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Khavandegar A, Mahdaviani SA, Zaki-Dizaji M, Khalili-Moghaddam F, Ansari S, Alijani S, Taherzadeh-Ghahfarrokhi N, Mansouri D, Casanova JL, Bustamante J, Jamee M. Genetic, immunologic, and clinical features of 830 patients with Mendelian susceptibility to mycobacterial diseases (MSMD): A systematic review. J Allergy Clin Immunol 2024; 153:1432-1444. [PMID: 38341181 DOI: 10.1016/j.jaci.2024.01.021] [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: 05/17/2023] [Revised: 11/14/2023] [Accepted: 01/24/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Mendelian susceptibility to mycobacterial diseases (MSMD) is a rare clinical syndrome characterized by vulnerability to weakly virulent mycobacterial species, including Bacillus Calmette-Guérin (BCG) vaccines and environmental mycobacteria. OBJECTIVE We sought to perform a systematic review of the genetic, immunologic, and clinical findings for reported patients with MSMD. METHODS We searched PubMed, Web of Science, and Scopus databases for publications in English relating to MSMD. All full texts were evaluated for eligibility for inclusion. Two reviewers independently selected the publications, with a third reviewer consulted in cases of disagreement. RESULTS A primary systematic search and searches of other resources identified 16,155 articles. In total, 158 articles from 63 countries were included in qualitative and quantitative analyses. In total, 830 patients-436 males (52.5%), 369 females (44.5%), and 25 patients of unknown sex (3.0%)-from 581 families were evaluated. A positive family history was reported in 347 patients (45.5%). The patients had a mean age of 10.41 ± 0.42 (SEM) years. The frequency of MSMD was highest in Iran, Turkey, and Saudi Arabia. Lymphadenopathy was the most common clinical manifestation of MSMD, reported in 378 (45.5%) cases and multifocal in 35.1%. Fever, organomegaly, and sepsis were the next most frequent findings, reported in 251 (30.2%), 206 (24.8%), and 171 (20.8%) cases, respectively. In total, 299 unique mutations in 21 genes known to be involved in MSMD were reported: 100 missense (34%), 80 indel-frameshift (insertion or deletion, 27%), 53 nonsense (18%), 35 splice site (12%), 10 indel-in frame (2.7%), 6 indel (2%), and 15 large deletion/duplication mutations. Finally, 61% of the reported patients with MSMD had mutations of IL12RB1 (41%) or IFNGR1 (20%). At the time of the report, 177 of the patients (21.3%) were dead and 597 (71.9%) were still alive. CONCLUSIONS MSMD is associated with a high mortality rate, mostly due to impaired control of infection. Preexposure strategies, such as changes in vaccination policy in endemic areas, the establishment of a worldwide registry of patients with MSMD, and precise follow-up over generations in affected families, appear to be vital to decrease MSMD-related mortality.
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Affiliation(s)
- Armin Khavandegar
- Student Research Committee, Alborz University of Medical Sciences, Karaj, Iran; Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Seyed Alireza Mahdaviani
- Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Majid Zaki-Dizaji
- Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
| | | | - Sarina Ansari
- Student Research Committee, Alborz University of Medical Sciences, Karaj, Iran
| | - Saba Alijani
- Student Research Committee, Alborz University of Medical Sciences, Karaj, Iran
| | | | - Davood Mansouri
- Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Clinical Immunology and Infectious Diseases, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Jean-Laurent Casanova
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris Cité University, Imagine Institute, Paris, France; St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY; Howard Hughes Medical Institute, New York, NY; Department of Pediatrics, Necker Hospital for Sick Children, AP-HP, Paris, France
| | - Jacinta Bustamante
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris Cité University, Imagine Institute, Paris, France; St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY; Study Center for Primary Immunodeficiencies, Necker Hospital for Sick Children, AP-HP, Paris, France
| | - Mahnaz Jamee
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.
