在印度南部，疑似肺结核和肺外结核患者中非结核分枝杆菌的流行情况和种型分布。
Prevalence and speciation of non-tuberculous mycobacteria among pulmonary and extrapulmonary tuberculosis suspects in South India.
机构信息
Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India.
Department of Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India.
出版信息
J Infect Public Health. 2021 Mar;14(3):320-323. doi: 10.1016/j.jiph.2020.12.027. Epub 2021 Feb 19.
BACKGROUND AND OBJECTIVES
Non tuberculous mycobacteria (NTM) is an emerging opportunistic pathogen increasing globally and indistinguishable from tuberculosis (TB), which remains a challenge particularly in developing countries. This study aimed to identify the prevalence and diversity of NTM among both pulmonary TB (PTB) and extrpulmonary TB (EPTB) clinical isolates from south India.
METHODOLOGY
A total of 7633 specimens from TB suspects (PTB, n = 4327 and EPTB, n = 3306) were collected during the study period (July 2018-March 2020) in a tertiary care hospital. The study specimens were subjected to Ziehl Neelsen (ZN) staining and Auramine phenol (AP) staining followed by Lowenstein-Jensen (LJ) and mycobacteria growth indicator tube (MGIT) culture. The MPT64 immunochromatographic test (ICT) was performed among mycobacterial cultures and ICT negative isolates were subjected to Line Probe Assay (LPA). In addition, 53 (PTB, 48 and EPTB, 5) NTM MGIT positive cultures were collected from Intermediate Reference Laboratory (IRL), Puducherry and subjected to LPA for speciation.
RESULTS
Of the 7633 TB suspects, 0.6% were diagnosed as NTM diseases and 5.5% with Mycobacterium tuberculosis (MTBC). NTM infection was observed among 0.7% (31/4327) of PTB and 0.4% (14/3306) of EPTB. MTBC was detected among 6.1% (264/4327) of PTB and 4.6% (153/3306) of EPTB. Among 98 NTM cultures, 80.6% of isolates were recovered from PTB and 19.4% from EPTB specimens. Among pulmonary specimens, Mycobacterium intracellulare (26.6%), Mycobacterium abscessus (17.7%) and Mycobacterium kansasii (12.7%) were the most frequently detected species, while Mycobacterium intracellulare (21.1%), Mycobacterium scrofulaceum (15.8%) and Mycobacterium fortuitum (10.5%) were common in extrapulmonary specimens.
CONCLUSION
The frequency of NTM infection among TB suspects was low at a South Indian tertiary care hospital. The most predominant NTM species isolated from both pulmonary and extrapulmonary specimens was M. intracellulare.
背景和目的
非结核分枝杆菌（NTM）是一种新兴的机会性病原体，在全球范围内不断增加，与结核病（TB）无法区分，这在发展中国家仍是一个挑战。本研究旨在鉴定来自印度南部的肺结核（PTB）和肺外结核（EPTB）临床分离株中 NTM 的流行率和多样性。
方法
在这项研究期间（2018 年 7 月至 2020 年 3 月），从一家三级护理医院收集了 7633 份疑似结核病（PTB，n=4327 份和 EPTB，n=3306 份）患者的标本。研究标本进行齐-尼氏（ZN）染色和金胺酚（AP）染色，然后进行 Lowenstein-Jensen（LJ）和分枝杆菌生长指示剂管（MGIT）培养。在分枝杆菌培养物中进行 MPT64 免疫色谱检测（ICT），ICT 阴性的分离物进行线探针分析（LPA）。此外，从 Puducherry 的中级参考实验室（IRL）收集了 53 株（PTB，48 株和 EPTB，5 株）NTM MGIT 阳性培养物，进行 LPA 鉴定。
结果
在 7633 例疑似结核病患者中，0.6%被诊断为 NTM 疾病，5.5%为结核分枝杆菌（MTBC）。在 0.7%（31/4327）的 PTB 和 0.4%（14/3306）的 EPTB 患者中观察到 NTM 感染。MTBC 分别在 6.1%（264/4327）的 PTB 和 4.6%（153/3306）的 EPTB 患者中检出。在 98 株 NTM 培养物中，80.6%的分离株来自 PTB，19.4%来自 EPTB 标本。在肺部标本中，最常检测到的物种是细胞内分枝杆菌（26.6%）、脓肿分枝杆菌（17.7%）和堪萨斯分枝杆菌（12.7%），而在肺外标本中，最常见的物种是细胞内分枝杆菌（21.1%）、瘰疬分枝杆菌（15.8%）和偶发分枝杆菌（10.5%）。
结论
在印度南部的一家三级护理医院，疑似结核病患者的 NTM 感染率较低。从肺和肺外标本中分离到的最主要的 NTM 物种是细胞内分枝杆菌。
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