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Shiau MY, Lee MS, Huang TL, Tsai JN, Chang YH. Mycobacterial Prevalence and Antibiotic Resistance Frequency Trends in Taiwan of Mycobacterial Clinical Isolates From 2002 to 2014. Medicine (Baltimore) 2016; 95:e2942. [PMID: 27015168 PMCID: PMC4998363 DOI: 10.1097/md.0000000000002942] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Tuberculosis, caused by Mycobacterium tuberculosis complex (MTBC) infections, is one of the most widespread infectious diseases worldwide. Nontuberculous mycobacteria (NTM) also cause chronic pulmonary infections, however, NTM infection is generally overlooked.This study analyzed the frequencies of MTBC and NTM clinical isolates from 181,132 specimens obtained from patients in Taiwan suspected of having a pulmonary mycobacterial infection from 2002 to 2014. The resistant rates to 4 first-line antibiotics (isoniazid, ethambutol, rifampicin, and streptomycin) of 9079 clinical MTBC isolates were also examined by the modified agar proportion method.Overall, the mycobacterial isolation rate was 8.65%, and this consisted of MTBC isolation rate of 5.01% and NTM isolation rate of 3.63%. The prevalence of MTBC isolates among the identified mycobacterial strains could be seen to decrease significantly from 82.5% in 2002 to 41.18% in 2014. Notably, the corresponding NTM prevalence increased 3.36 fold from 17.54% in 2002 to 58.82% in 2014. The frequencies of MTBC and NTM isolates showed a reciprocal trend with the crossing over occurring in the years 2010 and 2011. Although the resistance rates of the MTBC isolates to isoniazid and streptomycin were relatively stable over the study period, resistance rates of the MTBC isolates against rifampicin and ethambutol fluctuated across the study period. Overall, the incidence of multidrug resistance was relatively consistent at about 1.74%.The diagnosis, identification, and susceptibility tests for NTM should be standardized and integrated into appropriate clinical settings to cope with the increase in NTM infections. In addition, the documentation of the antibiotic resistance rates of MTBC clinical isolates to the antibiotic treatments most often clinically prescribed over a decade provides valuable clues and reference points for effective mycobacterial control.
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Affiliation(s)
- Ming-Yuh Shiau
- From the Department of Nursing (M-YS), College of Medicine and Nursing, Hungkuang University, Taichung; Clinical Laboratory (M-SL, T-LH), Chung Shan Medical University-Hospital, Taichung; School of Medical Laboratory and Biotechnology (M-SL, J-NT), Chung Shan Medical University, Taichung; and Department of Biotechnology and Laboratory Science in Medicine (Y-HC), National Yang-Ming University, Taipei, Taiwan
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Yoo JW, Jo KW, Kim SH, Lee SO, Kim JJ, Park SK, Lee JH, Han DJ, Hwang S, Lee S, Shim TS. Incidence, characteristics, and treatment outcomes of mycobacterial diseases in transplant recipients. Transpl Int 2016; 29:549-58. [DOI: 10.1111/tri.12752] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 07/16/2015] [Accepted: 01/22/2016] [Indexed: 01/01/2023]
Affiliation(s)
- Jung-Wan Yoo
- Department of Pulmonary and Critical Care Medicine; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - Kyung-Wook Jo
- Department of Pulmonary and Critical Care Medicine; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - Sung-Han Kim
- Department of Infectious Diseases; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - Sang-Oh Lee
- Department of Infectious Diseases; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - Jae Joong Kim
- Department of Cardiology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - Su-Kil Park
- Department of Nephrology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - Je-Hwan Lee
- Department of Hematology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - Duck Jong Han
- Department of Surgery; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - Shin Hwang
- Department of Surgery; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - SeungGyu Lee
- Department of Surgery; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - Tae Sun Shim
- Department of Pulmonary and Critical Care Medicine; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
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Tebruegge M, Pantazidou A, MacGregor D, Gonis G, Leslie D, Sedda L, Ritz N, Connell T, Curtis N. Nontuberculous Mycobacterial Disease in Children - Epidemiology, Diagnosis & Management at a Tertiary Center. PLoS One 2016; 11:e0147513. [PMID: 26812154 PMCID: PMC4727903 DOI: 10.1371/journal.pone.0147513] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 12/25/2015] [Indexed: 11/18/2022] Open
Abstract
Background There are limited data on the epidemiology, diagnosis and optimal management of nontuberculous mycobacterial (NTM) disease in children. Methods Retrospective cohort study of NTM cases over a 10-year-period at a tertiary referral hospital in Australia. Results A total of 140 children with NTM disease, including 107 with lymphadenitis and 25 with skin and soft tissue infections (SSTIs), were identified. The estimated incidence of NTM disease was 0.6–1.6 cases / 100,000 children / year; no increasing trend was observed over the study period. Temporal analyses revealed a seasonal incidence cycle around 12 months, with peaks in late winter/spring and troughs in autumn. Mycobacterium-avium-complex accounted for most cases (77.8%), followed by Mycobacterium ulcerans (14.4%) and Mycobacterium marinum (3.3%). Polymerase chain reaction testing had higher sensitivity than culture and microscopy for acid-fast bacilli (92.0%, 67.2% and 35.7%, respectively). The majority of lymphadenitis cases underwent surgical excision (97.2%); multiple recurrences in this group were less common in cases treated with clarithromycin and rifampicin compared with clarithromycin alone or no anti-mycobacterial drugs (0% versus 7.1%; OR:0.73). SSTI recurrences were also less common in cases treated with two anti-mycobacterial drugs compared with one or none (10.5% versus 33.3%; OR:0.23). Conclusions There was seasonal variation in the incidence of NTM disease, analogous to recently published observations in tuberculosis, which have been linked to seasonal variation in vitamin D. Our finding that anti-mycobacterial combination therapy was associated with a reduced risk of recurrences in patients with NTM lymphadenitis or SSTI requires further confirmation in prospective trials.
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Affiliation(s)
- Marc Tebruegge
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Infectious Diseases Unit, Royal Children’s Hospital Melbourne, Parkville, Victoria, Australia
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Academic Unit of Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- NIHR Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- * E-mail:
| | - Anastasia Pantazidou
- Infectious Diseases Unit, Royal Children’s Hospital Melbourne, Parkville, Victoria, Australia
| | - Duncan MacGregor
- Department of Anatomical Pathology, Royal Children’s Hospital Melbourne, Parkville, Victoria, Australia
| | - Gena Gonis
- Department of Microbiology, Royal Children’s Hospital Melbourne, Parkville, Victoria, Australia
| | - David Leslie
- Mycobacterium Reference Laboratory, Victorian Infectious Diseases Reference Laboratory, North Melbourne, Australia
| | - Luigi Sedda
- Department of Geography and Environment, University of Southampton, Southampton, United Kingdom
| | - Nicole Ritz
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Infectious Diseases Unit, University Children’s Hospital Basel, Basel, Switzerland
| | - Tom Connell
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Infectious Diseases Unit, Royal Children’s Hospital Melbourne, Parkville, Victoria, Australia
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | - Nigel Curtis
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Infectious Diseases Unit, Royal Children’s Hospital Melbourne, Parkville, Victoria, Australia
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia
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Matsuyama M, Ishii Y, Sakurai H, Ano S, Morishima Y, Yoh K, Takahashi S, Ogawa K, Hizawa N. Overexpression of RORγt Enhances Pulmonary Inflammation after Infection with Mycobacterium Avium. PLoS One 2016; 11:e0147064. [PMID: 26784959 PMCID: PMC4718649 DOI: 10.1371/journal.pone.0147064] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 12/27/2015] [Indexed: 12/26/2022] Open
Abstract
Mycobacterium avium complex (MAC) is the most common cause of nontuberculous mycobacterial disease in humans. The role of Th17 immunity in the pathogenesis of intracellular bacteria, such as MAC, is not currently understood. Transcription factor RAR-related orphan receptor gamma t (RORγt) is known as the master regulator for Th17 cell development. Here, we investigated the role of RORγt in host responses against MAC infection. Wild-type (WT) mice and RORγt-overexpressing mice were infected with MAC via intratracheal inoculation. Systemic MAC growth was not different between WT mice and RORγt-overexpressing mice. However, neutrophilic pulmonary inflammation following MAC infection was enhanced in RORγt-overexpressing mice compared with that in WT mice. The cytokine expression shifted toward a Th17 phenotype in the lungs of RORγt-overexpressing mice following MAC infection; the levels of IL-6 and IL-17 were significantly higher in the lung of these mice than in WT mice. In addition to the increase in IL-17 single-positive T cells, T cells producing both IL-17 and interferon-γ were elevated in the lung of RORγt-overexpressing mice following MAC infection. These findings suggest that RORγt overexpression-mediated Th17 bias contributes to local inflammation rather than systemic responses, by regulating neutrophil recruitment into the sites of infection during MAC infection.
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Affiliation(s)
- Masashi Matsuyama
- Department of Respiratory Medicine, Division of Clinical Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yukio Ishii
- Department of Respiratory Medicine, Division of Clinical Medicine, University of Tsukuba, Tsukuba, Japan
- * E-mail:
| | - Hirofumi Sakurai
- Department of Respiratory Medicine, Division of Clinical Medicine, University of Tsukuba, Tsukuba, Japan
| | - Satoshi Ano
- Department of Respiratory Medicine, Division of Clinical Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yuko Morishima
- Department of Respiratory Medicine, Division of Clinical Medicine, University of Tsukuba, Tsukuba, Japan
| | - Keigyou Yoh
- Department of Nephrology, Division of Clinical Medicine, University of Tsukuba, Tsukuba, Japan
| | - Satoru Takahashi
- Department of Anatomy and Embryology, University of Tsukuba, Tsukuba, Japan
- International Institute for Integrative Sleep Medicine, Life Science Center, University of Tsukuba, Tsukuba, Japan
- Tsukuba Advanced Research Alliance, University of Tsukuba, Tsukuba, Japan
- Laboratory Animal Resource Center, University of Tsukuba, Tsukuba, Japan
| | - Kenji Ogawa
- Department of Clinical Research, National Hospital Organization, Higashinagoya National Hospital, Nagoya, Japan
| | - Nobuyuki Hizawa
- Department of Respiratory Medicine, Division of Clinical Medicine, University of Tsukuba, Tsukuba, Japan
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Improvement in Quality of Life after Therapy forMycobacterium abscessusGroup Lung Infection. A Prospective Cohort Study. Ann Am Thorac Soc 2016; 13:40-8. [DOI: 10.1513/annalsats.201508-529oc] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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106
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Chanda-Kapata P, Kapata N, Klinkenberg E, Mulenga L, Tembo M, Katemangwe P, Sunkutu V, Mwaba P, Grobusch MP. Non-tuberculous mycobacteria (NTM) in Zambia: prevalence, clinical, radiological and microbiological characteristics. BMC Infect Dis 2015; 15:500. [PMID: 26545357 PMCID: PMC4636841 DOI: 10.1186/s12879-015-1264-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 11/05/2015] [Indexed: 01/15/2023] Open
Abstract
Background Non-tuberculous mycobacteria (NTM) infection is an emerging health problem. We present here the Zambia-specific national level data of prevalence, symptomatic, radiological and microbiological characteristics of NTM, using results from a national Tuberculosis (TB) prevalence survey. Methods This was a cross-sectional study of the prevalence of NTM among adults aged 15 years and above, who were participants in a national TB prevalence survey. Participants who had either an abnormal chest x-ray or were symptomatic were considered presumptive TB cases and submitted sputum for smear and culture analysis. HIV testing was performed on an opt-out basis. Symptomatic NTM prevalence was estimated from individual level analysis. Results Of the 6,123 individuals with presumptive TB, 923 (15.1 %) were found to have NTM, 13 (0.2 %) were MTB/NTM co-infected and 338 (5.5 %) were contaminated (indeterminate). The prevalence of symptomatic NTM was found to be 1,477/100,000 [95 % CI 1010–1943]. Smear positivity, history of cough or chest pain and HIV positivity were risk factors for NTM. Conclusion This first study to estimate the national prevalence of NTM in Zambia indicates that the burden is high. The NTM occurrence in Zambia constitutes both a public health and ethical issue requiring action from health managers.
