عفونتها، تستهای شناسایی و روشهای درمانی جدید مایکوباکتریومهای غیرسلی

نوع مقاله : مروری

نویسندگان

1 دانشجوی دکتری تخصصی باکتری‌شناسی پزشکی، دانشکدة پزشکی، دانشگاه علوم پزشکی مشهد، مشهد، ایران

2 دانشجوی دکتری تخصصی باکتری‌شناسی پزشکی، دانشگاه علوم پزشکی تهران، تهران، ایران

3 استادیار باکتری‌شناسی، دانشکدة پزشکی، دانشگاه علوم پزشکی ایرانشهر، ایرانشهر، ایران

4 دانشجوی دکتری تخصصی باکتری‌شناسی پزشکی، دانشکدة پزشکی، دانشگاه علوم پزشکی تهران، تهران، ایران

چکیده

مایکوباکتریوم ها، باکتری های اسید فاست حاوی مایکولیک اسید با درصد گوانین و سیتوزین 71-61 مول درصد می باشند. مایکوباکتریوم ها بر اساس ویژگی های رشد به دو گروه: سریع الرشد و کندرشد تقسیم بندی می شوند. بر اساس تولید رنگدانه به سه زیر گروه فوتوکروموژن، اسکوتوکروموژن و نان کروموژن طبقه بندی می شوند. پاتوژن های انسانی (مایکوباکتریوم توبرکلوزیس و لپره) و گونه های ساپروفیت محیطی در جنس مایکوباکتریوم وجود دارند. عفونت های مایکوباکتریومی، بیماری ریوی تا انواع عفونت های بافت های پوستی، استخوانی، غدد لنفی و بیماری های منتشر را شامل می شوند. افراد دارای نقص ایمنی حساسیت بالایی در برابر عفونت مایکوباکتریوم های غیر سلی دارند. رنگ آمیزی اسید فست، انواع تست های بیوشیمیایی و تجزیه و تحلیل مایکولیک اسید و اسید های چرب برای تشخیص مایکوباکتریوم ها استفاده می شود. تست های مولکولی از قبیل انواع PCR، تست های هیبریدازیسیون و سکانسینگ ژن های خانه دار برای تایید تشخیص مایکوباکتریوم ها استفاده میگردند. مایکوباکتریوم های کند رشد به طور معمول با دارو های کلاریتروماسین، ریفابوتین، سیپروفلوکساسین، ریفامپین و اتامبوتول درمان می شوند؛ در حالیکه برای مایکوباکتریوم های سریع الرشد ماکرولید ها، سفالوسپورین ها و فلوئوروکوئینولون ها تجویز می شوند. برای تعیین حساسیت دارویی مایکوباکتریوم توبرکلوزیس روش های تناسبی (Proportional method) استفاده می شود. همچنین برای مایکوباکتریوم های سریع الرشد روش های دیسک دیفوژن، دیسک الوشن و براث میکرودیلوشن و برای مایکوباکتریوم های کند رشد روش های رادیومتریک و براث میکرودیلوشن مناسبترین روش های تعیین حساسیت دارویی می باشند. روش های مولکولی نظیر: PCR single-strand conformational polymorphism ، Sequencing، PCR-RFLP و Multiplex-PCR برای تعیین حساسیت دارویی استفاده می شوند. با توجه به اهمیت مایکوباکتریوم های غیرسلی و مقاومت های آنتی بیوتیکی این باکتری ها آزمایشگاه های تشخیص طبی و تیم درمان می بایست به عفونت های مایکوباکتریوم های محیطی در بیماران واجد شرایط خاص توجه داشته باشند.

کلیدواژه‌ها

موضوعات


عنوان مقاله [English]

Infections, Identification Tests and New Therapeutic Techniques for NonTuberculosis Mycobacteria

نویسندگان [English]

  • Masoud keykhah 1
  • Morteza Karami 2
  • Hosseinali Rahdar 3
  • Elahe Taki 4
1 Ph.D. student of medical bacteriology, School of medicine, Mashhad University of Medical Sciences, Mashhad, Iran
2 Ph.D. student of medical bacteriology, School of medicine, Tehran University of Medical Sciences, Tehran, Iran
3 Assistant professor of medical bacteriology, School of medicine, Iranshahr University of Medical Sciences, Iranshahr, Iran
4 Ph.D. student of medical bacteriology, School of medicine, Tehran University of Medical Sciences, Tehran, Iran
چکیده [English]

The genus Mycobacterium is a group of acid fast bacteria with DNA G+C content of 61-71% and the cell wall containing mycolic acid. According to growth physiology, mycobacteria grouped into two divisions: rapidly-growing and slow-growing mycobacteria. Three groups of mycobacteria exist based on pigment production: nonpigmented (nonphotochromogens), photo-chromogens and scotochromogen. Both human obligate pathogens (M. tuberculosis and M.leprae) and opportunistic species exist in mycobacteria genus. There is different kind of mycobacterial infections such asrespiratory infections, lymphatic node and skeletal involvement, dermal and disseminated infection. Spread of HIV virus and immunodeficiency in recent years makes the mycobacterial infections one of the most dangerous infections. Acid fast staining, biochemical tests and cell wall mycolic acid and fatty acid analysis are used for detection of mycobacteria. Different molecular tests including different PCR basedmethods; hybridization and sequencing tests are used for diagnosis and also verifying phenotypic and biochemical tests. Clarithromycin, rifabutin, ciprofloxacin, rifampin and ethambutol currently were used for treatment of slow growing mycobacterial infections. Whereas macrolides, cephalosporins and fluoroquinolones are used for rapidly growing treatment. For rapidly growing mycobacteria, disk diffusion method, disk elution method and broth micro dilution method are more appropriate. Radiometric methods and broth micro dilution method are choice methods for slow growing mycobacteria drug susceptibility test. Moreover molecular methods like PCR single-strand conformational polymorphism (PCR-SSCP), Sequencing, PCR-RFLP and Multiplex-PCR are developed for drug susceptibility determination in mycobacteria. According to non-tuberculosis mycobacteria clinical significance, clinical laboratories and health care team most take attention to diagnosis of these bacterial infections.

کلیدواژه‌ها [English]

  • "mycobacteria"
  • "new diagnosis methods"
  • "new Therapetic methods"
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