Mycobacterium avium and Klebsiella pneumoniae co-infection in the domestic ferret (Mustela putorius furo) - Case Report.

Introduction and Objective. Pets infected with zoonotic pathogens might become a source of infections for their owners, especially those who are immuno-compromised. The aim of this report is to describe a case of chronic, untreatable pneumonia in a domestic ferret. Materials and method. The subject was a 5-year-old female ferret suffering from recurrent pneumonia. Ante-mortally, swabs from the nasal cavity, alveolus and throat were collected from the animal. Post-mortally, lesioned organ fragments were collected. Standard microbiological testing was performed. Additionally, mycobacterial diagnosis including culture and molecular tests was performed. Results. The co-infection of Mycobacterium avium and Klebsiella pneumoniae was microbiologically confirmed. Conclusions. This case demonstrates the need to pay attention to the possibility of zoonotic pathogens in ferrets. Veterinarians diagnosing ferrets are potentially exposed to Mycobacteria spp. infections and other pathogens.

Positive Culture of Atypical Mycobacterium Avium Following Revision Total Knee Arthroplasty.

CASE: We report a rare case of mycobacterial periprosthetic joint infection (PJI) after primary total knee arthroplasty 14 years earlier. Progressive knee pain over three years with a negative PJI infectious workup led to revision total knee arthroplasty. A surprising result was isolation of Mycobacterium avium from tissue cultures taken at time of revision surgery. After six months of antibiotic treatment, the patient is alive with well- functioning pain-free TKA at over one-year follow-up. CONCLUSION: Periprosthetic joint infection can present acutely or chronically years following total knee arthroplasty. Depending on the infecting organism, patients can present with sepsis, or a more indolent slower course that mimics aseptic loosening. In the absence of positive pre-operative labs and cultures, and based on the Musculoskeletal Infection Society (MSIS) criteria, aseptic loosening is a diagnosis of exclusion. An atypical infectious organism should be considered a possible cause and may require specialized cultures of operative specimens.

Extrapulmonary Nontuberculous Mycobacteriosis in a Lung Transplant Recipient / Micobacteriosis no tuberculosa extrapulmonar en un receptor de transplante de pulmón

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Nontuberculous mycobacteria in patients with suspected tuberculosis and the genetic diversity of Mycobacterium avium in the extreme south of Brazil / Micobactérias não tuberculosas em pacientes com suspeita de tuberculose e a diversidade genética de Mycobacterium avium no extremo sul do Brasil

ABSTRACT Objective: Nontuberculous mycobacteria (NTM) are a heterogeneous group of bacteria that are widely distributed in nature and associated with opportunistic infections in humans. The aims of this study were to identify NTM in patients with suspected tuberculosis who presented positive cultures and to evaluate the genetic diversity of strains identified as Mycobacterium avium. Methods: We studied pulmonary and extrapulmonary samples obtained from 1,248 patients. The samples that tested positive on culture and negative for the M. tuberculosis complex by molecular identification techniques were evaluated by detection of the hsp65 and rpoB genes and sequencing of conserved fragments of these genes. All strains identified as M. avium were genotyped using the eight-locus mycobacterial interspersed repetitive unit-variable-number tandem-repeat method. Results: We found that NTM accounted for 25 (7.5%) of the 332 mycobacteria isolated. Of those 25, 18 (72%) were M. avium, 5 (20%) were M. abscessus, 1 (4%) was M. gastri, and 1 (4%) was M. kansasii. The 18 M. avium strains showed high diversity, only two strains being genetically related. Conclusions: These results highlight the need to consider the investigation of NTM in patients with suspected active tuberculosis who present with positive cultures, as well as to evaluate the genetic diversity of M. avium strains.

