, n=1,609); sensitivity is lower here, probably because of limited understanding of the underlying genetic mechanisms. We give evidence that minor alleles improve detection of extremely drug-resistant strains, and demonstrate feasibility of the use of emerging single-molecule nanopore sequencing techniques for these purposes.
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Affiliation(s)
- Phelim Bradley
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK
| | - N Claire Gordon
- Nuffield Department of Medicine, University of Oxford, Oxford OX1 1NF, UK
| | - Timothy M Walker
- Nuffield Department of Medicine, University of Oxford, Oxford OX1 1NF, UK
| | - Laura Dunn
- Nuffield Department of Medicine, University of Oxford, Oxford OX1 1NF, UK
| | - Simon Heys
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK
| | - Bill Huang
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK
| | - Sarah Earle
- Nuffield Department of Medicine, University of Oxford, Oxford OX1 1NF, UK
| | - Louise J Pankhurst
- Nuffield Department of Medicine, University of Oxford, Oxford OX1 1NF, UK
| | - Luke Anson
- Nuffield Department of Medicine, University of Oxford, Oxford OX1 1NF, UK
| | | | - Paolo Piazza
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK
| | | | - Tanya Golubchik
- Nuffield Department of Medicine, University of Oxford, Oxford OX1 1NF, UK
| | - Daniel J Wilson
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK.,Nuffield Department of Medicine, University of Oxford, Oxford OX1 1NF, UK
| | - David H Wyllie
- Nuffield Department of Medicine, University of Oxford, Oxford OX1 1NF, UK
| | - Roland Diel
- Institute for Epidemiology, University Medical Hospital Schleswig-Holstein, Niemannsweg 11, 24105 Kiel, Germany
| | - Stefan Niemann
- Molecular and Experimental Mycobacteriology, Research Centre Borstel, Parkallee 1, 23845 Borstel, Germany.,German Centre for Infection Research, Partner Site Borstel, Parkallee 1, 23845 Borstel, Germany
| | - Silke Feuerriegel
- Molecular and Experimental Mycobacteriology, Research Centre Borstel, Parkallee 1, 23845 Borstel, Germany.,German Centre for Infection Research, Partner Site Borstel, Parkallee 1, 23845 Borstel, Germany
| | - Thomas A Kohl
- Molecular and Experimental Mycobacteriology, Research Centre Borstel, Parkallee 1, 23845 Borstel, Germany
| | - Nazir Ismail
- Centre for Tuberculosis, National Institute for Communicable Diseases, Private Bag X4 Sandringham, Johannesburg 2131, South Africa.,Department of Medical Microbiology, University of Pretoria, PO Box 667, Pretoria 0001, South Africa
| | - Shaheed V Omar
- Centre for Tuberculosis, National Institute for Communicable Diseases, Private Bag X4 Sandringham, Johannesburg 2131, South Africa
| | - E Grace Smith
- Regional Centre for Mycobacteriology, PHE Public Health Laboratory Birmingham. Heartlands Hospital, Bordesley Green East, Birmingham B9 5SS, UK
| | - David Buck
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK
| | - Gil McVean
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK
| | - A Sarah Walker
- Nuffield Department of Medicine, University of Oxford, Oxford OX1 1NF, UK.,Biomedical Research Centre, NIHR (National Institutes of Health Research) Oxford Biomedical Research Centre, Oxford OX3 7LE, UK
| | - Tim E A Peto
- Nuffield Department of Medicine, University of Oxford, Oxford OX1 1NF, UK.,Biomedical Research Centre, NIHR (National Institutes of Health Research) Oxford Biomedical Research Centre, Oxford OX3 7LE, UK
| | - Derrick W Crook
- Nuffield Department of Medicine, University of Oxford, Oxford OX1 1NF, UK.,Biomedical Research Centre, NIHR (National Institutes of Health Research) Oxford Biomedical Research Centre, Oxford OX3 7LE, UK.,National Infection Service, Public Health England, Wellington House, 133-155 Waterloo Road, London SE1 8UG, UK
| | - Zamin Iqbal
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK
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Chiang CY, Yu MC, Yang SL, Yen MY, Bai KJ. Surveillance of Tuberculosis in Taipei: The Influence of Nontuberculous Mycobacteria. PLoS One 2015; 10:e0142324. [PMID: 26544554 PMCID: PMC4636369 DOI: 10.1371/journal.pone.0142324] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 10/19/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Notification of tuberculosis (TB) but not nontuberculous mycobacteria (NTM) is mandatory in Taiwan. Partly due to the strict regulation on TB notification, several patients infected with NTM were notified as TB cases. Notification of patients infected with NTM as TB cases can trigger public health actions and impose additional burdens on the public health system. We conducted a study to