Non-tuberculosis Mycobacterial Infection Research Articles

A clinical case of non-tuberculosis mycobacterial infection of the lungs and larynx

ABSTRACT. An actual clinical case of the diagnosis and course features of non-tuberculosis mycobacterial infection (NTMI) of the lungs and larynx in a patient treated at the Zaporizhzhia Regional Phthisiopulmonology Clinical Treatment and Diagnostic Center is presented. The clinical case demonstrates the difficulty of differential diagnosis of NTMI of the lung caused by scotochromogenic mycobacterium and tuberculosis, since the clinical and radiological manifestations for both diseases are identical, and there are no pathognomonic symptoms of NTMI. NTM affect the respiratory system and mimic the symptoms of tuberculosis, which significantly complicates not only timely differential diagnosis, but also leads to “treatment failure” of tuberculosis, which the patient did not have. After a month of antimycobacterial treatment an ulcerative lesion of the right vocal fold was diagnosed in the patient. Detection of the culture of NTM 1.5 months after its inoculation was the only one method of diagnosis in this case, the diagnosis NTMI of both the lungs and the larynx was made considering those results. The patient did not receive appropriate treatment before receiving the results of the bacteriological examination, which led to the development of negative clinical and radiological dynamics. But, despite the late diagnosis of NTMI, after 6 months of appropriate treatment the patient had a positive clinical and X-ray dynamics with healing of the ulcerative lesion of the right vocal fold. Thus, the presented case shows that despite the late diagnosis of NTMI of the lungs, which was complicated by NTMI of the larynx during antimycobacterial therapy, in the absence of severe concomitant lung diseases in the patient, after 6 months of appropriate treatment of NTMI, it was possible to achieve positive clinical and radiological dynamics with complete healing of the ulcerative lesion of the right vocal fold.

Difficulties in Diagnosing of Pancreatic Cancer in HIV Infection with Generalised Lymphadenopathy: Tuberculosis, Non-Tuberculosis Mycobacterial Infection or Metastases (Clinical Case)

Difficulties in Diagnosing of Pancreatic Cancer in HIV Infection with Generalised Lymphadenopathy: Tuberculosis, Non-Tuberculosis Mycobacterial Infection or Metastases (Clinical Case)

CPMAS NMR platform for direct compositional analysis of mycobacterial cell-wall complexes and whole cells

Tuberculosis and non-tuberculosis mycobacterial infections are rising each year and often result in chronic incurable disease. Important antibiotics target cell-wall biosynthesis, yet some mycobacteria are alarmingly resistant or tolerant to currently available antibiotics. This resistance is often attributed to assumed differences in composition of the complex cell wall of different mycobacterial strains and species. However, due to the highly crosslinked and insoluble nature of mycobacterial cell walls, direct comparative determinations of cell-wall composition pose a challenge to analysis through conventional biochemical analyses. We introduce an approach to directly observe the chemical composition of mycobacterial cell walls using solid-state NMR spectroscopy. 13C CPMAS spectra are provided of individual components (peptidoglycan, arabinogalactan, and mycolic acids) and of in situ cell-wall complexes. We assigned the spectroscopic contributions of each component in the cell-wall spectrum. We uncovered a higher arabinogalactan-to-peptidoglycan ratio in the cell wall of M. abscessus, an organism noted for its antibiotic resistance, relative to M. smegmatis. Furthermore, differentiating influences of different types of cell-wall targeting antibiotics were observed in spectra of antibiotic-treated whole cells. This platform will be of value in evaluating cell-wall composition and antibiotic activity among different mycobacteria and in considering the most effective combination treatment regimens.

Nontuberculous Mycobacterial Infection in Wisconsin Adults and Its Relationship to Race and Social Disadvantage.

