WCIM 2014 SEOUL KOREA 461
Poster Session
The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
PS 1611 Mycobacterial Diseases
Clinical Signifi cance of Isolation of Nontuberculous Mycobacteria in Patients with Pulmonary Tuberculosis
Hye Seon Kang1, Hwa Young Lee2, Ah Young Shin1, Hea Yon Lee2, Chin Kook Rhee2, Ju Sang Kim1, Seung Joon Kim2, Seok Chan Kim2, Sook Young Lee2, Joong Hyun Ahn1, Young Kyoon Kim2, Ji Young Kang2
Incheon St. Mary`s Hospital, Korea1, Seoul St. Mary’s Hospital, The Catholic University of Korea, Korea2 Background: The presence of nontuberculos mycobacteria (NTM) in respiratory specimens from patients with pulmonary tuberculosis (TB) causes diagnostic and therapeutic error.
Moreover, the coexistence of NTM lung disease with TB is not determined clearly.
Methods: We retrospectively reviewed the medical records of all the patients diagnosed with culture confi rmed pulmonary TB at Seoul St. Mary’s Hospital and Incheon St. Mary’s Hospital between Jan 2011 and Dec 2013.
Results: Eight hundred thirty-four patients were surveyed. NTM species were isolated from 50 patients (6.0%) and 130 respiratory specimens. The frequently isolated NTM species were M. abscessus (n=36, 27.7%), M. intracellulare (n=19, 14.6%), and M. fortuitum (n=11, 8.5%). NTM species were identifi ed in 26 patients and 7 patients had two or more NTM species. NTM species were isolated after initiation of anti-TB treatment in 35 patients and mean duration was 7 months. In 14 patients, NTM and Mycobacterium tuberculosis were isolated simultaneously. Among 50 patients with the isolation of NTM, NTM lung disease by 2007 ATS/IDSA guidelines was confi rmed in 11(22%) subjects. The median age was 69.4 years. Eight (72.7%) patients were men. Main radiologic fi ndings were micronodules and bronchiectasis. Two patients had two and 9 patieths had three or more positive cultures for the same NTM species. The detected NTM species were M. abscessus (n=5), M. intra- cellulare (n=3), M. massiliense (n=2) and M. lentifl avum (n=1). Aggravation of radiologic fi ndings and clinical symptoms were found in 5 (10%) patients and NTM treatment was required in 2 patients after the completion of anti-TB treatment. NTM species isolated from treated patients was M. abscessus.
Conclusions: NTM isolation from patients with pulmonary TB was not rare. Careful serial monitoring such as microbiologic and radiologic evaluation is required if clinically needed.
PS 1612 Mycobacterial Diseases
Heterogeneous Humoral Immune Responses to
Mycobacterial Antigens in Active Tuberculosis and Their Serodiagnostic Potential
Jeong-Ran Kim1, Hwa-Jung Kim2, Young Kil Park1, Hee Jin Kim1 Korean Institute of Tuberculosis, Korea1, Chungnam National University, Korea2
Background: Effective diagnosis of active pulmonary tuberculosis (TB), a chronic in- fectious disease, is important for the treatment, prevention, and control of TB.
Methods: To develop serodiagnosis of active TB, the mycobacterial antigens (CFP- 10, ESAT-6, Rv3872, HBHA, 16kD, 38kD, MPT64, Ag85B, malate synthase, Rv3878 and MTB48) were cloned, expressed from E. coli and evaluated in the serum antibody (Ab) response of 100 active TB patients, 27 latent TB infection (LTBI), and 25 healthy con- trols.
Results: Positive Ab response to mycobacterial antigens by western blot analysis could distinguish active TB from latent TB infection. The humoral immune responses to the recombinant proteins in active patients are heterogeneous and differential antigen reactivity was detected in each active TB patient. Among 100 active TB patients, 95 patients were positive for the specifi c Ab response, however 5 patients were negative.
The immunodominant antigens were 38kD, CFP-10, malate synthase, and MTB48.
Sensitivities of 69%, 48%, 25%, and 52% were observed using 38kD, CFP-10, malate synthase, and MTB48.