RESUMO Objetivo: As micobactérias não tuberculosas (MNT) são um grupo heterogêneo de bactérias amplamente distribuídas na natureza e relacionadas com infecções oportunistas em seres humanos. Os objetivos deste estudo foram identificar MNT em pacientes com suspeita de tuberculose e culturas positivas e avaliar a diversidade genética de cepas identificadas como Mycobacterium avium. Métodos: Foram estudadas amostras pulmonares e extrapulmonares provenientes de 1.248 pacientes. As amostras que apresentaram resultado positivo em cultura e negativo para o complexo M. tuberculosis na identificação molecular foram avaliadas por meio da detecção dos genes hsp65 e rpoB e de sequenciamento de fragmentos conservados desses genes. Todas as cepas identificadas como M. avium foram genotipadas pelo método mycobacterial interspersed repetitive unit-variable-number tandem-repeat com oito loci. Resultados: Das 332 micobactérias isoladas, 25 (7,5%) eram MNT. Dessas 25, 18 (72%) eram M. avium, 5 (20%) eram M. abscessus, 1 (4%) era M. gastri e 1 (4%) era M. kansasii. As 18 cepas de M. avium apresentaram alta diversidade, e apenas duas eram geneticamente relacionadas. Conclusões: Esses resultados mostram a necessidade de considerar a investigação de MNT em pacientes com suspeita de tuberculose ativa e culturas positivas e de avaliar a diversidade genética de cepas de M. avium.

Paratuberculosis: new histopathological findings in red deer (Cervus elaphus) and fallow deer (Dama dama) in Chile / Paratuberculosis: novos achados histopatológicos em Veado Vermelho (Cervus elaphus) e Gamo (Dama dama) no Chile

Paratuberculosis is a disease caused by Mycobacterium avium subsp. paratuberculosis (MAP) that affects domestic and wild ruminants. The most common gross lesions are emaciation and corrugation and thickening of the mucosa of the small intestine. Mesenteric lymph nodes might be enlarged. For the present study, 14 red deer and 9 fallow deer from game reserves or venison farms were analyzed. The lesions found correspond to those found by other authors in other geographic locations, except for some differences in histopathological examinations. Among these differences, stands out that intestinal lesions were concentrated mostly in the ileum and granulomas were shown to be more frequent in this section of the intestine than in the corresponding lymph node. Furthermore, in multibacillary lesions the inflammatory infiltrate in the lymph nodes was mainly composed of macrophages. These differences may be due to individual variations of the animals, the stage of disease or a different strain of the pathogen. This study allowed to obtain basic information about the disease and to describe patterns of lesions found in red deer and fallow deer with prediagnosis of clinical paratuberculosis which were not described in the literature before.(AU)

Paratuberculosis é uma doença causada por Mycobacterium avium subsp. paratuberculosis (MAP) que afecta ruminantes selvagens e domésticos. As lesões macroscópicas mais comuns são ondulação e espessamento da mucosa do intestino delgado. Os linfonodos mesentéricos podem aparecer com volume aumentado. Para este estudo, foram analisados 14 veados vermelhos e 9 veados gamo de reservas de caça e fazendas de carne. As lesões encontradas correspondem à encontrada por outros autores em outras localizações geográficas, com exceção de algumas diferenças no exame histopatológico. Entre essas diferenças, sobressai que as lesões intestinais se concentraram principalmente no íleo, os granulomas ocorreram com maior frequência nesta seção do intestino que no seu correspondente linfonodo. Além disso, nas lesões bacterianas, o infiltrado inflamatório linfonodos linfáticos era composta principalmente por macrófagos. Estas diferenças podem ser devidas a variações individuais dos animais, o estádio da doença ou de uma estirpe diferente do agente patogénico. Este estudo permitiu obter informação básica sobre a doença e descrever padrões de lesões encontradas em veados e em gamos com pré-diagnóstico, de paratuberculosis clínica nunca antes descritas na literatura.(AU)

Coinfección por Mycobacterium africanum y Mycobacterium avium en una paciente con SIDA / Mycobacterium africanum and Mycobacterium avium co-infection in an AIDS patient

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Broncho-Pleural Fistula with Hydropneumothorax at CT: Diagnostic Implications in Mycobacterium avium Complex Lung Disease with Pleural Involvement

