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Bölgemizdeki tüberküloz dışı mikobakteri enfeksiyonları: Buzdağının sadece görünen yüzü

Year 2023, Volume: 16 Issue: 3, 406 - 419, 18.12.2023

Leyla Ersoy Kevser Elçi Taylan Bozok Eylem Sercan Özgür Ahmet Arslantürk Gönül Aslan

Abstract

Amaç: İmmünsüpresif tedavi rejimleri, ortalama yaşam süresinin uzaması, AIDS gibi hastalıkların artması, tüberküloz dışı mikobakteri (TDM) kaynaklı enfeksiyonların tedavisindeki zorluklar ve fırsatçı patojen olarak bilinen TDM’lerin sağlıklı kişilerde de etken olabilmesi TDM’yi tüm dünyada önemli bir enfeksiyon kaynağı haline getirmiştir. Bu çalışmada, 2015-2022 yılları arasında mikobakteriyoloji laboratuvarında klinik örneklerinden TDM izole edilen hastaların demografik özelliklerinin, enfeksiyon etkeni TDM türlerinin ve ilaç duyarlılık profillerinin retrospektif olarak değerlendirilmesi amaçlanmıştır. Yöntem: Mersin Ü. Hastanesi Tıbbi Mikrobiyoloji Laboratuvarı Mikobakteriyoloji Birimi’nde tüberküloz (TB) şüphesi üzerine alınan örneklerin işlenmesi, kültürü, mikroskopisi ve kültürde üreyenlere Mycobacterium tuberculosis kompleks (MTBK)-TDM ayrımı yapılmıştır. TDM üremesi saptanan hastalarda, ilgili klinisyenden görüş alınıp kontaminant/çevresel TDM olma olasılığı dışlanan izolatlar için TDM identifikasyonu ve ilaç duyarlılık testleri rehberlere uygun olarak yapılmıştır. Bulgular: Mikobakteriyoloji laboratuvarına gelen 25148 örneğin 1685 (%6.7)’inde mikobakteri üremesi tespit edilmiş ve izolatların 1487 (%88.2)’sinde MTBK, 198 (%11.8)’inde TDM üremesi saptanmıştır. Bunlardan 56 hastaya ait 56 izolat hastalık etkeni olarak değerlendirmeye alınmıştır. İzolatların %92.5’i akciğer (AC) örneklerden izole edilmiştir, hastaların yaş ortalaması 60±15.2 ve %66’sı erkek’tir. Çalışmaya dahil edilen 56 izolatın 40’ına tür tanımlaması yapılmıştır. Klinik bilgilerine erişilebilen hastaların %51.3’ünde kanser, romatoid artrit nedeniyle tümör nekroz faktör-alfa tedavisi alma, böbrek yetmezliği, böbrek nakli gibi immünsüpresif durumlar, %51.2’sinde kronik obstrüktif akciğer hastalığı, astım, kistik fibrozis gibi AC hastalıkları, %58.9’unda sigara ve alkol kullanım öyküsü, %17.9’unda diyabet, %25.6’sında hipertansiyon gibi eşlik eden hastalık öyküsü, %25.6’sında D vitamin eksikliği, %23.1’inde hemoptizi öyküsü olduğu tespit edilmiştir. Tanımlaması yapılan izolatlarda en sık tespit edilen beş tür, M. intracellulare, M. szulgai, M. kansasii, M. abscessus ve M. simiae olmuştur. Hızlı ve yavaş üreyen TDM’ler amikasin, klaritromisin, linezolid, moksifloksasine, hızlı üreyen TDM’ler sefoksitine %100 duyarlı bulunmuştur. Sonuç: Tüberküloz dışı mikobakteri enfeksiyonlarında klinik-laboratuvar iş birliği, hızlı ve doğru tanı yanında uygun tedavi rejiminin belirlenmesinde önemli katkılar sağlayacaktır. Çalışmamızda bölge TB laboratuvarı verileri analiz edilerek TDM enfeksiyonlarının epidemiyolojik, demografik özelliklerini, TDM türlerini ve ilaç duyarlılık profillerini belirleyerek hastaların tedavisinde klinisyene yol gösterecek ve literatüre katkı sağlayacak veriler elde edildiği inancındayız.