Conclusions: The immune reaction to the combinations of CFP-10, 38kD, and malate synthase exhibited detection rate of ~90% in active TB patients but undetected in LTBI. These results suggest that combination of antigens is useful for the accurate diagnosis of active TB.
PS 1613 Mycobacterial Diseases
Serial Evaluation of Humoral Immune Responses to Mycobacterial Antigens in Chronic Tuberculosis Excretors
Jeong-Ran Kim1, Kyeol Choi1, Jiseun Hyun1, Young Kil Park1, Hee Jin Kim1 Korean Institute of Tuberculosis, Korea1
Background: To understand the function of B cells in immune response of chronic excretors, a serious health problem, in tuberculosis control, we evaluated serological status of chronic excretors during chemotheraphy.
Methods: Consecutive hospital treated patients with intractable pulmonary tubercu- losis (TB) were evaluated in the antibody responses to mycobacterial antigens such as CFP-10, ESAT-6, Rv3872, HBHA, 16kD, 38kD, MPT64, Ag85B, malate synthase, Rv3878 and MTB48 by Western blot analysis.
Results: The same pattern of antibody responses against TB antigens was maintained in intractable pulmonary TB patients for 1 year or 2 years. In comparison between present and past serological antibody responses to the TB antigens, the results were not altered signifi cantly in each chronic excretors during treatment.
Conclusions: Our data suggest that chronic excretors consistently produce same kind of antibodies and the humoral responses to TB antigens were not affected by drug treatment.
PS 1614 Mycobacterial Diseases
Initiation of Anti-TNF Therapy Within 3 Weeks of LTBI Treatment in Patients with Immune-Mediated Infl ammatory Diseases
Ji-Young Yang1, Kyung-Wook Jo1, Seokchan Hong2, Bin Yoo2, Chang-Keun Lee2, Yong- Gil Kim2, Suk-Kyun Yang3, Jeong-Sik Byeon3, Kyung-Jo Kim3, Byong Duk Ye3, Sang- Hyoung Park3, Tae Sun Shim1
Asan Medical Center, Department of Pulmonary and Critical Care Medicine, Korea1, Asan Medical Cen- ter, Department of Rheumatology, Korea2, Asan Medical Center, Department of Gastroenterology, Korea3 Background: Tumor necrosis factor antagonists are increasingly used to treat patients with immune-mediated infl ammatory disease including rheumatoid arthritis, ankylos- ing spondylitis, Crohn’s disease, and ulcerative colitis. Because TNF-alpha is essential for the prevention of latent tuberculosis recrudescence, patients treated with TNF-al- pha inhibitors are at increased risk of developing active TB. The time of initiating anti-TNF therapy following the induction of LTBI treatment is different depending on each nation’s guideline. We aimed to investigate the treatment outcome of patients with immune-mediated infl ammatory disease who received anti-tumor necrosis factor therapy within 3 weeks of latent tuberculosis infection treatment.
Methods: A total of 411 patients received LTBI treatment before commencing TNF antagonist between June 2004 and October 2013 at a tertiary referral center in South Korea. Their medical records were retrospectively reviewed.
Results: The mean age of the 411 study subjects was 44.5 years and 261(63.5%) were male. The underlying IMID was ankylosing spondylitis in 203(49.4%), rheumatoid ar- thritis in 136(33.3%) and infl ammatory bowel diseases in 57(13.9%) patients. Anti-TNF agent was initiated in 61 patients(14.8%) within 3 weeks after chemoprophylaxis for LTBI, whereas 3 weeks later in remaining 350 patients(85.2%). These two groups were comparable in terms of baseline characteristics, treatment regimens, anti-TNF agents used and follow-up duration except signifi cant difference of the mean duration of LTBI treatment before starting anti-TNF therapy(8 vs. 30 days, p < 0.001). A total of 6 patients developed TB during follow-up period. All of these patients received anti-TNF agents 3 weeks after initiation of LTBI treatment. None in the patients who com- menced TNF antagonist within 3 weeks of LTBI treatment developed TB.
Conclusions: The present study suggested that TNF antagonist may be initiated within 3 weeks of LTBI treatment in patients with IMID.