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Affiliation(s)
- Pascalina Chanda-Kapata
- Department of Disease Surveillance, Control and Research, Ministry of Health, Lusaka, Zambia. .,Center of Tropical Medicine and Travel Medicine, Amsterdam Medical Centre, University of Amsterdam, Amsterdam, Netherlands.
| | - Nathan Kapata
- Center of Tropical Medicine and Travel Medicine, Amsterdam Medical Centre, University of Amsterdam, Amsterdam, Netherlands. .,Department of Epidemics and Disease Control, Ministry of Community Development, Mother and Child Health, Lusaka, 10101, Zambia.
| | - Eveline Klinkenberg
- KNCV Tuberculosis Foundation, The Hague, Netherlands. .,Department of Global Health and Development, Amsterdam Medical Centre, Amsterdam, Netherlands.
| | - Lutinala Mulenga
- Department of Clinical Care and Diagnostics, Chest Diseases Laboratory, Ministry of Health, Lusaka, 10101, Zambia.
| | - Mathias Tembo
- Tuberculosis Laboratory, Tropical Diseases Research Centre, Ndola, Zambia.
| | - Patrick Katemangwe
- Tuberculosis Laboratory, University Teaching Hospital, Lusaka, 10101, Zambia.
| | - Veronica Sunkutu
- Radiology Department, University Teaching Hospital, Lusaka, 10101, Zambia.
| | - Peter Mwaba
- Department of Disease Surveillance, Control and Research, Ministry of Health, Lusaka, Zambia.
| | - Martin P Grobusch
- Center of Tropical Medicine and Travel Medicine, Amsterdam Medical Centre, University of Amsterdam, Amsterdam, Netherlands.
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108
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Kodana M, Tarumoto N, Kawamura T, Saito T, Ohno H, Maesaki S, Ikebuchi K. Utility of the MALDI-TOF MS method to identify nontuberculous mycobacteria. J Infect Chemother 2015; 22:32-5. [PMID: 26603481 DOI: 10.1016/j.jiac.2015.09.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 09/10/2015] [Accepted: 09/23/2015] [Indexed: 11/15/2022]
Abstract
In comparison to the conventional real-time polymerase chain reaction method (PCR method) or the DNA-DNA hybridization method (DDH method), the utility of NTM identification by the matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) method has seldom been reported. In this study, 75 clinical NTM isolates from our hospital between April 2013 and July 2014 were identified and analyzed using PCR, DDH, and MALDI-TOF MS methods, and the results for the MALDI-TOF MS method were compared with the others. Identification at the species level was in agreement for 71 (94.5%) of the 75 isolates. For further details, identification was possible for 23 (95.8%) of 24 Mycobacterium avium, 11 (100%) of 11 Mycobacterium intracellulare, and 1 (50%) of 2 isolates mixed with M. avium and M. intracellulare. Mycobacterium ksansasii, Mycobacterium abscessus, Mycobacterium fortuitum, Mycobacterium gordonae, and Mycobacterium chelonae identified by DDH method were same result by MALDI-TOF MS. Additionally, Mycobacterium mucogenicum, which could not be identified by the DDH method, was identified by the MALDI-TOF MS method. However, two isolates identified as Mycobacterium terrae by DDH method could not be identified by the MALDI-TOF MS method and were determined to be Mycobacterium arupense by 16S ribosomal RNA (rRNA) sequence analysis. The present findings show that, for rare bacterial species, identification is sometimes not possible, but, in most cases, the results of identification by the MALDI-TOF MS method have a high concordance rate with the results of the PCR and DDH methods.
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Affiliation(s)
- Masahiro Kodana
- Clinical Laboratory Medicine, Saitama Medical University Hospital, Japan
| | - Norihito Tarumoto
- Department of Infectious Disease and Infection Control, Saitama Medical University, Japan.
| | - Tohru Kawamura
- Clinical Laboratory Medicine, Saitama Medical University Hospital, Japan
| | - Taeko Saito
- Clinical Laboratory Medicine, Saitama Medical University Hospital, Japan
| | - Hideaki Ohno
- Department of Infectious Disease and Infection Control, Saitama Medical Center, Saitama Medical University, Japan
| | - Shigefumi Maesaki
- Department of Infectious Disease and Infection Control, Saitama Medical University, Japan
| | - Kenji Ikebuchi
- Clinical Laboratory Medicine, Saitama Medical University Hospital, Japan
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van Ingen J, Kuijper EJ. Drug susceptibility testing of nontuberculous mycobacteria. Future Microbiol 2015; 9:1095-110. [PMID: 25340838 DOI: 10.2217/fmb.14.60] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Diseases caused by nontuberculous mycobacteria are emerging in many settings. With an increased number of patients needing treatment, the role of drug susceptibility testing is again in the spotlight. This articles covers the history and methodology of drug susceptibility tests for nontuberculous mycobacteria, but focuses on the correlations between in vitro drug susceptibility, pharmacokinetics and in vivo outcomes of treatment. Among slow-growing nontuberculous mycobacteria, clear correlations have been established for macrolides and amikacin (Mycobacterium avium complex) and for rifampicin (Mycobacterium kansasii). Among rapid-growing mycobacteria, correlations have been established in extrapulmonary disease for aminoglycosides, cefoxitin and co-trimoxazole. In pulmonary disease, correlations are less clear and outcomes of treatment are generally poor, especially for Mycobacterium abscessus. The clinical significance of inducible resistance to macrolides among rapid growers is an important topic. The true role of drug susceptibility testing for nontuberculous mycobacteria still needs to be addressed, preferably within clinical trials.
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Affiliation(s)
- Jakko van Ingen
- Department of Medical Microbiology, Radboud University Medical Center, PO Box 9101, 6500HB Nijmegen, The Netherlands
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Falkinham JO, Pruden A, Edwards M. Opportunistic Premise Plumbing Pathogens: Increasingly Important Pathogens in Drinking Water. Pathogens 2015; 4:373-86. [PMID: 26066311 PMCID: PMC4493479 DOI: 10.3390/pathogens4020373] [Citation(s) in RCA: 135] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 06/03/2015] [Indexed: 01/20/2023] Open
Abstract
Opportunistic premise plumbing pathogens are responsible for a significant number of infections whose origin has been traced to drinking water. These opportunistic pathogens represent an emerging water borne disease problem with a major economic cost of at least $1 billion annually. The common features of this group of waterborne pathogens include: disinfectant-resistance, pipe surface adherence and biofilm formation, growth in amoebae, growth on low organic concentrations, and growth at low oxygen levels. Their emergence is due to the fact that conditions resulting from drinking water treatment select for them. As such, there is a need for novel approaches to reduce exposure to these pathogens. In addition to much-needed research, controls to reduce numbers and human exposure can be instituted independently by utilities and homeowners and hospital- and building-operators.
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Affiliation(s)
- Joseph O Falkinham
- Department of Biological Sciences, Virginia Tech, 5008 Derring Hall, Blacksburg, VA 24060, USA.
| | - Amy Pruden
- Via Department of Civil and Environmental Engineering, Virginia Tech, 401 Durham Hall, Blacksburg, VA 24060, USA.
| | - Marc Edwards
- Via Department of Civil and Environmental Engineering, Virginia Tech, 401 Durham Hall, Blacksburg, VA 24060, USA.
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Nasiri MJ, Dabiri H, Darban-Sarokhalil D, Hashemi Shahraki A. Prevalence of Non-Tuberculosis Mycobacterial Infections among Tuberculosis Suspects in Iran: Systematic Review and Meta-Analysis. PLoS One 2015; 10:e0129073. [PMID: 26052701 PMCID: PMC4460155 DOI: 10.1371/journal.pone.0129073] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Accepted: 05/04/2015] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION The infections due to Non-Tuberculosis Mycobacteria (NTM) are becoming an important health problem in many countries in the world. Globally, an increase in NTM infections has been reported from many countries around the world. However, limited information is available about the prevalence of NTM infections in Iran. MATERIAL AND METHODS The data of the prevalence of NTM infections were collected from databases such as PubMed, Web of science, Cochrane Library, Embase, Scopus, Iranmedex, and Scientific Information Database. Comprehensive Meta-Analysis (V2.0, Biostat) software was used to analyze the data. RESULTS The meta-analyses showed that the prevalence of NTM infections was 10.2% (95% confidence interval [95% CI] 6.3-15.9) among culture-positive cases of tuberculosis (TB) in Iran. The further stratified analyses indicated that the prevalence of NTM was higher in studies that were done after year 2000. Additionally, M. simiae (43.3% [95% CI 36.8-50.0]), M. intracellucar (27.3% [95% CI 0.7-95.5]) and M. fortuitum (22.7% [95% CI 16.1-30.9]) were the most prevalent NTM species, respectively. DISCUSSION The relatively high prevalence of NTM infections (10.2%) among culture positive cases for TB underlines the need for greater enforcement of infection control strategies. Establishment of appropriate diagnostic criteria and management guidelines for NTM diseases and expanding the number and quality of regional reference laboratories may facilitate more accurate action for prevention and control of NTM infections in Iran.