assess the influence of NTM infection on surveillance of TB in Taipei. METHODOLOGY/PRINCIPAL FINDINGS The study population included all individuals with a positive culture for Mycobacterium who were citizens of Taipei City and notified as TB cases in the calendar years 2007-2010. Of the 4216 notified culture-positive tuberculosis (TB) cases, 894 (21.2%) were infected with NTM. The average annual reported case rate of infection with NTM was 8.6 (95% confidence interval 7.7-9.4) per 100,000 people. The reported case rate of NTM increased with age in both males and females. The proportion of reported TB cases infected with NTM was significantly higher in females than in males (27.6% vs 17.8%, adjusted OR (adjOR) 1.93, 95% confidence interval (CI) 1.63-2.28); in smear-positive than in smear-negative (23.1% vs 19.2%, adjOR 1.26, 95% CI 1.08-1.47); and in previously treated cases than in new cases (35.7% vs 19.1%, adjOR 2.30, 95% CI 1.88-2.82). The most frequent species was M. avium complex (32.4%), followed by M. chelonae complex (17.6%), M. fortuitum complex (17.0%) and M. kansasii (9.8%). Of the 890 notified NTM cases assessed, 703 (79.0%) were treated with anti-TB drugs, and 730 (82.0%) were de-notified. CONCLUSIONS/SIGNIFICANCE The influence of NTM on surveillance of TB in Taipei was substantial. Health authorities should take action to ensure that nucleic acid amplification tests are performed in all smear-positive cases in a timely manner to reduce the misdiagnosis of patients infected with NTM as TB cases.
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Affiliation(s)
- Chen-Yuan Chiang
- International Union Against Tuberculosis and Lung Disease, Paris, France
- Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ming-Chih Yu
- Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shiang-Lin Yang
- Centers for Disease Control, Department of Health, Taipei, Taiwan
| | - Muh-Yong Yen
- Department of Disease Control and Prevention, Taipei City Hospital, Taipei City Government, Taipei, Taiwan
| | - Kuan-Jen Bai
- Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan
- * E-mail:
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70
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Senoputra MA, Shiratori B, Hasibuan FM, Koesoemadinata RC, Apriani L, Ashino Y, Ono K, Oda T, Matsumoto M, Suzuki Y, Alisjahbana B, Hattori T. Diagnostic value of antibody responses to multiple antigens from Mycobacterium tuberculosis in active and latent tuberculosis. Diagn Microbiol Infect Dis 2015; 83:278-85. [PMID: 26307672 DOI: 10.1016/j.diagmicrobio.2015.07.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 07/23/2015] [Accepted: 07/25/2015] [Indexed: 10/23/2022]
Abstract
We investigated the antibody responses to 10 prospective Mycobacterium tuberculosis (MTB) antigens and evaluated their ability to discriminate between latent (LTBI) and active pulmonary tuberculosis (TB). Our results indicate that plasma levels of anti-α-crystallin (ACR), antilipoarabinomannan, anti-trehalose 6,6'-dimycolate, and anti-tubercular-glycolipid antigen antibodies were higher in patients with active TB, compared to those in the LTBI and control subjects. No differences in the antibodies were observed between the control and LTBI subjects. Antibodies against the glycolipid antigens could not distinguish between Mycobacterium avium complex (MAC)-negative TB patients and MAC-infected LTBI individuals. The most useful serological marker was antibodies to ACR, with MAC-negative TB patients having higher titers than those observed in MAC-positive LTBI and control subjects. Our data indicate that antibody to ACR is a promising target for the serological diagnosis of patients with active TB patients. When dealing with antiglycolipid antibodies, MAC coinfection should always be considered in serological studies.
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Affiliation(s)
- Muhammad Andrian Senoputra
- Division of Emerging Infectious Diseases, Graduate School of Medicine, Tohoku University, 21 Seiryo-machi, Aoba-ku, Sendai, 980-8574 Miyagi, Japan; Public Health Science Program, Faculty of Medicine, Universitas Padjadjaran, Jl. Eicjkman 38, Bandung, 40161, West Java, Indonesia.
| | - Beata Shiratori
- Division of Emerging Infectious Diseases, Graduate School of Medicine, Tohoku University, 21 Seiryo-machi, Aoba-ku, Sendai, 980-8574 Miyagi, Japan; Division of Disaster-related Infectious Diseases, International Research Institute of Disaster Science, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Miyagi, Japan; Japan International Corporation of Welfare Services, 2-3-20 Toranomon YHK Bldg. 4F, Toranomon, Minato-ku, 105-0001 Tokyo, Japan.
