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He Y, Wu YH, Han C, Gong HZ, Wang MS. Bronchial brushing Xpert improves the diagnostic efficiency of sputum Xpert in patients with pulmonary tuberculosis. Ther Adv Infect Dis 2021; 8:20499361211020174. [PMID: 34164125 PMCID: PMC8188970 DOI: 10.1177/20499361211020174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 05/05/2021] [Indexed: 12/02/2022] Open
Abstract
Background: The role of bronchial brushing Xpert MTB/RIF (hereafter referred to as Xpert) in patients with pulmonary tuberculosis (PTB) remains unclear. Therefore, a retrospective study was conducted aiming to evaluate the diagnostic efficiency of bronchial brushing Xpert in patients with PTB. Methods: Between July 2018 and August 2019, suspected PTB patients who were admitted to our hospital and had bronchial brushing and matched sputum collection for acid-fast bacilli (AFB) smear, mycobacterial culture, and Xpert were included for further analysis. Subsequently, PTB was defined based on mycobacterial culture, and if an alternative diagnosis was established, ‘non-tuberculosis (TB)’ was considered. Comparison of bronchial brushing and matched sputum examination was performed between groups. Then, the differences in the sensitivities between bronchial brushing and sputum Xpert were examined using the chi-square test. Results: A total of 111 patients were included and divided into TB and non-TB groups (52 versus 59 patients). The sensitivities of Xpert against culture were calculated as follows: sputum, 44.2% (23/52); bronchial brushing, 59.6% (31/52); sputum and bronchial brushing, 69.2% (36/52). The specificities of all Xpert assays were the same (100.0%, 59/59). A significant difference was found in the comparison of the sensitivities of Xpert using sputum, bronchial brushing and both, and the sensitivity of Xpert on both sputum and bronchial brushing was higher than that on sputum alone (p < 0.05). Moreover, it appears that bronchial brushing Xpert was more sensitive than sputum Xpert in the detection of PTB. Conclusion: Bronchial brushing Xpert improves the diagnostic efficiency of sputum Xpert in the detection of PTB.
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Affiliation(s)
- Yu He
- Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yan-Hua Wu
- Department of Lab Medicine, Shandong Provincial Chest Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Chao Han
- Department of Geriatrics, Shandong Mental Health Center, Jinan, China
| | - Huai-Zheng Gong
- Department of Lab Medicine, Shandong Provincial Chest Hospital, 46# Lishan Road, Jinan City, 250013, PR China
| | - Mao-Shui Wang
- Department of Lab Medicine, Shandong Provincial Chest Hospital, 46# Lishan Road, Jinan City, 250013, PR China
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Katale BZ, Mbugi EV, Keyyu JD, Fyumagwa RD, Rweyemamu MM, van Helden PD, Dockrell HM, Matee MI. One Health approach in the prevention and control of mycobacterial infections in Tanzania: lessons learnt and future perspectives. ONE HEALTH OUTLOOK 2019; 1:2. [PMID: 33829123 PMCID: PMC7990093 DOI: 10.1186/s42522-019-0002-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 09/24/2019] [Indexed: 06/12/2023]
Abstract
BACKGROUND One Health (OH) is an integrated approach, formed inclusive of using multiple disciplines to attain optimal health for humans, animals, and the environment. The increasing proximity between humans, livestock, and wildlife, and its role in the transmission dynamics of mycobacterial infections, necessitates an OH approach in the surveillance of zoonotic diseases. The challenge remains as humans, livestock, and wildlife share resources and interact at various interfaces. Therefore, this review explores the potential of the OH approach to understand the impact of mycobacterial infections in Tanzania in terms of lessons learnt and future perspectives. MATERIALS AND METHODS Available literature on OH and mycobacterial infections in Tanzania was searched in PubMed, Google Scholar, and Web of Science. Articles on mycobacterial infections in Tanzania, published between 1997 to 2017, were retrieved to explore the information on OH and mycobacterial infections. MAIN BODY The studies conducted in Tanzania had have reported a wide diversity of mycobacterial species in humans and animals, which necessitates an OH approach in surveillance of diseases for better control of infectious agents and to safeguard the health of humans and animals. The close proximity between humans and animals increases the chances of inter-specific transmission of infectious pathogens, including drug-resistant mycobacteria. In an era where HIV co-infection is also the case, opportunistic infection by environmental non-tuberculous mycobacteria (NTM), commonly known as mycobacteria other than tuberculosis (MOTT) may further exacerbate the impact of drug resistance. NTM from various sources have greatest potential for diverse strains among which are resistant strains due to continued evolutional changes. CONCLUSION A collaborative interdisciplinary approach among professionals could help in solving the threats posed by mycobacterial infections to public health, particularly by the spread of drug-resistant strains.
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Affiliation(s)
- Bugwesa Z. Katale
- Department of Microbiology and Immunology, School of Medicine, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
- Tanzania Wildlife Research Institute (TAWIRI), Arusha, Tanzania
- Southern African Centre for Infectious Diseases Surveillance (SACIDS), Sokoine University of Agriculture (SUA), Chuo Kikuu, Morogoro, Tanzania
| | - Erasto V. Mbugi
- Department of Biochemistry, School of Medicine, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Julius D. Keyyu
- Tanzania Wildlife Research Institute (TAWIRI), Arusha, Tanzania
| | | | - Mark M. Rweyemamu
- Southern African Centre for Infectious Diseases Surveillance (SACIDS), Sokoine University of Agriculture (SUA), Chuo Kikuu, Morogoro, Tanzania
| | - Paul D. van Helden
- DST/NRF Centre of Excellence for Biomedical Tuberculosis Research/ South African Medical Research Council (MRC) Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Hazel M. Dockrell
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Mecky I. Matee
- Department of Microbiology and Immunology, School of Medicine, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
- Southern African Centre for Infectious Diseases Surveillance (SACIDS), Sokoine University of Agriculture (SUA), Chuo Kikuu, Morogoro, Tanzania
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Wang MG, Luo L, Zhang Y, Liu X, Liu L, He JQ. Treatment outcomes of tuberculous meningitis in adults: a systematic review and meta-analysis. BMC Pulm Med 2019; 19:200. [PMID: 31694599 PMCID: PMC6833188 DOI: 10.1186/s12890-019-0966-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 10/18/2019] [Indexed: 02/05/2023] Open
Abstract
Background Tuberculous meningitis is the most devastating presentation of disease with Mycobacterium tuberculosis. We sought to evaluate treatment outcomes for adult patients with this disease. Methods The Ovid MEDLINE, EMBASE, Cochrane Library and Web of Science databases were searched to identify all relevant studies. We pooled appropriate data to estimate treatment outcomes at the end of treatment and follow-up. Results Among the articles identified, 22 met our inclusion criteria, with 2437 patients. In a pooled analysis, the risk of death was 24.7% (95%CI: 18.7–31.9). The risk of neurological sequelae among survivors was 50.9% (95%CI: 40.2–61.5). Patients diagnosed in stage III or human immunodeficiency virus (HIV) positive were significantly more likely to die (64.8, 53.4% respectively) during treatment. The frequency of cerebrospinal fluid (CSF) acid-fast-bacilli smear positivity was 10.0% (95% CI 5.5–17.6), 23.8% (15.2–35.3) for CSF culture positivity, and 22.3% (17.8–27.5) for CSF polymerase chain reaction positivity. We found that the headache, fever, vomiting, and abnormal chest radiograph were the most common symptoms and diagnostic findings among tuberculous meningitis patients. Conclusions Despite anti-tuberculosis treatment, adult tuberculous meningitis has very poor outcomes. The mortality rate of patients diagnosed in stage III or HIV co-infection increased significantly during treatment.
