Prevalence of non-tuberculosis mycobacteria among samples deposited from the National Tuberculous Reference Laboratory of Iran (2011-2018)

Objective: To investigate the prevalence of non-tuberculosis mycobacteria (NTM) among the samples deposited from the National Tuberculosis Reference Laboratory of Iran between 2011 and 2018. Methods: The study evaluated the prevalence of NTM among specimens from patients with pulmonary tuberculosis symptoms (n=15 771) deposited at the National Tuberculosis Reference Laboratory of Iran from 2011 to 2018. Detection of Mycobacterium (M.) tuberculosis was based on presence of a 190-bp amplicon from IS6110 insertion sequence using Tb1 and Tb2 primers, and amplicon-negative specimens were tested for NTM and M. tuberculosis (refractory to IS6110 amplification) using restriction fragment length polymorphism PCR of hsp65 amplicon fragment. Results: A total of 7 307 (46.33%) M. tuberculosis and 658 (4.17%) NTM specimens were found, the latter mainly comprising M. abscessus (10.18%), M. avium (2.28%), M. chelonae (8.97%), M. intracellulare (10.49%), M. kansasii (4.71%), and M. simiae (56.08%). Conclusions: As treatment for NTM differs from that for M. tuberculosis, accurate detection of Mycobacterium sp. is of public health significance.

Conocimientos y actitudes sobre la transmisión de la tuberculosis en estudiantes de odontología y terapia respiratoria

Introducción. La tuberculosis sigue siendo un problema importante de salud pública, que afecta tanto a trabajadores como estudiantes de la salud, quienes deben tener unos conocimientos adecuados y sólidos para asegurar una adecuada prevención y control de la enfermedad. Objetivo. Evaluar los conocimientos y actitudes sobre la transmisión de la tuberculosis en estudiantes de odontología y terapia respiratoria. Métodos. Estudio descriptivo realizado con 291 estudiantes de los programas de odontología y terapia respiratoria de una institución de educación superior de la ciudad de Medellín, quienes se encontraban en práctica clínica al momento del estudio. Ellos respondieron una encuesta que contenía información sociodemográfica, conocimientos y actitudes frente a la transmisión de la tuberculosis. Se realizó un análisis descriptivo y bivariado. Resultados. El 57,7% de los estudiantes de odontología y el 42,3% de los estudiantes de terapia respiratoria consideran que la tuberculosis es trasmitida por una bacteria, y respecto a si la tos es considerada un mecanismo de transmisión, el 89,2% de los estudiantes de odontología dijo que sí y el 10,8% de los estudiantes de terapia respondieron que no. Conclusiones. La mayoría de los estudiantes respondieron que el factor etiológico de la tuberculosis es una bacteria y en cuanto a la vacunación, la mayoría considera que es importante para la protección.

Introduction. Tuberculosis continues to be a major public health issue, affecting both workers and students of health, who must have adequate and solid knowledge to ensure adequate prevention and control of the disease. Objective. To evaluate the knowledge and attitudes on the transmission of tuberculosis in students of dentistry and respiratory therapy. Methods. A descriptive study was carried out with 291 students from the dentistry and respiratory therapy programs of a higher education institution in the city of Medellín, who were in clinical practice at the time of the study. They answered a survey based on sociodemographic information, knowledge and attitudes regarding the transmission of tuberculosis. A descriptive and bivariate analysis was carried out. Results. 57.7% of dentistry students and 42.3% of respiratory therapy students consider that tuberculosis is transmitted by a bacterium, and if cough is considered a transmission mechanism, 89.2% of dentistry students said that it was and 10.8% of the therapy students answered no. Conclusions. The majority of the students answered that the etiological factor of tuberculosis is a bacterium and regarding to vaccination, most of them consider it is important for protection.