Keywords

Tüberküloz dışı mikobakteri identifikasyon epidemiyoloji ilaç direnci duyarlılık

References

  • Thangavelu K, Krishnakumariamma K, Pallam G, et al. Prevalence and speciation of non-tuberculous mycobacteria among pulmonary and extrapulmonary tuberculosis suspects in South India. Journal of Infection and Public Health. 2021;14(3):320-323.
  • Zhou L, Xu D, Liu H, et al. Trends in the prevalence and antibiotic resistance of non-tuberculous mycobacteria in Mainland China, 2000–2019: systematic review and meta-analysis. Frontiers in Public Health. 2020;8:295.
  • Matsumoto Y, Kinjo T, Motooka D, et al. Comprehensive subspecies identification of 175 nontuberculous mycobacteria species based on 7547 genomic profiles. Emerging Microbes & Infections. 2019;8(1):1043-1053.
  • Ratnatunga CN, Lutzky VP, Kupz A, et al. The rise of non-tuberculosis mycobacterial lung disease. Frontiers in immunology. 2020;11:303.
  • Saxena S, Spaink HP, Forn-Cuní G. Drug resistance in nontuberculous mycobacteria: mechanisms and models. Biology. 2021;10(2):96.
  • López-Roa P, Aznar E, Cacho J, et al. Epidemiology of Non-Tuberculous Mycobacteria isolated from clinical specimens in Madrid, Spain, from 2013 to 2017. European Journal of Clinical Microbiology & Infectious Diseases. 2020;39:1089-1094.
  • Gunaydin M, Yanik K, Eroglu C, et al. Distribution of nontuberculous mycobacteria strains. Annals of Clinical Microbiology and Antimicrobials. 2013;12(1):1-6.
  • Ulusal Mikrobiyoloji Standartları Ulusal Tüberküloz Tanı Rehberi. https://hsgm.saglik.gov.tr/depo/birimler/Mikrobiyoloji_Referans_Laboratuvarlari_ve_Biyolojik_Urunler_DB/rehberler/TuberkulozRehberi.pdf Ocak 2014’de basıldı. 22 Ağustos 2022’de erişildi.
  • Umrao J, Singh D, Zia A, et al. Prevalence and species spectrum of both pulmonary and extrapulmonary nontuberculous mycobacteria isolates at a tertiary care center. International journal of mycobacteriology. 2016;5(3):288-293.
  • Aliyu G, El-Kamary SS, Abimiku Al, et al. Prevalence of non-tuberculous mycobacterial infections among tuberculosis suspects in Nigeria. PloS one. 2013;8(5):e63170.
  • Nyamogoba H, Mbuthia G, Mining S, et al. HIV co-infection with tuberculous and non-tuberculous mycobacteria in western Kenya: challenges in the diagnosis and management. African health sciences. 2012;12(3):305-311.
  • Vande Weygaerde Y, Cardinaels N, Bomans P, et al. Clinical relevance of pulmonary non-tuberculous mycobacterial isolates in three reference centres in Belgium: a multicentre retrospective analysis. BMC Infectious Diseases. 2019;19:1-10.
  • Baek H-G. Study on the prevalence of lung disease of non-tuberculosis mycobacterium isolated from respiratory specimens in Gwangju Second Hospital over the last 10 years. Korean Journal of Clinical Laboratory Science. 2020;52(4):349-355.
  • Özen N, ATİK TK, DURAN AÇ. Klinik Örneklerden İzole Edilen Mycobacterium tuberculosis Kültür ve İlaç Duyarlılık Test Sonuçlarının Analizi ve Tüberküloz Dışı Mikobakterilerin Dağılımının İncelenmesi. Mikrobiyol Bul. 2020;54(4):559-574.
  • Özçolpan OO, Sürücüoğlu S, Özkütük N, et al. Distribution of nontuberculous mycobacteria isolated from clinical specimens and identified with DNA sequence analysis. Mikrobiyoloji Bulteni. 2015;49(4):484-493.
  • Park Y, Kim CY, Park MS, et al. Age-and sex-related characteristics of the increasing trend of nontuberculous mycobacteria pulmonary disease in a tertiary hospital in South Korea from 2006 to 2016. The Korean Journal of Internal Medicine. 2020;35(6):1424.
  • Prevots DR, Shaw PA, Strickland D, et al. Nontuberculous mycobacterial lung disease prevalence at four integrated health care delivery systems. American journal of respiratory and critical care medicine. 2010;182(7):970-976.
  • Koh W-J, Kwon OJ, Lee KS. Nontuberculous mycobacterial pulmonary diseases in immunocompetent patients. Korean Journal of Radiology. 2002;3(3):145-157.
  • Nishiuchi Y, Iwamoto T, Maruyama F. Infection sources of a common non-tuberculous mycobacterial pathogen, Mycobacterium avium complex. Frontiers in medicine. 2017;4:27.
