复治肺结核患者结核分枝杆菌L型培养结果分析

目的:了解复治肺结核患者的结核分枝杆菌L型培养情况,探讨结核分枝杆菌L型阳性与耐多药的关系。方法:选择180例肺结核患者的痰标本进行结核分枝杆菌培养和结核分枝杆菌L型培养,同时对110例复治组中培养阳性的标本行耐药监测。结果:复治组的L型阳性率为43.6%,初治组的L型阳性率为15.7%,复治组显著高于初治组(P<0.01);菌阳复治组的L型阳性率50%,菌阴复治组的L型阳性率39.4%,菌阳组明显高于菌阴组(P<0.05);L型菌阳性患者的耐药率显著高于L型菌阴性组(P<0.05)。结论:结核分枝杆菌L型阳性是引起结核病复发、耐药的重要原因;MDR-TB与结核分枝杆菌L型感染有关。     

2018—2020年平顶山地区非结核分枝杆菌菌种鉴定及耐药性分析

本文旨在观察2018—2020年河南省平顶山地区非结核分枝杆菌(nontuberculous mycobacteria,NTM)的菌种分布及耐药情况。收集2018年1月—2020年12月平顶山市传染病医院分离到的326株NTM,采用DNA微阵列芯片鉴定菌种,改良罗氏培养基比例法进行药敏试验。结果显示,从61～80岁患者中分离的NTM菌株最多,其次是41～60岁患者。共鉴定出8个NTM菌种,分别为胞内分枝杆菌(35.28%)、龟/脓肿分枝杆菌(24.85%)、鸟分枝杆菌(18.40%)、偶然分枝杆菌(5.21%)、戈登分枝杆菌(1.23%)、堪萨斯分枝杆菌(12.58%)、浅黄分枝杆菌(1.53%)、瘰疬分枝杆菌(0.92%)。NTM对异烟肼的耐药率最高,为97.85%。除戈登分枝杆菌外,其他NTM菌种对异烟肼的耐药率均＞94%;胞内分枝杆菌对丙硫异烟胺的耐药率(8.70%)相对较低,鸟分枝杆菌对丙硫异烟胺的耐药率为10.00%;龟/脓肿分枝杆菌对异烟肼、利福平、链霉素、乙胺丁醇、阿米卡星的耐药率均＞95%;偶然分枝杆菌对左氧氟沙星的耐药率为35.29%,堪萨斯分枝杆菌对左氧氟沙星的耐药率最低(7.32%);戈登分枝杆菌对异烟肼、乙胺丁醇、链霉素、对氨基水杨酸的耐药率均≥50%;浅黄分枝杆菌对乙胺丁醇、左氧氟沙星、阿米卡星、卡那霉素的耐药率均＜50%;瘰疬分枝杆菌对阿米卡星和丙硫异烟胺的耐药率为0。结果提示,2018—2020年河南省平顶山地区鉴定出的8个NTM菌种中,胞内分枝杆菌占比最高,不同菌种对不同抗结核药物的耐药性差异较大,因此菌种鉴定对临床治疗有重要意义。     

