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Tan J, Wang Y, Li Z, Xia S, Guo Z, Li W, Yuan Y, Gao J, Wang W. Laboratory tests and analysis of drug resistance in non-tuberculous mycobacteria. Heliyon 2024; 10:e28665. [PMID: 38586355 PMCID: PMC10998137 DOI: 10.1016/j.heliyon.2024.e28665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/09/2024] Open
Abstract
Background This study analyzed the laboratory diagnosis results and drug resistance of patients infected with non-tuberculous mycobacterium (NTM). Methods We collected information on patients with positive indicators of NTM infection at the Henan Provincial Chest Hospital from 2020 to 2022. Acid-fast smear, mycobacterium culture, QB-SPOT assay, GeneXpert MTB/RIF assay, immunoglobulin E test, tuberculosis antibody test, and microplate method for drug sensitivity test were analyzed using strain identification as the gold standard. Results The 242 cases of NTM infection were predominantly detected with slow-growing mycobacteria (a detection rate of 87.19%), among which Mycobacterium intracellulare (66.53%), Mycobacterium avium (15.70%), and Mycobacterium chelonei/abscessus complex (11.16%) ranked the top three in terms of the isolation rate. Males patients accounted for a higher proportion (58.26%) than females (41.74%), and the majority of them were over 60 years (50.83%). Among laboratory tests for patients with NTM infection, mycobacterium culture showed a highest detected rate (87.20%) among laboratory tests. The results of the drug sensitivity test demonstrated that the resistance rate of NTM was generally high. Moreover, the Mycobacterium avium complex with the highest isolation rate showed 100% resistant to doxycycline and minocycline, but exhibited relatively high sensitivity to moxifloxacin (a resistance rate of 7.89%) and rifabutin (a resistance rate of 13.16%). The Mycobacterium chelonei/abscessus complex was 100% resistant to doxycycline and relatively sensitive to cefoxitin (29.17%) and clarithromycin (37.50%). Conclusion The NTM species isolated by the Henan Provincial Chest Hospital is dominated by Mycobacterium intracellulare and the highest positive rate is detected by mycobacterium culture among laboratory tests. NTM infection generally exhibits a high rate of drug resistance. Accordingly, the accurate diagnosis of NTM diseases requires enhanced drug sensitivity testing to provide patients with targeted combination drug treatment.
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Affiliation(s)
- Jiao Tan
- Medical Laboratory, Henan Provincial Chest Hospital, Zhengzhou University, Henan Province Clinical Medical Research Center for Infectious Diseases (Tuberculosis), Zhengzhou, 450000, Henan, China
| | - Yachun Wang
- Medical Laboratory, Henan Provincial Chest Hospital, Zhengzhou University, Henan Province Clinical Medical Research Center for Infectious Diseases (Tuberculosis), Zhengzhou, 450000, Henan, China
| | - Zheng Li
- Medical Laboratory, Henan Provincial Chest Hospital, Zhengzhou University, Henan Province Clinical Medical Research Center for Infectious Diseases (Tuberculosis), Zhengzhou, 450000, Henan, China
| | - Shuang Xia
- Medical Laboratory, Henan Provincial Chest Hospital, Zhengzhou University, Henan Province Clinical Medical Research Center for Infectious Diseases (Tuberculosis), Zhengzhou, 450000, Henan, China
| | - Zhen Guo
- Medical Laboratory, Henan Provincial Chest Hospital, Zhengzhou University, Henan Province Clinical Medical Research Center for Infectious Diseases (Tuberculosis), Zhengzhou, 450000, Henan, China
| | - Wenbo Li
- Medical Laboratory, Henan Provincial Chest Hospital, Zhengzhou University, Henan Province Clinical Medical Research Center for Infectious Diseases (Tuberculosis), Zhengzhou, 450000, Henan, China
| | - Yingying Yuan
- Medical Laboratory, Henan Provincial Chest Hospital, Zhengzhou University, Henan Province Clinical Medical Research Center for Infectious Diseases (Tuberculosis), Zhengzhou, 450000, Henan, China
| | - Jingcai Gao
- Medical Laboratory, Henan Provincial Chest Hospital, Zhengzhou University, Henan Province Clinical Medical Research Center for Infectious Diseases (Tuberculosis), Zhengzhou, 450000, Henan, China
| | - Wei Wang