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Affiliation(s)
- Ming-Gui Wang
- Department of Respiratory and Critical Care Medicine West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Chengdu, 610041, China
| | - Lan Luo
- Department of Respiratory and Critical Care Medicine West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Chengdu, 610041, China
| | - Yunxia Zhang
- Chengdu Medical College, Chengdu, Sichuan Province, People's Republic of China
| | - Xiangming Liu
- Department of Respiratory and Critical Care Medicine West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Chengdu, 610041, China
| | - Lin Liu
- Department of Respiratory and Critical Care Medicine, 363 Hospital, Chengdu, Sichuan Province, People's Republic of China
| | - Jian-Qing He
- Department of Respiratory and Critical Care Medicine West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Chengdu, 610041, China.
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4
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Wang MG, Xue M, Wu SQ, Zhang MM, Wang Y, Liu Q, Sandford AJ, He JQ. Abbott RealTime MTB and MTB RIF/INH assays for the diagnosis of tuberculosis and rifampicin/isoniazid resistance. INFECTION GENETICS AND EVOLUTION 2019; 71:54-59. [PMID: 30902741 DOI: 10.1016/j.meegid.2019.03.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 03/18/2019] [Accepted: 03/18/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND The Abbott RealTime MTB (Abbott-RT) and Abbott RealTime MTB RIF/INH Resistance (Abbott-RIF/INH) assays have been introduced for the detection of tuberculosis (TB) and drug-resistant tuberculosis (DR-TB). We performed a systematic review and meta-analysis to assess the accuracy of Abbott-RT and Abbott-RIF/INH for the detection of TB and DR-TB. METHODS The Ovid MEDLINE, EMBASE, Cochrane and Web of Science databases were searched to identify eligible articles for the systematic review. The pooled analyses were calculated with a bivariate model. Hierarchical summary receiver operating characteristic curves and the area under the curve (AUC) were used to summarize overall diagnostic performance. Deeks' test was performed to evaluate potential publication bias. RESULTS For the Abbott-RT assay, 9 studies including 3, 640 patients met the study criteria. The pooled sensitivity of Abbott-RT for detecting TB was 0.96 (95% CI: 0.88-0.99) and specificity was 0.97 (95% CI: 0.93-0.99). For DR-TB, four studies were included to evaluate the diagnosis accuracy of Abbott-RIF/INH. The pooled sensitivity was 0.88 (95% CI, 0.82-0.93) and specificity was 0.99 (95% CI, 0.96-0.99). No publication bias was found. CONCLUSION Both Abbott-RT and Abbott-RIF/INH assays have good sensitivity, specificity and accuracy for the diagnosis of TB and DR-TB.
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Affiliation(s)
- Ming-Gui Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Miao Xue
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Shou-Quan Wu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Miao-Miao Zhang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yu Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Qianqian Liu
- Department of Respiratory Diseases, Chengdu Municipal First People's Hospital, Chengdu 610041, China
| | - Andrew J Sandford
- Centre for Heart Lung Innovation, University of British Columbia and St. Paul's Hospital, Vancouver V6T 1Z4, Canada
| | - Jian-Qing He
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China.
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Baldassarri RJ, Kumar D, Baldassarri S, Cai G. Diagnosis of Infectious Diseases in the Lower Respiratory Tract: A Cytopathologist's Perspective. Arch Pathol Lab Med 2018; 143:683-694. [PMID: 30203986 DOI: 10.5858/arpa.2017-0573-ra] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Respiratory cytology continues to play an important role in the diagnosis of lower respiratory tract infections. Prompt, accurate diagnosis of causative organisms is of paramount importance, particularly in immunosuppressed patients. In addition, a rapidly expanding arsenal of ancillary testing is now available, aiding tremendously in organism identification. OBJECTIVE.— To provide an updated review on the cytomorphologic features of common organisms in lower respiratory tract infection. Relevant ancillary tests, differential diagnoses, and potential pitfalls of organism identification will also be discussed. DATA SOURCES.— Data for this review were gathered from PubMed searches of infectious diseases of the lower respiratory tract, especially related to the diagnoses. CONCLUSIONS.— The lower respiratory tract is subject to infection by a wide variety of infectious agents. Pathologists should be familiar with common organisms, including their general clinical characteristics, cytomorphologic features, differential diagnoses, and ancillary methods of detection. Above all, correlation with microbiologic and clinical information is necessary to make a confident diagnosis of infection.
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Affiliation(s)
- Rebecca J Baldassarri
- From the Departments of Pathology (Drs R. J. Baldassarri, Kumar, and Cai) and Internal Medicine (Dr S. Baldassarri), Yale School of Medicine, New Haven, Connecticut
| | - Deepika Kumar
- From the Departments of Pathology (Drs R. J. Baldassarri, Kumar, and Cai) and Internal Medicine (Dr S. Baldassarri), Yale School of Medicine, New Haven, Connecticut
| | - Stephen Baldassarri
- From the Departments of Pathology (Drs R. J. Baldassarri, Kumar, and Cai) and Internal Medicine (Dr S. Baldassarri), Yale School of Medicine, New Haven, Connecticut
| | - Guoping Cai
- From the Departments of Pathology (Drs R. J. Baldassarri, Kumar, and Cai) and Internal Medicine (Dr S. Baldassarri), Yale School of Medicine, New Haven, Connecticut
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Wu J, Kong C, Huo F, Liang Q, Ma Y, Shang Y, Zhao L, Du J, Sun Z. The Mono-Prep system increases the detection rate of sputum smear microscopy for diagnosing tuberculosis. J Int Med Res 2018; 46:5137-5142. [PMID: 30178688 PMCID: PMC6300963 DOI: 10.1177/0300060518792354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective Direct sputum smear microscopy (DSSM) has a low detection rate. This study investigated whether an alternative method called Mono-Prep smear microscopy (MPSM) can enhance the diagnosis of tuberculosis in tuberculosis laboratories that perform direct smear microscopy in China. Methods A total of 117 sputum samples were collected from outpatients who attended Beijing Chest Hospital. DSSM, MPSM, solid culture, and Xpert MTB/RIF were performed on the samples. Results The positive rates of DSSM, MPSM, solid culture, and Xpert MTB/RIF were 27.4% (32/117), 40.2% (47/117), 35.9% (42/117), and 52.1% (61/117), respectively. MPSM could detect 15 more cases of tuberculosis compared with DSSM (47 vs 32) among 117 sputum samples. This represented a significantly higher positive rate and sensitivity of MPSM compared with DSSM. However, MPSM appeared to have a lower specificity (81.3%) compared with DSSM (90.7%) with the solid culture used as a standard. Conclusion Use of MPSM can increase the number of positive sputum samples, but it still needs improvement.
