title: Emergence of Rare Species of Nontuberculous Mycobacteria as Potential Pathogens in Saudi Arabian Clinical Setting.
abstract: Clinical relevance of nontuberculous mycobacteria (NTM) is increasing worldwide including in Saudi Arabia. A high species diversity of NTM's has been noticed in a recent study. However, the identification in diagnostic laboratories is mostly limited to common species. The impact of NTM species diversity on clinical outcome is so far neglected in most of the clinical settings.
  
  
  
  During April 2014 to September 2015, a nationwide collection of suspected NTM clinical isolates with clinical and demographical data were carried out. Primary identification was performed by commercial line probe assays. Isolates identified up to Mycobacterium species level by line probe assays only were included and subjected to sequencing of 16S rRNA, rpoB, hsp65 and 16S-23S ITS region genes. The sequence data were subjected to BLAST analysis in GenBank and Ez-Taxon databases. Male Saudi nationals were dominated in the study population and falling majorly into the 46-59 years age group. Pulmonary cases were 59.3% with a surprising clinical relevance of 75% based on American Thoracic Society guidelines. Among the 40.7% extra-pulmonary cases, 50% of them were skin infections. The identification revealed 16 species and all of them are reporting for the first time in Saudi Arabia. The major species obtained were Mycobacterium monascence (18.5%), M. cosmeticum (11.1%), M. kubicae (11.1%), M. duvalli (7.4%), M.terrae (7.4%) and M. triplex (7.4%). This is the first report on clinical relevance of M. kubicae, M. tusciae, M.yongonense, M. arupense and M.iranicum causing pulmonary disease and M. monascence, M. duvalli, M. perigrinum, M. insubricum, M. holsaticum and M. kyorinense causing various extra-pulmonary diseases in Saudi Arabia. Ascites caused by M. monascence and cecum infection by M. holsaticum were the rarest incidents.
  
  
  
  To the first time in the country, clinical significance of various rare NTM's are well explored and the finding warrants a new threat to the Saudi Arabian clinical settings.
authors.affiliation: Department of Infection and Immunity, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
authors.forename: Bright
authors.initials: B
authors.lastname: Varghese
authors.affiliation: Medical Specialties Department, King Fahad Medical City, Riyadh, Saudi Arabia.
authors.forename: Mushira
authors.initials: M
authors.lastname: Enani
authors.affiliation: National Biotechnology Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Shoukri
authors.affiliation: Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and research Centre, Riyadh, Saudi Arabia.
authors.forename: Sahar
authors.initials: S
authors.lastname: AlThawadi
authors.affiliation: Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
authors.forename: Sameera
authors.initials: S
authors.lastname: AlJohani
authors.affiliation: Department of Infection and Immunity, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
authors.forename: Sahal
authors.initials: S
authors.lastname: Al-Hajoj
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000453:epidemiology / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D009165:Mycobacterium Infections, Nontuberculous / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology*; D009170:Nontuberculous Mycobacteria / Q000235:genetics* / Q000302:isolation & purification*; D012529:Saudi Arabia / Q000453:epidemiology; D017422:Sequence Analysis, DNA / Q000379:methods; D012737:Sex Factors; D017192:Skin Diseases, Bacterial / Q000453:epidemiology / Q000382:microbiology