空洞型肺结核组织样本耐药菌及相关基因检测的临床研究

目的:比较分析空洞型肺结*核组织样本与痰样本结核分枝杆菌培养的阳性率及检测的一致性,并基于rpoB基因及KatG基因突变检测在诊断耐多药结核分枝杆菌中的重要作用,探讨直接应用肺结核组织样本进行结核分枝杆菌耐药性检测的临床意义.方法:对肺结核实施肺部手术患者,在术前和术后分别进行痰及手术切除组织样本利用BacT ALERT 3D快速培养系统进行分枝杆菌培养,对培养阳性者进行菌种鉴定,对结核分枝杆菌分离株应用绝对浓度法进行异烟肼(H)、利福平(R)药物敏感性测定,比较分析二者的一致性;同时应用特异性引物对手术切除组织样本直接进行分枝杆菌rpoB、KatG基因扩增,并与其培养结果进行比较.结果:62例进入分析的病例中,术前痰培养阳性22例,阳性率35.5%(22/62),药敏试验耐药18例,耐异烟肼16例,耐利福平13例.二者均耐药12例,术中所取结核组织培养阳性34例,阳性率55%(34/62),耐药30例,耐H26例,耐R20例,二者均耐药17例,术中所取结核组织耐药基因检测与INH耐药性相关的KatG基因突变表现有22例,与RFP的耐药性相关的rpoB基因突变18例.二者同时有突变表现的16例.所有培养为结核敏感菌的组织检测中,无上述二基因突变表现.在相关的rpoB基因突变18例病例中有16例同时表现出KatG基因突(89%,16/18).结论:厚壁空洞肺结核患者肺部手术切除组织样本病原学检测与痰样本间具有较好的一致性,且结核菌培养的阳性率明显高于普通痰培养.同时可直接应用组织样本进行结核分枝杆菌rpoB基因、KatG基因检测,可更加及时、准确地用于指导临床术后抗结核的药物治疗.     

耐药结核分枝杆菌感染动物模型所用菌株的筛选

本研究通过小鼠体内实验检测我国部分地区结核分枝杆菌耐药菌株的毒力,以筛选耐药结核分枝杆菌感染动物模型所用菌株。收集从我国部分省份98例结核病患者痰培养液中分离出的结核分枝杆菌,用比例法药敏试验进行结核分枝杆菌一线和二线药物的药敏试验,筛选出对二线药物敏感而对一线药物利福平或异烟肼耐药或敏感的菌株,然后进行小鼠体内毒力实验,对异烟肼耐药相关基因katG和利福平耐药相关基因rpoB测序并进行基因突变分析。从98株菌中筛选出药物敏感谱清晰的40株,进行小鼠体内毒力实验。结果显示,共35株半数死亡时间≤H37Rv的半数死亡时间,其中18株耐利福平合并耐异烟肼、5株单耐利福平,7株单耐异烟肼、5株对利福平和异烟肼均敏感。通过小鼠毒力研究,分别筛选出基因背景清晰,半数死亡时间≤7d的耐利福平合并耐异烟肼的菌株1株、半数死亡时间≤7d单耐利福平和异烟肼的菌株各1株,作为耐药结核分枝杆菌感染小鼠模型所用菌株及进一步进行豚鼠等其他动物模型感染用候选菌株。     

MTB新疆临床分离株MDR-TB和XDR-TB耐药情况初步调查

目的:分析新疆喀什地区结核分枝杆菌(MTB)临床分离株对4种一线和7种二线抗结核药物的耐药情况,初步探讨本地区耐多药结核病(MDR-TB)和广泛耐药结核病(XDR-TB)的流行情况。方法:收集2008.11.1~2009.10.31日期间新疆喀什地区结核病患者痰液标本,进行分离培养及菌种鉴定,并应用比例法对所分离得到的菌株进行耐药性检测。结果:102株分枝杆菌中,88株(86.3%)属于结核分枝杆菌复合群,7株(6.9%)属于牛型分枝杆菌,7株(6.9%)属于非结核分枝杆菌。对一种以上的抗结核药物具有耐药性的有20株,总耐药率为22.7%(20/88),耐多药率为6.8%(6/88),pre-XDR为33.3%(2/6),无XDR-TB病例。结论:新疆喀什地区结核病患者耐药率较高,在结核病治疗工作中应给予重视,尤其应加强对Pre-XDR的重视,以免发展成XDR-TB。     

