Yu Xiao-li, Lu Lian, Chen Gao-zhan, Liu Zhi-Guo, Lei Hang, Song Yan-zheng, Zhang Shu-lin
School of Biology and Pharmaceutical Engineering, Wuhan Polytechnic University, Wuhan, China.
Shanghai public health clinical center, Shanghai, China.
PLoS One. 2014 Dec 2;9(12):e114353. doi: 10.1371/journal.pone.0114353. eCollection 2014.
The incidence of non-tuberculous mycobacteria (NTM)-related death has increased globally recently. To obtain information of the species and characterization of pathogens involved in NTM pulmonary infection in Southern-central China, we identified 160 non-tuberculous infection cases from 3995 acid-fast bacilli (AFB)-positive tuberculous suspects. We then randomly selected 101 non-tuberculous patients, isolated bacteria from their sputa and genotyped the pathogens using the 16S rRNA gene and 16S-23S rRNA internal transcribed spacer sequences. M. intracellulare (32.67%, 33/101), M. abscessus (32.67%, 33/101) and M. fortuitum (7.92%, 8/101) are identified in these isolates. Surprisingly, non-mycobacteria including Gordonia (8.91%, 9/101), Nocardia (5.94%, 6/101) and Tsukamurella (0.99%, 1/101) are also discovered, and the case of Tsukamurella pulmonis infection is first discovered in Southern-central China. Moreover, species of M. mucogenicum group, M. chubuense, M. kansasii, M. gastri, M. avium, M. porcinum and M. smegmatis are identified. In addition, nine immune compromised cases (8.91%, 9/101), including type two diabetes mellitus and HIV/AIDS are found to be infected with non-tuberculous bacteria. This study revealed the distribution and characteristics of non-tuberculous AFB pathogen infection occurred in Southern-central China, and suggested that physicians should be alert of the emerging of NTM and non-mycobacteria infection in AFB positive cases and take caution when choosing chemotherapy for tuberculosis-like pulmonary infections. Generally, this study may help with the development of new strategy for the diagnosis and treatment of mycobacterial infection.
近年来，全球范围内非结核分枝杆菌（NTM）相关死亡的发生率有所上升。为了获取中国中南部地区NTM肺部感染病原体的种类及特征信息，我们从3995例抗酸杆菌（AFB）阳性的疑似结核病例中鉴定出160例非结核感染病例。然后，我们随机选取了101例非结核患者，从其痰液中分离细菌，并使用16S rRNA基因和16S - 23S rRNA内部转录间隔序列对病原体进行基因分型。在这些分离株中鉴定出胞内分枝杆菌（32.67%，33/101）、脓肿分枝杆菌（32.67%，33/101）和偶然分枝杆菌（7.92%，8/101）。令人惊讶的是，还发现了包括戈登氏菌（8.91%，9/101）、诺卡氏菌（5.94%，6/101）和冢村菌属（0.99%，1/101）在内的非分枝杆菌，并且肺部冢村菌感染病例是在中国中南部地区首次发现。此外，还鉴定出黏液产孢分枝杆菌组、中部分枝杆菌、堪萨斯分枝杆菌、胃分枝杆菌、鸟分枝杆菌、猪分枝杆菌和耻垢分枝杆菌等菌种。另外，发现9例免疫功能低下病例（8.91%，9/101），包括2型糖尿病和HIV/AIDS患者感染了非结核细菌。本研究揭示了中国中南部地区非结核AFB病原体感染的分布及特征，并提示医生应警惕AFB阳性病例中NTM和非分枝杆菌感染的出现，在为类似结核的肺部感染选择化疗方案时要谨慎。总体而言，本研究可能有助于制定新的分枝杆菌感染诊断和治疗策略。