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Affiliation(s)
- Jiannan Wu
- 1 National Tuberculosis Clinical Laboratory, Beijing Chest Hospital, Capital Medical University, Beijing, China.,2 Beijing Key Laboratory for Drug Resistance Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Chengcheng Kong
- 1 National Tuberculosis Clinical Laboratory, Beijing Chest Hospital, Capital Medical University, Beijing, China.,2 Beijing Key Laboratory for Drug Resistance Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Fengmin Huo
- 1 National Tuberculosis Clinical Laboratory, Beijing Chest Hospital, Capital Medical University, Beijing, China.,2 Beijing Key Laboratory for Drug Resistance Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Qian Liang
- 1 National Tuberculosis Clinical Laboratory, Beijing Chest Hospital, Capital Medical University, Beijing, China.,2 Beijing Key Laboratory for Drug Resistance Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Yifeng Ma
- 1 National Tuberculosis Clinical Laboratory, Beijing Chest Hospital, Capital Medical University, Beijing, China.,2 Beijing Key Laboratory for Drug Resistance Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Yuanyuan Shang
- 1 National Tuberculosis Clinical Laboratory, Beijing Chest Hospital, Capital Medical University, Beijing, China.,2 Beijing Key Laboratory for Drug Resistance Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Liping Zhao
- 1 National Tuberculosis Clinical Laboratory, Beijing Chest Hospital, Capital Medical University, Beijing, China.,2 Beijing Key Laboratory for Drug Resistance Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Jian Du
- 3 Administration Office, Clinical Center on Tuberculosis Control, Chinese Center for Disease Control and Prevention, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Zhaogang Sun
- 1 National Tuberculosis Clinical Laboratory, Beijing Chest Hospital, Capital Medical University, Beijing, China.,2 Beijing Key Laboratory for Drug Resistance Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
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Performance of a Highly Sensitive Mycobacterium tuberculosis Complex Real-Time PCR Assay for Diagnosis of Pulmonary Tuberculosis in a Low-Prevalence Setting: a Prospective Intervention Study. J Clin Microbiol 2018. [PMID: 29540457 DOI: 10.1128/jcm.00116-18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The potential impact of routine real-time PCR testing of respiratory specimens from patients with presumptive tuberculosis in terms of diagnostic accuracy and time to tuberculosis treatment inception in low-prevalence settings remains largely unexplored. We conducted a prospective intervention cohort study. Respiratory specimens from 1,020 patients were examined by acid-fast bacillus smear microscopy, tested by a real-time Mycobacterium tuberculosis complex PCR assay (Abbott RealTime MTB PCR), and cultured in mycobacterial media. Seventeen patients tested positive by PCR (5 were acid-fast bacillus smear positive and 12 acid-fast bacillus smear negative), and Mycobacterium tuberculosis was recovered from cultures for 12 of them. Patients testing positive by PCR and negative by culture (n = 5) were treated and deemed to have responded to antituberculosis therapy. There were no PCR-negative/culture-positive cases, and none of the patients testing positive for nontuberculous mycobacteria (n = 20) yielded a positive PCR result. The data indicated that routine testing of respiratory specimens from patients with presumptive tuberculosis by the RealTime MTB PCR assay improves the tuberculosis diagnostic yield and may reduce the time to antituberculosis treatment initiation. On the basis of our data, we propose a novel mycobacterial laboratory algorithm for tuberculosis diagnosis.
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8
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Abstract
The list of clinically important slow-growing nontuberculous mycobacteria (NTM) continues to expand as new species are identified and older ones are found to be pathogenic. Based on pigment production, the strains may be classified as photochromogenic, scotochromogenic, or unpigmented. Some of these organisms are not newly discovered but have heretofore been considered virtually nonpathogenic. Previously, many were regarded as contaminants when isolated from clinical specimens. Ubiquitous in nature, many NTM have been isolated from groundwater or tap water, soil, house dust, domestic and wild animals, and birds. Most infections result from inhalation or direct inoculation from environmental sources. They are not spread from person to person. The infections may be localized or disseminated. In most cases, the optimal regimen or duration of therapy has not been firmly established. The results of in vitro susceptibility testing may be used to select a therapeutic regimen. Many experts recommend clarithromycin with companion drugs such as rifampin and ethambutol for most, but not all, slowly growing species. Aminoglycosides, clofazimine, fluoroquinolones, linezolid, pyrazinamide, or trimethoprim-sulfamethoxazole also may be effective against some strains. Immunocompetent patients with clinically significant infections with NTM usually should receive 18 to 24 months of therapy. Infected immunocompromised patients, particularly those with disseminated infection, probably should receive therapy as long as their immune systems remain impaired. Some of the species discussed include Mycobacterium alsiense, M. celatum, M. gordonae, M. haemophilum, M. kyorinense, M. malmoense, M. simiae complex, M. szulgai, M. terrae complex, M. ulcerans, and M. xenopi.
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9
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Hinić V, Feuz K, Turan S, Berini A, Frei R, Pfeifer K, Goldenberger D. Clinical evaluation of the Abbott RealTime MTB Assay for direct detection of Mycobacterium tuberculosis-complex from respiratory and non-respiratory samples. Tuberculosis (Edinb) 2017; 104:65-69. [PMID: 28454651 DOI: 10.1016/j.tube.2017.03.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 02/27/2017] [Accepted: 03/02/2017] [Indexed: 10/20/2022]
Abstract
Rapid and reliable diagnosis is crucial for correct management of tuberculosis. The Abbott RealTime MTB Assay represents a novel qualitative real-time PCR assay for direct detection of M. tuberculosis-complex (MTB) DNA from respiratory samples. The test targets two highly conserved sequences, the multi-copy insertion element IS6110 and the protein antigen B (PAB) gene of MTB, allowing even the detection of IS6610-deficient strains. We evaluated this commercial diagnostic test by analyzing 200 respiratory and, for the first time, 87 non-respiratory clinical specimens from our tertiary care institution and compared its results to our IS6110-based in-house real-time PCR for MTB as well as MTB culture. Overall sensitivity for Abbott RealTime MTB was 100% (19/19) in smear positive and 87.5% (7/8) in smear negative specimens, while the specificity of the assay was 100% (260/260). For both non-respiratory smear positive and smear negative specimens Abbott RealTime MTB tests showed 100% (8/8) sensitivity and 100% (8/8) specificity. Cycle threshold (Ct) value analysis of 16 MTB positive samples showed a slightly higher Ct value of the Abbott RealTime MTB test compared to our in-house MTB assay (mean delta Ct = 2.55). In conclusion, the performance of the new Abbott RealTime MTB Assay was highly similar to culture and in-house MTB PCR. We document successful analysis of 87 non-respiratory samples with the highly automated Abbott RealTime MTB test with no inhibition observed.