201例结核病患者分离株的药敏结果分析

本文旨在分析2008年12月～2009年5月就诊于上海市肺科医院的201例结核病患者结核分枝杆菌的药敏试验结果。结核分枝杆菌培养采用罗氏培养系统,药敏试验采用绝对浓度法。201例患者中,耐药率由高到低依次为异烟肼(INH,52.24%)、链霉素(SM,45.77%)、利福平(RFP,30.35%)、乙胺丁醇(EMB,28.86%)、阿米卡星(AK,28.18%)、利福喷汀(RIB,26.40%)、力克肺疾(Pa,25.56%)、对氨基水杨酸(PAS,23.60%)、丙硫异烟胺(Pt,23.03%)、卷曲霉素(CPM,20.56%)。其中,初治患者的耐药率为3.08%～26.15%,复治患者为27.50%～64.71%,耐多药患者为64.44%～100%。总体来看,与低浓度相比,高浓度SM、INH、EMB、RIB、Pt可明显降低结核分枝杆菌的耐药率(P0.05)。除INH、SM、RFP外,女性患者的耐药率均高于男性,耐多药率亦高于男性(P0.05)。结果提示,临床上应足量应用抗结核药物,对女性结核病患者要给予更多关注。     

新疆南疆MTB临床分离株异烟肼耐药情况及耐药相关基因的突变研究

目的:探索新疆南疆部分地区维吾尔族结核病人群中分离到的结核分枝杆菌基因组中的katG、inhA、kasA、ahpC基因突变与耐异烟肼的关联,揭示新疆肺结核病高患病率、高死亡率的可能原因.方法:收集新疆南疆部分地区维吾尔族结核病患者痰液标本,对MTB进行分离培养后,应用比例法检测其对异烟肼耐药性,运用PCR技术对所分离菌株的上述基因相关片段扩增并进行测序及序列分析.结果:筛选出实验菌株99株,其中敏感株63株,耐异烟肼菌株36株,耐药率为36.4%.耐药株中katG基因突变率为63.9%,315位点突变,突变类型AGC→ACC(Ser→Thr)、AGC→AAC(Ser→Asn);inhA基因突变率为47.2%,有缺失、同义突变和错义突变;kasA基因突变率为41.7%,突变类型为缺失和错义突变;ahpC基因突变率为8.3%,属于错义突变.结论:新疆南疆结核病高患病率、高死亡率的可能原因之一是结核分枝杆菌对INH产生了耐药,结核分枝杆菌对INH耐药机制可能与耐药菌株基因组内katG、inhA、kasA和ahpC基因发生了突变有关.     

高分辨率熔解曲线分析技术检测结核分枝杆菌的耐药性

目的:探讨高分辨率熔解曲线分析(High resolution melting,HRM)技术检测结核分枝杆菌耐药突变位点的可行性。方法:对218株结核分枝杆菌进行利福平(RFP)和异烟肼(INH)的药物敏感性测定,并进行耐药基因位点的PCR扩增和测序,同时采用HRM方法检测RFP和INH耐药基因位点情况,分析HRM的敏感性和特异性。结果:218株结核分枝杆菌药敏试验结果显示,有106株(48.6%)对RFP耐药,100株(45.9%)对INH耐药,81株(37.4%)对RFP和INH均耐药。测序发现,101株(46.3%)存在RFP耐药基因的突变,107株(49.1%)存在INH耐药基因的突变。HRM检测结果显示,100株(45.9%)存在RFP耐药基因的突变,103株(47.2%)存在INH耐药基因的突变。分别以药敏试验和测序结果为标准,HRM检测RFP耐药的敏感性为94.3%(100/106)和99.0%(100/101);特异性为97.3%(109/112)和100%(117/117);INH耐药的敏感性为97.0%(97/100)和98.1%(103/105);特异性为97.3%(109/112)和100%(113/113)。结论:HRM快速检测结核分枝杆菌耐药具有较高的特异性和灵敏度,能够满足临床需求。     

