Occurrence of nontuberculous mycobacterial pulmonary infection in an endemic area of tuberculosis.

The majority of investigations of the epidemiology of nontuberculous mycobacteria (NTM) have focused on highly developed nations with a low prevalence of tuberculosis. In contrast, the Para state of north Brazil represents an area of high tuberculosis prevalence and increasing NTM incidence. Toward the goal of understanding the dynamics of infection by all Mycobacterium species, we report patient characteristics and the identification of NTM strains isolated from sputum samples from patients that were residents of Para, a state in the Amazon region, Northern of Brazil, over the period January 2010 through December 2011 (2 years). The 29 NTM patients comprised 13.5% of positive mycobacterial cultures over the 2-year period. A major risk factor for NTM pulmonary disease was previous tuberculosis (76%). Further, the average age of NTM patients (52 years) was significantly higher than that of tuberculosis patients (39 years) and more were female (72.4% vs. 37.4%). Unlike other Brazilian states, NTM pulmonary patients in Para were infected with a different spectrum of mycobacteria; primarily the rapidly growing Mycobacterium massiliense and Mycobacterium simiae complex.

Identificação genotípica de membros do complexo Mycobacterium avium isolados de infecções pulmonares no Estado do Pará, Brasil / Genotypic identification of members of the Mycobacterium avium complex isolated from pulmonary infections in Pará State, Brazil

INTRODUÇÃO: O complexo Mycobacterium avium (MAC) compreende micobactérias de crescimento lento, naturalmente encontradas no meio ambiente, capazes de causar infecções em diversas espécies de seres vivos, incluindo aves, suínos e humanos. Tais infecções podem ser assintomáticas, clinicamente significantes e, em alguns casos, fatais. No entanto, existe a necessidade de se disponibilizarem técnicas que ofereçam uma identificação conclusiva de bactérias estreitamente relacionadas. As técnicas de biologia molecular se apresentam como ferramentas promissoras para uma identificação mais precisa. MATERIAIS E MÉTODOS: Neste trabalho foram avaliados os marcadores moleculares RNAr 16S, hsp65 e rpoB aplicados à distinção de membros do MAC isolados no Laboratório de Micobactérias do Instituto Evandro Chagas. RESULTADOS: Amostras de MAC colhidas em 15 pacientes foram previamente avaliadas pelo método de análise de polimorfismo de fragmentos de restrição do gene hsp65 (PRA-hsp65), que forneceu três diferentes perfis: (I) BstEII: 235/115/100, HaeIII: 145/130/60; (II) BstEII: 235/210, HaeIII: 130/105; e (III) BstEII: 235/210, HaeIII:145/130. Árvores filogenéticas foram construídas após análise do RNAr 16S, em que as amostras foram distribuídas em dois grupos, semelhante ao encontrado na análise de hsp65. Entretanto, os resultados de rpoB foram discordantes daqueles das outras árvores, devido à modificação de topologia. CONCLUSÃO: Os achados deste estudo sugerem que diferentes forças evolucionárias podem estar atuando sobre o gene rpoB, e, desta forma, é necessário que se tenha precaução ao estabelecer esse alvo para fins taxonômicos. Adicionalmente, recomenda-se que mais de um marcador, incluindo o RNAr 16S, seja avaliado para a identificação micobacteriana.

INTRODUCTION: The Mycobacterium avium complex (MAC) is a group of slow-growing mycobacteria naturally found in the environment capable of causing infections in a wide variety of living species, including birds, swines and humans. These infections can be asymptomatic, clinically significant and, in some cases, fatal. There is a demand for techniques that are capable of conclusively identifying closely related bacteria. Molecular biological techniques are promising tools for a more precise identification. MATERIAL AND METHODS: In this study, we evaluated the ability of 16S rRNA, hsp65 and rpoB molecular markers to distinguish between members of the MAC isolated in the Mycobacteria Laboratory at the Instituto Evandro Chagas. RESULTS: MAC samples collected from 15 patients were previously evaluated using an hsp65 gene restriction fragment length polymorphism analytical method (RFLP-hsp65), and they showed three different profiles: (I) BstEII: 235/115/100, HaeIII: 145/130/60; (II) BstEII: 235/210, HaeIII: 130/105; and (III) BstEII: 235/210, HaeIII: 145/130. We constructed phylogenetic trees using 16S rRNA analysis in which the samples were distributed into two groups, similarly to those found in the hsp65 analysis. However, the results from the rpoB analysis disagreed with those of the other trees due to changes in topology. CONCLUSION: The findings from this study warrant that various evolutionary forces may be acting on the rpoB gene. Thus, it is necessary to be cautious when using this target for taxonomic analyses. Additionally, we recommend that multiple markers (including16S rRNA) be evaluated when identifying mycobacteria.