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Dartois V, Dick T. Therapeutic developments for tuberculosis and nontuberculous mycobacterial lung disease. Nat Rev Drug Discov 2024; 23:381-403. [PMID: 38418662 PMCID: PMC11078618 DOI: 10.1038/s41573-024-00897-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 03/02/2024]
Abstract
Tuberculosis (TB) drug discovery and development has undergone nothing short of a revolution over the past 20 years. Successful public-private partnerships and sustained funding have delivered a much-improved understanding of mycobacterial disease biology and pharmacology and a healthy pipeline that can tolerate inevitable attrition. Preclinical and clinical development has evolved from decade-old concepts to adaptive designs that permit rapid evaluation of regimens that might greatly shorten treatment duration over the next decade. But the past 20 years also saw the rise of a fatal and difficult-to-cure lung disease caused by nontuberculous mycobacteria (NTM), for which the drug development pipeline is nearly empty. Here, we discuss the similarities and differences between TB and NTM lung diseases, compare the preclinical and clinical advances, and identify major knowledge gaps and areas of cross-fertilization. We argue that applying paradigms and networks that have proved successful for TB, from basic research to clinical trials, will help to populate the pipeline and accelerate curative regimen development for NTM disease.
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Affiliation(s)
- Véronique Dartois
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, USA.
- Department of Medical Sciences, Hackensack Meridian School of Medicine, Nutley, NJ, USA.
| | - Thomas Dick
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, USA
- Department of Medical Sciences, Hackensack Meridian School of Medicine, Nutley, NJ, USA
- Department of Microbiology and Immunology, Georgetown University, Washington, DC, USA
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A rabbit model to study antibiotic penetration at the site of infection for non-tuberculous mycobacterial lung disease: macrolide case study. Antimicrob Agents Chemother 2022; 66:e0221221. [PMID: 35099272 DOI: 10.1128/aac.02212-21] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Nontuberculous mycobacterial pulmonary disease (NTM-PD) is a potentially fatal infectious disease requiring long treatment duration with multiple antibiotics and against which there is no reliable cure. Among the factors that have hampered the development of adequate drug regimens is the lack of an animal model that reproduces the NTM lung pathology required for studying antibiotic penetration and efficacy. Given the documented similarities between tuberculosis and NTM immunopathology in patients, we first determined that the rabbit model of active tuberculosis reproduces key features of human NTM-PD and provides an acceptable surrogate model to study lesion penetration. We focused on clarithromycin, a macrolide and pillar of NTM-PD treatment, and explored the underlying causes of the disconnect between its favorable potency and pharmacokinetics, and inconsistent clinical outcome. To quantify pharmacokinetic-pharmacodynamic target attainment at the site of disease, we developed a translational model describing clarithromycin distribution from plasma to lung lesions, including the spatial quantitation of clarithromycin and azithromycin in mycobacterial lesions of two patients on long-term macrolide therapy. Through clinical simulations, we visualized the coverage of clarithromycin in plasma and four disease compartments, revealing heterogeneous bacteriostatic and bactericidal target attainment depending on the compartment and the corresponding potency against nontuberculous mycobacteria in clinically relevant assays. Overall, clarithromycin's favorable tissue penetration and lack of bactericidal activity indicated that its clinical activity is limited by pharmacodynamic rather than pharmacokinetic factors. Our results pave the way towards the simulation of lesion pharmacokinetic-pharmacodynamic coverage by multi-drug combinations, to enable the prioritization of promising regimens for clinical trials.
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Complete Genome Sequences of Mycobacterium kansasii Strains Isolated from Rhesus Macaques. GENOME ANNOUNCEMENTS 2017; 5:5/16/e00187-17. [PMID: 28428296 PMCID: PMC5399255 DOI: 10.1128/genomea.00187-17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Mycobacterium kansasii is a nontuberculous mycobacterium. It causes opportunistic infections with pulmonary and extrapulmonary manifestations. We report here the complete genome sequences of two M. kansasii strains isolated from rhesus macaques. We performed genome comparisons with human and environmental isolates of M. kansasii to assess the genomic diversity of this species.
