The information on the contribution of non tuberculous mycobacteria (NTM) to mycobacterial infections in Africa is scarce due to limited laboratory culture for its isolation and identification. One hundred and thirty-seven sputum smear positive patients were recruited into a study on the molecular epidemiology of Mycobacterium tuberculosis in Cross River State. Following sputum culture, 97 pure isolates were obtained and identified using Capilia TB-Neo and further confirmed by the GenoType Mycobacterium CM kit. Of the 97 isolates, 81 (83.5%) isolates were Capilia TB-Neo positive while 16 (16.5%) were Capilia TB-Neo negative. Further confirmation with the GenoType Mycobacterium CM kit revealed that 4 (25%) of the 16 isolates belonged to NTM and included M. fortuitum I, M. fortuitum II/M magaritense, M. abscessus, and M. avium ssp. The remaining 12 (75%) Capilia TB-Neo negative isolates were not members of the genus Mycobacterium despite their AFB appearance. Six (33.3%) of the Capilia TB-Neo negative were from HIV positive tuberculosis patients. All subjects in this study were placed on DOTS shortly after the AFB results were obtained. The implication of isolation of 16.5% nontuberculous isolates further emphasizes the need for culture of sputum specimen especially in HIV positive patients prior to administration of antituberculosis therapy. 1. Introduction Mycobacterium tuberculosis is the most important causative agent of tuberculosis (TB) while nontuberculous mycobacteria (NTM) may play a key role in etiology of TB-like syndromes [1]. Data on nontuberculous mycobacterial disease in sub-Saharan Africa are limited, due mainly to the lack of laboratory culture facilities for the identification of mycobacterial species. Consequently, many laboratories do not discriminate between M. tuberculosis and NTM for similar reasons [2–4]. Treatment of TB patients in most sub-Saharan African countries including Nigeria is based solely on the results of microscopic smear positivity. As such, all sputum smear positive diagnosed patients are indiscriminately placed on DOTS, the current international TB treatment strategy. The implication is that NTM is inappropriately managed with first-line antituberculous drug [4, 5], worsening the patient’s condition and raising the risk of drug resistance. Although it is known that most sputum smear positive patients are truly TB patients [6], the continued increase in TB drug resistance raises the question on the impact of this indiscriminate use of TB drugs to treat all diagnosed sputum smear positive patients. In assessing the
References
[1]
P. C. A. M. Buijtels, M. A. B. Van Der Sande, C. S. De Graaff et al., “Nontuberculous mycobacteria, Zambia,” Emerging Infectious Diseases, vol. 15, no. 2, pp. 242–249, 2009.
[2]
C. L. Chang, T. H. Park, M. N. Kim, N. Y. Lee, H. J. Lee, and J. T. Suh, “Survey on changes in mycobacterial testing practices in Korean laboratories,” Korean Journal of Clinical Microbiology, vol. 4, pp. 108–114, 2001.
[3]
M. N. Kim, S. H. Lee, S. E. Yang, and C. H. Pai, “Mycobacterial testing in hospital laboratories in Korea: results of a survey of 40 university or tertiary-care hospitals,” Korean Journal of Clinical Pathology, vol. 19, pp. 86–91, 1999.
[4]
W. J. Koh and J. Kwon, “Treatment of tuberculosis patients in the private sector in Korea,” Tuberculosis and Respiratory Diseases, vol. 56, no. 5, pp. 443–449, 2004.
[5]
J. J. Yim and S. K. Han, “Diagnosis and treatment of nontuberculous mycobacterial pulmonary diseases,” Journal of Korean Medical Association, vol. 48, pp. 563–570, 2005.
[6]
E. O. Idigbe, C. E. Anyiwo, and D. I. Onwujekwe, “Human pulmonary infections with bovine and typical mycobacteria in Lagos, Nigeria,” Journal of Tropical Medicine and Hygiene, vol. 89, no. 3, pp. 143–148, 1986.
[7]
WHO, Laboratory Services in Tuberculosis Control. Part III. Culture, WHO, Geneva, Switzerland, 1998.
[8]
B. P. Thumamo, A. E. Asuquo, L. N. Abia-Bassey et al., “Molecular epidemiology and genetic diversity of Mycobacterium tuberculosis complex in the Cross River State, Nigeria,” Infection, Genetics and Evolution, vol. 12, no. 4, pp. 671–677, 2012.
[9]
O. Daniel, E. Osman, P. Adebiyi, G. Mourad, E. Declarcq, and R. Bakare, “Non tuberculosis mycobacteria isolates among new and previously treated pulmonary tuberculosis patients in Nigeria,” Asian Pacific Journal of Tropical Disease, vol. 1, no. 2, pp. 113–115, 2011.
[10]
W. J. Koh, O. J. Kwon, C. M. Yu et al., “Recovery rate of nontuberculous mycobacteria from acid-fast-bacilli smear-positive sputum specimens,” Tuberculosis and Respiratory Diseases, vol. 54, no. 1, pp. 22–32, 2003.
[11]
D. Wagner and L. S. Young, “Nontuberculous mycobacterial infections: a clinical review,” Infection, vol. 32, no. 5, pp. 257–270, 2004.
[12]
I. W. Fawcett and B. J. Watkins, “Initial resistance of Mycobacterium tuberculosis in Northern Nigeria,” Tubercle, vol. 57, no. 1, pp. 71–73, 1976.
[13]
J. D. Mawak, N. E. Gomwalk, C. S. S. Bello, and Y. T. Kandakai-Olukemi, “Human pulmonary infections with bovine and environment (Atypical) mycobacteria in Jos, Nigeria,” Ghana Medical Journal, vol. 40, no. 4, pp. 132–136, 2006.
[14]
D. E. Griffith, W. M. Girard, and R. J. Wallace, “Clinical features of pulmonary disease caused by rapidly growing mycobacteria: an analysis of 154 patients,” American Review of Respiratory Disease, vol. 147, no. 5, pp. 1271–1278, 1993.
[15]
J. A. Crump, J. Van Ingen, A. B. Morrissey et al., “Invasive disease caused by nontuberculous mycobacteria, Tanzania,” Emerging Infectious Diseases, vol. 15, no. 1, pp. 53–55, 2009.
[16]
D. E. Griffith, T. Aksamit, B. A. Brown-Elliott et al., “An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases,” American Journal of Respiratory and Critical Care Medicine, vol. 175, no. 4, pp. 367–416, 2007.
[17]
WHO, UNAIDS, UNICEF, “Towards universal access: scaling up priority HIV/AIDS Interventions in the health sector,” 2008.
[18]
F. Márquez-Diaz, L. E. Soto-Ramirez, and J. Sifuentes-Osornio, “Nocardiasis in patients with HIV infection,” AIDS Patient Care and STDs, vol. 12, no. 11, pp. 825–832, 1998.
[19]
S. V. S. Malladi, P. K. Ankathi, L. Vemu, and N. Rao, “Disseminated nocardiosis in an advanced AIDS patient,” Journal of Association of Physicians of India, vol. 58, no. 5, pp. 317–318, 2010.
[20]
V. Chopra, G. C. Ahir, and M. E. Grossman, “Cutaneous nocardiosis,” Journal of the American Academy of Dermatology, vol. 48, p. 211, 1985.