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Yuan J, Wang Y, Wang L, Wang H, Ren Y, Yang W. What do the clinical features of positive nontuberculous mycobacteria isolates from patients with HIV/AIDS in China reveal? A systematic review and meta-analysis. J Glob Health 2023; 13:04093. [PMID: 37651639 PMCID: PMC10472018 DOI: 10.7189/jogh.13.04093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Abstract
Background China has a high burden of nontuberculous mycobacterial (NTM) infections. Immunocompromised populations, such as those with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), are at a higher risk of being infected with NTM than immunocompetent individuals. Yet, there is a paucity of information on the clinical features of positive NTM isolates from patients with HIV/AIDS in China. To address this gap, we conducted a systematic review and meta-analysis of existing studies, comparing them against current expert consensus to provide guidance for clinical practice. Methods Two researchers independently searched eight databases (SinoMed, China National Knowledge Infrastructure, Wanfang, VIP, Cochrane Library, PubMed, Embase, and Web of Science) from inception to 26 December 2022 to retrieve published Chinese- and English-language studies reporting clinical features of NTM-positive isolates among patients with HIV/AIDS in China. Results We included 28 studies with 1861 patients. The rate of positive NTM isolates detected from men among all patients was 87.3%. NTM species distribution was mainly Mycobacterium avium complex (64.3%), which was predominant in different regions. The five most common clinical symptoms were fever (68.5%), cough or expectoration (67.0%), appetite loss (49.4%), weight loss (45.5%), and superficial lymphadenectasis (41.1%). The prevalence of laboratory tests were as follows: albumin <35 g/L (55.6%), erythrocyte sedimentation rate >20 mm/h (91.4%), anaemia (59.0%), predominantly mild, CD4+ T cell count ≤50 pieces/μL (70.3%), and CD4+ T cell count 51-200 pieces/μL (22.1%). Lesion manifestations in thoracic imaging mainly included bilateral lung involvement (83.8%), showed stripe shadows (60.3%), patchy shadows (42.9%), nodules (40.6%), and bronchiectasis (38.6%). Accompanied signs included thoracic lymph node enlargement (49.5%). Seventy per cent of symptoms improved after treatment. Conclusions Focusing on clinical symptoms, laboratory tests, and thoracic imaging helps with initial screening for NTM infections. Physicians should raise awareness of the diagnosis and treatment of Mycobacterium avium complex, providing guidance for experimental treatment, screening of priority populations for NTM infections, and prophylactic treatment of NTM disease. Registration PROSPERO CRD42023388185.
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Affiliation(s)
- Jianwei Yuan
- Department of Infection, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
| | - Yan Wang
- Department of Infection, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
| | - Lin Wang
- Department of Infection, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
| | - Hongxia Wang
- Department of Infection, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
| | - Yuan Ren
- School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Wenzhe Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
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Riopel ND, Wood K, Stokes W. Disseminated cutaneous Mycobacterium chelonae infection secondary to an indwelling catheter in an immunocompetent host. J Clin Tuberc Other Mycobact Dis 2023; 32:100373. [PMID: 37139480 PMCID: PMC10149383 DOI: 10.1016/j.jctube.2023.100373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
Background Mycobacterium chelonae is a species of nontuberculous mycobacteria that typically causes localized cutaneous disease in immunocompetent hosts. There have been few reports of disseminated infections in immunocompetent individuals which have often been associated with invasive medical procedures. Case Presentation In this report, we describe a 43-year-old immunocompetent female with an implanted venous access device who presented with skin lesions increasing in size and frequency over the course of five months despite antimicrobial therapy. A diagnosis was not made until mycobacterial culture from a skin biopsy grew M. chelonae. Conclusion Disseminated cutaneous M. chelonae infection can be a rare complication of indwelling venous catheterization among immunocompetent patients.
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Affiliation(s)
- Nicholas D. Riopel
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Kimberly Wood
- Department of Laboratory Medicine and Pathology, University of Alberta, Alberta, Canada
| | - William Stokes
- Department of Laboratory Medicine and Pathology, University of Alberta, Alberta, Canada
- Alberta Public Health Laboratory, Alberta Precision Laboratories, Alberta, Canada
- Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- Corresponding author at: 2B4.58 WMC, 8440-112 St NW, Edmonton, AB T6G 2J2, Canada.
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Verma AK, Arora VK. Non-tuberculous mycobacterial infections in geriatric patients-A neglected and emerging problem. Indian J Tuberc 2022; 69 Suppl 2:S235-S240. [PMID: 36400516 DOI: 10.1016/j.ijtb.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/12/2022] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Abstract
The diseases caused by Non-tuberculous mycobacteria (NTM) has increased steadily in the last two decades. Increase in incidence of NTM infections are being reported in elderly people as they are more susceptible and often experiencing high morbidity. There is prediction that NTM infections will further rise because of expected increase in elderly population by 2050. Given the importance of NTM infection in the elderly, the interest in studying NTM characteristics in the aged population is increasing. In this review, we summarize the characteristics of NTM infection among elderly patients. We focus on epidemiology, clinical presentation, and treatment options of NTM in this age group. We highlight the differences in the diagnosis and treatment between rapid and slow growing mycobacterial infections. The current recommendations for treatment of NTM have been discussed. Finally, we have reviewed the prognosis of NTM disease in elderly patients.