  • Velayati AA, Rahideh S, Nezhad ZD, et al. Nontuberculous mycobacteria in Middle East: Current situation and future challenges. International journal of mycobacteriology. 2015;4(1):7-17.
  • Winthrop KL, McNelley E, Kendall B, et al. Pulmonary nontuberculous mycobacterial disease prevalence and clinical features: an emerging public health disease. American journal of respiratory and critical care medicine. 2010;182(7):977-982.
  • Van der Werf MJ, Ködmön C, Katalinić-Janković V, et al. Inventory study of non-tuberculous mycobacteria in the European Union. BMC infectious diseases. 2014;14(1):1-9.
  • Dovriki E, Gerogianni I, Petinaki E, et al. Isolation and identification of nontuberculous mycobacteria from hospitalized patients and drinking water samples—examination of their correlation by chemometrics. Environmental monitoring and assessment. 2016;188:1-15.
  • Albayrak N, Simşek H, Sezen F, et al. Ulusal Tüberküloz Referans Laboratuvarında 2009-2010 yıllarında tesbit edilen tüberküloz dışı mikobakterilerin dağılımlarının irdelenmesi. Mikrobiyol Bul. 2012;46(4):560-567.
  • Bayram G, Emekdaş G. Mikobakteri Türlerinin İdentifikasyonunda Polimeraz Zincir Reaksiyonu-Parça Uzunluk Polimorfizmi Tekniği ile Klasik Yöntemler Arasındaki Uyumun Belirlenmesi. Mersin Üniversitesi Sağlık Bilimleri Dergisi. 2008;1(3):8-13.
  • Kim SH, Jhun BW, Jeong B-H, et al. The Higher Incidence of COVID-19 in Patients With Non-Tuberculous Mycobacterial Pulmonary Disease: A Single Center Experience in Korea. Journal of Korean Medical Science. 2022;37(32).
  • Aghajani J, Farnia P, Farnia P, et al. Effect of COVID-19 pandemic on incidence of mycobacterial diseases among suspected tuberculosis pulmonary patients in Tehran, Iran. International Journal of Mycobacteriology. 2022;11(4):415.
  • Koh W-J. Nontuberculous mycobacteria—overview. Microbiology spectrum. 2017;5(1):5.1. 11.
  • Jabbour J-F, Hamieh A, Sharara SL, et al. Mycobacterium simiae: harmless colonizer or deadly pathogen? PLoS pathogens. 2020;16(4):e1008418.
  • Chang H-Y, Tsai W-C, Lee T-F, et al. Mycobacterium gordonae infection in immunocompromised and immunocompetent hosts: a series of seven cases and literature review. Journal of the Formosan Medical Association. 2021;120(1):524-532.
  • Johnston JC, Chiang L, Elwood K. Mycobacterium kansasii. Tuberculosis and Nontuberculous Mycobacterial Infections. 2017:725-734.
  • Cook JL. Nontuberculous mycobacteria: opportunistic environmental pathogens for predisposed hosts. British medical bulletin. 2010;96(1):45-59.
  • Jeon K, Kim SY, Jeong BH, et al. Severe vitamin D deficiency is associated with non‐tuberculous mycobacterial lung disease: a case‐control study. Respirology. 2013;18(6):983-988.
  • Rao S. Serum cholesterol, HDL, LDL levels in pulmonary tuberculosis: A clinico-radiological correlation and implications. Infectious Diseases in Clinical Practice. 2009;17(2):99-101.
  • Hong JY, Yang GE, Ko Y, et al. Changes in cholesterol level correlate with the course of pulmonary nontuberculous mycobacterial disease. Journal of Thoracic Disease. 2016;8(10):2885.
  • Abakay Ö, Şen HS. Tüberküloz dışı mikobakterilere bağlı AC hastalıkları. Journal of Clinical and Experimental Investigations. 2013;4(2):252-257.
  • Pennington KM, Vu A, Challener D, et al. Approach to the diagnosis and treatment of non-tuberculous mycobacterial disease. Journal of Clinical Tuberculosis and Other Mycobacterial Diseases. 2021;24:100244.
  • Wayne PA. Clinical and Laboratory Standards Institute. Susceptibility testing of mycobacteria Ns, and other aerobic actinomycetes, 3rd ed, CLSI standard document M24: USA: Clinical and Laboratory Standards Institute; 2018.
  • Kwak N, Dalcolmo MP, Daley CL, et al. Mycobacterium abscessus pulmonary disease: individual patient data meta-analysis. European Respiratory Journal. 2019;54(1).
  • Wang SQ JG, Wei GM, et al. Antimicrobial susceptibility and genotyping of Mycobacterium intracellulare. Zhonghua Jie He He Hu Xi Za Zhi. Chinese journal of tuberculosis and respiratory diseases. 2018;41(7):539-54.

