الفهرس 
AcknowledgementOnly 14 pages are availabe for public view
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Abstract
Mycobacterial pulmonary diseases are of the ma j 0 r public heal th probl ems in most developing countries. Nontuberculous mycobacteria are accused in many cases of these diseases. Most wi th NTM infection are initially misdiagnosed as tuberculosis because the clinical and radiologic manifestations being very similar. However, the clinical course, the response to conventional chemotherapy, and the prognosis are different. Hence precise identification of these infecting agents is The NTM differ from M. tuberculosis in several respects; person-to-preson transmission generally does not occur, the species ueubiquitous in nature, and their pathogenic potential for humans The existence of predisposing factors is usually required NTM i nf ec t ions, most commonly; pneumoconiosis, previous tuberculosis, chronic pulmonary diseases, immunosuppressive therapy - . diseases that suppress immune responsiveness such as leukaemi as, aut 0- immune d is eas e and AIDS, however, they can be pathogenic for healthy persons. 193. The incidence of NTM diseases has increased in the developing wuntries over the past few decades. This may be due to a greater ~arness of such infections and also to the increasing numbers of immunocomprom is ed i nd i v i dua Is. This work had been carried out in order to: (I) evaluate the role of these NTM in some pulmonary diseases in Alexandr i a, and to estimate their ratio to those with M. tuberculosis infection. 11 (ii) to identify and classify the isolated strains to their specific species. The study was done on 420 patients of two groups: (a) Some 0 f them have been diagnosed clinically as pulmonary tuberculosis (370 patient). (b) Other s have chronic obstructive pulmonary diseases (SO pa ti en t s) . The patients were admitted to; EI-Maamoura Chest Hospital, Kom n Shoukaf a Chest Hospi ta.l , Chest department of Alexandria ~nivers i ty Hospital and .Gama 1 Abd EI-Naser Health Insurance ~ospi ta 1 . A questionnaire sheet was filled for every patient. Sputum sampl es were collected for three successive days. For those 194. were suspected to have NTM infection, another three s~ples were collected with two months interval. Each specimen was subjected to the following: !. Direct microscopic examination. using Kinyoun~s cold acid-fast stain. L Digestion, concentration and decontamination of the specimen using N-acetyl-L-cysteine alkali method. J, Microscopic examination after concentration using the Kinyoun Stain. 11 ,. Culture on: Lowenstein Jensen medium, MidQlebrook 7H10 Medium Middlebrook 7Hg broth. PNB-Lowenstein Jensen medium (PNB-L.J.) D and hydroxylamine hydrochloride Lowenstein Jensen medium (NHZOH.HCI-L.J.) . The latter two media were used in association with the niacin production to identify M. tuberculosis to exclude it. \. Identification and differentiation between the different species by; colonial morphology, rate and temperature of growth, pigment production, giowth on RMP (25 ~g/ml) medium, and certain biochemical tests including: nitrate production, catalase, semiquantitative (>45 mm foam), catalase, heat stable (6SoC), tween SO hydrolysis and telluri te reduction test. 195. 6. Serologic identification of some of the isolated strains, using the tube seroagglutination method advised by Schaefer (1979)23. 1. Identification of the isolated strains by the analysis of their lipid composition using thin-layer chromatography method and gas liquid ’chromatography. The results obtained in the study showed that twenty four NTM pathogenic strains were isolated, representing (7.9) from all the isolated mycobacterial strains. The following NTM species were isolated, M.avium complex (MAC) was the most prevalent species (29.2), M. kansasii (20.8), M.scrofulaceum (10.8), M. malmoense (12.5) and M.szulgai (4.2) . I n add i t i on , two one photochromogeni c strain and nonphotochromogenic strains could not be identified to their definite species (12.5). The incidence of NTM diseases were found to be highest in . . patients aged (30-39 yr) (25) and (20-29 yr) (20.7).