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Affiliation(s)
- Ajoy Kumar Verma
- Department of Microbiology, National Institute of Tuberculosis and Respiratory Diseases, Sri Aurobindo Marg, New Delhi 110030, India.
| | - Vijay Kumar Arora
- Santosh University, NCR Delhi, Formerly Director - National Institute of TB & Respiratory Diseases (LRS), Formerly - Additional DGHS, Goverment of India, India
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Lao CK, Wu TS, Lin KY, Lee MH. Disseminated Mycobacterium peregrinum and Mycobacterium avium infection in a patient with AIDS: A case report and review of literature. J Clin Tuberc Other Mycobact Dis 2022; 27:100314. [PMID: 35492430 PMCID: PMC9038537 DOI: 10.1016/j.jctube.2022.100314] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Disseminated nontuberculous mycobacterial infections are frequently recognized in patients living with human immunodeficiency virus/acquired immunodeficiency syndrome (AIDS) and Mycobacterium avium-intracellulare complex (MAIC) is the most common species. Mycobacterium peregrinum is a rapidly growing mycobacterium that accounts for 1–2% of community-acquired and healthcare-associated infections. It mainly causes skin and soft tissue infection. Disseminated infection by M. peregrinum has never been reported in patients with AIDS. We describe a case of disseminated co-infection of M. peregrinum and M. avium in a 33-year-old male with newly diagnosed AIDS, and review the literature regarding M. peregrinum infection. The patient’s bone marrow culture grew M. peregrinum and his blood culture grew M. avium. The diagnosis of disseminated co-infection of M. peregrinum and M. avium was confirmed. Disseminated infection due to M. peregrinum is rare and diagnosis can be challenging. Due to limited case numbers, there is no treatment guideline for M. peregrinum nowadays. Further study is warranted for better understanding M. peregrinum related infections.
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Varkey MR, Ali J, Lapinel NC. The chicken and the egg dilemma: A case of disseminated MAC with Hodgkin's lymphoma. Respir Med Case Rep 2020; 31:101253. [PMID: 33117648 PMCID: PMC7582096 DOI: 10.1016/j.rmcr.2020.101253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/07/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction Mycobacterium avium complex (MAC) as a cause of disseminated disease has been well described in immunocompromised hosts. We report a case of disseminated MAC diagnosed in an otherwise healthy patient, one year before further testing and follow-up revealed a diagnosis of Hodgkin's lymphoma. Case presentation A 48-year-old woman with no significant medical history presented with new-onset fever, chills and night sweats. Chest imaging revealed large conglomerate mediastinal lymph nodes (LN). Endobronchial ultrasound-guided biopsy demonstrated caseating granulomatous inflammation and MAC on broth culture. She was started on guideline-based antibiotic therapy for disseminated MAC but showed no improvement after 6 months. An open mediastinal biopsy confirmed the findings of non-caseating granuloma. However, due to continued symptoms and widespread lymphadenopathy on additional full body imaging, an iliac lymph node core biopsy was performed which revealed abnormal CD30+ lymphoid infiltrate consistent with Hodgkin's lymphoma (HL). She was started on steroids and chemotherapy, whilst maintained on MAC treatment. Discussion Disseminated MAC is largely limited to immunocompromised hosts, signs and symptoms of which may overlap with lymphoma. Our case demonstrated that multiple initial LN biopsies were unrevealing except for MAC. As no clinical improvement was observed with guideline based MAC treatment, further diagnostic measures were aggressively pursued ultimately leading to a diagnosis of HL. It is unclear whether disseminated MAC preceded lymphoma, an early undiagnosed lymphoma led to MAC infection or an undefined systemic immune disorder was causative for both these processes.
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Affiliation(s)
| | | | - Nicole C. Lapinel
- Corresponding author. LSU Pulmonary/Critical Care & Allergy Immunology, 1901 Perdido Street, Suite 3205, New Orleans, LA, 70112, USA.
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Feng JY, Chen WC, Chen YY, Su WJ. Clinical relevance and diagnosis of nontuberculous mycobacterial pulmonary disease in populations at risk. J Formos Med Assoc 2020; 119 Suppl 1:S23-S31. [PMID: 32482607 DOI: 10.1016/j.jfma.2020.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 04/26/2020] [Accepted: 05/12/2020] [Indexed: 12/11/2022] Open
Abstract
The lungs are the most common disease site of nontuberculous mycobacteria (NTM). However, the isolation of NTM in a respiratory specimen does not indicate lung disease (LD). Differentiation between NTM colonization and NTM-LD remains challenging. In this brief review, we summarize the clinical impact of NTM-LD on morbidity and mortality in high-risk populations. The diagnosis criteria for NTM-LD-including clinical features, radiological presentations, and microbiological evidence-are also reviewed, according to the latest American Thoracic Society (ATS)/Infectious Disease Society of America (IDSA) guideline and the British Thoracic Society (BTS) guideline. However, the diagnosis of NTM-LD does not necessitate the initiation of anti-NTM treatment. Both environmental, host, and bacterial factors should be considered to identify patients that require NTM-LD treatment.