| | - Fakhrial Mirwan Hasibuan
- Division of Emerging Infectious Diseases, Graduate School of Medicine, Tohoku University, 21 Seiryo-machi, Aoba-ku, Sendai, 980-8574 Miyagi, Japan; Public Health Science Program, Faculty of Medicine, Universitas Padjadjaran, Jl. Eicjkman 38, Bandung, 40161, West Java, Indonesia.
| | | | - Lika Apriani
- TB-HIV Research Center, Medical faculty, Padjadjaran University, Jl. Eicjkman 38, Bandung, 40161, West Java, Indonesia.
| | - Yugo Ashino
- Division of Emerging Infectious Diseases, Graduate School of Medicine, Tohoku University, 21 Seiryo-machi, Aoba-ku, Sendai, 980-8574 Miyagi, Japan; Division of Disaster-related Infectious Diseases, International Research Institute of Disaster Science, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Miyagi, Japan.
| | - Kenji Ono
- Microbiological Research Institute, Otsuka Pharmaceutical Co., Ltd., 463-10 Kagasuno, Kawauchi-cho, 771-0192 Tokushima, Japan.
| | - Tetsuya Oda
- Microbiological Research Institute, Otsuka Pharmaceutical Co., Ltd., 463-10 Kagasuno, Kawauchi-cho, 771-0192 Tokushima, Japan.
| | - Makoto Matsumoto
- Microbiological Research Institute, Otsuka Pharmaceutical Co., Ltd., 463-10 Kagasuno, Kawauchi-cho, 771-0192 Tokushima, Japan.
| | - Yasuhiko Suzuki
- Division of Global Epidemiology, Research Center for Zoonosis Control, Hokkaido University, North 20, West 10, Kita-ku, Sapporo, 001-0020 Hokkaido, Japan.
| | - Bachti Alisjahbana
- TB-HIV Research Center, Medical faculty, Padjadjaran University, Jl. Eicjkman 38, Bandung, 40161, West Java, Indonesia.
| | - Toshio Hattori
- Division of Emerging Infectious Diseases, Graduate School of Medicine, Tohoku University, 21 Seiryo-machi, Aoba-ku, Sendai, 980-8574 Miyagi, Japan; Division of Disaster-related Infectious Diseases, International Research Institute of Disaster Science, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Miyagi, Japan.
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Shao Y, Chen C, Song H, Li G, Liu Q, Li Y, Zhu L, Martinez L, Lu W. The epidemiology and geographic distribution of nontuberculous mycobacteria clinical isolates from sputum samples in the eastern region of China. PLoS Negl Trop Dis 2015; 9:e0003623. [PMID: 25775117 PMCID: PMC4361326 DOI: 10.1371/journal.pntd.0003623] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 02/13/2015] [Indexed: 11/18/2022] Open
Abstract
Background Nontuberculous mycobacteria (NTM) have been reported to be increasing worldwide and its geographic distribution differs by region. The aim of this study was to describe the epidemiology and distribution of NTM in the eastern part of China. Methods Sputum samples were collected from 30 surveillance sites for tuberculosis drug resistance test from May 1, 2008 to December 31, 2008. Identification was performed using a biochemical test, multiplex PCR and GenoType Mycobacterium CM/AS assay. Results A total of 1779 smear positive clinical isolates were obtained, of which 60 (3.37%) were NTM. Five species/complex of NTM were identified; M. intracellulare was the predominated species (68.33%), followed by M. abscessus-M. immunogenum (13.33%), Mycobacterium spec. (10.00%), M. Kansasii (6.67%) and M. peregrinum-M. alvei-M. septicum (1.67%). Conclusion M. intracellulare was the main species of NTM in the eastern part of China and clinical physicians should pay more attention to NTM induced pulmonary disease. Nontuberculous mycobacteria (NTM) exist ubiquitously in the environment and cause many kinds of diseases including pulmonary infection. Despite this, NTM does not match compulsory report policy in many countries, such as China. Thus, the epidemiology of NTM is generally unknown. Furthermore, misdiagnosis of nontuberculous mycobacterium disease as multi-drug resistant tuberculosis (MDR-TB) frequently occurs in clinical settings because of similar clinical manifestations. Therefore, elucidating the epidemiology and distribution of NTM species is important and may have a profound and lasting impact on the prevalence of pulmonary NTM disease. In our study, we enrolled smear-positive sputum samples during 2008 from Jiangsu province in the eastern region of China. Traditional biochemical tests and molecular biological methods were performed to distinguish NTM isolates to species/complex level. For the first time, we provide a snapshot of the epidemiology and geographic distribution of NTM in Jiangsu province. The proportion of NTM was 3.37% of all the Mycobacterium isolates and the species of NTM differed by area.