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Affiliation(s)
- Mohammad Javad Nasiri
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- * E-mail:
| | - Hossein Dabiri
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Davood Darban-Sarokhalil
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Ide S, Nakamura S, Yamamoto Y, Kohno Y, Fukuda Y, Ikeda H, Sasaki E, Yanagihara K, Higashiyama Y, Hashiguchi K, Futsuki Y, Inoue Y, Fukushima K, Suyama N, Kohno S. Epidemiology and clinical features of pulmonary nontuberculous mycobacteriosis in Nagasaki, Japan. PLoS One 2015; 10:e0128304. [PMID: 26020948 PMCID: PMC4447365 DOI: 10.1371/journal.pone.0128304] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Accepted: 04/27/2015] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Recent reports indicate that the incidence of nontuberculous mycobacterial-lung disease (NTM-LD) is increasing. This study aimed to investigate the epidemiology and clinical features of NTM-LD patients in Nagasaki prefecture, Japan to identify the negative prognostic factors for NTM-LD in Japan. METHODS The medical records of patients newly diagnosed with NTM-LD in eleven hospitals in Nagasaki prefecture between January 2001 and February 2010 were reviewed. Data regarding the annual population of each region and the incidence of all forms of tuberculosis were collected to assess geographic variations in NTM-LD incidence, isolates, and radiological features. RESULTS A total 975 patients were diagnosed with NTM-LD. The incidence increased over the study period and reached 11.0 and 10.1 per 100,000 population in 2008 and 2009, respectively. M. intracellulare was the most common pathogen in the southern region, and M. avium most common in other regions. The most common radiographic pattern was the nodular-bronchiectatic pattern. Age >60 years, body mass index <18.5 kg/m2, underlying lung disease, and cavitary pattern were the negative prognostic factors at the 1-year follow-up. CONCLUSIONS The incidence of NTM-LD has been increasing in Nagasaki prefecture. The isolates and radiographic features of patients vary markedly by region.
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Affiliation(s)
- Shotaro Ide
- Department of Respiratory Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Unit of Molecular Microbiology and Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Shigeki Nakamura
- Department of Respiratory Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Department of Chemotherapy and Mycoses, National Institute of Infectious Diseases, Shinjuku-ku, Tokyo, Japan
- * E-mail:
| | - Yoshihiro Yamamoto
- Department of Clinical Infectious Diseases, Toyama University Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | | | | | | | - Eisuke Sasaki
- National Hospital Organization Nagasaki Medical Center, Omura, Japan
| | - Katsunori Yanagihara
- Department of Laboratory Medicine, Nagasaki University Hospital, Nagasaki, Japan
| | | | | | | | - Yuichi Inoue
- Isahaya Health Insurance General Hospital, Isahaya, Japan
| | | | | | - Shigeru Kohno
- Department of Respiratory Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Mehta M, Chapman KR, Heffer M, Marras TK. Impact of pulmonary nontuberculous mycobacterial treatment on pulmonary function tests in patients with and without established obstructive lung disease. Respirology 2015; 20:987-93. [PMID: 26011313 DOI: 10.1111/resp.12565] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Revised: 02/27/2015] [Accepted: 03/01/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE There is relatively little data regarding pulmonary function test (PFT) findings and impact of treatment on PFT in pulmonary nontuberculous mycobacterial (pNTM) disease. METHODS We performed a retrospective study on pNTM patients. Clinical, radiographical, microbiological and PFT data were reviewed. Patients were divided into three groups based on pre-existing obstructive lung disease: (i) normal (no chronic obstructive pulmonary disease (COPD) or asthma); (ii) asthma; and (iii) COPD. We studied pre-treatment PFT and assessed for PFT changes after anti-mycobacterial therapy. RESULTS A total of 96 patients fulfilled ATS disease criteria and had pre-treatment PFT (54 'normal', 18 asthma, 24 COPD). Most common causative NTM was Mycobacterium avium complex (76%), and radiographical disease type was nodular bronchiectasis (71%). Before therapy, all groups had PFT abnormalities, including obstruction, gas trapping and at least mildly low diffusion capacity of carbon monoxide (DLCO). Pre-treatment PFT abnormalities were more pronounced among patients with asthma and COPD. A total of 44 patients had >12 months anti-mycobacterial therapy and post-treatment PFT. There tended to be small and generally not statistically significant reductions in spirometry and DLCO in most groups. Among the nine asthmatic patients, there was a small reduction in residual volume (RV) (1.5% predicted, P = 0.01) and RV/total lung capacity (by 7% predicted, P = 0.06). CONCLUSIONS Patients with pNTM have abnormal PFT, and treatment was not associated with substantial changes therein. Asthmatics may experience some improvements in gas trapping after NTM therapy, but because the sample size and the observed change were both small, this requires further investigation.
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Affiliation(s)
- Mauli Mehta
- Department of Internal Medicine, Schulich School of Medicine and Dentistry - Western University, London, Ontario, Canada
| | - Kenneth R Chapman
- Joint Division of Respirology, University Health Network and Mount Sinai Hospital, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Matthew Heffer
- Division of Respirology and Medicine, St. Joseph's Health Centre, Toronto, Ontario, Canada
| | - Theodore K Marras
- Joint Division of Respirology, University Health Network and Mount Sinai Hospital, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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114
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Pathogenic nontuberculous mycobacteria resist and inactivate cathelicidin: implication of a novel role for polar mycobacterial lipids. PLoS One 2015; 10:e0126994. [PMID: 25993058 PMCID: PMC4436335 DOI: 10.1371/journal.pone.0126994] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 04/09/2015] [Indexed: 12/05/2022] Open
Abstract
Nontuberculous mycobacteria (NTM) are a large group of environmental organisms with worldwide distribution, but only a relatively few are known to be pathogenic. Chronic, debilitating lung disease is the most common manifestation of NTM infection, which is often refractory to treatment. The incidence and prevalence of NTM lung disease are increasing in the United States and in many parts of the world. Hence, a more complete understanding of NTM pathogenesis will provide the foundation to develop innovative approaches to treat this recalcitrant disease. Herein, we demonstrate that several species of NTM show broad resistance to the antimicrobial peptide, cathelicidin (LL-37). Resistance to LL-37 was not significantly different between M. avium that contain serovar-specific glycopeptidolipid (GPL, M. aviumssGPL) and M. avium that do not (M. aviumΔssGPL). Similarly, M. abscessus containing non-specific GPL (M. abscessusnsGPL(+)) or lacking nsGPL (M. abscessusnsGPL(-)) remained equally resistant to LL-37. These findings would support the notion that GPL are not the components responsible for NTM resistance to LL-37. Unexpectedly, the growth of M. abscessusnsGPL(-) increased with LL-37 or scrambled LL-37 peptide in a dose-dependent fashion. We also discovered that LL-37 exposed to NTM had reduced antimicrobial activity, and initial work indicates that this is likely due to inactivation of LL-37 by lipid component(s) of the NTM cell envelope. We conclude that pathogenic NTM resist and inactivate LL-37. The mechanism by which NTM circumvent the antimicrobial activity of LL-37 remains to be determined.
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115
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Endobronchial lesions caused by nontuberculous mycobacteria in apparently healthy pediatric patients. Pediatr Infect Dis J 2015; 34:532-5. [PMID: 25478650 DOI: 10.1097/inf.0000000000000606] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Pulmonary disease caused by nontuberculous mycobacteria in healthy children is rare, and its pathogenesis is unknown in most cases and standardized treatment is lacking. Here, we report various endobronchial manifestations in 5 patients including hitherto undescribed diffuse tracheobronchial granulomas in 2 patients. Bronchoscopic debulking was performed in all patients and tuberculostatic treatment in 4. All patients including 1 without tuberculostatic treatment showed remission.
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116
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Ito Y, Hirai T, Fujita K, Maekawa K, Niimi A, Ichiyama S, Mishima M. Increasing patients with pulmonary Mycobacterium avium complex disease and associated underlying diseases in Japan. J Infect Chemother 2015; 21:352-6. [DOI: 10.1016/j.jiac.2015.01.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 11/20/2014] [Accepted: 01/01/2015] [Indexed: 10/24/2022]
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Falkinham JO. Common features of opportunistic premise plumbing pathogens. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:4533-45. [PMID: 25918909 PMCID: PMC4454924 DOI: 10.3390/ijerph120504533] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 04/20/2015] [Accepted: 04/20/2015] [Indexed: 12/29/2022]
Abstract
Recently it has been estimated that the annual cost of diseases caused by the waterborne pathogens Legionella pneumonia, Mycobacterium avium, and Pseudomonas aeruginosa is $500 million. For the period 2001-2012, the estimated cost of hospital admissions for nontuberculous mycobacterial pulmonary disease, the majority caused by M. avium, was almost $1 billion. These three waterborne opportunistic pathogens are normal inhabitants of drinking water--not contaminants--that share a number of key characteristics that predispose them to survival, persistence, and growth in drinking water distribution systems and premise plumbing. Herein, I list and describe these shared characteristics that include: disinfectant-resistance, biofilm-formation, growth in amoebae, growth at low organic carbon concentrations (oligotrophic), and growth under conditions of stagnation. This review is intended to increase awareness of OPPPs, identify emerging OPPPs, and challenge the drinking water industry to develop novel approaches toward their control.
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Affiliation(s)
- Joseph O Falkinham
- Department of Biological Sciences, Virginia Tech., 1405 Perry Street, Blacksburg, VA 24061, USA.
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118
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Álvaro-Meca A, Rodríguez-Gijón L, Díaz A, Gil Á, Resino S. Trends in nontuberculous mycobacterial disease in hospitalized subjects in Spain (1997-2010) according to HIV infection. HIV Med 2015; 16:485-93. [PMID: 25854195 DOI: 10.1111/hiv.12251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2014] [Indexed: 01/15/2023]
Abstract
OBJECTIVES The aim of the study was to estimate the incidence of nontuberculous mycobacterial (NTM) disease and the rate of NTM disease-related mortality and to analyse trends in these variables according to HIV infection. METHODS We performed a retrospective study for the period 1997-2010 using data from the Minimum Basic Data Set (MBDS) provided by the Spanish Ministry of Health. The exposure variables were: (i) HIV infection (HIV positive versus HIV negative); (ii) calendar period in relation to widespread use of combination antiretroviral therapy (cART) [1997-1999 (early cART period), 2000-2003 (middle cART period) and 2004-2010 (late cART period)]. The outcome variables were (i) new NTM disease diagnosis and (ii) mortality. RESULTS A total of 3729 cases of incident NTM disease were collected in MBDS, 1795 in the HIV-negative group and 1934 in the HIV-positive group, among whom 602 deaths occurred, 223 in the HIV-negative group and 379 in the HIV-positive group. The incidence of NTM disease and the rate of NTM disease-related mortality were 1000-fold higher in the HIV-positive group than in the HIV-negative group. Regarding the incidence of NTM disease, in the HIV-negative group the incidence increased from 2.91 to 3.97 events per 1,000,000 patient-years from 1997-1999 to 2004-2010 (P < 0.001), while in the HIV-positive group the incidence decreased from 2.29 to 0.71 events per 1000 patient-years from 1997-1999 to 2004-2010 (P < 0.001). Regarding mortality, in the HIV-negative group mortality increased from 2.63 to 4.26 events per 10,000,000 patient-years from 1997-1999 to 2000-2003 (P = 0.059), and then the rate stabilized at around 3.87 events per 10,000,000 patient-years in 2004-2010 (P = 0.128), while in the HIV-positive group mortality decreased from 4.28 to 1.39 events per 10,000 patient-years from 1997-1999 to 2004-2010 (P < 0.001). CONCLUSIONS HIV infection was associated with a higher NTM disease incidence and higher NTM disease-related mortality than in the general population, but these rates decreased in the HIV-positive group from 1997-1999 to 2004-2010, whereas the NTM disease incidence increased in the HIV-negative group.