OBJECTIVE: To determine the patho-mechanism of pleural effusion or hydropneumothorax in Mycobacterium avium complex (MAC) lung disease through the computed tomographic (CT) findings. MATERIALS AND METHODS: We retrospectively collected data from 5 patients who had pleural fluid samples that were culture-positive for MAC between January 2001 and December 2013. The clinical findings were investigated and the radiological findings on chest CT were reviewed by 2 radiologists. RESULTS: The 5 patients were all male with a median age of 77 and all had underlying comorbid conditions. Pleural fluid analysis revealed a wide range of white blood cell counts (410-100690/microL). The causative microorganisms were determined as Mycobacterium avium and Mycobacterium intracellulare in 1 and 4 patients, respectively. Radiologically, the peripheral portion of the involved lung demonstrated fibro-bullous changes or cavitary lesions causing lung destruction, reflecting the chronic, insidious nature of MAC lung disease. All patients had broncho-pleural fistulas (BPFs) and pneumothorax was accompanied with pleural effusion. CONCLUSION: In patients with underlying MAC lung disease who present with pleural effusion, the presence of BPFs and pleural air on CT imaging are indicative that spread of MAC infection is the cause of the effusion.

Caracterização histológica e imuno-histoquímica das lesões de tuberculose em bovinos e de linfadenite granulomatosa em suínos / Histological and immunohistochemical characterization of tuberculosis lesions in cattle and of granulomatous lymphadenitis in swine

Mycobacterium sp. induz inflamação granuloma-tosa em diferentes espécies animais. Mycobacterium bovis e o complexo Mycobacterium avium são importantes patógenos de bovinos e suínos e podem causar infecção em humanos, principalmente imunossuprimidos. Perdas na produção, barreiras comerciais e prejuízos por condenação de carcaças em abatedouro/frigorífico estão atrelados à ocorrência dessas infecções, com prejuízos econômicos significativos. Foi realizado um estudo de casos diagnosticados como tuberculose em bovinos e linfadenite granulomatosa em suínos no Setor de Patologia Veterinária da Universidade Federal do Rio Grande do Sul (SPV-UFRGS) no período de janeiro de 2007 a dezembro de 2011. Dados referentes à raça, ao sexo, à idade e ao histórico clínico foram compilados dos livros de registro e analisados. As características histológicas das lesões em linfonodos e pulmões foram avaliadas em Hematoxilina-Eosina, com predomínio de células gigantes nas lesões de tuberculose bovina e de macrófagos epitelioides em suínos. As técnicas histoquímicas de Ziehl-Neelsen e Tricrômico de Masson foram utilizadas para evidenciar, respectivamente, bacilos álcool-ácido resistentes e tecido conjuntivo fibroso nas lesões. A técnica de imuno-histoquímica foi utilizada em aproximadamente 30% dos casos estudados de cada espécie, selecionados aleatoriamente, para a caracterização do infiltrado linfocítico. Foram utilizados os anticorpos anti-CD3 para a marcação de linfócitos T e anti-CD79cy para a marcação de linfócitos B. Linfócitos T predominaram nas lesões em ambas as espécies, com diferença estatisticamente significativa entre as médias dos linfócitos T e linfócitos B. Foi usado o teste t pareado, com t=5,501 (p<0,001) nas lesões dos bovinos e t=5,826 (p<0,001) para as lesões de linfadenite dos suínos...

Mycobacterium sp. induces granulomatous inflammation in different animal species. Mycobacterium bovis and the Mycobacterium avium complex are important cattle and swine pathogens that can also infect humans, especially those immunosuppressed. Losses in production, commercial barriers and carcasses condemnations in slaughtering are related to this infection, which implies in large economic losses. It was carried out a study on bovine tuberculosis lesions and granulomatous lymphadenitis in pigs, diagnosed by the Setor de Patologia Veterinária from the Universidade Federal do Rio Grande do Sul (SPV-UFRGS), Brazil, between January 2007 and December 2011. Data concerning breed, sex, age and clinical history were retrieved from the files and analyzed. Histological features of the lesions in lymph nodes and lungs were evaluated in Hematoxylin-Eosin staining. Multinucleated giant cells were predominant in bovine tuberculosis lesions and epithelioid macrophages were abundant in swine. Ziehl-Neelsen and Masson's trichrome techniques were used respectively to demonstrate the alcohol-acid resistant bacillus and fibrous connective tissue in the lesions. The immunohistochemistry technique was performed to characterize the lymphocytic infiltrate. Anti-CD3 antibodies were utilized to immunolabeling lymphocytes T, and anti-CD79cy to lymphocytes B. Lymphocytes T were predominant in both species lesions, confirmed statistically by paired t test, which showed significantly differ means of T and B lymphocytes, with t=5,501 (p<0.001) for the bovines tuberculosis lesions, and t=5.826 (p<0.001), for the cases of pigs lymphadenitis...