Introdução. A tuberculose continua sendo um grande problema de saúde pública, afetando tanto os trabalhadores quanto os estudantes de saúde, que devem ter conhecimentos adequados e sólidos para garantir a prevenção e o controle adequados da doença. Objetivo. Avaliar os conhecimentos e atitudes sobre a transmissão da tuberculose em estudantes de odontologia e fisioterapia respiratória. Métodos. Foi realizado um estudo descritivo com 291 estudantes dos cursos de odontologia e fisioterapia respiratória de uma instituição de ensino superior da cidade de Medellín, que estavam em prática clínica na época do estudo. Eles responderam a uma pesquisa que continha informações sociodemográficas, conhecimentos e atitudes em relação à transmissão da tuberculose. Uma análise descritiva e bi-variada foi realizada. Resultados. 57,7% dos estudantes de odontologia e 42,3% dos estudantes de fisioterapia respiratória consideram que a tuberculose é transmitida por bactérias; com respeito a se a tosse é considerada um mecanismo de transmissão, 89 2% dos estudantes de odontologia disseram que sim e 10,8% dos estudantes de terapia responderam que não. Conclusões. A maioria dos estudantes respondeu que o fator etiológico da tuberculose é uma bactéria e a maioria considera a vacinação importante para a proteção.

Identification and drug susceptibility testing of Mycobacterium thermoresistibile and Mycobacterium elephantis isolated from a cow with mastitis / 中华流行病学杂志

Objective To understand the etiological characteristics and drug susceptibility of Mycobacterium thermoresistibile and Mycobacterium elephantis isolated from a cow with mastitis and provide evidence for the prevention and control of infectious mastitis in cows.Methods The milk sample was collected from a cow with mastitis,which was pretreated with 4％ NaOH and inoculated with L-J medium for Mycobacterium isolation.The positive cultures were initially identified by acid-fast staining and multi-loci PCR,then Mycobacterium species was identified by the multiple loci sequence analysis (MLSA) with 16S rRNA,hsp65,ITS and SodA genes.The drug sensitivity of the isolates to 27 antibiotics was tested by alamar blue assay.Results Two anti-acid stain positive strains were isolated from the milk of a cow with mastitis,which were identified as non-tuberculosis mycobacterium by multi-loci PCR,and multi-loci nucleic acid sequence analysis indicated that one strain was Mycobacterium thermoresistibile and another one was Mycobacterium elephantis.The results of the drug susceptibility test showed that the two strains were resistant to most antibiotics,including rifampicin and isoniazid,but they were sensitive to amikacin,moxifloxacin,levofloxacin,ethambutol,streptomycin,tobramycin,ciprofloxacin and linezolid.Conclusions Mycobacterium thermoresistibile and Mycobacterium elephantis were isolated in a cow with mastitis and the drug susceptibility spectrum of the pathogens were unique.The results of the study can be used as reference for the prevention and control the infection in cows.

Identification and drug susceptibility testing of Mycobacterium thermoresistibile and Mycobacterium elephantis isolated from a cow with mastitis / 中华流行病学杂志

Objective To understand the etiological characteristics and drug susceptibility of Mycobacterium thermoresistibile and Mycobacterium elephantis isolated from a cow with mastitis and provide evidence for the prevention and control of infectious mastitis in cows.Methods The milk sample was collected from a cow with mastitis,which was pretreated with 4％ NaOH and inoculated with L-J medium for Mycobacterium isolation.The positive cultures were initially identified by acid-fast staining and multi-loci PCR,then Mycobacterium species was identified by the multiple loci sequence analysis (MLSA) with 16S rRNA,hsp65,ITS and SodA genes.The drug sensitivity of the isolates to 27 antibiotics was tested by alamar blue assay.Results Two anti-acid stain positive strains were isolated from the milk of a cow with mastitis,which were identified as non-tuberculosis mycobacterium by multi-loci PCR,and multi-loci nucleic acid sequence analysis indicated that one strain was Mycobacterium thermoresistibile and another one was Mycobacterium elephantis.The results of the drug susceptibility test showed that the two strains were resistant to most antibiotics,including rifampicin and isoniazid,but they were sensitive to amikacin,moxifloxacin,levofloxacin,ethambutol,streptomycin,tobramycin,ciprofloxacin and linezolid.Conclusions Mycobacterium thermoresistibile and Mycobacterium elephantis were isolated in a cow with mastitis and the drug susceptibility spectrum of the pathogens were unique.The results of the study can be used as reference for the prevention and control the infection in cows.

