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Jeong, Kim, Chang, and Lee: Distribution and Clinical Significance of Nontuberculous Mycobacteria Identified by High Performance Liquid Chromatography in Clinical Specimens
Original Article

Korean J Clin Microbiol 2008;11(1):34-42.

Published online: 20 April 2008

DOI: https://doi.org/10.5145/kjcm.2008.11.1.34

Distribution and Clinical Significance of Nontuberculous Mycobacteria Identified by High Performance Liquid Chromatography in Clinical Specimens

Joseph Jeong, Sung-Ryul Kim, Chulhun L. Chang1, Seon Ho Lee

Department of Laboratory Medicine, Ulsan University Hospital, Ulsan, Korea

1Department of Laboratory Medicine, College of Medicine, Pusan National University, Busan, Korea

Department of Laboratory Medicine, Ulsan University Hospital, Jeonha-dong, Dong-gu, Ulsan 682-714, Korea. (Tel) 82-52-250-7273, (Fax) 82-52-250-8269, (E-mail) joseph@uuh.ulsan.kr, 690519@hitel.net

Received 20 October 2007       Revised 26 February 2008

Copyright © 2008 Korean Journal of Clinical Microbiology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Infections caused by nontuberculous mycobacteria (NTM) are significantly increasing over the last decade. Due to the uncertainty in the clinical significance of these organisms, their effective diagnosis and treatment has been challenging. The purpose of this study was to investigate the distribution and clinical significance of NTM in clinical specimens.

Methods

Acid-fast culture positive 3,107 clinical specimens were identified by mycolic acid analysis using high performance liquid chromatography (HPLC.) The HPLC patterns of 384 NTM strains were compared with those of standard mycobacterium species. Clinical significance of NTM was investigated by a retrospective study including acid-fast stain and culture, medical history, symptoms and signs, radiological and other laboratory findings, pathologic findings, response to treatment, and follow-up study, and was confirmed according to the guideline of American Thoracic Society.

Results

Among the 3,107 Mycobacterium-positive specimens, 384 (12.4%) were found to be positive for NTM. Of these, 367 (95.6%) were successfully identified by HPLC as 19 different species, each of which comprising 0.3% to 15.9% of the total NTM, Studies on the pathogenic role of NTM showed that 0∼79.6% of each species or 0∼100% of isolates from each specimen could be considered clinically significant.

Conclusion

HPLC method is highly discriminative for the identification of NTM in clinical specimens. When NTM is isolated from clinical specimens in the Ulsan area, the findings from this study could serve as a database on which to determine its clinical significance depending on species type and also specimen type.

Keywords: Mycobacterium, Nontuberculous mycobacteria, HPLC, Mycobacterial identification, Pathogenic rate

