October - LRS Institute of Tuberculosis & Respiratory Diseases

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176 S.S. TRIVEDI; S.G. DESAI AND S.B. TRIVEDI As shown in Table 1, if the test organisms showed negative niacin production and growth on the PNB and/or Hydroxylamine medium, organisms were considered to be suspicious of NTM, and were subjected to further identification test. Table 1 Screening of Non-tuberculous Mycobacteria Organisum Niacian test Growth on PNB- medium Growth on Hydro- xylamine- medium M.tuberculosis + - - M.bovis - - - Other Mycobacterisa - + + Identification: Identification of mycobacteria was made following the system of successive differentiation with the use of dichotomous keys. At every step, at least three key charasteristics were used and differentiation was decided by taking two or more fitnesses for these characteristics. Final identification was decided by comparison of overall similarity of the characteristics of our isolates with the keycharacteristics of named species (Tsukamura, 1967; Tsukamura, 1975; Tsukamura, 1981 b). Identification tests were monitored by including standard mycobacterial cultures as known positive and negative controls. A group of standard mycobacterial cultures was obtained from Trudeau Mycobacterial Culture Collection, National Jewish Hospital and Research Centre, Denver, Colorado, U.S.A. The following tests were performed to identify the strains: (Tsukamura, 1975; Vestal, 1.975). 1. Growth at 28° C. and 45° C. 2. Growth within 7 days. 3. Photochromogenicity. 4. Growth on hydroxylamine (0.25 mg. and 0.5 mg/ml.) 5.Catalase test (Semi-quantitative pH 7/68° C.). 6: Growth on 5 % Nacl medium. 7. Iron uptake. 8Arylsulfatase test (3 days and 2 weeks) 9. Growth on MacConkey’s agar. 10 Nitrate reduction test. 11. Tween hydrolysis (7 days and 14 days). 12. Tellurite reduction test. 13. Pyrazinamidase test. 14. Urease test. Definition off lung disease due to nontuberculous mycobacteria Occasional isolation. of these organisms from sputum in the absence of related disease or without any association with the disease, may occur due to temporary colonization in the respiratory tract. These organisms were referred to as causal isolates. A definite diagnosis of lung disease due to NTM was based on the criteria published by American Thoracic Society. (American Thoracic Society, 1974). i) Presence of radiographic abnormalities indicating active disease. ii) Isolation of the same mycobacterial strain repeatedly from the sputum in the absence of other pathogens. Results Out of a total 2,945 sputum specimens, 2,016 (68.4 %) were culture positive for acid-fast bacilli. Among these, 8 strains (0.4%) were screened out as non-tuberculous mycobacteria. All others were identified as M. tuberculosis. The species of NTM isolates are shown in Table 2. Three NTM strains, 2 of M. kansasii and 1 of M. fortuitum, were found to be associated with disease, giving an isolation rate of 0.15 %. The other 5 strains were found to be Species TABLE 2 Kind of Non-tuberculous Mycobacterial species isolated during the study Number of strains Disease Causal Associated isolates Total M. kansasii 2 - 2 M. fortuitum 1 3 4 M. scrofulaceum - 1 1 M. gordonae - 1 1 Total 3 5 8
NON-TUBERCULOUS LUNG MYCOBACTERIOSIS IN GUJARAT 177 casual isolates, giving a background isolation rate of tuberculous mycobacteriosis was too small to 0.25 %. indicate the prevalence of particular type of species. However, M. Kansasii and M. fortuitum were found Discussion to cause the disease, and it was noticable. that no M. avium-intracellulare strain was isolated. In other Increasing interest of mycobacteriologists in the parts of India, however, isolation of M. aviumintracellulare from sputum has been reported non-tuberculous mycobacteria has improved our knowledge about the incidence of lung disease due to (Kotian et al, 1981; Das et al, 1982; Paramsivan et al, NTM. Data on the frequency of lung disease due to 1985). NTM are available for several countries. The In United States and Japan, it has been noticed frequency is 4.6% in Western Australia (Carruthers that as the number of cases of tuberculosis and Edwards, 1955), 0.1 % in South Africa (Stottmeir, Kleeberg and Blockbergen, 1966), 2.8%in species increases (Good, 1979; Mycobateriosis declines, disease due to other mycro baterial Canada (Gale, 1976), 1.7% in Japan). (Tsukamura et Research Group of tha Japanese National Chest al, 1981), 3.3% in Rhodesia (Tsukamura et al, 1972), Hospital, 1983). In Gujarat, with a relatively high 1 to 30%, in various locations of United States morbidity of tuberculosis (about 1.5 %- (Wolinsky, 1979). In India, the isolation rate varies unpublished date from Tuberculosis Research from 0.7 to 34Y. (Thomas et al, 1961; Patel, D’ Souza Centre, Amargadh), the prevalence of lung disease and Sayed, 1966; Choudhri et al, 1979; Ramakrishnan, 1981; Kotian et al, 1981; Das et al, 1982; due to NTM appears to be very low. Hardas and Jayaraman, 1984; Paramsivan et al, 1985). However, most of the reports from India range from Acknowledgements less than 1.0 Y. to as high as 13.1 %, except one, We are grateful to Dr. J. Kenneth McClatchy, which reports 34 % isolation rate (Pate)., D’ Souza Ph.D., Curator, Trudeau Mycobaeterial Culture and Sayed, . 