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Objective The epidemiological characteristics and risk factors of infection of non-tuberculous mycobacterial (NTM) by elderly bronchiectasis patients in Huai 'an area were analyzed, and the theoretical basis for prevention of NTM infection by elderly bronchiectasis patients in Huai 'an area was provided. Methods Among the 371 elderly patients with bronchiectasis admitted to our hospital from January 2020 to June 2022 were selected and divided into control group and NTM group according to whether they had NTM or not. The NTM strains were isolated and identified. Clinical data of patients were collected from the medical record system. Independent risk factors of NTM infection in elderly patients with ramus were analyzed by univariate analysis and logistic regression, including gender, age, previous smoking status, number of ramus, pulmonary cavities, hypoproteinemia, and CD4+T cell level. Results A total of 108 cases NTM infection (29.11%) among the 371 patients with branch enlargement. There was no statistical significance in cough, phlegm, hemoptysis and fever between the two groups (P>0.05). The proportion of chest tightness and shortness in NTM group was significantly higher than that in control group (P20 years (OR=1.692), number of branchial dilated lobe ≥5 (OR=2.671) and thin-walled cavity (OR=2.458) were independent risk factors for NTM infection in elderly patients with branchial dilated lobe (P20 years, and thin-walled cavity. Patients should actively quit smoking, improve the body immunity, and prevent NTM infection in patients with bronchiectasis.
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To study the risk factors and the clinical characteristics of non-tuberculous mycobacterial (NTM) pulmonary diseases in patients with mechanical ventilation. Methods Retrospective survey was carried out in the patients with mechanical ventilation who combined with NTM pulmonary disease admitted to intensive care unit (ICU) of the First Affiliated Hospital of Guangzhou Medical University from May 2016 to May 2019. The general information, basic diseases, symptoms, signs, biochemical examinations, acid-fast stain test, mycobacterium culture and strain identification results, and chest CT data were collected to summarize the clinical characteristics of patients with mechanical ventilation combined with NTM pulmonary disease. Results There were 12 patients with mechanical ventilation combined with NTM pulmonary disease, 6 males and 6 females, 37-82 years old, with an average age of 65 years. In these 12 cases, patients with cancer (lung cancer were 4 cases, mediastinal tumor was 1 case) and after lung transplantation (use of anti-rejection drugs at the same time) were 5 and 2 respectively. Patients with at least 3 underlying diseases [included hypertension, diabetes, coronary heart disease, chronic obstructive pulmonary disease (COPD), bronchiectasis, chronic renal insufficiency] were 5. Clinical symptoms of the 12 cases were non-specific. The CT findings were not characteristic, including nodules, patchy infiltrations and fibrous streak. Pleural effusion was common among these subjects but nodular bronchiectatic patterns were absence. Routine laboratory indicators of bacterial infection were non-specific. But the number of lymphocytes of all cases decreased. Mycobacteria cultures were positive with the rapid growth of mycobacteria in these 12 cases. Mycobacterium avium (4 cases), Mycobacterium chelonae (4 cases), Mycobacterium chelonae-abscessus complex (2 cases) and Mycobacterium intracellulare (2 cases) were isolated. Anti-NTM therapy was given to the patients when the acid-fast staining test of their airway secretion was positive and the TB-DNA test was negative, including oral levofloxacin and clarithromycin. Finally, all patients were successfully weaned and discharged from ICU. Conclusions The clinical symptoms of NTM patients with pulmonary disease are non-specific, and the imaging features of chest CT are varied. Patients with mechanical ventilation in ICU, who have the risk of immune dysfunction or underlying structural lung diseases, and who have difficult controlled lung infection, accompanied by pleural effusion and with decreased lymphocytes, should be aware that pneumonia may be caused by non-tuberculous mycobacteria.
