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        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">Patients with cystic fibrosis are at great risk of infection by nontuberculous mycobacteria from the environment because of certain predisposing factors such as bronchiectasis&#44; malnutrition&#44; and diabetes&#46; The aim of this study was to analyze the mycobacterial content of sputum smears and cultures from adult patients with cystic fibrosis attended at a specialized unit for adults from March 1997 through December 2001&#46;</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p class="elsevierStyleSimplePara elsevierViewall">Sputum samples were collected prospectively according to a protocol applied at each visit&#44; and during most exacerbations staining and culture for mycobacteria were ordered in addition to the usual cultures for bacteria and fungi&#46; A tuberculin test was performed at the end of the study&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">Twenty-eight patients &#40;16 men&#41; with cystic fibrosis were enrolled&#46; The mean &#40;SD&#41; age was 25&#46;3 &#40;6&#46;7&#41; years&#46; A total of 251 samples were cultured &#40;range in number of samples per patient&#44; 1-31&#41;&#46; The mean period of follow up was 40&#46;3 &#40;22&#46;1&#41; months&#46; The sputum smear was positive in 29 cases &#40;4 patients&#41;&#59; the culture was positive in 7 patients&#46; More than 3 samples were positive in only 4 patients&#46; <span class="elsevierStyleItalic">Mycobacterium abscessus</span> was isolated in 3 cases&#44; <span class="elsevierStyleItalic">Mycobacterium avium</span> complex in 2 and <span class="elsevierStyleItalic">Mycobacterium simiae</span> in 1 and other an unidentified rapid growth <span class="elsevierStyleItalic">Mycobacterium</span> species&#46; The Mantoux test was positive in 5 patients&#46; Two of the 4 patients in whose samples mycobacteria were isolated repeatedly required treatment&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">The prevalence of nontuberculous mycobacterial infection is high in patients with cystic fibrosis&#46; Staining and culture for mycobacteria should be carried out regularly and whenever exacerbation of pulmonary symptoms cannot be attributed to bacteria usually found in such patients&#46; Patients with recurrent isolations of mycobacteria should be monitored closely&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">LOS pacientes con fibrosis qu&#237;stica &#40;FQ&#41; presentan un mayor riesgo de infecci&#243;n por micobacterias ambientales en relaci&#243;n con ciertos factores predisponentes como bronquiectasias&#44; desnutrici&#243;n y diabetes&#46; El objetivo del presente estudio es analizar los resultados de las baciloscopias y cultivos de micobacterias de esputos de pacientes con FQ de una unidad de adultos&#44; entre marzo de 1997 y diciembre de 2001&#46;</p> <span class="elsevierStyleSectionTitle">Pacientes y m&#233;todos</span><p class="elsevierStyleSimplePara elsevierViewall">Las muestras de esputo se recogieron de forma prospectiva y protocolizada en cada visita y en la mayor&#237;a de las exacerbaciones&#44; en las que&#44; adem&#225;s de los cultivos bacterianos habituales y de hongos&#44; se solicitaron tinci&#243;n y cultivo para micobacterias&#46; Se realiz&#243; la prueba de la tuberculina al final del estudio&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">Se incluy&#243; a 28 pacientes con FQ&#44; 16 varones&#44; con una edad media &#40;&#177; DE&#41; de 25&#44;3 &#177; 6&#44;7 a&#241;os&#46; Se cultivaron un total de 251 muestras &#40;rango por paciente de 1 a 31&#41;&#46; El tiempo medio de seguimiento fue de 40&#44;3 &#177; 22&#44;1 meses&#46; En 29 casos &#40;4 pacientes&#41; la baciloscopia fue positiva y se obtuvieron cultivos positivos en 7 pacientes&#44; s&#243;lo en 4 en m&#225;s de 3 muestras&#46; Se aislaron&#58; <span class="elsevierStyleItalic">Mycobacterium abscessus</span> en 3 casos&#44; <span class="elsevierStyleItalic">M&#46; avium complex</span> en 2 y <span class="elsevierStyleItalic">M&#46; simiae</span> en uno y en otro una especie de crecimiento r&#225;pido no identificada&#46; En 5 pacientes el Mantoux fue positivo&#46; Dos de los 4 pacientes con aislamientos reiterados presentaron deterioro cl&#237;nico y requirieron tratamiento&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">Hay una alta prevalencia de micobacterias ambientales en pacientes con FQ&#46; Habr&#237;a que realizar tinci&#243;n y cultivo para micobacterias de forma peri&#243;dica y en caso de exacerbaci&#243;n pulmonar no atribuible a infecci&#243;n bacteriana habitual&#46; Hay que vigilar estrechamente a los pacientes con aislamientos repetidos&#46;</p>"
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                            4 => "A Sol&#233;"
                            5 => "S Valdezate"
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                        "tituloSerie" => "Arch Bronconeumol"
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                        "paginaInicial" => "376"
                        "paginaFinal" => "385"
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                        "tituloSerie" => "Am J Med Sci"
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                        "paginaFinal" => "55"
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Infecciones respiratorias por micobacterias ambientales"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J Garc&#237;a"
                            1 => "J Palacios"
                            2 => "A S&#225;nchez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2005"
                        "volumen" => "41"
                        "paginaInicial" => "206"
                        "paginaFinal" => "219"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15826531"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nontuberculous mycobacteria&#46; I&#58; multicenter prevalence study in cystic fibrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "K Olivier"
                            1 => "D Weber"
