Albayrak Nurhan, Simşek Hülya, Sezen Figen, Arslantürk Ahmet, Tarhan Gülnur, Ceyhan Ismail
Refik Saydam National Public Health Agency, National Tuberculosis Reference Laboratory, Ankara, Turkey.
Mikrobiyol Bul. 2012 Oct;46(4):560-7.
Non-tuberculous mycobacteria (NTM) are commonly encountered environmental bacteria, and most of them are associated with lung diseases. Diagnosis of infections caused by NTM is based on clinical, radiological and microbiological findings. The aim of this study was to investigate the distribution of non-tuberculous mycobacterial species isolated from clinical specimens as etiologic agents. The NTM strains isolated from clinical specimens in National Tuberculosis Reference Laboratory (NTRL), together with the strains that were sent to NTRL for the advanced identification of non-tuberculous mycobacterial species that have clinical or microbiological significance, were analysed retrospectively. The strains belonged to January 2009 - December 2010 period. If the same NTM type was isolated more than once in the clinical specimens of a patient, then it was defined microbiologically as a causative agent. Identification of mycobacteria species was performed by using a commercial line-probe assay (GenoType Mycobacterium CM/AS; Hain Lifescience, Germany). In our study, pulmonary and non-pulmonary samples obtained from 206 patients yielded mycobacterial growth in their cultures, and of them 24 (11.7%) were identified as NTM. On the other hand, 51 of the 101 samples sent to NTRL for identification were confirmed as NTM. Of the patients who were found to be infected with NTM (n= 75), 59 (78.7%) were male and the mean age was 50.9 ± 18.8 years. The most frequently identified NTM species was M.fortuitum (33.3%, n= 25), followed by M.abscessus (18.7%, n= 14), M.gordonae (10.7%, n= 8) and M.avium (%8; n= 6). The other types of NTM species identified in our laboratory were M.chelonae (n= 3), M.intracellulare (n= 3), M.kansasii (n= 3), M.peregrinum (n= 2), M.scrofulaceum (n= 2), M.szulgai (n= 2), M.celatum (n= 1), M.haemophilum (n= 1), M.smegmatis (n= 1) and M.xenopi (n= 1). Rapidly growing NTM species (M.fortuitum and M.abscessus) were the most frequent (52%) species isolated in our laboratory as the cause of non-tuberculous mycobacterial infection. Interestingly, the majority of M.fortuitum isolates (n= 21) which was the most common species identified in our laboratory, were those received from the peripheral laboratories. The most common species identified in our laboratory were rapidly growing NTM, however the countrywide distribution of the NTM species was found different than previously reported. In conclusion, further investigation of the non-tuberculous mycobacteria profile in adjunct with epidemiological data seems to be essential in our country.
非结核分枝杆菌（NTM）是常见的环境细菌，其中大多数与肺部疾病有关。NTM感染的诊断基于临床、影像学和微生物学检查结果。本研究旨在调查从临床标本中分离出的非结核分枝杆菌作为病原体的分布情况。对国家结核病参考实验室（NTRL）从临床标本中分离出的NTM菌株，以及因具有临床或微生物学意义而被送往NTRL进行非结核分枝杆菌高级鉴定的菌株进行回顾性分析。这些菌株来自2009年1月至2010年12月期间。如果在一名患者的临床标本中多次分离出同一NTM类型，则在微生物学上定义为病原体。采用商业线性探针检测法（GenoType Mycobacterium CM/AS；德国海因生命科学公司）对分枝杆菌菌种进行鉴定。在我们的研究中，从206例患者获得的肺部和非肺部样本在培养物中出现分枝杆菌生长，其中24例（11.7%）被鉴定为NTM。另一方面，送往NTRL进行鉴定的101份样本中有51份被确认为NTM。在被发现感染NTM的患者（n = 75）中，59例（78.7%）为男性，平均年龄为50.9±18.8岁。最常鉴定出的NTM菌种是偶然分枝杆菌（33.3%，n = 25），其次是脓肿分枝杆菌（18.7%，n = 14）、戈登分枝杆菌（10.7%，n = 8）和鸟分枝杆菌（8%；n = 6）。在我们实验室鉴定出的其他类型的NTM菌种有龟分枝杆菌（n = 3）、胞内分枝杆菌（n = 3）、堪萨斯分枝杆菌（n = 3）、偶发分枝杆菌（n = 2）、瘰疬分枝杆菌（n = 2）、苏尔加分枝杆菌（n = 2）、塞拉分枝杆菌（n = 1）、嗜血性分枝杆菌（n = 1）、耻垢分枝杆菌（n = 1）和蟾分枝杆菌（n = 1）。快速生长的NTM菌种（偶然分枝杆菌和脓肿分枝杆菌）是我们实验室分离出的最常见的非结核分枝杆菌感染病原体（52%）。有趣的是，我们实验室鉴定出的最常见菌种——大多数偶然分枝杆菌分离株（n = 21）是从周边实验室收到的。我们实验室鉴定出的最常见菌种是快速生长的NTM，但发现NTM菌种在全国的分布与先前报道的不同。总之，在我国，结合流行病学数据进一步调查非结核分枝杆菌谱似乎至关重要。
