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        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">Epidemiological description of individuals from whom <span class="elsevierStyleItalic">Mycobacterium kansasii</span> isolates were obtained in respiratory samples&#44; and analysis of the isolates using molecular biological techniques&#46;</p> <span class="elsevierStyleSectionTitle">Material and Methods</span><p class="elsevierStyleSimplePara elsevierViewall">A descriptive retrospective&#47;prospective study was carried out from January 1994 to April 2002 in Basurto Hospital and Santa Marina Hospital and from January 2000 to April 2002 in Cruces Hospital&#44; Galdakao Hospital&#44; and San Eloy Hospital&#46; Diagnosis of the disease was performed according to American Thoracic Society criteria&#59; other definitions were also applied to allow inclusion of all cases&#46; Disease caused by <span class="elsevierStyleItalic">M kansasii</span> in patients who were not infected with the human immunodeficiency virus &#40;HIV&#41; was compared with disease caused by <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span> in a control group&#46; Polymerase chain reaction was applied with analysis of restriction fragment length polymorphisms to differentiate between species of mycobacteria and classify them into genotypes&#46; Amplified fragment length polymorphisms were used to recognize clones within each genotype&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">The patient charts of 334 patients in which an isolate of <span class="elsevierStyleItalic">M kansasii</span> had been recorded were reviewed&#46; We considered 220 patients to be suffering from disease caused by <span class="elsevierStyleItalic">M kansasii</span> &#40;American Thoracic Society criteria along with probable disease according to established definitions&#41;&#46; The disease was more frequent in male patients &#40;n&#61;185&#59; 84&#46;1&#37;&#41; and in individuals who were not HIV positive &#40;n&#61;184&#59; 83&#46;6&#37;&#41;&#46; The highest incidence of disease in the Bizkaia region was found in Margen Izquierda-Encartaciones&#44; where the rate was 8&#46;05 per 100&#8200;000 inhabitants&#46; In the Bilbao area&#44; the highest rate was found in the districts lying on the outskirts&#46; The underlying diseases were tuberculosis &#40;20&#46;5&#37;&#41;&#44; chronic obstructive pulmonary disease &#40;25&#46;9&#37;&#41;&#44; pulmonary neoplasia &#40;7&#46;7&#37;&#41;&#44; silicosis &#40;0&#46;9&#37;&#41;&#44; chronic liver disease &#40;11&#46;4&#37;&#41;&#44; and duodenal ulcer &#40;8&#46;6&#37;&#41;&#46; The most frequent constitutional symptoms were fever &#40;39&#46;1&#37;&#41;&#44; loss of appetite &#40;23&#46;2&#37;&#41;&#44; and weight loss &#40;33&#46;3&#37;&#41;&#46; Among the respiratory symptoms&#44; the most outstanding were cough &#40;70&#46;9&#37;&#41; and expectoration &#40;62&#46;3&#37;&#41;&#46; The most frequent radiographic patterns were cavitation and pulmonary infiltration&#46; The most common treatment regimen was rifampicin&#44; isoniazid&#44; and ethambutol &#40;43&#46;4&#37;&#41;&#44; and the average duration was 12 months in patients who were HIV negative&#46; Analysis of antibiotic sensitivity&#44; performed on 56 strains&#44; revealed that 100&#37; were resistant to isoniazid&#44; while none displayed rifampicin resistance&#46; Thirty-four cases of disease caused by <span class="elsevierStyleItalic">M kansasii</span> were compared with 68 cases of tuberculosis&#44; all of them without HIV infection&#46; The comparison revealed a predominance of smokers&#44; respiratory symptoms&#44; and cavitation in patients with disease caused by <span class="elsevierStyleItalic">M kansasii&#46;</span> The majority of the isolates &#40;98&#46;5&#37;&#41; corresponded to genotype I&#46; A total of 8 clones were obtained&#59; the clones designated 1 and 3 were more common in HIV-positive and HIV-negative individuals respectively&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">In recent years&#44; there has been an increase in the number of patients with disease caused by <span class="elsevierStyleItalic">M kansasii</span> in the province of Bizkaia&#46; The disease is more frequent in male patients&#44; individuals who are HIV negative&#44; and in urban areas&#46; In addition&#44; more respiratory symptoms and a higher incidence of cavitation were found in patients with disease caused by <span class="elsevierStyleItalic">M kansasii</span> than in those with tuberculosis&#46; Genotype I is the most common isolate&#44; and clones 1 and 3 affect 80&#37; of patients suffering from the disease&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">Descripci&#243;n epidemiol&#243;gica de los individuos con aislamiento de <span class="elsevierStyleItalic">Mycobacterium kansasii</span> en muestras respiratorias y an&#225;lisis de estos aislamientos mediante t&#233;cnicas de biolog&#237;a molecular&#46;</p> <span class="elsevierStyleSectionTitle">Material Y