- Medical Laboratory, Henan Provincial Chest Hospital, Zhengzhou University, Henan Province Clinical Medical Research Center for Infectious Diseases (Tuberculosis), Zhengzhou, 450000, Henan, China
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Narimisa N, Bostanghadiri N, Goodarzi F, Razavi S, Jazi FM. Prevalence of Mycobacterium kansasii in clinical and environmental isolates, a systematic review and meta-analysis. Front Microbiol 2024; 15:1321273. [PMID: 38440139 PMCID: PMC10911025 DOI: 10.3389/fmicb.2024.1321273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 02/02/2024] [Indexed: 03/06/2024] Open
Abstract
Background Mycobacterium kansasii infection is one of the most common causes of non-tuberculosis mycobacterial (NTM) disease worldwide. However, accurate information on the global prevalence of this bacterium is lacking. Therefore, this study was conducted to investigate the prevalence of M. kansasii in clinical and environmental isolates. Methods Databases, including PubMed, Scopus, and the Web of Science, were utilized to gather articles on the prevalence of M. kansasii in clinical and environmental isolates. The collected data were analyzed using Comprehensive Meta-Analysis software. Results A total of 118 and 16 studies met the inclusion criteria and were used to analyze the prevalence of M. kansasii in clinical and environmental isolates, respectively. The prevalence of M. kansasii in NTM and environmental isolates were 9.4 and 5.8%, respectively. Subsequent analysis showed an increasing prevalence of M. kansasii over the years. Additionally, the results indicated a significant difference in the prevalence of this bacteria among different regions. Conclusion The relatively high prevalence of M. kansasii among NTM isolates suggests the need for further implementation of infection control strategies. It is also important to establish appropriate diagnostic criteria and management guidelines for screening this microorganism in environmental samples in order to prevent its spread, given its high prevalence in environmental isolates.
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Affiliation(s)
- Negar Narimisa
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Narjess Bostanghadiri
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Forough Goodarzi
- Department of Bacteriology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Shabnam Razavi
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Faramarz Masjedian Jazi
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Ndanga MED, Abdul JBPAA, Edoa JR, Ibinda GARM, Adegbite BR, Mevyann RC, Biyogho CM, Mahoumbou J, Manguinga S, Roguet NM, Lell B, Kremsner PG, Alabi AS, Grobusch MP, Adegnika AA. Species identification and drug susceptibility testing of non-tuberculous mycobacteria by Line Probe Assay in Lambaréné, Gabon-a cross-sectional study. BMC Infect Dis 2023; 23:651. [PMID: 37789292 PMCID: PMC10548664 DOI: 10.1186/s12879-023-08617-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 09/18/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Non-tuberculous mycobacteria (NTM) are a group of bacteria that cause rare lung infections and are increasingly recognized as causative agents of opportunistic and device-associated infections in humans. In Gabon, there is a lack of data on NTM species identification and drug susceptibility. The aim of this study was to identify the frequency of NTM species and their genotypic susceptibility pattern to commonly used antibiotics for NTM infections in Gabon. METHODS A cross-sectional study was conducted at the CERMEL TB laboratory from January 2020 to December 2022, NTM subspecies identification and drug susceptibility testing to macrolides and aminoglycosides were performed using the genotype NTM-DR kit. RESULTS The study found that out of 524 culture-positive specimens, 146 (28%) were NTM, with the predominant group being Mycobacterium avium complex (MAC) and Mycobacterium abscessus complex (MABC). All MAC isolates were fully susceptible to macrolides and aminoglycosides, while five MABC isolates carried mutations indicative of reduced susceptibility to macrolide and aminoglycoside drugs. CONCLUSIONS These findings suggest that clinicians may use macrolides and aminoglycosides to manage NTM infections caused by MAC, but further investigation is required to determine MABC drug susceptibility.
