Longitudinal non-cystic fibrosis trends of pulmonary Mycobacterium abscessus disease from 2010 to 2017: spread of the "globally successful clone" in Asia

Aristine Cheng; Hsin-Yun Sun; Yi-Tzu Tsai; Po-Liang Lu; Susan Shin-Jung Lee; Yi-Tzu Lee; Yung-Chih Wang; Po-Yu Liu; Jung-Yien Chien; Po-Ren Hsueh; Shu-Yuan Chang; Un-In Wu; Wang-Huei Sheng; Yee-Chun Chen; Shan-Chwen Chang

doi:10.1183/23120541.00191-2020

Longitudinal non-cystic fibrosis trends of pulmonary Mycobacterium abscessus disease from 2010 to 2017: spread of the "globally successful clone" in Asia

ERJ Open Res. 2021 Jan 18;7(1):00191-2020. doi: 10.1183/23120541.00191-2020. eCollection 2021 Jan.

Authors

Aristine Cheng^{1

2}, Hsin-Yun Sun^{1

2}, Yi-Tzu Tsai¹, Po-Liang Lu^{3

4}, Susan Shin-Jung Lee⁵, Yi-Tzu Lee^{6

7}, Yung-Chih Wang⁸, Po-Yu Liu⁹, Jung-Yien Chien^{1

2}, Po-Ren Hsueh^{1

2

10}, Shu-Yuan Chang¹, Un-In Wu^{1

2}, Wang-Huei Sheng^{1

2}, Yee-Chun Chen^{1

2}, Shan-Chwen Chang^{1

2}

Affiliations

¹ Dept of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
² College of Medicine, National Taiwan University, Taipei, Taiwan.
³ Dept of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
⁴ Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁵ Dept of Internal Medicine, Dept of Pathology and Laboratory, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
⁶ Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
⁷ Dept of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
⁸ Dept of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
⁹ Dept of Internal Medicine, Taichung, Veterans General Hospital, Taichung, Taiwan.
¹⁰ Dept of Laboratory Medicine, National Taiwan University Hospital, Taiwan.

Abstract

Background: Mycobacterium abscessus (MAB) has emerged as the predominant pulmonary non-tuberculous mycobacterial pathogen in parts of Asia, including Taiwan. The reasons for the significant increase in MAB infections in the non-cystic fibrosis (CF) populations are poorly understood. The study aimed to elucidate whether this increase is related to the spread of the globally successful clone of MAB.

Methods: We performed multilocus sequence typing of 371 nonduplicated MAB pulmonary isolates from 371 patients sampled between 2010-2017 at seven hospitals across Taiwan.

Results: In total, 183 (49.3%) isolates were M. abscessus subsp. abscessus (MAB-a), 187 (50.4%) were M. abscessus subsp. massiliense (MAB-m), and 1 (0.3%) was M. abscessus subsp. bolletii (MAB-b). MAB-a sequence type (ST)1 (23.7%) and ST127 (3.8%), followed by MAB-m ST48 (16.2%), ST117 (15.1%), ST23 (8.6%) were most common overall. Of MAB-a strains, 50 (27.3%) belonged to novel STs and 38 (10.2%) were singleton strains, while of MAB-m strains, only 10 (5.3%) were novel and 8 (2.2%) were singletons. From 2010 to 2017, the frequency of the historically dominant ST1 declined from 28.6% to 22.5%, whereas the recently emerged globally successful clonal cluster 3, ST23 and ST48, increased from 14.3% to 40.0%.

Conclusions: The dominance of ST1 particularly in the last 2 years of this study appears to be declining, while ST23, reported in outbreaks among CF and post-surgical cohorts across the Americas and Europe, alongside the closely related ST48, is present among non-CF populations in Taiwan. These trends need to be confirmed with further ongoing studies to track the molecular epidemiology of clinical MAB isolates worldwide.