Comparative analysis of CT images of non-tuberculous mycobacterium tuberculosis and multidrug-resistant pulmonary tuberculosis / 天津医药

Objective To study the computed tomograhpy (CT) features of non-tuberculous mycobacteria (NTM) and multidrug-resistant pulmonary tuberculosis (MDR-TB), and to improve the differential diagnosis of the disease. Methods The CT imaging data of 67 patients diagnosed with NTM pulmonary disease (NTM lung disease group) and 103 patients with MDR-TB (MDR-TB group) were selected from January 2010 to December 2015 in our hospital. The imaging findings and differences in lesion location were compared between two groups. Results Lesions of NTM lung disease occurred in the posterior segment of the posterior and posterior lumbar dorsal (Ⅰarea), clustered lobular central nodules, accompanied by bronchiectasis and subpleural thin wall empty, rare bronchial foci. MDR-TB lesions occurred in the middle lobe of the right lung and the upper lobe of the left lung (Ⅱarea). The upper lung of the lungs were patch, nodules and caseous lesions, with thick wall and chronic lung inflammation, showing thick wall empty, pulmonary consolidation, atelectasis, calcification (lung), hilar mediastinal lymph node calcification, lung volume reduction, pleural thickening and pleural effusion. Conclusion Chest CT images are similar in NTM lung disease and MDR-TB, but there are differences. The detailed analysis of image features can provide a basis for clinical differential diagnosis.

First Report in China on the Identification and Drug Sensitivity of Mycobacterium elephantis Isolated from the Milk of a Cow with Mastitis / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>In this study, milk from a cow with mastitis was analyzed to determine the presence of mycobacterial infection. Milk quality and security problems pertaining to the safe consumption of dairy products were also discussed in this study.</p><p><b>METHODS</b>Milk was preprocessed with 4% NaOH. Then, mycobacteria were isolated from the milk sample on L-J medium. The isolate was identified using multiple loci Polymerase Chain Reaction (PCR) and multi-locus sequence analysis with 16S rRNA, sodA, hsp65, and ITS genes. The drug sensitivity of the isolate to 27 antibiotics was tested through alamar blue assay.</p><p><b>RESULTS</b>Smooth, moist, pale yellow colonies appeared on the L-J medium within a week after inoculation. Based on the results of multiple loci PCR analysis, the isolate was preliminarily identified as non-tuberculous mycobacteria. The 16S rRNA, SodA, hsp65, and ITS gene sequences of the isolate exhibited 99%, 99%, 99%, and 100% similarities, respectively, with those of the published reference strains of Mycobacterium elephantis (M. elephantis). The drug sensitivity results showed that the strain is resistant to isoniazid, p-aminosalicylic acid, and trimesulf but is sensitive to ofloxacin, rifampicin, amikacin, capreomycin, moxifloxacin, kanamycin, levofloxacin, cycloserine, ethambutol, streptomycin, tobramycin, rifabutin, ciprofloxacin, linezolid, cefoxitin, clarithromycin, and minocycline.</p><p><b>CONCLUSION</b>To the best of our knowledge, this study is initially to report the isolation of M. elephantis from the milk of a cow with mastitis in China.</p>

Nivel de cumplimiento de la norma técnica de salud para control de tuberculosis con evaluación de sintomáticos respiratorios y control de contactos BK positivos. Hospital Provincial Docente Belén de Lambayeque 2011 / Level of compliance with the technical health standard for tuberculosis control with evaluation of respiratory symptoms and control of positive BK contacts. Belén de Lambayeque Provincial Teaching Hospital 2011

