BACKGROUND: Infections caused by mycobacteria have been significantly increasing. Due to the difficulty of making a decision about the pathogenicity of mycobacteria, species-level identification is very important for patients' diagnosis and treatment. The purpose of this study was to identify mycobacteria species using a high performance liquid chromatography (HPLC) method and to provide an initial database for the distribution of mycobacteria in Korea. METHODS: Acid fast bacteria isolated from 3,107 clinical specimens were identified by mycolic acid analysis using HPLC. The HPLC patterns were compared with those of standard mycobacteria species. RESULTS: The HPLC patterns were divided into single, double, and triple cluster groups, each group comprising 9, 20, and 4 species, respectively. Mycobacteria and non-tuberculous mycobacteria (NTM) were identifies by HPLC at the rates of 99.5% and 95.6%, respectively. NTM was isolated in 12.4% of the mycobacteria positive specimens. This study also found that there were 20 different NTM species with the distribution of each species ranging from 0.3% to 15.9% of the total NTM. While the rate of NTM has been increasing in Korea, M. avium-intracellulare, M. fortuitum, and M. chelonae are relatively decreasing, and M. kansasii and M. gordonae are relatively increasing. CONCLUSIONS: HPLC method was highly discriminative for the identification of NTM in clinical specimens.
Bacterial Typing Techniques ; Chromatography, High Pressure Liquid/*methods ; Hospitals, University ; Humans ; Korea ; Mycobacteria, Atypical/chemistry/*isolation & purification ; Mycobacterium Infections, Atypical/drug therapy/microbiology ; Mycolic Acids/analysis

The incidence of pulmonary disease caused by nontuberculous mycobacteria (NTM) appears to be increasing worldwide. In Korea, M. avium complex and M. abscessus account for most of the pathogens encountered, whilst M. kansasii is a relatively uncommon cause of NTM pulmonary diseases. NTM pulmonary disease is highly complex in terms of its clinical presentation and management. Because its clinical features are indistinguishable from those of pulmonary tuberculosis and NTMs are ubiquitous in the environment, the isolation and identification of causative organisms are mandatory for diagnosis, and some specific diagnostic criteria have been proposed. The treatment of NTM pulmonary disease depends on the infecting species, but decisions concerning the institution of treatment are never easy. Treatment requires the use of multiple drugs for 18 to 24 months. Thus, treatment is expensive, often has significant side effects, and is frequently not curative. Therefore, clinicians should be confident that there is sufficient pathology to warrant prolonged, multidrug treatment regimens. In all of the situations, outcomes can be best optimized only when clinicians, radiologists, and laboratories work cooperatively.
Anti-Bacterial Agents/therapeutic use ; Female ; Humans ; Korea ; Lung Diseases/*diagnosis/drug therapy/microbiology ; Male ; Mycobacterium Infections, Atypical/*diagnosis/drug therapy/microbiology ; Mycobacterium avium-intracellulare Infection/diagnosis/drug therapy/microbiology ; Research Support, Non-U.S. Gov't

Although the treatment of pulmonary diseases due to nontuberculous mycobacteria (NTM) requires the long-term use of antibiotics in combination, the treatment success rates are unsatisfactory. We evaluated the clinical characteristics and surgical outcomes of 23 patients with NTM lung diseases who had underwent pulmonary resection. The median age of the patients was 45 yr. Of the 23 patients, 10 had Mycobacterium avium-intracellulare complex infection, 12 had M. abscessus infection, and one had M. xenopi infection. The indications for surgery were antibiotic therapy failure (n=11), remnant cavitary lesion with high probability of relapse (n=8), and massive hemoptysis (n=4). The most common procedure was lobectomy (48%). Postoperative complications occurred in eight patients (35%), including postoperative pneumonia (n=3) and late bronchopleural fistula (n=2). Negative sputum culture conversion was achieved and maintained in all except two mortalities. Although it is associated with a relatively high complication rate, patients with NTM lung disease whose disease is localized to one lung and who can tolerate resectional surgery might be considered for surgery, if there has been poor response to drug therapy or if the patients develop significant disease-related complications such as hemoptysis.
Adult ; Antitubercular Agents/therapeutic use ; Drug Resistance, Bacterial ; Female ; Hemoptysis/microbiology/surgery ; Humans ; Male ; Middle Aged ; Mycobacterium Infections, Atypical/drug therapy/*surgery ; *Mycobacterium avium Complex ; Mycobacterium avium-intracellulare Infection/drug therapy/*surgery ; *Mycobacterium xenopi ; Postoperative Complications ; Retrospective Studies ; Treatment Outcome

Mycobacterium kansasii is one of the most common cause of pulmonary diseases due to nontuberculous mycobacteria. We investigated the changing in the number of isolation of M. kansasii and the clinical characteristics of M. kansasii pulmonary disease in Korea. Through searching the database of the Korean Institute of Tuberculosis, we identified the cases of isolated M. kansasii from 1992 to 2002. The number of M. kansasii isolation had increased from once in 1992 to 62 in 2002. Fifteen patients with M. kansasii pulmonary disease were identified during the period January 1997 to December 2002. Twelve patients (80%) were male and fourteen (93%) were from highly industrialized areas. The most common symptom was a cough. Seven patients (47%) had a cavitary lesion and right upper lobe was most commonly involved. Patients responded well to isoniazid and rifampicin based regimens both bacteriologically and radiographically. In conclusion, M. kansasii isolation has increased, especially in highly industrialized areas, as well as other nontuberculous mycobacteria in Korea.
Adult ; Aged ; Anti-Bacterial Agents/therapeutic use ; Female ; Humans ; Korea/epidemiology ; Lung Diseases/diagnosis/drug therapy/*epidemiology/microbiology ; Male ; Middle Aged ; Mycobacterium Infections, Atypical/diagnosis/drug therapy/*epidemiology/microbiology ; *Mycobacterium kansasii/isolation and purification ; Research Support, Non-U.S. Gov't