Rationale: Population-based data on the epidemiology of nontuberculosis mycobacterial (NTM) infections are limited, particularly with respect to variation in NTM infection among racial groups and socioeconomic strata. Wisconsin is one of a handful of states where mycobacterial disease is notifiable, allowing large, population-based analyses of the epidemiology of NTM infection in this state. Objectives: To estimate the incidence of NTM infection in Wisconsin adults, describe the geographic distribution of NTM infection across the state, identify the frequency and type of infection caused by different NTM species, and investigate associations between NTM infection and demographics and socioeconomic status. Methods: We conducted a retrospective cohort study using laboratory reports of all NTM isolates from Wisconsin residents submitted to the Wisconsin Electronic Disease Surveillance System from 2011 to 2018. For the analyses of NTM frequency, multiple reports from the same individual were enumerated as separate isolates when nonidentical, collected from different sites or collected more than one year apart. Results: A total of 8,135 NTM isolates from 6,811 adults were analyzed. Mycobacterium avium complex accounted for 76.4% of respiratory isolates. The M. chelonae-abscessus group was the most common species isolated from skin and soft tissue. The annual incidence of NTM infection was stable over the study period (from 22.1 per 100,000 to 22.4 per 100,000). The cumulative incidence of NTM infection among Black (224 per 100,000) and Asian (244 per 100,000) individuals was significantly higher compared with that among their White counterparts (97 per 100,000). Total NTM infections were significantly more frequent (P < 0.001) in individuals from disadvantaged neighborhoods, and racial disparities in the incidence of NTM infection generally remained consistent when stratified by measures of neighborhood disadvantage. Conclusions: More than 90% of NTM infections were from respiratory sites, with the vast majority caused by M. avium complex. Rapidly growing mycobacteria predominated as skin and soft tissue pathogens and were important minor respiratory pathogens. We found a stable annual incidence of NTM infection in Wisconsin between 2011 and 2018. NTM infection occurred more frequently in non-White racial groups and in individuals experiencing social disadvantage, suggesting that NTM disease may be more frequent in these groups as well.

Contemporary Pharmacotherapies for Nontuberculosis Mycobacterial Infections: A Narrative Review.

Nontuberculous mycobacteria (NTM) are a group of atypical bacteria that may cause a spectrum of clinical manifestations, including pulmonary, musculoskeletal, skin and soft tissue, and cardiac infections. Antimycobacterial medication regimens for NTM infections require multiple agents with prolonged treatment courses and are often associated with poor tolerance in patients and suboptimal clinical outcomes. This review summarizes NTM pharmacotherapy, including treatment concepts, preferred medication regimens according to NTM species and site of infection, and emerging treatment methods for difficult-to-treat species.

Dosing of Bedaquiline with Rifamycins reduces Rifabutin Plasma Concentrations

Bedaquiline (BDQ), a diarylquinoline mycobacterial ATP synthase inhibitor approved in the United States for drug-resistant tuberculosis, is metabolized by CYP3A4, an hepatic enzyme strongly induced by rifampin (RIF), an essential part of drug-sensitive tuberculosis treatment. BDQ is used more broadly in some other countries and has been evaluated for treatment of non-tuberculosis mycobacterial infections, often in combination with rifabutin (RBT). We examined the pharmacokinetic interactions of BDQ plus either RIF or RBT in 33 healthy volunteers. Subjects were randomly assigned to receive two single 400 mg doses of BDQ, given 29 days apart, and either RBT 300 mg or RIF 600 mg, given daily from day 20 to 41 after the first dose of BDQ. Blood samples were collected prior to dosing and at multiple subsequent time points to measure plasma drug concentrations, including those of the rifamycin primary metabolites. BDQ treatment had little effect on the disposition of RIF but resulted in a dramatic shortening of the half-life of RBT and decreased exposure to it. When the drugs were administered together (Day 29) the peak rifamycin concentrations and peak rifamycin metabolite concentrations were reduced significantly (p &lt;0.001). This appeared to result from reduced absorption and raises a concern that doses of BDQ and the rifamycins, particularly RBT should be staggered when the two drugs are given on the same day. The optimum time between dosing should be determined.

Genomic features of Mycobacterium avium subsp. hominissuis isolated from pigs inJapan.

