Pathogenität von Mycobacterium kansasii ^[*]

 

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Zusammenfassung

Hintergrund: In einer prospektiven Studie der Wissenschaftlichen Arbeitsgemeinschaft für die Therapie von Lungenkrankheiten (WATL) über pulmonale nicht-tuberkulöse Mykobakteriosen wurde bei Patienten mit Nachweis von M. kansasii im Gegensatz zu anderen nicht-tuberkulösen Mykobakterienspezies (NTM) regelhaft eine Infektion mit Krankheitswert gefunden. Wir haben den Verdacht einer derart hohen Pathogenität monozentrisch überprüft.

Methoden: Retrospektiv wurden die Krankenunterlagen sämtlicher Patienten der Lungenklinik Heckeshorn evaluiert, bei denen im Zeitraum vom 1. 1. 2003 bis zum 30. 6. 2013 kulturell M. kansasii aus respiratorischen Materialien nachgewiesen wurde. Der Krankheitswert wurde anhand der ATS-Kriterien bemessen. Zur Genotypisierung der Stämme wurde die 16S-23S rDNA internal transcribed spacer-Region sequenziert.

Ergebnisse: Insgesamt wurden 43 konsekutive Fälle untersucht, nur zu 38 Patienten verfügten wir über vollständige Krankenakten. In einem Fall gelang ein molekularbiologischer Nachweis, ein kultureller Nachweis gelang bei 37 Fällen. Nur bei 25/37 Patienten (68 %) lag nach ATS-Kriterien eine behandlungsbedürftige Erkrankung durch M. kansasii vor (Grunderkrankungen: u. a. COPD 8/25 (32 %), Bronchiektasen 5/25 (20 %), postspezifische oder Operations-Narbe 3 /25 (12 %), Alkoholabusus 4 /25 (16 %)). Bei 12/37 (32 %) Patienten musste von einer Kolonisation und/oder einer nicht therapiewürdigen Infektion ausgegangen werden (Grunderkrankungen: u. a. COPD 7 /12 (58 %), Bronchiektasen 3 /12 (25 %), TB- oder Operations-Narbe 3/12 (25 %)). Bei 32 Proben gelang eine weitere Typisierung durch Sequenzierung, 30 Stämme wurden dem Genotyp I und 2 Stämme dem Genotyp II zugeordnet. In 22/30 Fällen (73 %) ging die Isolierung von Genotyp I mit Pathogenität einher.

Schlussfolgerungen: Die Vermutung einer besonders hohen Pathogenität von M. kansasii ließ sich in unserem Krankengut nicht bestätigen. Auch ließ sich für die Subtypen von M. kansasii keine unterschiedliche Pathogenität erkennen. Die klinischen und semiquantitativen mikrobiologischen Kriterien für die Diagnose einer nicht-tuberkulösen Mykobakteriose durch M. kansasii sind einzuhalten.

Abstract

Background: In a recent prospective study on pulmonary infections with non-tuberculous mycobacteria (NTM) led by the WATL group, disease rates in patients with M. kansasii infection were found to be 100 %. In the present study we re-evaluated the pathogenicity of M. kansasii infections in a large lung diseases treatment center in Berlin (Lungenklinik Heckeshorn).

Methods: All patients in whose respiratory specimen cultures M. kansasii was detected between January 2003 and June 2013 were included. The 2007 ATS diagnostic criteria were applied to differentiate disease from asymptomatic infection. The strains were further investigated by sequencing of the 16S-23S rDNA internal transcribed spacer (ITS) region.

Results: We evaluated 43 consecutive cases. Complete patient data were available in 38 cases. In one patient, no culture results were obtained, in 37 patients M. kansasii was isolated and patient data could be retrieved. In 25/37 patients (68 %) clinical disease was present so that a specific treatment was initiated (underlying diseases were COPD in 8/25 (32 %), bronchiectasis in 5/25 (20 %), TB scar or scar due to prior chest surgery in 3/25 (12 %) and alcohol abuse in 4/25 (16 %)). Twelve out of 37 patients (32 %) were found to be colonized or asymptomatically infected (underlying diseases were COPD in 7/12 (58 %), bronchiectasis in 3/12 (25 %) and TB scar or scar due to prior chest surgery in 3/12 (25 %)). Sequencing results identified 30 strains as genotype I, and 2 strains as genotype II. In 22/30 cases (73 %) genotype I was considered pathogenic.

Conclusions: In our cohort, we could not confirm the high M. kansasii pathogenicity of 100 % found in a previous multi-center study; we therefore support the clinical and semiquantitative microbiologic diagnostic criteria also for infection with M. kansasii.

^* Die Auswertung wurde durch die Oskar-Helene-Heim Stiftung unterstützt.

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