Objetivo: el presente estudio tuvo como objetivo principal determinar el Cumplimiento de la Norma Técnica de Salud para el Control de la Tuberculosis en relación a la evaluación de Sintomáticos Respiratorios y control de contactos de pacientes BK positivos en el Hospital Provincial Docente Belén de Lambayeque, Enero - Diciembre del 2011. Material y métodos: Se realizó el presente estudio con diseño epidemiológico de tipo descriptivo, observacional, retrospectivo y transversal con. La muestra de estudio estuvo constituida por 267 Sintomáticos Respiratorios. Resultados: Los principales resultados fueron: En los pacientes BK positivos predominó el sexo femenino, las edades entre 25 y 29 años y el grado de instrucción nivel secundario; el porcentaje de Sintomáticos Respiratorios examinados con dos muestras de esputo fue 52.1%; el porcentaje de visitas domiciliarias a los pacientes con diagnóstico de BK positivo fue 39.1%, el número de contactos examinados en relación a los contactos censados fue 12.8% del total. Conclusión: un 61% de incumplimiento de la Norma Técnica de Salud para el control de la Tuberculosis en relación a la evaluación de Sintomáticos Respiratorios y control de contactos de pacientes BK positivos en el HPDBL del año 2011-(AU)

Objetive: The present study had as main objective to determine the level of fulfillment of the Technical Norm of Health for the Tuberculosis control in the evaluation of respiratory symptomatic patients and contacts surveillance in positive Ziehl Neelsen stain patients from the Hospital Provincial Docente Belén in Lambayeque, in the year 2011. Material and Methods: This study had a descriptive, observational, retrospective and cros s - sectional epidemiological design. The study sample consisted of 267 patients with respiratory symptoms. Results: The main results were: most positive BK patients were females, ages between 25 and 29 and with high school education, the percentage of respiratory symptomatic patients with two sputum samples was 52.1%, the percentage of home visits patients with positive diagnosis of BK was 39.1%, the number of contacts examined in relation to contacts census was 12.8% of the total. Conclusions: 61% of non-fulfillment with health standards for TB control in relation to the evaluation of respiratory symptomatic patients and contact control of BK positive patients in the HPDBL of 2011.(AU)

Rapid identification and differentiation of the species of the Mycobacterium chelonae /abscessus complex by hsp65 and rpoB PCR-RFLP / 中国人兽共患病学报

The Mycobacterium chelonae/abscessus (M.chelonae/abscessus) complex belongs to the rapidly growing genus Mycobacterium (RGM).It is one of the most important pathogenic members of Mycobacterium leading to nosocomial infections and outbreaks.It includes members of M.chelonae,M.immnunogenum,M.abscessus,M.massiliense,and M.bolletii.In order to investigate the epidemiological characteristics of the M.chelonae/abscessus complex in China and to conduct the molecular methods for species identification of M.chelonae/abscessus,we collected clinical M.chelonae/abscessus complex strains identified by phenotypic tests.Members were verified by sequencing of 16S rRNA,Species and subspecies were identified by hsp65 and rpoB PCR RFLP methods.In total,27 clinical specimens were identified as Mycobacterium chelonae/abscessus complex by phenotypic tests.16s rRNA gene sequence analysis of all 27 clinical samples shared over 99.7％ similarity with M.chelonae and M.abscessus.Species identification with hsp65 PCR-RFLP and rpoB PCR-RFLP revealed that 18 specimens were M.abscessus and 4 were M.absecces.The remaining 5 samples displayed a pattern that failed to match any previously reported pattern.Thus,this might represent a novel species that is part of the Mycobacterium chelonae/abscessus complex.We identified that a majority of the chronic lung infection in China is caused by the M.chelonae/abscessus complex.Specifically,the M.abscessus species might be the most infectious,while other species in the complex can still cause infection.Interestingly,there may be a novel or previously unidentified species that is a part of the complex.Finally,we show that species identification can be carried out more accurately by combined use of hsp65 and rpoB PCR-RFLP.