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Affiliation(s)
- Yan Shao
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, China
| | - Cheng Chen
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, China
| | - Honghuan Song
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, China
| | - Guoli Li
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, China
| | - Qiao Liu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, China
| | - Yan Li
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, China
| | - Limei Zhu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, China
| | - Leonardo Martinez
- Department of Epidemiology and Biostatistics, University of Georgia School of Public Health, Athens, Georgia, United States of America
| | - Wei Lu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, China
- * E-mail:
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Non-tuberculous mycobacteria in children: muddying the waters of tuberculosis diagnosis. THE LANCET RESPIRATORY MEDICINE 2015; 3:244-56. [DOI: 10.1016/s2213-2600(15)00062-4] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 01/11/2015] [Accepted: 01/12/2015] [Indexed: 11/24/2022]
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Xu K, Bi S, Ji Z, Hu H, Hu F, Zheng B, Wang B, Ren J, Yang S, Deng M, Chen P, Ruan B, Sheng J, Li L. Distinguishing nontuberculous mycobacteria from multidrug-resistant Mycobacterium tuberculosis, China. Emerg Infect Dis 2015; 20:1060-2. [PMID: 24856951 PMCID: PMC4036753 DOI: 10.3201/eid2006.130700] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
MESH Headings
- Antitubercular Agents/therapeutic use
- China
- Diagnosis, Differential
- Diagnostic Errors
- Drug Resistance, Multiple, Bacterial/genetics
- Genes, Bacterial
- Humans
- Mutation
- Mycobacterium Infections, Nontuberculous/diagnosis
- Mycobacterium Infections, Nontuberculous/drug therapy
- Mycobacterium Infections, Nontuberculous/microbiology
- Mycobacterium tuberculosis/drug effects
- Mycobacterium tuberculosis/genetics
- Mycobacterium tuberculosis/isolation & purification
- Nontuberculous Mycobacteria/drug effects
- Nontuberculous Mycobacteria/genetics
- Nontuberculous Mycobacteria/isolation & purification
- RNA, Ribosomal, 16S/genetics
- Sputum/microbiology
- Tuberculosis, Multidrug-Resistant/diagnosis
- Tuberculosis, Multidrug-Resistant/drug therapy
- Tuberculosis, Multidrug-Resistant/microbiology
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74
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Prevots DR, Marras TK. Epidemiology of human pulmonary infection with nontuberculous mycobacteria: a review. Clin Chest Med 2014; 36:13-34. [PMID: 25676516 DOI: 10.1016/j.ccm.2014.10.002] [Citation(s) in RCA: 581] [Impact Index Per Article: 58.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Population-based data have documented a worldwide increase in the prevalence of human nontuberculous mycobacterial (NTM) infections since 2000. Mycobacterium avium complex is predominant in North America and East Asia, whereas in regions within Europe, M kansasii, M xenopi, and M malmoense are more common. Host factors important to the current epidemiology of NTM pulmonary disease include thoracic skeletal abnormalities, rheumatoid arthritis, and use of immunomodulatory drugs. Clustering of disease within families suggests a heritable genetic predisposition to disease susceptibility. Warm, humid environments with high atmospheric vapor pressure contribute to population risk.
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Affiliation(s)
- D Rebecca Prevots
- Epidemiology Unit, Laboratory of Clinical Infectious Diseases, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 9000 Rockville Pike, Building 15B-1, 8 West Drive, MSC 2665, Bethesda, MD 20892, USA.