Mycobacterium avium subsp. hominissuis (MAH) is one of the most important agents causing non-tuberculosis mycobacterial infection in humans and pigs. There have been advances in genome analysis of MAH from human isolates, but studies of isolates from pigs are limited despite its potential source of infection to human. Here, we obtained 30 draft genome sequences of MAH from pigs reared in Japan. The 30 draft genomes were 4,848,678-5,620,788bp in length, comprising 4652-5388 coding genes and 46-75 (median: 47) tRNAs. All isolates had restriction modification-associated genes and 185-222 predicted virulence genes. Two isolates had tRNA arrays and one isolate had a clustered regularly interspaced short palindromic repeat (CRISPR) region. Our results will be useful for evaluation of the ecology of MAH by providing a foundation for genome-based epidemiological studies.

In vitro activity of SPR719 against Mycobacterium ulcerans, Mycobacterium marinum and Mycobacterium chimaera.

Nontuberculosis mycobacterial (NTM) infections are increasing in prevalence across the world. In many cases, treatment options for these infections are limited. However, there has been progress in recent years in the development of new antimycobacterial drugs. Here, we investigate the in vitro activity of SPR719, a novel aminobenzimidazole antibiotic and the active form of the clinical-stage compound, SPR720, against several isolates of Mycobacterium ulcerans, Mycobacterium marinum and Mycobacterium chimaera. We show that SPR719 is active against these NTM species with a MIC range of 0.125–4 μg/ml and that this compares favorably with the commonly utilized antimycobacterial antibiotics, rifampicin and clarithromycin. Our findings suggest that SPR720 should be further evaluated for the treatment of NTM infections.

Increased whiB7 expression and antibiotic resistance in Mycobacterium chelonae carrying two prophages

BackgroundThe global rise in the incidence of non-tuberculosis mycobacterial infections is of increasing concern due their high levels of intrinsic antibiotic resistance. Although integrated viral genomes, called prophage, are linked to increased antibiotic resistance in some bacterial species, we know little of their role in mycobacterial drug resistance.ResultsWe present here for the first time, evidence of increased antibiotic resistance and expression of intrinsic antibiotic resistance genes in a strain of Mycobacterium chelonae carrying prophage. Strains carrying the prophage McProf demonstrated increased resistance to amikacin. Resistance in these strains was further enhanced by exposure to sub-inhibitory concentrations of the antibiotic, acivicin, or by the presence of a second prophage, BPs. Increased expression of the virulence gene, whiB7, was observed in strains carrying both prophages, BPs and McProf, relative to strains carrying a single prophage or no prophages.ConclusionsThis study provides evidence that prophage alter expression of important mycobacterial intrinsic antibiotic resistance genes and additionally offers insight into the role prophage may play in mycobacterial adaptation to stress.

1640. A Clinical Audit and Cost Analysis of Tuberculosis Management at a Tertiary Referral Centre in the Republic of Ireland

BackgroundIreland is a low tuberculosis (TB) incidence country. Effective TB services are important in the efforts to meet WHO End TB Targets. A dedicated TB clinic was established in our tertiary referral centre in 2018. Our aim is to describe the patients with TB attending our service and evaluate the care provided to them in terms of cost and clinical effectiveness.MethodsWe performed a retrospective review of patients attending our service from 01/07/2018-31/12/2019. We included patients who were referred for assessment of symptoms of active tuberculosis. We collected data on patients risk factors for TB, time from illness onset to diagnosis and resources utilized (including hospital admissions, outpatient appointments, investigations and drug treatment). We estimated the productivity losses due to TB in our cohort following the Hanover Consensus. Using national TB notifications data we used our estimate treatment cost and productivity losses to estimate the total national cost of TB in Ireland in 2019.ResultsFifty-four patients were assessed for TB in our clinic. Most patients (68.5%) referred had a diagnosis of TB made, 5.6% had a non-tuberculosis mycobacterial infection and the remainder had no mycobacterial infection diagnosed. Over half (51.4%) of patients with TB had respiratory TB. The most prevalent risk factor was being from a country of high TB incidence (59.5% of TB patients). Five patients (13.5%) had drug resistance. Patients were referred most frequently from the emergency department (54.1%). The median time from symptom onset to diagnosis was 14.1 weeks (IQR 5.3-30) in patients with respiratory TB compared to 25.9 weeks (IQR 6.3-55.9) in patients with non-respiratory TB. Out of 35 patients who remained within our service 97.1% (34/35) completed treatment and 2.9% (1/35) are still on treatment.We estimate that the median cost of managing a case of TB in our centre was €6088 (€1,003-17,588). The estimated cost of managing all 267 cases of TB in Ireland in 2019 was €9,048,380 which incurred productivity losses of €791,421. The total cost of TB to Ireland in 2019 was €9,839,801.ConclusionOur clinic had a high rate of treatment success. Interventions to reduce diagnostic delay and cost are needed.Disclosures All Authors: No reported disclosures