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Affiliation(s)
- Jia-Yih Feng
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Chih Chen
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ying-Ying Chen
- Department of Internal Medicine, Taipei Veterans General Hospital Taoyuan Branch, Taoyuan, Taiwan
| | - Wei-Juin Su
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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Ricotta EE, Olivier KN, Lai YL, Prevots DR, Adjemian J. Hospital-based antibiotic use in patients with Mycobacterium avium complex. ERJ Open Res 2018; 4:00109-2018. [PMID: 30402451 PMCID: PMC6213287 DOI: 10.1183/23120541.00109-2018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 09/02/2018] [Indexed: 11/17/2022] Open
Abstract
Treatment guidelines exist for pulmonary Mycobacterium avium complex (MAC) infection, although studies suggest poor concordance in clinician practice. Using a national database including hospital encounters of laboratory-confirmed MAC patients, we sought to characterise US treatment practices. We assessed patients in the Premier Healthcare Database from 2009 to 2013 with two or more MAC-positive cultures or one MAC-positive culture and the International Classification of Diseases (9th revision) code for pulmonary nontuberculous mycobacteria (PNTM). Treatment was characterised by patient-, provider- and facility-level factors; significant differences were assessed (p<0.05). Multilevel Poisson regression estimated adjusted relative risks (aRR) of receiving guidelines-based or macrolide resistance-promoting regimens. Of 1326 MAC patients, 645 (49%) received treatment: 10% received guidelines-based treatment and 18% resistance-associated therapy. Patients were more likely to receive guidelines-based therapy if they had multiple hospital encounters (aRR 1.5), codes for PNTM (aRR 5.7) or tuberculosis (aRR 4.5) or radiological procedures (aRR 10.9); multiple hospital encounters (aRR 0.8) or a tuberculosis code (aRR 0.1) were less likely to be associated with receiving resistance-promoting regimens. In hospital-based MAC patients, half received antibiotics active against MAC, a low proportion received therapy based on MAC guidelines and many received antibiotics that promote macrolide resistance. Improved implementation of guidelines-based treatment is needed to decrease use of regimens associated with macrolide resistance. Few MAC patients receive recommended therapy and improved treatment is needed to prevent resistancehttp://ow.ly/4F0S30lIihn
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Affiliation(s)
- Emily E Ricotta
- Epidemiology Unit, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Kenneth N Olivier
- Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Yi Ling Lai
- Epidemiology Unit, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - D Rebecca Prevots
- Epidemiology Unit, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Jennifer Adjemian
- Epidemiology Unit, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA.,United States Public Health Service, Commissioned Corps, Rockville, MD, USA
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Kobayashi T, Nishijima T, Teruya K, Aoki T, Kikuchi Y, Oka S, Gatanaga H. High Mortality of Disseminated Non-Tuberculous Mycobacterial Infection in HIV-Infected Patients in the Antiretroviral Therapy Era. PLoS One 2016; 11:e0151682. [PMID: 26985832 PMCID: PMC4795669 DOI: 10.1371/journal.pone.0151682] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 03/02/2016] [Indexed: 11/18/2022] Open
Abstract
Background Little information is available on the mortality and risk factors associated with death in disseminated non-tuberculous mycobacterial infection (dNTM) in HIV-infected patients in the ART-era. Methods In a single-center study, HIV-infected dNTM with positive NTM culture from sterile sites between 2000 and 2013 were analysed. The clinical characteristics at commencement of anti-mycobacterial treatment (baseline) were compared between those who survived and died. Results Twenty-four patients were analyzed. [The median CD4 27/μL (range 2–185)]. Mycobacterium avium and M. intracellulare accounted for 20 (83%) and 3 (13%) of isolated NTM. NTM bacteremia was diagnosed in 15 (63%) patients. Seven (29%) patients died, and NTM bacteremia was significantly associated with mortality (p = 0.022). The baseline CD4 count was significantly lower in the non-survivors than the survivors (median 7/μL versus 49, p = 0.034). Concomitant AIDS-defining diseases or malignancies were not associated with mortality. Immune-reconstitution syndrome (IRS) occurred to 19 (79%) patients (8 paradoxical and 11 unmasking), and prognosis tended to be better in unmasking-IRS than the other patients (n = 13) (p = 0.078). Patients with paradoxical-IRS had marginally lower CD4 count and higher frequency of bacteremia than those with unmasking-IRS (p = 0.051, and 0.059). Treatment with systemic corticosteroids was applied in 63% and 55% of patients with paradoxical and unmasking-IRS, respectively. Conclusion dNTM in HIV-infected patients resulted in high mortality even in the ART-era. NTM bacteremia and low CD4 count were risk factors for death, whereas patients presented with unmasking-IRS had marginally better prognosis. IRS occurred in 79% of the patients, suggesting difficulty in the management of dNTM.