| | - Theodore K Marras
- Division of Respirology, Department of Medicine, University of Toronto and Toronto Western Hospital, 399 Bathurst Street, 7E-452, Toronto, ON M5T 2S8, Canada
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75
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Doughty EL, Sergeant MJ, Adetifa I, Antonio M, Pallen MJ. Culture-independent detection and characterisation of Mycobacterium tuberculosis and M. africanum in sputum samples using shotgun metagenomics on a benchtop sequencer. PeerJ 2014; 2:e585. [PMID: 25279265 PMCID: PMC4179564 DOI: 10.7717/peerj.585] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 08/28/2014] [Indexed: 01/27/2023] Open
Abstract
Tuberculosis remains a major global health problem. Laboratory diagnostic methods that allow effective, early detection of cases are central to management of tuberculosis in the individual patient and in the community. Since the 1880s, laboratory diagnosis of tuberculosis has relied primarily on microscopy and culture. However, microscopy fails to provide species- or lineage-level identification and culture-based workflows for diagnosis of tuberculosis remain complex, expensive, slow, technically demanding and poorly able to handle mixed infections. We therefore explored the potential of shotgun metagenomics, sequencing of DNA from samples without culture or target-specific amplification or capture, to detect and characterise strains from the Mycobacterium tuberculosis complex in smear-positive sputum samples obtained from The Gambia in West Africa. Eight smear- and culture-positive sputum samples were investigated using a differential-lysis protocol followed by a kit-based DNA extraction method, with sequencing performed on a benchtop sequencing instrument, the Illumina MiSeq. The number of sequence reads in each sputum-derived metagenome ranged from 989,442 to 2,818,238. The proportion of reads in each metagenome mapping against the human genome ranged from 20% to 99%. We were able to detect sequences from the M. tuberculosis complex in all eight samples, with coverage of the H37Rv reference genome ranging from 0.002X to 0.7X. By analysing the distribution of large sequence polymorphisms (deletions and the locations of the insertion element IS6110) and single nucleotide polymorphisms (SNPs), we were able to assign seven of eight metagenome-derived genomes to a species and lineage within the M. tuberculosis complex. Two metagenome-derived mycobacterial genomes were assigned to M. africanum, a species largely confined to West Africa; the others that could be assigned belonged to lineages T, H or LAM within the clade of "modern" M. tuberculosis strains. We have provided proof of principle that shotgun metagenomics can be used to detect and characterise M. tuberculosis sequences from sputum samples without culture or target-specific amplification or capture, using an accessible benchtop-sequencing platform, the Illumina MiSeq, and relatively simple DNA extraction, sequencing and bioinformatics protocols. In our hands, sputum metagenomics does not yet deliver sufficient depth of coverage to allow sequence-based sensitivity testing; it remains to be determined whether improvements in DNA extraction protocols alone can deliver this or whether culture, capture or amplification steps will be required. Nonetheless, we can foresee a tipping point when a unified automated metagenomics-based workflow might start to compete with the plethora of methods currently in use in the diagnostic microbiology laboratory.
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Affiliation(s)
- Emma L. Doughty
- Microbiology and Infection Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Martin J. Sergeant
- Microbiology and Infection Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | | | - Martin Antonio
- Microbiology and Infection Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
- Medical Research Council Unit, Fajara, The Gambia
| | - Mark J. Pallen
- Microbiology and Infection Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
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76
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Kwon YS, Koh WJ. Diagnosis of pulmonary tuberculosis and nontuberculous mycobacterial lung disease in Korea. Tuberc Respir Dis (Seoul) 2014; 77:1-5. [PMID: 25114696 PMCID: PMC4127406 DOI: 10.4046/trd.2014.77.1.1] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 05/08/2014] [Accepted: 05/15/2014] [Indexed: 01/15/2023] Open
Abstract
The recovery of nontuberculous mycobacteria (NTM) from respiratory specimens and the number of patients with NTM lung disease have been rapidly increasing in Korea. An early differential diagnosis of NTM lung disease from pulmonary tuberculosis (TB) is important, as the therapeutic regimen differs from that of pulmonary TB, and it is not necessary to track the contacts of patients with NTM lung disease. However, differentiating NTM lung disease from pulmonary TB remains difficult, because the clinical presentations of the two diseases are similar and a definite diagnosis of NTM lung disease based on sputum culture takes time. This review focuses on the changing epidemiology, clinical and radiographic manifestation, and laboratory diagnosis of pulmonary TB and NTM lung disease in Korea.
