Ann Lab Med 2021; 41(5): 463-468
Published online September 1, 2021 https://doi.org/10.3343/alm.2021.41.5.463
Copyright © Korean Society for Laboratory Medicine.
Determination of Clinical Characteristics of Mycobacterium kansasii-Derived Species by Reanalysis of Isolates Formerly Reported as M. kansasii
Young-gon Kim, M.D.1 , Hong Yeul Lee, M.D.2 , Nakwon Kwak, M.D.2 , Jae Hyeon Park, M.D.1 , Taek Soo Kim, M.D.1 , Man Jin Kim, M.D.1 , Jee-Soo Lee, M.D.1 , Sung-Sup Park, M.D., Ph.D.1 , Jae-Joon Yim, M.D., Ph.D.2,3 , and Moon-Woo Seong, M.D., Ph.D.1
1Department of Laboratory Medicine, Seoul National University Hospital, Seoul, Korea; 2Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea; 3Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
Correspondence to: Moon-Woo Seong, M.D., Ph.D.
Department of Laboratory Medicine Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background: Seven genotypic subtypes of Mycobacterium kansasii were recently demonstrated to represent distinct species based on phylogenomic analysis. Mycobacterium kansasii sensu stricto (formerly known as subtype 1) is most frequently associated with human diseases; only a few studies have compared the diverse clinical characteristics of M. kansasii subtypes, including their drug susceptibilities. We determined the actual incidence of infections caused by each subtype of M. kansasii and identified their clinical characteristics.
Methods: We subtyped isolates identified as M. kansasii over the last 10 years at a tertiary care hospital. Percent identity score of stored sequencing data was calculated using curated reference sequences of all M. kansasii subtypes. Clinical characteristics were compared between those classified as subtype 1 and other subtypes. Student’s t-test, Wilcoxon rank-sum test, and Fisher’s exact test were used for comparisons.
Results: Overall, 21.7% of the isolates were identified as species distinct from M. kansasii. The proportion of patients with subtype 1 M. kansasii infection who received treatment was significantly higher than that of patients with other subtype infections (55.3% vs. 7.7%, P=0.003). Only patients with subtype 1 infection received surgical treatment. Non-subtype 1 M. kansasii isolates showed a higher frequency of resistance to ciprofloxacin and trimethoprim/sulfamethoxazole.
Conclusions: Non-subtype 1 M. kansasii isolates should be separately identified in routine clinical laboratory tests for appropriate treatment selection.
Keywords: Mycobacterium kansasii, subtypes, subtype 1 M. kansasii, Non-subtype 1 M. kansasii
Although the difference in the pathogenicity of
The detection frequency of
To fill this knowledge gap, we reanalyzed the sequencing trace files of all isolates reported to involve
MATERIALS AND METHODS
Participants and samples
This study was approved by the Institutional Review Board of Seoul National University Hospital (SNUH), Seoul, Korea. We reviewed the medical records of 60 consecutive patients with
Figure 1. Among 9,364 isolates in the non-tuberculous mycobacterial (NTM) identification tests, 114 isolates were identified as
M. kansasii(1.2%). After removing repeated isolates for the same patients, 60 isolates reported as M. kansasiiwere included in this analysis.
M. kansasii subtypes
Sequencing data generated from routine identification testing were used. For the 60 patients, percent identity score was calculated based on curated reference sequences of each subtype of
Grouping of patients
The patients were divided into two groups for comparison. Group 1 comprised patients infected with
Review of medical records
Patient characteristics including age, sex, body mass index, and smoking history were retrieved from the medical records. Medical histories of tuberculosis, malignancy, diabetes mellitus, liver diseases, kidney diseases, and immunocompromising diseases were reviewed. Radiologic findings and pulmonary function test results including forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and FEV1/FVC were retrieved. Clinical course of NTM isolation, such as co-infection with other NTM organisms, presence of NTM pulmonary diseases, and treatment initiation were reviewed. The drug susceptibility test results were also reviewed.
Statistical analysis was performed using R software (version 4.0.2, R Foundation for Statistical Computing, Vienna, Austria). For quantitative variable comparison, Shapiro test was used to evaluate the normality of data. Student’s
Among the 60 isolates included in the analysis, 13 were reclassified as one of the newly reported
The baseline characteristics of the two patients’ groups are shown in Table 1. FVC was significantly lower in Group 1 than in Group 2 (88.0% vs. 97.5% predicted,
The clinical course of the two groups is summarized in Table 2. Co-infection with
In this study, 21.7% of isolates previously identified as
Most reports on
Only a few studies have examined the drug susceptibility of
Our study had some limitations. First, the utilization of only two target regions, the 16S rRNA gene and
In conclusion, approximately one-fifth of the isolates identified as
Kim YG identified patients with
CONFLICTS OF INTEREST
No potential conflicts of interest relevant to this article were reported.
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