Original Articles

Prevalence of Nontuberculous Mycobacteria (NTM) in Iranian Clinical Specimens: Systematic Review and Meta-Analysis


Background:    Although, nontuberculous mycobacteria can cause disease in different organisms, they usually are not reported in most countries because scientists in general consider them as non-pathogens. But, increasing nontuberculous mycobacteria diseases occurrence has changed this belief. Nevertheless, there is no meta-analysis review about prevalence of nontuberculous mycobacteria in Iran. Methods:   Any data about prevalence of nontuberculous mycobacteria in clinical specimens in Iran were retrieved by searching data bases such as Pub Med, MEDLINE, and Iranian data bases. Then the meta-analysis was performed by comprehensive meta-analysis software (CMA). Results:    The meta-analysis showed that the prevalence of nontuberculous mycobacteria in the clinical specimens in Iran was 1.3%. In the studies that had sample size less than 300, and in studies conducted after 2004, the prevalence was higher. Also, the prevalence of nontuberculous mycobacteria was higher in the West of Iran. In this study, the most prevalent rapid-growing mycobacterium was Mycobacterium. fortuitum and  most prevalent slow-growing mycobacterium was M. simiae with the prevalence 44.2% and 14.3%, respectively.Conclusion:   M. simiae is the most prevalent nontuberculous mycobacteria in the clinical specimens in Iran. As this species of nontuberculous mycobacteria has similar clinical and radiological manifestations with tuberculosis, it is often treated as tuberculosis. Unfortunately, M. simiae is resistant against first-line anti-TB drugs resulting in treatment failure after using routine anti-TB medication. Therefore, there is an urgent need for application of new diagnostic strategy for identification of nontuberculous mycobacteria species.

Panagiotou M, Papaioannou AI, Kostikas K, et al. The Epidemiology of Pulmonary Nontuberculous Mycobacteria. Data from a General Hospital in Athens, Greece, 2007-2013.

Shojaei H, Hashemi A, Heidarieh P, et al. Mycobacterium novocastrense–associated pulmonary and wound infections. Emerg Infect Dis. 2011; 17(3):550.

Hoel T, Casals Jb, Eng J. In vitro antimicrobial susceptibility testing of rapidly growing mycobacteria using the tablet diffusion method: resistance pattern of Norwegian M. fortuitum and M. chelonae isolates. APMIS. 1993; 101(1‐6):27-32.

Chimara E, Ferrazoli L, Ueky SYM, et al. BMC microbiol Vol: 8 ISSN: 1471-2180 ISO Abbreviation: BMC Microbiol. Publication Date: 2008; 23(8); 234-9.

Sampaio JLM, Junior DN, de Freitas D, et al. An outbreak of keratitis caused by Mycobacterium immunogenum. J Clin Microbiol. 2006; 44(9):3201-7.

Ohnishi H, Yonetani S, Matsushima S, et al. Mycobacterium kyorinense infection. Emerg Infect Dis. 2013; 19(3):508.

Thomson RM. Changing epidemiology of pulmonary nontuberculous mycobacteria infections. Emerg Infect Dis. 2010; 16(10):1576.

Walsh T, Baca V, Stalling S, et al. Mycobacterium avium-intracellulare pulmonary infection complicated by cutaneous leukocytoclastic vasculitis in a woman with anorexia nervosa. J Infec Dis. 2014; 42(3):559-63.

Ernst P. Canadian asthma consensus conference summary of recommendations. Can Respir J. 1996; 3:5A-10A.

Moher D, Schulz KF, Simera I, et al. Guidance for developers of health research reporting guidelines. PLoS Med. 2010 7(2):e1000217.

Mohammadi MS, Bahrmand AR, Aref AKh. Investigation of drug resistance in Mycobacteria. J Teb Taz. 1998; (28):23-7[in Persian].

