López-Varela Elisa, García-Basteiro Alberto L, Augusto Orvalho J, Fraile Oscar, Bulo Helder, Ira Tasmiya, Gondo Kizito, van Ingen Jakko, Naniche Denise, Sacarlal Jahit, Alonso Pedro L
Centro de Investigação em Saude de Manhiça (CISM), Maputo, Mozambique.
ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain.
PLoS One. 2017 Jan 17;12(1):e0169757. doi: 10.1371/journal.pone.0169757. eCollection 2017.
Non-tuberculous mycobacteria (NTM) can cause disease which can be clinically and radiologically undistinguishable from tuberculosis (TB), posing a diagnostic and therapeutic challenge in high TB settings. We aim to describe the prevalence of NTM isolation and its clinical characteristics in children from rural Mozambique.
This study was part of a community TB incidence study in children <3 years of age. Gastric aspirate and induced sputum sampling were performed in all presumptive TB cases and processed for smear testing using fluorochrome staining and LED Microscopy, liquid and solid culture, and molecular identification by GenoType® Mycobacterium CM/AS assays.
NTM were isolated in 26.3% (204/775) of children. The most prevalent NTM species was M. intracellulare (N = 128), followed by M. scrofulaceum (N = 35) and M. fortuitum (N = 9). Children with NTM were significantly less symptomatic and less likely to present with an abnormal chest radiograph than those with M. tuberculosis. NTM were present in 21.6% of follow-up samples and 25 children had the same species isolated from ≥2 separate samples. All were considered clinically insignificant and none received specific treatment. Children with NTM isolates had equal all cause mortality and likelihood of TB treatment as those with negative culture although they were less likely to have TB ruled out.
NTM isolation is frequent in presumptive TB cases but was not clinically significant in this patient cohort. However, it can contribute to TB misdiagnosis. Further studies are needed to understand the epidemiology and the clinical significance of NTM in children.
非结核分枝杆菌（NTM）可引发疾病，在临床和影像学上与结核病（TB）难以区分，这在结核病高发地区构成了诊断和治疗方面的挑战。我们旨在描述莫桑比克农村地区儿童中NTM分离株的流行情况及其临床特征。
本研究是一项针对3岁以下儿童社区结核病发病率研究的一部分。对所有疑似结核病病例进行胃抽吸物和诱导痰采样，并采用荧光染色和LED显微镜进行涂片检测、液体和固体培养，以及通过GenoType®分枝杆菌CM/AS检测进行分子鉴定。
在775名儿童中，26.3%（204/775）分离出NTM。最常见的NTM菌种是胞内分枝杆菌（N = 128），其次是瘰疬分枝杆菌（N = 35）和偶然分枝杆菌（N = 9）。与结核分枝杆菌感染的儿童相比，NTM感染的儿童症状明显较轻，胸部X线片异常的可能性也较小。在21.6%的随访样本中发现了NTM，25名儿童从≥2个独立样本中分离出相同菌种。所有这些都被认为临床意义不大，且无人接受特异性治疗。NTM分离株阳性的儿童与培养阴性的儿童全因死亡率相同，接受结核病治疗的可能性也相同，尽管他们被排除结核病的可能性较小。
在疑似结核病病例中，NTM分离较为常见，但在本患者队列中临床意义不大。然而，它可能导致结核病误诊。需要进一步研究以了解儿童NTM的流行病学和临床意义。
