Mycobacterial infections in reptiles

Mycobacteriosis is an important disease worldwide. Although commonly associated with higher vertebrates, including humans, it has been reported in only a handful of reptile cases. The purpose of this article is to review the literature as it relates to mycobacteriosis in reptiles. Knowledge of the epidemiology of this disease can be useful to veterinarians working with these animals, especially when working on a diagnosis and making recommendations to clients regarding the need for case follow-up to rule in or rule out the potential presence of these pathogens in pet reptiles and best handling practices to minimize their exposure.

Mycobacteriosis in the rabbit and rodent

Spontaneous mycobacteriosis is rare in rabbits and rodents with the exception of the pygmy rabbit, and there are only a handful of reported cases involving other rodents. Mycobacterium avium complex was the most commonly identified organism in reports of spontaneous mycobacteriosis involving rabbits and rodents. The resistance of rabbits and rodents to mycobacterial disease has been useful in understanding the disease in humans and other animals. Preventing or controlling Mycobacterium sp transmission from wildlife to domestic animals will require collaboration between agriculture, wildlife, environmental, and political entities. Understanding the ecology and epidemiology of mycobacteria is needed for better worldwide management of tuberculosis.

[Nontuberculous mycobacterial lung infections]

Diagnosis of nontuberculous mycobacterial infection, which most often cause pulmonary disease, are increasing. Only a few of the numerous mycobacteria species are clearly pathogenic. Patients, either immunocompetent or immunocompromised, with orwithout underlying disease, are contaminated from the environment. Diagnosis, according to standardized criteria, is based on clinical picture, radiological exams and positive microbiological samples, usually on more than one occasion (slow growing culture and PCR). There are several typical presentations, such as tuberculosis-like disease and lung nodules associated with bronchiectasis. Treatment combines several antimicrobials, is long (occasionally more than one year) and is not always successful.

Isolation-drug resistance profile and molecular characterization of indigenous typical and atypical mycobacteria

One hundred and fifty mycobacterial isolates from different pathological Labs. of Karachi were collected and screened as acid fast. On the bases of phenotypic and biochemical results, it was found that, 58.66% isolates were typical mycobacteria while 41.33% belonged to atypical mycobacteria. The individual percentages of different mycobacterial species include: M. xenopi 35%, M. thermoresistible 19 %, M. terrae complex 6 %, M. marinum 6 %, M. fortuitum 6 %, M. kansasii 25 % and M. tuberculosis 58.66 %. The sensitivity of mycobacterial isolates was determined against 5 first line, 3 second line and 1 third line anti-tuberculosis drugs. The highest number of the isolates (typical and atypical mycobacteria) offered resistance against isoniazid and streptomycin. Clarithromycin was found to be the drug of choice as regards the drug sensitivity in case of atypical mycobacterial isolates. A total of 40 isolates were subjected to PCR based identification and differentiation of 16S rRNA gene(s). Accordingly, 37.5% isolates were identified as typical mycobacteria while 25% were identified as atypical mycobacteria. These findings carry significance because a detailed research based identification (PCR and Multiplex PCR based) regarding indigenous mycobacteria has been reported for the first time in Pakistan. However, both the approaches (conventional and molecular methods) have experimental importance while identifying these organisms.

Characterization and management of asymptomatic Mycobacterium infections at the Zebrafish International Resource Center

The Zebrafish International Resource Center (ZIRC) supplies wildtype, mutant, and transgenic zebrafish (Danio rerio) to the international research community. In 2005, the ZIRC halted shipment of adult Tübingen (TU) zebrafish, a popular wildtype line, after diagnosis of asymptomatic Mycobacterium chelonae infections in a high proportion of the TU stock. Mycobacterium presents a zoonotic risk to fish handlers. In addition, the presence of underlying chronic disease in a model organism is unacceptable. The TU stock was depopulated and replaced by a new import of TU with the intent of reducing disease prevalence. In the current study, we sampled the new population of TU and fish of the AB, Tupfel long-fin (TL), TAB5 and TAB14 (2 AB × TU hybrid lines), and wildtype-in-Kalkutta (WIK) lines for histologic evaluation and acid-fast staining and compared the prevalence of subclinical mycobacteriosis between these lines. Although prevalence in the new TU stock was lower than that of the original TU stock, asymptomatic infections with Mycobacterium remained high (10%) in the new TU stock held in 20-gal tanks. The prevalence was similar (10%) in the TAB5 line compared with other wildtype lines held in similar conditions. Prevalence of infections in TU can be minimized by husbandry adjustments, including tank size, population density, and cleaning method. Application of these findings has allowed us to decrease mycobacteriosis in TU zebrafish and resume shipment of TU adults to the research community.