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Affiliation(s)
- A Álvaro-Meca
- Department of Preventive Medicine & Public Health, Rey Juan Carlos University, Madrid, Spain
| | - L Rodríguez-Gijón
- Department of Preventive Medicine & Public Health, Rey Juan Carlos University, Madrid, Spain
| | - A Díaz
- Unit of HIV Surveillance and Behavioural Monitoring, National Center of Epidemiology, Institute of Health Carlos III, Madrid, Spain
| | - Á Gil
- Department of Preventive Medicine & Public Health, Rey Juan Carlos University, Madrid, Spain
| | - S Resino
- Unit of Viral Infection and Immunity, National Center for Microbiology, Institute of Health Carlos III, Majadahonda, Madrid, Spain
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119
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Kobayashi M, Oana K, Kawakami Y. Bath water contamination with Legionella and nontuberculous mycobacteria in 24-hour home baths, hot springs, and public bathhouses of Nagano Prefecture, Japan. Jpn J Infect Dis 2015; 67:276-81. [PMID: 25056073 DOI: 10.7883/yoken.67.276] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Bath water samples were collected from 116 hot springs, 197 public bathhouses, and 38 24-hour home baths in Nagano Prefecture, Japan, during the period of April 2009 to November 2011, for determining the presence and extent of contamination with Legionella and nontuberculous mycobacteria. Cultures positive for Legionella were observed in 123 of the 3,314 bath water samples examined. The distribution and abundance of Legionella and/or combined contamination with Legionella and nontuberculous mycobacteria were investigated to clarify the contamination levels. The abundance of Legionella was demonstrated to correlate considerably with the levels of combined contamination with Legionella and nontuberculous mycobacteria. Legionella spp. were obtained from 61% of the water samples from 24-hour home baths, but only from 3% of the samples from public bathhouses and hot springs. This is despite the fact that a few outbreaks of Legionnaires' disease in Nagano Prefecture as well as other regions of Japan have been traced to bath water contamination. The comparatively higher rate of contamination of the 24-hour home baths is a matter of concern. It is therefore advisable to routinely implement good maintenance of the water basins, particularly of the 24-hour home baths.
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Affiliation(s)
- Michiko Kobayashi
- Division of Infection Control and Microbiological Regulation, Department of Health and Medical Sciences, Shinshu University Graduate School of Medicine
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120
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Prevalence of nontuberculous mycobacteria among extrapulmonary tuberculosis cases in tertiary care centers in Northern India. BIOMED RESEARCH INTERNATIONAL 2015; 2015:465403. [PMID: 25883962 PMCID: PMC4391508 DOI: 10.1155/2015/465403] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 03/05/2015] [Indexed: 01/15/2023]
Abstract
The reports of nontuberculous mycobacteria (NTM) associated with extrapulmonary diseases are increasing in tertiary care hospitals. Despite a significant increase in knowledge about NTM infections, they still represent a diagnostic and therapeutic challenge. The aim of this study is to know the prevalence of NTN among extrapulmonary tuberculosis cases in tertiary care centers in Northern India. A total of 227 culture positive isolates from 756 cases were tested for niacin production and catalase assay. BIO-LINE SD Ag MPT64 TB test and final identification and differentiation between MTBC and different species of NTM were further confirmed by GenoType Mycobacterium CM/AS assay. 71 cases (9.3%) were positive for AFB by ZN staining and 227 cases (30.1%) were positive for mycobacteria by culture. Niacin production and catalase activity were negative in 62/227 (27.4%) strains and after using a panel of different biochemicals and final confirmation by GenoType Mycobacterium CM assay. Out of 227 cultures tested, 165 (72.6%) strains were confirmed as M. tuberculosis complex, and 62 (27.4%) were confirmed as NTM. The most common NTM species identified were M. fortuitum 17 (27.5%) and M. intracellulare 13 (20.9%). The rapid identification of NTM species may help in targeted therapy and management of the diseases.
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121
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Abstract
Diseases and therapies that reduce cell-mediated immunity increase the risk of nontuberculous mycobacterial (NTM) disease. Extrapulmonary NTM disease, including disseminated, skin, and catheter-related disease, is more common in immunosuppressed than immunocompetent patients. Mycobacterium avium complex remains the most common cause of NTM infection, but rapid growers including Mycobacterium abscessus, Mycobacterium chelonae, and Mycobacterium fortuitum play an important role in skin and catheter-related infections. With the exception of antibiotic prophylaxis for AIDS patients, the prevention of NTM remains difficult. Management is complicated, involving restoration of immune function and removal of catheters in addition to treatment with species-specific antibiotics per current guidelines.
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Affiliation(s)
- Emily Henkle
- HIV, STD, and TB Section, Public Health Division, Oregon Health Authority, Portland, Oregon
| | - Kevin Winthrop
- Division of Infectious Diseases, Oregon Health and Science University, Portland, Oregon
- Division of Public Health and Preventative Medicine, Oregon Health and Science University, Portland, Oregon
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122
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Zlojtro M, Jankovic M, Samarzija M, Zmak L, Jankovic VK, Obrovac M, Zlojtro I, Jakopovic M. Nosocomial pseudo-outbreak of Mycobacterium gordonae associated with a hospital's water supply contamination: a case series of 135 patients. JOURNAL OF WATER AND HEALTH 2015; 13:125-130. [PMID: 25719472 DOI: 10.2166/wh.2014.061] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Nontuberculous mycobacteria (NTM) are opportunistic pathogens found in natural and human-engineered waters. In 2009, a relative increase in the isolation of Mycobacterium gordonae from pulmonary samples originating from General Hospital Zabok was noted by the National Mycobacteria Reference Laboratory. An epidemiological survey revealed a contamination of the cold tap water with M. gordonae and guidelines regarding sputum sample taking were issued. In addition, all incident cases of respiratory infection due to NTM reported from 2007 to 2012 at General Hospital Zabok were included in a retrospective review. Out of 150 individual NTM isolates, M. gordonae was the most frequently isolated species (n = 135; 90%) and none of the cases met the criteria of the American Thoracic Society for pulmonary NTM disease. While concomitant Mycobacterium tuberculosis infection was confirmed in only 6 (4%) patients, anti-tuberculosis treatment was initiated for a significant portion of patients (n = 64; 42.6%) and unnecessary contact tracing was performed. This study points out the need to enhance the knowledge about NTM in our country and indicates the importance of faster NTM identification, as well as the importance of good communication between laboratory personnel and physicians when evaluating the significance of the isolated NTM.
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Affiliation(s)
- Marija Zlojtro
- Department for Respiratory Diseases, General Hospital Zabok, Bracak 8, 49210 Zabok, Croatia
| | - Mateja Jankovic
- Department for Respiratory Diseases, University Hospital Centre Zagreb, Jordanovac 104, 10000 Zagreb, Croatia E-mail:
| | - Miroslav Samarzija
- Department for Respiratory Diseases, University of Zagreb Medical School, University Hospital Centre, Salata 3 10000 Zagreb, Croatia
| | - Ljiljana Zmak
- National Mycobacterial Reference Laboratory, Croatian National Institute of Public Health, Zagreb, Rockefellerova ulica 7, 10000 Zagreb, Croatia
| | - Vera Katalinic Jankovic
- National Mycobacterial Reference Laboratory, Croatian National Institute of Public Health, Zagreb, Rockefellerova ulica 7, 10000 Zagreb, Croatia
| | - Mihaela Obrovac
- National Mycobacterial Reference Laboratory, Croatian National Institute of Public Health, Zagreb, Rockefellerova ulica 7, 10000 Zagreb, Croatia
| | - Igor Zlojtro
- University of Zagreb Medical School, Salata 3, 10000 Zagreb, Croatia
| | - Marko Jakopovic
- Department for Respiratory Diseases, University of Zagreb Medical School, University Hospital Centre, Salata 3 10000 Zagreb, Croatia
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123
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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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124
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Chern EC, King D, Haugland R, Pfaller S. Evaluation of quantitative polymerase chain reaction assays targeting Mycobacterium avium, M. intracellulare, and M. avium subspecies paratuberculosis in drinking water biofilms. JOURNAL OF WATER AND HEALTH 2015; 13:131-9. [PMID: 25719473 DOI: 10.2166/wh.2014.060] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Mycobacterium avium (MA), Mycobacterium intracellulare (MI), and Mycobacterium avium subsp. paratuberculosis (MAP) are difficult to culture due to their slow growing nature. A quantitative polymerase chain reaction (qPCR) method for the rapid detection of MA, MI, and MAP can be used to provide data supporting drinking water biofilms as potential sources of human exposure. The aim of this study was to characterize two qPCR assays targeting partial 16S rRNA gene sequences of MA and MI and use these assays, along with two previously reported MAP qPCR assays (IS900 and Target 251), to investigate Mycobacterium occurrence in kitchen faucet biofilms. MA and MI qPCR assays demonstrated 100% specificity and sensitivity when evaluated against 18 non-MA complex, 76 MA, and 17 MI isolates. Both assays detected approximately 1,000 cells from a diluted cell stock inoculated on a sampling swab 100% of the time. DNA analysis by qPCR indicated that 35.3, 56.9 and 11.8% of the 51 kitchen faucet biofilm samples collected contained MA, MI, and MAP, respectively. This study introduces novel qPCR assays designed to specifically detect MA and MI in biofilm. Results support the use of qPCR as an alternative to culture for detection and enumeration of MA, MI, and MAP in microbiologically complex samples.