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Lovell JP, Zerbe CS, Olivier KN, Claypool RJ, Frein C, Anderson VL, Freeman AF, Holland SM. Mediastinal and Disseminated Mycobacterium kansasii Disease in GATA2 Deficiency. Ann Am Thorac Soc 2016; 13:2169-2173. [PMID: 27607353 PMCID: PMC5291495 DOI: 10.1513/annalsats.201603-207bc] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 08/25/2016] [Indexed: 02/02/2023] Open
Abstract
RATIONALE Mycobacterium kansasii usually causes chronic pulmonary infections in immunocompetent patients. In contrast, disseminated M. kansasii disease is commonly associated with advanced human immunodeficiency virus infection, but is reported infrequently in other immunocompromised patients. OBJECTIVES To identify common clinical manifestations and potential risk factors for M. kansasii infection in patients with GATA2 deficiency. METHODS We reviewed M. kansasii disease associated with GATA2 deficiency at one institution and disease associated with primary and other immunodeficiencies reported in the literature. MEASUREMENTS AND MAIN RESULTS Nine patients with GATA2 deficiency developed M. kansasii infections. Six patients developed disseminated disease. All patients presented with significant mediastinal lymphadenopathy or abscesses. Seven patients had pulmonary risk factors, including six smokers. The majority of patients had low numbers of neutrophils, monocytes, B cells, CD4+ T cells, and natural killer cells. Other conditions associated with disseminated M. kansasii disease were thymic disorders and IFN-γ/IL-12 defects. CONCLUSIONS Disseminated M. kansasii disease involving mediastinal lymph nodes is surprisingly common in GATA2 deficiency, but also occurs in defects of IFN-γ synthesis and response. Disseminated M. kansasii should be considered a marker indicating a need to evaluate for immunodeficiency syndromes.
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Affiliation(s)
- Jana P. Lovell
- Laboratory of Clinical Infectious Diseases, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, and
| | - Christa S. Zerbe
- Laboratory of Clinical Infectious Diseases, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, and
| | - Kenneth N. Olivier
- Pulmonary Clinical Medicine Section, Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland; and
| | - Reginald J. Claypool
- Laboratory of Clinical Infectious Diseases, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, and
| | - Cathleen Frein
- Clinical Research Directorate, Clinical Monitoring Research Program, Leidos Biomedical Research Inc., Frederick National Laboratory for Cancer Research, Frederick, Maryland
| | - Victoria L. Anderson
- Laboratory of Clinical Infectious Diseases, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, and
| | - Alexandra F. Freeman
- Laboratory of Clinical Infectious Diseases, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, and
| | - Steven M. Holland
- Laboratory of Clinical Infectious Diseases, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, and
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Sajduda A, Martin A, Portaels F, Palomino JC. hsp65 PCR-restriction analysis (PRA) with capillary electrophoresis for species identification and differentiation of Mycobacterium kansasii and Mycobacterium chelonae-Mycobacterium abscessus group. Int J Infect Dis 2012; 16:e193-7. [PMID: 22240012 DOI: 10.1016/j.ijid.2011.11.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Revised: 11/28/2011] [Accepted: 11/28/2011] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The aim of the present study was to identify and differentiate Mycobacterium kansasii and Mycobacterium chelonae-Mycobacterium abscessus group strains isolated from clinical and environmental sources in different countries. METHODS PCR-restriction analysis of the hsp65 gene (PRA) with automated capillary electrophoresis was applied to the isolates previously identified by conventional biochemical testing and the molecular INNO-LiPA MYCOBACTERIA assay. RESULTS PRA performed very well in comparison with the two other methods (96.4% concordance). Among 27 M. kansasii isolates, this method detected five genetic types, of which type 1 represented the most common clinical isolate, as it is worldwide. PRA differentiated 29 M. chelonae-M. abscessus group isolates into Mycobacterium immunogenum type 2 (n=13), M. chelonae (n=12), and M. abscessus types 1 (n=1) and 2 (n=1). M. immunogenum was the most frequent (69%) isolate from humans, but only one of 11 cases was clinically significant. M. chelonae was the most commonly (83%) recovered from water. PRA also identified two isolates with hsp65 alleles representing previously unreported patterns. CONCLUSIONS PRA based on automated capillary electrophoresis is a rapid, simple, and reliable method for the identification and differentiation of both clinically relevant and environmental isolates of M. kansasii and M. chelonae-M. abscessus group.