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El Mycobacterium marinum es un tipo de micobacteria no tuberculosa (NTM). La infección por esta bacteria es frecuente en peces de agua dulce o salada y muy raramente, suele causar infecciones en la población humana. Presentamos el caso de un paciente varón de 60 años, que consulta por placa ulcerosa en dorso de mano izquierda. El estudio histopatológico de biopsia informa: hiperplasia epitelial con un denso infiltrado en dermis y escasos granulomas con células gigantes. Se solicitan distintas pruebas, siendo únicamente positiva el PCR para Mycobacterium marinum, por lo que se procede a instaurar regimen antimicrobiano con evolución favorable. El contagio por esta bacteria, se produce por inoculación directa del microorganismo, a través de heridas o erosiones cutáneas o por mordeduras de peces contaminados. Las formas de presentación clínica varían, siendo la más común la presencia de pápulas o nódulos solitarios en dedos o manos. También se puede manifestar en forma de linfangitis proximal o esporotricoide, extensión a órganos profundos y patrón esporotricoide facial. El diagnóstico requiere un alto índice de sospecha, debido a que la frecuencia de esta afección es muy baja, siendo de 0.04 a 0.27 por cada 100.000 habitantes. La biopsia de tejido proporciona el diagnóstico en solo la mitad de los casos. El cultivo confirma el diagnóstico, pero se reportan como positivos en 70 a 80% de los casos. Técnicas de amplificación de ácidos nucleicos, como la reacción en cadena polimerasa (PCR) son otros métodos para el diagnóstico, su mayor ventaja es la rapidez de sus resultados en comparación con el cultivo. Existen muchas modalidades terapéuticas: el tratamiento tópico, la administración sistémica de antimicrobianos, la cirugía, la termoterapia local y la terapia combinada. Sin embargo, los pacientes infectados con M. marinum por lo común, son tratados con antimicrobianos en monoterapia o combinados.
Introduction: Mycobacterium marinum is a type of non-tuberculous mycobacterium (NTM). Infection by this bacterium is frequent in freshwater or saltwater fish and very rarely causes infection in human population. Case report: we present the case of a 60-year-old male patient, who consulted for an ulcerative plaque on the back of his left hand. The histopathological study of biopsy reports: epithelial hyperplasia with a dense infiltrate in dermis and few granulomas with giant cells. Different tests were requested, PCR the only one positive for Mycobacterium marinum, which is why we proceeded to establish an antimicrobial regimen with favorable evolution. Discussion: infection by this bacterium is produced by direct inoculation of the microorganism through wounds or skin erosions or by contaminated fish bites. The forms of clinical presentation vary, being the most common the presence of solitary papules or nodules on fingers or hands. It can also manifest in the form of proximal or sporotrichoid lymphangitis, extension to deep organs, and facial sporotrichoid pattern. Diagnosis requires high index of suspicion, since the frequency of this condition is very low, from 0.04 to 0.27 per 100.000 habitants. Tissue biopsy provides the diagnosis in only half of the cases. Culture confirms the diagnosis, but they are reported as positive in 70 to 80% of cases. Nucleic acid amplification techniques, such as polymerase chain reaction (PCR) are other methods for diagnosis; its greatest advantage is the speed of its results compared to culture. There are many therapeutic modalities: topical treatment, systemic administration of antimicrobials, surgery, local thermotherapy and combination therapy. However, patients infected with M. marinum are usually treated with antimicrobials alone or in combination.
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Background: Silent presence of non-tuberculous mycobacterium (NTM) has been observed since the last 100 years, but now the increasing incidence of NTM is of great concern for clinical microbiologists as well as clinicians. Although many advanced efforts are being made for identification and control of Mycobacterium tuberculosis, still the silently growing menace of non-tuberculous mycobacteria is receiving negligible attention. Objectives: This study was aimed to find NTMs in positive cultures and identify them up to species level. Material & Methods: During the study period, i.e. from January 2009 to June 2011, a total of 4104 positive cultures were subjected to species identification by different morphological and biochemical tests. All the tests for identification were performed as per standard procedure along with the standard strains of NTM provided by JALMA, Agra. Results: The identification of positive cultures showed 4044/15581 (25.95%) Mycobacterium tuberculosis complex and 60/15581(0.38%) NTM. The mycobacterium species identification results showed that out of total 60 NTM, 21 different species of NTM were found and they belonged to all the four groups of runyon. The most common species identified in this study was M.simiae (07) followed by M.avium(06), M.gordonae(05), M.kansasii(05), M.fortuitum(05), M.chelonae(05), M.pheli(05), M.terrae(04), M.szulgai(02), M.vaccae(02), M.flavescens(02), M. trivale(02), M.malmoense(01), M.scrofulaceum(01), M.intracellulare(01), M.xenopi(01), M.ulcerans(01), M.tusciae(01), M.triplex(01), M.septicum(01), M.mucogenicum(01). Conclusion: The isolation of NTMs from different clinical samples indicated that they may be the causative agents for pulmonary and extra-pulmonary non-tuberculous diseases. Elaborate and focused studies are needed to differentiate NTMs amongst commensal/colonizer, pathogen and laboratory contaminants.