Characterization of photochromogenic Mycobacterium spp. from Chesapeake Bay striped bass Morone saxatilis

A large diversity of Mycobacterium spp. has been isolated from striped bass Morone saxatilis in Chesapeake Bay, USA. The new species M. shottsii and M. pseudoshottsii are the dominant isolates, while the classical fish pathogen M. marinum is found much less frequently. M. fortuitum and M. chelonae, other Mycobacterium spp. known to commonly infect fishes, have not yet been aseptically isolated from striped bass within Chesapeake Bay. While M. pseudoshottsii and M. shottsii have been phenotypically and genotypically characterized, other less common mycobacterial isolates have not. In the present study, we describe 17 photochromogenic isolates from Chesapeake Bay striped bass using phenotypic characterization and multilocus sequencing of 16S rRNA, hsp65 and rpoB genes. Genetic characterization reveals that these isolates are related to widely divergent portions of the mycobacterial phylogeny; however, some interesting trends are observed, such as a majority of isolates (10/17) belonging to the M. simiae-related grouping. Five additional isolates were assigned to the slow-growing mycobacteria (including 2 identified as M. marinum), while 2 are clearly shown to belong genetically to the fast-growing mycobacteria.

Mycobacterium salmoniphilum infection in burbot Lota lota

Burbot Lota lota sampled from lakes Mjosa and Losna in southeastern Norway between 2005 and 2008 were found to be infected with Mycobacterium salmoniphilum at a culture-positive prevalence of 18.6 and 3.3%, respectively. The condition factor (CF) of mycobacteria-affected fish sampled from Mjøsa in 2008 was lower than the average CF of total sampled fish the same year. Externally visible pathological changes included skin ulceration, petechiae, exopthalmia and cataract. Internally, the infections were associated with capsulated, centrally necrotic granulomas, containing large numbers of acid-fast bacilli, found mainly in the mesenteries, spleen, heart and swim bladder. Mycobacterial isolates recovered on Middlebrook 7H10 agar were confirmed as M. salmoniphilum by phenotypical investigation and by partial sequencing of the 16S rRNA, rpoB and Hsp65genes as well as the internal transcribed spacer (ITS1) locus. This study adds burbot to the list of fish species susceptible to piscine mycobacteriosis and describes M. salmoniphilum infection in a non-salmonid fish for the first time.

The reliability of diagnostic coding and laboratory data to identify tuberculosis and nontuberculous mycobacterial disease among rheumatoid arthritis patients using anti-tumor necrosis factor therapy

PURPOSE

Anti-tumor necrosis factor-alpha (anti-TNF) therapies are associated with severe mycobacterial infections in rheumatoid arthritis patients. We developed and validated electronic record search algorithms for these serious infections.

METHODS

The study used electronic clinical, microbiologic, and pharmacy records from Kaiser Permanente Northern California (KPNC) and the Portland Veterans Affairs Medical Center (PVAMC). We identified suspect tuberculosis and nontuberculous mycobacteria (NTM) cases using inpatient and outpatient diagnostic codes, culture results, and anti-tuberculous medication dispensing. We manually reviewed records to validate our case-finding algorithms.

RESULTS

We identified 64 tuberculosis and 367 NTM potential cases, respectively. For tuberculosis, diagnostic code positive predictive value (PPV) was 54% at KPNC and 9% at PVAMC. Adding medication dispensings improved these to 87% and 46%, respectively. Positive tuberculosis cultures had a PPV of 100% with sensitivities of 79% (KPNC) and 55% (PVAMC). For NTM, the PPV of diagnostic codes was 91% (KPNC) and 76% (PVAMC). At KPNC, ≥ 1 positive NTM culture was sensitive (100%) and specific (PPV, 74%) if non-pathogenic species were excluded; at PVAMC, ≥1 positive NTM culture identified 76% of cases with PPV of 41%. Application of the American Thoracic Society NTM microbiology criteria yielded the highest PPV (100% KPNC, 78% PVAMC).

