Increasing Incidence of Nontuberculous Mycobacteria, Taiwan, 2000–2008 (response) LETTERS by ubp29826



Address for correspondence: Leslie L. Barton,   showed that the incidence in patients             Thoracic Society and Infectious Dis-
University of Arizona, College of Medicine,     treated for NTM pulmonary disease                 eases Society of America (3).
2335 East Seneca St, Tucson, AZ 85719; USA:     (the group used as a surrogate of NTM                  Annual proportions of NTM iso-
email:                     disease) has been decreasing over                 lates causing colonizations ranged
                                                time, which is reassuring.                        from 29.2% in 2001 to 19.8% in 2007.
                                                                                                  During the study period, annual in-
                                                 Eduardo Hernández-Garduño                        cidences of NTM colonization and
                                                    and R. Kevin Elwood                           disease increased from 6.6/100,000
                                                Author affiliation: British Columbia Centre        inpatients and 2.7/100,000 outpatients
                                                for Disease Control, Vancouver, British Co-       in 2000 to 34.5/100,000 inpatients and
    Increasing                                                                                    10.2/100,000 outpatients in 2008. My-
                                                lumbia, Canada
                                                                                                  cobacterium avium complex (MAC)
   Incidence of                                 DOI: 10.3201/eid1606.100228
                                                                                                  was the most prevalent species, colo-
 Nontuberculous                                 References                                        nizing 1,282 (34.8%) of 3,681 patients.
  Mycobacteria,                                  1.   Lai CC, Tan CK, Chou CH, Hsu HL,
                                                                                                  Annual proportions of MAC isolates
                                                                                                  causing colonization ranged from
Taiwan, 2000–2008                                     Liao CH, Huang YT, et al. Increasing in-    20.0% in 2000 to 12.6% in 2006. An-
                                                      cidence of nontuberculous mycobacteria,
                                                      Taiwan, 2000–2008. Emerg Infect Dis.        nual incidence of MAC colonization
     To the Editor: Lai et al. (1) re-
                                                      2010;16:294–6.                              increased from 1.9/100,000 inpatients
ported an increase in the number of              2.   Griffith DE, Aksamit T, Brow-Elliott BA,     in 2000 to 12.3/100,000 inpatients
nontuberculous mycobacteria (NTM)                     Catanzaro A, Daley C, Gordin F, et al. An   in 2008; incidence of MAC disease
isolates and patients with pulmonary                  official ATS/IDSA statement: diagnosis,
                                                      treatment, and prevention of nontuber-      also increased from 0.5/100,000 in-
NTM diseases after implementation of
                                                      culous mycobacterial diseases. Am J Re-     patients in 2000 to 2.1/100,000 in-
the BACTEC system (Becton Dickin-                     spir Crit Care Med. 2007;175:367–416        patients in 2008. M. abscessus, the
son, Sparks, MD, USA) late in 2001.                   10.1164/rccm.200604-571. DOI: 10.1164/      second most common species in our
These authors also reported that the in-              rccm.200604-571ST
                                                 3.   Hernández-Garduño E, Rodrigues M,           study (2), caused colonization and
crease was mainly in persons infected
                                                      Elwood RK. The incidence of pulmonary       disease in 669 and 155 patients, re-
with Mycobacterium avium complex                      non-tuberculous mycobacteria in British     spectively. Annual incidence of M.
(MAC) and M. abscessus. They stated                   Columbia, Canada. Int J Tuberc Lung Dis.    abscessus colonization and infection
that diseases caused by NTM were                      2009;13:1086–93.
                                                                                                  also increased from 1.49/100,000 in-
defined according to current diagno-
                                                Address     for    correspondence:  Eduardo
                                                                                                  patients and 0.3/100,000 outpatients
sis criteria published in 2007 (2). This
                                                Hernández-Garduño, Department of Tuber-
                                                                                                  in 2000 to 7.0/100,000 inpatients and
finding suggests that Lai et al. were
                                                culosis Control, British Columbia Centre
                                                                                                  1.9/100,000 outpatients in 2008.
able to review the clinical and radio-
                                                for Disease Control, 1063-655 W 12th Ave,
                                                                                                       Our study and a previous study
logic information for all patients.
                                                Vancouver, British Columbia V5Z 4R4, Canada;
                                                                                                  in British Columbia (4) suggest that
     We wonder whether they were
                                                                                                  improvement in diagnostic methods
also able to identify and exclude peo-
                                                                                                  would detect increased incidence of
ple with NTM colonization, i.e., per-
                                                                                                  NTM, especially of MAC; most iso-
sons with positive cultures for NTM
                                                                                                  lates identified in these studies were
who did not meet the American Tho-
                                                                                                  associated with colonization. We also
racic Society disease criteria. It would
                                                                                                  demonstrated a gradual increase in the
have been interesting to know the
                                                                                                  incidence of all NTM, MAC, and M.
trend in colonized persons. In a previ-              In Response: We thank Hernán-                abscessus over time in Taiwan, which
ous study from British Columbia (3),            dez-Garduño and Elwood for drawing                may be attributable to increasing vigi-
we found an increase in the number of           attention to the issue of nontubercu-             lance and awareness of these bacteria
NTM isolates mostly in persons with             lous mycobacteria (NTM) coloniza-                 as human pathogens and the increased
MAC colonization. This finding coin-             tion (1), which was not described in              population of immunocompromised
cided with implementation of a new              our study (2). Among 4,786 patients               patients. Thus, clinicians should con-
laboratory technique in 2000, which             with NTM isolates treated at our hos-             sider diagnosing NTM diseases with
suggested that the new technology is            pital during 2000–2008, colonization              sensitive and advanced laboratory
more sensitive in detecting MAC. In             was found in 76.9% (3,681), and only              methods because of the increasing
contrast with the findings of Lai et             23.1% (1,105) had NTM diseases ac-                population of patients at risk.
al., our study from British Columbia            cording to the criteria of the American