快速方法检测结核分枝杆菌耐药基因突变

快速准确地鉴定结核分枝杆菌与结核分枝杆菌对利福平和异烟肼耐药基因突变的快速检测,对结核病人的诊断与治疗具有重要指导意义。本次根据结核分枝杆菌标准株H37RV序列,利用覆盖rpoB、katG、inhA基因突变区的系列寡核苷酸探针,并检测临床样品中结核分枝杆菌的基因突变情况,以此来判断耐药结果,并对其进行方法学评价。     

复治肺结核患者结核分枝杆菌L型培养结果分析

目的：了解复治肺结核患者的结核分枝杆菌L型培养情况,探讨结核分枝杆菌L型阳性与耐多药的关系。方法：选择180例肺结核患者的痰标本进行结核分枝杆菌培养和结核分枝杆菌L型培养,同时对110例复治组中培养阳性的标本行耐药监测。结果：复治组的L型阳性率为43．6％,初治组的L型阳性率为15．7％,复治组显著高于初治组（P〈0．01）;菌阳复治组的L型阳性率50％,菌阴复治组的L型阳性率39．4％,菌阳组明显高于菌阴组（P〈0．05）;L型菌阳性患者的耐药率显著高于L型菌阴性组（P〈0．05）。结论：结核分枝杆菌L型阳性是引起结核病复发、耐药的重要原因;MDR-TB与结核分枝杆菌L型感染有关。     

牛型纯化蛋白衍生物皮内变态反应试验阳性牛中分枝杆菌的分离与鉴定

为评价牛分枝杆菌纯化蛋白衍生物(purified protein derivative,PPD)单纯颈部皮内变态反应试验(single intradermal cervical tuberculin,SICT)在奶牛结核病检测中的特异性,采集54头SICT阳性牛的118份组织样品进行病原分离和鉴定。结果显示,14头SICT阳性牛样品中分离到抗酸阳性菌,占SICT阳性牛总数的25.9%(14/54)。其中,10头阳性牛样品中分离到分枝杆菌,占18.5%(10/54);1头阳性牛样品中分离到牛分枝杆菌,占1.9%(1/54)。从118份组织样品中分离到16株抗酸阳性菌,其中12株为分枝杆菌,分枝杆菌分离率为10.2%(12/118)。12株分枝杆菌中,1株为牛分枝杆菌,其余11株为禽分枝杆菌、土地分枝杆菌等非结核分枝杆菌。牛分枝杆菌与非结核分枝杆菌分别占分枝杆菌分离株的8.3%(1/12)和91.7%(11/12)。病原分离和鉴定结果表明,SICT阳性牛的牛分枝杆菌分离率较低,为确保检测结果的准确性,有必要采用其他检测方法进行验证。同时,可将分枝杆菌快速分离培养及菌种鉴定检测技术引入对皮内变态反应试验阳性牛的实验室诊断,进一步提高牛结核病检测的特异性。     

Predictive value of the acid fast smear for detection of Mycobacterium tuberculosis in respiratory specimens in a reference center of HIV/AIDS in Rio de Janeiro, Brazil

In order to evaluate the predictive value of acid fast bacilii (AFB) smear for the diagnosis of Mycobacterium tuberculosis in respiratory specimens in a setting with a high prevalence of AIDS and an unknown prevalence of nontuberculous mycobacteria (NTM), we retrospectively examined specimens cultured for mycobacteria between 1 September 1993 and 30 September 1994 and medical records of patients with positive culture in a General Hospital, AIDS reference in Rio de Janeiro, Brazil. Seventy three per cent (1517/2077) of samples were respiratory specimens and mycobacteria were recovered from 20.6% (313/1517) of these. M. tuberculosis was identified in 94.2% (295/313) and NTM in 5.8% (18/313). The yield of positive AFB smear and of positive culture was 6.1% (93/1517) and 20.6% (313/1517), respectively. The positive predictive value (PPV) of AFB for M. tuberculosis was 98.4% in expectorated sputum and 96.4% in bronchoalveolar lavage. Forty four percent (130/295) of specimens with positive culture for M. tuberculosis and 66.7% (12/18) for NTM were from patients HIV positive. The conclusion was that in our study population, the PPV of AFB for M. tuberculosis in respiratory specimens was high and the prevalence of NTM was low despite the high prevalence of HIV positive.     