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Affiliation(s)
- Yong Soo Kwon
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Won-Jung Koh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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77
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Shaarawy H, Elhawary AT. Risk factors for atypical mycobacterial disease in patients with smear positive pulmonary TB. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2014. [DOI: 10.1016/j.ejcdt.2014.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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78
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Xu K, Bi S, Ji Z, Hu H, Hu F, Zheng B, Wang B, Ren J, Yang S, Deng M, Chen P, Ruan B, Sheng J, Li L. Distinguishing Nontuberculous Mycobacteria from Multidrug-Resistant Mycobacterium tuberculosis, China. Emerg Infect Dis 2014. [DOI: 10.3201/eid2006.140700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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79
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Wildner LM, Bazzo ML, Liedke SC, Nogueira CL, Segat G, Senna SG, Schlindwein AD, Oliveira JGD, Rovaris DB, Bonjardim CA, Kroon EG, Ferreira PCP. Mycobacteria mobility shift assay: a method for the rapid identification of Mycobacterium tuberculosis and nontuberculous mycobacteria. Mem Inst Oswaldo Cruz 2014; 109:356-61. [PMID: 24821059 PMCID: PMC4131790 DOI: 10.1590/0074-0276130458] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 03/11/2014] [Indexed: 12/04/2022] Open
Abstract
The identification of mycobacteria is essential because tuberculosis (TB) and
mycobacteriosis are clinically indistinguishable and require different therapeutic
regimens. The traditional phenotypic method is time consuming and may last up to 60
days. Indeed, rapid, affordable, specific and easy-to-perform identification methods
are needed. We have previously described a polymerase chain reaction-based method
called a mycobacteria mobility shift assay (MMSA) that was designed for
Mycobacterium tuberculosis complex (MTC) and nontuberculous mycobacteria
(NTM) species identification. The aim of this study was to assess the MMSA for the
identification of MTC and NTM clinical isolates and to compare its performance with
that of the PRA-hsp65 method. A total of 204 clinical isolates (102
NTM and 102 MTC) were identified by the MMSA and PRA-hsp65. For
isolates for which these methods gave discordant results, definitive species
identification was obtained by sequencing fragments of the 16S rRNA and
hsp65 genes. Both methods correctly identified all MTC isolates. Among
the NTM isolates, the MMSA alone assigned 94 (92.2%) to a complex or species, whereas
the PRA-hsp65 method assigned 100% to a species. A 91.5% agreement
was observed for the 94 NTM isolates identified by both methods. The MMSA provided
correct identification for 96.8% of the NTM isolates compared with 94.7% for
PRA-hsp65. The MMSA is a suitable auxiliary method for routine
use for the rapid identification of mycobacteria.
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Affiliation(s)
- Letícia Muraro Wildner
- Laboratório de Biologia Molecular e Micobactérias, Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil
| | - Maria Luiza Bazzo
- Laboratório de Biologia Molecular e Micobactérias, Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil
| | - Susie Coutinho Liedke
- Laboratório de Biologia Molecular e Micobactérias, Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil
| | - Christiane Lourenço Nogueira
- Laboratório de Biologia Molecular e Micobactérias, Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil
| | - Gabriela Segat
- Laboratório de Biologia Molecular e Micobactérias, Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil
| | - Simone Gonçalves Senna
- Laboratório de Biologia Molecular e Micobactérias, Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil
| | | | | | - Darcita B Rovaris
- Laboratório Central, Estado de Santa Catarina, Florianópolis, SC, Brasil
| | - Claudio A Bonjardim
- Laboratório de Vírus, Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - Erna G Kroon
- Laboratório de Vírus, Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - Paulo C P Ferreira
- Laboratório de Vírus, Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
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80
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Yuan MK, Chang CY, Tsai PH, Lee YM, Huang JW, Chang SC. Comparative chest computed tomography findings of non-tuberculous mycobacterial lung diseases and pulmonary tuberculosis in patients with acid fast bacilli smear-positive sputum. BMC Pulm Med 2014; 14:65. [PMID: 24755048 PMCID: PMC4022395 DOI: 10.1186/1471-2466-14-65] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 04/10/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early diagnosis and treatment of nontuberculous mycobacterial lung diseases (NTM-LD) and pulmonary tuberculosis (PTB) are important clinical issues. The present study aimed to compare and identify the chest CT characteristics that help to distinguish NTM lung disease from PTB in patients with acid-fast bacilli (AFB) smear-positive sputum. METHODS From January 2009 to April 2012, we received 467 AFB smear-positive sputum specimens. A total of 95 CT scans obtained from the 159 patients were analyzed, 75 scans were from patients with PTB and 20 scans from NTM-LD. The typical chest CT findings of mycobacterial diseases were analyzed. RESULTS In patients with PTB, the prevalence of pleural effusion (38.7% vs. 15.0%; P = 0.047), nodules < 10 mm in size (76.0% vs. 25.0%; P < 0.001), tree-in-bud pattern (81.3% vs. 55.0%; P = 0.021), and cavities (31.1% vs. 5.0%; P = 0.018) were significantly higher than patients with NTM. Of the 20 patients with NTM lung diseases, bronchiectasis and cystic changes were significantly higher than patients with PTB (20.0% vs. 4.0%; P = 0.034). In multivariate analysis, CT scan findings of nodules was independently associated with patients with diagnoses of PTB (odds ratio [OR], 0.07; 95% confidence interval [CI], 0.02-0.30). Presence of bronchiectasis and cystic changes in CT scans was strongly associated with patients with NTM-LD (OR, 33.04; 95% CI, 3.01-362.55). CONCLUSIONS The CT distinction between NTM-LD and PTB may help radiologists and physicians to know the most likely diagnoses in AFB-smear positive patients and avoid unnecessary adverse effects and the related costs of anti-TB drugs in endemic areas.