                            2 => "R Wallace"
                            3 => "A Faiz"
                            4 => "J Lee"
                            5 => "Y Zhang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.200207-678OC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2003"
                        "volumen" => "167"
                        "paginaInicial" => "828"
                        "paginaFinal" => "834"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12433668"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fisiopatolog&#237;a y cl&#237;nica de la afectaci&#243;n digestiva"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M Acu&#241;a"
                            1 => "M Escalera"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:4 [
                        "titulo" => "Fibrosis qu&#237;stica"
                        "paginaInicial" => "143"
                        "paginaFinal" => "159"
                        "serieFecha" => "1997"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Long-term study of one hundred five patients with cystic fibrosis&#58; studies made over a five to fourteen year period"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "H Shwachman"
                            1 => "l Kulczycki"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Am J Dis Child"
                        "fecha" => "1958"
                        "volumen" => "96"
                        "paginaInicial" => "6"
                        "paginaFinal" => "15"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evaluation of scoring system of the chest radiograph in cystic fibrosis&#58; a collaborative study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "D Brasfield"
                            1 => "G Hicks"
                            2 => "S Soong"
                            3 => "J Peters"
                            4 => "R Tiller"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2214/ajr.134.6.1195"
                      "Revista" => array:6 [
                        "tituloSerie" => "AJR Am J Roentgenol"
                        "fecha" => "1980"
                        "volumen" => "134"
                        "paginaInicial" => "1195"
                        "paginaFinal" => "1198"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6770630"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sputum digestion and decontamination with N-acetyl-1-cysteine-sodium hydroxide for culture of mycobacteria"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "G Kubica"
                            1 => "W Dye"
                            2 => "M Cohn"
                            3 => "G Middlebrook"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/arrd.1963.87.5.775"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am Rev Respir Dis"
                        "fecha" => "1963"
                        "volumen" => "87"
                        "paginaInicial" => "775"
                        "paginaFinal" => "779"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/13927224"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The respiratory system"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D Orenstein"
                            1 => "B Rosenstein"
                            2 => "R Stern"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:4 [
                        "titulo" => "Cystic fibrosis&#58; medical care"
                        "paginaInicial" => "55"
                        "paginaFinal" => "92"
                        "serieFecha" => "2000"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Normativa del diagn&#243;stico y tratamiento de la afecci&#243;n respiratoria en la fibrosis qu&#237;stica"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L Maiz"
                            1 => "F Baranda"
                            2 => "R Coll"
                            3 => "C Prados"
                            4 => "M Vendrell"
                            5 => "A Escribano"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2001"
                        "volumen" => "37"
                        "paginaInicial" => "316"
                        "paginaFinal" => "324"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11562317"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nontuberculous mycobacteria in the setting of cystic fibrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D Ebert"
                            1 => "K Olivier"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Chest Med"
                        "fecha" => "2002"
                        "volumen" => "23"
                        "paginaInicial" => "655"
                        "paginaFinal" => "663"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12371001"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "State of the art&#58; cystic fibrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "RE Wood"
                            1 => "RF Boat"
                            2 => "CF Doershurk"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/arrd.1976.113.6.833"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am Rev Respir Dis"
                        "fecha" => "1976"
                        "volumen" => "113"
                        "paginaInicial" => "833"
                        "paginaFinal" => "878"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/779549"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Isolation of rapidly growing mycobacteria in patients with cystic fibrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "B Boxerbaum"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Pediatrics"
                        "fecha" => "1980"
                        "volumen" => "96"
                        "paginaInicial" => "689"
                        "paginaFinal" => "691"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mycobacterial isolations in young adults with cystic fibrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "MJ Smith"
                            1 => "J Efthimiou"
                            2 => "M Hodson"