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Affiliation(s)
- Tetsuro Kobayashi
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Takeshi Nishijima
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
- * E-mail:
| | - Katsuji Teruya
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Takahiro Aoki
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yoshimi Kikuchi
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Shinichi Oka
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
- Center for AIDS Research, Kumamoto University, Kumamoto, Japan
| | - Hiroyuki Gatanaga
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
- Center for AIDS Research, Kumamoto University, Kumamoto, Japan
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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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Mirsaeidi M, Farshidpour M, Ebrahimi G, Aliberti S, Falkinham JO. Management of nontuberculous mycobacterial infection in the elderly. Eur J Intern Med 2014; 25:356-63. [PMID: 24685313 PMCID: PMC4067452 DOI: 10.1016/j.ejim.2014.03.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 03/04/2014] [Accepted: 03/10/2014] [Indexed: 01/15/2023]
Abstract
The incidence of nontuberculous mycobacteria (NTM) has increased over the last decades. Elderly people are more susceptible to NTM and experience increased morbidities. NTM incidence is expected to rise due to an increasing elderly population at least up to 2050. Given the importance of NTM infection in the elderly, an increasing interest exists in studying NTM characteristics in the aged population. In this review, we summarize the characteristics of NTM infection among elderly patients. We focus on epidemiology, clinical presentation, and treatment options of NTM in this age group. We highlight the differences in the diagnosis and treatment between rapid and slow growing mycobacterial infections. The current recommendation for treatment of NTM is discussed. We debate if in vitro susceptibility testing has a role in the treatment of NTM. Drug-drug interaction between antibiotics used to treat NTM and other medications, particularly warfarin, is another important issue that we discuss. Finally, we review the prognosis of NTM disease in elderly patients.
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Affiliation(s)
- Mehdi Mirsaeidi
- Section of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine M/C 719, University of IL at Chicago, USA.
| | - Maham Farshidpour
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Golnaz Ebrahimi
- Section of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine M/C 719, University of IL at Chicago, USA
| | - Stefano Aliberti
- Department of Health Science, University of Milan Bicocca, Clinica Pneumologica, AO San Gerardo, Via Pergolesi 33, Monza, Italy
| | - Joseph O Falkinham
- Department of Biological Science, University of Virginia Tech, Blacksburg, VA, USA
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Mycobacterium massiliense bacteremia as a consequence of M. massiliense pneumonia in a patient with acute lymphoblastic leukemia. J Clin Microbiol 2014; 52:2235-8. [PMID: 24648551 DOI: 10.1128/jcm.03543-13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 52-year-old woman with relapsed acute lymphoblastic leukemia was diagnosed with Mycobacterium massiliense pneumonia after 4 months of chemotherapy. She developed M. massiliense bacteremia 1 month later. This is the first report of a proven case of M. massiliense bacteremia as a consequence of M. massiliense pneumonia.
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Mycobacterial bone marrow infections at a medical centre in Taiwan, 2001-2009. Epidemiol Infect 2013; 142:1524-32. [PMID: 24168831 DOI: 10.1017/s0950268813002707] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Mycobacterial bone marrow (BM) infection is the most common diagnosis established by BM examinations for fever of unknown origin. In this study, clinical features and outcomes of patients who fulfilled the criteria for BM infection due to Mycobacterium tuberculosis (MTB) and non-tuberculous mycobacteria (NTM) at a medical centre in Taiwan from 2001 to 2009 were investigated. The BM histopathological findings were also analysed. A total of 24 patients (16 men, eight women) with mycobacterial BM infections were found. Of these, nine (38%) were positive for human immunodeficiency virus (HIV) and six (25%) had no pre-existing immunocompromised conditions. MTB isolates were obtained from 11 (46%) patients and NTM species were isolated from 10 (42%) patients, including M. avium complex (MAC, n = 7) and M. kansasii (n = 3). Patients with MTB infections were significantly older than those with NTM infections (60·5 vs. 47·7 years, P = 0·043) and were less likely to have a positive BM culture (45% vs. 100%, P = 0·012). The 90-day survival rates for MTB and NTM BM infections were 68% and 60%, respectively (P = 0·61). In addition, the presence of BM granulomas was significantly more common in patients with MTB BM infections than in those with NTM infections (82% vs. 30%, P = 0·030). In Taiwan, the importance of NTM was not inferior to MTB and besides MAC, M. kansasii might be an important pathogen in non-HIV-infected patients. The presence of BM granulomas and caseation provides valuable information regarding early treatment pending culture results.