Frecuencia de micobacterias ambientales en Chile en el año 2008 / Frequency of environmental mycobacterium in Chile: 2008

Objective: To know the frequency of environmental mycobacterium isolations in Chile in the year 2008. Methods: 600 AFB (acid fast bacilli) positive cultures from 22 laboratories of Tuberculosis Bacteriology of the different Network Health Services that constitute the Tuberculosis Control Program of the country were studied, during four months at 2008. 545 (90.8 percent) were pulmonary and 55 (9.2 percent) extra pulmonary. Acid fast bacilli smears were confirmed by Ziehl Neelsen and identification of mycobacteria species or complex were identified by traditional tests according to Runyon classification and biochemical tests, genetic probes and pattern analysis restriction (PRA). Results: 585 cultures were appropriated for inclusion in the study. In 91.3 percent (n = 534) of the cases Mycobacterium tuberculosis was isolated while 0.3 percent was Mycobacterium bovis subspecie BCG (n = 3) and 8.4 percent (n = 48) corresponded to environmental mycobacterium. Of the latter, Mycobacterium kansasii (2.6 percent), Mycobacterium avium-intracellulare (1.5 percent) and Mycobacterium chelonae (1.0 percent) were the most commonly isolated. Conclusion: According to the figures of this study and comparing them with studies of previous years (1988 and 1998) it is concluded that the number of environmental mycobacterium isolated has been relatively constant during the last decade, as well as the species, more commonly isolated.

Objetivos: Conocer la frecuencia de aislamientos de micobacterias ambientales en Chile en el año 2008. Material y Métodos: Se recibieron 600 cultivos desde 22 laboratorios de Bacteriología de la Tuberculosis de los distintos Servicios de Salud de la red que comprende el Programa de Control de la Tuberculosis del país, durante un período de cuatro meses del año 2008. Quinientos cuarenta y cinco (90,8 por ciento) correspondieron a localización pulmonar y 55 (9,2 por ciento) a extrapulmonar. Se confirmó la alcohol-ácido resistencia por tinción de Ziehl Neelsen y para la identificación de especies o complejos micobacterianos se utilizaron pruebas tradicionales y bioquímicas de acuerdo al criterio de clasificación de Runyon, sondas genéticas y análisis de patrones de restricción (PRA). Resultados: De los 600 cultivos recibidos, 585fueron aptos para ser incluidos en el estudio. De éstos, en el 91,3 por ciento (n = 534) de los casos se aisló Mycobacterium tuberculosis, en un 0,3 por ciento Mycobacterium bovis subespecie BCG (n = 3) y un 8,4 por ciento (n = 48) correspondió a micobacterias ambientales. De estas últimas, Mycobacterium kansasii (2,6 por ciento), Mycobacterium avium-intracellulare (1,5 por ciento) y Mycobacterium chelonae (1,0 por ciento) fueron las más comúnmente aisladas. Conclusiones: De acuerdo a las cifras obtenidas en este estudio y comparadas con estudios de años anteriores (1988 y 1998) se concluye que el número de aislamientos de micobacterias ambientales permaneció relativamente constante esta última década, como también las especies más comúnmente aisladas.