Bahrmand AR, Samar HMG, Khalilzadeh L, et al. Detection and identification of non-tuberculous mycobacterial infections in 6,472tuberculosis suspected patients. Scand J Infect Dis. 1996; 28(3):275-8.

Derakhshani nejad Z PF, Shekholeslami FM, Afrayee Kahroodi M, et al. Prevalence of non-tuberculous Maycobacterium in patients with tuberculosis in the Mycobacteriology research center. Sci J Kurdistan Uni. 2014 (19), [in Persian].

Nasiri MJ, Dabiri H, Darban-Sarokhalil D, et al. Prevalence of drug-resistant tuberculosis in Iran: Systematic review and meta-analysis. Am J Infect Control. 2014; 42(11):1212-8.

Heidari F FP, Nowrouzi J, Majd A, et al. Rapid detection atepic mycobacteria in patients with signs of pulmonary tuberculosis: assessment of QUB 3232 (590bp) lucose by VNTR method. J Zanjan Univ Med Sci. 2009; 17:33-44[In Persian].

Moniri R RS, Moosavi SGHA. Investigation of Mycobacterium types and determines drug susceptibility Mycobacterium tuberculosis has isolated from clinical specimens in kashan. Sci J Yazd Univ. 1998-1999 [In Persian].

Shafipour M, Ghane M, Alang SR, et al. Non tuberculosis Mycobacteria isolated from tuberculosis patients in Golestan province, North of Iran. Ann J Biol Res. 2013, 4(12):133-137

Javid NGE, Mozafari A, Rafihi S, et al. Resistance to rifampin and isoniazid from isolated Mycobacterium tuberculosis from tuberculosis patients of Golestan province. J Lab Sci. 2007-2008; 3(1), [In Persian].

Nasrollahi M, Pourhaji Bagher M AM, Khalilian AR. The Diagnostic Value of gyrB RFLP PCR Test in Differentiation between Pathogenic Mycobacteria in Patients Clinically Suspected of Contracting Tuberculosis in Mazandaran. J Mazandaran Uni Med Sci. 2010-2011; 21(88):132-41[In Persian].

Moghtaderi P MR, Rafih N. Drug resistance of nontuberculous mycobacteria causative pulmonary infections to first and second line anti TB drugs Irn. J Infect Dis. 2000-2010; 17(58):59-6[In Persian].

Heidarnejad H, B N. Primary resistance of Mycobacterium Tuberculosis to Isoniazid, Streptomycin, Rifampin, and Ethambutol in Pulmonary Tuberculosis. Arch Iran Med. 2001; 4(1):1.

Naserpour Farivar T, Sharifi Moud B, Salehi M, Naderi M, Salari N, Neda-Naserfar N. Prevalence of Non Tuberculosis Mycobacteria in Southeast of Iran. J Med Sci. 2006; 6:292-5.

Naderi M, Alavi-Naini R, Sharifi-Mood B, et al. Prevalence of Tuberculosis and Non Tuberculosis Mycobacterium in Zahedan, Southeast of Iran. Res J Microbiol. 2010; 5(10):1067-9[In Persian].

Namaei MH, Naderi Nasab M. Drug resistance in isolated Mycobacterium tuberculosis from tuberculosis patients in Mashhad. J Ardabil Uni Med Sci. 2003; 2(7), [In Persian].

Hashemi-Shahraki A, Bostanabad SZ, Heidarieh P, et al. Species spectrum of nontuberculous mycobacteria isolated from suspected tuberculosis patients, identification by multi locus sequence analysis. Infect Genet Evolut. 2013; 20:312-24.

Hashemi-Shahraki A, Darban-Sarokhalil D, Heidarieh P, et al. Mycobacterium simiae: a Possible Emerging Pathogen in Iran. Jpn J Infect Dis. 2013; 66(6):475-9.

Roayaei M, Qmars GHS JM, Kajbaf MJ Ferequency of Nontubberculosis Mycobacteria in suspected tuberculosis patients from Ahvaz. J. 1994; 21(s):69-76[In Persian].