Evaluation of a MPB70-ELISA to differentiate Mycobacterium bovis from M. avium-sensitized swine / Avaliação de um MPB70-ELISA para diferenciar entre suínos sensibilizados com Mycobacterium bovis ou M. avium

Swine are susceptible to different mycobacteria species, being Mycobacterium bovis an agent of tuberculosis, with most significant zoonotic risks, while M. avium determines a granulomatous lymphadenitis with low zoonotic risk. Currently performed intradermal tests present some important limitations, such as the lack of ability to detect anergic animals or to differentiate among mycobacterial species. In order to improve the TB diagnosis, serological assays have been developed, with encouraging results. The purpose of this study was to evaluate the performance of a MPB70-ELISA in 82 piglets divided into four groups: sensitized by inactivated M. bovis, M. avium, inoculated with oil adjuvant, or with saline solution. The test was able to discriminate between an animal sensitized by M. bovis and animals of the three other groups, including M. avium-sensitized animals; for this reason, we suggest that MPB70-ELISA could be used as a complementary tool for discriminating the agent of the mycobacteriosis, and therefore to diagnose tuberculosis in a swine herd.(AU)

Suínos são suscetíveis a diferentes espécies de micobactérias, sendo Mycobacterium bovis agente de tuberculose (TB), com claro risco zoonótico, enquanto M. avium determina uma linfadenite granulomatosa (LG) de baixo risco zoonótico. Os testes intradérmicos atualmente realizados apresentam algumas limitações importantes, como a falta de habilidade em detectar animais anérgicos ou de diferenciar entre as espécies micobacterianas. Com o intuito de melhorar o diagnóstico de TB, testes sorológicos têm sido desenvolvidos, com resultados encorajadores. O objetivo do presente estudo foi avaliar um MPB70-ELISA em 82 leitões divididos em quatro grupos: sensibilizados por M. bovis, por M. avium, inoculados com óleo adjuvante ou com solução salina. O teste foi capaz de discriminar entre os animais sensibilizados com M. bovis dos demais três grupos, incluindo aqueles que foram sensibilizados com M. avium; desta forma, sugere-se que o MPB70-ELISA poderia ser utilizado como ferramenta complementar para discriminar o agente da micobacteriose, e portanto diagnosticar TB em um plantel de suínos.(AU)

Síndrome de Lady Windermere: afectación del lóbulo medio y língula por Mycobacterium avium complex / Lady Windermere syndrome: involvement of the middle lobe and lingula by Mycobacterium avium complex

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Padronização do teste imunoalérgico aplicado ao diagnóstico da tuberculose e micobacterioses em suínos (Sus scrofa) experimentalmente sensibilizados com suspensões oleosas de Mycobacterium bovis ou M. avium inativados / Standardization of the immunoallergic skin test applied for the diagnosis of tuberculosis and mycobacterioses in swine (Sus scrofa) experimentally sensitized with oil suspensions of inactivated Mycobacterium bovis or M. avium