EVALUATION OF CORD FORMATION IN KINYOUN-STAINED SMEARS OF MGIT CULTURES AS A RAPID IDENTIFICATION METHOD FOR MYCOBACTERIUM TUBERCULOSIS COMPLEX

Tuberculosis (TB) is a major cause of morbidity and mortality worldwide. One hundred and nineteen acid-fast bacilli-positive smears for Mycobacterium Growth Indicator Tube cultures from 119 patients were examined by microscopy for the presence of cord formation. The results were compared with those of the traditional TB identification method, IS6110 polymerase chain reaction (PCR) , and the Capilia TB assay which uses a monoclonal antibody to identify. With the traditional TB identification method, 57 of these 119 specimens were determined to be positive for Mycobacterium tuberculosis complex, and the organisms in the remaining 62 specimens were identified as non-tuberculosis mycobacteria (NTM). Both IS6110 PCR and the Capilia TB assay yielded results identical to those of the traditional method with 57 true TB and 62 NTM. For the cord formation assay, all 62 NTM cultures were negative, but 54 of the 57 true TB cultures were positive. Therefore, the cord formation method had a sensitivity of 94.74% (54/57), specificity of 100% (62/62), negative predictive value of 95.38% (62/65) and positive predictive value of 100% (54/54) for identification of M. tuberculosis complex. The cord formation method is less expensive and 3–5 weeks quicker than the biochemical tests in the identification of M. tuberculosis.

PRACTICAL APPLICATIONS

Due to the slow growth of Mycobacterium tuberculosis bacilli, delays in the detection of TB infection may occur in clinical TB laboratories when only conventional methods for recovery of mycobacteria are used. This problem can be supported by other techniques, such as cord formation in Kinyoun-stained smears of Mycobacterium Growth Indicator Tube cultures and molecular biology-based systems, which can be used in combination to obtain accurate results in a much shorter period of time.     

Non‐Tuberculosis mycobacterium speciation using HPLC under Revised National TB Control Programme (RNTCP) in India

Aims

Non‐Tuberculous Mycobacteria (NTM) are ubiquitous in nature. The data on prevalence of NTM under the RNTCP is scarce. Many NTM species have clinical significance, and hence their identification and speciation are important.

Methods and Results

It is a cross‐sectional study conducted at the five RNTCP accredited culture and drug susceptibility testing (CDST) laboratory. The culture isolates from AFB positive but Immunochromatographic test negative samples were taken for identification and speciation using HPLC. Of the total 266 isolates only 164 isolates had a second sample received at the laboratory. The speciation was done using HPLC for those isolates. The type of species identified are: 26·8% (44) were Mycobacterium chelonae, 12·8% (21) were Mycobacterium fortuitum, 9% (15) were Mycobacterium gordonae, 9% (15) were Mycobacterium tuberculosis complex, 6·1% (10) were Mycobacterium kansasii, 4·9% (8) were Mycobacterium simiae, 2·4% (4) were Mycobacterium thermophile, 1·2% (2) were Mycobacterium gastri, 0·6% (1) were Mycobacterium scrofulaceum, 0·6% (1) were Mycobacterium avium and 4·9% (8) isolates had chromatogram which was un‐interpretable.

Conclusion

Identification and its speciation of NTM are not routinely done under TB control programme. Since HPLC could identify 95% of isolates belonging to 10 species, the speciation of NTM using HPLC should gain importance in the diagnosis of disease caused by NTM.

Significance and Impact of Study

NTM are emerging as important causative agents of pulmonary and extra pulmonary disease, the ability to recognize disease caused by NTM and subsequently treat such disease has become increasingly important. The identification of NTM up to its species level should gain importance in all TB reference Laboratories.     