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Affiliation(s)
- Vladimira Hinić
- Division of Clinical Microbiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland.
| | - Kinga Feuz
- Division of Clinical Microbiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland.
| | - Selda Turan
- Division of Clinical Microbiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland.
| | - Andrea Berini
- Division of Clinical Microbiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland.
| | - Reno Frei
- Division of Clinical Microbiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland.
| | - Karin Pfeifer
- Abbott Molecular, Max-Planck-Ring 2, 65205 Wiesbaden, Germany.
| | - Daniel Goldenberger
- Division of Clinical Microbiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland.
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10
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Gundavda MK, Patil HG, Agashe VM, Soman R, Rodriques C, Deshpande RB. Nontuberculous mycobacterial infection of the musculoskeletal system in immunocompetent hosts. Indian J Orthop 2017; 51:205-212. [PMID: 28400668 PMCID: PMC5361473 DOI: 10.4103/0019-5413.201718] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Nontuberculous mycobacteria (NTM) were considered saprophytic organisms for many years but now are recognized as human pathogens. Although humans are routinely exposed to NTM, the rate of clinical infection is low. Such infections usually occur in the elderly and in patients who are immunocompromised. However, there has been an increasing incidence in recent years of infections in immunocompetent hosts. NTM infections in immunocompetent individuals are secondary to direct inoculation either contamination from surgical procedures or penetrating injuries rather than hematogenous dissemination. Clinically and on histopathology, musculoskeletal infections caused by NTM resemble those caused by Mycobacterium tuberculosis but are mostly resistant to routine antituberculosis medicines. MATERIALS AND METHODS Six cases of NTM infection in immunocompetent hosts presenting to the department from 2004 to 2015 were included in study. Of which two cases (one patella and one humerus) of infection were following an open wound due to trauma while two cases (one hip and one shoulder) of infection were by inoculation following an intraarticular injection for arthrogram of the joint, one case was infection following arthroscopy of knee joint and one case (calcaneum) was infection following local injection for the treatment of plantar fasciitis. All patients underwent inaging and tissue diagnosis with samples being sent for culture, staining, and histopathology. RESULTS Clinical suspicion of NTM inoculation led to the correct diagnosis (four cases with culture positive and two cases with histopathological diagnosis). There treatment protocol for extrapulmonary NTM infection was radical surgical debridement and medical management based on drug sensitivity testing in culture positive cases. At a mean follow up of 3 years (range1-9 years) all patients had total remission and excellent results. CONCLUSIONS Whenever a case of chronic granulomatous infection is encountered that does not respond to standard anti-tuberculous treatment, with a history of open trauma, surgical intervention, or injection as shown in this study, a possible NTM infection should be considered and managed appropriately.
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Affiliation(s)
- Manit K Gundavda
- Department of Orthopaedics, Hinduja Hospital and Medical Research Center, Mumbai, Maharashtra, India,Address for correspondence: Dr. Manit K Gundavda, B/204, Hilton CHS, Shastri Nagar, Andheri West, Mumbai - 400 053, Maharashtra, India. E-mail:
| | - Hitendra G Patil
- Department of Orthopaedics, Hinduja Hospital and Medical Research Center, Mumbai, Maharashtra, India
| | - Vikas M Agashe
- Department of Orthopaedics, Hinduja Hospital and Medical Research Center, Mumbai, Maharashtra, India
| | - Rajeev Soman
- Department of Infectious Diseases, Hinduja Hospital and Medical Research Center, Mumbai, Maharashtra, India
| | - Camilla Rodriques
- Department of Microbiology, Hinduja Hospital and Medical Research Center, Mumbai, Maharashtra, India
| | - Ramesh B Deshpande
- Department of Pathology, Hinduja Hospital and Medical Research Center, Mumbai, Maharashtra, India
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The Mycobacterium tuberculosis PPE protein Rv1168c induces stronger B cell response than Rv0256c in active TB patients. INFECTION GENETICS AND EVOLUTION 2015; 40:339-345. [PMID: 26364913 DOI: 10.1016/j.meegid.2015.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 07/30/2015] [Accepted: 09/08/2015] [Indexed: 10/23/2022]
Abstract
Tuberculosis (TB) caused by Mycobacterium tuberculosis is a serious global health problem and is responsible for millions of deaths every year. For effective control of this dreadful disease, it is necessary to diagnose TB cases at the initial stages of infection. The serodiagnosis of disease represents simple, rapid and inexpensive method that can be used at the primary health care levels. In this study we have compared sensitivity of two PPE proteins of M. tuberculosis, i.e., Rv0256c and Rv1168c for their use as serodiagnostic markers in active tuberculosis patients. Employing a standardized enzyme immunoassay with these PPE proteins as candidate antigens we were able to successfully discriminate the TB patients' sera from the BCG-vaccinated healthy controls. Further, we observed that Rv1168c displayed higher sensitivity in detecting extrapulmonary and smear negative pulmonary TB cases which are difficult to diagnose by available diagnostic methods. Overall the study highlights that Rv1168c can be used as a potential serodiagnostic marker for the diagnosis of active tuberculosis disease.
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12
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Sarmiento JMH, Restrepo NB, Mejía GI, Zapata E, Restrepo MA, Robledo J. Rapid diagnosis of pulmonary tuberculosis. Pan Afr Med J 2014; 18:141. [PMID: 25419279 PMCID: PMC4236790 DOI: 10.11604/pamj.2014.18.141.2295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 05/02/2014] [Indexed: 11/30/2022] Open
Abstract
Introduction World Health Organization had estimated 9.4 million tuberculosis cases on 2009, with 1.7 million of deaths as consequence of treatment and diagnosis failures. Improving diagnostic methods for the rapid and timely detection of tuberculosis patients is critical to control the disease. The aim of this study was evaluating the accuracy of the cord factor detection on the solid medium Middlebrook 7H11 thin layer agar compared to the Lowenstein Jensen medium for the rapid tuberculosis diagnosis. Methods Patients with suspected tuberculosis were enrolled and their sputum samples were processed for direct smear and culture on Lowenstein Jensen and BACTEC MGIT 960, from which positive tubes were subcultured on Middlebrook 7H11 thin layer agar. Statistical analysis was performed comparing culture results from Lowenstein Jensen and the thin layer agar, and their corresponding average times for detecting Mycobacterium tuberculosis. The performance of cord factor detection was evaluated determining its sensitivity, specificity, positive and negative predictive value. Results 111 out of 260 patients were positive for M. tuberculosis by Lowenstein Jensen medium with an average time ± standard deviation for its detection of 22.3 ± 8.5 days. 115 patients were positive by the MGIT system identifying the cord factor by the Middlebrook 7H11 thin layer agar which average time ± standard deviation was 5.5 ± 2.6 days. Conclusion The cord factor detection by Middlebrook 7H11 thin layer agar allows early and accurate tuberculosis diagnosis during an average time of 5 days, making this rapid diagnosis particularly important in patients with negative sputum smear.