Non- tuberculous mycobacteria infections in our region: Only the tip of the ıceberg

Year 2023, Volume: 16 Issue: 3, 406 - 419, 18.12.2023

Leyla Ersoy Kevser Elçi Taylan Bozok Eylem Sercan Özgür Ahmet Arslantürk Gönül Aslan

Abstract

Aim: Immunosuppressive treatment regimens, prolongation of life expectancy, increase in diseases such as AIDS, difficulties in the treatment of infections caused by non-tuberculous mycobacteria (NTM) and the fact that NTMs, known as opportunistic pathogens, can also be effective in healthy people have made NTM an important source of infection all over the world. This study aimed to evaluate the demographic characteristics of the patients retrospectively whose clinical specimens were isolated from NTM, the infectious agent NTM types and drug susceptibility profiles in the mycobacteriology laboratory between the years 2015-2022. Method: In the mycobacteriology unit of the Medical Microbiology laboratory of Mersin University Hospital, samples with suspected tuberculosis (TB) were processed, cultured, microscopy and Mycobacterium tuberculosis complex (MTBK)-NTM distinction was made. In patients with detected NTM growth, NTM identification and drug susceptibility tests were performed in accordance with the guidelines for the isolates, whose possibility of contaminant/environmental NTM was excluded after obtaining the opinion of the relevant clinician. Results: Mycobacteria growth was detected in 1685 (6.7%) of 25148 samples that were sent to the mycobacteriology laboratory, and MTBK growth was found in 1487 (88.2%) of the isolates, and TDM growth was found in 198 (11.8%) of the isolates. Of these, 56 isolates from 56 patients were evaluated as disease agents. 92.5% of the isolates were isolated from pulmonary samples, the mean age of the patients was 60±15.2 years, and 66% were male. Species identification was made for 40 of the 56 isolates included in the study. Of the patients whose clinical information could be accessed, 51.3% had cancer, tumour necrosis factor alpha therapy for rheumatoid arthritis, immunosuppressive conditions such as kidney failure, kidney transplantation, 51.2% had lung diseases such as COPD, asthma, hypertension cystic fibrosis, 58.9% had a history of smoking and alcohol use, 17.9% had diabetes, 25.6% had a history of concomitant diseases such as, 25.6% had vitamin D deficiency, and 23.1% had hemoptysis. The five most frequently detected species in the isolates identified were M. intracellulare, M. szulgai, M. kansasii, M. abscessus and M. simiae. Fast and slow growing NTMs were found 100% sensitive to amikacin, clarithromycin, linezolid, moxifloxacin, and fast growing NTMs were 100% sensitive to cefoxitin. Conclusion: Clinic-laboratory cooperation in NTM infections will make important contributions to rapid and accurate diagnosis as well as determining the appropriate treatment regimen. We believe that by analyzing the regional TB laboratory data in our study, we obtained data that will guide the clinician in the treatment of patients and contribute to the literature by determining the epidemiological and demographic characteristics, NTM species and drug susceptibility profiles of NTM infections.

