2012年至2021年上海市艾滋病合并分枝杆菌感染患者的菌种分布特征

摘要/Abstract

摘要：

目的：分析上海市艾滋病合并分枝杆菌感染患者的菌种分布特征。方法：收集2012年1月1日至2021年12月31日间上海市公共卫生临床中心9 619例门诊及住院艾滋病且有分枝杆菌培养记录的患者,获取培养阳性者的分离菌株,采用结核菌群特异性分泌蛋白MPB64免疫胶体金法或分枝杆菌测序（16S rDNA）法鉴定菌种,分析艾滋病合并分枝杆菌感染患者的菌种分布特征。结果：艾滋病合并分枝杆菌培养阳性患者共1 478例（15.4%）,其中有菌种鉴定结果的患者1 367例。结核分枝杆菌复合群（Mycobacterium tuberculosiscomplex,MTBC）患者为494例（36.1%）,非结核分枝杆菌（non-tuberculous mycobacteria,NTM）患者838（61.3%）例,MTBC兼NTM混合感染患者35例（2.6%）。2012年至2021年的分枝杆菌培养阳性病例中,鉴定为NTM（不包含MTBC兼NTM混合感染患者）的构成比逐年分别为55.2%（53/96）、65.5%（78/119）、66.2%（90/136）、55.1%（70/127）、61.6%（93/151）、66.1%（111/168）、58.9%（99/168）、61.8%（94/152）、63.6%（77/121）、56.6%（73/129）。MTBC感染患者、NTM感染患者及MTBC兼NTM混合感染患者的组织标本均以痰液为主,痰液标本构成比为68.0%（336/494）、78.0%（654/838）和88.6%（31/35）,其次为血液。1 271例分枝杆菌培养阳性患者为感染与免疫科收治,其中NTM占比为58.5%（743/1 271）。结论：在2012年至2021年间,上海市艾滋病患者合并分枝杆菌培养阳性率为15.4%（1 478/9 619）,其中历年NTM构成比高于MTBC,临床医师需高度重视NTM的诊治。

关键词:人类免疫缺陷病毒/获得性免疫缺陷综合征,结核分枝杆菌,非结核分枝杆菌

Abstract:

Objective:To analyze the distribution ofmycobacterium(MB) species in patients with AIDS and with MB.Methods:From January 1, 2012 to December 31, 2021, a total of 9 619 outpatients and inpatients with AIDS and with mycobacterial culture in the Shanghai Public Health Clinical Center were enrolled. The clinical data of those with positive culture of MB were analyzed, and the isolated strains were obtained. The strains were identified using the immunocolloidal gold method of MPB64, a specific secreted protein of tubercle bacilli, or mycobacterial sequencing (16S rDNA) method, and the distribution characteristics of strains in AIDS patients with MB infection were analyzed.Results:A total of 1 478 patients got a positive result of MB culture and among them, 1 367 patients obtained an identified strain species result, including 494 (36.1%) cases of mycobacterium tuberculosis complex (MTBC), 838 (61.3%) cases of non-tuberculous mycobacteria (NTM), and 35 (2.6%) cases of MTBC combined with NTM. The year-by-year composition of NTM (patients with mixed MTBC and NTM infection are not included) from 2012 to 2021 were 55.2%(53/96), 65.5% (78/119), 66.2% (90/136), 55.1% (70/127), 61.6% (93/151), 66.1% (111/168), 58.9% (99/168), 61.8% (94/152), 63.6%(77/121), and 56.6% (73/129). Sputum was the main tissue specimen, accounted for 68.0% (336/494), 78.0% (654/838) and 88.6% (31/35) in patients with MTBC, NTM, mixed MTBC-NTM infection, respectively. One thousand two hundred and seventy-one patients with positive MB culture were admitted to the Department of Infection and Immunology, of which the NTM accounted for 58.5%(743/1 271).Conclusions:From 2012 to 2021, the positive rate of MB culture among AIDS patients in Shanghai is 15.4%(1 478/9 619), of which the composition ratio of NTM are higher than that of MTBC over the years. This suggests that clinicians should pay high attention to the diagnosis and treatment of NTM.

Key words:Human immunodeficiency virus/Acquired immune deficiency syndrome,Mycobacterium tuberculosis,Non-tuberculous mycobacteria

中图分类号:

R541.7

胡静静, 吕海伟, 荀静娜, 沈银忠, 刘莉, 卢洪洲. 2012年至2021年上海市艾滋病合并分枝杆菌感染患者的菌种分布特征[J]. 诊断学理论与实践, 2022, 21(04): 450-455.

