title: Clinical Relevance of Nontuberculous Mycobacteria Isolated from Sputum in a Gold Mining Workforce in South Africa: An Observational, Clinical Study.
abstract: BACKGROUND
  The clinical relevance of nontuberculous mycobacteria (NTM), detected by liquid more than solid culture in sputum specimens from a South African mining workforce, is uncertain. We aimed to describe the current spectrum and relevance of NTM in this population.
  
  
  METHODS
  An observational study including individuals with sputum NTM isolates, recruited at workforce tuberculosis screening and routine clinics. Symptom questionnaires were administered at the time of sputum collection and clinical records and chest radiographs reviewed retrospectively.
  
  
  RESULTS
  Of 232 individuals included (228 (98%) male, median age 44 years), M. gordonae (60 individuals), M. kansasii (50), and M. avium complex (MAC: 38) were the commonest species. Of 38 MAC isolates, only 2 (5.3%) were from smear-positive sputum specimens and 30/38 grew in liquid but not solid culture. MAC was especially prevalent among symptomatic, HIV-positive individuals. HIV prevalence was high: 57/74 (77%) among those tested. No differences were found in probability of death or medical separation by NTM species.
  
  
  CONCLUSIONS
  M. gordonae, M. kansasii, and MAC were the commonest NTM among miners with suspected tuberculosis, with most MAC from smear-negative specimens in liquid culture only. HIV testing and identification of key pathogenic NTM in this setting are essential to ensure optimal treatment.
authors.affiliation: London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
authors.forename: Clare L
authors.initials: CL
authors.lastname: van Halsema
authors.affiliation: The Aurum Institute, Postnet Suite No. 300, Private Bag X30500, Houghton, Johannesburg 2041, South Africa.
authors.forename: Violet N
authors.initials: VN
authors.lastname: Chihota
authors.affiliation: DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, MRC Centre for Molecular and Cellular Biology, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Private Bag X1, Matieland, Cape Town 7602, South Africa.
authors.forename: Nicolaas C
authors.initials: NC
authors.lastname: Gey van Pittius
authors.affiliation: London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Fielding
authors.affiliation: London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
authors.forename: James J
authors.initials: JJ
authors.lastname: Lewis
authors.affiliation: DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, MRC Centre for Molecular and Cellular Biology, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Private Bag X1, Matieland, Cape Town 7602, South Africa.
authors.forename: Paul D
authors.initials: PD
authors.lastname: van Helden
authors.affiliation: London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK ; The Aurum Institute, Postnet Suite No. 300, Private Bag X30500, Houghton, Johannesburg 2041, South Africa ; School of Public Health, University of Witwatersrand, Private Bag 3, Wits 2050, South Africa.
authors.forename: Gavin J
authors.initials: GJ
authors.lastname: Churchyard
authors.affiliation: London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
authors.forename: Alison D
authors.initials: AD
authors.lastname: Grant
mesh_terms: D000328:Adult; D006801:Humans; D008297:Male; D008875:Middle Aged; D006046:Gold; D015658:HIV Infections / Q000453:epidemiology / Q000382:microbiology; D000067572:Miners; D008906:Mining; D009165:Mycobacterium Infections, Nontuberculous / Q000453:epidemiology / Q000382:microbiology; D009170:Nontuberculous Mycobacteria / Q000302:isolation & purification; D015995:Prevalence; D013021:South Australia / Q000453:epidemiology; D013183:Sputum / Q000382:microbiology
chemical_list: D006046:Gold