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Affiliation(s)
- Eunice C Chern
- National Exposure Research Laboratory, US Environmental Protection Agency, Office of Research and Development, 26 W. Martin Luther King Dr., Cincinnati, OH 45268, USA E-mail:
| | - Dawn King
- National Exposure Research Laboratory, US Environmental Protection Agency, Office of Research and Development, 26 W. Martin Luther King Dr., Cincinnati, OH 45268, USA E-mail:
| | - Richard Haugland
- National Exposure Research Laboratory, US Environmental Protection Agency, Office of Research and Development, 26 W. Martin Luther King Dr., Cincinnati, OH 45268, USA E-mail:
| | - Stacy Pfaller
- National Exposure Research Laboratory, US Environmental Protection Agency, Office of Research and Development, 26 W. Martin Luther King Dr., Cincinnati, OH 45268, USA E-mail:
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125
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Wang J, McIntosh F, Radomski N, Dewar K, Simeone R, Enninga J, Brosch R, Rocha EP, Veyrier FJ, Behr MA. Insights on the emergence of Mycobacterium tuberculosis from the analysis of Mycobacterium kansasii. Genome Biol Evol 2015; 7:856-70. [PMID: 25716827 PMCID: PMC5322544 DOI: 10.1093/gbe/evv035] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
By phylogenetic analysis, Mycobacterium kansasii is closely related to Mycobacterium tuberculosis. Yet, although both organisms cause pulmonary disease, M. tuberculosis is a global health menace, whereas M. kansasii is an opportunistic pathogen. To illuminate the differences between these organisms, we have sequenced the genome of M. kansasii ATCC 12478 and its plasmid (pMK12478) and conducted side-by-side in vitro and in vivo investigations of these two organisms. The M. kansasii genome is 6,432,277 bp, more than 2 Mb longer than that of M. tuberculosis H37Rv, and the plasmid contains 144,951 bp. Pairwise comparisons reveal conserved and discordant genes and genomic regions. A notable example of genomic conservation is the virulence locus ESX-1, which is intact and functional in the low-virulence M. kansasii, potentially mediating phagosomal disruption. Differences between these organisms include a decreased predicted metabolic capacity, an increased proportion of toxin–antitoxin genes, and the acquisition of M. tuberculosis-specific genes in the pathogen since their common ancestor. Consistent with their distinct epidemiologic profiles, following infection of C57BL/6 mice, M. kansasii counts increased by less than 10-fold over 6 weeks, whereas M. tuberculosis counts increased by over 10,000-fold in just 3 weeks. Together, these data suggest that M. kansasii can serve as an image of the environmental ancestor of M. tuberculosis before its emergence as a professional pathogen, and can be used as a model organism to study the switch from an environmental opportunistic pathogen to a professional host-restricted pathogen.
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Affiliation(s)
- Joyce Wang
- Department of Microbiology and Immunology, McGill University, Montreal, Québec, Canada McGill International TB Centre, Montreal, Québec, Canada
| | - Fiona McIntosh
- McGill International TB Centre, Montreal, Québec, Canada Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Nicolas Radomski
- McGill International TB Centre, Montreal, Québec, Canada Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Ken Dewar
- McGill University and Génome Québec Innovation Center, Montreal, Québec, Canada
| | - Roxane Simeone
- Unit for Integrated Mycobacterial Pathogenomics, Institut Pasteur, Paris, France
| | - Jost Enninga
- Dynamics of Host-Pathogen Interactions Unit, Institut Pasteur, Paris, France
| | - Roland Brosch
- Unit for Integrated Mycobacterial Pathogenomics, Institut Pasteur, Paris, France
| | - Eduardo P Rocha
- Microbial Evolutionary Genomics Unit, Institut Pasteur, Paris, France
| | - Frédéric J Veyrier
- McGill International TB Centre, Montreal, Québec, Canada INRS-Institut Armand-Frappier, Laval, Québec, Canada
| | - Marcel A Behr
- Department of Microbiology and Immunology, McGill University, Montreal, Québec, Canada McGill International TB Centre, Montreal, Québec, Canada Department of Medicine, McGill University, Montreal, Québec, Canada
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126
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Wang HY, Kim H, Kim S, Bang H, Kim DK, Lee H. Evaluation of PCR-reverse blot hybridization assay for the differentiation and identification of Mycobacterium
species in liquid cultures. J Appl Microbiol 2014; 118:142-51. [DOI: 10.1111/jam.12670] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 10/07/2014] [Accepted: 10/15/2014] [Indexed: 11/29/2022]
Affiliation(s)
- H.-Y. Wang
- M&D, Inc.; Wonju Eco Environmental Technology Center; Wonju Gangwon Korea
| | - H. Kim
- Department of Biomedical Laboratory Science; College of Health Sciences; Yonsei University; Wonju Gangwon Korea
| | - S. Kim
- Department of Biomedical Laboratory Science; College of Health Sciences; Yonsei University; Wonju Gangwon Korea
- Institute for Life Science and Biotechnology; Yonsei University; Seoul Korea
| | - H. Bang
- Department of Biomedical Laboratory Science; College of Health Sciences; Yonsei University; Wonju Gangwon Korea
| | - D.-K. Kim
- Department of Laboratory Medicine; St. Vincent's Hospital; The Catholic University of Korea; Suwon Gyeonggi Korea
| | - H. Lee
- Department of Biomedical Laboratory Science; College of Health Sciences; Yonsei University; Wonju Gangwon Korea
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127
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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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128
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Ichijo T, Izumi Y, Nakamoto S, Yamaguchi N, Nasu M. Distribution and respiratory activity of mycobacteria in household water system of healthy volunteers in Japan. PLoS One 2014; 9:e110554. [PMID: 25350137 PMCID: PMC4211706 DOI: 10.1371/journal.pone.0110554] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 09/24/2014] [Indexed: 11/29/2022] Open
Abstract
The primary infectious source of nontuberculous mycobacteria (NTM), which are known as opportunistic pathogens, appears to be environmental exposure, and it is important to reduce the frequency of exposure from environmental sources for preventing NTM infections. In order to achieve this, the distribution and respiratory activity of NTM in the environments must be clarified. In this study, we determined the abundance of mycobacteria and respiratory active mycobacteria in the household water system of healthy volunteers using quantitative PCR and a fluorescent staining method, because household water has been considered as one of the possible infectious sources. We chose healthy volunteer households in order to lessen the effect of possible residential contamination from an infected patient. We evaluated whether each sampling site (bathroom drain, kitchen drain, bath heater pipe and showerhead) have the potential to be the sources of NTM infections. Our results indicated that drains in the bathroom and kitchen sink are the niche for Mycobacterium spp. and M. avium cells were only detected in the bathtub inlet. Both physicochemical and biologic selective pressures may affect the preferred habitat of Mycobacterium spp. Regional differences also appear to exist as demonstrated by the presence (US) or absence (Japan) of Mycobacterium spp. on showerheads. Understanding of the country specific human activities and water usage will help to elucidate the infectious source and route of nontuberculous mycobacterial disease.
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Affiliation(s)
- Tomoaki Ichijo
- Environmental Science and Microbiology, Graduate School of Pharmaceutical Sciences, Osaka University, Suita, Osaka, Japan
- Research Institute for Humanity and Nature, Kyoto, Japan
| | - Yoko Izumi
- Environmental Science and Microbiology, Graduate School of Pharmaceutical Sciences, Osaka University, Suita, Osaka, Japan
| | - Sayuri Nakamoto
- Environmental Science and Microbiology, Graduate School of Pharmaceutical Sciences, Osaka University, Suita, Osaka, Japan
| | - Nobuyasu Yamaguchi
- Environmental Science and Microbiology, Graduate School of Pharmaceutical Sciences, Osaka University, Suita, Osaka, Japan
- * E-mail:
| | - Masao Nasu
- Environmental Science and Microbiology, Graduate School of Pharmaceutical Sciences, Osaka University, Suita, Osaka, Japan
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129
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Flores-Moreno K, Celis-Meneses JS, Meneses-Ruiz DM, Castillo-Rodal AI, Orduña P, Montiel BA, López-Vidal Y. Potential cross-reactivity of monoclonal antibodies against clinically relevant mycobacteria. Clin Exp Immunol 2014; 177:454-63. [PMID: 24580144 DOI: 10.1111/cei.12309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2014] [Indexed: 12/31/2022] Open
Abstract
Tuberculosis is a disease caused by the Mycobacterium tuberculosis complex (MTb). In 2011, global mortality due to tuberculosis was 1·4 million individuals. The only available vaccine is the attenuated M. bovis [bacillus Calmette-Guérin (BCG)] strain, which confers variable protection against pulmonary tuberculosis. Some widely distributed non-tuberculous mycobacteria (NTM), such as M. avium and M. arupense, are also potential pathogens for humans. This work aimed to produce and characterize monoclonal antibodies against the M. bovis BCG Mexico strain of the MTb, M. avium subs. hominissuis and the M. arupense strain from NTM. Hybridomas were produced from splenocytes of BALB/c female mice immunized with radiation-inactivated mycobacteria, and the immunoglobulin (Ig)G2a antibody-producing clones with the highest antigenic recognition were selected. The selected clones, Mbv 2A10 for M. bovis BCG Mexico, Mav 3H1 for M. avium and Mar 2D10 for M. arupense, were used in further studies. Enzyme-linked immunosorbent assay (ELISA) and immune proteomics analyses characterized the clones as having the highest cross-reactivity with mycobacteria. Using mass spectrometry, a number of proteins recognized by the monoclonal antibody (mAb) clones were identified. These proteins had roles in metabolic processes, hypoxia, cell cycle and dormancy. In addition, a Clustal W and Immune Epitope Database (IEDB) in-silico analysis was performed in protein sequences that result in the conserved regions within probability epitopes that could be recognized for Mbv2A10 and Mav3H1 clones.
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Affiliation(s)
- K Flores-Moreno
- Programa de Inmunología Molecular Microbiana, Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México, México City, México
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Ito Y, Hirai T, Fujita K, Kubo T, Maekawa K, Ichiyama S, Togashi K, Mishima M. The influence of environmental exposure on the response to antimicrobial treatment in pulmonary Mycobacterial avium complex disease. BMC Infect Dis 2014; 14:522. [PMID: 25266993 PMCID: PMC4261885 DOI: 10.1186/1471-2334-14-522] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 09/24/2014] [Indexed: 01/15/2023] Open
Abstract
Background Environmental exposure is a likely risk factor for the development of pulmonary Mycobacterium avium complex (MAC) disease. The influence of environmental exposure on the response to antimicrobial treatment and relapse is unknown. Methods We recruited 72 patients with pulmonary MAC disease (male [female], 18 [54]; age, 61.7 ± 10.3 years) who initiated and completed standard three-drug regimens for more than 12 months between January 2007 and December 2011. The factors associated with sputum conversion, relapse and treatment success without relapse were retrospectively evaluated after adjustments for confounding predictors. Results Fifty-two patients (72.2%) demonstrated sputum conversion, and 15 patients (28.8%) relapsed. A total of 37 patients (51.4%) demonstrated treatment success. Sputum conversion was associated with negative smears (odds ratio [OR], 3.89; 95% confidence interval [CI], 1.27-12.60; P = 0.02). A relapse occurred in patients with low soil exposure after the start of treatment less frequently than in patients with high soil exposure (7/42 [16.7%] vs. 8/10 [80.0%], P = 0.0003). Treatment success was associated with low soil exposure after the beginning of treatment (OR, 13.46; 95% CI, 3.24-93.43; P = 0.0001) and a negative smear (OR, 2.97; 95% CI, 1.02-9.13; P = 0.047). Conclusion Low soil exposure was independently associated with better microbiological outcomes in patients with pulmonary MAC disease after adjusting for confounding clinical, microbiological and radiographic findings.
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Affiliation(s)
- Yutaka Ito
- Department of Respiratory Medicine, Kyoto, Japan.