利用rpoB基因芯片技术进行快速分枝杆菌菌种鉴定

利用rpoB基因芯片技术快速进行分枝杆菌菌种鉴定.以分枝杆菌rpoB基因编码序列为靶基因,用基因芯片技术检测21种分枝杆菌标准株;8种其它细菌标准株;126株临床分离株.分枝杆菌与其它细菌标准株经PCR扩增后,分枝杆菌标准株均扩增出360 bp DNA片段,在其它细菌中,除甲型溶血性链球菌和假白喉棒状杆菌出现同样片段外,其它细菌均未见扩增.21种寡核苷酸探针除海分枝杆菌与偶然分枝杆菌的探针有交叉杂交外,其余均为特异性杂交.对126株临床分离株进行鉴定,89株为结核分枝杆菌,占70.6%(89/126),非结核分枝杆菌(NTM)占9.2%(9/98).应用rpoB基因芯片技术鉴定分枝杆菌菌种,是一种快速、准确的方法,具有较高的临床应用价值.     

利用rpoB基因芯片技术进行快速分枝杆菌菌种鉴定

利用rpoB基因芯片技术快速进行分枝杆菌菌种鉴定。以分枝杆菌rpoB基因编码序列为靶基因, 用基因芯片技术检测21种分枝杆菌标准株;8种其它细菌标准株;126株临床分离株。分枝杆菌与其它细菌标准株经PCR扩增后, 分枝杆菌标准株均扩增出360 bp DNA片段, 在其它细菌中, 除甲型溶血性链球菌和假白喉棒状杆菌出现同样片段外, 其它细菌均未见扩增。21种寡核苷酸探针除海分枝杆菌与偶然分枝杆菌的探针有交叉杂交外, 其余均为特异性杂交。对126株临床分离株进行鉴定, 89株为结核分枝杆菌, 占70.6％(89/126), 非结核分枝杆菌(NTM)占9.2％(9/98)。应用rpoB基因芯片技术鉴定分枝杆菌菌种, 是一种快速、准确的方法, 具有较高的临床应用价值。     

2019—2020年上海地区儿童幽门螺杆菌感染及其耐药性分析

为分析2019-2020年上海地区儿童幽门螺杆菌感染及其对4种常用抗菌药物的耐药状况,本研究收集了2019年1月-2020年10月于复旦大学附属儿科医院就诊且经胃镜检查、快速尿素酶试验阳性的患儿 1 605 例,取胃黏膜样本进行幽门螺杆菌分离培养及鉴定,采用E-test法进行体外药敏试验,分析不同年龄组患儿幽门螺杆菌耐药状况。结果显示,本研究入组患儿标本的幽门螺杆菌分离率为31.5%(506/1 605),无性别和年龄差异。幽门螺杆菌临床分离株对甲硝唑、克拉霉素、左氧氟沙星、阿莫西林的耐药率分别为42.3%、25.1%、8.1%、3.0%。除13～16岁组幽门螺杆菌对克拉霉素的耐药率显著高于1～3岁组(31.2% vs. 13.3%,P＝0.040)外,其他各年龄和性别组之间耐药率均无统计学差异。此外,幽门螺杆菌对克拉霉素＋甲硝唑的双重耐药率为18.0%,显著高于对克拉霉素＋左氧氟沙星(5.1%)、甲硝唑＋左氧氟沙星(4.9%)、甲硝唑＋阿莫西林(1.4%)和阿莫西林＋左氧氟沙星的耐药率(0.8%)(χ2＝172.706, P<0.01)。多重耐药分析显示,幽门螺杆菌对左氧氟沙星＋克拉霉素＋甲硝唑的耐药率为3.0%,显著高于对左氧氟沙星＋阿莫西林＋克拉霉素(0.6%)、阿莫西林＋甲硝唑＋左氧氟沙星的耐药率(0.6%)(χ2＝13.907,P＝0.01)。结果提示,2019--2020年从上海地区儿童分离的幽门螺杆菌对甲硝唑、克拉霉素的耐药率较高,对阿莫西林和左氧氟沙星的耐药率较低,对甲硝唑和克拉霉素的双重耐药率较高。     