Keywords

Non-tuberculosis mycobacteria identification epidemiology drug resistance susceptibility

References

  • Thangavelu K, Krishnakumariamma K, Pallam G, et al. Prevalence and speciation of non-tuberculous mycobacteria among pulmonary and extrapulmonary tuberculosis suspects in South India. Journal of Infection and Public Health. 2021;14(3):320-323.
  • Zhou L, Xu D, Liu H, et al. Trends in the prevalence and antibiotic resistance of non-tuberculous mycobacteria in Mainland China, 2000–2019: systematic review and meta-analysis. Frontiers in Public Health. 2020;8:295.
  • Matsumoto Y, Kinjo T, Motooka D, et al. Comprehensive subspecies identification of 175 nontuberculous mycobacteria species based on 7547 genomic profiles. Emerging Microbes & Infections. 2019;8(1):1043-1053.
  • Ratnatunga CN, Lutzky VP, Kupz A, et al. The rise of non-tuberculosis mycobacterial lung disease. Frontiers in immunology. 2020;11:303.
  • Saxena S, Spaink HP, Forn-Cuní G. Drug resistance in nontuberculous mycobacteria: mechanisms and models. Biology. 2021;10(2):96.
  • López-Roa P, Aznar E, Cacho J, et al. Epidemiology of Non-Tuberculous Mycobacteria isolated from clinical specimens in Madrid, Spain, from 2013 to 2017. European Journal of Clinical Microbiology & Infectious Diseases. 2020;39:1089-1094.
  • Gunaydin M, Yanik K, Eroglu C, et al. Distribution of nontuberculous mycobacteria strains. Annals of Clinical Microbiology and Antimicrobials. 2013;12(1):1-6.
  • Ulusal Mikrobiyoloji Standartları Ulusal Tüberküloz Tanı Rehberi. https://hsgm.saglik.gov.tr/depo/birimler/Mikrobiyoloji_Referans_Laboratuvarlari_ve_Biyolojik_Urunler_DB/rehberler/TuberkulozRehberi.pdf Ocak 2014’de basıldı. 22 Ağustos 2022’de erişildi.
  • Umrao J, Singh D, Zia A, et al. Prevalence and species spectrum of both pulmonary and extrapulmonary nontuberculous mycobacteria isolates at a tertiary care center. International journal of mycobacteriology. 2016;5(3):288-293.
  • Aliyu G, El-Kamary SS, Abimiku Al, et al. Prevalence of non-tuberculous mycobacterial infections among tuberculosis suspects in Nigeria. PloS one. 2013;8(5):e63170.
  • Nyamogoba H, Mbuthia G, Mining S, et al. HIV co-infection with tuberculous and non-tuberculous mycobacteria in western Kenya: challenges in the diagnosis and management. African health sciences. 2012;12(3):305-311.
  • Vande Weygaerde Y, Cardinaels N, Bomans P, et al. Clinical relevance of pulmonary non-tuberculous mycobacterial isolates in three reference centres in Belgium: a multicentre retrospective analysis. BMC Infectious Diseases. 2019;19:1-10.
  • Baek H-G. Study on the prevalence of lung disease of non-tuberculosis mycobacterium isolated from respiratory specimens in Gwangju Second Hospital over the last 10 years. Korean Journal of Clinical Laboratory Science. 2020;52(4):349-355.
