Journal Article

Clinical Relevance of <i>Mycobacterium szulgai</i> in The Netherlands

Jakko van Ingen, Martin J. Boeree, Wiel C. M. de Lange, Petra E. W. de Haas, P. N. Richard Dekhuijzen and Dick van Soolingen

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 46, issue 8, pages 1200-1205
Published in print April 2008 | ISSN: 1058-4838
Published online April 2008 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/529443
Clinical Relevance of Mycobacterium szulgai in The Netherlands

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  • Infectious Diseases
  • Immunology
  • Public Health and Epidemiology
  • Microbiology

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Background. The clinical relevance of Mycobacterium szulgai isolates is unknown, and available literature focuses on case reports of M. szulgai disease. We assessed the clinical relevance of M. szulgai isolated from patients in The Netherlands.

Methods. We reviewed medical files for all 21 patients in The Netherlands from whom M. szulgai was isolated during 1999–2006, applying the diagnostic criteria of the American Thoracic Society for nontuberculous mycobacterial infection. Random amplified polymorphic DNA genotyping was performed using IS986, OPA-2, and OPA-18 as primers.

Results. Of the 21 patients, 16 (76%) met the American Thoracic Society diagnostic criteria and were thus likely to have M. szulgai disease. Pulmonary M. szulgai disease was the most common presentation, with extrapulmonary disease restricted to patients with an impaired systemic immunity. Although treatment regimens varied in content and duration, the outcomes were mostly favorable. Both overtreatment and undertreatment were noticed. Random amplified polymorphic DNA genotyping revealed a higher degree of interpatient variability, with limited intrapatient variability, suggesting persisting monoclonal infection and good reproducibility. No genotype was associated with clinical relevance.

Conclusions. Clinical isolation of M. szulgai generally represents true disease and demands careful follow-up. Extrapulmonary disease occurs in patients with impaired immunity. Adherence to diagnostic guidelines can be improved.

Journal Article.  3073 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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