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Affiliation(s)
- José Mauricio Hernández Sarmiento
- School of Health Sciences, Universidad Pontificia Bolivariana (UPB), Medellín, Colombia ; Bacteriology and Mycobacteriology Unit, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia
| | - Natalia Builes Restrepo
- Bacteriology and Mycobacteriology Unit, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia
| | - Gloria Isabel Mejía
- School of Health Sciences, Universidad Pontificia Bolivariana (UPB), Medellín, Colombia ; Bacteriology and Mycobacteriology Unit, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia
| | - Elsa Zapata
- Bacteriology and Mycobacteriology Unit, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia
| | - Mary Alejandra Restrepo
- Bacteriology and Mycobacteriology Unit, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia
| | - Jaime Robledo
- School of Health Sciences, Universidad Pontificia Bolivariana (UPB), Medellín, Colombia ; Bacteriology and Mycobacteriology Unit, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia
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Dizdar S, Dzinovic A, Gojak R, Bakalovic G, Selimovic A. Descriptive review of the patients suffering from tuberculosis in the past 10 years treated at pediatric clinic of clinical center of sarajevo university. Med Arch 2014; 68:317-8. [PMID: 25568562 PMCID: PMC4269533 DOI: 10.5455/medarh.2014.68.317-318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 09/15/2014] [Indexed: 12/02/2022] Open
Abstract
Introduction: Due to the geographical position of Bosnia and Herzegovina and its socio economic momentum even though the standard vaccination program is carried out, the child population continues to suffer from pulmonary tuberculosis in significant percentage. Material and methods: The study was retrospective and included patients who were in the period from January 1, 2004 to December 31, 2013 (or the 10 years period) hospitalized at the Department of Pulmonology Pediatric Clinic dually diagnosed with lung TB and start treatment. Data were adopted from available medical records (history of disease). Goal: The aim of the study was to determine the epidemiological and clinical characteristics of tuberculosis of the lungs in children who were hospitalized at the Pediatric Clinic. Results: In the period from January 1, 2004 to December 31, 2013 there were hospitalized a total of 50 children with a proven active infection with MBT, where it was initiated treatment with a specific therapy. From this number 44% of patients were aged from 5 to 10 years, 22% of patients were aged younger than 5 years. Peak incidence was in 2009. About 66% of patients had a positive history of sick close relative, while 10% of them had a history of contact with other sick person. From baseline 28% of patients were referred to the Department with suspicion of a specific process. From the total 70% of respondents were regularly vaccinated, and 29% of them had a visible BCG scar. In 55% of cases there was anamnestic information - decresed body weight, in 82% of cases the presence of cough, of which 52% of the occurrence of expectoration. In 78% of cases we had positive auscultatory findings of the lungs. In 14% of cases on X-ray of the lungs was noticed changes in terms of the primary complex positive. In this material we had one cavernous and one miliary TB of the lungs. Sputum or gastric lavage was positive in 62% of cases, and Quantiferon because of the lack of the same (in the past) was positive in 34% of cases. All subjects at the time of discharge were classified as recovered. In that period we had proven resistant TB. Conclusion: Bosnia and Herzegovina belongs to the group of countries with still present and evident TB. In the investigated period of ten years from the pediatric pulmonary TB, usually have suffered small children and adolescents. At moment of discharge, all patients were classified as recovered. In the teste material we did not have proven resistant TB.
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Affiliation(s)
- Selma Dizdar
- Pediatric clinic, Clinical center of University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Amra Dzinovic
- Pediatric clinic, Clinical center of University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Refet Gojak
- Clinic for Infectious Diseases, Clinical center of University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Ganimeta Bakalovic
- Pediatric clinic, Clinical center of University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Amina Selimovic
- Pediatric clinic, Clinical center of University of Sarajevo, Sarajevo, Bosnia and Herzegovina
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Kothavade RJ, Dhurat RS, Mishra SN, Kothavade UR. Clinical and laboratory aspects of the diagnosis and management of cutaneous and subcutaneous infections caused by rapidly growing mycobacteria. Eur J Clin Microbiol Infect Dis 2012; 32:161-88. [PMID: 23139042 DOI: 10.1007/s10096-012-1766-8] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Accepted: 10/15/2012] [Indexed: 10/27/2022]
Abstract
Rapidly growing mycobacteria (RGM) are known to cause pulmonary, extra-pulmonary, systemic/disseminated, and cutaneous and subcutaneous infections. The erroneous detection of RGM that is based solely on microscopy, solid and liquid cultures, Bactec systems, and species-specific polymerase chain reaction (PCR) may produce misleading results. Thus, inappropriate therapeutic measures may be used in dermatologic settings, leading to increased numbers of skin deformity cases or recurrent infections. Molecular tools such as the sequence analyses of 16S rRNA, rpoB and hsp65 or PCR restriction enzyme analyses, and the alternate gene sequencing of the superoxide dismutase (SOD) gene, dnaJ, the 16S-23S rRNA internal transcribed spacers (ITS), secA, recA1, dnaK, and the 32-kDa protein gene have shown promising results in the detection of RGM species. PCR restriction enzyme analyses (PRA) work better than conventional methods at identifying species that are closely related. Recently introduced molecular tools such as matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), pyrosequencing, DNA chip technology, and Beacon probes-combined PCR probes have shown comparable results in the detection of various species of RGM. Closely related RGM species (e.g., Mycobacterium fortuitum, M. chelonae, and M. abscessus) must be clearly differentiated using accurate molecular techniques because their therapeutic responses are species-specific. Hence, this paper reviews the following aspects of RGM: (i) its sources, predisposing factors, clinical manifestations, and concomitant fungal infections; (ii) the risks of misdiagnoses in the management of RGM infections in dermatological settings; (iii) the diagnoses and outcomes of treatment responses in common and uncommon infections in immunocompromised and immunocompetent patients; (iv) conventional versus current molecular methods for the detection of RGM; (v) the basic principles of a promising MALDI-TOF MS, sampling protocol for cutaneous or subcutaneous lesions and its potential for the precise differentiation of M. fortuitum, M. chelonae, and M. abscessus; and (vi) improvements in RGM infection management as described in the recent 2011 Clinical and Laboratory Standards Institute (CLSI) guidelines, including interpretation criteria of molecular methods and antimicrobial drug panels and their break points [minimum inhibitory concentrations (MICs)], which have been highlighted for the initiation of antimicrobial therapy.
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Affiliation(s)
- R J Kothavade
- Microbiology Lab, Epcor, 10065 Jasper Ave NW, Edmonton, AB, T5J 3B1, Canada.