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Affiliation(s)
- Anna Sajduda
- Mycobacteriology Unit, Department of Microbiology, Institute of Tropical Medicine, Nationalestraat 155, B-2000 Antwerp, Belgium.
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Lillie PJ, Barlow GD, Moss PJ, Parsonage MJ, Adams K, Thaker HK. HIV seroconversion complicated by Mycobacterium kansasii infection. AIDS 2007; 21:650-2. [PMID: 17314530 DOI: 10.1097/qad.0b013e32803277e9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Manfredi R, Nanetti A, Valentini R, Ferri M, Morelli S, Calza L. Epidemiological, clinical and therapeutic features of AIDS-related Mycobacterium kansasii infection during the HIV pandemic: an 11-year follow-up study. HIV Med 2005; 5:431-6. [PMID: 15544696 DOI: 10.1111/j.1468-1293.2004.00249.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Optimal diagnosis and timely treatment of atypical mycobacteriosis, and especially Mycobacterium kansasii disease, remain a serious challenge for clinicians engaged in the management of the immunocompromised host. METHODS AND RESULTS From more than 2700 hospitalizations (over 1800 patients) attributable to HIV-associated disorders over an 11-year period, 12 patients were found to have a confirmed M. kansasii infection. This reflects the recent reduction in the frequency of this HIV-related complication, which virtually disappeared after the introduction of potent antiretroviral combinations in 1996. In the early 1990s, the lack of effective antiretroviral regimens made frequent the association with AIDS, a mean CD4 lymphocyte count of nearly 20 cells/microL, and an extremely variable chest X-ray features. The recent detection of a further case was attributable to late recognition of very advanced HIV disease, complicated by multiple opportunistic disorders. CONCLUSIONS Mycobacterium kansasii respiratory or disseminated infection continues to occur, and poses diagnostic problems in terms of late or missed identification as a result of slow culture and frequently concurrent opportunistic disease. Serious therapeutic difficulties also arise from the unpredictable in vitro antimicrobial susceptibility profile of these organisms, and from the need to start an effective combination therapy that does not interfere with other medications as soon as possible.
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Affiliation(s)
- R Manfredi
- Division of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Bologna, 'Alma Mater Studiorum', Bologna, Italy.
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Yano T, Okuda S, Kato KI, Kato K, Kishimoto T. Mycobacterium kansasii osteomyelitis in a patient with AIDS on highly active antiretroviral therapy. Intern Med 2004; 43:1084-6. [PMID: 15609709 DOI: 10.2169/internalmedicine.43.1084] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Skeletal infections with atypical mycobacteria are usually a manifestation of advanced HIV disease with most patients having CD4 counts of less than 100 cells/mm3. We report a case of Mycobacterium kansasii vertebral osteomyelitis on highly active antiretroviral therapy with a CD4 count of 320 cells/mm3 and viral load below the level of detection at the onset.