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Affiliation(s)
| | | | | | | | | | - Shih-Chieh Chang
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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81
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Jain S, Sankar MM, Sharma N, Singh S, Chugh TD. High prevalence of non-tuberculous mycobacterial disease among non-HIV infected individuals in a TB endemic country--experience from a tertiary center in Delhi, India. Pathog Glob Health 2014; 108:118-22. [PMID: 24649868 PMCID: PMC4005591 DOI: 10.1179/2047773214y.0000000133] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Sarika Jain
- Department of Microbiology, VMMC and Safdarjung Hospital, New Delhi, India
| | - Manimuthu M Sankar
- Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Navneet Sharma
- Department of Microbiology, BLK Superspeciality Hospital, Pusa Road, New Delhi, India
| | - Sarman Singh
- Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - T D Chugh
- Department of Microbiology, BLK Superspeciality Hospital, Pusa Road, New Delhi, India
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82
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Koh WJ, Chang B, Jeong BH, Jeon K, Kim SY, Lee NY, Ki CS, Kwon OJ. Increasing Recovery of Nontuberculous Mycobacteria from Respiratory Specimens over a 10-Year Period in a Tertiary Referral Hospital in South Korea. Tuberc Respir Dis (Seoul) 2013; 75:199-204. [PMID: 24348667 PMCID: PMC3861375 DOI: 10.4046/trd.2013.75.5.199] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Revised: 07/01/2013] [Accepted: 07/22/2013] [Indexed: 11/27/2022] Open
Abstract
Background The number of patients with pulmonary disease caused by nontuberculous mycobacteria (NTM) has been increasing worldwide. The aim of this study was to evaluate long-term trends in the NTM recovery rate from respiratory specimens over a 10-year period in a tertiary referral hospital in South Korea. Methods We retrospectively reviewed the records of mycobacterial cultures of respiratory specimens at Samsung Medical Center from January 2001 to December 2011. Results During the study period, 32,841 respiratory specimens from 10,563 patients were found to be culture-positive for mycobacteria. These included 12,619 (38%) Mycobacterium tuberculosis and 20,222 (62%) NTM isolates. The proportion of NTM among all positive mycobacterial cultures increased from 43% (548/1,283) in 2001 to 70% (3,341/4,800) in 2011 (p<0.001, test for trend). The recovery rate of NTM isolates from acid-fast bacilli smear-positive specimens increased from 9% (38/417) in 2001 to 64% (1,284/1,997) in 2011 (p<0.001, test for trend). The proportion of positive liquid cultures was higher for NTM than for M. tuberculosis (p<0.001). The most frequently isolated NTM were Mycobacterium avium-intracellulare complex (53%) and Mycobacterium abscessus-massiliense complex (25%). Conclusion The recovery rate of NTM from respiratory specimens in South Korea has increased steadily.
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Affiliation(s)
- Won-Jung Koh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Boksoon Chang
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byeong-Ho Jeong
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyeongman Jeon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Su-Young Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Nam Yong Lee
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chang-Seok Ki
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - O Jung Kwon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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83
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Efflux inhibition with verapamil potentiates bedaquiline in Mycobacterium tuberculosis. Antimicrob Agents Chemother 2013; 58:574-6. [PMID: 24126586 DOI: 10.1128/aac.01462-13] [Citation(s) in RCA: 113] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Drug efflux is an important resistance mechanism in Mycobacterium tuberculosis. We found that verapamil, an efflux inhibitor, profoundly decreases the MIC of bedaquiline and clofazimine to M. tuberculosis by 8- to 16-fold. This exquisite susceptibility was noted among drug-susceptible and drug-resistant clinical isolates. Thus, efflux inhibition is an important sensitizer of bedaquiline and clofazimine, and efflux may emerge as a resistance mechanism to these drugs.