                            3 => "JC Batten"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Thorax"
                        "fecha" => "1984"
                        "volumen" => "39"
                        "paginaInicial" => "369"
                        "paginaFinal" => "375"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6429879"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "<span class="elsevierStyleItalic">Mycobacterium avium complex</span> in a patient with cystic fibrosis&#58; disease vs&#46; colonization"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "JS Kinney"
                            1 => "BJ Little"
                            2 => "RH Yolken"
                            3 => "BR Rosenstein"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Infect Dis J"
                        "fecha" => "1989"
                        "volumen" => "8"
                        "paginaInicial" => "393"
                        "paginaFinal" => "396"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2748240"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prospective study of mycobacterial infections in patients with cystic fibrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "L Hjelte"
                            1 => "B Petrini"
                            2 => "G K&#228;llenius"
                            3 => "B Starndvik"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Thorax"
                        "fecha" => "1990"
                        "volumen" => "45"
                        "paginaInicial" => "397"
                        "paginaFinal" => "400"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2382245"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nontuberculous mycobacteria in adult patients with cystic fibrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "JM Kilby"
                            1 => "P Gilligan"
                            2 => "R Yankaska"
                            3 => "WE Highsmith"
                            4 => "LJ Edwards"
                            5 => "MR Knowles"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "1992"
                        "volumen" => "102"
                        "paginaInicial" => "70"
                        "paginaFinal" => "75"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1623799"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib22"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nontuberculous mycobacteria in adult patients with cystic fibrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "ML Aitken"
                            1 => "W Burke"
                            2 => "G McDonald"
                            3 => "C Wallis"
                            4 => "B Ramsey"
                            5 => "C Nolan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "1993"
                        "volumen" => "103"
                        "paginaInicial" => "1096"
                        "paginaFinal" => "1099"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8131446"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib23"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The role of mycobacteria other than tuberculosis &#40;MOTT&#41; in patients with cystic fibrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K Hjelt"
                            1 => "N Hojlyng"
                            2 => "P Howitz"
                            3 => "N Illum"
                            4 => "E Munk"
                            5 => "N Valerius"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Scand J Infect Dis"
                        "fecha" => "1994"
                        "volumen" => "26"
                        "paginaInicial" => "569"
                        "paginaFinal" => "576"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7855554"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0140673603139128"
                          "estado" => "S300"
                          "issn" => "01406736"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib24"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Aislamiento de micobacterias en pacientes con fibrosis qu&#237;stica&#58; estudio prospectivo"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "F Pedraza"
                            1 => "C San Jos&#233;"
                            2 => "N Cobos"
                            3 => "F Fern&#225;ndez"
                            4 => "N Mart&#237;n"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "An Esp Pediatr"
                        "fecha" => "1996"
                        "volumen" => "45"
                        "paginaInicial" => "157"
                        "paginaFinal" => "160"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8967645"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib25"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nontuberculous mycobacterial pulmonary disease in cystic fibrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "KN Olivier"
                            1 => "JR Yankaska"
                            2 => "MR Knowles"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Sem Resp Infect"
                        "fecha" => "1996"
                        "volumen" => "11"
                        "paginaInicial" => "272"
                        "paginaFinal" => "284"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib26"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mycobacterial lung disease in cystic fibrosis&#58; a prospective study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "B Fauroux"
                            1 => "B Delaisi"
                            2 => "A Clement"
                            3 => "C Saizou"
                            4 => "D Moissenet"
                            5 => "C Truffot-Pernot"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Infect Dis&#46; J"
                        "fecha" => "1997"
                        "volumen" => "16"
                        "paginaInicial" => "354"