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Managing pulmonary nontuberculous mycobacterial infection. time for a patient-centered approach. Ann Am Thorac Soc 2014; 11:117-21. [PMID: 24460445 DOI: 10.1513/annalsats.201308-278ot] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The incidence of nontuberculous mycobacteria is increasing worldwide. However, the evidence base for clinical management comprises mostly expert opinion, case series, and few randomized clinical trials. Most currently recommended treatment regimens entail prolonged use of multiple antimicrobial agents associated with multiple self-limited and persistent potential adverse effects, including irreversible impairments of hearing, vision, and kidney function. Yet, little is known about how treatment impacts an individual patient's overall health status. Current treatment guidelines, although of undoubted value, are constrained by these limitations. Here we call for new studies that reassess recommendations for medical management of pulmonary nontuberculous mycobacteria infections, in particular Mycobacterium avium-intracellulare complex and Mycobacterium abscessus complex. We propose pragmatic, person-centered outcome measures that might be used in clinical assessments and new research studies, including patient-reported experience measures and patient-reported outcome measures. This will enable patients and their health-care providers to make clinical management decisions that derive from a realistic view of what they can hope to achieve from treatment.
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132
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Association between polyclonal and mixed mycobacterial Mycobacterium avium complex infection and environmental exposure. Ann Am Thorac Soc 2014; 11:45-53. [PMID: 24251904 DOI: 10.1513/annalsats.201309-297oc] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
RATIONALE Polyclonal and mixed mycobacterial Mycobacterium avium complex (MAC) infection is observed in pulmonary MAC disease. Human living environments contain multiple species or genotypes of nontuberculous mycobacterial strains and are considered sources of infection. OBJECTIVES To investigate the association of environmental exposure with polyclonal and mixed mycobacterial infection in pulmonary MAC disease after adjustments for potential confounding diseases and conditions and radiographic findings. METHODS We collected two separate sputum samples from 102 patients and single sputum samples from 18 patients in whom the second MAC strain was not isolated in our prospective cohort of pulmonary MAC disease. MAC isolates from sputum samples and patients' residential soils were used for variable number of tandem repeats (VNTR) analyses. Polyclonal and mixed mycobacterial MAC infections were defined as having different VNTR genotypes and other mycobacterial species, respectively. Monoclonal MAC infection was defined as all isolates showing a single VNTR genotype. Associations of the type of infection with clinical and radiographic findings and environmental exposure were measured. MEASUREMENTS AND MAIN RESULTS Polyclonal and mixed mycobacterial MAC and monoclonal infections were observed in 42 and 78 patients, respectively. By stepwise regression analysis, patients with polyclonal and mixed mycobacterial MAC infections were associated with history of asthma (odds ratio [OR], 11.56; 95% confidence interval [CI], 1.41-255.77; P = 0.021), high soil exposure (≥2 h/wk; OR, 4.31; 95% CI, 1.72-11.45; P < 0.01), shower use in a bathroom (OR, 4.57; 95% CI, 1.28-23.23; P = 0.018), and swimming in a pool (OR, 9.69; 95% CI, 1.21-206.92; P < 0.01). CONCLUSIONS Environmental exposure was associated with polyclonal and mixed mycobacterial MAC infection in pulmonary MAC disease.
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Abstract
Mycobacterium xenopi is an opportunistic mycobacterial pathogen of increasing clinical importance. Surveillance of M. xenopi is hampered by the absence of tools for genotyping and molecular epidemiology. In this study, we describe the development and evaluation of an effective multilocus sequence typing strategy for M. xenopi.
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Al-Harbi A, Al-Jahdali H, Al-Johani S, Baharoon S, Bin Salih S, Khan M. Frequency and clinical significance of respiratory isolates of non-tuberculous mycobacteria in Riyadh, Saudi Arabia. CLINICAL RESPIRATORY JOURNAL 2014; 10:198-203. [PMID: 25130951 DOI: 10.1111/crj.12202] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Accepted: 08/01/2014] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND AIMS The prevalence of pulmonary non-tuberculous mycobacteria (NTM) disease is increasing worldwide. The aim of this study was to assess the frequency and clinical significance of NTM isolated from respiratory specimens at King Abdul-Aziz Medical City-Riyadh, Saudi Arabia. METHODS The medical records of all patients who had at least one respiratory specimen that was positive for growth of NTM between 2006 and 2012 were retrospectively reviewed. The clinical significance of the isolates was determined using the diagnostic criteria for NTM disease published by the American Thoracic Society (ATS). RESULT A total of 380 respiratory specimens with positive culture for NTM from 142 patients were identified. Forty patients (28%) had definite pulmonary NTM disease with a mean (± standard deviation) age of 54 ± 16 years, 58% were male and 50% had had underlying chronic lung disease. Mycobacterium avium complex (MAC) (n = 19, 48%) and Mycobacterium abscessus (n = 10, 25%) were the most commonly encountered NTM. The clinical manifestations of NTM lung disease are non-specific, with symptoms indistinguishable from pulmonary tuberculosis (TB). The most common radiological features of NTM lung disease were nodular bronchiectasis (45%) and fibrocavitary lesions (40%). CONCLUSIONS Twenty-eight percent of the patients with NTM isolates met the ATS diagnostic criteria for NTM lung disease. MAC and M. abscessus were the most encountered NTM isolated species that caused NTM lung disease in our population, which is a rate similar to many previous studies.
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Affiliation(s)
- Abdullah Al-Harbi
- Department of Medicine, Pulmonary Division, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Hamdan Al-Jahdali
- Department of Medicine, Pulmonary Division, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Sameera Al-Johani
- Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Salim Baharoon
- Department of Critical Care, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Salih Bin Salih
- Department of Medicine, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohammad Khan
- Department of Medicine, Pulmonary Division, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Sgarioni SA, Hirata RDC, Hirata MH, Leite CQF, de Prince KA, de Andrade Leite SR, Filho DV, Siqueira VLD, Caleffi-Ferracioli KR, Cardoso RF. Occurrence of Mycobacterium bovis and non-tuberculous mycobacteria (NTM) in raw and pasteurized milk in the northwestern region of Paraná, Brazil. Braz J Microbiol 2014; 45:707-11. [PMID: 25242962 PMCID: PMC4166303 DOI: 10.1590/s1517-83822014000200046] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 09/09/2013] [Indexed: 11/22/2022] Open
Abstract
Milk is widely consumed in Brazil and can be the vehicle of agent transmission. In this study, was evaluated the occurrence of Mycobacterium bovis and non-tuberculous mycobacteria (NTM) in raw and pasteurized milk consumed in the northwestern region of Paraná, Brazil. Fifty-two milk samples (20 pasteurized and 32 raw) from dairy farms near the municipality of Maringa, Parana State, Brazil were collected. Milk samples were decontaminated using 5% oxalic acid method and cultured on Lowenstein-Jensen and Stonebrink media at 35 °C and 30 °C, with and without 5–10% CO2. Mycobacteria isolates were identified by morphological features, PCR-Restriction Fragment Length Polymorphism Analysis (PCR-PRA) and Mycolic acids analysis. Thirteen (25%) raw and 2 (4%) pasteurized milk samples were positive for acid fast bacilli growth. Nine different species of NTM were isolated (M. nonchromogenicum, M. peregrinum, M. smegmatis, M. neoaurum, M. fortuitum, M. chelonae, M. flavescens, M. kansasii and M. scrofulaceum). M. bovis was not detected. Raw and pasteurized milk may be considered one source for NTM human infection. The paper reinforces the need for intensification of measures in order to avoid the milk contamination and consequently prevent diseases in the south of Brazil.
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Affiliation(s)
- Sônia Aparecida Sgarioni
- Departamento de Análises Clínicas e Biomedicina Universidade Estadual de Maringá MaringáPR Brazil Departamento de Análises Clínicas e Biomedicina, Universidade Estadual de Maringá, Maringá, PR, Brazil
| | - Rosario Dominguez Crespo Hirata
- Departamento de Análises Clínicas e Toxicológicas Universidade de São Paulo São PauloSP Brazil Departamento de Análises Clínicas e Toxicológicas, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Mario Hiroyuki Hirata
- Departamento de Análises Clínicas e Toxicológicas Universidade de São Paulo São PauloSP Brazil Departamento de Análises Clínicas e Toxicológicas, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Clarice Queico Fujimura Leite
- Faculdade de Ciências Farmacêutica da Universidade Estadual Paulista AraraquaraSP Brazil Faculdade de Ciências Farmacêutica da Universidade Estadual Paulista, Araraquara, SP, Brazil
| | - Karina Andrade de Prince
- Faculdade de Ciências Farmacêutica da Universidade Estadual Paulista AraraquaraSP Brazil Faculdade de Ciências Farmacêutica da Universidade Estadual Paulista, Araraquara, SP, Brazil
| | - Sergio Roberto de Andrade Leite
- Instituto de Química da Universidade Estadual Paulista AraraquaraSP Brazil Instituto de Química da Universidade Estadual Paulista, Araraquara, SP, Brazil
| | - Dirceu Vedovello Filho
- Secretaria de Saúde do Estado do Paraná MaringáPR Brazil Secretaria de Saúde do Estado do Paraná, Maringá, PR, Brazil
| | - Vera Lucia Dias Siqueira
- Departamento de Análises Clínicas e Biomedicina Universidade Estadual de Maringá MaringáPR Brazil Departamento de Análises Clínicas e Biomedicina, Universidade Estadual de Maringá, Maringá, PR, Brazil
| | - Katiany Rizzieri Caleffi-Ferracioli
- Departamento de Análises Clínicas e Biomedicina Universidade Estadual de Maringá MaringáPR Brazil Departamento de Análises Clínicas e Biomedicina, Universidade Estadual de Maringá, Maringá, PR, Brazil
| | - Rosilene Fressatti Cardoso
- Departamento de Análises Clínicas e Biomedicina Universidade Estadual de Maringá MaringáPR Brazil Departamento de Análises Clínicas e Biomedicina, Universidade Estadual de Maringá, Maringá, PR, Brazil
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Fujita K, Ito Y, Hirai T, Kubo T, Togashi K, Ichiyama S, Mishima M. Prevalence and risk factors for chronic co-infection in pulmonary Mycobacterium avium complex disease. BMJ Open Respir Res 2014; 1:e000050. [PMID: 25478192 PMCID: PMC4212714 DOI: 10.1136/bmjresp-2014-000050] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 08/15/2014] [Indexed: 01/09/2023] Open
Abstract
Background Patients with pulmonary Mycobacterium avium complex (MAC) disease are often co-infected with various pathogenic microorganisms. This study aimed to determine the prevalence of co-infection with non-MAC pathogens and the risk factors associated with co-infection in patients with pulmonary MAC disease. Methods We retrospectively reviewed the patient characteristics, microbiological results and chest CT findings in 275 patients with pulmonary MAC who visited the Kyoto University Hospital from January 2001 to May 2013. We defined chronic pathogenic co-infection as the isolation of non-MAC pathogens from sputum samples taken on more than two visits that occurred at least 3 months apart. Results The participants were predominantly female (74.5%) and infected with M. avium (75.6%). Chronic co-infection with any pathogen was observed in 124 patients (45.1%). Methicillin-sensitive Staphylococcus aureus (MSSA; n=64), Pseudomonas aeruginosa (n=35) and Aspergillus spp (n=18) were the most prevalent pathogens. The adjusted factors were chronic obstructive pulmonary disease (COPD; OR=4.2, 95% CI 1.6 to 13.1) and pulmonary M. intracellulare disease (OR=2.2, 95% CI 1.1 to 4.4) in chronic co-infections; COPD (OR=4.2, 95% CI 2.1 to 31.4), long duration of MAC disease (OR=2.2, 95% CI 1.2 to 4.4) and nodules (OR=3.5, 95% CI 1.2 to 13.2) in chronic MSSA co-infection; COPD (OR=7.5, 95% CI 2.1 to 31.4) and lower lobe involvement (OR=9.9, 95% CI 2.0 to 90.6) in chronic P. aeruginosa co-infection; and use of systemic corticosteroids (OR=7.1, 95% CI 1.2 to 50.9) and pulmonary M. intracellulare disease (OR=4.0, 95% CI 1.1 to 14.5) in chronic Aspergillus spp co-infection. Conclusions Patients with pulmonary MAC disease frequently had chronic co-infections with pathogenic microorganisms such as MSSA, P. aeruginosa and Aspergillus. The risk factors for chronic co-infection were COPD and pulmonary M. intracellulare disease.