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84
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Simultaneous detection of Mycobacterium tuberculosis complex and nontuberculous mycobacteria in respiratory specimens. Tuberculosis (Edinb) 2013; 93:642-6. [PMID: 23988279 DOI: 10.1016/j.tube.2013.07.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 07/25/2013] [Accepted: 07/30/2013] [Indexed: 11/22/2022]
Abstract
Many nontuberculous mycobacteria (NTM) species have clinical significance, and the rapid and reliable identification of Mycobacterium tuberculosis complex (MTBC) and NTM species is important. We evaluated the simultaneous detection of MTBC and NTM in respiratory specimens. MTBC and NTM were simultaneously detected and identified by laboratory-developed (LDT) real-time PCR, multiplex real-time PCR/melting curve analysis, rpoB PCR restriction fragment length polymorphisms and the AdvanSure Mycobacteria GenoBlot assay (LG Life Sciences). Eighty-five respiratory specimens from 69 patients showed simultaneous detection of MTBC and NTM. A line probe assay showed 70.6% concordance with LDT. Ten patients (14.5%) had a history of tuberculosis, and eight patients (11.6%) had been previously diagnosed with bronchiectasis. Mixed cultures were present one time in 57 patients (82.6%) and repeatedly in 12 patients (17.4%). MTBC was more frequent in 44 patients (63.8%), and NTM was isolated in seven patients (10.1%). The commonly detected NTM species in the mixed cultures were Mycobacterium intracellulare (29.0%) and Mycobacterium abscessus (29.0%). Co-isolation caused a failure of antitubercular drug susceptibility testing in 2 patients (2.9%). Molecular methods allow MTBC and NTM species to be simultaneously identified in respiratory specimens. NTM isolated with MTBC has clinical significance in some patients and should not be ignored.
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85
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Serodiagnosis of Mycobacterium avium complex and Mycobacterium abscessus complex pulmonary disease by use of IgA antibodies to glycopeptidolipid core antigen. J Clin Microbiol 2013; 51:2747-9. [PMID: 23740728 DOI: 10.1128/jcm.00702-13] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
An enzyme immunoassay kit that detects serum IgA antibody reacting to glycopeptidolipid core antigen derived from Mycobacterium avium complex (MAC) was not useful for differentiating MAC pulmonary disease (PD) from Mycobacterium abscessus complex PD (MAB-PD). However, this assay could be useful for differentiating MAC- and MAB-PD from pulmonary tuberculosis. (This study has been registered at ClinicalTrials.gov under registration no. NCT00970801.).
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86
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Chang CY, Hong JY, Yuan MK, Chang SJ, Lee YM, Chang SC, Hsu LC, Cheng SL. Risk factors in patients with AFB smear-positive sputum who receive inappropriate antituberculous treatment. DRUG DESIGN DEVELOPMENT AND THERAPY 2013; 7:53-8. [PMID: 23386785 PMCID: PMC3563317 DOI: 10.2147/dddt.s39247] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Acid-fast bacilli (AFB) smear-positive sputum is usually an initial clue in the diagnosis of pulmonary tuberculosis (TB); however, the test is not disease-specific. Nontuberculous mycobacterium-related colonization or lung disease often has AFB smear-positive sputum results, and physicians may prescribe unnecessary antituberculous drugs for these patients. The aim of this study was to analyze the clinical characteristics of patients with AFB smear-positive sputum who received unnecessary anti-TB treatment. METHODS AND PATIENTS From January 2008 to July 2011, we retrospectively enrolled 97 patients with AFB smear-positive sputum who did not have pulmonary TB according to mycobacterial cultures and clinical judgment. We analyzed the clinical and radiographic features of the patients who received inappropriate and unnecessary anti-TB treatment. Preliminary analyses of chisquare and Fisher's exact tests were applied to determine factors unlikely to be associated with the independent variables. The relationship between independent covariates was then analyzed using multivariate logistic regression. RESULTS Of the 97 enrolled patients, 25 (25.8%) were diagnosed with pulmonary TB and prescribed anti-TB drugs (mostly a combination of isoniazid, rifampicin, ethambutol, and pyrazinamide). The other 72 (74.2%) patients were not initially diagnosed with pulmonary TB and were classified as the control group. Compared to the control group, the patients who received inappropriate anti-TB treatment had more chronic cough as presentation symptom and heavy AFB Ziehl-Neelsen staining in sputum (>10/100 fields, grading 2+ to 4+). There were no significant differences in the radiographic analysis between the two groups. CONCLUSION Among the patients with AFB smear-positive sputum that did not have pulmonary TB, chronic cough and heavy AFB staining (2+ to 4+) were risk factors for the inappropriate administration of unnecessary anti-TB treatment.
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Affiliation(s)
- Cheng-Yu Chang
- Division of Chest Medicine, Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan
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