Evaluation of BACTEC MGIT 960 system for recovery of Mycobacterium tuberculosis complex in Pakistan

We evaluated the performance of MGIT 960 system in terms of recover rate, detection time of mycobacteria and contamination rate from various human clinical specimens and compared it with already in use BACTEC 460 TB system and conventional LJ medium. This is the first reported study on MGIT 960 and its comparison with BACTEC 460 system in Pakistan. A total of 260 different clinical specimens received for the culture of mycobacteria were dealt during the six months study period. All the specimens were digested and decontaminated according to the standard N-acetyl-Lcysteine NaOH method. All the processed specimens were inoculated on both the liquid systems and solid medium and incubated for six weeks and eight weeks consecutively. A total of 44 mycobacterial isolates (Mycobacterium tuberculosis, n=43; Mycobacteria other than tuberculosis, n=1) were recovered from 260 clinical specimens. The recovery rate of M. tuberculosis complex was 97.6% on BACTEC MGIT 960 system and 93.0% on BACTEC 460 system and 83.7% on LJ medium. The mean detection time of mycobacteria on BACTEC MGIT 960 system was 11.2 days in smear positive cases, 14.2 days in smear negative cases and 14.8 days in smear positive cases on BACTEC 460 system. Contamination rates were 9.6% and 5.6% and 3.4% for BACTEC MGIT 960, BACTEC 460 system and LJ medium respectively. The non-radiometric, fully automated BACTEC MGIT 960 system has better diagnostic ability as compared with radiometric, semi-automated BACTEC 460 system and LJ medium, so it can be used as a reliable alternative in over burden laboratories.

Descripción de la resistencia adquirida del Mycobacterium tuberculosis a los antibióticos contra la tuberculosis en Bogotá, entre octubre de 1996 y diciembre de 2000 / Description of acquired resistance of Mycobacterium tuberculosis to anti-tuberculosis antibiotics in Bogotá, between October 1996 and December 2000

Antecedentes: la multirresistencia (MR) a fármacos antituberculosos aumenta cada año a causa de la emergencia del VIH y SIDA. Las investigaciones realizadas en Colombia acerca de la resistencia a antibióticos buscan mejorar las pautas para el tratamiento de la tuberculosis (TBC). Objetivo: describir el estado actual de la resistencia a fármacos antituberculosos en la red adscrita a la Secretaría Distrital de Salud de Bogotá D.C. Metodología: se realizó un análisis descriptivo de las bases de datos y los archivos disponibles en el Laboratorio de Salud Pública (LSP) entre octubre de 1996 y diciembre de 2000. Resultados: se analizaron 652 registros encontrando que 63.3% fueron cultivos positivos para Mycobacterium tuberculosis, de los cuales el 27.0% pertenece a pacientes de género femenino y el 72.5% al género masculino. Se solicitó prueba de sensibilidad a un total de 19.1% de los cultivos positivos cuyos resultados mostraron que el 4.1% desarrolló resistencia a la Isoniazida (H), 2.6% a la Rifampicina. 1.2% a Tioacetazona, 0.9% a Estreptomicina y 0.7 a Ethambutol. Conclusión: se concluyó que la mayor frecuencia de resistencia se da con la Isoniazida seguida de la Rifampicina y el porcentaje de multirresistencia es de 2.6%.

Background: multidrug resistance (MR) to anti-tuberculosis drugs is increasing every year due to the emergence of HIV and AIDS. Research conducted in Colombia on antibiotic resistance seeks to improve guidelines for the treatment of tuberculosis (TB). Objective: to describe the current state of resistance to antituberculosis drugs in the network assigned to the District Health Secretariat of Bogotá D.C. Methodology: a descriptive analysis was made of the databases and files available at the Public Health Laboratory (LSP) between October 1996 and December 2000. Results: 652 records were analyzed and 63.3% were positive cultures for Mycobacterium tuberculosis, of which 27.0% belonged to female patients and 72.5% to male patients. Sensitivity testing was requested to a total of 19.1% of the positive cultures whose results showed that 4.1% developed resistance to Isoniazid (H), 2.6% to Rifampicin, 1.2% to Tioacetazid and 1.2% to Tioacetazid. 1.2% to Thioacetazone, 0.9% to Streptomycin and 0.7 to Ethambutol. Conclusion: it was concluded that the highest frequency of resistance is with Isoniazid followed by Rifampicin and the percentage of multiresistance is 2.6%.