Prevalence and Molecular Typing of Non-Tuberculous Mycobacteria in Hospital Water Sources of Tehran, Iran
Abstract
Background: Non-tuberculous mycobacteria (NTM) pose a growing public health concern, especially in regions with high prevalence rates. Iran, situated near high-burden countries like Afghanistan and Pakistan, is particularly vulnerable. This study aimed to investigate the molecular epidemiology of NTM in water samples from Farhikhtegan Hospital, Tehran.
Methods: A total of 70 water samples were collected from various hospital departments. After culture and phenotypic identification, 33 mycobacterial isolates were subjected to polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis of the rpoB gene.
Results: Mycobacterium fortuitum type I was the most prevalent NTM species, accounting for 81% of the isolates. Mycobacterium kansasii type I and Mycobacterium gordonae type I followed, each comprising 6% of the isolates. Less common species included M. gordonae type II and Mycobacterium intracellulare. The PCR-RFLP method proved to be a sensitive and accurate tool for identifying NTM species.
Conclusion: This study provides valuable insights into the NTM profile in Farhikhtegan Hospital and underscores the importance of effective surveillance and control measures to mitigate the risk of NTM infections.
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4. Firoozeh F, Firoozeh A, Salmani A. An Update on the Prevalence of Nontuberculous Mycobacteria in Clinical Samples in Iran during 2000-2022: a systematic review and meta-analysis. Med Lab J 2023; 17(3):22-31.
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10. Dezhkhi H, Farnia P, Haddadi A, et al. Characterization of clinical isolates of Mycobacterium simiae using drug susceptibility tests and molecular analyses. Curr Microbiol 2021; 78:2324-31.
11. Khosravi AD, Hashemi Shahraki A, Hashemzadeh M, et al. Prevalence of non-tuberculous mycobacteria in hospital waters of major cities of Khuzestan Province, Iran. Front Cell Infect Microbiol 2016; 6:42.
12. Peters M, Müller C, Rüsch-Gerdes S, et al. Isolation of atypical mycobacteria from tap water in hospitals and homes: is this a possible source of disseminated MAC infection in AIDS patients? J Infect 1995; 31(1):39-44.
13. Makovcova J, Babak V, Slany M, et al. Comparison of methods for the isolation of mycobacteria from water treatment plant sludge. Antonie van Leeuwenhoek 2015; 107:1165-79.
14. Hammer-Dedet F, Dupont C, Evrevin M, et al. Improved detection of non-tuberculous mycobacteria in hospital water samples. Infect Dis Now 2021; 51(5):488-91.
15. Cole B. Essential components of a public health tuberculosis prevention, control, and elimination program: recommendations of the advisory council for the elimination of tuberculosis and the national tuberculosis controllers association. MMWR 2020; 69.
16. Nasr-Esfahani B, Sarikhani E, Moghim S, et al. Molecular characterization of environmental non-tuberculous mycobacteria using PCR-RFLP analysis of 441 Bp heat shock protein 65 fragments. Iran J Public Health 2012; 41(4):108.
17. Dávalos AF, Garcia PK, Montoya-Pachongo C, et al. Identification of nontuberculous mycobacteria in drinking water in Cali, Colombia. Int J Environl Res Pub Health 2021; 18(16):8451.
18. Moghaddam S, Nojoomi F, Dabbagh Moghaddam A, et al. Isolation of nontuberculous mycobacteria species from different water sources: a study of six hospitals in Tehran, Iran. BMC Microbiol 2022; 22(1):261.
19. Fernandes HM, Conceição EC, Gomes KM, et al. Recovery of non-tuberculous mycobacteria from water is influenced by phenotypic characteristics and decontamination methods. Curr Microbiol 2020; 77:621-31.
20. Roshdi Maleki M. Species and genetic diversity of nontuberculous mycobacteria (ntm) in suspected tuberculosis cases in east Azerbaijan, Iran: a cross-sectional analysis. bioRxiv 2024: 06(10):598344.