Low serum estradiol levels are related to Mycobacterium avium complex lung disease: a cross-sectional study

BackgroundThe risk factors for Mycobacterium avium complex lung disease (MAC-LD) are not well known. We hypothesized that low serum estradiol (E2) levels are related to MAC-LD as most patients with MAC-LD are postmenopausal women.MethodsThis cross-sectional study compared patients with MAC-LD and healthy controls. Study subjects were postmenopausal women aged 65 years or younger. Serum testosterone, dehydroepiandrosterone sulfate (DHEA-S), and E2 levels were measured and categorized as high or low based on median levels. We performed multivariate analysis, receiver operating characteristic (ROC) curve analysis, and age- and body mass index (BMI)-matched subgroup analysis to evaluate the association between low serum E2 levels and MAC-LD.Additionally, using blood samples obtained for other clinical studies, the levels of sex steroid hormones were compared between age- and BMI-matched MAC-LD and bronchiectasis female patients without non-tuberculosis mycobacterial infections (non-NTM BE).ResultsForty-two patients with MAC-LD and 91 healthy controls were included. The median E2 (2.20 pg/mL vs. 15.0 pg/mL, p < 0.001), testosterone (0.230 ng/L vs. 0.250 ng/L, p = 0.005), and DHEA-S (82.5 μg/dL vs. 114.0 μg/dL, p < 0.001) levels were lower in the MAC-LD group than in the control group. Multivariate analysis revealed that low serum E2 (adjusted odds ratio = 34.62, 95% confidence interval = 6.02–199.14) was independently related to MAC-LD, whereas low DHEA-S and testosterone were not. ROC analysis illustrated a strong relationship between low serum E2 levels and MAC-LD (area under the curve = 0.947, 95% confidence interval = 0.899–0.995). Even the age- and BMI-matched subgroup analysis of 17 MAC-LD patients and 17 healthy controls showed lower serum E2 in MAC-LD patients than in healthy controls. Additionally, serum E2 levels of 20 MAC-LD patients were lower than plasma E2 levels of 11 matched non-NTM BE patients (1.79 pg/mL vs. 11.0 pg/mL, p < 0.001).ConclusionsLow serum E2 levels were strongly related to MAC-LD in postmenopausal women.

Identification of Non-Tuberculosis Mycobacteria by Line Probe Assay and Determination of Drug Resistance Patterns of Isolates in Iranian Patients.

The potentially pathogenic Non-Tuberculosis Mycobacteria (NTM) are emerging nowadays which result in pulmonary and non-pulmonary infections in human. This group of bacteria consists of at least 200 different species. While the pulmonary disease is the most common form of NTM infections, NTM can cause diffused infections as well as extrapulmonary infections in every organ, such as bone marrow, skin, eye, and brain. The NTM cause tuberculosis-like infections, therefore, correct identification of these Mycobacteria is necessary to avoid faulty treatment. Different species of NTM isolates were identified from clinical specimens using phenotypic methods and Line Probe Assay. Minimum Inhibitory Concentration for selected antibiotics was obtained by the broth micro-dilution method. Totally, 42 NTM isolates were identified in this study. Moreover, the frequency of NTM between all positive mycobacterium cultures was estimated at 12%. The most common Rapidly Growing Mycobacteria included Mycolicibacterium fortuitum (30.9%), Mycobacterium abscessus (7.1%), and Mycobacterium chelonae (2.3%), whereas Mycobacterium simiae (40.4%), Mycobacterium kansasii (16.6%), and Mycobacterium avium complex (2.3%) were the most recurring among the Slowly Growing Mycobacteria. Amikacin, clarithromycin, and ciprofloxacin were the most effective antibiotics against isolated NTM. The NTM isolates are frequently being separated from Iranian patients, and are mostly resistant to the wide spectrum of antibiotics. Correct identification and determination of antibiotic susceptibility can be helpful in the healing process of the patients who suffer from non-tuberculosis mycobacterial infections.