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Affiliation(s)
- Tomofumi Yano
- Department of Internal Medicine, Okayama Rosai Hospital, Okayama
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Marras TK, Morris A, Gonzalez LC, Daley CL. Mortality Prediction in PulmonaryMycobacterium KansasiiInfection and Human Immunodeficiency Virus. Am J Respir Crit Care Med 2004; 170:793-8. [PMID: 15215152 DOI: 10.1164/rccm.200402-162oc] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In the setting of human immunodeficiency virus (HIV) infection, the clinical implications of American Thoracic Society (ATS) diagnostic criteria and the significance of a single positive respiratory culture for Mycobacterium kansasii are unknown. We retrospectively studied HIV-infected patients with pulmonary M. kansasii isolated between 1989 and 2002 at one institution. Of 127 patients, 33% fulfilled ATS disease criteria. Twenty-nine percent received at least three active drugs for at least 3 months, and 53% died. In survival analysis, a lower CD4 count (hazard ratio [HR], 1.6; 95% confidence interval [CI], 1.1-2.3) and positive smear microscopy (HR, 2.8; 95% CI, 1.3-6.1) were associated with mortality, whereas antiretroviral therapy (HR, 0.3; 95% CI, 0.1-0.8) and M. kansasii treatment (HR, 0.4; 95% CI, 0.2-0.9) were associated with survival. ATS criteria did not predict mortality (HR, 0.9; 95% CI, 0.4-1.9). Fifteen patients (12%) apparently had indolent infection, not requiring immediate therapy. They had fewer positive cultures and lower rates of positive smear microscopy and ATS-defined disease. In HIV-infected patients with pulmonary M. kansasii infection, predictors of survival include higher CD4 counts, antiretroviral therapy, negative smear microscopy, and adequate treatment for M. kansasii infection, but not ATS diagnostic criteria. Withholding treatment in HIV-infected patients with respiratory M. kansasii isolates should only be considered with negative smear microscopy, few positive cultures, and mild immunosuppression.
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Affiliation(s)
- Theodore K Marras
- Department of Medicine (Respiratory), University of Toronto, Ontario, Canada.
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Marras TK, Daley CL. A Systematic Review of the Clinical Significance of Pulmonary Mycobacterium kansasii Isolates in HIV Infection. J Acquir Immune Defic Syndr 2004; 36:883-9. [PMID: 15220694 DOI: 10.1097/00126334-200408010-00001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Guidelines recommend treating HIV-infected patients with pulmonary Mycobacterium kansasii infection only in the presence of multiple positive cultures and clinical and radiographic abnormalities. Some authors suggest a single positive culture warrants treatment. A systematic literature review was done to determine whether HIV-infected patients who had M. kansasii isolated from respiratory specimens may have an indolent infection (often referred to as colonization) not requiring treatment and to determine the utility of diagnostic criteria in distinguishing disease from indolent infection. Sixteen studies were included, with at least 573 patients: mean age 44 years; 91% male; 64% men who had sex with men; 35% injection drug users; and median CD4 lymphocyte count of 2-381 cells/microL. The median rate of indolent infection was 8%. Of the few patients who did not satisfy diagnostic criteria and were left untreated, outcomes were generally favorable. Overall, survival was longer in treated patients (mean 12 vs. 4 months). Indolent pulmonary infection with M. kansasii may exist in the setting of HIV, but published data do not provide adequate information to identify such patients. It is unclear whether unfulfilled diagnostic criteria necessarily imply the absence of disease in this context.
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Affiliation(s)
- Theodore K Marras
- Department of Medicine, Division of Respirology, University of Toronto, Toronto Western Hospital, Ontario, Canada.
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Zhang Y, Mann LB, Wilson RW, Brown-Elliott BA, Vincent V, Iinuma Y, Wallace RJ. Molecular analysis of Mycobacterium kansasii isolates from the United States. J Clin Microbiol 2004; 42:119-25. [PMID: 14715741 PMCID: PMC321655 DOI: 10.1128/jcm.42.1.119-125.2004] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We studied the population genetics of Mycobacterium kansasii isolates from the United States by PCR restriction enzyme analysis (PRA) of the 441-bp Telenti fragment of the hsp-65 gene and pulsed-field gel electrophoresis (PFGE) of genomic DNA with the restriction endonucleases AseI, DraI, and XbaI, and we compared the patterns to those previously reported from France and Japan. By PRA, 78 of 81 clinical isolates (96%) from the United States belonged to subspecies I. With PFGE, 28 AseI patterns, 32 DraI patterns, and 35 XbaI patterns were produced. PFGE showed marked clonality of the U.S. isolates, with differences between genotypes involving only one or two bands. Isolates within Texas showed lower pattern diversity than those from different states. With DraI, 31 of 71 isolates (44%) had the same common PFGE pattern, which matched the predominant pattern in France (pattern Ia), determined by Picardeau et al. (M. Picardeau, G. Prod'hom, L. Raskine, M. P. LePennec, and V. Vincent, J. Clin. Microbiol. 35:25-32, 1997), and in Japan (type M), determined by Iinuma et al. (Y. Iinuma, S. Ichiyama, Y. Hasegawa, K. Shimokata, S. Kawahara, and T. Matsushima, J. Clin. Microbiol. 35:596-599, 1997). With AseI, 42% of isolates produced a common pattern indistinguishable from the common pattern seen in French isolates (Ia) and with only one band difference from the common pattern (type M) in Japan. This study demonstrates that subspecies I is the predominant subspecies of M. kansasii among clinical isolates in the United States, as it is in Europe and Japan, and that genotype I is highly clonal worldwide, with the same major genotype responsible for human infection. The fact that a single clone of M. kansasii is responsible for most cases of human disease suggests that specific virulence factors may be associated with this specific genotype.