Foi investigado o valor diagnóstico da resposta alérgica cutânea em leitões experimentalmente sensibilizados, pela via intramuscular, com suspensões oleosas de Mycobacterium bovis ou M. avium inativados pelo calor.Foram utilizados 91 animais, divididos em quatro grupos: grupos A e B, cada um com 25 indivíduos, grupos C e D com 21 e 20 indivíduos respectivamente, balanceando-se as características de raça, linhagem, faixa etária e sexo. Aos 30 dias de idade, todos os animais foram submetidos a uma triagem com a aplicação de tuberculina PPD bovina, pela via intradérmica na base da orelha e não houve qualquer tipo de reação. Decorridos 60 dias do teste tuberculínico de triagem, o grupo A recebeu injeção intramuscular de 0,5 mL de uma suspensão oleosa de M. avium estirpe D4; o grupo B recebeu 0,5 mL de uma suspensão oleosa de M. bovis estirpe AN5; o grupo C (controle I), recebeu 0,5 mL do adjuvante oleoso; e o grupo D (controle II), recebeu 0,5 mL de solução fisiológica. Após 30 dias da sensibilização foi realizada a prova de tuberculinização comparativa com reação medida pela variação da espessura da pele com cutímetro de mola às 0h, 24h, 48h e 72h, após a aplicação das tuberculinas. No teste comparativo, lido às 48 ou 72 horas, a reação foi considerada negativa quando a diferença das reações entre o PPD bovino e o PPD aviário foi menor que 6,7 mm; suspeito ou inconclusivo quando a diferença se situou na faixa de 6,7 a 7,5 mm; e positiva de acordo com o tipo de PPD, considerando-se tuberculose para PPD M. bovis e micobacteriose para PPD M. avium, quando a diferença da reação foi superior a 7,5 mm.

The diagnostic value of the cutaneous allergic response to tuberculin in piglets experimentally sensitized intramuscularly with the oily suspensions of heat inactivated M. bovis or M. avium was investigated. Ninety-one animals were used and divided into four groups: groups A and B were formed each with 25 individuals, and groups C and D, with 21 and 20 individuals, respectively, balancing the characteristics of race, ancestry, age and sex. At the age of 30 days, all the animals were submitted to the screening test with the use of M. bovis PPD, by the intradermal route at the base of the ear and no reaction was detected. Sixty days after the screening tuberculin test, animals of the group A were injected intramuscularly with 0.5 mL of oily suspension of M. avium D4 strain; animals of the group B received 0.5 mL of an oily suspension of M. bovis, AN5 strain; group C (control I) received 0.5 mL of an oily adjuvant; and the individuals of the group D (control II) received 0.5 mL of saline solution. Following 30 days of sensitization, comparative skin reactions were measured by the variation in skin thickness with a caliper at 0h, 24h, 48h an 72h after applications of tuberculins. In the comparative test measured at 48 or 72h, the reaction was considered negative when the difference of the reactions between bovine PPD and avian PPD was less than 6.7 mm; suspected or inconclusive, when the difference stood in the range of 6.7 to 7.5 mm; and positive according to the type of PPD, considering tuberculosis the M. bovis PPD and mycobacteriosis the M. avium PPD, when the difference of the reaction was greater than 7.5 mm.

Relationship between Paratuberculosis and the microelements Copper, Zinc, Iron, Selenium and Molybdenum in Beef Cattle

To study the deficiency of minerals and its relationship with Paratuberculosis, blood, serum, and fecal samples were obtained from 75 adult bovines without clinical symptoms of the disease and from two bovines with clinical symptoms of the disease, from two beef herds with a previous history of Paratuberculosis in the Province of Buenos Aires, Argentina. Serum samples were processed by ELISA and feces were cultured in Herrolds medium. Copper, zinc and iron in serum were quantified by spectrophotometry and selenium was measured by the activity of glutathione peroxidase. We also determined copper, zinc, iron and molybdenum concentrations in pastures and the concentration of sulfate in water. Mycobacterium avium subsp paratuberculosis (Map) was isolated from 17.3% of fecal samples of asymptomatic animals and from the fecal samples from the two animals with clinical symptoms. All the Map-positive animals were also ELISA-positive or suspect, and among them, 84.6% presented low or marginal values of selenium and 69.2% presented low or marginal values of copper. The two animals with clinical symptoms, and isolation of Map from feces and organs were selenium-deficient and had the lowest activity of glutathione peroxidase of all the animals from both herds. All the animals negative to Map in feces and negative to ELISA had normal values of Se, while 13.8% of animals with positive ELISA or suspect and culture negative presented low levels of Se. Half of the animals that were negative both for ELISA and culture in feces were deficient in copper but none of them presented low values of selenium. The content of molybdenum and iron in pasture was high, 2.5 ppm and 1.13 ppm in one herd and 2.5 ppm and 2.02 ppm in the other, respectively, whereas the copper:molybdenum ratio was 1.5 and 5.2, respectively. These results do not confirm an interaction between imbalances of the micronutrients and clinical Paratuberculosis, but show evidence of the relationship between selenium...