Prevalence of nontuberculous Mycobacterial infection in Non-HIV subjects of clinically presumed tuberculosis at a tertiary care center, Hyderabad

Introduction: Tuberculosis continues to be the leading cause of morbidity and mortality in developing nations. Off late infections due to mycobacterial species other than tubercle bacilli are being reported frequently. Nontuberculous mycobacteria are being increasingly recognized and isolated as pathogens from immunocompetent host too. They are found in both pulmonary and extrapulmonary form of disease. The prevalence of infections due to NTM is known to vary with place, host and climatic factors. Aim: the present study is a retrospective cross-sectional observational study for a period of two years from Jan.2013- Dec.2014, at Princess Era Hospital,a teaching hospital of Deccan college of medical sciences at Hyderabad. Data from microbiology lab records was retrieved and analysed. Materials and Methods: about 232 specimens from 229 patients with clinical symptoms of tuberculosis were analysed for laboratory diagnosis of nontuberculosis mycobacterial infection in mycobacteriology section of microbiology laboratory. Seventy nine samples were obtained from 78 patients with pulmonary form of disease and 153 samples were from 151 patients with extrapulmonary form of disease. Study was approved by ethical committee of the college and patient consent was obtained prior to sample collection. All the specimens received in the laboratory were processed by direct microscopy for acid fast bacilli using Ziehl Neelsen stain. Culture was performed on conventional LJ media and Middle Brook 7H12 media in MGIT 320 automated system. Identification of culture positive isolates was achieved by standard biochemical test and rapid immunochromatography test for detection of mycobacterial tuberculosis protein 64 antigen [MPT64]. Results: Direct microscopy was positive in 20.52%. and 4.25% of which were later identified as NTM. Culture yielded positive result in 22.27% of the subjects. NTM were isolated in 3.49% of the total subjects studied. Mycobacterium tuberculosis was the most common

Mycobacterium scrofulaceum disease: experience from a tertiary medical centre and review of the literature

Introduction: Mycobacterium scrofulaceum infection has been identified in cases of paediatric cervical lymphadenitis but is less well defined in adults. To further characterize manifestations of M. scrofulaceum disease and treatment approaches, we reviewed our medical centre’s experience and other published reports.Methods: We performed a retrospective chart review of patients at our medical centre with a positive M. scrofulaceum culture over a 15-year period. We compare our findings with those published in the literature to identify commonalities in disease presentations and treatment outcomes.Results: We identified 17 patients in our centre with positive M. scrofulaceum cultures, 10 of whom were diagnosed with clinical infection. The types of disease encountered included pulmonary and pleural infection (4), bone and joint infections with a foreign body (2), skin and soft tissue infection (2), brain abscess (1) and paediatric cervical adenitis (1). Structural lung disease was a common finding in cases of pulmonary infection. All adult patients except those with bone and joint infections had some type of immunomodulatory condition and/or structural lung disease. In seven patients, M. scrofulaceum was isolated in urinary or respiratory cultures without signs of clinical disease.Conclusion: M. scrofulaceum is a rare cause of non-tuberculosis mycobacterial infection in humans but can infect any tissue. Adults with pulmonary disease often have underlying structural lung disease, and those with extrapulmonary disease commonly have immunosuppressive conditions or foreign body-associated infections. Treatment outcomes are generally favourable; however, in patients with pulmonary M. scrofulaceum disease prognosis is more guarded.