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Table 1.
Di tribution of nontuberculous Mycobacterium species from clinical specimens
s Mycobacterium species Specimen
Sputum Bronchial aspiration Urine Pleural fluid Skin tissue Lymph node pus CSF Gastric aspiration Bone marow Joint fluid Total (%)
M. kansasii (%) 39 (10.16) 9 (2.34) 0 (0) 5 (1.30) 0 (0) 6 (1.56) 1 (0.26) 1 (0.26) 0 (0) 0 (0) 0 (0) 61 (15.89)
M. intracellurare (%) 33 (8.59) 6 (1.56) 0 (0) 2 (0.52) 2 (0.52) 3 (0.78) 0 (0) 1 (0.26) 0 (0) 2 (0.21) 0 (0) 49 (12.76)
M. gordonae (%) 21 (5.47) 3 (0.78) 15 (3.91) 2 (0.52) 0 (0) 1 (0.26) 0 (0) 0 (0) 1 (0.26) 0 (0) 1 (0.26) 44 (11.46)
M. avium (%) 25 (6.51) 2 (0.52) 0 (0) 2 (0.52) 2 (0.52) 3 (0.78) 3 (0.78) 0 (0) 0 (0) 1 (0) 0 (0) 38 (9.90)
M. fortuitum (%) 24 (6.25) 1 (0.26) 2 (0.52) 3 (0.78) 1 (0.26) 1 (0.26) 1 (0.26) 0 (0) 1 (0.26) 0 (0) 0 (0) 34 (8.85)
M. abscessus (%) 19 (4.95) 2 (0.52) 0 (0) 2 (0.52) 0 (0) 0 (0) 0 (0) 2 (0.52) 0 (0) 0 (0) 0 (0) 25 (6.51)
M. peregrinum (%) 16 (4.17) 1 (0.26) 2 (0.52) 1 (0.26) 0 (0) 2 (0.52) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 22 (5.73)
M. szlugai (%) 14 (3.65) 0 (0) 0 (0) 0 (0) 0 (0) 1 (0.26) 2 (0.52) 2 (0.52) 0 (0) 0 (0) 0 (0) 19 (4.95)
M. marinum (%) 4 (1.04) 0 (0) 0 (0) 0 (0) 8 (2.08) 0 (0) 2 (0.52) 0 (0) 0 (0) 0 (0) 0 (0) 14 (3.65)
M. mucogenicum (%) 9 (2.34) 1 (0.26) 2 (0.52) 1 (0.26) 0 (0) 1 (0.26) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 14 (3.65)
M. xenopi (%) 2 (0.56) 0 (0) 0 (0) 0 (0) 8 (2.08) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 10 (2.60)
M. terrae (%) 6 (1.56) 1 (0.26) 0 (0) 1 (0.26) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 8 (2.08)
M. scrofulaceum (%) 5 (1.30) 1 (0.26) 0 (0) 1 (0.26) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 7 (1.82)
M. chelonae (%) 4 (1.04) 1 (0.26) 0 (0) 1 (0.26) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 6 (1.56)
M. triviale (%) 4 (1.04) 0 (0) 0 (0) 1 (0.26) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 5 (1.30)
M. simiae (%) 3 (0.78) 0 (0) 1 (0.26) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 4 (1.04)
M. acpulsensis (%) 2 (0.52) 0 (0) 1 (0.26) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 3 (0.78)
M. asiaticum (%) 2 (0.52) 0 (0) 1 (0.26) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 3 (0.78)
M. nonchromogenicum (%) 1 (0.26) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 1 (0.26)
Unclassified NTM (%) 11 (2.86) 1 (0.26) 1 (0.26) 1 (0.26) 1 (0.26) 1 (0.26) 0 (0) 0 (0) 1 (0.26) 0 (0) 0 (0) 17 (4.43)
Total 244 (63.54) 29 (7.55) 25 (6.51) 23 (5.99) 22 (5.73) 19 (4.95) 9 (2.34) 6 (1.56) 3 (0.78) 3 (0.78) 1 (0.26) 384 (100)
Table 2.
Annual distribution of eight nontunerculous Mycobacterium species, each comprising more than 5% of the total
Mycobacterium species Year
2002 2003 2004 2005 2006 Total
M. kansasii 12 12 14 11 12 61