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Affiliation(s)
- Micheska Epola Dibamba Ndanga
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon
- Ecole Doctorale d'infectiologie Tropicale de Franceville, Franceville, Gabon
| | | | - Jean Ronald Edoa
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon
| | | | - Bayodé Romeo Adegbite
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, Location University of Amsterdam, Amsterdam Infection & Immunity, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | - Jocelyn Mahoumbou
- Programme National de Lutte Contre La Tuberculose, Libreville, Gabon
| | | | | | - Bertrand Lell
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Peter Gottfried Kremsner
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon
- German Center for Infection Research, Tübingen, Germany
- Institut Für Tropenmedizin, Universität Tübingen, Tübingen, Germany
| | - Abraham Sunday Alabi
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon
- Health Focus GmbH, Potsdam, Germany
| | - Martin Peter Grobusch
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon.
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, Location University of Amsterdam, Amsterdam Infection & Immunity, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands.
- Institut Für Tropenmedizin, Universität Tübingen, Tübingen, Germany.
- Masanga Medical Research Unit (MMRU), Masanga, Sierra Leone.
- Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
| | - Ayola Akim Adegnika
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon
- German Center for Infection Research, Tübingen, Germany
- Institut Für Tropenmedizin, Universität Tübingen, Tübingen, Germany
- Fondation Pour La Recherche Scientifique, Cotonou, Bénin
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
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Nohrenberg M, Wright A, Krause V. Non-tuberculous mycobacterial skin and soft tissue infections in the Northern Territory, Australia, 1989-2021. Int J Infect Dis 2023; 135:125-131. [PMID: 37524256 DOI: 10.1016/j.ijid.2023.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND A previous review demonstrated that the majority of NTM infections in the Northern Territory (NT) are pulmonary in nature [1], however skin and soft tissue (SST) are likely the next most common sites of disease. The current epidemiology of NTM SST infections across the NT is not known. We aimed to establish the current and historical incidence rates, and the organisms involved. METHODS All NTM cases reported to the Centre for Disease Control in Darwin from 1989-2021 were retrospectively reviewed. RESULTS 226 NTM notifications were reviewed. 73 (32%) cases were SST infections. The incidence of SST cases increased over the study period. Female cases were more common (p=0·002). Disease occurred across a wide age range (1-85 years). Only 16% of cases occurred in Aboriginal individuals which may reflect immunological factors requiring further investigation. Many cases had no clear provocation, but localised skin trauma was the most common risk factor. The most common organism identified was M. fortuitum (41%). Diagnosis was often delayed, with a median time to diagnosis of 69 days (IQR=31-149). Most cases (60%) underwent surgical intervention with adjunctive anti-mycobacterial medical therapy. CONCLUSION NTM SST incidence rates increased over the study period. NTM SST infections are a rare but important differential diagnosis for non-healing cutaneous wounds.
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Affiliation(s)
- Michael Nohrenberg
- Public Health Unit (Centre for Disease Control & Environmental Health), Building 4, 105 Rocklands Drive, Tiwi, Northern Territory, Australia, 0810.
| | - Alyson Wright
- Public Health Unit (Centre for Disease Control & Environmental Health), Building 4, 105 Rocklands Drive, Tiwi, Northern Territory, Australia, 0810; Health Statistics and Informatics, Sector and System Leadership, NT Health, Floor 7, Manunda Place, 38 Cavenagh Street, Darwin
| | - Vicki Krause
- Public Health Unit (Centre for Disease Control & Environmental Health), Building 4, 105 Rocklands Drive, Tiwi, Northern Territory, Australia, 0810
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Echeverria G, Rueda V, Espinoza W, Rosero C, Zumárraga MJ, de Waard JH. First Case Reports of Nontuberculous Mycobacterial (NTM) Lung Disease in Ecuador: Important Lessons to Learn. Pathogens 2023; 12:pathogens12040507. [PMID: 37111393 PMCID: PMC10142742 DOI: 10.3390/pathogens12040507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/12/2023] [Accepted: 03/16/2023] [Indexed: 04/29/2023] Open
Abstract
Nontuberculous mycobacteria (NTM) lung infections are often misdiagnosed as tuberculosis, which can lead to ineffective antibiotic treatments. In this report, we present three cases of NTM lung infections in Ecuador that were initially diagnosed and treated as tuberculosis based on the results of sputum smear microscopy. The patients, all male, included two immunocompetent individuals and one HIV-positive subject. Unfortunately, sputum culture was not initiated until late in the course of the disease and the cause of the lung infection, Mycobacterium avium complex (MAC), was only identified after the patients had either passed away or were lost to follow-up. These cases are the first documented cases of NTM lung infections in the English medical literature from Ecuador. We emphasize the importance of accurate diagnosis of NTM infections by culture and identification to species level. Sputum smear staining alone cannot differentiate between mycobacterial species, which can lead to misidentification and ineffective treatments. Additionally, reporting NTM pulmonary disease as a notifiable disease to national TB control programs is recommended to obtain accurate prevalence data. These data are critical in determining the importance of this public health problem and the necessary actions needed to address it.
