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Distribution and Clinical Significance of NontuberculousMycobacteria Identified by High Performance LiquidChromatography in Clinical Specimens

이선호|장철훈|김성률|정윤성
대한임상미생물학회 (Korean Society of Clinical Microbiology)|2008.04|Annals of Clinical Microbiology|제11권 제1호|pp. 34-42

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참고문헌

키워드

HPLCNontuberculous mycobacteriaMycobacteriumMycobacterial identificationPathogenic rate

초록

배경: Nontuberculous mycobacteria (NTM)에 의한 감염증은 증가하고 있으나, 병원성 여부를 판단하기 힘들고, 효과적인 치료가 어렵기 때문에 임상 검체에서 NTM의 균종 분포와 병원성률에 대한 조사는 환자의 적절한 진단과 치료 방침 수립에 대단히 중요하다. 이에 본 연구에서는 HPLC법을 이용하여 NTM을 동정하여 임상검체에서의 NTM의 균종별 분포를 파악하고, 균종 및 검체에 따른 병원성률을 조사하고자 하였다. 방법: 항산균 배양 검사에서 양성이었던 3,107검체를 HPLC법으로 동정하여 NTM으로 확인된 384검체를 대상으로 균종 분포를 확인하였다. 항산균 염색과 배양 결과외에 환자의 병력, 징후 및 증상, 방사선학적 소견, 다른 검사실 소견, 병리 조직학적 소견, 치료에 대한 반응, 추후 경과 관찰 등을 후향적으로 조사하여 임상적인 감염증으로 판정된 경우 중에서 American Thoracic Society에서 발표한 지침에 포함되는 경우를 병원성으로 판정하여 병원성률을 조사하였다. 결과: HPLC법을 이용한 NTM의 동정성공률은 95.6%로 우수하였다. 항산균 배양 양성 검체 중 NTM의 비율은 12.4%였고, 총 19종의 NTM은 0.3∼15.9%까지의 분포를 보였고, 병원성률은 균종별로는 0∼79.6%, 검체별로는 0∼100%였다. 결론: HPLC법은 임상 검체에서 NTM을 동정하는데 우수한 변별력을 보였고, 울산 지역 임상검체에서 NTM이 검출될 경우, 본 연구의 결과를 기초 자료로 균주별, 검체별 병원성률을 추정할 수 있을 것으로 판단된다

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.

참고문헌 (40)

