Závěrečná zpráva o řešení grantu Agentury pro zdravotnický výzkum MZ ČR
nestr.
The epidemiological situation of tuberculosis is favourable in the Czech Republic thanks to a functional control and diagnosis system. However, we are facing serious shortcomings in today's clinical practice at all levels of the emerging issue of mycobacterioses. Incidence of current cases of disease is strongly underestimated in the Czech R. A comprehensive concept of prevention and evaluation of mycobacterial findings in variously predisposed persons, especially children, is missing. At the same time, due to the increasing antituberculotic drug resistance, dilemmas arise associated with the long-term medical follow-up care and suitability of therapy. The main focus of the project is to evaluate all the findings obtained by detailed examinations of patients on clinical, laboratory and the demographic level, and at the same time to clarify the epidemiological context by researching the presence of non-tuberculous mycobacteria and their properties in the environment and the immediate vicinity of humans.
Epidemiologická situace tuberkulózy je díky funkčnímu systému kontroly a diagnostiky v České republice příznivá. S vážnými nedostatky se však v současné klinické praxi potýkáme na všech úrovních řešení stále aktuálnějších mykobakterióz. Incidence skutečných případů onemocnění je jednoznačně v České R. podhlášená. Současně chybí ucelená koncepce prevence a hodnocení nálezů mykobakterií u různě predisponovaných osob, zejm. dětí. Zároveň se vzrůstem rezistence k antituberkulotikům vyvstávají rozpaky související s případnou dispenzarizací či vhodností terapie. Hlavní náplní projektu je zhodnotit veškeré poznatky získané podrobným vyšetřováním pacientů na klinické, laboratorní a socio-demografické úrovni a zároveň objasnit epidemiologické souvislosti výzkumem přítomnosti netuberkulózních mykobakterií a jejich vlastností ve vnějším prostředí a v bezprostředním okolí člověka.
- Klíčová slova
- cystická fibróza, cystic fibrosis, mykobakteriózy, mycobacterioses, molekulární epidemiologie, molecular epidemiology, COPD, CHOPN, Mycobacterium avium, MDR, mykobakteriální lymfadenitida, kvantitativní PCR, BCG, ekologie NTM, Mycobacterium avium, mycobacterial lymphadenitis, MDR, quantitative PCR, BCG, NTM ecology,
- NLK Publikační typ
- závěrečné zprávy o řešení grantu AZV MZ ČR
Počet diagnostikovaných onemocnění vyvolaných netuberkulózními mykobakteriemi u predisponovaných jedinců zůstává v České republice každoročně konstantní. Jejich klinické uplatnění je variabilní a závisí na vlastnostech konkrétního druhu, jeho přítomnosti a kvantity v bezprostředním okolí člověka. Mezi nejčastější klinicky zaznamenávané druhy patří Mycobacterium avium, M. kansasii a M. xenopi. Nejvýznamnějším zdrojem M. avium je rašelina a z ní odvozené produkty. Sekundárně osídluje teplovodní systémy, které jsou velice rizikové z hlediska expozice (především vířivky). M. kansasii je stále přítomno ve vodách v oblastech ovlivněných průmyslovou a důlní činností. Jeho recentně vyčleněné genetické varianty jsou obvykle zcela bez klinického významu, nicméně mohou být přítomny jako kontaminace ve zdravotnických přípravcích. M. xenopi trvale osídluje většinu teplovodních systémů a jeho praktická všudypřítomnost ovlivňuje správné diagnostické závěry u nejasného nálezu při zobrazovacích metodách. Iniciace antibiotické léčby, která nemusí být vždy úspěšná, by měla probíhat na základě komplexního posouzení stavu pacienta, nálezu a jeho progrese. Ani výsledky laboratorních vyšetření nemusí být při rozhodování vždy směrodatné.