                               Emerging Infectious Diseases • • Vol. 16, No. 6, June 2010                           1047

 Chih-Cheng Lai, Che-Kim Tan,                        Food Reservoir for                         field gel electrophoresis , indicating
                                                                                                that identical genotypes (between iso-
      Chien-Hong Chou,
       Hsaio-Leng Hsu,
                                                      Escherichia coli                          lates from retail meat and human in-
       Chun-Hsing Liao,                               Causing Urinary                           fections) were observed only once.
Yu-Tsung Huang, Pan-Chyr Yang,                        Tract Infections                               Although we agree that the find-
        Kwen-Tay Luh,                                                                           ing of a partial overlap between mul-
      and Po-Ren Hsueh                                   To the Editor: We read with in-        tilocus sequence types of isolates
Author affiliations: Cardinal-Tien Hospital,         terest the article by Vincent et al. that   from retail meat and from human UTI
Taipei, Taiwan (C.-C. Lai); Chi-Mei Medical         compared Escherichia coli isolates          isolates is noteworthy (especially re-
Center, Tainan, Taiwan (C.-K. Tan); Nation-         from 3 sources (human urinary tract         covery of an ST131 isolate of avian
al Taiwan University College of Medicine,           infections [UTIs], retail meat, and res-    origin), the emphasis posed for the
Taipei (C.-H. Chou, H.-L. Hsu, Y.-T. Huang,         taurant/ready-to-eat foods) by multiple     role of food transmission in the dis-
P.-C. Yang, K.-T. Luh, P.-R. Hsueh); and Far        molecular typing methods (1). This          semination of the E. coli strains that
Eastern Memorial Hospital, Taipei (C.-H.            study has to be considered in the con-      cause community-acquired UTIs, in
Liao)                                               text of the larger debate about the pos-    our opinion, does not seem strongly
                                                    sible animal origin of E. coli isolates     supported by the experimental data.
DOI: 10.3201/eid1606.100329
                                                    that cause extraintestinal infections in    Nevertheless, the topic is relevant, and
                                                    humans (2–5), and the same authors          we would highlight the importance of
                                                    (Vincent et al.) have declared, in the      further research on this issue.
 1.    Hernández-Garduño E, Elwood RK. In-          introduction, that their efforts were
       creasing incidence of nontuberculous         directed toward investigating the hy-       Maria Giufrè, Caterina Graziani,
       mycobacteria, Taiwan, 2000–2008. Emerg       pothesis that retail chicken is the main           Marisa Accogli,
       Infect Dis. 2010;16:1047.                                                                     and Marina Cerquetti
 2.    Lai C-C, Tan C-K, Chou C-H, Hsu H-L,         reservoir for extraintestinal E. coli.
       Liao C-H, Huang Y-T, et al. Increasing in-        We strongly appreciate the             Author affiliations: Istituto Superiore di San-
       cidence of nontuberculous mycobacteria,      amount of the experimental data and         ità, Rome, Italy
       Taiwan, 2000–2008. Emerg Infect Dis.         some interesting findings, but we are
       2010;16:294–6.                                                                           DOI: 10.3201/eid1606.100158
 3.    Griffith DE, Aksamit T, Brow-Elliott BA,      not totally convinced of the authors’
       Catanzaro A, Daley C, Gordin F, et al. An    conclusions, particularly the assump-       References
       official ATS/IDSA statement: diagnosis,       tion that the study strongly supports
       treatment, and prevention of nontubercu-     the preliminary hypothesis. First, the       1. Vincent C, Boerlin P, Daignault D, Do-
