Trends from the Last Decade with Nontuberculous Mycobacteria Lung Disease (NTM-LD): Clinicians' Perspectives in Regional Center of Pulmonology in Bydgoszcz, Poland.

BACKGROUND: Nontuberculous mycobacteria (NTM) are the cause of chronic lung disease called NTM lung disease (NTM-LD). There are about 180 known species of NTM. Nowadays the number of NTM-LD is increasing. OBJECTIVE: To evaluate the clinical significance of NTM isolated from specimens and assess the frequency and clinical relevance of isolation of NTM in the Regional Center of Pulmonology in Bydgoszcz, hospital of Northern Poland. DESIGN: Clinical, radiological, and microbiological data were collected from all patients from whom NTM was isolated between 2013 and 2022. Data were reviewed retrospectively. Diagnostic criteria for NTM-LD published by the American Thoracic Society (ATS) were used to determine clinical relevance. MATERIAL AND METHODS: The study comprised 81,985 clinical specimens submitted for mycobacterial culture in the Department of Microbiology at the Regional Center of Pulmonology in Bydgoszcz between 2013 and 2022. Clinical specimens were processed according to the standard procedure in mycobacteria laboratories in Poland. NTM strains were identified using analysis of mycolic acids by chromatography as well as GenoType NTM-DR, GenoType Mycobacterium AS, and GenoType Mycobacterium CM. RESULTS: There were 395 patients with NTM strains between 2013 and 2022. Out of them, 149 cases met the diagnostic criteria of NTM-LD and were classified as definite cases. M. kansasii (n = 77) was the most common species in the group (51.68%), followed by M. avium complex (n = 46). Patients with NTM-LD were 22-88 years old (median age was 60 years). There were 81 men and 68 women. The most common symptoms were cough, hemoptysis, and fever. Radiological X-ray images were dominated by infiltrative lesions in the upper and middle lobe of the right lung with cavities; the changes were in the upper lobe of the left lung and on both sides of the chest. They were smokers in 61%. The most common concomitant diseases were chronic obstructive pulmonary disease (COPD), diabetes mellitus, pulmonary carcinoma, and human immunodeficiency virus (HIV) infection, and other immunodeficiencies. The most common treatment was isoniazid, ethambutol, rifampicin, and ofloxacin for 18 months with a minimum of 12 months of culture negativity. CONCLUSIONS: NTM-LD infections are present with other pulmonary illnesses and extrapulmonary diseases and may be connected to primary immunologic deficiencies. These diseases concern patients of all ages and have various clinical manifestations. M. kansasii and MAC are the most prevalent NTM isolates among respiratory samples in Northern Poland. In addition, an increase in MAC and a decrease in M. kansasii both in cultivation and the cause of NTM-LD were reported.

Unemployment in TB patients - ten-year observation at regional center of pulmonology in Bydgoszcz, Poland.

BACKGROUND: Tuberculosis (TB) affects the poorest of the poor and is an example of a disease that can contribute to the "disease-poverty trap". The variable epidemiological situation is associated with social risk factors, such as unemployment, which may favor the occurrence of this disease. The aim of this study was to analyze unemployment as a factor that can influence the incidence and course of the disease. MATERIAL AND METHODS: We analyzed TB patients with confirmed status of employment or unemployment admitted to the Regional Center of Pulmonology in Bydgoszcz in during the years 2001 to 2010. Out of 1130 patients, 604 were unemployed and the other confirmed their employment. RESULTS: The unemployed patients were mostly single men over age 40, with a low level of education, and living in a city. We observed that the proportions of smokers and alcohol abusers were significantly higher among the unemployed patients. The advanced radiological lesions, smear-positive pulmonary TB, and extra-pulmonary sites were diagnosed significantly more often in this group. The rate of death in the course of hospitalization was significantly higher in the group of unemployed patients. CONCLUSIONS: Unemployment among TB patients is a serious problem. We found that more advanced radiological lesions were associated with more frequent treatment interruptions and a higher rate of death in the course of hospitalization. Increased efforts are needed to reduce and eliminate the problem of unemployment among patients with TB. This may, indirectly, contribute to a decrease in notifications of TB cases and improve treatment outcomes.

Nosocomial outbreak of Streptococcus pneumoniae Spain9V­ST156­14 clone in a pulmonary diseases ward.

INTRODUCTION:  Streptococcus pneumoniae (S. pneumoniae) is one of the most common bacterial pathogens in community­acquired pneumonia. However, nosocomial pneumococcal infections are more and more widely observed. OBJECTIVES:  The aim of the study was to analyze nosocomial outbreak in one of the Polish hospitals and to characterize the causative isolates. PATIENTS AND METHODS:  Within 10 days, in 6 patients receiving an antimicrobial therapy due to a primary disease, pneumococcal infections of the lower respiratory tract were identified. All patients, except 1 patient with asthma, were hospitalized due to exacerbation of chronic obstructive pulmonary disease (COPD). The isolates were identified by standard methods. The serotypes of S. pneumoniae were determined by the Pneumotest­Latex kit. The relatedness among isolates was evaluated by restriction fragment length polymorphism followed by pulsed­field gel electrophoresis (RFLP­PFGE). Multilocus sequence typing (MLST) was performed for a representative isolate. RESULTS:  The outbreak was suspected when characteristic multidrug­resistant pneumococci were isolated from patients of a single ward. The outbreak was confirmed by molecular typing techniques. All isolates belonged to serotype 14 and shared the RFLP­PFGE pattern. MLST for a representative isolate revealed that it was a member of the epidemic Spain9V­ST156 clonal complex. CONCLUSIONS:  Timely implementation of infection control measures enabled to eradicate the outbreak. Pneumococcal conjugate vaccine, recently registered for use in adult populations, may have a considerable effect on limiting pneumococcal disease­associated morbidity and mortality. It is especially important for patients with COPD, a disease entity that constitutes a risk factor for the acquisition of multidrug­resistant pneumococci. 