                        "paginaFinal" => "358"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9109135"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib27"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Non-tuberculous mycobacteria in cystic fibrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "JK Torrens"
                            1 => "P Dawkins"
                            2 => "SP Conway"
                            3 => "E Moya"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Thorax"
                        "fecha" => "1998"
                        "volumen" => "53"
                        "paginaInicial" => "182"
                        "paginaFinal" => "185"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9659352"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib28"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Early chemotherapy for non tuberculous mycobacterial infections in patients with cystic fibrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "U Forslow"
                            1 => "A Geborek"
                            2 => "L Hjelte"
                            3 => "B Petrini"
                            4 => "N Heurlin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Paediatr"
                        "fecha" => "2003"
                        "volumen" => "92"
                        "paginaInicial" => "910"
                        "paginaFinal" => "915"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12948065"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib29"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nontuberculous mycobacterial pulmonary infection in patients with cystic fibrosis&#58; diagnosis and treatment"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "L Maiz"
                            1 => "E Navas"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Med"
                        "fecha" => "2002"
                        "volumen" => "1"
                        "paginaInicial" => "107"
                        "paginaFinal" => "117"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14720065"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib30"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nontuberculous mycobacteria&#46; II&#58; nested-cohort study of impact in cystic fibrosis lung disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "K Olivier"
                            1 => "D Weber"
                            2 => "J Lee"
                            3 => "A Handler"
                            4 => "G Tudor"
                            5 => "P Molina"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.200207-679OC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2003"
                        "volumen" => "167"
                        "paginaInicial" => "835"
                        "paginaFinal" => "840"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12433669"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib31"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnosis and treatment of disease caused by nontuberculous mycobacteria"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "American Thoracic Society"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm.156.2.atsstatement"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "1997"
                        "volumen" => "156"
                        "paginaInicial" => "S1"
                        "paginaFinal" => "S25"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9279284"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib32"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nontuberculous mycobacteria in cystic fibrosis&#46; An autopsy study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "JF Tomashefski"
                            1 => "RC Stern"
                            2 => "CA Demko"
                            3 => "CF Doershuk"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm.154.2.8756832"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "1996"
                        "volumen" => "154"
                        "paginaInicial" => "523"
                        "paginaFinal" => "528"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8756832"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib33"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Improved recovery of mycobacteria from respiratory secretions of patients with cystic fibrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "S Whittier"
                            1 => "RL Hopfer"
                            2 => "MR Knowles"
                            3 => "PH Gilligan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Clin Microbiol"
                        "fecha" => "1993"
                        "volumen" => "31"
                        "paginaInicial" => "861"
                        "paginaFinal" => "864"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib34"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Skin testing with <span class="elsevierStyleItalic">Mycobacterium avium</span> sensitin to identify infection with <span class="elsevierStyleItalic">M avium complex</span> in patient with cystic fibrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R Pinto-Powell"
                            1 => "KN Olivier"
                            2 => "BJ Marsh"
                            3 => "S Donaldson"
                            4 => "HW Parker"
                            5 => "W Boyle"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Infect Dis"
                        "fecha" => "1996"
                        "volumen" => "22"
                        "paginaInicial" => "560"
                        "paginaFinal" => "562"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8852979"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
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Vol. 41. Issue 10.
Pages 560-565 (October 2005)
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Vol. 41. Issue 10.
Pages 560-565 (October 2005)
Original Articles
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Nontuberculous Mycobacteria in Patients With Cystic Fibrosis
Visits
5360
R.M. Giróna,
Corresponding author
med002861@nacom.es