M&#233;todos</span><p class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; un estudio retrospectivo&#44; prospectivo y descriptivo de enero de 1994 a abril de 2002 en los hospitales de Basurto y Santa Marina&#44; y de enero de 2000 a abril de 2002 en los hospitales de Cruces&#44; Galdakao y San Eloy&#46; Se aplicaron los criterios de la American Thoracic Society para el diagn&#243;stico de enfermedad y se utilizaron otras definiciones para abarcar todos los casos&#46; Se compar&#243; la enfermedad por <span class="elsevierStyleItalic">M&#46; kansasii</span> en pacientes sin infecci&#243;n por el virus de la inmunodeficiencia humana &#40;VIH&#41; con un grupo control con enfermedad por <span class="elsevierStyleItalic">Mycobacterium tuberculosis&#46;</span> Se aplic&#243; la reacci&#243;n en cadena de la polimerasa con an&#225;lisis de RFLP <span class="elsevierStyleItalic">&#40;restriction fragment-length polymorphisms&#41;</span> para diferenciar las especies de micobacterias y subtipificaci&#243;n en genotipos&#44; y la AFLP <span class="elsevierStyleItalic">&#40;amplified fragment-length polymorphisms&#41;</span> para reconocer clones dentro de cada genotipo&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">Se revisaron 334 historias cl&#237;nicas de pacientes en los que exist&#237;a un registro de aislamiento microbiol&#243;gico de <span class="elsevierStyleItalic">M&#46; kansasii&#46;</span> Consideramos que 220 eran enfermos &#40;criterio de la American Thoracic Society m&#225;s enfermedad probable de definiciones creadas&#41;&#46; La enfermedad era m&#225;s frecuente en varones &#40;n &#61; 185&#59; 84&#44;1&#37;&#41; y en personas sin infecci&#243;n por el VIH &#40;n &#61; 184&#59; 83&#44;6&#37;&#41;&#46; La tasa de incidencia de enfermedad m&#225;s alta en la comarca de Bizkaia fue en Margen Izquierda-Encartaciones&#44; con un 8&#44;05 por cada 100&#46;000 habitantes&#44; y en el &#193;rea de Bilbao&#44; en los distritos de la periferia&#46; Las enfermedades de base fueron&#58; tuberculosis &#40;20&#44;5&#37;&#41;&#44; enfermedad pulmonar obstructiva cr&#243;nica &#40;25&#44;9&#37;&#41;&#44; neoplasia de pulm&#243;n &#40;7&#44;7&#37;&#41;&#44; silicosis &#40;0&#44;9&#37;&#41;&#44; hepatopat&#237;a cr&#243;nica &#40;11&#44;4&#37;&#41; y gastrectom&#237;a &#40;8&#44;6&#37;&#41;&#46; Los s&#237;ntomas consti-tucionales m&#225;s frecuentes fueron&#58; fiebre &#40;39&#44;1&#37;&#41;&#44; anorexia &#40;23&#44;2&#37;&#41; y disminuci&#243;n de peso &#40;33&#44;3&#37;&#41;&#46; Entre los s&#237;ntomas respiratorios destacaron la tos &#40;70&#44;9&#37;&#41; y la expectoraci&#243;n &#40;62&#44;3&#37;&#41;&#46; Los patrones radiol&#243;gicos m&#225;s frecuentes fueron cavitaci&#243;n e infiltrados pulmonares&#46; La pauta de tratamiento m&#225;s habitual fue rifampicina&#44; isoniacida y etambutol &#40;43&#44;4&#37;&#41;&#44; y el tiempo medio de duraci&#243;n fue de 12 meses en las personas sin infecci&#243;n por el VIH&#46; En el estudio de sensibilidad realizado en 56 cepas&#44; el 100&#37; fue resistente a isoniacida y ninguna mostr&#243; resistencia a rifampicina&#46; Se compararon 34 casos de enfermedad por <span class="elsevierStyleItalic">M&#46; kansasii</span> con 68 casos de tuberculosis&#44; todos sin infecci&#243;n por el VIH&#44; y se obtuvieron los siguientes resultados&#58; predominio de fumadores&#44; de s&#237;ntomas respiratorios y de cavitaci&#243;n en los pacientes con enfermedad por <span class="elsevierStyleItalic">M&#46; kansasii&#46;</span> El 98&#44;5&#37; de los aislamientos pertenecieron al genotipo I&#46; Se obtuvieron un total de 8 clones&#59; el clon denominado 1 fue m&#225;s frecuente en personas con infecci&#243;n por el VIH y el denominado 3 en los que no la presentaban&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">Se ha registrado un aumento del n&#250;mero de pacientes con enfermedad por <span class="elsevierStyleItalic">M&#46; kansasii</span> en la provincia de Bizkaia en los &#250;ltimos a&#241;os&#46; Dicha enfermedad es m&#225;s frecuente en varones&#44; personas sin infecci&#243;n por el VIH y zonas urbanas&#46; Asimismo&#44; se han encontrado m&#225;s s&#237;ntomas respiratorios como manifestaciones cl&#237;nicas y mayor presencia de cavitaci&#243;n como hallazgo radiol&#243;gico en la enfermedad por <span class="elsevierStyleItalic">M&#46; kansasii</span> al compararla con la tuberculosis&#46; El genotipo I es el aislado con m&#225;s frecuencia&#44; y los clones 1 y 3 afectan al 80&#37; de los individuos enfermos&#46;</p>"
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Vol. 41. Issue 4.
Pages 189-196 (April 2005)
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Vol. 41. Issue 4.
Pages 189-196 (April 2005)
Original Articles
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Clinical and Epidemiological Study of Disease Caused by Mycobacterium kansasii in the Metropolitan Area of Bilbao, Spain
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M.V. Leal Arranza,
Corresponding author
mavija@euskalnet.net

