联合应用表型分析、热休克蛋白65限制性片段长度多态性分析和测序鉴定养鱼水中的非结核分枝杆菌

目的了解养鱼水中非结核分枝杆菌(NTM)的分布情况。方法采集30份市售养鱼水标本,通过分离培养和生化反应初步鉴定,然后从培养菌落中提取DNA,PCR扩增65kD分枝杆菌抗原,扩增产物:(1)分别应用两种限制性内切酶BstEⅡ和HaeⅢ酶切,然后进行琼脂糖凝胶电泳和限制性片段长度多态性分析(PRA);(2)直接测序。结果30份市售养鱼水中29份样本分枝杆菌培养阳性,其中6份样本分别生长出两种形态性状完全不同的菌落,共分离出35株分枝杆菌,表型特征均符合NTM。理化性质、PRA和测序鉴定发现,戈登分枝杆菌8株(23%)、龟-偶然分枝杆菌复合群8株(23%)、日内瓦分枝杆菌9株(26%)、不产色分枝杆菌1株,其余9株未鉴定到种。结论NTM广泛存在于市售养鱼水中,分子生物学方法与常规细菌学鉴定可互相补充,提高鉴定的正确性。     

联合应用表型分析、热休克蛋白65限制性片段长度多态性分析和测序鉴定养鱼水中的非结核分枝杆菌

目的了解养鱼水中非结核分枝杆菌（NTM）的分布情况。方法采集30份市售养鱼水标本，通过分离培养和生化反应初步鉴定，然后从培养菌落中提取DNA，PCR扩增65kD分枝杆菌抗原，扩增产物：（1）分别应用两种限制性内切酶BstE Ⅱ和Hae Ⅲ酶切，然后进行琼脂糖凝胶电泳和限制性片段长度多态性分析（PRA）；（2）直接测序。结果30份市售养鱼水中29份样本分枝杆菌培养阳性，其中6份样本分别生长出两种形态性状完全不同的菌落，共分离出35株分枝杆菌，表型特征均符合NTM。理化性质、PRA和测序鉴定发现，戈登分枝杆菌8株（23％）、龟-偶然分枝杆菌复合群8株（23％）、日内瓦分枝杆菌9株（26％）、不产色分枝杆菌1株，其余9株未鉴定到种。结论NTM广泛存在于市售养鱼水中，分子生物学方法与常规细菌学鉴定可互相补充，提高鉴定的正确性。     

非结核分支杆菌肺病24例临床分析

目的总结非结核分支杆菌(NTM)肺病的临床特点。方法回顾性分析我所1994年至2004年间收治的24例NTM肺病的临床特点。结果本组NTM肺病以老年患者多见,症状较轻,肺部病变范围广,耐药率高,治疗效果差,部分患者持续菌阳。结论NTM肺病治疗方案有待探讨。     

Regional differences of nontuberculous mycobacteria species in Ulsan,Korea

Background

In Korea recently, nontuberculous mycobacteria (NTM) have been more frequently isolated in respiratory specimens, while Mycobacterium tuberculosis (MTB) isolations have decreased. The major NTM lung disease species in Korea are M. intracellulare, M. avium, and M. abscessus, whereas M. kansasii is a rare species. This retrospective study was performed to determine if there are region-specific characteristics of lung disease-causing NTM species in Ulsan, a highly industrialized city in Korea.

Methods

Between January 2010 and July 2013, the results of all acid-fast bacilli (AFB) cultures of respiratory specimens performed at Ulsan University Hospital (Ulsan, Korea) were collected. NTM were identified and regional differences of NTM species were compared.

Results

AFB cultures were performed on 33,567 respiratory specimens, obtained from 10,208 patients, during the study period. Further, 10% of the specimens (3,287/33,567) were AFB culture-positive [MTB, 2,288/3,287 (70%); NTM 999/3,287 (30%)]. The proportion of NTM isolations gradually increased between 2010 and 2013, at 25% and 38%, respectively. The most common NTM species was M. intracellulare (356/999, 36%), followed by M. kansasii (295/999, 30%), M. avium (161/999, 16%), M. abscessus (117/999, 12%) and M. fortuitum (39/999, 4%). This trend was maintained throughout the study period.

Conclusions

In Ulsan, NTM isolation from respiratory specimens is increasing, consistent with previous studies performed in Korea. The distribution of respiratory NTM species, however, differed from previous studies that were performed in other regions of Korea: M. kansasii was the second most common NTM species in Ulsan. In Ulsan, there is a regional difference in the NTM species isolated.     