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Affiliation(s)
- Kohei Fujita
- Department of Respiratory Medicine , Graduate School of Medicine, Kyoto University , Kyoto , Japan
| | - Yutaka Ito
- Department of Respiratory Medicine , Graduate School of Medicine, Kyoto University , Kyoto , Japan
| | - Toyohiro Hirai
- Department of Respiratory Medicine , Graduate School of Medicine, Kyoto University , Kyoto , Japan
| | - Takeshi Kubo
- Department of Diagnostic Imaging and Nuclear Medicine , Graduate School of Medicine, Kyoto University , Kyoto , Japan
| | - Kaori Togashi
- Department of Diagnostic Imaging and Nuclear Medicine , Graduate School of Medicine, Kyoto University , Kyoto , Japan
| | - Satoshi Ichiyama
- Department of Clinical Laboratory Medicine , Graduate School of Medicine, Kyoto University , Kyoto , Japan
| | - Michiaki Mishima
- Department of Respiratory Medicine , Graduate School of Medicine, Kyoto University , Kyoto , Japan
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Yoo JW, Jo KW, Kang BH, Kim MY, Yoo B, Lee CK, Kim YG, Yang SK, Byeon JS, Kim KJ, Ye BD, Shim TS. Mycobacterial diseases developed during anti-tumour necrosis factor-α therapy. Eur Respir J 2014; 44:1289-95. [PMID: 25102962 DOI: 10.1183/09031936.00063514] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Nontuberculous mycobacterial (NTM) disease and tuberculosis (TB) develop during anti-tumour necrosis factor (TNF)-α therapy. We compared clinical characteristics and outcomes between the two diseases. A total of 1165 patients were screened for TB and treated with TNF-α antagonists from July 2004 to July 2013 for the following conditions: inflammatory bowel disease (n = 422), rheumatoid arthritis (n = 320), and ankylosing spondylitis (n = 389). TB and NTM disease were diagnosed at baseline screening in four and three patients, respectively, and developed during anti-TNF-α therapy in 19 and six patients, respectively. The incidence rate of TB and NTM disease was 747.7 per 100 000 and 238.2 per 100 000 person-years, respectively. Patients with NTM disease were older, with a greater proportion of females. All cases of NTM disease involved the lung, with rheumatoid arthritis (83.3%) being the most frequent underlying disease. The most common radiological feature was consolidation in NTM disease, and honeycombing was present in two rheumatoid arthritis patients with NTM disease. The most common pathogen was Mycobacterium intracellulare (n = 3) followed by Mycobacterium avium (n = 2). Both the NTM and TB group showed favourable outcomes. The clinical characteristics differed between NTM disease and TB that developed on anti-TNF-α agents, but clinical outcomes were favourable in both diseases.
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Affiliation(s)
- Jung-Wan Yoo
- Dept of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Kyung-Wook Jo
- Dept of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Bo-Hyung Kang
- Dept of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Mi Young Kim
- Dept of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Bin Yoo
- Dept of Rheumatology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Chang-Keun Lee
- Dept of Rheumatology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Yong-Gil Kim
- Dept of Rheumatology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Suk-Kyun Yang
- Dept of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Jeong-Sik Byeon
- Dept of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Kyung-Jo Kim
- Dept of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Byong Duk Ye
- Dept of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Tae Sun Shim
- Dept of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
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Comparison of the Spectrum of Radiologic and Clinical Manifestations of Pulmonary Disease Caused by Mycobacterium avium Complex and Mycobacterium xenopi. Can Assoc Radiol J 2014; 65:207-13. [DOI: 10.1016/j.carj.2013.05.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 04/17/2013] [Accepted: 05/23/2013] [Indexed: 11/21/2022] Open
Abstract
Aim Mycobacterium xenopi is described with upper lobe cavitation (“fibrocavitary” pattern), whereas the Mycobacterium avium complex (MAC) is described with bronchiectasis and centrilobular nodules (“nodular bronchiectasis”). We retrospectively described and compared computed tomography (CT) chest manifestations of disease caused by MAC and M xenopi. Materials and Methods We reviewed patients who had either MAC or M xenopi lung disease and who had CTs between January 2002 and December 2003. Clinical data were recorded, and the patterns on chest CTs were categorized as “fibrocavitary,” “nodular bronchiectatic,” and “unclassified.” Results There were 74 patients; 50 with MAC and 24 with M xenopi. The patients with MAC were older (mean 69 vs 58 years; P = .007). Patients with M xenopi more often had emphysema (50% vs 20%; P = .02), cavities (46% vs 16%; P = .01), and nodules ≤5 mm (88% vs 58%; P = .02). M xenopi cases more commonly had a fibrocavitary radiologic pattern (33% vs 18%), with no statistically significant difference ( P = .24). MA C was more often associated with a nodular bronchiectatic pattern (68% MAC vs 4% M xenopi; P < .0001). Sixty-three percent of patients with M xenopi had a pattern that was predominantly randomly distributed nodules (11/15 [73%]) or consolidation and/or ground-glass opacities (4/15 [27%]). Conclusion Compared with MAC, patients with M xenopi infection develop more cavities and more nodules, and they less often have a predominant nodular bronchiectatic pattern. Although a predominantly cavitary pattern appears to be more common with M xenopi, the majority of patients with M xenopi had CT patterns of random nodules or consolidation and/or ground-glass opacities rather than classically described findings.
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139
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Lai CC, Hsueh PR. Diseases caused by nontuberculous mycobacteria in Asia. Future Microbiol 2014; 9:93-106. [PMID: 24328383 DOI: 10.2217/fmb.13.138] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The isolation rate of nontuberculous mycobacteria (NTM) species and the prevalence of NTM-associated diseases are on the rise in Asian, as well as in Western countries; however, the species distribution of NTM isolates and the types of diseases caused by NTM species vary from region to region. In this review, we present an update on the epidemiology of NTM in Asia. We demonstrate that the distribution of NTM species varies within Asia and differs from that in North America and Europe. In addition, the clinical manifestations of NTM diseases include respiratory tract infections, disseminated infections, skin and soft tissue infections, lymphadenitis, empyema, ocular infections, CNS infections and genitourinary infections. Finally, the rate of adaptive resistance of anti-NTM antimicrobial agents remains high and may be associated with a poor outcome for patients with NTM diseases.
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Affiliation(s)
- Chih-Cheng Lai
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan
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140
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Genome sequencing of Mycobacterium abscessus isolates from patients in the united states and comparisons to globally diverse clinical strains. J Clin Microbiol 2014; 52:3573-82. [PMID: 25056330 DOI: 10.1128/jcm.01144-14] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Nontuberculous mycobacterial infections caused by Mycobacterium abscessus are responsible for a range of disease manifestations from pulmonary to skin infections and are notoriously difficult to treat, due to innate resistance to many antibiotics. Previous population studies of clinical M. abscessus isolates utilized multilocus sequence typing or pulsed-field gel electrophoresis, but high-resolution examinations of genetic diversity at the whole-genome level have not been well characterized, particularly among clinical isolates derived in the United States. We performed whole-genome sequencing of 11 clinical M. abscessus isolates derived from eight U.S. patients with pulmonary nontuberculous mycobacterial infections, compared them to 30 globally diverse clinical isolates, and investigated intrapatient genomic diversity and evolution. Phylogenomic analyses revealed a cluster of closely related U.S. and Western European M. abscessus subsp. abscessus isolates that are genetically distinct from other European isolates and all Asian isolates. Large-scale variation analyses suggested genome content differences of 0.3 to 8.3%, relative to the reference strain ATCC 19977(T). Longitudinally sampled isolates showed very few single-nucleotide polymorphisms and correlated genomic deletion patterns, suggesting homogeneous infection populations. Our study explores the genomic diversity of clinical M. abscessus strains from multiple continents and provides insight into the genome plasticity of an opportunistic pathogen.
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141
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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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142
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Sheu LC, Tran TM, Jarlsberg LG, Marras TK, Daley CL, Nahid P. Non-tuberculous mycobacterial infections at San Francisco General Hospital. CLINICAL RESPIRATORY JOURNAL 2014; 9:436-42. [PMID: 24799125 DOI: 10.1111/crj.12159] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 04/07/2014] [Accepted: 05/02/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS The epidemiology of non-tuberculous mycobacteria (NTM) infection is not well defined. We evaluated the trends in incidence of NTM infections at San Francisco General Hospital (SFGH), a large metropolitan county hospital. METHODS We performed a retrospective review of microbiologic and clinical records of all patients with a positive NTM culture reported from 1993 to 2001. NTM infection was defined by the isolation of >1 NTM from any clinical specimen. Patients were stratified by human immunodeficiency virus (HIV) status. Univariate and multivariate logistic regression were used to identify factors that were independently associated with NTM infection. Trends over time were assessed using Poisson test for trend. RESULTS During the study period, 25 736 samples from 7395 patients were cultured for mycobacteria. Of these samples, 2853 (11.1%) from 1345 patients (18.2%) were culture positive for NTM. Patient characteristics associated with infection included younger age (P < 0.001), male gender (P < 0.001), White ethnicity compared with Asian and Hispanic (P < 0.001 and P = 0.01, respectively), and HIV positivity (P < 0.001). Overall, NTM infection at SFGH decreased significantly from 319 cases in 1993 to 59 in 2001 (P < 0.001). Mycobacterium avium was predominant in both HIV-positive and HIV-negative populations (74.5% and 44.6% of isolates, respectively), and Mycobacterium kansasii was the second most common NTM species isolated. The proportion of other NTM species isolated in these groups differed. CONCLUSION In contrast to other published studies, time-series analyses show that NTM isolation rates decreased during the study period at SFGH, where NTM was most strongly associated with HIV infection.