21. Nasiri MJ, Dabiri H, Darban-Sarokhalil D, et al. Prevalence of non-tuberculosis mycobacterial infections among tuberculosis suspects in Iran: systematic review and meta-analysis. PloS one 2015; 10(6):e0129073.
22. Covert TC, Rodgers MR, Reyes AL, et al. Occurrence of nontuberculous mycobacteria in environmental samples. Appl.Environ. Microbiol 1999; 65(6):2492-6.
23. Shin J, Lee E, Lee H, et al. Prevalence of non-tuberculous mycobacteria in a hospital environment. J Hosp Infect 2007; 65(2):143-8.
24. Moraes PRdS, Chimara E, Telles MAdS, et al. Identification of non-tuberculous mycobacteria from the central public health laboratory from Mato Grosso do Sul and analysis of clinical relevance. Brazil J Microbiol 2008; 39:268-72.
25. Falkinham III JO. Nontuberculous mycobacteria in the environment. Tuberculosis 2022; 137:102267.
26. Pfaller S, King D, Mistry JH, et al. Chloramine concentrations within distribution systems and their effect on heterotrophic bacteria, mycobacterial species, and disinfection byproducts. Water Res 2021; 205:117689.
27. Oriani AS, Sierra F, Baldini MD. Effect of chlorine on Mycobacterium gordonae and Mycobacterium chubuense in planktonic and biofilm state. Int J Mycobacteriol 2018; 7(2):122-7.
28. Falkinham JO. Current epidemiologic trends of the nontuberculous mycobacteria (NTM). Curr.Environ.Health. Rep 2016; 3:161-7.
29. Ayoubi S, Farnia P, Farnia P, et al. Prevalence of non-tuberculosis mycobacteria among samples deposited from the national tuberculous reference laboratory of Iran (2011-2018). Asian.Pac J Trop Med 2021; 14(10):451-5.
30. Arfaatabar M, Karami P, Khaledi A. An update on prevalence of slow-growing mycobacteria and rapid-growing mycobacteria retrieved from hospital water sources in Iran–a systematic review. Germs 2021; 11(1):97.
31. Aghajani J, Saif S, Farnia P, et al. An 8-year study on the prevalence and drug resistance of mycobacteria in clinical specimens (2011–2018). Clin Epidemiol Glob Health 2020; 8(2):557-61.
32. Falkinham III JO. Ecology of nontuberculous mycobacteria. Microorganisms 2021; 9(11):2262.
33. Zulu M, Monde N, Nkhoma P, et al. Nontuberculous mycobacteria in humans, animals, and water in Zambia: a systematic review. Front Trop Dis 2021; 2:679501.
34. Gan Y, Rahmatika I, Kurisu F, et al. The fate and risk of nontuberculous mycobacteria in the water supply system: a review. H2Open J 2022; 5(2):180-97.
35. Tagini F, Pillonel T, Bertelli C, et al. Pathogenic determinants of the Mycobacterium kansasii complex: an unsuspected role for distributive conjugal transfer. Microorganisms 2021; 9(2):348.
36. Tateishi Y, Ozeki Y, Nishiyama A, et al. Comparative genomic analysis of Mycobacterium intracellulare: implications for clinical taxonomic classification in pulmonary Mycobacterium avium-intracellulare complex disease. BMC Microbiol 2021; 21:1-15.
37. Guo Y, Cao Y, Liu H, et al. Clinical and microbiological characteristics of Mycobacterium kansasii pulmonary infections in China. Microbiol Spectr 2022; 10(1):e01475-21.
2. Velayati AA, Farnia P, Mozafari M, et al. Nontuberculous mycobacteria isolation from clinical and environmental samples in Iran: twenty years of surveillance. BioMed Res Int 2015; 2015(1):254285.
3. Khaledi A, Bahador A, Esmaeili D, et al. Prevalence of nontuberculous mycobacteria isolated from environmental samples in Iran: A meta-analysis. J Res Med Sci 2016; 21(1):58.