  1. Dawson DJ, "Mycobacterial terminology", J Clin Microbiol, 38, pp.3913~ (2000)
  2. Primm TP, "Health impacts of environmental mycobacteria", Clin Microbiol Rev, 17, pp.98~106 (2004)
  3. Falkinham JO 3rd, "Epidemiology of infection by nontuberculous mycobacteria", Clin Microbiol Rev, 9, pp.177~215 (1996)
  4. "Scientific committee in Korean academy of tuberculosis and respiratory diseases. National survey of mycobacterial diseases other than tuberculosis in Korea", Tuberc Respir Dis, 42, pp.277~294 (1995)
  5. Olivier KN, "Nontuberculous mycobacterial pulmonary disease", Curr Opin Pulm Med, 4, pp.148~153 (1998)
  6. Shin S, "Identification of nontuberculous mycobacteria by sequence analysis of the 16S ribosomal RNA, the heat-shock protein 65 and the RNA polymerase β-subunit genes", Korean J Lab Med, 26, pp.153~060 (2006)
  7. Lee HW, "Nontuberculous mycobacterial pulmonary infection in immunocompetent patients", Tuberc Respir Dis, 53, pp.173~182 (2002)
  8. Koh WJ, "Recovery rate of nontuberculous mycobacteria from acid-fast-bacilli smear-positive sputum specimen", Tuberc Respir Dis, 54, pp.22~32 (2003)
  9. Jeong J, "Identification of Mycobacteria using High Performance Liquid Chromatography in Clinical Specimens", Korean J Clin Microbiol, 7, pp.148~155 (2004)
  10. Hoffner SE, "Pulmonary infections caused by less frequently encountered slow-growing environmental mycobacteria", Eur J Clin Microbiol Infect Dis, 13, pp.937~941 (1994)
  11. Prince DS, "Infection with Mycobacterium avium complex in patients without predisposing conditions", N Engl J Med, 321, pp.863~868 (1989)
  12. Dobos KM, "Emergence of a unique group of necrotizing mycobacterial diseases", Emerg Infect Dis, 5, pp.367~378 (1999)
  13. Inderlied CB, "The Mycobacterium avium complex", Clin Microbiol Rev, 6, pp.266~310 (1993)
  14. Wolinsky E, "Nontuberculous mycobacteria and associated diseases", Am Rev Respir Dis, 119, pp.107~159 (1979)
  15. Wallace RJ Jr, "Diagnosis and treatment of disease caused by nontuberculous mycobacteria", Am Rev Respir Dis, 142, pp.940~953 (1990)
  16. Phillips MS, "Nosocomial infections due to nontuberculous mycobacteria", Clin Infect Dis, 33, pp.1363~1374 (2001)
  17. Wallace RJ Jr, "Nosocomial outbreaks", pseudo-outbreaks caused by nontuberculous mycobacteria, 1998, pp.52, 453~190
  18. Kim HJ, "Application of Polymerase Chain Reaction (PCR) to the Diagnosis of tuberculosis", Tuberc Respir Dis, 39, pp.517~525 (1992)
  19. Nah J, "Identification of Mycobacterium tuberculosis Complex Using a Gene Probe method", Korean J Clin Pathol, 17, pp.71~78 (1997)
  20. Kim MN, "Mycobacterial testing in hospital laboratories in Korea: results of a survey of 40 university or tertiary-care hospitals", Korean J Clin Pathol, 19, pp.86~91 (1999)
  21. Butler WR, "Mycolic acid analysis by high-performance liquid chromatography for identification of Mycobacterium species", Clin Microbiol Rev, 14, pp.704~726 (2001)
  22. Butler WR, "Identification of mycobacteria by high-performance liquid chromatography", J Clin Microbiol, 29, pp.2468~2472 (1991)
  23. Butler WR, "Mycolic acid pattern standards for HPLC identification of mycobacteria", pp.150~86 (1999), Centers for Disease Control and Prevention, U.S. Department of Health and Human Services
  24. Butler WR, "Standardized method for HPLC identification of mycobacteria", pp.1463~99 (1996), U.S. Department of Health and Human Services
  25. No authors listed, "Diagnosis and treatment of disease caused by nontuberculous mycobacteria", Am J Respir Crit Care Med, 156, pp.S1~25 (1997)
  26. Euzeby JP, "List of bacterial names with standing in nomenclature, 1998" (2002), Society for Systematic and Veterinary Bacteriology
  27. Tortoli E, "Burden of unidentifiable mycobacteria in a reference laboratory", J Clin Microbiol, 39, pp.4058~4065 (2001)
  28. O'Brien RJ, "The epidemiology of nontuberculous mycobacterial diseases in the United States. Results from a national survey", Am Rev Respir Dis, 135, pp.1007~1014 (1987)
  29. Noordhoek GT, "Questionable reliability of the polymerase chain reaction in the detection of Mycobacterium tuberculosis", N Engl J Med, 329, pp.2036~ (1993)
  30. Reisner BS, "Use of Gen-Probe Accu- Probes to identify Mycobacterium avium complex, Mycobacterium tuberculosis complex, Mycobacterium kansasii, and Mycobacterium gordonae directly from BACTEC TB broth cultures", J Clin Microbiol, 32, pp.2995~2998 (1994)
  31. Park CM, "Isolation of nontuberculous mycobacteria using polymerase chain reaction-restriction fragment length polymorphism", Korean J Lab Med, 26, pp.161~167 (2006)
  32. Clinical and Laboratory Standards Institute, "National Committee for Clinical Laboratory Standards. Molecular diagnostic methods for infectious diseases. Proposed guideline, 2nd ed. MM3-P2" (2005), CLSI
  33. Lee SD, "Mycobacterium tuberculosis and nontuberculous mycobacteria by PCR assay", Korean J Clin Microbiol, 10, pp.135~142 (2007)
  34. Kim KS, "Epidermiologic study of unclassified mycobacteria", Tuberc Respir Dis, 13, pp.5~20 (1966)
  35. Lee SK, "Epidermiologic study of atypical mycobacterial infection", Tuberc Respir Dis, 14, pp.12~38 (1967)
  36. Kim SC, "A Study on Unclassified Mycobacteria Isolated from Human Sputa", Tuberc Respir Dis, 17, pp.33~42 (1970)
  37. Koh WJ, "Clinical significance of nontuberculous mycobacteria isolated from respiratory specimens in Korea", Chest, 129, pp.341~348 (2006)
  38. Yim JJ, "Mycobacterium kansasii pulmonary diseases in Korea", J Korean Med Sci, 20, pp.957~960 (2005)
  39. Centers for Disease Control and Prevention, "Nontuberculous mycobacteria reported to the public health laboratory information system by state public health laboratories United States, 1993-6" (1999), Centers for Disease Control and Prevention
  40. Griffith DE, "An official ATS", IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases, 2007, pp.175, 367~416

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