CONCLUSIONS

The sensitivity and predictive value of electronic microbiologic data for tuberculosis and NTM infections is generally high, but varies with different facilities or models of care. Unlike NTM, tuberculosis diagnostic codes have poor PPV, and in the absence of laboratory data, should be combined with anti-tuberculous therapy dispensings for pharmacoepidemiologic research.

Species identification of neglected nontuberculous mycobacteria in a developing country

In developing countries where tuberculosis is still a health challenge, the prevalence of nontuberculous mycobacterial diseases is expected to rise as medical conditions that compromise the immune system become more widespread. In the current study, we aimed to determine the presence and diversity of nontuberculous mycobacteria (NTM) causing infections in Iranian patients. Sixty-seven clinical NTM isolates were identified using conventional and molecular methods, including PCR-restriction fragment length polymorphism analysis (PRA) and 16S rRNA sequencing. Out of 67 patients with confirmed mycobacterial infection, 29 had an associated immunosuppressive syndrome, including 9 who were HIV-infected. Forty-nine NTM isolates were identified using PRA, and the remaining 18 isolates were identified using 16S rRNA sequencing. We obtained the following results: Mycobacterium fortuitum, 30 isolates; M. kansasii, 12 isolates; M. gordonae, 8 isolates; M. porcinum, 3 isolates; M. conceptionense, 3 isolates; M. phlei, 2 isolates; and M. austroafricanum, M. avium, M. elephantis, M. intracellulare, M. lentiflavum, M. monacense, M. parascrofulaceum, and M. thermoresistibile, 1 isolate each; and 1 potentially novel mycobacterial species. With regard to the complexity of identification, it is recommended that laboratory diagnosis of NTM diseases be centralized by strengthening or setting up quality national and regional infrastructure.

[Lymphadenitis caused by nontuberculous mycobacteriae]

Lymphadenitis caused by nontuberculous mycobacteriae has been increasingly seen in Finland since the cessation of universal BCG vaccination in 2006. An otherwise healthy child develops a slowly growing unilateral mass in the cervicofacial region. Without treatment, the lymphadenitis suppurates and forms a draining sinus, which dries after some weeks or months, leaving a scar. Surgical excision is curative treatment but cannot always be performed because of risk to the facial nerve or need of extensive surgery. In these cases, observation without antimicrobial treatment is usually recommended. The parents need professional information and support.

Nontuberculous mycobacterial lung disease prevalence at four integrated health care delivery systems

RATIONALE

Single-site clinic-based studies suggest an increasing prevalence of pulmonary nontuberculous mycobacteria (NTM) disease, but systematic data are lacking.

OBJECTIVES

To describe prevalence and trends for NTM lung disease at four geographically diverse integrated heath care delivery systems in the United States.

METHODS

We abstracted mycobacterial culture results from electronic laboratory databases and linked to other datasets containing clinical and demographic information. Possible cases were defined as a single positive NTM pulmonary isolate, and definite cases were defined as two positive sputum cultures, or one positive culture from a bronchoalveolar lavage or lung biopsy. Annual prevalence was calculated using United States census data; average annual prevalence is presented for 2004-2006. Poisson regression models were used to estimate the annual percent change in prevalence.

MEASUREMENTS AND MAIN RESULTS

A total of 28,697 samples from 7,940 patients were included in the analysis. Of these, 3,988 (50%) were defined as possible cases, and 1,865 (47%) of these were defined as definite cases. Average annual (2004-2006) site-specific prevalence ranged from 1.4 to 6.6 per 100,000. Prevalence was 1.l- to 1.6-fold higher among women relative to men across sites. The prevalence of NTM lung disease was increasing significantly at the two sites where trends were studied, by 2.6% per year among women and 2.9% per year among men. Among persons aged greater than or equal to 60 years, annual prevalence increased from 19.6 per 100,000 during 1994-1996 to 26.7 per 100,000 during 2004-2006.