Diagnosis of paratuberculosis in cattle: microbiological culture, serology and PCR

The aim of this study was to confirm clinical diagnosis of paratuberculosis in two cows showing suggestive clinical signs of the disease. Based on clinical signs, in culture and in IS900 PCR results from the individual milk samples it was possible to diagnose paratuberculosis in the cows studied.

Parameter estimation and use of gamma interferon assay for the diagnosis of bovine tuberculosis in Brazil / Estimação dos parâmetros e uso do teste do interferon gama para o diagnóstico da tuberculose bovina no Brasil

This study aimed to evaluate the interference of tuberculin test on the gamma-interferon (INFg) assay, to estimate the sensitivity and specificity of the INFg assay in Brazilian conditions, and to simulate multiple testing using the comparative tuberculin test and the INFg assay. Three hundred-fifty cattle from two TB-free and two TB-infected herds were submitted to the comparative tuberculin test and the INFg assay. The comparative tuberculin test was performed using avian and bovine PPD. The INFg assay was performed by the BovigamTM kit (CSL Veterinary, Australia), according to the manufacturer's specifications. Sensitivity and specificity of the INFg assay were assessed by a Bayesian latent class model. These diagnostic parameters were also estimate for multiple testing. The results of INFg assay on D0 and D3 after the comparative tuberculin test were compared by the McNemar's test and kappa statistics. Results of mean optical density from INFg assay on both days were similar. Sensitivity and specificity of the INFg assay showed results varying (95% confidence intervals) from 72 to 100% and 74 to 100% respectively. Sensitivity of parallel testing was over 97.5%, while specificity of serial testing was over 99.7%. The INFg assay proved to be a very useful diagnostic method.(AU)

O presente estudo avalia a interferência do teste de tuberculinização no teste do interferon gama (INFg), estima a sensibilidade e a especificidade do INFg em condições brasileiras e simula a utilização dos testes múltiplos usando a tuberculinização comparada e o teste do INFg. Trezentos e cinquenta animais oriundos de dois rebanhos livres e dois rebanhos positivos foram submetidos à tuberculinização comparada e ao teste de INFg. A tuberculinização comparada foi realizada utilizando PPD aviária e bovina. O teste de INFg foi realizado utilizando o kit Bovigam® (CSL Veterinary, Austrália) de acordo com as especificações do fabricante. A sensibilidade e especificidade do teste de INFg foram calculadas pelo Modelo Bayesiano de Classe Latente. Esses parâmetros foram também estimados para os testes múltiplos. Os resultados do teste de INFg no D0 e D3 após o teste de tuberculinização foram comparados pelos testes estatísticos de McNemar e kappa. Os resultados das médias de densidade ótica do teste de INFg em ambos os dias foram similares. A sensibilidade e a especificidade do teste de INFg apresentaram resultados variando (95% intervalo de confiança) de 72 a 100% e 74 a 100%, respectivamente. A sensibilidade do teste em paralelo foi acima de 97,5% enquanto a especificidade do teste em série foi acima de 99,7%. O teste do INFg provou ser um método de diagnóstico muito útil.(AU)

Infección por micobacterias no tuberculosas en pacientes con bronquiectasias no causadas por fibrosis quística / Non-tuberculous mycobacterial infection in patients with non-cystic fibrosis bronchiectasias

Objetivo. Conocer la prevalencia y características de la infección por micobacterias no tuberculosas en enfermos con bronquiectasias no relacionadas con la fibrosis quística. Pacientes y métodos. Estudio descriptivo retrospectivo de pacientes adultos con bronquiectasias no relacionadas con la fibrosis quística con un seguimiento de al menos dos años. Resultados. Se incluyeron 68 pacientes, 50 mujeres (73,5%), con una edad media de 63,31±16,2 años. La etiología más frecuente fue la enfermedad pulmonar obstructiva crónica (28 pacientes, 41,2%) con una afectación leve-moderada y colonización por Pseudomonas aeruginosa (P. aeruginosa) (70,6%). Siete pacientes (10,3%) presentaron infección por micobacterias no tuberculosas, tratándose de Mycobacterium avium complex en 6 ocasiones (7,35%). Cuatro (57,14%) pacientes recibieron tratamiento antimicrobiano específico. En los enfermos infectados fue menor la frecuencia de P. aeruginosa y el uso de corticoides inhalados. No hubo diferencias espirométricas significativas entre los pacientes infectados por micobacterias no tuberculosas y los no infectados. Conclusiones. Las bronquiectasias no relacionadas con la fibrosis quística podrían considerarse un factor de riesgo para la infección por micobacterias no tuberculosas(AU)