The annual number of diagnosed diseases caused by non-tuberculous mycobacteria in predisposed individuals remains constant in the Czech Republic. Their clinical characteristics vary depending on the properties of the causative species and its presence and quantity in the immediate environment of the patient. The most common clinically relevant species are Mycobacterium avium, M. kansasii, and M. xenopi. The most important source of M. avium is peat and products derived from it. M. avium may colonise warm water systems, posing a high risk of exposure to users (jacuzzi users in particular). M. kansasii is still present in waters of areas affected by industrial and mining activities. Its recently isolated genetic variants are mostly of no clinical significance but may be present as contaminants in medical preparations. M. xenopi permanently colonises most warm water systems, and its practical ubiquity makes difficult the interpretation of ambiguous findings on imaging. The antibiotic treatment, which may not always be successful, should be initiated after a comprehensive assessment of the patient’s condition, imaging data, and disease progression. Similarly, the results of laboratory tests may not always be authoritative in decision making.
- MeSH
- lidé MeSH
- morbidita MeSH
- Mycobacterium avium komplex izolace a purifikace klasifikace patogenita MeSH
- Mycobacterium kansasii izolace a purifikace patogenita MeSH
- Mycobacterium xenopi izolace a purifikace patogenita MeSH
- Mycobacterium klasifikace patogenita MeSH
- mykobakteriózy * diagnóza etiologie farmakoterapie klasifikace mikrobiologie přenos MeSH
- netuberkulózní mykobakterie izolace a purifikace klasifikace patogenita MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- přehledy MeSH
- Geografické názvy
- Česká republika MeSH
- Publikační typ
- abstrakt z konference MeSH
The multiple forms of pulmonary aspergillosis caused by Aspergillus species are the most common respiratory mycoses. Although invasive, the analysis of diagnostic biomarkers in bronchoalveolar lavage fluid (BALF) is a clinical standard for diagnosing these conditions. The BALF samples from 22 patients with proven or probable aspergillosis were assayed for human pentraxin 3 (Ptx3), fungal ferricrocin (Fc), and triacetylfusarinine C (TafC) in a retrospective study. The infected group included patients with invasive pulmonary aspergillosis (IPA) and chronic aspergillosis (CPA). The BALF data were compared to a control cohort of 67 patients with invasive pulmonary mucormycosis (IPM), non-Aspergillus colonization, or bacterial infections. The median Ptx3 concentrations in patients with and without aspergillosis were 4545.5 and 242.0 pg/mL, respectively (95% CI, p < 0.05). The optimum Ptx3 cutoff for IPA was 2545 pg/mL, giving a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 100, 98, 95, and 100%, respectively. The median Ptx3 concentration for IPM was high at 4326 pg/mL. Pentraxin 3 assay alone can distinguish IPA from CPA and invasive fungal disease from colonization. Combining Ptx3 and TafC assays enabled the diagnostic discrimination of IPM and IPA, giving a specificity and PPV of 100%.
- Publikační typ
- časopisecké články MeSH
Nontuberculous mycobacteria (NTM) represent an important group of environmentally saprophytic and potentially pathogenic bacteria that can cause serious mycobacterioses in humans and animals. The sources of infections often remain undetected except for soil- or water-borne, water-washed, water-based, or water-related infections caused by groups of the Mycobacterium (M.) avium complex; M. fortuitum; and other NTM species, including M. marinum infection, known as fish tank granuloma, and M. ulcerans infection, which is described as a Buruli ulcer. NTM could be considered as water-borne, air-borne, and soil-borne pathogens (sapronoses). A lot of clinically relevant NTM species could be considered due to the enormity of published data on permanent, periodic, transient, and incidental sapronoses. Interest is currently increasing in mycobacterioses diagnosed in humans and husbandry animals (esp. pigs) caused by NTM species present in peat bogs, potting soil, garden peat, bat and bird guano, and other matrices used as garden fertilizers. NTM are present in dust particles and in water aerosols, which represent certain factors during aerogenous infection in immunosuppressed host organisms during hospitalization, speleotherapy, and leisure activities. For this Special Issue, a collection of articles providing a current view of the research on NTM-including the clinical relevance, therapy, prevention of mycobacterioses, epidemiology, and ecology-are addressed.
