Low-Colony Counts of Nontuberculous Mycobacteria: Clinical Significance Analysis / 대한임상미생물학회지

BACKGROUND: Diagnosis of nontuberculous mycobacterium (NTM) is challenging, and clinical, radiological and microbiological criteria should be met. Traditionally, culture results on solid media have been reported semi-quantitatively, but no study exists regarding the clinical significance of low-colony count culture reports. The authors of the present study analyzed the clinical significance of low-colony count specimens of NTM with a greater than three-year follow-up period. METHODS: A total of 341 clinical isolates were evaluated among the isolates at Seoul National University Hospital and Seoul National University Borame Hospital from October 2005 to September 2006. Colony count less than 50 was considered a low-colony count specimen. Identifications of NTM from all the isolates were performed using a DNA chip (PCR reverse hybridization, LG Life Science, Korea). Clinical significance was analyzed by reviewing the medical records of patients with greater than three years of follow-up data after NTM isolation from respiratory samples. RESULTS: NTM lung disease was observed in 27.0% of the patients with low-colony count specimens among 167 patients with respiratory samples, and 70.4% of the patients were treated. The low-colony count patients had less NTM lung disease, longer incubation period, and less acid fast bacilli-positivity than patients with a colony count greater than 50. CONCLUSION: The prevalence of NTM lung disease with a low-colony count specimen was greater than 25%. In a clinical setting, NTM lung disease should not be excluded only on the basis of a low-colony count.

Clinical Significance of Low-colony Count Scotochromogen Nontuberculous Mycobacteria / 결핵및호흡기질환

BACKGROUND: Even though it has been suggested that low-colony, scotochromogen nontuberculous mycobacteria (NTM) are usually contaminants and not true pathogens, evidence for this hypothesis has not been provided. This study investigated the colony characteristics, organism identification, and clinical significance of low-colony scotochromogen. METHODS: The laboratory cultured 6,898 respiratory clinical specimens for an examination of mycobacteria over a three-month period. A low-colony count was arbitrarily defined as < or = 20 colonies. This study analyzed the recovery rate of the mycobacteria, the number of colonies and their gross characteristics, and their clinical significance. PCR- restriction fragment length polymorphism analysis was carried out to identify the NTM species. NTM pulmonary disease was defined according to the American Thoracic Society. RESULTS: A total of 6,898 respiratory specimens for mycobacterium were cultured. Of these, 263 (3.8%) grew NTM, and 382 (5.5%) grew M. tuberculosis. Of the 263 cultured NTM specimens, 124 (47.1%) were scotochromogens. The smear-positive rate was significantly lower in these scotochromogens (4.8%) than in the non-scotochromogens (23.7%) (p<0.05). The most common isolates were M. gordonae (83/102, 81.4%) in the scotochromogens, and MAC (52/121, 43.0%) in the non-scotochromogens. Even though three out of 113 patients with a low-colony scotochromogen has been diagnosed with NTM pulmonary disease, the isolated scotochromogen was not considered to be the cause of the NTM disease but was just a contaminant. CONCLUSION: In this study, the most common isolate of a low-colony count scotochromogen was M. gordonae, which appeared to be contaminants and not true pathogens. Greater efforts in the quality control of a mycobacterium laboratory are needed in cases where there is a high recovery rate of low-colony count scotochromogen.