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Affiliation(s)
- Gustavo Echeverria
- Instituto de Investigación en Zoonosis-CIZ, Universidad Central del Ecuador, Quito 170518, Ecuador
- Programa de Doctorado, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Buenos Aires C1063ACV, Argentina
- División Investigación y Desarrollo, BioGENA, Quito 170509, Ecuador
| | - Veronica Rueda
- Instituto de Investigación en Zoonosis-CIZ, Universidad Central del Ecuador, Quito 170518, Ecuador
| | - Wilson Espinoza
- Departamento de Tuberculosis, Hospital de Especialidades Eugenio Espejo, Quito 170401, Ecuador
| | - Carlos Rosero
- Departamento de Tuberculosis, Hospital de Especialidades Eugenio Espejo, Quito 170401, Ecuador
| | - Martín J Zumárraga
- Instituto de Agrobiotecnología y Biología Molecular, IABIMO, INTA-CONICET, Buenos Aires C1063ACV, Argentina
| | - Jacobus H de Waard
- Departamento de Tuberculosis, Instituto de Biomedicina "Jacinto Convit", Universidad Central de Venezuela, Caracas 1010, Venezuela
- One Health Research Group, Facultad de Ciencias de la Salud, Universidad de Las Américas (UDLA), Quito 180602, Ecuador
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Park HE, Lee W, Choi S, Jung M, Shin MK, Shin SJ. Modulating macrophage function to reinforce host innate resistance against Mycobacterium avium complex infection. Front Immunol 2022; 13:931876. [PMID: 36505429 PMCID: PMC9730288 DOI: 10.3389/fimmu.2022.931876] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 10/21/2022] [Indexed: 11/25/2022] Open
Abstract
Mycobacterium avium complex (MAC) is the main causative agent of infectious diseases in humans among nontuberculous mycobacteria (NTM) that are ubiquitous organisms found in environmental media such as soil as well as in domestic and natural waters. MAC is a primary causative agent of NTM-lung disease that threaten immunocompromised or structural lung disease patients. The incidence and the prevalence of M. tuberculosis infection have been reduced, while MAC infections and mortality rates have increased, making it a cause of global health concern. The emergence of drug resistance and the side effects of long-term drug use have led to a poor outcome of treatment regimens against MAC infections. Therefore, the development of host-directed therapy (HDT) has recently gained interest, aiming to accelerate mycobacterial clearance and reversing lung damage by employing the immune system using a novel adjuvant strategy to improve the clinical outcome of MAC infection. Therefore, in this review, we discuss the innate immune responses that contribute to MAC infection focusing on macrophages, chief innate immune cells, and host susceptibility factors in patients. We also discuss potential HDTs that can act on the signaling pathway of macrophages, thereby contributing to antimycobacterial activity as a part of the innate immune response during MAC infection. Furthermore, this review provides new insights into MAC infection control that modulates and enhances macrophage function, promoting host antimicrobial activity in response to potential HDTs and thus presenting a deeper understanding of the interactions between macrophages and MACs during infection.