Correspondence: Dra. R.M. Girón. Servicio de Neumología. Hospital Universitario de la Princesa. Diego deLeón, 62. 28006 Madrid. España
, D. Domingob, B. Buendíab, E. Antóna, L.M. Ruiz-Velascoc, J. Ancocheaa
a Servicio de Neumología, Hospital Universitario de la Princesa, Madrid, Spain
b Servicio de Microbiología, Hospital Universitario de la Princesa, Madrid, Spain
c Área de Laboratorio, Clínica Moncloa, Madrid, Spain
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Objective

Patients with cystic fibrosis are at great risk of infection by nontuberculous mycobacteria from the environment because of certain predisposing factors such as bronchiectasis, malnutrition, and diabetes. The aim of this study was to analyze the mycobacterial content of sputum smears and cultures from adult patients with cystic fibrosis attended at a specialized unit for adults from March 1997 through December 2001.

Patients and methods

Sputum samples were collected prospectively according to a protocol applied at each visit, and during most exacerbations staining and culture for mycobacteria were ordered in addition to the usual cultures for bacteria and fungi. A tuberculin test was performed at the end of the study.

Results

Twenty-eight patients (16 men) with cystic fibrosis were enrolled. The mean (SD) age was 25.3 (6.7) years. A total of 251 samples were cultured (range in number of samples per patient, 1-31). The mean period of follow up was 40.3 (22.1) months. The sputum smear was positive in 29 cases (4 patients); the culture was positive in 7 patients. More than 3 samples were positive in only 4 patients. Mycobacterium abscessus was isolated in 3 cases, Mycobacterium avium complex in 2 and Mycobacterium simiae in 1 and other an unidentified rapid growth Mycobacterium species. The Mantoux test was positive in 5 patients. Two of the 4 patients in whose samples mycobacteria were isolated repeatedly required treatment.

Conclusions

The prevalence of nontuberculous mycobacterial infection is high in patients with cystic fibrosis. Staining and culture for mycobacteria should be carried out regularly and whenever exacerbation of pulmonary symptoms cannot be attributed to bacteria usually found in such patients. Patients with recurrent isolations of mycobacteria should be monitored closely.

Key Words:
Cystic fibrosis
Nontuberculous mycobacteria
Mycobacterium avium complex
Mycobacterium abscessus
Objetivo

LOS pacientes con fibrosis quística (FQ) presentan un mayor riesgo de infección por micobacterias ambientales en relación con ciertos factores predisponentes como bronquiectasias, desnutrición y diabetes. El objetivo del presente estudio es analizar los resultados de las baciloscopias y cultivos de micobacterias de esputos de pacientes con FQ de una unidad de adultos, entre marzo de 1997 y diciembre de 2001.

Pacientes y métodos

Las muestras de esputo se recogieron de forma prospectiva y protocolizada en cada visita y en la mayoría de las exacerbaciones, en las que, además de los cultivos bacterianos habituales y de hongos, se solicitaron tinción y cultivo para micobacterias. Se realizó la prueba de la tuberculina al final del estudio.

Resultados

Se incluyó a 28 pacientes con FQ, 16 varones, con una edad media (± DE) de 25,3 ± 6,7 años. Se cultivaron un total de 251 muestras (rango por paciente de 1 a 31). El tiempo medio de seguimiento fue de 40,3 ± 22,1 meses. En 29 casos (4 pacientes) la baciloscopia fue positiva y se obtuvieron cultivos positivos en 7 pacientes, sólo en 4 en más de 3 muestras. Se aislaron: Mycobacterium abscessus en 3 casos, M. avium complex en 2 y M. simiae en uno y en otro una especie de crecimiento rápido no identificada. En 5 pacientes el Mantoux fue positivo. Dos de los 4 pacientes con aislamientos reiterados presentaron deterioro clínico y requirieron tratamiento.