M. intracellurare 9 10 9 9 12 49
M. gordonae 10 9 7 10 8 44
M. avium 7 8 8 9 7 38
M. fortuitum 6 6 8 7 7 34
M. abscessus 5 4 5 5 6 25
M. peregrinum 3 5 4 4 6 22
M. szlugai 5 4 2 4 4 19
Total 57 58 57 59 62 293
Table 3.
Clinical significance of nontuberculous Mycobacterium species from clinical specimens
Pathogenic Mycobacterium species Specimen
Sputum Bronchial aspiration Urine Pleural fluid Skin tissue Lymph node pus CSF Gastric aspiration Bone marow Joint fluid Total (%)
M. kansasii (%) 18 (46.15) 8 (88.89) 0 (ND) 4 (80.00) 0 (ND) 6 (100) 1 (100) 1 (100) 0 (ND) 0 (ND) 0 (ND) 38 (62.30)
M. intracellurare (%) 24 (72.73) 5 (83.33) 0 (ND) 2 (100) 2 (0.52) 3 (100) 0 (ND) 1 (100) 0 (ND) 2 (100) 0 (ND) 39 (79.59)
M. gordonae (%) 5 (23.81) 1 (33.33) 0 (0) 1 (50.00) 0 (ND) 1 (100) 0 (ND) 0 (ND) 0 (0) 0 (ND) 0 (0) 8 (18.18)
M. avium (%) 13 (52.00) 2 (100) 0 (ND) 2 (100) 2 (100) 2 (66.67) 2 (66.67) 0 (ND) 0 (ND) 1 (100) 0 (ND) 24 (63.16)
M. fortuitum (%) 7 (29.17) 1 (100) 0 (0) 2 (66.67) 0 (0) 1 (100) 0 (0) 0 (ND) 0 (0) 0 (ND) 0 (ND) 11 (32.35)
M. abscessus (%) 9 (47.37) 2 (100) 0 (ND) 1 (50.00) 0 (ND) 0 (ND) 0 (ND) 2 (100) 0 (ND) 0 (ND) 0 (ND) 14 (56.00)
M. peregrinum (%) 5 (31.25) 0 (0) 0 (0) 1 (100) 0 (ND) 1 (50.00) 0 (ND) 0 (ND) 0 (ND) 0 (ND) 0 (ND) 7 (31.82)
M. szlugai (%) 6 (42.86) 0 (ND) 0 (ND) 0 (ND) 0 (ND) 1 (100) 0 (0) 2 (100) 0 (ND) 0 (ND) 0 (ND) 9 (47.37)
M. marinum (%) 2 (50.00) 0 (ND) 0 (ND) 0 (ND) 7 (87.50) 0 (ND) 1 (50.00) 0 (ND) 0 (ND) 0 (ND) 0 (ND) 10 (71.43)
M. mucogenicum (%) 2 (22.22) 1 (100) 0 (0) 1 (100) 0 (ND) 1 (100) 0 (ND) 0 (ND) 0 (ND) 0 (ND) 0 (ND) 5 (35.71)
M. xenopi (%) 1 (50.00) 0 (ND) 0 (ND) 0 (ND) 3 (37.50) 0 (ND) 0 (ND) 0 (ND) 0 (ND) 0 (ND) 0 (ND) 4 (40.00)
M. terrae (%) 1 (16.67) 1 (100) 0 (ND) 1 (100) 0 (ND) 0 (ND) 0 (ND) 0 (ND) 0 (ND) 0 (ND) 0 (ND) 3 (37.50)
M. scrofulaceum (%) 0 (0) 0 (0) 0 (ND) 1 (100) 0 (ND) 0 (ND) 0 (ND) 0 (ND) 0 (ND) 0 (ND) 0 (ND) 1 (14.29)
M. chelonae (%) 1 (25.00) 1 (100) 0 (ND) 0 (0) 0 (ND) 0 (ND) 0 (ND) 0 (ND) 0 (ND) 0 (ND) 0 (ND) 2 (33.33)
M. triviale (%) 1 (25.00) 0 (ND) 0 (ND) 1 (100) 0 (ND) 0 (ND) 0 (ND) 0 (ND) 0 (ND) 0 (ND) 0 (ND) 2 (40.00)
M. simiae (%) 1 (33.33) 0 (ND) 0 (0) 0 (ND) 0 (ND) 0 (ND) 0 (ND) 0 (ND) 0 (ND) 0 (ND) 0 (ND) 1 (25.00)
M. acpulsensis (%) 0 (0) 0 (ND) 0 (0) 0 (ND) 0 (ND) 0 (ND) 0 (ND) 0 (ND) 0 (ND) 0 (ND) 0 (ND) 0 (0)
M. asiaticum (%) 1 (50.00) 0 (ND) 0 (0) 0 (ND) 0 (ND) 0 (ND) 0 (ND) 0 (ND) 0 (ND) 0 (ND) 0 (ND) 1 (33.33)
M. nonchromogenicum (%) 0 (0) 0 (ND) 0 (ND) 0 (ND) 0 (ND) 0 (ND) 0 (ND) 0 (ND) 0 (ND) 0 (ND) 0 (ND) 0 (0)
Unclassified NTM (%) 1 (9.09) 0 (0) 0 (0) 1 (100) 0 (0) 1 (100) 0 (ND) 0 (ND) 0 (0) 0 (ND) 0 (ND) 3 (17.65)
Total 98 (40.16) 22 (75.86) 0 (0) 18 (78.26) 14 (63.64) 17 (89.47) 4 (44.44) 6 (100) 0 (0) 3 (100) 0 (0) 182 (47.40)

Abbreviation: ND, not detected.

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