1966), which was unusually high. In Collection, National Jewish Hospital and Research many reports, there is no distinction between casual Centre, Denver, Colorado, U.S.A. for providing us isolations and actual cases of disease, or mycobaterial standard mycobaterial strains, and to Mr. S.D. strains were not identified up to the species-level. Andharia, senior laboratory technician, Merely, the report of isolation rate or number of Tuberculosis Research Centre, Amargadh, for his mycobacteria) isolates does not give an exact idea of help throughout the study. the clinical significance of various species of potentially pathogenic non-tuberculous mycobacteria. In the present study, an isolation rate of 0-15% has been obtained, which is quite low, when compared with other reports. Temporary colonization of NTM in the respiratory tract is not uncommon, and about 5 % of the healthy individuals were found to have such colonization (Kotian et al, 1983). In the present study, all the patients were known cases of pulmonary diseases and were taking anti-tuberculous chemotherapy and this may be the reason for the supression of temporary colonization and hence, very low casual isolation rate of 0.25 % only. Geographic differences in the occurrence of disease due to a particular non-tuberculous mycobacteria) species have been reported. In Europe and the United States, about 50 % of all isolates of non-tuberculous mycobacteria obtained from the patients in Tuberculosis Hospital are M. Kansasii. In contrast, M. avium-intracellulare strains are in the majority among isolates in Japan, Rhodesia and Australia (as quoted by Tsukamura et al, 1981). In the present study, the number of cases of non- REFERENCES American Thoracic Society, Diagnostic Standards and Classification of Tuberculosis and other mycobacterial disease. American Lung Association, New York, 1974. Carruthers, K.J.M. and Edwards, F.G.B., Atypical mycobacteria in Western Australia. Am. Rev. Resp. Dis. 1955, 91, 887. Choudhri, D.S., Dube; M.K., Purohit, S.D., Dube, S. The prevalence of anonymous mycobacteria in both resistant as well as fresh cases of pulmonary tuberculosis in the local population of South east Rajasthan. Ind. J. Path. Micro. 1979, 22, 162. Das, B.K., Sharma, V.K., Rao Bhanu, L.N. Saxena, S.N., and Bhardwai, B.K. Characterization of mycobacteria) strains from clinical specimens. Ind. J. Path. Microbiol. 1982, 25, 19. Gale, G.L., Atypical mycobacteria in aTuberculosis hospital. Can. Med. Ass. J. 1976, 114, 612. Good, R.C. Non-tuberculous mycobacteria. Clin. Microbiol. Newsletter, 1979,1(20),1. Hardas, U.D. nd Jayaraman,V.S.Differential identification of mycobacteria, I nd J. Tub. 1 . 984, 31, 11.
Page 1 and 2: The Indian Journal of Tuberculosis
Page 3 and 4: REVIEW ARTICLE Ind, .J. Tub., 1986,
Page 5 and 6: ADULT RFSP1RATORY DISTRESS SYNDROME
Page 7 and 8: ADULT RESPIRATORY DISTRESS SYNDROMl
Page 9 and 10: Coping with initiating mechanisms P
Page 11 and 12: ADULT RESPIRATORY DISTRESS SYNDROME
Page 13 and 14: ADULT RESPIRATORY DISTRESS SYNDROME
Page 15 and 16: REVIEW ARTICLE Ind. J. Tub., 1986,
Page 17 and 18: PATHOGENESIS OF COR PULMONARE. IN P
Page 19 and 20: REVIEW ARTICLE Ind. J. Tub., 1986,
Page 21 and 22: 173 IMMUNOLOGY OF , OCCUPATIONAL LU
Page 23: NON-TUBERCULOUS LUNG MYCOBACTERIOSI
Page 27 and 28: Ind. J. Tub., 1986, 33, 179 DIAGNOS
Page 29 and 30: DIAGNOSIS OF SMEAR NEGATIVE PUBMONA
Page 31 and 32: Ind. J. Tub., 1986, 33, 183 REVERSI
Page 33 and 34: Ind.J.Tub,, 1986, 33, 185 MltlARY T
Page 35 and 36: MILIARY TUBERCULOSIS IN ASSOCIATION
Page 37 and 38: CaseNo. Chest X - ray Abdomen X- ra
Page 39 and 40: TUBERCULOUS PERITONITIS PRESENTING
Page 41 and 42: HEPATIC TOXICITY DUE TO ISONIAZID 1
Page 43 and 44: of India for the Ranbaxy-Robert Koc
Page 45 and 46: ABSTRACTS 197 Aspirin as Bronchodil
Page 47 and 48: ABSTRACTS 199 selection of a suitab
Page 49: ABSTRACTS 201 increased with the sm

October - LRS Institute of Tuberculosis & Respiratory Diseases

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