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Nontuberculous Mycobacterium in Pulmonary & Extrapulmonary Tuberculosis: Stilla Neglected & Underdiagnosed Pathogen in Developing Countries


Affiliations
1 Junior Resident, Department of Microbiology, M.M.I.M.S.R., Maharishi Markandeshwar (Deemed to be University), MMDU, Mullana, Ambala, Haryana, India
2 Professor, Department of Microbiology, M.M.I.M.S.R., Maharishi Markandeshwar (Deemed to be University), MMDU, Mullana, Ambala, Haryana, India
3 Junior Resident, Department of Pharmacology, M.M.I.M.S.R., Maharishi Markandeshwar (Deemed to be University), MMDU, Mullana, Ambala, Haryana, India
4 Junior Resident, Department of Respiratory Medicine, M.M.I.M.S.R., Maharishi Markandeshwar (Deemed to be University), MMDU, Mullana, Ambala, Haryana, India
5 General Physician, Baghpat, Uttar Pradesh, India
     

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Non-tuberculous mycobacterium (NTM) has been identified in human pulmonary and extra pulmonary diseases and is of great concern for clinicians and microbiologists because of their increasing global incidence. They are now increasingly recognized as important pathogens in both immunocompromised and immunocompetent population. They should be identified rapidly and should be carefully differentiated as contamination, colonization ordisease. Cultures were made on conventional LJ and LJ with PNB media. Growth was confirmed as AFB (acid fast bacilli) by ZN staining. NTM were identified by growth on LJ with PNB media, colony morphology, rate of growth, pigmentation, catalase activity and confirmed by MPT 64 antigen rapid test (using SD Bioline TB Ag MPT 64 test kit) . Data was analysed statistically using SPSS software. Out of total 500 processed samples (250 pulmonary & 250 extrapulmonary), 12(21.05%) and 7(21.8%) NTM were isolated from pulmonary and extrapulmonary samples respectively. Maximum pulmonary NTM (41.7%) were isolated from > 60 years age of patients in contrast to extrapulmonary NTM isolates which were more in 20-40 years of age group. There was 16.7% previously treated patients in pulmonary while 100% were newly diagnosed patients in extrapulmonary TB cases. This study highlights the importance of early diagnosis and differentiation among Mycobacterium tuberculosisand NTM so that these NTM are not underestimated in routine diagnostic procedures merely as environmental or laboratory contaminants.

Keywords

Non-tuberculous mycobacterium, p-nitrobenzoic acid, Pulmonary TB, extrapulmonary TB, MPT64 antigen.
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  • Nontuberculous Mycobacterium in Pulmonary & Extrapulmonary Tuberculosis: Stilla Neglected & Underdiagnosed Pathogen in Developing Countries

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Authors

Pankaj Saini
Junior Resident, Department of Microbiology, M.M.I.M.S.R., Maharishi Markandeshwar (Deemed to be University), MMDU, Mullana, Ambala, Haryana, India
Varsha A. Singh
Professor, Department of Microbiology, M.M.I.M.S.R., Maharishi Markandeshwar (Deemed to be University), MMDU, Mullana, Ambala, Haryana, India
Kunal Sharma
Junior Resident, Department of Pharmacology, M.M.I.M.S.R., Maharishi Markandeshwar (Deemed to be University), MMDU, Mullana, Ambala, Haryana, India
Gunjeet Singh
Junior Resident, Department of Pharmacology, M.M.I.M.S.R., Maharishi Markandeshwar (Deemed to be University), MMDU, Mullana, Ambala, Haryana, India
Abhishek Chauhan
Junior Resident, Department of Respiratory Medicine, M.M.I.M.S.R., Maharishi Markandeshwar (Deemed to be University), MMDU, Mullana, Ambala, Haryana, India
Shailja Sharma
General Physician, Baghpat, Uttar Pradesh, India

Abstract


Non-tuberculous mycobacterium (NTM) has been identified in human pulmonary and extra pulmonary diseases and is of great concern for clinicians and microbiologists because of their increasing global incidence. They are now increasingly recognized as important pathogens in both immunocompromised and immunocompetent population. They should be identified rapidly and should be carefully differentiated as contamination, colonization ordisease. Cultures were made on conventional LJ and LJ with PNB media. Growth was confirmed as AFB (acid fast bacilli) by ZN staining. NTM were identified by growth on LJ with PNB media, colony morphology, rate of growth, pigmentation, catalase activity and confirmed by MPT 64 antigen rapid test (using SD Bioline TB Ag MPT 64 test kit) . Data was analysed statistically using SPSS software. Out of total 500 processed samples (250 pulmonary & 250 extrapulmonary), 12(21.05%) and 7(21.8%) NTM were isolated from pulmonary and extrapulmonary samples respectively. Maximum pulmonary NTM (41.7%) were isolated from > 60 years age of patients in contrast to extrapulmonary NTM isolates which were more in 20-40 years of age group. There was 16.7% previously treated patients in pulmonary while 100% were newly diagnosed patients in extrapulmonary TB cases. This study highlights the importance of early diagnosis and differentiation among Mycobacterium tuberculosisand NTM so that these NTM are not underestimated in routine diagnostic procedures merely as environmental or laboratory contaminants.

Keywords


Non-tuberculous mycobacterium, p-nitrobenzoic acid, Pulmonary TB, extrapulmonary TB, MPT64 antigen.



DOI: https://doi.org/10.37506/v11%2Fi2%2F2020%2Fijphrd%2F194914