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Affiliation(s)
- Hyun-Eui Park
- Department of Microbiology and Convergence Medical Science, Institute of Health Sciences, College of Medicine, Gyeongsang National University, Jinju, South Korea
| | - Wonsik Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Sangwon Choi
- Department of Microbiology, Institute for Immunology and Immunological Disease, Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul, South Korea
| | - Myunghwan Jung
- Department of Microbiology and Convergence Medical Science, Institute of Health Sciences, College of Medicine, Gyeongsang National University, Jinju, South Korea
| | - Min-Kyoung Shin
- Department of Microbiology and Convergence Medical Science, Institute of Health Sciences, College of Medicine, Gyeongsang National University, Jinju, South Korea,*Correspondence: Min-Kyoung Shin, ; Sung Jae Shin,
| | - Sung Jae Shin
- Department of Microbiology, Institute for Immunology and Immunological Disease, Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul, South Korea,*Correspondence: Min-Kyoung Shin, ; Sung Jae Shin,
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Masoumi M, Sakhaee F, Zolfaghari MR, Tarashi S, Rahimi Jamnani F, Vaziri F, Siadat SD, Fateh A. Mixed pulmonary infection with four isolates of nontuberculous mycobacteria: a case report of mycobacterium bacteremicum infection. Pneumonia (Nathan) 2022; 14:7. [PMCID: PMC9636635 DOI: 10.1186/s41479-022-00100-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022] Open
Abstract
Abstract
Background
A mixed pulmonary infection of Mycobacterium bacteremicum and three different isolates of nontuberculous mycobacteria (NTM) is an unusual clinical manifestation and have not yet been indicated. In this case report, we reported four isolates of NTM using phenotypic and genotypic test of pulmonary sample in Tehran, Iran.
Case presentation
We report a case of severe pulmonary disease in a 19-year-old male patient with productive cough, shortness of breath, and low-grade fever for several weeks. The C-reactive protein (CRP) level (80.2 mg/L) and erythrocyte sedimentation rate (ESR) (95 mm/h) were high. The computed tomographic scan indicated bronchiectasis, nodular opacities, consolidation, and cavitary lesions on both sides. The result of purified protein derivative (PPD) test was equal to 15 mm. The sequences of hsp65, rpoB, and 16S rDNA genes indicated more than 99% homology to four isolates of nontuberculous mycobacteria (NTM), including Mycobacterium fortuitum, M. chelonae, M. mucogenicum, and M. bacteremicum. We found that all four strains were susceptible to amikacin, cefoxitin, ciprofloxacin, clarithromycin, imipenem, and linezolid. The patient was treated with ciprofloxacin, clarithromycin, and amikacin, along with Montelukast, for five months.
Conclusion
We report a case of severe pulmonary infection by four isolates of NTM. After treatment, the patient reported complete resolution of the signs and a weight gain of 5 kg; also, the CRP and ESR were normal. Nine months after the infection diagnosis, a new CT scan revealed further improvements.
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Cerro-Muñoz P, Navarro-Bielsa A, Almenara-Blasco M, Algara O, Gracia-Cazaña T, Gilaberte Y. Multiresistant Mycobacterium abscessus ulcer treated with photodynamic therapy with methyl-aminolevulinate. Dermatol Ther 2022; 35:e15756. [PMID: 35941060 DOI: 10.1111/dth.15756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 07/16/2022] [Accepted: 08/02/2022] [Indexed: 11/28/2022]
Affiliation(s)
| | - Alba Navarro-Bielsa
- Department of Dermatology, Miguel Servet University Hospital, Zaragoza, Spain. IIS Aragón, Universidad de Zaragoza
| | | | - Olga Algara
- Department of Microbiology, Miguel Servet University Hospital, Zaragoza, Spain
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Mitigation of nontuberculous mycobacteria in hospital water: challenges for infection prevention. Curr Opin Infect Dis 2022; 35:330-338. [PMID: 35849523 DOI: 10.1097/qco.0000000000000844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize recent literature on nontuberculous mycobacteria in water of healthcare systems. Despite improvement in identification techniques and emergence of infection prevention and control programs, nontuberculous mycobacteria remain present in hospital water systems, causing outbreaks and pseudo-outbreaks in healthcare settings. RECENT FINDINGS Waterborne outbreaks and pseudo-outbreaks of nontuberculous mycobacteria continue to affect hospitals. Improvements in methods of identification and investigation, including MALDI-TOF and whole genome sequencing with evaluation of single nucleotide polymorphisms, have been used successfully in outbreak and pseudo-outbreak investigations. Recent studies have shown control of outbreaks in immunocompromised patients through the use of sterile water for consumption, as well as control of pseudo-outbreaks by using sterile water for procedures. Construction activities have been implicated in outbreaks and pseudo-outbreaks of nontuberculous mycobacteria. Water management programs are now required by the Joint Commission, which will likely improve water risk mitigation. SUMMARY Improvement in detection and identification of nontuberculous mycobacteria has led to increasing recognition of waterborne outbreaks and pseudo-outbreaks. Water management programs are of vital importance in infection prevention.