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Affiliation(s)
- Leslie C Sheu
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Tu M Tran
- Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, CA, USA
| | - Leah G Jarlsberg
- Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, CA, USA
| | | | - Charles L Daley
- Division of Mycobacterial and Respiratory Infections, National Jewish Health, Denver, CO, USA
| | - Payam Nahid
- Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, CA, USA
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The epidemiology of pulmonary nontuberculous mycobacteria: data from a general hospital in Athens, Greece, 2007-2013. Pulm Med 2014; 2014:894976. [PMID: 25132991 PMCID: PMC4123541 DOI: 10.1155/2014/894976] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 05/21/2014] [Indexed: 01/15/2023] Open
Abstract
Background. The epidemiology of pulmonary nontuberculous mycobacteria (NTM) in Greece is largely unknown. Objectives. To determine the incidence and the demographic, microbiological, and clinical characteristics of patients with pulmonary NTM infection and pulmonary NTM disease. Methods. A retrospective review of the demographic, microbiological, and clinical characteristics of patients with NTM culture-positive respiratory specimens from January 2007 to May 2013. Results. A total of 120 patients were identified with at least one respiratory NTM isolate and 56 patients (46%) fulfilled the microbiological ATS/IDSA criteria for NTM disease. Of patients with adequate data, 16% fulfilled the complete ATS/IDSA criteria for NTM disease. The incidence of pulmonary NTM infection and disease was 18.9 and 8.8 per 100.000 inpatients and outpatients, respectively. The spectrum of NTM species was high (13 species) and predominated by M. avium-intracellulare complex (M. avium (13%), M. intracellulare (10%)), M. gordonae (14%), and M. fortuitum (12%). The ratio of isolation of NTM to M. tuberculosis in all hospitalized patients was 0.59. Conclusions. The first data on the epidemiology of pulmonary NTM in Athens, Greece, are presented. NTM infection is common in patients with chronic respiratory disease. However, only a significantly smaller proportion of patients fulfill the criteria for NTM disease.
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Ng KP, Rukumani DV, Chong J, Kaur H. Identification of Mycobacterium species following growth detection with the BACTEC MGIT 960 system by DNA line probe assay. Int J Mycobacteriol 2014; 3:82-7. [PMID: 26786328 DOI: 10.1016/j.ijmyco.2014.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 03/31/2014] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND The tuberculosis and infections caused by nontuberculous mycobacterial (NTM) species are increasing in patients presented with respiratory illness, and it is crucial to document the epidemiology of these infections. OBJECTIVES To study the mycobacterial species and in vitro drug susceptibility trends of Mycobacterium tuberculosis found in the respiratory specimens. MATERIALS AND METHODS A prospective descriptive study from July 2009 to December 2012. The BACTEC MGIT system tubes with growth were used in the study. GenoType Mycobacterium (Hain Diagnostika, Nehren, Germany) assays were used to identify the mycobacteria. The drug susceptibility testing was performed by the MGIT 960 system. RESULTS A total of 1745 MGIT 960 system positive tubes were included. M. tuberculosis complex (MTC) constituted 67.45% of the yield isolated, 30.83% were nontuberculous mycobacterial species, 0.17% were Mycobacterium bovis BCG and 1.55% were not interpretable to species levels. Mycobacterium fortuitum (45.71%), Mycobacterium abscessus (26.21%) and Mycobacterium intracellulare (10.41%) were major NTM identified. The drug susceptibility study showed that 6.88% (81/1177) of MTC were drug-resistant TB, 56 isolates were resistant to one of the first-line anti-TB drugs, 25 isolates were found to be resistant to 2 or more first-line anti-TB drugs, of which 19 (20.46%) were MDR-TB and one of the isolates in the year 2011 was confirmed XDR-TB. CONCLUSION M. tuberculosis, M. fortuitum, M. abscessus and M. intracellulare were major mycobacterial species detected in the respiratory samples. The drug susceptibility testing showed that the majority of MTC were sensitive to first-line anti-TB drugs.
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Affiliation(s)
- Kee Peng Ng
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 59400 Kuala Lumpur, Malaysia.
| | - Devi Velayuthan Rukumani
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 59400 Kuala Lumpur, Malaysia
| | - Jennifer Chong
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 59400 Kuala Lumpur, Malaysia
| | - Harvinder Kaur
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 59400 Kuala Lumpur, Malaysia
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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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Hermansen TS, Thomsen VØ, Lillebaek T, Ravn P. Non-tuberculous mycobacteria and the performance of interferon gamma release assays in Denmark. PLoS One 2014; 9:e93986. [PMID: 24705675 PMCID: PMC3976367 DOI: 10.1371/journal.pone.0093986] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 03/11/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The QuantiFERON-TB-Gold Test (QFT) is more specific than the Mantoux skin-test to discriminate between Mycobacterium tuberculosis (MTB) and non-tuberculous mycobacterial (NTM) infections. Here we study the performance of the QFT in patients with NTM disease. METHODS From 2005 to 2011, nationwide patient data on positive NTM cultures (n = 925) were combined with nationwide data on QFT results (n = 16,133), both retrieved from the International Reference Laboratory of Mycobacteriology, Denmark. A total of 112 patients with NTM infections had a QFT performed, 53 patients had definite NTM disease, 10 had possible disease and 49 had NTM colonization. RESULTS QFT was positive in 8% (4/53) of patients with definite disease, 40% (4/10) with possible disease and 31% (15/49) with colonization. Positivity rate was lowest among patients with definite disease infected with NTM without the RD1 region 4% (2/50). None of the 15 children with MAC lymphadenitis had a positive QFT. CONCLUSION This study is one of the largest assessing IGRAs in patients with NTM disease in a TB low-incidence setting. Our study showed that the QFT holds potential to discriminate between NTM and MTB infections. We found no positive IGRA test results among children with NTM not sharing the RD1-region of MTB resulting in a 100% specificity and we suggest that a QFT in a child presenting with cervical lymphadenitis may be helpful in distinguishing NTM from TB lymphadenitis.
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Affiliation(s)
- Thomas Stig Hermansen
- Department of Thoracic Medicine and Infectious Disease, Nordsjaelland Hospital, Hillerød, Denmark
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark
| | | | - Troels Lillebaek
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark
| | - Pernille Ravn
- Department of Thoracic Medicine and Infectious Disease, Nordsjaelland Hospital, Hillerød, Denmark
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Nodular bronchiectatic Mycobacterium avium complex pulmonary disease. Natural course on serial computed tomographic scans. Ann Am Thorac Soc 2014; 10:299-306. [PMID: 23952847 DOI: 10.1513/annalsats.201303-062oc] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
RATIONALE Existing literature is inconclusive regarding how the nodular bronchiectatic form of Mycobacterium avium complex (MAC) disease will progress without treatment and when treatment initiation should be considered. OBJECTIVES To assess the natural course of MAC pulmonary disease by serial thin-section computed tomography (CT). METHODS Of 339 patients with nodular bronchiectatic form of MAC disease, we selected 265 untreated patients who had serial CTs (mean observation period, 32 ± 21 mo). Two independent chest radiologists reviewed retrospectively all CT scans for the presence and extent of lung abnormalities (maximal total score, 30). MEASUREMENTS AND MAIN RESULTS Of 265 patients, 126 patients (48%) had disease that had progressed and that needed treatment owing to radiologic deterioration or worsening symptoms, and the remaining 139 patients (52%) did not. On multivariate analysis, the presence of cavity (adjusted hazard ratio, 2.06; P = 0.004) and consolidation (adjusted hazard ratio, 1.55; P = 0.019) at initial CT remained as independent factors associated with disease progression and treatment requirement. The presence of cavitary lesions demonstrated the highest positive predictive value (61%) and significant correlation (P = 0.005) with smear positivity. Differences in the extent of each pattern and total CT score in the serial studies were significantly larger (P < 0.05) in patients requiring treatment. The total CT score increased by 2.41 in the treatment-requiring group compared with 0.25 in the group that did not receive treatment. CONCLUSIONS Without treatment, about half of patients demonstrate progressive disease on serial CT over a mean follow-up period of 32 months and, thus, required treatment. Patients showing cavities or consolidation on initial CT are more likely to have progressive disease and thus to require treatment eventually.
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Abstract
In light of the increasing prevalence of Mycobacterium avium pulmonary disease and the challenges of treating patients with M. avium infection, consideration of measures to reduce exposure is warranted. Because M. avium inhabits water and soil, humans are surrounded by that opportunistic pathogen. Because infection has been linked to the presence of M. avium in household plumbing, increasing hot water temperature, reducing aerosol (mist) exposures in bathrooms and showers, and installing filters that prevent the passage of mycobacteria will likely reduce M. avium exposure. Granular activated carbon (charcoal) filters support the growth of M. avium and should be avoided. When gardening, avoid the inhalation of soil dusts by using a mask or wetting the soil because peat-rich potting soils have high numbers of mycobacteria.
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Nontuberculous mycobacterial disease mortality in the United States, 1999-2010: a population-based comparative study. PLoS One 2014; 9:e91879. [PMID: 24632814 PMCID: PMC3954860 DOI: 10.1371/journal.pone.0091879] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 02/17/2014] [Indexed: 01/15/2023] Open
Abstract
Background Environmental nontuberculous mycobacteria (NTM) are ubiquitous organisms with which humans commonly interact. The epidemiologic characteristics of NTM diseases including mortality rate and its associated factors remain largely unknown. In this study, we explored the geographical area of exposure and mortality and comorbid conditions of affected persons to determine environment, host, and host-pathogen interactive factors. Methods We analyzed mortality related to nontuberculous mycobacterial infections from 1999 through 2010 by examining multiple-cause-of-death data from the National Center for Health Statistics. Among those who died with these diseases, we analyzed age-adjusted mortality rates, trends, associations with demographic variables, and comorbid conditions and correlated this information with similar data for tuberculosis-related mortality during the same time. Measurements and Mean Results From 1999 through 2010, nontuberculous mycobacterial disease was reported as an immediate cause of death in 2,990 people in the United States with a combined overall mean age-adjusted mortality rate of 0.1 per 100,000 person-years. A significant increase in the number of NTM related deaths was seen from 1999 through 2010 (R2 = 0.72, p<0.0001), but it was not significant after adjustment for age. Persons aged 55 years and older, women, those living in Hawaii and Louisiana, and those of non-Hispanic, white ethnicity had higher mortality rates. Compared to tuberculosis-related mortality, chronic obstructive pulmonary disease, bronchiectasis, HIV, interstitial lung diseases, and tobacco use were significantly more common in persons with nontuberculous mycobacteria-related deaths. Conclusions Nontuberculous mycobacteria-related death numbers are rising and are unevenly distributed. The strong association of nontuberculous mycobacterial disease with age suggests that its prevalence will increase as the United States population ages.
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