[MDR, pre-XDR and XDR drug-resistant tuberculosis in Poland in 2000-2009]. / Gruzlica lekooporna typu MDR, pre-XDR i XDR w Polscew latach 2000­2009.

INTRODUCTION: Tuberculosis (TB) is a curable disease and its spread can be prevented by using appropriate diagnostic methods and effective treatment. The obstacle to the rapid eradication of the disease from a population may be strains resistant to essential and most effective antibiotics. In many places in the world MDR, pre-XDR and XDR-TB was reported. These forms of TB do not respond to the standard six-month treatment with first-line anti-TB drugs and the therapy should be conducted two years or more with drugs that are less potent, more toxic and much more expensive. MATERIAL AND METHODS: This study included MDR-TB strains isolated from 297 patients in 2000-2009. To determine the XDR-TB population structure, the 19 isolates were genotyped by spoligotyping and MIRU-VNTR (mycobacterial interspersed repetitive units-variable number of tandem repeats) method. RESULTS: Among 297 MDR-TB cases, 36 (12.1%) were pre-extensively drug-resistant (pre-XDR), 19 (6.4%) were XDR and 1 (0.3%) was pre-totally drug-resistant (pre-TDR). Four of the 19 XDR isolates exhibit a unique spoligopattern, while the rest 15 belonged to one of 5 clusters. The MIRU-VNTR analysis reduced the number of clustered isolates to 11. CONCLUSIONS: The study documented the emergence of pre-extensively and extensively drug-resistant tuberculosis in Poland among patients with multidrug-resistant TB. Genotyping methods showed clonal similarity among XDR strains and may suggest the possible transmission among patients with newly diagnosed and with recurrent TB.

[Transmission of Mycobacterium tuberculosis among household contacts of patients with tuberculosis]. / Badanie transmisji Mycobacterium tuberculosis wsród osób blisko spokrewnionych chorych na gruzlice.

OBJECTIVE: The aim of this study was estimation of usefulness of two molecular methods for Mycobacterium tuberculosis typing in the epidemiological research of tuberculosis (TB). We determined molecular patterns of M. tuberculosis strains isolated from 66 patients, members of 29 families living in 9 voivodeships of Poland. We also analysed drug susceptibility of the strains as well as some demographic characteristics of the patients. METHODS: The genotype analysis of the 66 clinical isolates was performed by using spoligotyping and IS6110-Mtb1/Mtb2 PCR. MAIN OBSERVATIONS: Of the 29 families examined in this study, in 23 each family member was infected with the same M. tuberculosis strain. Three drug-resistant strains and two members of the Beijing family were identified. RESULTS: We found that strains within each of the 23 families had the same genetic patterns, whereas those of the strains identified in the rest 6 families were different. Among those 6 families, in 3 differentiation of the strains was obtained with both spoligotyping and IS6110-Mtb1/Mtb2 PCR analysis, while in another 3 only with spoligotyping method. CONCLUSIONS: Based on the results from this study, the two genotyping methods used were demonstrated as an efficient approach for investigating the epidemiological relatedness of TB cases.

[Evaluation of humoral immune response against mycobacterial antigens in bronchoalveolar lavage fluid from patients with pulmonary tuberculosis confirmed by genetic and culture methods]. / Ocena odpowiedzi humoralnej przeciwko antygenom pratkaw popluczynach oskrzelowo-pecherzykowych u chorych na gruzlicepluc potwierdzona bakteriologicznie i metodami genetycznymi.

INTRODUCTION: The resistance to TB is cells-mediated but humoral response is common and may be correlated with the lack of effective local cellular defence mechanisms. The goal of the study was to evaluate IgG, IgA and IgM mediated humoral immune response against 38kDa plus 16kDa and 38kDa plus lipoarabinomannan (LAM) mycobacterial antigens in BALF from patients with culture confirmed and PCR positive pulmonary tuberculosis (TB) compared to non-tuberculous controls (NTB). MATERIAL AND METHODS: 79 BALF samples (46 TB and 30 NTB) were examined. In 25 BALF samples from TB patients nucleic acids from M. tuberculosis were detected by PCR method. Commercially available ELISA - based assays against proteins 38kDa and 16kDa or 38kDa plus LAM were used. Three different dilutions of BALF: 1 : 1 and 1 : 10 were tested. Mean IgG level against 38 + LAM was significantly higher in TB group compared to control (p < 0,0001). No difference was observed between TB and NTB group in titer of IgM antibodies. RESULTS: Sensitivity of the tests based on IgG anti38kDa + 16kDa was 49%, IgG anti38kDa + LAM - 33%, IgA anti38kDa + LAM - 100%, IgM anti38kDa + LAM - 35%. Specificity of examined assays: IgA anti38kDa + LAM - 13%, IgM anti38kDa + LAM - 75%, IgG anti38kDa + 16kDa - 87%, IgG anti38kDa + LAM - 93%. The findings of the study indicate that TB is associated with the presence of detectable levels of antibodies in the BALF. CONCLUSIONS: Examined tests detecting IgG in BALF can be used in combination with other diagnostic methods to increase diagnostic accuracy of pulmonary TB.