Correspondence: Dra. M.V. Leal Arranz. Avda. Montevideo, s/n. 48013 Bilbao. Bizkaia. España
, A. Gaafarb, M.J. Unzaga Barañanob, J.A. Crespo Notarioa, R. Cisterna Cáncerb, F. García Cebriána
a Servicio de Neumología, Hospital de Basurto, Bilbao, Bizkaia, Spain
b Servicio de Microbiología, Hospital de Basurto, Bilbao, Bizkaia, Spain
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Objective

Epidemiological description of individuals from whom Mycobacterium kansasii isolates were obtained in respiratory samples, and analysis of the isolates using molecular biological techniques.

Material and Methods

A descriptive retrospective/prospective study was carried out from January 1994 to April 2002 in Basurto Hospital and Santa Marina Hospital and from January 2000 to April 2002 in Cruces Hospital, Galdakao Hospital, and San Eloy Hospital. Diagnosis of the disease was performed according to American Thoracic Society criteria; other definitions were also applied to allow inclusion of all cases. Disease caused by M kansasii in patients who were not infected with the human immunodeficiency virus (HIV) was compared with disease caused by Mycobacterium tuberculosis in a control group. Polymerase chain reaction was applied with analysis of restriction fragment length polymorphisms to differentiate between species of mycobacteria and classify them into genotypes. Amplified fragment length polymorphisms were used to recognize clones within each genotype.

Results

The patient charts of 334 patients in which an isolate of M kansasii had been recorded were reviewed. We considered 220 patients to be suffering from disease caused by M kansasii (American Thoracic Society criteria along with probable disease according to established definitions). The disease was more frequent in male patients (n=185; 84.1%) and in individuals who were not HIV positive (n=184; 83.6%). The highest incidence of disease in the Bizkaia region was found in Margen Izquierda-Encartaciones, where the rate was 8.05 per 100 000 inhabitants. In the Bilbao area, the highest rate was found in the districts lying on the outskirts. The underlying diseases were tuberculosis (20.5%), chronic obstructive pulmonary disease (25.9%), pulmonary neoplasia (7.7%), silicosis (0.9%), chronic liver disease (11.4%), and duodenal ulcer (8.6%). The most frequent constitutional symptoms were fever (39.1%), loss of appetite (23.2%), and weight loss (33.3%). Among the respiratory symptoms, the most outstanding were cough (70.9%) and expectoration (62.3%). The most frequent radiographic patterns were cavitation and pulmonary infiltration. The most common treatment regimen was rifampicin, isoniazid, and ethambutol (43.4%), and the average duration was 12 months in patients who were HIV negative. Analysis of antibiotic sensitivity, performed on 56 strains, revealed that 100% were resistant to isoniazid, while none displayed rifampicin resistance. Thirty-four cases of disease caused by M kansasii were compared with 68 cases of tuberculosis, all of them without HIV infection. The comparison revealed a predominance of smokers, respiratory symptoms, and cavitation in patients with disease caused by M kansasii. The majority of the isolates (98.5%) corresponded to genotype I. A total of 8 clones were obtained; the clones designated 1 and 3 were more common in HIV-positive and HIV-negative individuals respectively.