CONCLUSIONS

The epidemiology of nontuberculous mycobacterial lung disease is changing, with a predominance of women and increasing prevalence at the sites studied.

Evaluation of Hypersensitivity Pneumonitis Among Workers Exposed to Metal Removal Fluids

Hypersensitivity pneumonitis (HP) was identified among employees in an automobile parts manufacturing facility. Mycobacteria immunogenum (MI) was identified as a metal removal fluid (MRF) contaminant at this facility and had been identified as a contaminant in other facilities where HP had occurred. We therefore questioned whether measurement of MI-specific cell-mediated immunity would be associated with HP in this facility. We also questioned whether measures of cell-mediated immunity would be more informative about the presence of HP than evaluation of serum anti-MI antibody levels. Workers were categorized for exposure and disease status by questionnaire and review of medical records. Cell-mediated immunity to MI was assessed by measuring in vitro secretion of cytokines (interleukin 8, tumor necrosis factor alpha, and interferon-gamma) from peripheral blood mononuclear cells or anticoagulated whole blood induced by culture with MI antigen. Serum antibodies against MI were also measured. Six study participants met our survey definition for HP and 48 did not. As has been reported for various agents causing HP, serum antibody levels against MI were increased in both exposed workers and workers with HP. Serum antibodies did not distinguish between the two. When expressed as a percentage of secretion induced by lipopolysaccharide, MI induced a significant increase in interleukin-8 secretion in exposed participants' whole blood cultures. There were trends for increased MI-induced secretion of interferon-gamma by peripheral blood mononuclear cells from both exposed workers and workers with HP. However, these trends did not attain statistical significance. Thus, several measures of immunity to MI distinguished between exposed and unexposed workers but not between workers with and without HP. These evaluations of cell-mediated immunity were not more informative than measurement of serum antibodies. As was done at this facility, institution of a comprehensive safety and health plan for MRF is necessary to eliminate (or minimize) health effects related to occupational exposures in the machining environment.

Nontuberculous mycobacterial cervicofacial lymphadenitis in children from the multicenter, randomized, controlled trial in The Netherlands: relevance of polymorphisms in candidate host immunity genes

OBJECTIVE

The annual incidence of nontuberculous mycobacterial (NTM) cervicofacial lymphadenitis in otherwise healthy children is unexpectedly high (8 per million). It mostly arises as localized cervicofacial lymphadenitis. Previous research has suggested environmental risk factors for oral exposure to NTM and a temporal association with eruption of teeth. We studied 22 polymorphisms in relevant candidate genes, some related to periodontitis, in children with NTM lymphadenitis. We also tested for the most common mutation in IFNGR1.

METHODS

We analyzed DNA from 81 Dutch children with NTM from a nationwide surveillance study and 215 community controls for 22 polymorphisms in CD209, IL1B, IL8, IL10, IL12B, IL12RB1, IL18, PTX3, TLR4, TNF, VDR and SLC11A1 by MassArray platform (Sequenom) and CONTING. We screened for 818del4 in IFNGR1 by PCR and VspI restriction enzyme cleavage.

RESULTS

We found a positive association between NTM lymphadenitis and +3953TT in IL1B (OR 2.9; 95%-CI: 1.2-7.2). Furthermore, our results showed that -592C/A heterozygosity in IL10 is linked to protection from disease (OR 0.54; 95%-CI: 0.3-0.95), but that other polymorphisms were unrelated to localized NTM disease. However, these associations were not robust to Bonferroni's correction for multiple testing. None of the children carried the IFNGR1 818del4 mutation.

CONCLUSIONS

Dominance of environmental factors over genetic ones and insufficient sample size might explain the fragility of this study's results. Nevertheless, the association between NTM lymphadenitis and 3953C>T, a polymorphism previously linked to periodontitis, supports our hypothesis that oral exposure to mycobacteria during eruption of teeth plays a role in the etiology of cervical NTM lymphadenitis.