4. Firoozeh F, Firoozeh A, Salmani A. An Update on the Prevalence of Nontuberculous Mycobacteria in Clinical Samples in Iran during 2000-2022: a systematic review and meta-analysis. Med Lab J 2023; 17(3):22-31.
5. Siavashifar M, Rezaei F, Motallebirad T, et al. Species diversity and molecular analysis of opportunistic Mycobacterium, Nocardia and Rhodococcus isolated from the hospital environment in a developing country, a potential resources for nosocomial infection. Genes Environ 2021; 43:1-12.
6. Mortazavi Z, Bahrmand A, Sakhaee F, et al. Evaluating the clinical significance of nontuberculous mycobacteria isolated from respiratory samples in Iran: an often overlooked disease. Infect Drug Resist 2019: 19:17-27.
7. Tarashi S, Sakhaee F, Masoumi M, et al. Molecular epidemiology of nontuberculous mycobacteria isolated from tuberculosis-suspected patients. AMB Express 2023; 13(1):49.
8. Firoozeh F, Firoozeh A, Salmani A. An Update on the prevalence of nontuberculous in clinical samples in iran during 2000-2022: a retrospective systematic review and meta-analysis. Med Lab J 2023;17(3).
9. Hashemzadeh M, Asareh Zadegan Dezfuli A, Khosravi A, et al. Antibiotic resistance and genomic characterization of Mycobacterium abscessus complex isolates from patients with pulmonary tuberculosis in Iran: A multi-center study (2010–2021). Acta Microbiol Immunol Hung 2024.
10. Dezhkhi H, Farnia P, Haddadi A, et al. Characterization of clinical isolates of Mycobacterium simiae using drug susceptibility tests and molecular analyses. Curr Microbiol 2021; 78:2324-31.
11. Khosravi AD, Hashemi Shahraki A, Hashemzadeh M, et al. Prevalence of non-tuberculous mycobacteria in hospital waters of major cities of Khuzestan Province, Iran. Front Cell Infect Microbiol 2016; 6:42.
12. Peters M, Müller C, Rüsch-Gerdes S, et al. Isolation of atypical mycobacteria from tap water in hospitals and homes: is this a possible source of disseminated MAC infection in AIDS patients? J Infect 1995; 31(1):39-44.
13. Makovcova J, Babak V, Slany M, et al. Comparison of methods for the isolation of mycobacteria from water treatment plant sludge. Antonie van Leeuwenhoek 2015; 107:1165-79.
14. Hammer-Dedet F, Dupont C, Evrevin M, et al. Improved detection of non-tuberculous mycobacteria in hospital water samples. Infect Dis Now 2021; 51(5):488-91.
15. Cole B. Essential components of a public health tuberculosis prevention, control, and elimination program: recommendations of the advisory council for the elimination of tuberculosis and the national tuberculosis controllers association. MMWR 2020; 69.
16. Nasr-Esfahani B, Sarikhani E, Moghim S, et al. Molecular characterization of environmental non-tuberculous mycobacteria using PCR-RFLP analysis of 441 Bp heat shock protein 65 fragments. Iran J Public Health 2012; 41(4):108.
17. Dávalos AF, Garcia PK, Montoya-Pachongo C, et al. Identification of nontuberculous mycobacteria in drinking water in Cali, Colombia. Int J Environl Res Pub Health 2021; 18(16):8451.
18. Moghaddam S, Nojoomi F, Dabbagh Moghaddam A, et al. Isolation of nontuberculous mycobacteria species from different water sources: a study of six hospitals in Tehran, Iran. BMC Microbiol 2022; 22(1):261.
19. Fernandes HM, Conceição EC, Gomes KM, et al. Recovery of non-tuberculous mycobacteria from water is influenced by phenotypic characteristics and decontamination methods. Curr Microbiol 2020; 77:621-31.
20. Roshdi Maleki M. Species and genetic diversity of nontuberculous mycobacteria (ntm) in suspected tuberculosis cases in east Azerbaijan, Iran: a cross-sectional analysis. bioRxiv 2024: 06(10):598344.