Clinical and microbiological characteristics of non-tuberculous mycobacteria diseases in Singapore with a focus on pulmonary disease, 2012-2016

BackgroundInformation on non-tuberculosis mycobacterial (NTM) diseases remains limited in Singapore and other Southeast Asian countries. This study aimed to delineate epidemiological and clinical features of pulmonary NTM disease.MethodsA retrospective review was performed on all NTM isolates identified in Singapore General Hospital from 2012 to 2016 using the 2007 ATS/IDSA diagnostic criteria.ResultsA total of 2026 NTM isolates from 852 patients were identified. M. abscessus-chelonae group (1010, 49.9%) was the most commonly isolated and implicated in pulmonary NTM disease. Pulmonary cases (352, 76%) had the highest prevalence among patients diagnosed with NTM diseases (465/852, 54.6%) with no gender difference. Male patients were older (68.5 years, P = 0.014) with a higher incidence of chronic obstructive pulmonary disease (COPD) (23.6%, P < 0.001) and recurrent cough with phlegm production (51.6%, P = 0.035). In contrast, more female patients had bronchiectasis (50%, P < 0.001) and haemoptysis (37.6%, P = 0.042). Age and COPD were associated with multiple NTM species isolation per patient.ConclusionsM. abscessus-chelonae group was the commonest NTM species isolated in Singapore. Pulmonary NTM infection has the highest frequency with male and female patients associated with a higher incidence of COPD and bronchiectasis respectively. Age and COPD were associated with multiple NTM species isolation per patient.

Non-tuberculous Mycobacterium infection after transfer of autologous fat to the face: a rare case

Autologous fat has long been used as a filler in the face, and has recently gained popularity in plastic surgery with a wound infection rate of 1% − 5%. The incidence of mycobacterial infections has increased over recent decades, which is attributed in part to the increased popularity of these procedures.2 Infections by non-tuberculosis mycobacteria often cause chronic inflammation and progressive infection that may eventually manifest themselves as severe scars, fistulas, and hollows, and irregular facial contours. However, few cases of mycobacterial infection have been reported to have been caused by plastic surgery. We present a rare case of non-tuberculosis mycobacterial infection after transfer of autologous fat to the face.

The effectiveness of individualized treatment regimen on smear-positive retreatment pulmonary tuberculosis with mono- and poly-drug resistance

Objective: To analyze and evaluate the effectiveness of individualized treatment regimen in the therapy of smear-positive retreatment pulmonary tuberculosis with mono-and poly-drug resistance, and therefor to provide information on how to develop rational individualized regimen for retreatment tuberculosis cases with drug resistance. Methods: This was a multi-centered, prospective cohort study. Totally 254 cases of sputum positive tuberculosis with previous treatment history during the period from July 1, 2009 to August 30, 2016 were included in the analysis. All the cases were randomly divided into 3 groups and received therapy after randomization into treatment groups. After 3 months, cases with multidrug resistant tuberculosis, extensively drug-resistant tuberculosis, non-tuberculosis mycobacterial infection and those with smear-positive but culture-negative tuberculosis were excluded according to result of sputum culture and drug susceptibility test (DST). In treatment group A (individualized treatment group), 86 cases with an average age of (42.1±13.7) years for men and (38.5±12.8) years for women, were treated with individualized regimen, which allowed drug replacement on the basis of standard regimen (2SHRZE/6HRE) according to DST result. Treatment duration was recalculated after drug replacement and the total length should be 12 months or more. If the DST result did not show drug resistance, the patients would continue the 8 months' standard treatment. In treatment group B (intensified retreatment regimen group), 86 cases with an average age of (43.2±14.2) years for man and (37.9±14.1) years for women, received intensified retreatment regimen (2HL(2)EZS/2HL(2)EZS(3)/4HL(2)E). The dose for H was 0.3 g/d for patients with body weight <50 kg, and 0.4~0.5 g/d for higher body weight (≥50 kg); The doses for L(2,)E and Z were 0.6 g, 2/w; 0.75, 1/d and 0.5g, 3/d. In treatment group C (standard treatment group), 82 cases with an average of (42.5±11.9) years for man and (38.6±12.8) years for women, were treated with standardized regimen recommended by national tuberculosis program (2HREZS/6HRE). In both group B and C, the total treatment duration was 8 months and the drugs were not replaced for mono-and poly-drug resistance. Treatment outcomes of the 3 groups were analyzed, the status of drug replacement in group A was analyzed, and the adjustment of dose of H and R according to patients' body weight was observed. SPSS 19.0 was used for data analysis. Results: The treatment cure rates for group A, B and C were 73.3%(63/86), 76.7%(66/86) and 50%(41/82), and the treatment success rates were 80.2%(69/86), 84.9%(73/86) and 62.2%(51/82) respectively. Treatment failure was 8.1%(7/86), 4.7%(4/86) and 19.5%(16/82) in 3 groups. There were significant differences in the above indicators for group A and B in comparison with group C(χ(2)=13.127, P=0.001). However, there was no difference observed between group A and B(χ(2)=0.646, P=0.422). In group A, tuberculosis specialized hospitals using regular doses for R was only 38.7%(12/31). After 3 years' follow-up, no-relapse-success for group A was 66.7% (10/15). Conclusions: Inappropriate individualized treatment would increase treatment failure for retreatment tuberculosis. Higher doses of H and R and prolonged extensive therapy phase could contribute to increased treatment success.