Low prevalence of splenic mycobacteriosis in migratory striped bass Morone saxatilis from North Carolina and Chesapeake Bay, U.S.A

Mycobacteriosis is a chronic bacterial disease causing an ongoing epizootic in striped bass Morone saxatilis in Chesapeake Bay, U.S.A. Prevalence of disease is high in pre-migratory fish, and multiple species of Mycobacterium spp. have been isolated. However, prevalence of mycobacteriosis in the coastal migratory population is unknown and is of concern to multiple coastal states, as disease-related mortality may impact the long-term health of the population. Histological examinations of spleens collected from fish caught by recreational anglers during the winter fishery in coastal North Carolina (2005-2006, n=249) and during the spring fishery in Chesapeake Bay (2006, n=120) indicated a low prevalence of mycobacteriosis (6.8% of all fish examined) in comparison to smaller, pre-migratory Chesapeake Bay fish. Genus-level PCR and subsequent sequencing of the 16-23S intergenic transcribed spacer (ITS) region revealed that all bacteria were phylogenetically related, but species is unknown. Location of survey, gender of fish, and total length of fish had no significant effect on prevalence of mycobacteriosis, parasitic granulomas, or the density of splenic granulomas (p > 0.05). These results may indicate that either granulomas resolve after Chesapeake Bay fish enter the coastal migratory population, or that there is disease-related mortality among pre-migratory Chesapeake Bay fish.

Nontuberculous mycobacteria: susceptibility pattern and prevalence rate in Shanghai from 2005 to 2008

BACKGROUND

An increasing incidence of disease caused by nontuberculous mycobacteria (NTM) is being reported. The purpose of this study was to determine the isolation rates of NTM from various clinical specimens, and their antimicrobial susceptibility patterns, over a 4-year period in Shanghai.

METHODS

All NTM isolated between 2005 and 2008 at Shanghai Pulmonary Hospital, a key laboratory of mycobacteria tuberculosis in Shanghai, China, were identified with conventional biochemical tests and 16S rRNA gene sequencing. Antimicrobial susceptibility for all NTM was determined using the BACTEC MGIT 960 system.

RESULTS

A total of 21,221 specimens were cultured, of which 4868 (22.94%) grew acid fast bacilli (AFB), and 248 (5.09%) of the AFB were NTM. The prevalence rate of NTM was determined as 4.26%, 4.70%, 4.96% and 6.38% among mycobacteria culture positive samples in years 2005, 2006, 2007 and 2008 respectively. These data indicated that the prevalence rate has continuously increased. Sixteen different species of NTM were identified, the most commonly encountered NTM in Shanghai were M. chelonae (26.7%), followed by M. fortuitum (15.4%), M. kansasii (14.2%), M. avium-intracellulare complex (13.1%) and M. terrae (6.9%). The rare species identified were M. marinum, M. gastri, M. triviale, M. ulcerans, M. smegmatis, M. phlci, M. gordonae, M. szulgai, M. simiae, M. scrofulaceum and M. xenopi. The five most commonly identified NTM species showed high drug resistance to general anti-tuberculosis drugs, particularly, M. chelonae and M. fortuitum appear to be multi-drug resistance.

CONCLUSIONS

The prevalence of NTM in Shanghai showed a tendency to increase over the course of the study. The five most commonly isolated NTM species showed high drug resistance to first line anti-tuberculosis drugs.

[Disease due to Mycobacterium simiae and "Mycobacterium sherrisii" in Argentina]

A revision of mycobacterial disease due to M simiae (n = 4) and "M. sherrisii" (n = 6) identified during an eight-year period is presented. Cases occurred among patients with AIDS (n = 6), previous history of silicosis (n = 2) or tuberculosis (n = 2). One case was lost to follow-up and the remaining nine responded poorly to chemotherapy based on clarithromycin, ethambutol and fluoroquinolones. Five patients died of whom four were HIV-positive, three remained chronic and one was cured. These microorganisms originated 2.1% of mycobacterioses cases detected in an eight-year period. Timely identification of this group of uncommon mycobacteria by molecular methods seems to be clinically relevant in order to warn of difficulties inherent to the treatment. However, the distinction between both closely related microorganisms might not be crucial for case management as no distinctive characteristics were evident among patients affected by M. simiae or "M. sherrisii".

