Cândido Pedro Henrique Campanini, Nunes Luciana de Souza, Marques Elizabeth Andrade, Folescu Tânia Wrobel, Coelho Fábrice Santana, de Moura Vinicius Calado Nogueira, da Silva Marlei Gomes, Gomes Karen Machado, Lourenço Maria Cristina da Silva, Aguiar Fábio Silva, Chitolina Fernanda, Armstrong Derek T, Leão Sylvia Cardoso, Neves Felipe Piedade Gonçalves, Mello Fernanda Carvalho de Queiroz, Duarte Rafael Silva
Programa de Pós Graduação em Clínica Médica, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Programa de Pós Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
J Clin Microbiol. 2014 Aug;52(8):2990-7. doi: 10.1128/JCM.00549-14. Epub 2014 Jun 11.
Worldwide, nontuberculous mycobacteria (NTM) have become emergent pathogens of pulmonary infections in cystic fibrosis (CF) patients, with an estimated prevalence ranging from 5 to 20%. This work investigated the presence of NTM in sputum samples of 129 CF patients (2 to 18 years old) submitted to longitudinal clinical supervision at a regional reference center in Rio de Janeiro, Brazil. From June 2009 to March 2012, 36 NTM isolates recovered from 10 (7.75%) out of 129 children were obtained. Molecular identification of NTM was performed by using PCR restriction analysis targeting the hsp65 gene (PRA-hsp65) and sequencing of the rpoB gene, and susceptibility tests were performed that followed Clinical and Laboratory Standards Institute recommendations. For evaluating the genotypic diversity, pulsed-field gel electrophoresis (PFGE) and/or enterobacterial repetitive intergenic consensus sequence PCR (ERIC-PCR) was performed. The species identified were Mycobacterium abscessus subsp. bolletii (n = 24), M. abscessus subsp. abscessus (n = 6), Mycobacterium fortuitum (n = 3), Mycobacterium marseillense (n = 2), and Mycobacterium timonense (n = 1). Most of the isolates presented resistance to five or more of the antimicrobials tested. Typing profiles were mainly patient specific. The PFGE profiles indicated the presence of two clonal groups for M. abscessus subsp. abscessus and five clonal groups for M. abscesssus subsp. bolletii, with just one clone detected in two patients. Given the observed multidrug resistance patterns and the possibility of transmission between patients, we suggest the implementation of continuous and routine investigation of NTM infection or colonization in CF patients, including countries with a high burden of tuberculosis disease.
在全球范围内，非结核分枝杆菌（NTM）已成为囊性纤维化（CF）患者肺部感染的新兴病原体，估计患病率在5%至20%之间。本研究调查了巴西里约热内卢一家区域参考中心对129例接受纵向临床监测的CF患者（2至18岁）痰液样本中NTM的存在情况。从2009年6月至2012年3月，从129名儿童中的10名（7.75%）患者中分离出36株NTM。通过针对hsp65基因的PCR限制性分析（PRA-hsp65）和rpoB基因测序进行NTM的分子鉴定，并按照临床和实验室标准协会的建议进行药敏试验。为评估基因型多样性，进行了脉冲场凝胶电泳（PFGE）和/或肠杆菌重复基因间共识序列PCR（ERIC-PCR）。鉴定出的菌种有脓肿分枝杆菌博列蒂亚种（n = 24）、脓肿分枝杆菌脓肿亚种（n = 6）、偶然分枝杆菌（n = 3）、马赛分枝杆菌（n = 2）和蒂蒙分枝杆菌（n = 1）。大多数分离株对五种或更多测试抗菌药物耐药。分型谱主要具有患者特异性。PFGE谱显示脓肿分枝杆菌脓肿亚种存在两个克隆群，脓肿分枝杆菌博列蒂亚种存在五个克隆群，仅在两名患者中检测到一个克隆。鉴于观察到的多重耐药模式以及患者之间传播的可能性，我们建议对CF患者，包括结核病负担高的国家，实施对NTM感染或定植的持续常规调查。