Clinical characteristics of nontuberculosis mycobacterial pulmonary infection in immunocompetent adult patients: 6 cases.

Clinical characteristics of nontuberculosis mycobacterial pulmonary infection in immunocompetent adult patients: 6 cases.

Nontuberculosis mycobacterial infections at a specialized tuberculosis treatment centre in the Republic of Korea

BackgroundThe incidence of nontuberculous mycobacteria (NTM) infections is increasing worldwide, however formal evaluations of the epidemiology of NTM infections are limited. Understanding the trends and true prevalence of NTM is a major priority for optimizing infection control programmes and resources. The purpose of this study was to investigate the epidemiology, clinical manifestations, and radiologic findings in NTM-infected patients at specialized Tuberculosis (Tb) treatment centre in South Korea, which is endemic to Tb, and find solutions to control NTM infections.MethodsA retrospective descriptive study was conducted among patients who were diagnosed with NTM from November 2011 to January 2016 at Seoul Metropolitan Government Seobuk hospital, Korea, using medical records and chest radiography results. Prevalence of NTM using national health insurance data was compared to the prevalence and incidence of Tb using National statistics data.ResultsThe age- and sex- adjusted prevalence of NTM infection per 100,000 population increased between 2009 (9.4) and 2016 (36.1). However, the prevalence and incidence of Tb per 100,000 population decreased from 106.5 to 74.4, and 81.2 to 61.8, respectively. In total, 64 patients (37 [57.8%] men) were enrolled in the study. Among 33 (51.6%) patients with slowly growing nontuberculous mycobacteria (SGM) infection, 29 were detected with Mycobacterium avium complex (n = 13, M. avium; n = 16, M. intracellulare), and 4 with M. kansasii. Among 31 (48.4%) patients with rapidly growing nontuberculous mycobacteria (RGM) infection, 27 and 4 patients were detected with M. abscessus complex and M. fortuitum complex, respectively. RGM patients were more likely to have current Tb (P = 0.041), cough (P < 0.05), and sputum (P < 0.01) than SGM patients in the univariate analysis, but not in the multivariate analysis.ConclusionGiven the increasing prevalence of NTM infections, precise epidemiological and surveillance data should be obtained by reporting NTM infections to public health authorities. Introducing nucleic acid amplification tests to differentiate between Tb and NTM in smear-positive specimens should be considered.

Using Syndromic Surveillance to Investigate Tattoo-Related Skin Infections in New York City.

In response to two isolated cases of Mycobacterium chelonae infections in tattoo recipients where tap water was used to dilute ink, the New York City (NYC) Department of Health and Mental Hygiene conducted an investigation using Emergency Department (ED) syndromic surveillance to assess whether an outbreak was occuring. ED visits with chief complaints containing the key word “tattoo” from November 1, 2012 to March 18, 2013 were selected for study. NYC laboratories were also contacted and asked to report skin or soft tissue cultures in tattoo recipients that were positive for non-tuberculosis mycobacterial infection (NTM). Thirty-one TREDV were identified and 14 (45%) were interviewed to determine if a NTM was the cause for the visit. One ED visit met the case definition and was referred to a dermatologist. This individual was negative for NTM. No tattoo-associated NTM cases were reported by NYC laboratories. ED syndromic surveillance was utilized to investigate a non-reportable condition for which no other data source existed. The results were reassuring that an outbreak of NTM in tattoo recipients was not occurring. In response to concerns about potential NTM infections, the department sent a letter to all licensed tattoo artists advising them not to dilute tattoo ink with tap water.