HU Jingjing, LÜ Haiwei, XUN Jingna, SHEN Yinzhong, LIU Li, LU Hongzhou. Characteristcs of mycobacterial species distribution in acquired immunodeficiency syndrome patients with mycobacterial infection in Shanghai[J]. Journal of Diagnostics Concepts & Practice, 2022, 21(04): 450-455.

图/表2

图1

表1

不同类型标本MTBC与NTM分离情况[n（%）]

标本类型	MTBC （n=494）	NTM （n=838）	MTBC兼NTM （n=35）
痰液	336（68.0）	654（78.0）	31（88.6）
血液	83（16.8）	160（19.1）	8（22.9）
粪便	24（4.9）	59（7.0）	5（14.3）
脑脊液	33（6.7）	13（1.6）	2（5.7）
穿刺液	16（3.2）	17（2.0）	0（0）
灌洗液	11（2.2）	17（2.0）	1（2.9）
胸水	23（4.7）	5（0.6）	1（2.9）
分泌物	14（2.8）	11（1.3）	0（0）
尿液	7（1.4）	11（1.3）	2（5.7）
支刷物	1（0.2）	6（0.7）	0（0）
腹水	3（0.6）	3（0.4）	0（0）
引流物	5（1.0）	0（0）	0（0）

表1

参考文献25

[1]	Haworth CS, Banks J, Capstick T, et al. British thoracic society guideline for the management of non-tuberculous mycobacterial pulmonary disease(NTM-PD)[J]. BMJ Open Respir Res, 2017, 4(1):e000242.
[2]	Bryant JM, Grogono DM, Rodriguez-Rincon D, et al. Emergence and spread of a human-transmissible multidrug-resistant nontuberculous mycobacterium[J]. Scie-nce, 2016, 354(6313):751-757.
[3]	Agizew T, Basotli J, Alexander H, et al. Higher-than-expected prevalence of non-tuberculous mycobacteria in HIV setting in Botswana: Implications for diagnostic algorithms using Xpert MTB/RIF assay[J]. PLoS One, 2017, 12(12):e0189981.
[4]	Rivero-Lezcano OM, González-Cortés C, Mirsaeidi M. The unexplained increase of nontuberculous mycobacteriosis[J]. Int J Mycobacteriol, 2019, 8(1):1-6. doi:10.4103/ijmy.ijmy_18_19pmid:30860172
[5]	Koenig SP, Kim A, Shepherd BE, et al. Increased mortality after tuberculosis treatment completion in persons living with human immunodeficiency virus in Latin America[J]. Clin Infect Dis, 2020, 71(1):215-217. doi:10.1093/cid/ciz1032pmid:31629369
[6]	Kobayashi T, Nishijima T, Teruya K, et al. High mortality of disseminated non-tuberculous mycobacterial infection in HIV-infected patients in the antiretroviral therapy era[J]. PLoS One, 2016, 11(3):e0151682.
[7]	LIN Q, MO L, SU X, et al. Distribution characteristics of drug susceptibility test results of tuberculosis and non-tuberculous bacilli in patients with opportunistic infections of AIDS[J]. J Tuberc Res, 2021, 9(4):256-265. doi:10.4236/jtr.2021.94024 URL
[8]	王娟娟, 施旭东, 肖园园, 等. 南京地区HIV/AIDS患者分枝杆菌感染分布及耐药性分析[J]. 临床检验杂志, 2021, 39(2):148-150.
	Wang JJ, Shi XD, Xiao YY, et al. Analysis of mycobacterium infection distribution and drug resistance in HIV/AIDS patients in Nanjing[J]. Chin J Clin Lab Sci, 2021, 39(2):148-150.
[9]	邓西子, 唐小平, 雷杰, 等. 广州地区艾滋病患者合并感染分枝杆菌菌种的分布特征[J]. 中华传染病杂志, 2015(6):331-334.
	Deng XZ, Tang XP, Lei J, et al. The mycobacterial species distribution in acquired immunodeficiency syndrome patients in Guangzhou[J]. Chin J Infect Dis, 2015(6):331-334.
[10]	邓晓军, 张峣, 杨炼, 等. 艾滋病合并非结核分枝杆菌感染的流行病学调查与临床特征分析[J]. 中外医疗, 2013, 32(24):53-54,56.
	Deng XJ, Zhang X, Yang L, et al. Epidemiological investigation and clinical characteristics of AIDS co-infection with non-tuberculous mycobacteria[J]. China Foreign Med Treat, 2013, 32(24):53-54.
[11]	黄文滨, 张满娥, 卢志华, 等. 福建省龙岩市333份分枝杆菌菌种鉴定结果回顾性分析[J]. 检验医学与临床, 2020, 17(22):3275-3278.
	Huang WB, Zhang ME, Lu ZH, et al. Retrospective analysis of the identification results of 333 Mycobacterium species in Longyan City, Fujian Province[J]. Lab Med Clin, 2020, 17(22):3275-3278.
[12]	陈晓. 2009-2013年我院非结核分枝杆菌菌种分布及临床特点[C]. 杭州: 2014年浙江省检验医学学术年会, 2014.