Aims. To know the characteristics and prevalence of non-tuberculous mycobacterial infection infection in patients with non-cystic fibrosis bronchiectasis. Patients and methods. A retrospective descriptive study of NCFB adult patients whose disease had been followed-up for at least two years was performed. Results. A total of 68 subjects were included, 50 females (73.5%), with mean age of 63.31± 16.2 years. The most frequent etiology of the non-cystic fibrosis bronchiectasis was COPD in 28 cases (41.2%) with a light-moderate pulmonary involvement and Pseudomonas aeruginosa (P. aeruginosa) colonization (70.6%). Seven patients (10.3%) had MNT infection, six of whom had Mycobacterium avium complex (7.35%). Four patients (57.14%) were treated. In the infected patients, P. aeruginosa and the use of inhaled steroids were observed with less frequency. There were no significant differences between the infected and non-infected patients in relation to spirometric values. Conclusions. The non-cystic fibrosis bronchiectasis could be considered a risk factor for non-tuberculous mycobacterial infection(AU)

Utilización de diferentes técnicas de biología molecular integradas en un algoritmo de identificación de micobacterias no tuberculosas / Use of different PCR-based techniques integrated into a non-tuberculous identification algorithm

Introducción El objetivo del presente trabajo fue demostrar la utilidad de un algoritmo de identificación de micobacterias no tuberculosas (MNT) que integra diferentes técnicas de biología molecular y características fenotípicas básicas. Además se ha realizado una actualización del algoritmo de interpretación del análisis del patrón de restrición de hsp65 (PRA hsp65).Métodos La manera elegida de trabajar consistió en la identificación mediante hibridación con sondas de ADN seguido de PRA hsp65 en aquellos aislados que no pudieron ser identificados mediante hibridación con sondas de ADN. En caso necesario se realizó secuenciación del 16S rDNA y hsp65.ResultadosSe aislaron 236 MNT. De ellos, 102 (43,2%) aislados fueron identificados mediante hibridación con sondas de ADN y 76 (32,2%) mediante PRA hsp65. En los 58 (24,5%) aislados restantes se secuenció 16S rDNA, lo cual permitió la identificación de 53 (22,4%). Para 5 (2,1%) aislados se secuenció hsp65 y permitió la identificación de un aislado más. Cuatro (1,7%) aislados no pudieron ser identificados. Tres nuevos patrones de PRA hsp65 fueron encontrados. Siete aislamientos hibridaron con la sonda AccuProbe Mycobacterium avium complex Identification pero no lo hicieron con las sondas específicas de especie incluidas en el MAC. Cinco y 2 aislados fueron identificados como M. intracellulare y Mycobacterium colombiense, respectivamente. Conclusión Este esquema de trabajo nos permitió la identificación de casi todas las MNT encontradas en este estudio, incluyendo especies recientemente descritas(AU)

Introduction The aim of the present work was to demonstrate the utility of a non-tuberculous mycobacteria (NTM) identification algorithm, which integrates different PCR-based techniques and basic phenotypic features. Moreover, the algorithm for pattern restriction analysis of hsp65 (hsp65 PRA) interpretation has been updated. Methods The workflow chosen consisted of the identification by a DNA hybridization probe method, followed by PCR-restriction enzyme analysis of hsp65 (hsp65 PRA) in those isolates that cannot be identified by hybridization probes. If necessary, 16S rRNA gene and hsp65 gene sequencing were used for speciation. Results A total of 236 NTM were collected, in which 102 (43.2%) isolates were identified by DNA specific probes and 76 (32.2%) isolates were identified with hsp65 PRA. Partial sequencing of the 16S rRNA gene was used for species identification of the remaining 58 (24.5%) isolates. Fifty-three (22.4%) were identified using this method. Five isolates (2.1%) were submitted for partial sequencing of hsp65 gene and one isolate was identified with this method. Four strains (1.7%) could not be identified at species level. Three new PRA patterns were found. Seven isolates tested positive with the AccuProbe Mycobacterium avium complex identification test but did not test positive with the M. avium or Mycobacterium intracellulare specific probes. Five and two of these isolates were identified as M. intracellulare and Mycobacterium colombiense, respectively. Conclusion This approach allowed us to identify almost all NTM isolates found in this study, including some recently described species(AU)