Khosravi A, Seghatoleslami S, Hashemzadeh M. Application of PCR-based fingerprinting for detection of nontuberculous mycobacteria among patients referred to tuberculosis reference center of Khuzestan Province, Iran. Res J Microbiol. 2009; 4(4):143-9.

Mozafari M FP, Velayati A A, Mirsaeidi M. Nontuberculous mycobacteria isolation from clinical and environmental samples in Iran; Twenty years of surveillances. Bio Med Res Int. 2 http://dx.doi.org/ 10.1155 / 2015/ 254285

Kopperdahl DL, Morgan EF, Keaveny TM. Quantitative computed tomography estimates of the mechanical properties of human vertebral trabecular bone. J Ortho Res. 2002; 20(4):801-5.

Chu H, Zhao L, Xiao H, et al. Systematic review/Meta-analysis Prevalence of nontuberculous mycobacteria in patients with bronchiectasis: a meta-analysis. Arch Med Sci 2014; 10, 4: 661–668

O'Brien RJ, Geiter LJ, Snider Jr DE. The epidemiology of nontuberculous mycobacterial diseases in the United States. Results from a national survey. Am Rev Respir Dis. 1987; 135(5):1007-14.

Wang HX, Yue J, Han M, et al. Nontuberculous mycobacteria: susceptibility pattern and prevalence rate in Shanghai from 2005 to 2008. Chin Med J (English Edition). 2010; 123(2):184.

Velayati AA, Farnia P, Mozafari M, et al. Molecular Epidemiology of Nontuberculous Mycobacteria Isolates from Clinical and Environmental Sources of a Metropolitan City. PloS one. 2014; 9(12):e114428.

Baghaei P, Tabarsi P, Farnia P, et al. Pulmonary disease caused by Mycobacterium simiae in Iran’s national referral center for tuberculosis. J Infect Dev Ctries. 2011; 6(01):23-8.

Milne B, Arnold M, Hudson B, et al. Infectious arthritis of the knee caused by Mycobacterium terrae. J Ortho Surg. 2009; 17(1).

Gunaydin M, Yanik K, Eroglu C, et al. Distribution of Nontuberculous Mycobacteria strains. Ann Clin Microbiol Antimicrob. 2013; 12(1):33.

Van Ingen J, Van Soolingen D. Molecular Typing of Nontuberculous Mycobacteria. Molecular Typing in Bacterial Infections: Springer; 2013. p. 167-77.

Winthrop KL, Varley CD, Ory J, et al. Pulmonary disease associated with nontuberculous mycobacteria, Oregon, USA. Emerg Infect Dis. 2011; 17(9):1760.

Jing H, Wang H, Wang Y, et al. Prevalence of nontuberculous mycobacteria infection, China, 2004–2009. Emerg Infect Dis. 2012; 18(3):527-8.

Cattamanchi A, Davis JL, Worodria W, et al. Sensitivity and specificity of fluorescence microscopy for diagnosing pulmonary tuberculosis in a high HIV prevalence setting. The international journal of tuberculosis and lung disease: Int J Tuberc Lung Dis. 2009; 13(9):1130.

Lai C-C, Tan C-K, Chou C-H, et al. Increasing incidence of nontuberculous mycobacteria, Taiwan, 2000–2008. Emerg Infect Dis. 2010; 16(2):294.

IssueVol 5 No 3-4 (2016) QRcode
SectionOriginal Articles
Nontuberculous Mycobacteria Prevalence Iran Clinical specimen

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How to Cite
Khaledi A, Bahador A, Esmaeili D, Ghazvini K. Prevalence of Nontuberculous Mycobacteria (NTM) in Iranian Clinical Specimens: Systematic Review and Meta-Analysis. J Med Bacteriol. 2017;5(3-4):29-40.