Tülin KUYUCU, Dilek ERNAM, Mualla PARTAL, Kaya KÖKSALAN, Aylin BABALIK, Emine N. ORDU

Non-tuberculous mycobacteria infection: 75 cases

Giriş: Tüberküloz dışı mikobakteri özellikle AIDS ve immünsüpresif hastalarda yaygın olarak gözlenmektedir. Bu çalışma, klinik önemi açısından hastaların balgam örneklerinde MOTT içeriğinin araştırılması amacıyla tasarlanmıştır. Hastalar ve Metod: 2009-2010 yıllarında, Süreyyapaşa Göğüs Hastalıkları ve Göğüs Cerrahisi Eğitim ve Araştırma Hastanesi kliniklerinde tüberküloz dışı mikobakteri tanısı alan toplam 75 hastada [30 kadın (%40), 45 erkek (%69); ortalama yaş (SS): 48.7 (15.9) yıl] hızlı test ve NAP testi kullanılarak MGIT yöntemiyle Löwenstein-Jensen (LJ) de (51.864 LJ) atipik bü- yüme tespit edildi. Tespit işlemleri 31 (%43) hastada, Hsp65PCRREA yöntemlerine göre yapıldı. Tedavi yönetimi, radyoloji, bakteriyoloji, eşlik eden hastalıklar ve tedavi sonuçları tıbbi kayıtların incelenmesi, hastaların doğrudan aranması ve tü- berküloz dispanserlerin verilerine ulaşılması yolu ile elde edildi. Bulgular: Mycobacterium abscessus 9 (%28) hastada, Mycobacterium avium kompleks 8 (%25) hastada, Mycobacterium kansasii 5 (%16) hastada Hsp65PCRREA yöntemleriyle tespit edildi. American Thoracic Society tanım ve tedavi kriterlerine sahip 18 (%24) hastada, tedavi minör ve majör ilaçlarla yürütüldü. Standart tüberküloz tedavisi 75 olgunun 25 (%33)inde uygulandı. Tüberküloz dışı mikobakteri tespiti 25 olgudan 8 (%32)inde gözlendi. Takip dönemi 75 olgunun 32sinde tedavisiz yürütüldü. Tek bir pozitif atipik büyüme 43 (%72) olguda saptandı. Toplamda 43 olguya uygulanan tedavi, 25 (%58) olguda iyileşme, 3 (%7) olguda başarısızlık ve 3 (%7) olguda ölümle sonuçlandı. İlaç direnci 36 olguda saptandı. Herhangi bir ilaç direnci 31 (%86) olguda, HR ilaç direnci ise 27 (%75) olguda tespit edildi. Tüberküloz tedavi öykü- sü 20 (%40) olguda mevcuttu. Respiratuar ve nonrespiratuar hastalıklar eşit şekilde olguların 18 (%38)inde tespit edildi. Radyolojik konsolidasyon 28 (%65) olguda, kavite ise 16 (%37) olguda tespit edildi. Sonuç: Kültür yöntemleri aracılığıyla tüberküloz dışı mikobakteri tespiti, uygun tedavi ve epidemiyolojik değerlendirme yapabilmek adına önemlidir.

Akciğerde tüberküloz dışı mikobakteri infeksiyonu: 75 olgu

Introduction: Non-tuberculosis mycobacterium is especially seen in AIDS and non-immunosuppressant patients. This study was designed to evaluate data relating to non-tuberculosis mycobacterium content in patients sputum for the clinical importance. Patients and Methods: During 2009-2010 at Sureyyapasa Chest Diseases and Chest Surgery Training and Research Hospital clinics, 75 patients [30 women (40%) and 45 men (69%); mean age (SD): 48.7 (15.9) years] with non-tuberculosis mycobacterium were determined by the rapid test and NAP test in Mycobacteria Growth Indicator Tube (MGIT), which had atypical growth in 51.864 Lowenstein-Jensen. Identification was done with Hsp65PCRREA methods in 32 (43%) cases. Treatment management, radiology, bacteriology, co-morbidity, treatment outcomes were evaluated from medical records, calling patients and from tuberculosis dispensaries. Results: In 9 (28%) patients Mycobacterium abscessus, in 8 (25%) patients Mycobacterium avium complex (MAC), in 5 (16%) patients Mycobacterium kansasii was found with identification Hsp65PCRREA methods. In 18 (24%) of 75 cases with American Thoracic Society definition and treatment criteria, treatment was administered using major and minor drugs. Standard tuberculosis treatment was administered in 25 (33%) of the 75 cases. In 8 of 25 (32%) cases identification of non-tuberculosis mycobacterium was evident. In 32 of 75 cases follow up was performed with no treatment. One positive atypical growth culture was identified in 23 (72%) of 32 patients. Treatment was administered in 43 cases while 25 (58%) of 43 were cured, 3 (7%) of 43 were default and 3 (7%) died. Drug resistance was the outcome in 36 cases. While 31 (86%) had any drug resistance, 27 (75%) had HR drug resistance. Past history of tuberculosis treatment was evident in 20 (40%) cases. Respiratory and non-respiratory diseases were identified equally in 18 (38%) cases. Radiological consolidation in 28 (65%), and cavity in 16 (37%) cases were determined. Conclusion: In order to carry out the right treatment and epidemiologic evaluation, it is important to identify non-tuberculosis mycobacterium by culture methods.

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