Longitudinal non-cystic fibrosis trends of pulmonary Mycobacterium abscessus disease from 2010–2017 - spread of the “globally successful clone” in Asia
- Aristine Cheng1,2,
- Hsin-Yun Sun1,2,
- Yi-Tzu Tsai1,
- Po-Liang Lu3,4,
- Susan Shin-Jung Lee5,
- Yi-Tzu Lee6,7,
- Yung-Chih Wang8,
- Po-Yu Liu9,
- Jung-Yien Chien1,2,
- Po-Ren Hsueh1,2,10,
- Shu-Yuan Chang1,
- Un-In Wu1,2,
- Wang-Huei Sheng1,2,
- Yee-Chun Chen1,2 and
- Shan-Chwen Chang1,2⇑
- 1Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- 2College of Medicine, National Taiwan University, Taipei, Taiwan
- 3Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- 4Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- 5Department of Internal Medicine, Department of Pathology and Laboratory, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- 6Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- 7Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- 8Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- 9Department of Internal Medicine, Taichung, Veterans General Hospital, Taichung, Taiwan
- 10Department of Laboratory Medicine, National Taiwan University Hospital, Kaohsiung, Taiwan
- Shan-Chwen Chang, M.D. PhD., Professor, National Taiwan University College of Medicine, No. 1 Ren-Ai Road, Taipei 100, Taiwan. E-mail: changsc{at}ntu.edu.tw
Abstract
Background Mycobacterium abscessus (MAB) has emerged as the predominant pulmonary non-tuberculous mycobacterial pathogen in parts of Asia, including Taiwan. The reasons for the significant increase in MAB infections in the non-cystic fibrosis (CF) populations are poorly understood. The study aimed to elucidate whether this increase is related to the spread of the globally successful clone of MAB.
Methods We performed multi-locus sequence typing (MLST) of 371 non-duplicated MAB pulmonary isolates from 371 patients sampled between 2010–2017 at 7 hospitals across Taiwan.
Results In total, 183 (49.3%) isolates were M. abscessus subsp. abscessus (MAB-a), 187 (50.4%) were M. abscessus subsp. massiliense (MAB-m), and 1 (0.3%) was M. abscessus subsp. bolletii (MAB-b). MAB-a sequence type 1 (ST1) [23.7%] and ST127 [3.8%], followed by MAB-m ST48 [16.2%], ST117 [15.1%], ST23 [8.6%] were commonest overall. Of MAB-a strains, 50 (27.3%) belonged to novel STs and 38 (10.2%) were singleton strains, while of MAB-m strains, only 10 (5.3%) were novel and 8 (2.2%) were singletons. From 2010 to 2017, the frequency of the historically dominant ST1 declined from 28.6% to 22.5%, whereas the recently emerged globally successful clonal cluster 3, ST23 and ST48, increased from 14.3% to 40.0%.
Conclusions The dominance of ST1 particularly in the last 2 years of this study appears to be declining whilst ST23, reported in outbreaks among CF and post-surgical cohorts across the Americas and Europe, alongside the closely related ST48, is present among non-CF populations in Taiwan. These trends need to be confirmed with further ongoing studies to track the molecular epidemiology of clinical MAB isolates worldwide.
Footnotes
This manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.
Conflict of interest: Dr. Cheng has nothing to disclose.
Conflict of interest: Dr. Sun has nothing to disclose.
Conflict of interest: Ms. Tsai has nothing to disclose.
Conflict of interest: Dr. Lu has nothing to disclose.
Conflict of interest: Dr. Lee has nothing to disclose.
Conflict of interest: Dr. Lee has nothing to disclose.
Conflict of interest: Dr. Wang has nothing to disclose.
Conflict of interest: Dr. Liu has nothing to disclose.
Conflict of interest: Dr. Chien has nothing to disclose.
Conflict of interest: Dr. Hsueh has nothing to disclose.
Conflict of interest: Dr. Chang has nothing to disclose.
Conflict of interest: Dr. Wu has nothing to disclose.
Conflict of interest: Dr. Sheng has nothing to disclose.
Conflict of interest: Dr. Chen has nothing to disclose.
Conflict of interest: Dr. Chang has nothing to disclose.
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- Received April 16, 2020.
- Accepted September 30, 2020.
- Copyright ©ERS 2020
This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.