|Year : 2022 | Volume
| Issue : 1 | Page : 14-20
Is a time to established medical mycobacteriology as an academic degree (master of science)? Strategical plan for next future
Ali Akbar Velayati, Jafar Aghajani, Parissa Farnia
Mycobacteriology Research Centre, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
|Date of Submission||17-Dec-2021|
|Date of Decision||12-Jan-2022|
|Date of Acceptance||16-Feb-2022|
|Date of Web Publication||23-Mar-2022|
Mycobacteriology Research Centre, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran
Source of Support: None, Conflict of Interest: None
The genus Mycobacterium contains more than 190 species, including several major human pathogens as well as numerous environmental species. With so much advances in molecular methods, the transmission of huge number of mycobacteria called nontuberculosis mycobacterium (NTM) is still under a question. Till date, the majority of work have been focused on tuberculosis (TB) complex mycobacteria, the knowledge of human-to-human, environmental, animal-to-human transmission, and vice versa susceptibility, and most of their NTM genomic structures have been ignored, especially in limited-resource countries. For example, in Iran, there are currently 423 public laboratories for direct smear microscopy (DSM) and 42 laboratories for mycobacterial cultures, and 9 diagnostic centers for susceptibility and identification of TB complex from NTM species. Only National TB Reference Laboratory in Iran is capable of identifying subspecies of NTMs and preforms second-line drug resistant. Furthermore, there are some governmental centers such as Pasteur and Razi Institutes that are capable to detect TB and NTM species within the country. Due to the importance of these opportunistic microorganisms that caused pulmonary and extrapulmonary infections, the need for specialized personnel in this field seems to be necessary. Due to the weakness of governing bodies to educate personals in the TB laboratories, it is essential to have an academic degree as a “Master of Science (MSc)” in medical universities to educate skilled academic individuals in this particular field. As a consequence, we can expect to use the updated identification methods and perform research in various fields of NTMs. With no doubt, this course will help to recognize the related diseases and improve the overall public health problems because Mycobacterium species are no longer considered to be a narrow group of microorganisms.
Keywords: Academic degree, medical mycobacteriology, Mycobacterium, nontuberculous mycobacteria
|How to cite this article:|
Velayati AA, Aghajani J, Farnia P. Is a time to established medical mycobacteriology as an academic degree (master of science)? Strategical plan for next future. J Prev Diagn Treat Strategies Med 2022;1:14-20
|How to cite this URL:|
Velayati AA, Aghajani J, Farnia P. Is a time to established medical mycobacteriology as an academic degree (master of science)? Strategical plan for next future. J Prev Diagn Treat Strategies Med [serial online] 2022 [cited 2022 May 24];1:14-20. Available from: http://www.jpdtsm.com/text.asp?2022/1/1/14/340552
| Introduction|| |
Why Mycobacterium family is important?
Mycobacteria are a large group of ancient organisms that are neither fungi or microbes. At first, it was thought to contain only 4–5 species, but now more than 190 different species have been discovered and isolated, over 60% of this large family are pathogenic to humans and animals (especially livestock). They exist in all environments of the world, including water, soil, and air. Today, there is a defined cure for only 3% of these species, and for majority of them, there is no proper susceptibility testing whether molecular or classical methods.,,,,,, Even the whole-genome sequences of many nontuberculosis mycobacteria (NTMs), their root and source of transmission are not yet clear., So far, a few information about their human-to-human transmission have been documented. Thereby, we are facing a large group of microorganisms that their in vitro and in vivo life cycle remains to be resolved.
Due to SARS-COV-2 pandemic in the last 2 years, many of opportunistic NTM species infected humans in pulmonary or extrapulmonary forms., This shows that NTMs are important microorganisms that could infect humans and there is a need to identify them with trained academic personals.
Up to date, what we know about NTM species is their identification and susceptibility testing. but their life cycle, the root of transmission, the possibility of human-to-human, human-to-animal, environmental transmission and/or vice versa is not very clear. Even with so much advances in molecular methods such as whole-genome sequence and other polymerase chain reaction-restriction fragment length polymorphism, many of NTM subspecies and their differences in histopathology of infected patients are not yet known. In addition, we need to know the standard treatment protocol for various NTMs by international organization bodies. This will be possible with establishing laboratories and produce skilled individuals in the medical university to do research in various filed of NTMs.
Mycobacterium in Iran
The main focus of mycobacteria in Mycobacterium was detection of Mycobacterium tuberculosis, Mycobacterium bovis, M. bovis-BCG, and Mycobacterium leprae.
There are currently 423 public laboratories in the country for direct smearing (DSM) and 42 laboratories for Mycobacterium culture, and only 9 diagnostic centers for susceptibility and identification from tuberculosis (TB) and NTMs [Figure 1]. Only National TB Reference Laboratory in Iran is capable of identifying subspecies of NTMs and preforms second-line drug resistant, based on the Ministry of Health information,, [Figure 1]. Furthermore, there are some governmental organizations such as Pasteur and Razi Institutes that detect TB and NTM species within the country. However, in a country with more than 82,000,000 people which has a cross-border whit countries such as Afghanistan, Iraq, Pakistan, and post-Russian countries, the need for more specialized and academic skilled personals in mycobacteriology is essential.