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Min KW, Ko JY, Park CK. Histopathological spectrum of cutaneous tuberculosis and non-tuberculous mycobacterial infections. J Cutan Pathol 2012; 39:582-95. [PMID: 22616600 DOI: 10.1111/j.1600-0560.2012.01903.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The non-specific clinical findings and variable histopathological features of cutaneous tuberculosis and non-tuberculous mycobacterial infections often make it difficult to establish a diagnosis and initiate appropriate therapy. We investigated 25 patients diagnosed with mycobacterial infections of the skin in Hanyang University Hospital between 2001 and 2011. Skin biopsy specimens were re-evaluated by various histopathological criteria and molecular studies. To identify the mycobacteria, we performed staining for acid-fast bacilli and also completed polymerase chain reaction analysis. The non-tuberculous mycobacterium species were identified by genetic sequencing of formalin-fixed, paraffin-embedded tissues. Immunocompromised status was more frequent in non-tuberculous mycobacterial infections than in tuberculosis (p = 0.017) while disease duration was longer in tuberculosis (p = 0.026). Microscopically, neutrophil infiltration, interstitial granuloma, small vessel proliferation and increased numbers of bacilli were found to be associated with non-tuberculous mycobacterial infections (all p < 0.05). In contrast, giant cells, plasma cells, tuberculoid granulomas and necrosis were associated with tuberculosis (all p < 0.05). There were no species-specific histopathological findings in non-tuberculous mycobacterial infections. The significant histopathological differences between cutaneous tuberculous and non-tuberculous mycobacterial infections are helpful in considering differential diagnoses. In addition, molecular techniques together with clinico-pathological findings may assist in making accurate diagnoses of cutaneous non-tuberculous mycobacterial infections.
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Affiliation(s)
- Kyueng-Whan Min
- Department of Pathology, College of Medicine, Hanyang University, Seoul, Korea
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García-Martos P, García-Agudo L. [Infections due to rapidly growing mycobacteria]. Enferm Infecc Microbiol Clin 2011; 30:192-200. [PMID: 22133415 DOI: 10.1016/j.eimc.2011.09.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 08/30/2011] [Accepted: 09/10/2011] [Indexed: 01/07/2023]
Abstract
Rapidly growing mycobacteria (RGM) are ubiquitous in nature and widely distributed in water, soil and animals. During the past three decades we have observed a notable increment of infections caused by RGM, both localized and disseminated, as well as nosocomial outbreaks of contaminated medical equipment. The microbiological diagnosis of RGM infections includes direct microscopic observation and culture. The taxonomic identification is performed by phenotypic, biochemical, chromatographic and molecular biology techniques. The treatment differs from that of other mycobacteriosis like tuberculosis, owing to the variable in vitro susceptibility of the species of this group. The RGM are resistant to conventional antituberculous drugs, but can be susceptible to broad spectrum antimicrobial agents. In this study we comment on the significant aspects of human infections by RGM, including their biology, epidemiology, pathology, microbiological diagnosis, taxonomic identification, antimicrobial susceptibility and treatment.
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Affiliation(s)
- Pedro García-Martos
- Unidad de Micobacterias, Servicio de Microbiología, Hospital Universitario Puerta del Mar, Cádiz, Spain.
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Amin I, Idrees M, Awan Z, Shahid M, Afzal S, Hussain A. PCR could be a method of choice for identification of both pulmonary and extra-pulmonary tuberculosis. BMC Res Notes 2011; 4:332. [PMID: 21899772 PMCID: PMC3224489 DOI: 10.1186/1756-0500-4-332] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Accepted: 09/08/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nucleic acid amplification assays including PCR have revolutionized the detection of Mycobacterium tuberculosis (MTB). Tuberculosis spread to almost every organ of the body and is characterized on the basis of localization of infection. Therefore, different types of body fluids and tissues can be used for the detection of MTB.From 2004 to 2010 total 766 different types of smear negative samples from patients, clinically suspected for tuberculosis were received and investigated at Division of Molecular Diagnostics, University of the Punjab Lahore for the diagnosis of tuberculosis. Mycobacterial DNA was extracted followed by PCR amplification. FINDINGS A total of 356 (46.5%) samples were found positive by PCR for MTB. These included; serum (4.8%), blood (36.3%), urine (46.6%), cerebro spinal fluid (CSF) (42.1%), ascetic fluid (67.6%), pleural fluid (52%), pericardial fluid (30%), pus (38.6%), bone marrow (60%), sputum (38.8%) and bronchoalveolar lavage (BAL) (70%). Over all there was no significant difference in males and females neither in different age groups for the identification of MTB. CONCLUSION We conclude that PCR is a useful and sensitive tool for the early diagnosis of MTB in variety of clinical samples.
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Affiliation(s)
- Iram Amin
- Division of Molecular Virology & Molecular Diagnostics, National Centre of Excellence in Molecular Biology, University of the Punjab, Lahore-53500, Pakistan.
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Is it appropriate to routinely use a nucleic acid amplification test for the diagnosis of tuberculosis? Kaohsiung J Med Sci 2011; 27:138-43. [DOI: 10.1016/j.kjms.2010.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Accepted: 06/07/2010] [Indexed: 11/17/2022] Open
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Song HJ, An JS, Han J, Koh WJ, Kim HK, Choi YS. Pathologic Findings of Surgically Resected Nontuberculous Mycobacterial Pulmonary Infection. KOREAN JOURNAL OF PATHOLOGY 2010. [DOI: 10.4132/koreanjpathol.2010.44.1.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Hye-Jong Song
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Suk An
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joungho Han
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Jung Koh
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hong Kwang Kim
- Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong Soo Choi
- Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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20
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Wilson M. Medical Microbiology: Assuring the Quality of Clinical Microbiology Test Results. Clin Infect Dis 2008; 47:1077-82. [DOI: 10.1086/592071] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Evaluation of methods for rapid detection of resistance to isoniazid and rifampin in Mycobacterium tuberculosis isolates collected in the Caribbean. J Clin Microbiol 2008; 46:3426-8. [PMID: 18701663 DOI: 10.1128/jcm.01455-08] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The rapid identification of drug-resistant strains of Mycobacterium tuberculosis is crucial for the timely initiation of appropriate antituberculosis therapy. The performance of the Genotype MTBDRplus assay was compared with that of the Bactec 460 TB system, a "gold standard" culture-based method. The Genotype MTBDRplus assay was quicker and more cost-effective for the detection of rifampin resistance, but it was not as good for the detection of isoniazid-resistant strains in our setting.
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22
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Pulmonary infections associated with non-tuberculous mycobacteria in immunocompetent patients. THE LANCET. INFECTIOUS DISEASES 2008; 8:323-34. [DOI: 10.1016/s1473-3099(08)70100-2] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Martins M, Viveiros M, Amaral L. The TB laboratory of the future: macrophage-based selection of XDR-TB therapeutics. Future Microbiol 2008; 3:135-44. [DOI: 10.2217/17460913.3.2.135] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Therapy of multidrug-resistant (MDR)-TB is highly problematic; that of extensively drug-resistant (XDR)-TB even more so. Both infections result in high mortality, especially if the patient is coinfected with HIV or presents with AIDS. Selection of therapy for these infections is limited and, for most situations, it is performed ‘blind’. However, there is a solution for the selection of effective therapy and this is presented herein. Ideal therapy of the patient infected with MDR-TB or XDR-TB can be determined a priori by the mycobacteriology laboratory. This would involve the isolation of the patient’s macrophages, the phagocytosis of the mycobacterial isolate and the presentation of the antitubercular agent to the macrophage–bacterium complex. This system is reviewed in its entirety and its potential and feasibility are supported by hard experimental demonstrations.
