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However, as yet, there are no such data relating to Tunisia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Here we carried out a retrospective review of mycobacterial cultures originating from Northern Tunisia, which have been processed in the laboratory of mycobacteria of the Institut Pasteur de Tunis, during the time period 2002\u20132016. All pulmonary NTM (PNTM) isolates available for culture were characterized phenotypically and their taxonomic status was further established based on polymorphisms in\n                      <jats:italic>rpoB<\/jats:italic>\n                      , 16S rRNA,\n                      <jats:italic>hsp65,<\/jats:italic>\n                      and\n                      <jats:italic>sodA<\/jats:italic>\n                      DNA gene sequences.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of the 10,466 specimens collected from HIV-negative Tunisian patients with presumptive clinical pulmonary TB, 60 (0.6%) yielded PNTM isolates. An overall annual PNTM isolation prevalence of 0.2\/100,000 was estimated. As far as could be ascertained, this isolation rate accounts amongst the lowest reported hitherto throughout the world. Among the 30 NTM isolates that were available for culture, 27 (90.0%) have been identified to the species level. The most commonly encountered species was\n                      <jats:italic>Mycobacterium kansasii<\/jats:italic>\n                      (23.3%) subtype 1. Strikingly, all\n                      <jats:italic>M. kansasii<\/jats:italic>\n                      cases were male patients originating from Bizerte, an industrialized region particularly known for iron industry. The remaining NTM species were\n                      <jats:italic>M. fortuitum<\/jats:italic>\n                      (16.6%)\n                      <jats:italic>, M. novocastrense<\/jats:italic>\n                      (16.6%)\n                      <jats:italic>, M. chelonae<\/jats:italic>\n                      (10.0%),\n                      <jats:italic>M. gordonae<\/jats:italic>\n                      (6.6%),\n                      <jats:italic>M. gadium<\/jats:italic>\n                      (6.6%),\n                      <jats:italic>M. peregrinum<\/jats:italic>\n                      (3.3%),\n                      <jats:italic>M. porcinum<\/jats:italic>\n                      (3.3%), and\n                      <jats:italic>M. flavescens<\/jats:italic>\n                      (3.3%). There were no bacteria of the\n                      <jats:italic>M. avium<\/jats:italic>\n                      complex, the most frequently isolated NTM globally, and the main driver of the rise of NTM-lung diseases.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      This study uncovered an exceptional low prevalence of PNTM isolation among HIV-negative TB suspects in Northern Tunisia, suggesting a very low burden of NTM pulmonary disease. However, the frequent isolation of\n                      <jats:italic>M. kansasii<\/jats:italic>\n                      subtype 1, the most pathogenic subtype, particularly from the industrialized region of Bizerte, strongly suggests its effective involvement in a typical pulmonary disease.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12879-019-4441-1","type":"journal-article","created":{"date-parts":[[2019,9,18]],"date-time":"2019-09-18T09:04:57Z","timestamp":1568797497000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Nontuberculous mycobacteria isolated from specimens of pulmonary tuberculosis suspects, Northern Tunisia: 2002\u20132016"],"prefix":"10.1186","volume":"19","author":[{"given":"Reem","family":"Gharbi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Besma","family":"Mhenni","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saloua","family":"Ben Fraj","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0026-0764","authenticated-orcid":false,"given":"Helmi","family":"Mardassi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2019,9,18]]},"reference":[{"key":"4441_CR1","doi-asserted-by":"crossref","unstructured":"Honda JR, Virdi R, Chan ED. 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Only fully anonymized data were processed, ensuring the privacy for the individuals whose samples were analyzed. Therefore, no further ethical clearance was required. Furthermore, the samples used in this study have been collected as part of the routine diagnostic activity of the laboratory of Mycobacteria of the Institut Pasteur de Tunis, which is authorized by the Tunisian Ministry of Public Health, as part of the National TB program. Therefore, no administrative permissions were required to access the raw data.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interest.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"819"}}