|Figure 1: Government tuberculosis laboratory network (including the number of laboratories available by type of activity). Purple color: Three centers that have the ability to identifying subspecies of nontuberculosis mycobacterium in Iran: 1 - National Tuberculosis Reference Laboratory, 2 - Pasteur Institute, 3 - Razi Institute|
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Bahrmand et al. (1993–1994) were among the first who isolated 82 NTM species from 6472 patients with suspected TB. They identified Mycobacterium fortuitum 26.8% followed by Mycobacterium gastri 23.1% and Mycobacterium terrae complex 18.3% from identified NTMs. Velayati et al. (2015) reported that the published information about NTM strains from clinical and environmental samples for 22 years in Iran (1992–2014). A total of 997 NTMs were found, whereof the rapidly growing mycobacterial species M. fortuitum (229/997; 23%) was most commonly isolated in both clinical (28%) and environmental (19%) samples. Among slow-growing mycobacteria, Mycobacterium simiae (103/494; 21%) was more common in clinical samples while in environmental samples was Mycobacterium flavescens (44/503; 9%) [Figure 2]. Overall, only 9 centers are active which are not even covered ½ of the country. Thereby, the information about the prevalence of NTMs is not clear in majority of regional cities of Iran [Figure 1].
|Figure 2: The provinces of Iran which work on nontuberculosis mycobacterium in clinical or environmental samples. The most prevalent slow-growing mycobacteria and rapid-growing mycobacteria were noted. In the last 22 years, there have been limited reports of non-tuberculous mycobacteria. But as can be seen in the picture, most places in the counry did not have any clinical epidemiology reports of non-tuberculous mycobacteria. The majority of reported nontuberculosis mycobacteria are case reports and notes based on classical epidemiological studies|
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It is important to note that in Iran, like most other developing countries, more than 60% of TB staff works in the network of national TB laboratories have no academic education and/or higher university degree related to mycobacteriology. As a result, the need for specialized personnel in this field seems to be necessary. Even the WHO protocols are more emphasize on TB complex isolation rather than NTM species identification and distribution. It is already known that NTMs exist in all environments such as water, soil, and air, but there were generally considered to be opportunistic bacteria. However, we know that these opportunistic bacteria can very well infect humans in considerable amount. Hence, there is a need to be more precaution when we discuss mycobacterial species. For example, in the study performed by Farnia et al. (2019), 983 NTMs were found in environments, whereas 1107 were isolated from humans infected with NTMs. It should also be noted that recent reports showed the different geographical distribution of NTMs in various places in Iran and other countries,,,,,,,, [Figure 3]. Based on most of the review literatures, Mycobacterium family can cause diseases with similar histopathological and radiological patterns, which can mislead the physicians, due to lack of proper laboratory reports.
|Figure 3: Overview of tuberculosis prevalence in different regions of Iran|
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Despite all of the mentioned problems, which underline the high importance of NTMs, some individuals and/or organizations will still have difficulty to accept the reality of the problem. This is mainly because their financial profits will be jeopardized. However, it should be noted that the main purpose of establishing a university major will help us to improve the community health. Keeping in mind, the similar educational subject such as virology, mycology, and parasitology did exist in the university and produced skilled personals that could improve and control the spreading of disease related to this microorganism using standard protocols, and by doing research, they could answer many unsolved questions. Thereby, educating individual for 3 years in specific field will not only increase their knowledge of basic science, but also the result of their thesis work on Mycobacterium can be used in different fields of investigations.
In view of all issues regarding the importance of this large family, we suggest that there is a need to establish an academic course in the level of postgraduate study as a “medical mycobacteriology.”
In fact, we should consider mycobacteria as a separate group such as mycology, virology, and parasitology which were previously studied under microbiology, but now with advances in science, each of them has different levels of academic education in the universities.
What to study in Master of Science degree of medical mycobacteriology
The main purpose of establishing this academic major is to train skilled individuals to study and work with large families of mycobacteria. They will be able to detect, diagnose, control, and prevent related diseases belonging to this family. The graduated students can help the community by their skilled professionals and will be improved the health-care system by properly dealing with the disease caused by mycobacteria. On the other hand, many new fields of research will be developed that can be used for treatment, transmission, and/or vaccine production in each subfamily of Mycobacterium [Table 1].
|Table 1: The list of mycobacteria published by the International Code of Nomenclature of Bacteria|
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Reasons for needing this academic major
- High burden of diseases by NTMs
- The lack of this academically major in most of the laboratories, especially in resource-limited countries
- The need for skilled individuals.
What are the main tasks of the graduates of this field?
- Screening and prevention of diseases caused by NTMs
- Research on NTM in order to identify and control their underline mechanisms in the host
- Preparing standards and effective diagnostic methods
- Preparing the standard treatment protocols
- Research and development of NTMs in host cellular and humoral system.
Courses overlapping with this academic major
The general and specific courses offered in this field are compiled according to [Table 2], [Table 3], [Table 4], which do not have any overlap compared to the syllabus of masters and doctoral degrees in medical microbiology, medical bacteriology, and medical mycology.
|Table 2: Compensatory courses for Master of Science in medical mycobacteriology|
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|Table 3: Compulsory specialized courses in the field of medical mycobacteriology|
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|Table 4: Optional specialized courses in the field of medical mycobacteriology|
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The specifications of this field (Master of Science Degree Program in Mycobacteriology) and our proposed syllabus are as follows:
- Degree name: Master of Science (MSc) in Medical Mycobacteriology.
- Program structure and contents: According to the regulations of the master's degree approved by the High Planning Council.
- Name and number of courses: The student in this field must complete the following units.
- A – Special courses (compulsory) in 22 units
- B – Special courses (optional) in 4 units
- C – Thesis in 6 units
Total 32 units.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3], [Table 4]