Comparison of NaOH-N-acetyl cysteine and sulfuric acid decontamination methods for recovery of mycobacteria from clinical specimens

We compared the NaOH-N-acetyl cysteine (NaOH-NALC) and the sulfuric acid decontamination procedure in the detection of mycobacteria using the Mycobacteria Growth Indicator Tube (MGIT). In total 219 sputum specimens were collected from 142 Zambian patients and subjected to mycobacterial culture. One half of the specimen was decontaminated with NaOH-NALC and the other half was decontaminated with sulfuric acid. From the 438 samples a total of 261 (60%) cultures yielded growth of mycobacteria, consisting of 22 different species. The sulfuric acid method was more successful than the NaOH-NALC method in recovering mycobacteria in MGITs (146 versus 115 respectively, p = 0.001). Of the 146 positive mycobacterial cultures recovered after sulfuric acid decontamination 28 were Mycobacterium tuberculosis, 84 nontuberculous mycobacteria (NTM) and 34 acid fast bacterial isolates which could not be identified to the species level. The 115 mycobacteria recovered by the NaOH-NALC method consisted of 34 M. tuberculosis strains, 55 NTM and 26 acid fast bacteria that could not be identified. The most frequently isolated NTM were Mycobacterium lentiflavum and Mycobacterium intracellulare. Comparing the two decontamination methods the recovery of NTM in the sulfuric acid group was significant higher than in the NaOH-NALC group (p = 0.001). In contrast, no significant difference was found for the recovery of M. tuberculosis. These results show that the decontamination method used affects the recovery of nontuberculous mycobacteria in particular.     

Distribution of non-tuberculosis mycobacteria strains from suspected tuberculosis patients by heat shock protein 65 PCR–RFLP

The genus Mycobacterium contains more than 150 species. Non-tuberculosis mycobacteria (NTM) often cause extrapulmonary and pulmonary disease. Mycobacteria detection at species level is necessary and provides useful information on epidemiology and facilitates successful treatment of patients. This retrospective study aimed to determine the incidence of the NTM isolates and Mycobacterium tuberculosis (Mtb) in clinical specimens collected from Iranian patients during February 2011–December 2013, by PCR–restriction fragment length polymorphism analysis (PRA) of the hsp65 gene. We applied conventional biochemical test and hsp65–PRA identification assay to identify species of mycobacteria in specimens from patients suspected of having mycobacterial isolates. This method was a sensitive, specific and effective assay for detecting mycobacterial species and had a 100% sensitivity and specificity for Mtb and Mycobacterium avium complex (MAC) species. Using PRA for 380 mycobacterial selected isolates, including 317 Mtb, four Mycobacterium bovis and of the 59 clinical isolates, the most commonly identified organism was Mycobacterium kansasii (35.6%), followed by Mycobacterium simiae (16.9%), Mycobacterium gordonae (16.9%), Mycobacterium fortuitum (5.1%), Mycobacterium intracellulare (5.1%), Mycobacterium avium (5.1%), Mycobacterium scrofulaceum (3.4%), Mycobacterium gastri (3.4%), Mycobacterium flavescens (3.4%), Mycobacterium chelonae (3.4%) and Mycobacterium nonchromogenicum (1.7%). PRA method, in comparison with classical methods, is rapid, useful and sensitive for the phylogenetic analysis and species detection of mycobacterial strains. Mycobacterium kansasii is the most common cause of infection by NTM in patients with non-HIV and HIV which demonstrated a high outbreak and diversity of NTM strains in our laboratory.