Are phylogenetic position, virulence, drug susceptibility and in vivo response to treatment in mycobacteria interrelated?
Phylogenetic analyses on the basis of multiple house-keeping genes and whole genome sequences have offered new insights in the phylogeny of the genus Mycobacterium. This genus yields obligate pathogens, the M. tuberculosis complex and M. leprae, as well as opportunistic pathogens (e.g. M. avium, M. intracellulare, M. kansasii, M. marinum, M. malmoense) and saprophytes (e.g. M. phlei, M. sphagni, M. gordonae). The most virulent mycobacteria, the M. tuberculosis complex, M. leprae and the M. kansasii-M. szulgai-M. marinum-M. ulcerans group are phylogenetically related and infections by these organisms are better treatable than those caused by less virulent and phylogenetically more distantly related Mycobacterium species. The most virulent Mycobacterium species are also characterized by high levels of natural drug susceptibility. In this paper, we review studies of phylogeny, drug susceptibility, and clinical significance to support our hypothesis that drug susceptibility in mycobacteria is acquired and reflects the low level of competition in -and adaptation to- a closer-to-human (environmental) niche. In turn, mycobacteria that inhabit the most competitive environmental niches are the least adapted to humans, thus of low clinical significance, but most tolerant to antibiotics derived from microbes with which they share their habitat, lowering the chances of cure in case of infection.
Department of Clinical Microbiology, Radboud University Nijmegen Medical Center, P.O. BOX 9101, 6500 HB Nijmegen, The Netherlands. j.vaningen@mmb.umcn.nl
Jakko
J
van Ingen
Martin J
MJ
Boeree
Dick
D
van Soolingen
Michael D
MD
Iseman
Leonid B
LB
Heifets
Charles L
CL
Daley
D000995:Antitubercular Agents / Q000627:therapeutic use*; D006801:Humans; D009161:Mycobacterium / Q000145:classification / Q000235:genetics* / Q000472:pathogenicity*; D009164:Mycobacterium Infections / Q000188:drug therapy*; D010802:Phylogeny; D016896:Treatment Outcome; D014774:Virulence / Q000235:genetics
D000995:Antitubercular Agents