  • Özen N, ATİK TK, DURAN AÇ. Klinik Örneklerden İzole Edilen Mycobacterium tuberculosis Kültür ve İlaç Duyarlılık Test Sonuçlarının Analizi ve Tüberküloz Dışı Mikobakterilerin Dağılımının İncelenmesi. Mikrobiyol Bul. 2020;54(4):559-574.
  • Özçolpan OO, Sürücüoğlu S, Özkütük N, et al. Distribution of nontuberculous mycobacteria isolated from clinical specimens and identified with DNA sequence analysis. Mikrobiyoloji Bulteni. 2015;49(4):484-493.
  • Park Y, Kim CY, Park MS, et al. Age-and sex-related characteristics of the increasing trend of nontuberculous mycobacteria pulmonary disease in a tertiary hospital in South Korea from 2006 to 2016. The Korean Journal of Internal Medicine. 2020;35(6):1424.
  • Prevots DR, Shaw PA, Strickland D, et al. Nontuberculous mycobacterial lung disease prevalence at four integrated health care delivery systems. American journal of respiratory and critical care medicine. 2010;182(7):970-976.
  • Koh W-J, Kwon OJ, Lee KS. Nontuberculous mycobacterial pulmonary diseases in immunocompetent patients. Korean Journal of Radiology. 2002;3(3):145-157.
  • Nishiuchi Y, Iwamoto T, Maruyama F. Infection sources of a common non-tuberculous mycobacterial pathogen, Mycobacterium avium complex. Frontiers in medicine. 2017;4:27.
  • Velayati AA, Rahideh S, Nezhad ZD, et al. Nontuberculous mycobacteria in Middle East: Current situation and future challenges. International journal of mycobacteriology. 2015;4(1):7-17.
  • Winthrop KL, McNelley E, Kendall B, et al. Pulmonary nontuberculous mycobacterial disease prevalence and clinical features: an emerging public health disease. American journal of respiratory and critical care medicine. 2010;182(7):977-982.
  • Van der Werf MJ, Ködmön C, Katalinić-Janković V, et al. Inventory study of non-tuberculous mycobacteria in the European Union. BMC infectious diseases. 2014;14(1):1-9.
  • Dovriki E, Gerogianni I, Petinaki E, et al. Isolation and identification of nontuberculous mycobacteria from hospitalized patients and drinking water samples—examination of their correlation by chemometrics. Environmental monitoring and assessment. 2016;188:1-15.
  • Albayrak N, Simşek H, Sezen F, et al. Ulusal Tüberküloz Referans Laboratuvarında 2009-2010 yıllarında tesbit edilen tüberküloz dışı mikobakterilerin dağılımlarının irdelenmesi. Mikrobiyol Bul. 2012;46(4):560-567.
  • Bayram G, Emekdaş G. Mikobakteri Türlerinin İdentifikasyonunda Polimeraz Zincir Reaksiyonu-Parça Uzunluk Polimorfizmi Tekniği ile Klasik Yöntemler Arasındaki Uyumun Belirlenmesi. Mersin Üniversitesi Sağlık Bilimleri Dergisi. 2008;1(3):8-13.
