ABSTRACT
Background: Tuberculosis is still a major global health problem. Human tuberculosis is caused by species of bacteria belonging to the Mycobacterium genus. In this study we determined mycobacterial species affecting patients from Botucatu, Brazil, and tested M. tuberculosis sensitivity to different drugs. Methods: Data were obtained from Clinical Laboratory Analysis records at Botucatu Medical School University Hospital, UNESP. All samples were processed according to standard isolation procedures from the 2008 Brazil Ministry of Health Mycobacteria Manual, which consist of staining smears by the Ziehl-Neelsen technique and seeding cultures in the Löwenstein-Jensen medium. Results: Samples were isolated from sputum (80.5%), bronchoalveolar lavage (13.8%), pleural fluid (4.6%), and cerebrospinal liquor (1.1%). Smears were evaluated in 87 cases and a total of 59 patients showed positive smears; 55 from 70 sputum samples and 4 from 12 bronchoalveolar lavage samples. No pleural fluid (4) or cerebrospinal liquor (1) samples showed positive smears. The most commonly identified strain was M. tuberculosis (61 cases); followed by M. avium and M. gordonae 2 cases each, and M. peregrinum and M. abscessus 1 case each. Mycobacteria were not identified in 20 patients. Only two strains of M. tuberculosis were multidrug resistant; one was resistant to isoniazid, rifampicin, and pyrazinamide. These two patients evolved to cure. Conclusion: This study highlights a small but troubling percentage of multidrug resistant samples and reveals the occurrence of nontuberculous mycobacteria, emphasizing the importance of correctly identifying species and testing sensitivity to antibacilar drugs to assure an adequate therapy.
ABSTRACT
Bacteremia due to mycobacteria can occur in AIDS patients in whom a rapid diagnosis is extremely important in order to plan a therapeutic conduct. Blood culture of mycobacteria using a biphasic system was set up in the Regional Laboratories of the Adolfo Lutz Institute, SP (Campinas, RibeirÒo Preto, Santo AndrÚ, Santos, SÒo JosÚ do Rio Preto and Sorocaba). During a three year period (1994-97), 1521 blood samples were analyzed from 1336 AIDS patients, with CD4+ cell count < 100/ml, hematocrit < 30 and serum albumin concentration < 3.0 g/dl seen in regional outpatient clinics or as inpatients in hospitals. Of the blood samples examined, 9.9 were positive for mycobacteria. The predominant species was Mycobacterium avium complex (MAC) (53.8) followed by Mycobacterium tuberculosis (28.0). Mycobacterium xenopi was isolated in one case (0.8) and in the remaining 17.4 the mycobacteria isolated were not identified. The implementation of blood culture for mycobacteria in our Institute has permitted the laboratory diagnosis of mycobacterial infections, in addition to providing data on the frequency of disseminated mycobacterial disease in AIDS patients in the region.