Successful management of primary nontuberculous mycobacterial infection of hepatic allograft following orthotopic liver transplantation for hepatitis C

A. Singhal, C. Gates, N. Malhotra, D.A. Irwin, D.H. Chansolme, V. Kohli. Successful management of primary nontuberculous mycobacterial infection of hepatic allograft following orthotopic liver transplantation for hepatitis C
Transpl Infect Dis 2011: 13: 47–51. All rights reserved Abstract: Nontuberculous mycobacteria are a rare cause of disease in solid organ and hematopoietic stem cell transplant recipients. The impact of mycobacterial infections in transplant recipients necessitates prompt diagnosis and early initiation of therapy. However, diagnosis remains difficult and there is a lack of specific recommendations for the choice of anti‐mycobacterial drugs, duration of therapy, and monitoring of graft function as well as immunosuppression in these patients. Issues involved in the management are illustrated by an index case of hepatic allograft infection due to Mycobacterium avium complex.     

Pathophysiology of pulmonary nontuberculous mycobacterial (NTM) disease

In recent years, the incidence and prevalence of pulmonary nontuberculous mycobacterial (NTM) disease have increased worldwide. Although the reasons for this increase are unclear, dealing with this disease is essential. Pulmonary NTM disease is a chronic pulmonary infection caused by NTM bacteria, which are ubiquitous in various environments. In Japan, Mycobacterium avium-intracellulare complex (MAC) accounts for approximately 90% of the causative organisms of pulmonary NTM disease, which is also called pulmonary MAC disease or pulmonary MAI disease.It is important to elucidate the pathophysiology of this disease, which occurs frequently in postmenopausal women despite the absence of obvious immunodeficiency. The pathophysiology of this disease has not been fully elucidated; however, it can largely be divided into bacterial (environmental) and host-side problems. The host factors can be further divided into immune and airway problems. The authors suggest that the triangular relationship between bacteria, immunity, and the airway is important in the pathophysiology of this disease. The latest findings on the pathophysiology of pulmonary NTM disease are reviewed.     

Application of a commercial serodiagnostic kit that measures the serum anti-glycopeptidolipid core IgA antibody in Mycobacterium avium complex pulmonary disease

The diagnosis of Mycobacterium avium complex (MAC) pulmonary disease is occasionally cumbersome and time-consuming because the MAC species is ubiquitous, and therefore its detection is not necessarily indicative of a definitive diagnosis. A serodiagnostic method specific for MAC pulmonary disease that measures the serum anti-glycopeptidolipid core antigen IgA has been developed and is commercially available. Meta-analysis revealed that the test showed a good diagnostic accuracy. The estimated sensitivity and specificity values were 69.6% (95% confidence interval 62.1–76.1) and 90.6% (95% confidence interval 83.6–95.1), respectively. As antibody levels may reflect the disease activity, their serial measurement can also be used in the management of MAC disease. To justify its routine use in clinical practice, further validation in various regions and studies addressing whether serodiagnosis combined with present diagnostic criteria facilitate more rapid accurate diagnosis of MAC pulmonary disease are necessary.     

Clinical Aspects of Pulmonary Nontuberculous Mycobacteriosis

Nontuberculous mycobacterial (NTM) infections are an emerging problem. Common organisms include Mycobacterium avium, M. intracellulare, and M. kansasii, along with the M. avium intracellulare complex (MAC), which includes both M. avium and M. intracellulare. Typically, NTM infections affect the lungs and subsequently demonstrate a chronic course. Therefore, persistent respiratory symptoms generally indicate of the presence of pulmonary NTM diseases, and chest radiography, along with a sputum examination, are essential for its diagnosis. Because NTM are ubiquitous environmental organisms, a positive culture from a minimum of two separate expectorated sputum samples are required to make a diagnosis. The repertoire of effective drugs for treatment is considerably limited, indicating the need for long-term management with multiple drugs. Establishing a treatment regimen with high therapeutic efficacy and safety is an important issue for the future.     

Analysis of the impact of lung cancer treatment on nontuberculous mycobacterial lung diseases

Background

Although nontuberculous mycobacteria (NTM) lung diseases can occur in association with lung cancer, no study has evaluated the effect of lung cancer treatment on NTM lung diseases. Therefore, the present study aimed to retrospectively examine the effect of lung cancer treatment on NTM lung diseases.

AIDS合并非结核分枝杆菌肺病的诊治进展

近年来,随着AIDS的流行及实验室检测技术的进步,非结核分枝杆菌(Nontuberculous mycobacteria,NTM)肺病的发病率呈增多趋势。NTM肺病已成为AIDS患者常见的机会性感染及死亡原因之一。AIDS合并NTM肺病临床表现不典型,影像学无特异性,诊断困难,需要结合临床表现、体格检查和辅助检查结果来进行综合分析。提高对该病的认识,尽早诊治,是降低该病病死率的关键。加强对NTM鉴定和分型技术研究以及治疗方案优化是今后发展的方向和重点。