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Affiliation(s)
- Marta Martins
- Unit of Mycobacteriology, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Rua da Junqueira, 96, 1349-008 Lisboa, Portugal and, UPMM, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Rua da Junqueira, 96, 1349-008 Lisboa, Portugal
| | - Miguel Viveiros
- Unit of Mycobacteriology, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Rua da Junqueira, 96, 1349-008 Lisboa, Portugal
| | - Leonard Amaral
- Unit of Mycobacteriology, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Rua da Junqueira, 96, 1349-008 Lisboa, Portugal and UPMM, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Rua da Junqueira, 96, 1349-008 Lisboa, Portugal
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Beqaj SH, Flesher R, Walker GR, Smith SA. Use of the real-time PCR assay in conjunction with MagNA Pure for the detection of mycobacterial DNA from fixed specimens. ACTA ACUST UNITED AC 2007; 16:169-73. [PMID: 17721325 DOI: 10.1097/pdm.0b013e318037552e] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Tuberculosis in immunocompromised patients is often caused by Mycobacterial species other than Mycobacterium tuberculosis. Thus, detection of and differentiation between M. tuberculosis and nontuberculosis species is necessary for diagnosis of disease in these patients. Furthermore, when tissue changes show granulomatous inflammation, quick confirmation testing for mycobacterial infection is needed for conclusive diagnosis. The aim of this study was to validate the utility of a real-time polymerase chain reaction (PCR) assay in conjunction with the MagNA Pure LC automated extraction system for the detection of mycobacterial DNA from formalin-fixed, paraffin-embedded specimens. A total of 46 archived, paraffin-embedded, fixed specimens showing granulomatous inflammation were studied for mycobacterial infection by real-time PCR. Bacterial DNA was extracted and isolated using the MagNA Pure extraction system. Real-time PCR was performed on the LightCycler using the Artus Real Art Mycob Diff ASR kit from Qiagen. Thirteen of the 46 patient specimens were positive for mycobacterial infection by acid-fast bacilli (AFB) stain. Of the13 reported positive by AFB stain, 12 where positive by real-time PCR. All 13 specimens reported positive by AFB were sent for culture confirmation. Eleven of 13 were returned positive by culture. Specimens reported as negative by culture and positive by real-time PCR were confirmed positive by a second PCR method from another reference laboratory. We believe that these studies are beneficial in the differential diagnosis of mycobacterial infection from fixed tissue specimens where tuberculosis might not have been clinically initially suspected and when specimens are not suitable for microbiologic examination.
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Falconi FQ, Suárez LI, López MDJC, Sancho CG. Comparison of the VersaTREK system and Löwenstein-Jensen medium for the recovery of mycobacteria from clinical specimens. ACTA ACUST UNITED AC 2007; 40:49-53. [PMID: 17852938 DOI: 10.1080/00365540701522967] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Laboratory services for the detection of tuberculosis form an essential component of the DOTS strategy. Our objective was to evaluate the recovery rate and mean time to detection (TTD) of mycobacteria of 2 culture media: the VersaTREK system and the Löwenstein-Jensen medium (LJ). Clinical specimens were processed using the standard N-acetyl-L-cysteine (NALC)-NaOH method, and then inoculated onto VersaTREK system and LJ slants. Of 1510 specimens cultured, a total of 200 mycobacterial isolates (159 Mycobacterium tuberculosis and 41 no M. tuberculosis mycobacteria) were detected. The recovery rates were 84.8% (168/198) for the VersaTREK system and 89.4% (168/188) for LJ (p=0.2); while the contamination rates were 4.2% for the VersaSATREK system and 7.4% for LJ (p<0.001). The TTDs for mycobacteria spp. were 18.2 (+/-11.4) d for the VersaTREK system and 27.9 (+/-10.9) d for LJ (p<0.001). The TTDs for M. tuberculosis were 19.8 (+/-11.2) d for the VersaTREK system and 27.3 (+/-10.2) d for LJ (p<0.001). The difference in TTD between smear-positive and smear-negative specimens for Mycobacterium spp. was 15.9 (+/-10.0) vs 23.0 (+/-12.5) d, and for M. tuberculosis 16.7 (+/-9.5) vs 28.4 (+/-11.1) d for the VersaTREK system. The VersaTREK system significantly reduces the TTDs of mycobacteria detection, which is clinically relevant.
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Affiliation(s)
- Francisco Quiñones Falconi
- Servicio de Microbiología Clínica, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
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Savić B, Vuković D, Dakić I, Kurucin T, Vukelić A. [Microbiological diagnosis of tuberculosis in Serbia in the period 2001-2003]. MEDICINSKI PREGLED 2007; 59:495-8. [PMID: 17345830 DOI: 10.2298/mpns0610495s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The National tuberculosis Reference Laboratory (NTRL) and the National TB Laboratory Network in Serbia, provided data on drug susceptibility profiles of M. tuberculosis, incidence of TB among laboratory workers and on protective measures. MATERIAL AND METHODS The TB laboratory network in Serbia comprises 46 laboratories. 11 laboratories perform acid fast microscopy only, 24 perform microscopic and culture examinations, and complete identification and drug susceptibility testing (DST) is performed in 11 laboratories. Protective measures for laboratory workers are mostly inadequate. Four cases of occupational TB were reported over the study period. RESULTS DST was performed in 61.8% to 62.8% of bacteriologically proven TB cases. Isolates of M. tuberculosis strains showing drug-resistance ranged from 7.9% to 8.9%, while multidrug resistant (MDR) isolates varied from 2.2% to 2.5%. In order to determine the accuracy of DST in 6 local laboratories, NTRL carried out a quality assurance program for DST. Four laboratories reached 100% agreement with NTRL for rifampicin. At least 90% agreement with NTRL for isoniazid was achieved in three tested laboratories. CONCLUSION A relatively low and stable rates of drug-resistant and MDR TB in our study indicate that the situation in Serbia is still satisfactory. However, a reliable surveillance of drug-resistant TB in the region requires routine DST of all patients with culture confirmed TB. This is one of the goals included in the new National TB Program. In summary, all laboratories in Serbia should be included in the quality assurance program and their number should be reduced in accordance with the annual number of analyses performed, geographical location and results of proficiency testing.
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Affiliation(s)
- Branislava Savić
- Medicinski fakultet, Univerzitet u Beogradu Institut za mikrobiologiju i imunologiju.