Conclusions

In recent years, there has been an increase in the number of patients with disease caused by M kansasii in the province of Bizkaia. The disease is more frequent in male patients, individuals who are HIV negative, and in urban areas. In addition, more respiratory symptoms and a higher incidence of cavitation were found in patients with disease caused by M kansasii than in those with tuberculosis. Genotype I is the most common isolate, and clones 1 and 3 affect 80% of patients suffering from the disease.

Key Words:
Epidemiology
Human immunodeficiency virus
M kansasii
Objetivo

Descripción epidemiológica de los individuos con aislamiento de Mycobacterium kansasii en muestras respiratorias y análisis de estos aislamientos mediante técnicas de biología molecular.

Material Y Métodos

Se realizó un estudio retrospectivo, prospectivo y descriptivo de enero de 1994 a abril de 2002 en los hospitales de Basurto y Santa Marina, y de enero de 2000 a abril de 2002 en los hospitales de Cruces, Galdakao y San Eloy. Se aplicaron los criterios de la American Thoracic Society para el diagnóstico de enfermedad y se utilizaron otras definiciones para abarcar todos los casos. Se comparó la enfermedad por M. kansasii en pacientes sin infección por el virus de la inmunodeficiencia humana (VIH) con un grupo control con enfermedad por Mycobacterium tuberculosis. Se aplicó la reacción en cadena de la polimerasa con análisis de RFLP (restriction fragment-length polymorphisms) para diferenciar las especies de micobacterias y subtipificación en genotipos, y la AFLP (amplified fragment-length polymorphisms) para reconocer clones dentro de cada genotipo.

Resultados

Se revisaron 334 historias clínicas de pacientes en los que existía un registro de aislamiento microbiológico de M. kansasii. Consideramos que 220 eran enfermos (criterio de la American Thoracic Society más enfermedad probable de definiciones creadas). La enfermedad era más frecuente en varones (n = 185; 84,1%) y en personas sin infección por el VIH (n = 184; 83,6%). La tasa de incidencia de enfermedad más alta en la comarca de Bizkaia fue en Margen Izquierda-Encartaciones, con un 8,05 por cada 100.000 habitantes, y en el Área de Bilbao, en los distritos de la periferia. Las enfermedades de base fueron: tuberculosis (20,5%), enfermedad pulmonar obstructiva crónica (25,9%), neoplasia de pulmón (7,7%), silicosis (0,9%), hepatopatía crónica (11,4%) y gastrectomía (8,6%). Los síntomas consti-tucionales más frecuentes fueron: fiebre (39,1%), anorexia (23,2%) y disminución de peso (33,3%). Entre los síntomas respiratorios destacaron la tos (70,9%) y la expectoración (62,3%). Los patrones radiológicos más frecuentes fueron cavitación e infiltrados pulmonares. La pauta de tratamiento más habitual fue rifampicina, isoniacida y etambutol (43,4%), y el tiempo medio de duración fue de 12 meses en las personas sin infección por el VIH. En el estudio de sensibilidad realizado en 56 cepas, el 100% fue resistente a isoniacida y ninguna mostró resistencia a rifampicina. Se compararon 34 casos de enfermedad por M. kansasii con 68 casos de tuberculosis, todos sin infección por el VIH, y se obtuvieron los siguientes resultados: predominio de fumadores, de síntomas respiratorios y de cavitación en los pacientes con enfermedad por M. kansasii. El 98,5% de los aislamientos pertenecieron al genotipo I. Se obtuvieron un total de 8 clones; el clon denominado 1 fue más frecuente en personas con infección por el VIH y el denominado 3 en los que no la presentaban.

Conclusiones

Se ha registrado un aumento del número de pacientes con enfermedad por M. kansasii en la provincia de Bizkaia en los últimos años. Dicha enfermedad es más frecuente en varones, personas sin infección por el VIH y zonas urbanas. Asimismo, se han encontrado más síntomas respiratorios como manifestaciones clínicas y mayor presencia de cavitación como hallazgo radiológico en la enfermedad por M. kansasii al compararla con la tuberculosis. El genotipo I es el aislado con más frecuencia, y los clones 1 y 3 afectan al 80% de los individuos enfermos.

Palabras clave:
Epidemiología
Virus de la inmunodeficiencia humana
M. kansasii
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