Nontuberculous
Mycobacteria and Incidence of Mycobacterioses in Prague in 1999–2004
Polanecký V1., Kalina P1., Kubín M1., Kozáková B2., Müllerová M.3
1Hygienická stanice hl. m. Prahy, 2Zdravotní ústav se sídlem v Praze, 3KLINLAB, s.r.o. |
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Summary:
Objective: To analyze the incidence of nontuberculous mycobacteria detected in Prague patients
in 1999–2004 as either single findings suggestive of clinical insignificance or repetitive findings
suggestive of mycobacteriosis when reported together with the corresponding organ damage and
symptomatology.
Material and methods: Nontuberculous mycobacteria were isolated and identified according to
the Czech recommended methods for mycobacterial diagnosis in two Prague laboratories. The
determined incidence rates of Mycobacterium (M.) kansasii, M. avium complex (MAC) and M.
xenopi were compared with the respective nationwide rates and those of other nontuberculous
bacteria, M. tuberculosis and M. bovis. The data on cases of mycobacterioses reported within the
Czech Registry of Tuberculosis were provided by the Institute of Health Information and
Statistics of the Czech Republic.
Results: In 1999–2004, the annual incidence rates of nontuberculous mycobacteria detected in
Prague patients ranged between 169–139 and accounted for 13–25% of the totals of isolated mycobacteria including M. tuberculosis and M. bovis. Over this period, M. kansasii, MAC and M.
xenopi were detected in 45, 76 and 43 patients, respectively. The single to repetitive detection ratio
was the highest for M. kansasii (1:1.6), followed by MAC (1:1.8) and M. xenopi (1:2.3). Most male
excretors were from higher age categories (median of 58–73 years) while the median age of female
excretors ranged between 41 and 75 years. As many as 47 cases of mycobacterioses caused by the
following agents: M. kansasii (20 cases), MAC (17 cases), M. xenopi (6 cases) and other
nontuberculous mycobacteria (4 cases), were reported to the National Registry of Tuberculosis
over the study period.
Conclusions: Detection and identification of nontuberculous mycobacteria have become part of
diagnostic routine of mycobacteriological laboratories. Compared to conventional tuberculous
mycobacteria, detection of nontuberculous mycobacteria often requires the use of different and
more cumbersome procedures such as incubation at preferential temperatures, longer incubation
for detection of growth in primary cultures, species specific culture media, etc.. More skills and
experience are needed for the use of automated detection systems and molecular biological
techniques for species identification and interpretation of results. Regular consultations with
clinical and outpatient physicians are crucial for the assessment of pathogenetic potential of
nontuberculous mycobacteria.
Key words:
mycobacteriosis – nontuberculous mycobacteria – Mycobacterium avium –
Mycobacterium kansasii – Mycobacterium xenopi.
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