Micobacteriosis no tuberculosa de origen zoonósico relacionada con hepatotoxicidad por aflatoxinas. Estudio de un brote familiar / Non-tuberculous mycobacteriosis of animal origin associated with aflatoxin-induced hepatoxicity. Report of an outbreak within a family

Antecedentes. La asociación de micobacteriosis por Mycobacterium avium con intoxicación crónica por aflatoxinas procedentes de maíz contaminado es extraordinariamente rara. Algunos estudios demuestran que las aflatoxinas son potentes inmunosupresores que pueden predisponer a infecciones por gérmenes oportunistas. Casos clínicos y métodos. Familia de inmigrantes colombianos que tienen un pequeño aviario en su domicilio donde crían tórtolas, gallinas y pavos. Todos son consumidores habituales de maíz, que es almacenado en condiciones de alta humedad y temperatura. El padre, sufrió un cuadro de diarrea intermitente, pérdida de peso y ascitis mientras que el hijo pequeño presentó una linfadenopatía submandibular bilateral simétrica y diarreas intermitentes. El estudio familiar, de las aves y el entorno demostró patología micobacteriana en 2 miembros de la familia (padre e hijo pequeño) y en las aves, así como contaminación fúngica y tóxica en el maíz. Resultados. El padre de familia presentó hepatopatía compatible con intoxicación crónica por aflatoxinas y micobacteriosis pulmonar y entérica no tuberculosa. El hijo pequeño fue diagnosticado de linfadenopatía micobacteriana y en el resto de familia se detectó sensibilización positiva alta a la prueba de Mantoux. Las aves fueron diagnosticadas de tuberculosis aviar. Los estudios de tipificación molecular realizados a los 3 aislamientos, identificaron la misma cepa de Mycobacterium avium. Conclusiones. La asociación de estas 2 patologías es excepcional en la literatura infectopatológica, aunque cada vez se están reportando más casos. Esta circunstancia nos ha motivado a realizar una descripción de las principales lesiones que caracterizan a ambos procesos (micobacteriosis y hepatopatía por aflatoxinas)(AU)

Background. The association of Mycobacterium avium mycobacteriosis with chronic intoxication produced by aflatoxins from contaminated corn is extremely rare. It has been proposed that aflatoxins are powerful immunosupressors which could facilitate infection by opportunistic microrganisms. Material and Methods. A Colombian immigrant family of four, father, mother and two sons, kept turtle doves, hens and turkeys in a small domestic aviary and fed the birds with corn stored under hot and humid conditions. The father presented with intermittent diarrhoea, weight loss and ascites and the younger son with symmetrical, bilateral, submandibular lymphadenitis. When the whole family and their living conditions were studied, both human and avian mycobacteriosis were discovered, together with fungal and toxic contamination of the corn used for bird food. Results. The father was found to have hepatic lesions compatible with chronic intoxication with aflatoxins. Furthermore, non tuberculous mycobacteriosis was present in his lungs and intestinal tract. The 5 year old son was diagnosed with mycobacterial lymphadenitis. The mother and 17 year old son were symptom free but had a positive Mantoux (PPD intradermorreaction). The birds were found to have avian tuberculosis. Molecular typing revealed the same strain of Mycobacterium avium to be present in the father, his son and the birds. Conclusions. Reports of mycobacteriosis associated with aflatoxin-induced hepatic pathology are exceptional, although recently more cases are coming to light. Due to the extremely unusual nature of the case reported here, we have made an in-depth study of the major lesions characteristic of both conditions(AU)