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Hsiao CH, Lai CC, Hsueh PR. High recurrence rate of lymphadenitis due to nontuberculous mycobacteria and its association with concurrent Salmonella infection in Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2013; 47:217-21. [PMID: 23615164 DOI: 10.1016/j.jmii.2012.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 10/19/2012] [Accepted: 11/19/2012] [Indexed: 10/26/2022]
Abstract
BACKGROUND The objective of this study is to investigate the clinical characteristics of lymphadenitis due to nontuberculous mycobacteria (NTM) in Taiwan. METHODS We retrospectively reviewed the medical records of all patients who presented to the National Taiwan University Hospital with culture-positive NTM lymphadenitis during the period 2000-2010. Patients with concurrent extranodal involvement were excluded. RESULTS From 2000 to 2010, 15 patients with lymphadenitis caused by nontuberculous mycobacteria were identified. Most patients (80%, n = 12) were infected with rapidly growing mycobacteria. Mycobacterium abscessus was the most common infective species (n = 8). Recurrence of infection involving multiple organs occurred 2-7 years after the completion of treatment in 11 (73%) patients. Five (33.3%) patients had concurrent Salmonella infections (4 patients with bacteremia and 1 patient with empyema thoracis) during the course of the disease. CONCLUSION In Taiwanese patients, we found a high recurrence rate of NTM lymphadenitis that was closely associated with Salmonella infections. We also noted that the clinical and epidemiological manifestations of NTM lymphadenitis in Taiwan differed from their manifestations in western countries.
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Affiliation(s)
- Cheng-Hsiang Hsiao
- Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan; General Education Center, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Chih-Cheng Lai
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - Po-Ren Hsueh
- Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University, College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University, College of Medicine, Taipei, Taiwan.
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Viehman JA, Khalil D, Barhoma C, Hanna RM. Mycobacterium avium-intracellulare otomastoiditis in a young AIDS patient: case report and review of the literature. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2013; 5:61-6. [PMID: 23459156 PMCID: PMC3583439 DOI: 10.2147/hiv.s36545] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Mycobacterium avium-intracellulare (MAI) complex is a common opportunistic infection that generally occurs in patients with a CD4 cell count less than 75. Current recommendations for prophylaxis include using a macrolide once a week, while treatment usually requires a multidrug regimen. Disseminated MAI infections often occur in patients who are not compliant with prophylaxis or their highly active antiretroviral therapy (HAART). Many manifestations of MAI infection are well documented in human immunodeficiency virus (HIV) patients, including pulmonary and cutaneous manifestations, but other unusual manifestations such as pericarditis, pleurisy, peritonitis, brain abscess, otitis media, and mastoiditis are sporadically reported in the infectious diseases literature. This case report is of a 22-year-old female who contracted HIV at a young age and who was subsequently noncompliant with HAART, MAI prophylaxis, and prior treatment for disseminated MAI infection. Unsurprisingly, the patient developed recurrent disseminated MAI infection. The patient’s presentation was atypical, as she developed severe otomastoiditis and posterior reversible encephalopathy syndrome. The posterior reversible encephalopathy syndrome was thought to be due to the disseminated MAI infection or to immune reconstitution inflammatory syndrome. The infection was confirmed to be secondary to MAI by culture of the mastoid bone. Microbiological analysis of the MAI strain cultured showed resistance to several first-line antibiotics used for prophylaxis against and treatment of MAI. This was likely due to the patient’s chronic noncompliance. Otomastoiditis secondary to MAI is extremely rare in adults and has been reported in only four case reports and one case series previously. Improved clinician education in the diagnosis, treatment, and, most important, prevention of MAI and other opportunistic infections is needed. Greater HIV screening, appropriate HAART medication administration, and availability of infectious disease specialists is needed in at-risk populations to help prevent such serious infections. Patient education and greater access to care should serve to prevent medication nonadherence and to enhance affordability of HAART and prophylactic antibiotics.