Husbandry stress exacerbates mycobacterial infections in adult zebrafish, Danio rerio (Hamilton)

Mycobacteria are significant pathogens of laboratory zebrafish, Danio rerio (Hamilton). Stress is often implicated in clinical disease and morbidity associated with mycobacterial infections but has yet to be examined with zebrafish. The aim of this study was to examine the effects of husbandry stressors on zebrafish infected with mycobacteria. Adult zebrafish were exposed to Mycobacterium marinum or Mycobacterium chelonae, two species that have been associated with disease in zebrafish. Infected fish and controls were then subjected to chronic crowding and handling stressors and examined over an 8-week period. Whole-body cortisol was significantly elevated in stressed fish compared to non-stressed fish. Fish infected with M. marinum ATCC 927 and subjected to husbandry stressors had 14% cumulative mortality while no mortality occurred among infected fish not subjected to husbandry stressors. Stressed fish, infected with M. chelonae H1E2 from zebrafish, were 15-fold more likely to be infected than non-stressed fish at week 8 post-injection. Sub-acute, diffuse infections were more common among stressed fish infected with M. marinum or M. chelonae than non-stressed fish. This is the first study to demonstrate an effect of stress and elevated cortisol on the morbidity, prevalence, clinical disease and histological presentation associated with mycobacterial infections in zebrafish. Minimizing husbandry stress may be effective at reducing the severity of outbreaks of clinical mycobacteriosis in zebrafish facilities.

Nontuberculous mycobacterial lung disease in southern Taiwan

BACKGROUND

The aim of this study was to assess the prevalence of the major nontuberculous mycobacterium (NTM) species and the outcome of their treatment in southern Taiwan (a high-prevalence area for mycobacterium tuberculosis [MTB]).

METHODS

The study was a retrospective review of patients with NTM pulmonary disease at the Kaohsiung Chang Gung Memorial Hospital from 2004 to 2005. The variables recorded and analyzed included demographics, particularly age and gender; primary clinical presentations; chest radiographic findings; risk factors; medication and outcome of treatment.

RESULTS

The study included 67 patients with NTM pulmonary disease. The average age was 66.6+/-14.5 years and they were predominantly male (70.1%). Of these patients, 88.1% had pre-existing lung disease, with chronic obstructive pulmonary disease (61.2%) and TB (58.2%) as the main underlying lung diseases. Rapid-growth species (M. abscessus, 44.8% and M. fortuitum, 23.9%)were the most commonly isolated species. Of the forty patients that were treated and followed up for at least one year, 31 had a favorable outcome (mean duration of therapy, 8.46+/-2.96 months).

CONCLUSIONS

The predominant species in southern Taiwan differ from those in other countries as well as in northern Taiwan, with rapid-growth species predominating in southern Taiwan.

Expanded range and new host species of Mycobacterium shottsii and M. pseudoshottsii

Mycobacterium shottsii and M. pseudoshottsii are recently described mycobacteria commonly isolated from Chesapeake Bay striped bass Morone saxatilis. However, their distribution in striped bass outside of the Chesapeake region and their ability to infect alternative hosts have not been described. Mycobacteria identified as M. shottsii (based on fatty acid methyl ester analysis and multigene sequencing) were isolated from striped bass collected in Albemarle Sound, North Carolina, and white perch Morone americana in the Rhode River, Maryland, and detected in striped bass from the New York Bight off Long Island, New York. Mycobacterium pseudoshottsii were isolated from white perch in the Rhode and Corsica rivers, Maryland, and detected in striped bass in the New York Bight. This work demonstrates that these mycobacteria can be found outside of the Chesapeake Bay as well as in hosts other than striped bass.

Mycobacterial species diversity at a general hospital on the island of Crete: First detection of Mycobacterium lentiflavum in Greece

The objective of the present study was to investigate the diversity of mycobacterial isolates in a general hospital in Crete, Greece. 48 positive Lowenstein-Jensen cultures over a 3-y period were analysed by means of AccuProbe and GenoType assays. Non-tuberculous mycobacteria (NTM) comprised the majority of the isolates (56.3%, 27/48) vs 33.3% (16/48) of M. tuberculosis; 10.4% of the isolates could not be classified. Among NTM, M. lentiflavum was the predominant species isolated (9/27) followed by M. kansasii, M. gordonae and M. peregrinum, whereas no M. avium complex isolates were detected. This is the first detection of M. lentiflavum in Greece. The susceptibilities of the M. lentiflavum isolates to an extended panel of antibiotics were determined by the proportions method and the medical files of the 9 patients were reviewed. Three isolates were from urine, which is an unusual site. All strains exhibited multidrug resistance. The patients were adults with immunosuppression or predisposing conditions for NTM infection. Diagnosis of true infection was either not pursued or the patients died shortly after isolation.