Subject(s)
Culture Media/diagnosis , Humans , India/epidemiology , Mycobacterium/analysis , Mycobacterium/classification , Mycobacterium/epidemiology , Mycobacterium/isolation & purification , Mycobacterium avium/analysis , Mycobacterium avium/isolation & purificationABSTRACT
Objective To identify non-tuberculous Mycobacterium(NTM) rapidly with HAIN molecular assay genotype Mycobacterium kit,and investigate the advantages and disadvantages of this method.Methods Seventy-four clinical NTM isolates were collected from hospitals in Zhejiang and Anhui province.Clinical strains were identified with HAIN molecular assay genotype Mycobacterium kit.16S rRNA gene sequencing was used to estimate and compare with this method.Results The results of kit showed that there were thirty-one M.intracellulare strains,twelve M.chelonae strains,eight M.fortuitum strains,six M.kansasii strains,five M.avium strains,three M.smegmatis strains,two M.phlei strains,two M.scrofulaceum strains and one M.gordon strain.Four strains were identified as Mycobacterium without further identification.Eight M.tuberculosis strains were identified correctly too.Compared with 16S rRNA gene sequencing,except for four strains identified as Mycobacterium,others 70 strains got the same results as 16S rRNA gene sequencing,the coincidence was 94.59％,and it could further identify thirteen Mycobacterium chelonae complex and eight Mycobacterium kansasii complex to subspecies M.abscessus and M.kansasii,respectively.If only to identify strains under the identification range of this kit,the coincidence reach to 100％,Conclusion The method of HAIN molecular assay genotype Mycobacterium kit is simple and accurate,the time is shorter and should widely be applied clinically.
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PURPOSE: PCR is widely used for rapidly and accurately detecting Mycobacterium Species. The purpose of this study was to assess the diagnostic performance of three real-time PCR kits and evaluate the concordance with two older PCR methods. MATERIALS AND METHODS: Using 128 samples, the five PCR methods were assessed, including an in-house PCR protocol, the COBAS Amplicor MTB, the COBAS TaqMan MTB, the AdvanSure TB/NTM real-time PCR, and the Real-Q M. tuberculosis kit. The discrepant results were further examined by DNA sequencing and using the AdvanSure Mycobacteria Genotyping Chip for complete analysis. RESULTS: For Mycobacterium tuberculosis (MTB) detection, all five kits showed 100% matching results (positive; N = 11 and negative; N = 80). In non-tuberculous mycobacterium (NTM) discrimination, the AdvanSure yielded two true-positive outcomes from M. intracellulare and one false positive outcome, while the Real-Q resulted in one true-positive outcome and one false negative outcome for each case and another false negative result using the provided DNA samples. CONCLUSION: Real-time PCR, yielded results that were comparable to those of the older PCR methods for detecting MTB. However, there were disagreements among the applied kits in regard to the sample test results for detecting NTM. Therefore, we recommend that additional confirmatory measures such as DNA sequencing should be implemented in such cases, and further research with using a larger numbers of samples is warranted to improve the detection of NTM.
Subject(s)
Humans , DNA, Bacterial/genetics , Mycobacterium/genetics , Mycobacterium Infections/diagnosis , Mycobacterium avium Complex/genetics , Mycobacterium avium-intracellulare Infection/diagnosis , Mycobacterium tuberculosis/genetics , Polymerase Chain Reaction/standards , Reagent Kits, Diagnostic/standards , Tuberculosis/diagnosisABSTRACT
Renal involvement is frequently seen in patients with systemic lupus erythematosus (SLE). The occurrence of non-lupus nephritis, and especially IgA nephropathy, in SLE patients has rarely been reported. We describe here the case of a 30-year-old woman who had systemic lupus erythematosus and nontuberculous mycobacterial lung disease, and her biopsy of a renal lesion was unexpectedly diagnostic of IgA nephropathy. Although both IgA nephropathy and lupus nephritis are immune complex mediated diseases, their laboratory and histopathologic findings and the extra-renal clinical manifestations are different and these all support a different pathogenesis for the 2 diseases. Renal biopsy plays a crucial role in identifying and diagnosing renal lesions, which may have prognostic and therapeutic implications that are distinct from those of lupus nephritis. In conclusion, performing a renal biopsy in SLE patients who have urinary abnormalities is important since a correct diagnosis would permit the most appropriate treatment to be started and so avoid unnecessary immunosuppressive treatments.