Conclusiones

Hay una alta prevalencia de micobacterias ambientales en pacientes con FQ. Habría que realizar tinción y cultivo para micobacterias de forma periódica y en caso de exacerbación pulmonar no atribuible a infección bacteriana habitual. Hay que vigilar estrechamente a los pacientes con aislamientos repetidos.

Palabras clave:
Fibrosis quística
Micobacterias ambientales
Mycobacterium avium
Mycobacterium abscessus
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REFERENCES
[1]
KW Southern.
Newborn screening for cystic fibrosis: the practical implications.
J R Soc Med, 97 (2004), pp. 57-59
[2]
R Gibson, J Burn, B Ramsey.
Pathophysiology and management of pulmonary infection in cystic fibrosis.
Am J Respir Crit Care Med, 168 (2003), pp. 918-951
[3]
Cystic Fibrosis Foundation.
Patient Registry Annual Data Report 1999, Cystic Fibrosis Foundation, (2000),
[4]
R Cantón, RM Girón, L Martínez-Martínez, A Oliver, A Solé, S Valdezate, et al.
Patógenos multirresistentes en la fibrosis quística.
Arch Bronconeumol, 38 (2002), pp. 376-385
[5]
SM Holland.
Nontuberculous mycobacteria.
Am J Med Sci, 321 (2001), pp. 49-55
[6]
D Griffith, R Wallace.
Epidemiology of nontuberculous mycobacterial infections.
UpToDate,
[7]
J García, J Palacios, A Sánchez.
Infecciones respiratorias por micobacterias ambientales.
Arch Bronconeumol, 41 (2005), pp. 206-219
[8]
K Olivier, D Weber, R Wallace, A Faiz, J Lee, Y Zhang.
Nontuberculous mycobacteria. I: multicenter prevalence study in cystic fibrosis.
Am J Respir Crit Care Med, 167 (2003), pp. 828-834
[9]
M Acuña, M Escalera.
Fisiopatología y clínica de la afectación digestiva.
Fibrosis quística, pp. 143-159
[10]
H Shwachman, l Kulczycki.
Long-term study of one hundred five patients with cystic fibrosis: studies made over a five to fourteen year period.
Am J Dis Child, 96 (1958), pp. 6-15
[11]
D Brasfield, G Hicks, S Soong, J Peters, R Tiller.
Evaluation of scoring system of the chest radiograph in cystic fibrosis: a collaborative study.
AJR Am J Roentgenol, 134 (1980), pp. 1195-1198
[12]
G Kubica, W Dye, M Cohn, G Middlebrook.
Sputum digestion and decontamination with N-acetyl-1-cysteine-sodium hydroxide for culture of mycobacteria.
Am Rev Respir Dis, 87 (1963), pp. 775-779
[13]
D Orenstein, B Rosenstein, R Stern.
The respiratory system.
Cystic fibrosis: medical care, pp. 55-92
[14]
L Maiz, F Baranda, R Coll, C Prados, M Vendrell, A Escribano, et al.
Normativa del diagnóstico y tratamiento de la afección respiratoria en la fibrosis quística.
Arch Bronconeumol, 37 (2001), pp. 316-324
[15]
D Ebert, K Olivier.
Nontuberculous mycobacteria in the setting of cystic fibrosis.
Clin Chest Med, 23 (2002), pp. 655-663
[16]
RE Wood, RF Boat, CF Doershurk.
State of the art: cystic fibrosis.
Am Rev Respir Dis, 113 (1976), pp. 833-878
[17]
B Boxerbaum.
Isolation of rapidly growing mycobacteria in patients with cystic fibrosis.
J Pediatrics, 96 (1980), pp. 689-691
[18]
MJ Smith, J Efthimiou, M Hodson, JC Batten.
Mycobacterial isolations in young adults with cystic fibrosis.
Thorax, 39 (1984), pp. 369-375
[19]