  • Kim SH, Jhun BW, Jeong B-H, et al. The Higher Incidence of COVID-19 in Patients With Non-Tuberculous Mycobacterial Pulmonary Disease: A Single Center Experience in Korea. Journal of Korean Medical Science. 2022;37(32).
  • Aghajani J, Farnia P, Farnia P, et al. Effect of COVID-19 pandemic on incidence of mycobacterial diseases among suspected tuberculosis pulmonary patients in Tehran, Iran. International Journal of Mycobacteriology. 2022;11(4):415.
  • Koh W-J. Nontuberculous mycobacteria—overview. Microbiology spectrum. 2017;5(1):5.1. 11.
  • Jabbour J-F, Hamieh A, Sharara SL, et al. Mycobacterium simiae: harmless colonizer or deadly pathogen? PLoS pathogens. 2020;16(4):e1008418.
  • Chang H-Y, Tsai W-C, Lee T-F, et al. Mycobacterium gordonae infection in immunocompromised and immunocompetent hosts: a series of seven cases and literature review. Journal of the Formosan Medical Association. 2021;120(1):524-532.
  • Johnston JC, Chiang L, Elwood K. Mycobacterium kansasii. Tuberculosis and Nontuberculous Mycobacterial Infections. 2017:725-734.
  • Cook JL. Nontuberculous mycobacteria: opportunistic environmental pathogens for predisposed hosts. British medical bulletin. 2010;96(1):45-59.
  • Jeon K, Kim SY, Jeong BH, et al. Severe vitamin D deficiency is associated with non‐tuberculous mycobacterial lung disease: a case‐control study. Respirology. 2013;18(6):983-988.
  • Rao S. Serum cholesterol, HDL, LDL levels in pulmonary tuberculosis: A clinico-radiological correlation and implications. Infectious Diseases in Clinical Practice. 2009;17(2):99-101.
  • Hong JY, Yang GE, Ko Y, et al. Changes in cholesterol level correlate with the course of pulmonary nontuberculous mycobacterial disease. Journal of Thoracic Disease. 2016;8(10):2885.
  • Abakay Ö, Şen HS. Tüberküloz dışı mikobakterilere bağlı AC hastalıkları. Journal of Clinical and Experimental Investigations. 2013;4(2):252-257.
  • Pennington KM, Vu A, Challener D, et al. Approach to the diagnosis and treatment of non-tuberculous mycobacterial disease. Journal of Clinical Tuberculosis and Other Mycobacterial Diseases. 2021;24:100244.
  • Wayne PA. Clinical and Laboratory Standards Institute. Susceptibility testing of mycobacteria Ns, and other aerobic actinomycetes, 3rd ed, CLSI standard document M24: USA: Clinical and Laboratory Standards Institute; 2018.
  • Kwak N, Dalcolmo MP, Daley CL, et al. Mycobacterium abscessus pulmonary disease: individual patient data meta-analysis. European Respiratory Journal. 2019;54(1).
  • Wang SQ JG, Wei GM, et al. Antimicrobial susceptibility and genotyping of Mycobacterium intracellulare. Zhonghua Jie He He Hu Xi Za Zhi. Chinese journal of tuberculosis and respiratory diseases. 2018;41(7):539-54.
There are 40 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Articles
Authors