       lous mycobacterial diseases. Am J Respir                                                     zois CM, Dutil L, Galanakis C, et al. Food
       Crit Care Med. 2007;175:367–416. DOI:        observation that only a low proportion
                                                                                                    reservoir for Escherichia coli causing uri-
       10.1164/rccm.200604-571ST                    (73/844, 8.6%) of the E. coli isolates          nary tract infections. Emerg Infect Dis.
 4.    Hernández-Garduño E, Rodrigues M, El-        analyzed belonged to clonal groups              2010;16:88–95.
       wood RK. The incidence of pulmonary          (defined as >2 E. coli isolates that had      2. Collignon P, Angulo FJ. Fluoroquino-
       nontuberculous mycobacteria in British                                                       lone-resistant Escherichia coli: food for
       Columbia, Canada. Int J Tuberc Lung Dis.     indistinguishable multilocus variable
                                                                                                    thought. J Infect Dis. 2006;194:8–10.
       2009;13:1086–93.                             number tandem repeats and enter-             3. Graziani C, Luzzi I, Corrò M, Tomei F,
                                                    obacterial repetitive intergenic con-           Parisi G, Giufrè M, et al. Phylogenetic
Address for correspondence: Po-Ren Hsueh,           sensus 2 patterns), including members           background and virulence genotype of
Departments of Laboratory Medicine and              from >1 source, suggests an overall             ciprofloxacin-susceptible and resistant Es-
                                                                                                    cherichia coli strains of human and avian
Internal Medicine, National Taiwan University       high degree of genetic heterogeneity            origin. J Infect Dis. 2009;199:1209–17.
Hospital, No. 7, Chung-Shan South Rd, Taipei        among isolates from different sources.          DOI: 10.1086/597423
100, Taiwan; email:              Second, looking at the single isolates       4. Johnson JR, Kuskowski MA, Menard
                                                    within clonal groups reported in Table          M, Gajewski A, Xercavins M, Garau J.
                                                                                                    Similarity between human and chicken
                                                    2, twelve (2.9%) of the 417 isolates            Escherichia coli isolates in relation to cip-
                                                    from retail meat shared multilocus              rofloxacin resistance status. J Infect Dis.
                                                    variable number tandem repeats, en-             2006;194:71–8.
                                                    terobacterial repetitive intergenic          5. Johnson JR, Sannes MR, Croy C, John-
                                                                                                    ston B, Clabots C, Kuskowski MA, et al.
                                                    consensus 2, and multilocus sequence            Antimicrobial drug–resistant Escherichia
                                                    types with some human UTI iso-                  coli from humans and poultry products,
                                                    lates; however, only 1 isolate (strain          Minnesota and Wisconsin, 2002–2004.
                                                    EC01DT06–1737–01) was also found                Emerg Infect Dis. 2007;13:838–46.
                                                    to be indistinguishable from a human
                                                    isolate (strain MSHS 161) by pulsed-

1048                              Emerging Infectious Diseases • • Vol. 16, No. 6, June 2010

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