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Affiliation(s)
- J Alexander Viehman
- Department of Medicine, Olive View-UCLA Medical Center, Los Angeles ; David Geffen School of Medicine at UCLA, Los Angeles
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Nei T, Okabe M, Mikami I, Koizumi Y, Mase H, Matsuda K, Yamamoto T, Takeda S, Tanaka K, Dan K. A non-HIV case with disseminated Mycobacterium kansasii disease associated with strong neutralizing autoantibody to interferon-γ. Respir Med Case Rep 2012; 8:10-3. [PMID: 26029606 PMCID: PMC3920570 DOI: 10.1016/j.rmcr.2012.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 11/26/2012] [Indexed: 10/27/2022] Open
Abstract
Disseminated non-tuberculous mycobacterium (dNTM) infection is rare in humans without human immunodeficiency virus (HIV) infection. Previous reports have shown autoantibodies to human interferon-gamma (IFN-γ), which play important roles in mycobacterium infection, in the sera of patients with non-HIV dNTM disease. Herein, we describe a 53-year-old male who was strongly suspected to have multicentric Castleman disease (MCD) based on bone marrow study and chest radiological findings. However, Mycobacterium kansasii was detected in respiratory samples including pleural effusion. We initiated anti-mycobacterial therapy under intensive care; he died on the 48(th) hospital day. We detected no hematological disorders, ruling out MCD postmortem. However, we detected M. kansasii in pulmonary, liver, spleen and bone marrow tissues. Moreover, anti-IFN-γ autoantibody was detected with strong neutralizing capacity for IFN-γ. We consider our present report to contribute to understanding of the relationship between anti-IFN-γ autoantibody and disease development.
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Affiliation(s)
- Takahito Nei
- Division of Intensive Care and Cardiac Care, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan ; Department of Internal Medicine, Division of Respiratory Medicine, Infection and Oncology, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
| | - Masahiro Okabe
- Department of Internal Medicine, Division of Hematology, Gastroenterology and Endocrinology and Metabolism, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
| | - Iwao Mikami
- Department of Surgery, Division of Thoracic Surgery, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
| | - Yumika Koizumi
- Division of Intensive Care and Cardiac Care, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
| | - Hiroshi Mase
- Division of Intensive Care and Cardiac Care, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
| | - Kuniko Matsuda
- Department of Internal Medicine, Division of Respiratory Medicine, Infection and Oncology, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
| | - Takeshi Yamamoto
- Division of Intensive Care and Cardiac Care, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
| | - Shinhiro Takeda
- Division of Intensive Care and Cardiac Care, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
| | - Keiji Tanaka
- Division of Intensive Care and Cardiac Care, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
| | - Kazuo Dan
- Department of Internal Medicine, Division of Hematology, Gastroenterology and Endocrinology and Metabolism, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
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Wang LH, Yen CL, Chang TC, Liu CC, Shieh CC. Impact of molecular diagnosis on treating Mendelian susceptibility to mycobacterial diseases. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2012; 45:411-7. [PMID: 23036270 DOI: 10.1016/j.jmii.2012.08.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 08/14/2012] [Accepted: 08/20/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND/OBJECTIVE The IL-12-IFN-γ axis is critical for immune defense against mycobacterial infections. Inherited mutations that affect normal activation of this self-amplifying cytokine reaction lead to increased chances of mycobacterial infections, known as Mendelian susceptibility to mycobacterial diseases (MSMD). Delayed diagnosis and difficulty in identifying pathogenic mycobacteria hinder proper treatment of patients, so the aim of this study was to facilitate the diagnosis of mycobacterial infections in MSMD patients using an oligonucleotide array method. METHODS Peripheral blood mononuclear cells (PBMCs) were isolated from three MSMD patients in the same family. A series of immunologic studies, including testing for cytokine secretion after leukocyte stimulation, cell-surface marker analysis, and cDNA sequencing, were then performed. An oligonucleotide array was used to rapidly identify pathogens. RESULTS Cytokine secretion testing showed normal IFN-γ secretion after IL-12 stimulation but low IL-12 secretion after IFN-γ stimulation, which indicates a defect in the IFN-γ receptor or its intracellular signaling. Cell-surface receptor analysis showed IFN-γ receptor 1 overexpression, suggesting an autosomal dominant IFN-γ receptor 1 deficiency. cDNA sequencing identified the IFNGR1 818del4 mutation in three members of the family with known MSMD, and an oligonucleotide array identified Mycobacterium tuberculosis complex and Mycobacterium abscessus as pathogens. CONCLUSIONS Patients with suspected MSMD should undergo molecular diagnosis of the primary immunodeficiency. Oligonucleotide array methods may be a tool for rapid identification of pathogens and for guiding antimicrobial treatment in immunodeficient patients.
