Mycobacterium simiae is an emerging and spreading pathogen in Iran and little data about its drug susceptibility test (DST) and no standard treatment regimen are available. We report a case of multidrug-resistant M. simiae respiratory infection in a 65-year-old woman with a history of previous Mycobacterium tuberculosis infection. The patient was treated with clarithromycin, levofloxacin, and cotrimoxazole for one year and eventually died while still suffering from respiratory problems. For DST, broth microdilution method was used according to the Clinical and Laboratory Standards Institute guidelines as well as molecular DST in clinical isolate. Mycobacterium simiae was resistant to streptomycin, moxifloxacin, clarithromycin, and cotrimoxazole antibiotics and was sensitive to clofazimine and amikacin antibiotics. Inappropriate use of antibiotics without determining the pattern of antibiotic resistance increases the likelihood of resistance and, for resistant specimens, the need to review the treatment protocol and replace antibiotics. Effectiveness based on antibiotic resistance pattern is essential.

Incidence of Mycobacterium simiae pulmonary infection is increasing and diagnosis and treatment are challenging. We surveyed the clinical features, risk factors, diagnosis, and management in 20 patients from northeastern Iran diagnosed by line probe assay and confirmed by sequencing the ITS ( 16S‐23S ) rRNA region and carried out a literature review using the keywords “pulmonary infection” and “ Mycobacterium simiae .” The mean age of patients was 55.1 years, with 80% female and 90% diagnosed by sputum. Clinical symptoms included severe cough (90%), sputum production (70%), haemoptysis (50%), and chest pain (35%). Comorbidities included a history of tuberculosis (60%), smoking (40%), or chronic obstructive pulmonary disease (20%). Patients were treated with levofloxacin, clarithromycin, and co‐trimoxazole. Except for two patients, the clinical symptoms improved. Mycobacterium simiae pulmonary infection is increasing in people with underlying diseases. Although choosing the most appropriate treatment remains a challenge, combining successful treatments could be useful in treating these patients.

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Background: Mycobacterium tuberculosis is an infectious agent responsible for major health problems and a large number of mortalities. The prevalence of Mycobacterium tuberculosis infection varies across countries. Knowing the infection prevalence can aid in improving public health and reduce the associated costs. The aim of this study was to determine the prevalence of tuberculosis (TB) infection in suspected cases in Mashhad, Iran.Methods: All the clinical specimens suspected of TB infection were sent to a laboratory for diagnosis during -March 2017 to March 2018. The samples were analyzed microscopically using Ziehl–Neelsen staining, by polymerase chain reaction (PCR) to identify the Mycobacterium tuberculosis species using IS6110 primers, and the samples were also grown on Lowenstein–Jensen medium.Results: Of 2,755 clinical samples analyzed, 153 (5.55%) were identified as Mycobacterium tuberculosis-positive, of which 54.9% originated from females and 45.1% from males. The highest rate of infection was observed in spring, especially in May (15%). Most TB cases were found in patients in VIP (43.1%), thorax (17%), and internal (15%) wards. TB infection was mostly detected in bronchial tube (70%) and sputum (23.5%) samples. The most common positive smear was 1+ (36%). Of the 153 cases, (147) 96.1% were culture –positive and 2% were PCR-negative also 84.3% were smear –positive.Conclusion: The highest rate of infection occurred in spring, when the number of religious tourists entering the city was at its peak. Considering the sensitive location of this city, awareness regarding TB status can lead to improved health in the community and development of basic strategies to control and eliminate the transmission of this infection from Mashhad to other areas.

This a preprint and has not been peer reviewed. Data may be preliminary.