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Cystic fibrosis patients are highly susceptible to infections with non-tuberculous mycobacteria. Especially  Mycobacterium abscessus  infections are common but reliable diagnosis is hampered by non-specific clinical symptoms and insensitive mycobacterial culture. In the present study we established novel methods for rapid detection and immune characterization of  Mycobacterium abscessus  infection in cystic fibrosis patients. We performed  Mycobacterium abscessus  specific DNA-strip- and quantitative PCR-based analyses of non-cultured sputum samples to detect and characterize  Mycobacterium abscessus  infections. Concomitantly  in vitro  T-cell reactivation with purified protein derivatives (PPDs) from different mycobacterial species was used to determine  Mycobacterium abscessus  specific T-cell cytokine expression of infected cystic fibrosis patients. Four of 35 cystic fibrosis patients (11.4%) were  Mycobacterium abscessus  culture positive and showed concordant DNA-strip-test results. Quantitative PCR revealed marked differences of mycobacterial burden between cystic fibrosis patients and during disease course. Tandem-repeat analysis classified distinct  Mycobacterium abscessus  strains of infected cystic fibrosis patients and excluded patient-to-patient transmission.  Mycobacterium abscessus  specific T-cells were detected in the blood of cystic fibrosis patients with confirmed chronic infection and a subgroup of patients without evidence of  Mycobacterium abscessus  infection. Comparison of cytokine expression and phenotypic markers revealed increased proportions of CD40L positive T-cells that lack Interleukin-2 expression as a marker for chronic  Mycobacterium abscessus  infections in cystic fibrosis patients. Direct sputum examination enabled rapid diagnosis and quantification of  Mycobacterium abscessus  in cystic fibrosis patients. T-cell  in vitro  reactivation and cytokine expression analyses may contribute to diagnosis of chronic  Mycobacterium abscessus  infection.

Rapid Detection and Immune Characterization of Mycobacterium abscessus Infection in Cystic Fibrosis Patients