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Affiliation(s)
- Li-Hui Wang
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Kim WY, Jang SJ, Ok T, Kim GU, Park HS, Leem J, Kang BH, Park SJ, Oh DK, Kang BJ, Lee BY, Ji WJ, Shim TS. Disseminated Mycobacterium intracellulare Infection in an Immunocompetent Host. Tuberc Respir Dis (Seoul) 2012; 72:452-6. [PMID: 23101011 PMCID: PMC3475463 DOI: 10.4046/trd.2012.72.5.452] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Revised: 10/04/2011] [Accepted: 11/16/2011] [Indexed: 12/01/2022] Open
Abstract
Disseminated Mycobacterium avium complex (MAC) infection can occur in immunocompromised patients, and rarely in immunocompetent subjects. Due to the extensive distribution of the disease, clinical presentation of disseminated MAC may mimic malignancies, and thorough examinations are required in order to make accurate diagnosis. We report a case of disseminated Mycobacterium intracellulare disease in an immunocompetent patient, which involved the lung, lymph nodes, spleen, and multiple bones. F-18 fluorodeoxyglucose positron-emission tomography imaging showed multiple hypermetabolic lesions, which are suggestive of typical hematogenous metastasis. However, there was no evidence of malignancy in serial biopsies, and M. intracellulare was repeatedly cultured from respiratory specimens and bones. Herein, we should know that disseminated infection can occur in the immunocompetent subjects, and it can mimic malignancies.
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Affiliation(s)
- Won-Young Kim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Kuo YM, Cheng A, Wu PC, Hsieh SC, Hsieh SM, Hsueh PR, Yu CL. Disseminated Mycobacterium abscessus infection and showerheads, Taiwan. Emerg Infect Dis 2012; 17:2077-8. [PMID: 22099106 PMCID: PMC3310555 DOI: 10.3201/eid1711.110050] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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20
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El Khéchine A, Couderc C, Flaudrops C, Raoult D, Drancourt M. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry identification of mycobacteria in routine clinical practice. PLoS One 2011; 6:e24720. [PMID: 21935444 PMCID: PMC3172293 DOI: 10.1371/journal.pone.0024720] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Accepted: 08/16/2011] [Indexed: 11/30/2022] Open
Abstract
Background Non-tuberculous mycobacteria recovered from respiratory tract specimens are emerging confounder organisms for the laboratory diagnosis of tuberculosis worldwide. There is an urgent need for new techniques to rapidly identify mycobacteria isolated in clinical practice. Matrix-assisted laser desorption time-of-flight mass spectrometry (MALDI-TOF MS) has previously been proven to effectively identify mycobacteria grown in high-concentration inocula from collections. However, a thorough evaluation of its use in routine laboratory practice has not been performed. Methodology We set up an original protocol for the MALDI-TOF MS identification of heat-inactivated mycobacteria after dissociation in Tween-20, mechanical breaking of the cell wall and protein extraction with formic acid and acetonitrile. By applying this protocol to as few as 105 colony-forming units of reference isolates of Mycobacterium tuberculosis, Mycobacterium avium, and 20 other Mycobacterium species, we obtained species-specific mass spectra for the creation of a local database. Using this database, our protocol enabled the identification by MALDI-TOF MS of 87 M. tuberculosis, 25 M. avium and 12 non-tuberculosis clinical isolates with identification scores ≥2 within 2.5 hours. Conclusions Our data indicate that MALDI-TOF MS can be used as a first-line method for the routine identification of heat-inactivated mycobacteria. MALDI-TOF MS is an attractive method for implementation in clinical microbiology laboratories in both developed and developing countries.
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Affiliation(s)
- Amel El Khéchine
- URMITE UMR CNRS 6236 IRD198, Institut Hospitalier Universitaire POLMIT, IFR48, Université de la Méditerranée et Pôle de Maladies Infectieuses, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Carine Couderc
- URMITE UMR CNRS 6236 IRD198, Institut Hospitalier Universitaire POLMIT, IFR48, Université de la Méditerranée et Pôle de Maladies Infectieuses, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Christophe Flaudrops
- URMITE UMR CNRS 6236 IRD198, Institut Hospitalier Universitaire POLMIT, IFR48, Université de la Méditerranée et Pôle de Maladies Infectieuses, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Didier Raoult
- URMITE UMR CNRS 6236 IRD198, Institut Hospitalier Universitaire POLMIT, IFR48, Université de la Méditerranée et Pôle de Maladies Infectieuses, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Michel Drancourt
- URMITE UMR CNRS 6236 IRD198, Institut Hospitalier Universitaire POLMIT, IFR48, Université de la Méditerranée et Pôle de Maladies Infectieuses, Assistance Publique-Hôpitaux de Marseille, Marseille, France
- * E-mail:
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