21. Nasiri MJ, Dabiri H, Darban-Sarokhalil D, et al. Prevalence of non-tuberculosis mycobacterial infections among tuberculosis suspects in Iran: systematic review and meta-analysis. PloS one 2015; 10(6):e0129073.
22. Covert TC, Rodgers MR, Reyes AL, et al. Occurrence of nontuberculous mycobacteria in environmental samples. Appl.Environ. Microbiol 1999; 65(6):2492-6.
23. Shin J, Lee E, Lee H, et al. Prevalence of non-tuberculous mycobacteria in a hospital environment. J Hosp Infect 2007; 65(2):143-8.
24. Moraes PRdS, Chimara E, Telles MAdS, et al. Identification of non-tuberculous mycobacteria from the central public health laboratory from Mato Grosso do Sul and analysis of clinical relevance. Brazil J Microbiol 2008; 39:268-72.
25. Falkinham III JO. Nontuberculous mycobacteria in the environment. Tuberculosis 2022; 137:102267.
26. Pfaller S, King D, Mistry JH, et al. Chloramine concentrations within distribution systems and their effect on heterotrophic bacteria, mycobacterial species, and disinfection byproducts. Water Res 2021; 205:117689.
27. Oriani AS, Sierra F, Baldini MD. Effect of chlorine on Mycobacterium gordonae and Mycobacterium chubuense in planktonic and biofilm state. Int J Mycobacteriol 2018; 7(2):122-7.
28. Falkinham JO. Current epidemiologic trends of the nontuberculous mycobacteria (NTM). Curr.Environ.Health. Rep 2016; 3:161-7.
29. Ayoubi S, Farnia P, Farnia P, et al. Prevalence of non-tuberculosis mycobacteria among samples deposited from the national tuberculous reference laboratory of Iran (2011-2018). Asian.Pac J Trop Med 2021; 14(10):451-5.
30. Arfaatabar M, Karami P, Khaledi A. An update on prevalence of slow-growing mycobacteria and rapid-growing mycobacteria retrieved from hospital water sources in Iran–a systematic review. Germs 2021; 11(1):97.
31. Aghajani J, Saif S, Farnia P, et al. An 8-year study on the prevalence and drug resistance of mycobacteria in clinical specimens (2011–2018). Clin Epidemiol Glob Health 2020; 8(2):557-61.
32. Falkinham III JO. Ecology of nontuberculous mycobacteria. Microorganisms 2021; 9(11):2262.
33. Zulu M, Monde N, Nkhoma P, et al. Nontuberculous mycobacteria in humans, animals, and water in Zambia: a systematic review. Front Trop Dis 2021; 2:679501.
34. Gan Y, Rahmatika I, Kurisu F, et al. The fate and risk of nontuberculous mycobacteria in the water supply system: a review. H2Open J 2022; 5(2):180-97.
35. Tagini F, Pillonel T, Bertelli C, et al. Pathogenic determinants of the Mycobacterium kansasii complex: an unsuspected role for distributive conjugal transfer. Microorganisms 2021; 9(2):348.
36. Tateishi Y, Ozeki Y, Nishiyama A, et al. Comparative genomic analysis of Mycobacterium intracellulare: implications for clinical taxonomic classification in pulmonary Mycobacterium avium-intracellulare complex disease. BMC Microbiol 2021; 21:1-15.
37. Guo Y, Cao Y, Liu H, et al. Clinical and microbiological characteristics of Mycobacterium kansasii pulmonary infections in China. Microbiol Spectr 2022; 10(1):e01475-21.
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| Issue | Vol 13 No 2 (2025) | |
| Section | Original Articles | |
| DOI | https://doi.org/10.18502/jmb.v13i2.18654 | |
| Keywords | ||
| Non-tuberculosis mycobacterium PCR-RFLP rpoB gene Water. | ||
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How to Cite
1.
Mahmoudi P, Amini K, Falsafl S. Prevalence and Molecular Typing of Non-Tuberculous Mycobacteria in Hospital Water Sources of Tehran, Iran. J Med Bacteriol. 2025;13(2):31-39.
