Occurrence and risk factors of nontuberculous mycobacteria in tuberculosis-suspected patients in the north of Iran

Maryam Shafipour; Hesamaddin Shirzad-Aski; Ezzat  Allah Ghaemi; Ahmad Sohrabi; Masoumeh Taziki; Maya  Babai Kochkaksaraei; Somayeh Rahimi

doi:10.18502/ijm.v13i2.5980

Maryam Shafipour Infectious Diseases Research Center, Golestan University of Medical Sciences, Gorgan, Iran
Hesamaddin Shirzad-Aski Infectious Diseases Research Center, Golestan University of Medical Sciences, Gorgan, Iran
Ezzat Allah Ghaemi Infectious Diseases Research Center, Golestan University of Medical Sciences, Gorgan, Iran
Ahmad Sohrabi Infectious Diseases Research Center, Golestan University of Medical Sciences, Gorgan, Iran
Masoumeh Taziki Tuberculosis Laboratory of Health Care Center, Golestan University of Medical Sciences, Gorgan, Iran
Maya Babai Kochkaksaraei Infectious Diseases Research Center, Golestan University of Medical Sciences, Gorgan, Iran
Somayeh Rahimi Tuberculosis Laboratory of Health Care Center, Golestan University of Medical Sciences, Gorgan, Iran

DOI: https://doi.org/10.18502/ijm.v13i2.5980

Keywords: Nontuberculous mycobacteria; Tuberculosis; 16S rDNA; Sequence alignment; Sequence homology; Mycobacterium simiae; Mycobacterium virginiense

Abstract

Background and Objectives: Some Nontuberculous Mycobacteria (NTM) can occasionally infect the human population and cause infections having symptoms similar to tuberculosis (TB). This study tried to provide updated data about the frequency and diversity of NTM species.

Materials and Methods: Suspicious samples of Mycobacterium tuberculosis (MTB) with both positive results in Ziehl-Neelsen (ZN) staining and Löwenstein-Jensen medium culturing were evaluated during January 2016 and December 2018 in Gorgan, Iran. After determination of MTB isolates by the growth rate, pigmentation status, the niacin test, and the insertion sequence 6110 (IS6110) PCR assay, other unknown isolates (presumably NTM) were detected by the 16S rDNA sequencing method and drawing the phylogenetic tree. Based on the patients’ demographic information, their risk factors were also assessed.

Results: Among 226 culture-positive samples, obtained from 2994 individuals with suspected symptoms of TB, the analyses found 12 (5.3%) NTM and three Mycobacterium caprae isolates. Mycobacterium simiae (6/12) was the most prevalent NTM species. The average nucleotide similarity value was 98.2% ± 3.7. In comparison to patients with MTB (211 confirmed cases), other mycobacterium infections were more common in patients over 65 years old (Odd ratio (95% convenience interval): 2.96 (0.69 - 12.59), P = 0.14).

Conclusion: Although the NTM species has a small portion in TB suspected patients, their prevalence has increased, mainly in elderly patients. Moreover, M. simiae was the most prevalent NTM species in our region. Therefore, identification of common species in each region is recommended and clinicians should pay more attention to them in each region.