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Affiliation(s)
- Yansheng Zhang
- Department of Microbiology, The University of Texas Health Center, Tyler, Texas 75708, USA.
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Smith MB, Molina CP, Schnadig VJ, Boyars MC, Aronson JF. Pathologic features of Mycobacterium kansasii infection in patients with acquired immunodeficiency syndrome. Arch Pathol Lab Med 2003; 127:554-60. [PMID: 12708897 DOI: 10.5858/2003-127-0554-pfomki] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Mycobacterium kansasii is a slow-growing photochromogenic mycobacterium that may infect patients with human immunodeficiency virus (HIV) late in the course of acquired immunodeficiency syndrome (AIDS). The clinical features of pulmonary and extrapulmonary infections have been described in the literature; however, the pathology of infection has not been adequately addressed. OBJECTIVE This report describes the pathologic features of 12 cases of M kansasii infection in patients with AIDS. DESIGN The medical records, autopsy protocols, cytologic material, and histologic material from patients with AIDS and concomitant M kansasii infection at a tertiary-care medical center during 1990-2001 were reviewed. RESULTS Twelve cases were identified, 6 by autopsy, 5 of which were diagnosed postmortem. Four of the 12 cases had cytologic material and 4 cases had histologic biopsies available for review. Pulmonary infection was most common (9/12), and all patients in whom thoracic lymph nodes were assessed showed involvement (7/7). Abdominal infection was less frequent, with only 1 of 6, 2 of 6, and 2 of 6, demonstrating liver, spleen, and abdominal lymph node infection, respectively. Isolated infections without documented pulmonary infection included brain abscess (n = 1), ulnar osteomyelitis (n = 1), and paratracheal mass (n = 1). Cytologic and histologic material showed a wide range of inflammatory reactions, including granulomas with and without necrosis, neutrophilic abscesses, spindle-cell proliferations, and foci of granular eosinophilic necrosis. The M kansasii bacillus was characteristically long, coarsely beaded, and frequently showed folded, bent, or curved ends. Intracellular bacilli were randomly or haphazardly distributed within histiocytes. CONCLUSION Mycobacterium kansasii infection produces predominantly pulmonary infection in late-stage AIDS with a high incidence of thoracic lymph node involvement and a much lower incidence of dissemination to other sites. Infection is manifest as a wide variety of inflammatory reactions on cytology and histology; however, the characteristic appearance of the bacillus on acid-fast bacilli stain and its intracellular arrangement in histiocytes can allow a presumptive identification.
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Affiliation(s)
- Michael B Smith
- Department of Pathology, University of Texas Medical Branch, Galveston, TX 77555-0740, USA.
