Nontuberculous mycobacteria in gastrostomy fed patients with cystic fibrosis

H Al-Momani,J Pearson,M Brodlie,I Forrest,T Forrest,A Perry,S Doe,C Ward,J Perry,S Bourke,R Jones,M Griffin,A Anderson

doi:10.1038/srep46546

Abstract

Multi-drug resistant Mycobacterium abscessus complex (MABSC) is a form of Nontuberculous mycobacteria (NTM) of special, international concern in Cystic Fibrosis (CF). We hypothesised that gastric juice and percutaneous endoscopic gastrostomy (PEG) feeding devices might yield MABSC isolates. Gastric juice and sputa from sixteen adult PEG fed CF patients and five replaced PEG tubes were studied. Bacterial and fungal isolates were cultured. Mycobacterium were identified by rpoB, sodA and hsp65 gene sequencing and strain typed using variable number tandem repeat. Bacteria and/or fungi grew from all gastric juice, sputa and PEG samples. MABSC were detected in 7 patients. Five had MABSC in their sputum. Two had an identical MABSC strain in their sputum and gastric juice and one had the same strain isolated from their PEG tube and sputum. Two patients who were sputum sample negative had MABSC isolated in their gastric juice or PEG tube. MABSC were therefore identified for the first time from a gastric sample in a minority of patients. We conclude that gastric juice and PEG-tubes may be a potential source of MABSC isolates in CF patients, and these findings warrant further study.

Highlights

Multi-drug resistant Mycobacterium abscessus complex (MABSC) is a form of Nontuberculous mycobacteria (NTM) of special, international concern in Cystic Fibrosis (CF)
We have recently described findings of a gastric juice reservoir of organisms relevant to CF lung pathophysiology in patients fed by percutaneous endoscopic gastrostomy (PEG) tubes, which confirmed a widespread presence of extra oesophageal reflux (EOR) symptoms and potential for micro-aspiration in patients with CF9,10
For the first time to our knowledge, we have shown that MABSC can be isolated from the gastric juice and PEG tubes of patients with CF in addition to sputum

Summary

Introduction

Multi-drug resistant Mycobacterium abscessus complex (MABSC) is a form of Nontuberculous mycobacteria (NTM) of special, international concern in Cystic Fibrosis (CF). Two patients who were sputum sample negative had MABSC isolated in their gastric juice or PEG tube. We conclude that gastric juice and PEG-tubes may be a potential source of MABSC isolates in CF patients, and these findings warrant further study. Of the rapidly growing NTM species, the multidrug resistant Mycobacterium abscessus complex (MABSC) has emerged as a major respiratory pathogen in individuals with CF, that is associated with an accelerated decline in lung function[3]. The study demonstrated that inferred transmission might occur from patients with persistent smear negative, culture positive sputa. This suggested that only a low level of inoculum might be needed for infection, contributing to debate regarding the need for rigorous preventative measures[8]

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Conclusion