Failure to Recognize Nontuberculous Mycobacteria Leads to Misdiagnosis of Chronic Pulmonary Tuberculosis 英文参考文献.docVIP

FailuretoRecognizeNontuberculousMycobacteria LeadstoMisdiagnosisofChronicPulmonary Tuberculosis MamoudouMaiga1.,SophiaSiddiqui2*.,SouleymaneDiallo1,BassirouDiarra1,BrehimaTraore′1, YvonneR.Shea3,AdrianM.Zelazny3,BindongoP.P.Dembele1,DrissaGoita1,HamadounKassambara1, AbdulrahmanS.Hammond1,MichaelA.Polis2,AnatoleTounkara1 1Project SEREFO-NIAID/University of Bamako Research Collaboration on HIV/TB, Bamako, Mali, 2CCRB, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, United States of America, 3Microbiology Service, Department of Laboratory Medicine, Clinical Center, National Institutes of Health,Bethesda,Maryland,UnitedStatesofAmerica Abstract Background:Nontuberculousmycobacterial(NTM)infectionscausemorbidityworldwide.Theyaredifficulttodiagnosein resource-limitedregions,andmostpatientsreceiveempirictreatmentfortuberculosis(TB).Ourobjectivehereistoevaluate thepotentialimpactofNTMdiseasesamongpatientstreatedpresumptivelyfortuberculosisinMali. Methods: We re-evaluated sputum specimens among patients newly diagnosed with TB (na?¨ve) and those previously treated for TB disease (chronic cases). Sputum microscopy, culture and Mycobacterium tuberculosis drug susceptibility testingwereperformed.IdentificationofstrainswasperformedusingmolecularprobesorsequencingofsecA1and/or16S rRNAgenes. Results:Of142patientsenrolled,61(43%)wereclinicallyclassifiedaschroniccasesand17(12%)wereinfectedwithNTM. Elevenofthe142(8%)patientshadNTMdiseasealone(8M.avium,2M.simiaeand1M.palustre).Allthese11werefrom thechronicTBgroup,comprising11/61(18%)ofthatgroupandallwereidentifiedascandidatesforsecondlinetreatment. The remaining 6/17 (35.30%) NTM infected patients had coinfection with M. tuberculosis and all 6 were from the TB treatmentna?¨vegroup.These6werecandidatesforthestandardfirstlinetreatmentregimenofTB.M.aviumwasidentified in11ofthe142(8%)patients,only3/11(27.27%)ofwhomwereHIVpositive. Conclusions: NTM infections should be considered a