Leyla Ersoy 0000-0002-9528-7766

Kevser Elçi This is me 0000-0002-2709-302X

Taylan Bozok 0000-0002-7094-4838

Eylem Sercan Özgür 0000-0003-4459-232X

Ahmet Arslantürk This is me 0000-0001-5738-1439

Gönül Aslan 0000-0002-1221-7907

Early Pub Date December 5, 2023
Publication Date December 18, 2023
Submission Date November 9, 2022
Acceptance Date March 29, 2023
Published in Issue Year 2023 Volume: 16 Issue: 3

Cite

APA Ersoy, L., Elçi, K., Bozok, T., Özgür, E. S., et al. (2023). Bölgemizdeki tüberküloz dışı mikobakteri enfeksiyonları: Buzdağının sadece görünen yüzü. Mersin Üniversitesi Sağlık Bilimleri Dergisi, 16(3), 406-419.
AMA Ersoy L, Elçi K, Bozok T, Özgür ES, Arslantürk A, Aslan G. Bölgemizdeki tüberküloz dışı mikobakteri enfeksiyonları: Buzdağının sadece görünen yüzü. Mersin Univ Saglık Bilim derg. December 2023;16(3):406-419.
Chicago Ersoy, Leyla, Kevser Elçi, Taylan Bozok, Eylem Sercan Özgür, Ahmet Arslantürk, and Gönül Aslan. “Bölgemizdeki tüberküloz dışı Mikobakteri enfeksiyonları: Buzdağının Sadece görünen yüzü”. Mersin Üniversitesi Sağlık Bilimleri Dergisi 16, no. 3 (December 2023): 406-19.
EndNote Ersoy L, Elçi K, Bozok T, Özgür ES, Arslantürk A, Aslan G (December 1, 2023) Bölgemizdeki tüberküloz dışı mikobakteri enfeksiyonları: Buzdağının sadece görünen yüzü. Mersin Üniversitesi Sağlık Bilimleri Dergisi 16 3 406–419.
IEEE L. Ersoy, K. Elçi, T. Bozok, E. S. Özgür, A. Arslantürk, and G. Aslan, “Bölgemizdeki tüberküloz dışı mikobakteri enfeksiyonları: Buzdağının sadece görünen yüzü”, Mersin Univ Saglık Bilim derg, vol. 16, no. 3, pp. 406–419, 2023.
ISNAD Ersoy, Leyla et al. “Bölgemizdeki tüberküloz dışı Mikobakteri enfeksiyonları: Buzdağının Sadece görünen yüzü”. Mersin Üniversitesi Sağlık Bilimleri Dergisi 16/3 (December 2023), 406-419.
JAMA Ersoy L, Elçi K, Bozok T, Özgür ES, Arslantürk A, Aslan G. Bölgemizdeki tüberküloz dışı mikobakteri enfeksiyonları: Buzdağının sadece görünen yüzü. Mersin Univ Saglık Bilim derg. 2023;16:406–419.
MLA Ersoy, Leyla et al. “Bölgemizdeki tüberküloz dışı Mikobakteri enfeksiyonları: Buzdağının Sadece görünen yüzü”. Mersin Üniversitesi Sağlık Bilimleri Dergisi, vol. 16, no. 3, 2023, pp. 406-19.
Vancouver Ersoy L, Elçi K, Bozok T, Özgür ES, Arslantürk A, Aslan G. Bölgemizdeki tüberküloz dışı mikobakteri enfeksiyonları: Buzdağının sadece görünen yüzü. Mersin Univ Saglık Bilim derg. 2023;16(3):406-19.
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MEU Journal of Health Sciences Assoc was began to the publishing process in 2008 under the supervision of Assoc. Prof. Gönül Aslan, Editor-in-Chief, and affiliated to Mersin University Institute of Health Sciences. In March 2015, Prof. Dr. Caferi Tayyar Şaşmaz undertook the Editor-in Chief position and since then he has been in charge.

Publishing in three issues per year (April - August - December), it is a multisectoral refereed scientific journal. In addition to research articles, scientific articles such as reviews, case reports and letters to the editor are published in the journal. Our journal, which has been published via e-mail since its inception, has been published both online and in print. Following the Participation Agreement signed with TÜBİTAK-ULAKBİM Dergi Park in April 2015, it has started to accept and evaluate online publications.

Mersin University Journal of Health Sciences have been indexed by Turkey Citation Index since November 16, 2011.

Mersin University Journal of Health Sciences have been indexed by ULAKBIM Medical Database from the first issue of 2016.

Mersin University Journal of Health Sciences have been indexed by DOAJ since October 02, 2019.

Article Publishing Charge Policy: Our journal has adopted an open access policy and there is no fee for article application, evaluation, and publication in our journal. All the articles published in our journal can be accessed from the Archive free of charge.

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