JS Kinney, BJ Little, RH Yolken, BR Rosenstein.
Mycobacterium avium complex in a patient with cystic fibrosis: disease vs. colonization.
Pediatr Infect Dis J, 8 (1989), pp. 393-396
[20]
L Hjelte, B Petrini, G Källenius, B Starndvik.
Prospective study of mycobacterial infections in patients with cystic fibrosis.
Thorax, 45 (1990), pp. 397-400
[21]
JM Kilby, P Gilligan, R Yankaska, WE Highsmith, LJ Edwards, MR Knowles.
Nontuberculous mycobacteria in adult patients with cystic fibrosis.
Chest, 102 (1992), pp. 70-75
[22]
ML Aitken, W Burke, G McDonald, C Wallis, B Ramsey, C Nolan.
Nontuberculous mycobacteria in adult patients with cystic fibrosis.
Chest, 103 (1993), pp. 1096-1099
[23]
K Hjelt, N Hojlyng, P Howitz, N Illum, E Munk, N Valerius, et al.
The role of mycobacteria other than tuberculosis (MOTT) in patients with cystic fibrosis.
Scand J Infect Dis, 26 (1994), pp. 569-576
[24]
F Pedraza, C San José, N Cobos, F Fernández, N Martín.
Aislamiento de micobacterias en pacientes con fibrosis quística: estudio prospectivo.
An Esp Pediatr, 45 (1996), pp. 157-160
[25]
KN Olivier, JR Yankaska, MR Knowles.
Nontuberculous mycobacterial pulmonary disease in cystic fibrosis.
Sem Resp Infect, 11 (1996), pp. 272-284
[26]
B Fauroux, B Delaisi, A Clement, C Saizou, D Moissenet, C Truffot-Pernot, et al.
Mycobacterial lung disease in cystic fibrosis: a prospective study.
Pediatr Infect Dis. J, 16 (1997), pp. 354-358
[27]
JK Torrens, P Dawkins, SP Conway, E Moya.
Non-tuberculous mycobacteria in cystic fibrosis.
Thorax, 53 (1998), pp. 182-185
[28]
U Forslow, A Geborek, L Hjelte, B Petrini, N Heurlin.
Early chemotherapy for non tuberculous mycobacterial infections in patients with cystic fibrosis.
Acta Paediatr, 92 (2003), pp. 910-915
[29]
L Maiz, E Navas.
Nontuberculous mycobacterial pulmonary infection in patients with cystic fibrosis: diagnosis and treatment.
Am J Respir Med, 1 (2002), pp. 107-117
[30]
K Olivier, D Weber, J Lee, A Handler, G Tudor, P Molina.
Nontuberculous mycobacteria. II: nested-cohort study of impact in cystic fibrosis lung disease.
Am J Respir Crit Care Med, 167 (2003), pp. 835-840
[31]
American Thoracic Society.
Diagnosis and treatment of disease caused by nontuberculous mycobacteria.
Am J Respir Crit Care Med, 156 (1997), pp. S1-S25
[32]
JF Tomashefski, RC Stern, CA Demko, CF Doershuk.
Nontuberculous mycobacteria in cystic fibrosis. An autopsy study.
Am J Respir Crit Care Med, 154 (1996), pp. 523-528
[33]
S Whittier, RL Hopfer, MR Knowles, PH Gilligan.
Improved recovery of mycobacteria from respiratory secretions of patients with cystic fibrosis.
Clin Microbiol, 31 (1993), pp. 861-864
[34]
R Pinto-Powell, KN Olivier, BJ Marsh, S Donaldson, HW Parker, W Boyle, et al.
Skin testing with Mycobacterium avium sensitin to identify infection with M avium complex in patient with cystic fibrosis.
Clin Infect Dis, 22 (1996), pp. 560-562

This study was financed by Red Respira (RTIC C03/011)-SEPAR (Spanish Society of Pulmonology and Thoracic Surgery).

Copyright © 2005. Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
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