	Chen X. Distribution and clinical characteristics of non-tuberculous mycobacterium species in our hospital from 2009 to 2013: Zhejiang Provincial Academic Conference on Laboratory Medicine[C]. Hangzhou:2014.
[13]	Bjerrum S, Oliver-Commey J, Kenu E, et al. Tuberculosis and non-tuberculous mycobacteria among HIV-infected individuals in Ghana[J]. Trop Med Int Health, 2016, 21(9):1181-1190. doi:10.1111/tmi.12749pmid:27383726
[14]	Agizew T, Basotli J, Alexander H, et al. Higher-than-expected prevalence of non-tuberculous mycobacteria in HIV setting in Botswana: implications for diagnostic algorithms using Xpert MTB/RIF assay[J]. PLoS One, 2017, 12(12):e0189981.
[15]	Chanda-Kapata P, Kapata N, Klinkenberg E, et al. Non-tuberculous mycobacteria (NTM) in Zambia: prevalence, clinical, radiological and microbiological characteristics[J]. BMC Infect Dis, 2015, 15:500. doi:10.1186/s12879-015-1264-6pmid:26545357
[16]	Karamat A, Ambreen A, Ishtiaq A, et al. Isolation of non-tuberculous mycobacteria among tuberculosis patients, a study from a tertiary care hospital in Lahore, Pakistan[J]. BMC Infect Dis, 2021, 21(1):381. doi:10.1186/s12879-021-06086-8pmid:33894767
[17]	Bouso JM, Planet PJ. Complete nontuberculous mycobacteria whole genomes using an optimized DNA extraction protocol for long-read sequencing[J]. BMC Genomics, 2019, 20(1):793. doi:10.1186/s12864-019-6134-ypmid:31666009
[18]	Deggim-Messmer V, Bloemberg GV, Ritter C, et al. Diagnostic molecular mycobacteriology in regions with low tuberculosis endemicity: combining real-time PCR assays for detection of multiple mycobacterial pathogens with line probe assays for identification of resistance mutations[J]. E Bio Medicine, 2016, 9:228-237.
[19]	Genc GE, Demir M, Yaman G, et al. Evaluation of MALDI-TOF MS for identification of nontuberculous mycobacteria isolated from clinical specimens in mycobacteria growth indicator tube medium[J]. New Microbiol, 2018, 41(3):214-219. pmid:29874386
[20]	Akyar I, Çavuolu C, Aya M, et al. Evaluation of the performance of MALDI-TOF MS and DNA sequence analysis in the identification of mycobacteria species[J]. Turk J Med Sci, 2018, 48(6):1351-1357. doi:10.3906/sag-1801-198pmid:30543090
[21]	Huang WC, Yu MC, Huang YW. Identification and drug susceptibility testing for nontuberculous mycobacteria[J]. J Formos Med Assoc, 2020, 119(Suppl 1):S32-S41. doi:10.1016/j.jfma.2020.05.002 URL
[22]	Mirzapour A, Alam AN, Bostanabadi SZ, et al. Identification of nontuberculous mycobacteria by high-performance liquid chromatography from patients in tehran[J]. Int J Mycobacteriol, 2016, 5(Suppl 1):S214. doi:10.1016/j.ijmyco.2016.09.003 URL
[23]	Baliga S, Murphy C, Sharon L, et al. Rapid method for detecting and differentiating Mycobacterium tuberculosis complex and non-tuberculous mycobacteria in sputum by fluorescence in situ hybridization with DNA probes[J]. Int J Infect Dis, 2018, 75:1-7. doi:S1201-9712(18)34469-2pmid:30048818
[24]	Matsumoto Y, Kinjo T, Motooka D, et al. Comprehensive subspecies identification of 175 nontuberculous mycobacteria species based on 7547 genomic profiles[J]. Emerg Microbes Infect, 2019, 8(1):1043-1053. doi:10.1080/22221751.2019.1637702 URL
[25]	Sharma S, Latawa R, Wanchu A, et al. Differential diagnosis of disseminated mycobacterium avium and Mycobacterium tuberculosis infection in HIV patients using duplex PCR[J]. Future Microbiol, 2021, 16(3):159-173. doi:10.2217/fmb-2020-0133 URL