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Table of Contents
CORRESPONDENCE
Year : 2019  |  Volume : 37  |  Issue : 1  |  Page : 58-59

Response to comment on report of two cases of cutaneous Mycobacterium abscessus infection complicating professional decorative tattoo


1 Department of Dermatology, National Taiwan University Hospital, Taipei, Taiwan
2 Department of Dermatology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan

Date of Web Publication28-Mar-2019

Correspondence Address:
Po-Hua Chen
No. 1, Changde St., Zhongzheng District., Taipei City 10048
Taiwan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ds.ds_42_18

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How to cite this article:
Chen PH, Wu CH. Response to comment on report of two cases of cutaneous Mycobacterium abscessus infection complicating professional decorative tattoo. Dermatol Sin 2019;37:58-9

How to cite this URL:
Chen PH, Wu CH. Response to comment on report of two cases of cutaneous Mycobacterium abscessus infection complicating professional decorative tattoo. Dermatol Sin [serial online] 2019 [cited 2019 Oct 17];37:58-9. Available from: http://www.dermsinica.org/text.asp?2019/37/1/58/255036



Dear Editor,

For identification of species of nontuberculous mycobacteria (NTM), traditional methods as phenotypic laboratory identification have been primarily based on growth in <7 days, typical Gram stain and colony morphology, acid-fastness, the absence of pigmentation, and a positive arylsulfatase at 3 days.[1] Modern techniques of speciation are accelerated via the development of molecular analysis of selected genes, such as 16S rRNA, rpoB, and hsp65.[2] Currently, polymerase chain reaction (PCR) sequencing and PCR hybridization are the qualified standards which plagued by lengthy turnaround times and the need for trained personnel. Novel techniques such as matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and whole-genome sequencing demonstrate new generation and great potential as evidenced by recently published literature.[3],[4]

The detail steps of mycobacterial isolation in our study are described below. The skin sample was ground, digested, and decontamination. Then, the specimen is inoculated to the culture plate. Two kinds of culture system are adopted. One is Löwenstein–Jensen medium plate combined with CO2 incubator at 35.0°C–37.7°C; the other one is mycobacteria growth indicator tube (MGIT) medium plate with MGIT 960 system. Positivity for either culture system confirms the presence of Mycobacterium. Thus, further subculture and biochemistry study will be done to identify the species. 7H11 medium plate is used to cultivate the colony. Biochemistry test including niacin, urease, tween 80, nitrate reduction, and arylsulfatase are also performed. According to the colonial phenotype and biochemistry results, the subspecies are differentiated.[5],[6] The steps are reformatted as algorithm as [Figure 1] showed.
Figure 1: Algorithm of reformatted steps to identify nontuberculous mycobacteria and differentiate the species

Click here to view


Nontuberculous mycobacteria as a large group of approximately 186 currently recognized unique Mycobacterium species are known have limited impact on human health in the majority.[7],[8] Therefore, it would be more necessary and vital to early identify the species causing infection and harm to life. As the evolution of knowledge to the NTM species identification, we will have clues to approach more and chance to reach an effective therapeutic management in time.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Brown-Elliott BA, Philley JV. Rapidly growing mycobacteria. Microbiol Spectr 2017;5: TNMI7-0027-2016.  Back to cited text no. 1
    
2.
Yam WC, Yuen KY, Kam SY, Yiu LS, Chan KS, Leung CC, et al. Diagnostic application of genotypic identification of mycobacteria. J Med Microbiol 2006;55:529-36.  Back to cited text no. 2
    
3.
El Khéchine A, Couderc C, Flaudrops C, Raoult D, Drancourt M. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry identification of mycobacteria in routine clinical practice. PLoS One 2011;6:e24720.  Back to cited text no. 3
    
4.
Choudhury S, Tan YE, Lee WB. MALDI-TOF identification of rapidly growing mycobacteria from fungal media in a biosafety level 2 laboratory. Pathology 2016;48:288-90.  Back to cited text no. 4
    
5.
Hsueh PR, Teng LJ, Yang PC, Chen YC, Ho SW, Luh KT, et al. Recurrent catheter-related infection caused by a single clone of Mycobacterium chelonae with two colonial morphotypes. J Clin Microbiol 1998;36:1422-4.  Back to cited text no. 5
    
6.
Cortes MA, Nessar R, Singh AK. Laboratory maintenance of Mycobacterium abscessus. Ch. 10. Curr Protoc Microbiol 2010; Unit 10D.1.1-10D.1.12.  Back to cited text no. 6
    
7.
Parte AC. LPSN – List of prokaryotic names with standing in nomenclature. Nucleic Acids Res 2014;42:D613-6.  Back to cited text no. 7
    
8.
Donohue MJ. Increasing nontuberculous mycobacteria reporting rates and species diversity identified in clinical laboratory reports. BMC Infect Dis 2018;18:163.  Back to cited text no. 8
    


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