Non-tuberculous mycobacterial infections

Non-tuberculous mycobacteria (NTM) are ubiquitous environmental organisms in contrast to those belonging to the M. tuberculosi complex (MTB). NTM infects and causes disease only in hosts with local or general predisposing factors. Lung infection following inhalation of NTM is the most common NTM disease but soft tissue infections may occur in connection with contaminated trauma or surgery. Microbiological diagnosis is obtained by microscopy for acid-fast bacteria (AFB) on secretions or biopsies, and by culture on special media. With the high specificity of MTB- polymerase chain reaction (PCR), a positive AFB smear combined with negative MTB-PCR denotes infection with NTM. Sophisticated species diagnosis of cultured NTM is attained by various molecular methods, where 16S rDNA-sequencing remains the gold standard. The panorama of infection with different rapidly growing (RGM) or slowly growing mycobacteria (SGM) in Sweden is described. Sensitivity testing in vitro to antimycobacterial drugs against NTM does not always preclude the in vivo efficacy. Standard antimycobacterial treatment regimens have been defined for infection with several NTM species. Sensitivity testing should be performed in selected cases only, as in case of relapse or suspected development of resistance of the NTM strain. The spectrum of disease caused by NTM species that display a very low pathogenic potential is likely to widen over time as severe immunosuppression will continue to be prevalent in several patient categories.

Mycobacterium tuberculosis infection precipitates SLE in patients from endemic areas

In a cohort of 70 systemic lupus erythematosus (SLE) patients diagnosed over 2 years period, 14 patients were found to have confirmed antecedent tuberculosis (20.0%) which was 40 times higher (p < 0.001, 95%CI 36.2-48.6) than the prevalence of tuberculosis in the local population. Demonstration of anti-histone antibodies in similar proportion of SLE patients with and without antecedent anti-TB treatment and similar proportion of renal involvement (36 vs. 40%) between anti-TB drug exposed and non-exposed patients ruled out the drugs to be causative factors in precipitating SLE in these patients with antecedent history of tuberculosis. A cohort of 30 confirmed pulmonary tuberculosis patients were also studied in parallel to demonstrate high incidence of autoantibodies in these patients but no SLE. This study suggests a role of prior tuberculosis in precipitating SLE in genetically predisposed patients.

[The detection rate of different species of non-tuberculous mycobacteria in Moscow]

The centralized microbiological laboratory of the Moscow Scientific-and-Practical Center for Tuberculosis Control (MSPCTC) conducted studies to isolate and identify mycobacterial cultures from clinical materials (sputum, bronchial and bronchoalveolar lavages) that had come from Moscow tuberculosis facilities in August 2005 to November 2008. The isolated mycobacterial cultures were identified by microbiological studies, high-performance liquid chromatography, and restriction fragment length polymorphism analysis of the hsp65 gene by means of the MAIS Dif test system developed at the MSPCTC. During the investigation, 117579 inoculations were made; 15786 (13.4%) of mycobacterial cultures were isolated, which included 15333 (97.1%) M. tuberculosis complex (MAC) cultures and 490 non-tuberculous mycobacteria (NTM) ones that amounted to 3.1% of the total number of the mycobacterial cultures isolated in this period. Two thirds of mycobacteria were referred to as slowly growing NTM (according to the Runyon classification; among them there were predominant MAC (32.40%), M. kansasii (14.7%), and M. xenopi (13.9%). Among the rapidly growing mycobacteria, M. fortuitum (21%) and M. chelonae/abscessus complex (6.5%) were isolated. MAC was frequently detected in all the examined administrative districts of the city However, among the slowly growing NTMs, M. kansasii was identified in the South and West districts even at a greater rate; M. xenopi ranked first in the West district. Among the rapidly growing NTM, M. fortuitum was most common in all districts. M. chelonae/abscessus complex was next in the East district (these NTMs were undetectable in other districts).