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Etxebarrieta M, Rodrigo A, Martín C, Ojer M, Ruz A, Dorronsoro I. [Clinical importance of Mycobacterium kansasii and evaluation of the need to identify nontuberculous mycobacteria]. Enferm Infecc Microbiol Clin 2002; 20:113-6. [PMID: 11904083 DOI: 10.1016/s0213-005x(02)72760-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the clinical importance of a single isolation of Mycobacterium kansasii in order to determine whether a single isolation of nontuberculous mycobacteria is sufficient to diagnose mycobacteriosis or whether multiple isolations are required, in which case, it would be better to wait until a second isolation is produced before undertaking identification of all nontuberculous mycobacteria. PATIENTS AND METHODS Between 1992-1998, we studied the characteristics of 77 isolates of M. kansasii because it is the nontuberculous mycobacterium most frequently associated with disease. Our hospital has 500 beds but processed the samples from the Principe de Viana Outpatient Center and those from the district hospitals of Tudela and Estella for mycobacteria. During the study period, a mean of 3,900 specimens were processed per year. The isolates came from 22 episodes in 21 patients (19 males and 2 females). The specimens were cultured using standard techniques and confirmation was performed using gene probes (Gen-Probe, San Diego, California). RESULTS Of the 22 episodes, positive cultures were obtained on multiple occasions in 15 (68.1%) and a single isolation was obtained in 7. All isolations came from respiratory samples. Isolations were obtained from blood on only 2 occasions (both in HIV-positive patients). Direct bacilloscopy was positive in 60% of cases with multiple isolations and negative in all cases of single isolation. Multiple isolations were found in 14 patients, 7 of whom were HIV-positive and with advanced immunodepression and 7 were HIV-negative. Of these, two were alcoholics and the remaining patients had chronic pulmonary diseases. All treated patients showed initial improvement after specific therapy and negative bacilloscopies and cultures. None of the patients with a single isolation, including two HIV-positive patients, showed clinical repercussions. CONCLUSION In our experience, a single isolation of M. kansasii was without clinical importance, even in two HIV-positive patients. Given that when the criteria of the American Thoracic Society for the diagnosis of mycobacteriosis are followed, in general, multiple mycobacteria should be isolated, a strategy of not undertaking the identification of all nontuberculous mycobacteria until a second isolation is produced can be established, unless there is serious clinical indication to suggest otherwise.
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Corbett EL, Churchyard GJ, Clayton TC, Williams BG, Mulder D, Hayes RJ, De Cock KM. HIV infection and silicosis: the impact of two potent risk factors on the incidence of mycobacterial disease in South African miners. AIDS 2000; 14:2759-68. [PMID: 11125895 DOI: 10.1097/00002030-200012010-00016] [Citation(s) in RCA: 113] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the combined effects of HIV infection and silicosis on mycobacterial disease. DESIGN AND SETTING A retrospective cohort of 1374 HIV-positive and 2648 HIV-negative miners who attended a South African gold mining hospital and primary health clinics. PARTICIPANTS Miners who had been tested for HIV, with consent, at primary health clinics during 1991-1996, predominantly because of a symptomatic sexually transmitted disease. RESULTS Tuberculosis (TB) incidence was 4.9 and 1.1 per 100 person-years in HIV-positive and HIV-negative miners respectively. The incidence of Mycobacterium kansasii disease was also high (0.32 and 0.10 per 100 person-years, respectively). Silicosis was highly prevalent, implying inadequate dust control, and was a significant TB risk factor among both HIV-positive and HIV-negative men (adjusted incidence rate ratios 1.4-2.5 according to radiological severity). The data were consistent with the risks of silicosis and HIV combining multiplicatively, but did not fit an additive model. The incidence of HIV-associated TB increased significantly during the study, with no corresponding change in HIV-negative rates, to reach 16.1 per 100 person-years among HIV-positive silicotics. CONCLUSIONS The risks of silicosis and HIV infection combine multiplicatively, so that TB remains as much a silica-related occupational disease in HIV-positive as in HIV-negative miners, and HIV-positive silicotics have considerably higher TB incidence rates than those reported from other HIV-positive Africans. The increasing impact of HIV over time may indicate epidemic TB transmission with rapid disease development in HIV-infected miners. Similar but currently unrecognized interactions may be contributing to TB control problems in other industrializing countries affected by the HIV epidemic.
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Affiliation(s)
- E L Corbett
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, UK.
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Braun-Falco O, Plewig G, Wolff HH, Burgdorf WHC. Bacterial Diseases. Dermatology 2000. [DOI: 10.1007/978-3-642-97931-6_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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