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Pfaller S, King D, Mistry JH, Donohue M. Occurrence revisited: Mycobacterium avium and Mycobacterium intracellulare in potable water in the USA. Appl Microbiol Biotechnol 2022; 106:2715-2727. [PMID: 35298694 PMCID: PMC9173748 DOI: 10.1007/s00253-022-11849-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 01/27/2022] [Accepted: 02/21/2022] [Indexed: 11/30/2022]
Abstract
Nontuberculous mycobacterium (NTM) infections are increasing in the USA and have a high cost burden associated with treatment. Thus, it is necessary to understand what changes could be contributing to this increase in NTM disease rate. Water samples from 40 sites were collected from around the USA. They represented three water types: groundwater disinfected with chlorine and surface water disinfected with chlorine or monochloramine. Two methods, culture and qPCR, were used to measure M. avium and M. intracellulare. Heterotrophic bacteria and NTM counts were also measured. M. avium and M. intracellulare were molecularly detected in 25% (73/292) and 35% (102/292) of samples. The mean concentrations of M. avium and M. intracellulare were 2.8 × 103 and 4.0 × 103 genomic units (GU) L-1. The Northeast sites had the highest sample positively rate for both M. avium and M. intracellulare. The highest NTM counts and M. avium concentrations were observed in the surface water treated with chloramine. Geographic location and source water/disinfectant type were observed to significantly influence M. avium and M. intracellulare occurrence rates. These studies can help improve public health risk management by balancing disinfectant treatments and diverse microbial loads in drinking water. KEY POINTS: • M. avium (MA) culture rate increased significantly: 1% (1999) to 13%. • Culture versus qPCR method: 13% vs 31% for MA and 6% vs 35% for MI. • The results of each method type tell two different stories of MA and MI occurrence.
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Affiliation(s)
- Stacy Pfaller
- Center for Exposure Research and Emergency Response, United States Environmental Protection Agency, 26 W. Martin Luther King Dr., Mail Stop 593, Cincinnati, OH, 45268, USA
| | - Dawn King
- Center for Exposure Research and Emergency Response, United States Environmental Protection Agency, 26 W. Martin Luther King Dr., Mail Stop 593, Cincinnati, OH, 45268, USA
| | - Jatin H Mistry
- United States Environmental Protection Agency, Region 6, Dallas, TX, USA
| | - Maura Donohue
- Center for Exposure Research and Emergency Response, United States Environmental Protection Agency, 26 W. Martin Luther King Dr., Mail Stop 593, Cincinnati, OH, 45268, USA.
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Evaluation of a new assay for nontuberculous mycobacteria species identification in diagnostic material and cultures. Tuberculosis (Edinb) 2021; 130:102124. [PMID: 34488079 DOI: 10.1016/j.tube.2021.102124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 11/21/2022]
Abstract
The purpose of the present study was to evaluate a real-time PCR system for 12 nontuberculous mycobacteria (NTM) species identification developed by Central Tuberculosis Research Institute (CTRI; Moscow, Russia) in cooperation with Syntol LLC (Moscow, Russia). NTM cultures (210 strains, 19 species), Mycobacterium tuberculosis complex (MTBC) cultures (21 strains, 2 species), non-mycobacterial microorganisms (18 strains, 13 species) were used for the first stage of the assay evaluation. Clinical samples (sputum, N = 973) positive for smear microscopy and MTBC/NTM DNA by a PCR-based screening assay collected from 819 patients were used for specificity and sensitivity evaluation. Sensitivity for determining the NTM species directly from diagnostic material was 99.71%, with the specificity of 100%. The sensitivity and specificity for NTM species identification in cultures was 99.67% and 100%, respectively. Both sensitivity and specificity for determining MTBC in cultures was 100%.
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