Mycobacteria are a unique group of microorganisms. They are characterised by exceptional adaptability and durability. They are capable of colonisation and survival even in very unfavourable conditions. In addition to the well-known obligate human pathogens, Mycobacterium tuberculosis and M. leprae, more than 200 other species have been described. Most of them form a natural part of the microflora of the external environment and thrive in aquatic and soil environments especially. For many of the mycobacterial species associated with human disease, their natural source has not yet been identified. From an ecological point of view, mycobacteria are saprophytes, and their application in human and animal diseases is opportunistic. Most cases of human disease from saprophytic mycobacteria occur in immunocompromised individuals. This adaptability and resilience to environmental pressures makes treatment of mycobacterial diseases (most often sapronoses and less often zoonoses) and permanent eradication of mycobacteria from the environment very difficult. Saprophytic mycobacterial diseases (sapronoses) are chronic and recurrent due to the fact of repeated endogenous or exogenous re-exposure. Therefore, knowledge regarding their occurrence in soil and dust would aid in the prevention of saprophytic mycobacterioses. In conjunction, their presence and ecological significance in the environment can be revealed.
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
Notwithstanding the fact that streptomycetes are overlooked in clinical laboratories, studies describing their occurrence in disease and potential pathogenicity are emerging. Information on their species diversity in clinical specimens, aetiology and appropriate therapeutic treatment is scarce. We identified and evaluated the antibiotic susceptibility profile of 84 Streptomyces clinical isolates from the Czech Republic. In the absence of appropriate disk diffusion (DD) breakpoints for antibiotic susceptibility testing (AST) of Streptomyces spp., we determined DD breakpoints by correlation with the broth microdilution method and by the distribution of zone diameters among isolates. Correlation accuracy was high for 9 antibiotics, leading to the establishment of the most valid DD breakpoints for Streptomyces antibiotic susceptibility evaluation so far. Clinical strains belonged to 17 different phylotypes dominated by a cluster of strains sharing the same percentage of 16S rRNA gene sequence identity with more than one species (S. albidoflavus group, S. hydrogenans, S. resistomycificus, S. griseochromogenes; 70% of isolates). AST results showed that Streptomyces exhibited intrinsic resistance to penicillin, general susceptibility to amikacin, gentamycin, vancomycin and linezolid, and high percentage of susceptibility to tetracyclines and clarithromycin. For the remaining antibiotics, AST showed inter- and intra-species variations when compared to available literature (erythromycin, trimethoprim-sulfamethoxazole), indicating a region-dependent rather than species-specific patterns.
For epidemiology studies, a decontamination method using a solution containing 4.0% NaOH and 0.5% tetradecyltrimethylammonium bromide (TDAB) represents a relatively simple and universal procedure for processing heavily microbially contaminated matrices together with increase of mycobacteria yield and elimination of gross contamination. A contamination rate only averaging 7.3% (2.4% in Cluster S; 6.9% in Cluster R and 12.6% in Cluster E) was found in 787 examined environmental samples. Mycobacteria were cultured from 28.5% of 274 soil and water sediments samples (Cluster S), 60.2% of 251 samples of raw and processed peat and other horticultural substrates (Cluster R), and 29.4% of 262 faecal samples along with other samples of animal origin (Cluster E). A total of 38 species of slow and rapidly growing mycobacteria were isolated. M. avium ssp. hominissuis, M. fortuitum and M. malmoense were the species most often isolated. The parameters for the quantitative detection of mycobacteria by PCR can be significantly refined by treating the sample suspension before DNA isolation with PMA (propidium monoazide) solution. This effectively eliminates DNA residue from both dead mycobacterial cells and potentially interfering DNA segments present from other microbial flora. In terms of human exposure risk assessment, the potential exposure to live non-tuberculous mycobacteria can be more accurately determined.
- Publikační typ
- časopisecké články MeSH
- O autorovi
- Kaustová, Jarmila, 1945-2020 Autorita
- MeSH
- Mycobacterium kansasii izolace a purifikace klasifikace MeSH
- mykobakteriózy diagnóza MeSH
- Publikační typ
- nekrology MeSH
- O autorovi
- Kaustová, Jarmila 1945-2020 Autorita
