임상 검체에서 분리한 Mycobacterium tuberculosis Complex 중에서 Mycobacterium tuberculosis의 빈도
Frequency of Mycobacterium tuberculosis Among M. tuberculosis Complex Strains Isolated from Clinical Specimen
2
조회
0
다운로드
3
인용
0
참고문헌
키워드
초록
배경: Mycobacterium tuberculosis (MTB)의 신속하고 정확한 검출은 감염 관리와 항 결핵약 선택에있어 가장 중요하다. 그러나 MTB, Mycobacterium bovis, Mycobacterium africanum, Mycobacterium microti, Mycobacterium caprae와 Mycobacterium pinnipedii를 포함하는 MTB complex (MTC)는 뉴클레오타이드 수준에서 99.9% 유사성을 가지며, 16S rRNA 서열이 동일하므로 대부분의 임상검사실에서는 MTB로 보고하지 않고 MTC로 보고한다. 이 연구의 목적은 임상 검체에서 MTC 분리균의 미코박테리아의 종별 빈도 분석이다. 방법: 2017년 2월부터 2018년 8월까지 상급종합요양병원의 임상 검체에서 분리된 MTC 310개를 대상으로 MTB를 특이적으로 검출하는 MolecuTech Real TB-Taq (YD 제약, 한국) 실시간 PCR 검사를 시행하였다. MTB 특이적인 실시간 PCR에서 음성이거나 피라진아미드 내성인 균주의DNA에 대하여 PCR 기반 MTC 타이핑, spoligotyping과 exact tandem repeat-D 유전자 염기서열분석을 시행하였다. 결과: 310개의 모든 MTC 균주가 MTB로 확인되었다. 한국에서 보고되지 않은 EAI4-VNM (East- African-Indian 4-Vietnam) 유전자형인 MTB가 2주 발견되었다. 결론: 이 연구에서는 인수공통결핵이 발견되지 않았다. 본 연구는 한 의료기관에서 검출된 310개의 작은 수의 MTC를 조사했기 때문에 우리나라의 인수공통결핵의 유병률을 정확하게 파악하려면 다기관 연구가 필요하다.
Abstract
Background: Rapid and accurate detection of Mycobacterium tuberculosis (MTB) is of primary importance for infection control and selection of anti-tuberculosis drugs. However, most clinical laboratories report MTB complex (MTC) without reporting MTB because MTC comprising MTB, Mycobacterium bovis, Mycobacterium africanum, Mycobacterium microti, Mycobacterium caprae and Mycobacterium pinnipedii have 99.9% similarity at the nucleotide level and identical 16S rRNA sequences. This study was conducted to analyze the species frequency of MTC isolates obtained from clinical specimen. Methods: Of 310 MTC isolates obtained from clinical samples in a tertiary care hospital from February 2017 to August 2018, MolecuTech Real TB-Taq (YD Diagnostics, Korea) real-time PCR was performed, specifically to detect MTB. For DNA showing MTB negative results by MTBspecific real-time PCR or pyrazinamide-resistant strains, PCR-based MTC typing, spoligotyping, and exact tandem repeat D gene sequencing were performed. Results: All the 310 MTC isolates were identified to be MTB. Two MTB strains of East-African- Indian 4-Vietnam genotype, which have not been reported in Korea, were also found. Conclusion: There was no zoonotic tuberculosis in this study. Since we investigated only 310 MTC isolates detected in only one medical institution, multi-center study is needed to accurately know the prevalence of zoonotic tuberculosis in Korea.
참고문헌 (16)
- Rodriguez-Campos S, "Overview and phylogeny of Mycobacterium tuberculosis complex organisms : Implications for diagnostics and legislation of bovine tuberculosis", Res Vet Sci, 97, pp.S5~S19 (2014)
- Rastogi N, "The mycobacteria : An introduction to nomenclature and pathogenesis", Rev Sci Tech, 20, pp.21~54 (2001)
- 황상선, "LG AdvanSure TB", NTM Real-Time PCR Kit의 항산균 진단 수행 능력 평가, 2011, pp.14(2), 55~59[DOI]
- Huard RC, "PCR-based method to differentiate the subspecies of the Mycobacterium tuberculosis complex on the basis of genomic deletions", J Clin Microbiol, 41, pp.1637~1650 (2003)
- Djelouadji Z, "A single-step sequencing method for the identification of Mycobacterium tuberculosis complex species", PLoS Negl Trop Dis, 2, pp.e253~ (2008)
- Coitinho C, "Identification of Mycobacterium tuberculosis complex by polymerase chain reaction of exact tandem repeat-D fragment from mycobacterial cultures", Int J Mycobacteriol, 1, pp.146~148 (2012)
- Global tuberculosis report 2018, "World Health Organization", WHO press, ~ (2018)
- World Health Organization, "Roadmap for zoonotic tuberculosis" (2017), WHO press
- Müller B, "Zoonotic Mycobacterium bovis-induced tuberculosis in humans", Emerg Infect Dis, 19, pp.899~908 (2013)
- Dürr S, "Differences in primary sites of infection between zoonotic and human tuberculosis: results from a worldwide systematic review", PLoS Negl Trop Dis, 7, pp.e2399~ (2013)
- 임성경, "국소적 농흉으로 나타난 Mycobacterium bovis 감염 1예", 대한내과학회지, 81(6), pp.792~796 (2011), 대한내과학회
- Brown T, "Associations between Mycobacterium tuberculosis strains and phenotypes", Emerg Infect Dis, 16, pp.272~280 (2010)
- Das S, "Occurrence of RD9 region and 500 bp fragment among clinical isolates of Mycobacterium tuberculosis and Mycobacterium bovis", Microbiol Immunol, 51, pp.231~234 (2007)
- Kamerbeek J, "Simultaneous detection and strain differentiation of Mycobacterium tuberculosis for diagnosis and epidemiology", J Clin Microbiol, 35, pp.907~914 (1997)
- Azadi D, "Mycobacteriosis and tuberculosis : laboratory diagnosis", Open Microbiol J, 12, pp.41~58 (2018)
- Nguyen VA, "High prevalence of Beijing and EAI4-VNM genotypes among M. tuberculosis isolates in northern Vietnam:sampling effect, rural and urban disparities", PLoS One, 7, pp.e45553~ (2012)