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Ongut G, Ogunc D, Gunseren F, Ogus C, Donmez L, Colak D, Gultekin M. Evaluation of the ICT Tuberculosis test for the routine diagnosis of tuberculosis. BMC Infect Dis 2006; 6:37. [PMID: 16504161 PMCID: PMC1402301 DOI: 10.1186/1471-2334-6-37] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2005] [Accepted: 02/27/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rapid and accurate diagnosis of tuberculosis (TB) is crucial to facilitate early treatment of infectious cases and thus to reduce its spread. To improve the diagnosis of TB, more rapid diagnostic techniques such as antibody detection methods including enzyme-linked immunosorbent assay (ELISA)-based serological tests and immunochromatographic methods were developed. This study was designed to evaluate the validity of an immunochromatographic assay, ICT Tuberculosis test for the serologic diagnosis of TB in Antalya, Turkey. METHODS Sera from 72 patients with active pulmonary (53 smear-positive and 19 smear-negative cases) and eight extrapulmonary (6 smear-positive and 2 smear-negative cases) TB, and 54 controls from different outpatient clinics with similar demographic characteristics as patients were tested by ICT Tuberculosis test. RESULTS The sensitivity, specificity, and negative predictive value of the ICT Tuberculosis test for pulmonary TB were 33.3%, 100%, and 52.9%, respectively. Smear-positive pulmonary TB patients showed a higher positivity rate for antibodies than smear-negative patients, but the difference was not statistically significant. Of the eight patients with extrapulmonary TB, antibody was detected in four patients. CONCLUSION Our results suggest that ICT Tuberculosis test can be used to aid TB diagnosis in smear-positive patients until the culture results are available.
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Affiliation(s)
- Gozde Ongut
- Department of Medical Microbiology, Akdeniz University, Faculty of Medicine, Antalya, Turkey
| | - Dilara Ogunc
- Department of Medical Microbiology, Akdeniz University, Faculty of Medicine, Antalya, Turkey
| | - Filiz Gunseren
- Department of Infectious Diseases and Clinical Microbiology, Akdeniz University, Faculty of Medicine, Antalya, Turkey
| | - Candan Ogus
- Department of Respiratory Medicine, Akdeniz University, Faculty of Medicine, Antalya, Turkey
| | - Levent Donmez
- Department of Public Health, Akdeniz University, Faculty of Medicine, Antalya, Turkey
| | - Dilek Colak
- Department of Medical Microbiology, Akdeniz University, Faculty of Medicine, Antalya, Turkey
| | - Meral Gultekin
- Department of Medical Microbiology, Akdeniz University, Faculty of Medicine, Antalya, Turkey
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Michos AG, Daikos GL, Tzanetou K, Theodoridou M, Moschovi M, Nicolaidou P, Petrikkos G, Syriopoulos T, Kanavaki S, Syriopoulou VP. Detection of Mycobacterium tuberculosis DNA in respiratory and nonrespiratory specimens by the Amplicor® MTB PCR. Diagn Microbiol Infect Dis 2006; 54:121-6. [PMID: 16406184 DOI: 10.1016/j.diagmicrobio.2005.09.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2005] [Revised: 09/05/2005] [Accepted: 09/08/2005] [Indexed: 02/02/2023]
Abstract
To evaluate the diagnostic performance of a commercially available Mycobacterium tuberculosis PCR assay (Amplicor MTB-ROCHE), 2296 respiratory and nonrespiratory specimens from 2296 patients with suspected tuberculosis (TB) were collected prospectively in an 8-year period. Clinical data for each patient were abstracted, and all samples were examined blindly by direct microscopy, culture, and PCR. M. tuberculosis DNA was detected in 93 of 113 culture-positive samples and in 29 of 38 samples from patients with probable TB. The lowest sensitivity was observed in pleural fluid and abscess aspirates. The sensitivity, specificity, and positive predictive value of the assay were 97.2%, 100%, and 100% for smear-positive specimens and 75.3%, 97.0%, and 47.5% for smear-negative specimens, respectively. The PCR cost per additional correct clinical decision was Euro 2826 but would have declined to Euro 308 if the test was applied only to smear-positive specimens. The overall performance of Amplicor MTB test was excellent for smear-positive, but suboptimal for smear-negative specimens.
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Affiliation(s)
- Athanasios G Michos
- First Department of Pediatrics, Aghia Sophia Children's Hospital, Athens University, 11527 Athens, Greece
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29
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Abstract
The incidence of pulmonary disease caused by nontuberculous mycobacteria (NTM) appears to be increasing worldwide. In Korea, M. avium complex and M. abscessus account for most of the pathogens encountered, whilst M. kansasii is a relatively uncommon cause of NTM pulmonary diseases. NTM pulmonary disease is highly complex in terms of its clinical presentation and management. Because its clinical features are indistinguishable from those of pulmonary tuberculosis and NTMs are ubiquitous in the environment, the isolation and identification of causative organisms are mandatory for diagnosis, and some specific diagnostic criteria have been proposed. The treatment of NTM pulmonary disease depends on the infecting species, but decisions concerning the institution of treatment are never easy. Treatment requires the use of multiple drugs for 18 to 24 months. Thus, treatment is expensive, often has significant side effects, and is frequently not curative. Therefore, clinicians should be confident that there is sufficient pathology to warrant prolonged, multidrug treatment regimens. In all of the situations, outcomes can be best optimized only when clinicians, radiologists, and laboratories work cooperatively.
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Affiliation(s)
- Won-Jung Koh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - O Jung Kwon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung Soo Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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30
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American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: Controlling Tuberculosis in the United States. Am J Respir Crit Care Med 2005; 172:1169-227. [PMID: 16249321 DOI: 10.1164/rccm.2508001] [Citation(s) in RCA: 182] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
During 1993-2003, incidence of tuberculosis (TB) in the United States decreased 44% and is now occurring at a historic low level (14,874 cases in 2003). The Advisory Council for the Elimination of Tuberculosis has called for a renewed commitment to eliminating TB in the United States, and the Institute of Medicine has published a detailed plan for achieving that goal. In this statement, the American Thoracic Society (ATS), Centers for Disease Control and Prevention (CDC), and the Infectious Diseases Society of America (IDSA) propose recommendations to improve the control and prevention of TB in the United States and to progress toward its elimination. This statement is one in a series issued periodically by the sponsoring organizations to guide the diagnosis, treatment, control, and prevention of TB. This statement supersedes the previous statement by ATS and CDC, which was also supported by IDSA and the American Academy of Pediatrics (AAP). This statement was drafted, after an evidence-based review of the subject, by a panel of representatives of the three sponsoring organizations. AAP, the National Tuberculosis Controllers Association, and the Canadian Thoracic Society were also represented on the panel. This statement integrates recent scientific advances with current epidemiologic data, other recent guidelines from this series, and other sources into a coherent and practical approach to the control of TB in the United States. Although drafted to apply to TB-control activities in the United States, this statement might be of use in other countries in which persons with TB generally have access to medical and public health services and resources necessary to make a precise diagnosis of the disease; achieve curative medical treatment; and otherwise provide substantial science-based protection of the population against TB. This statement is aimed at all persons who advocate, plan, and work at controlling and preventing TB in the United States, including persons who formulate public health policy and make decisions about allocation of resources for disease control and health maintenance and directors and staff members of state, county, and local public health agencies throughout the United States charged with control of TB. The audience also includes the full range of medical practitioners, organizations, and institutions involved in the health care of persons in the United States who are at risk for TB.
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31
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Viveiros M, Leandro C, Rodrigues L, Almeida J, Bettencourt R, Couto I, Carrilho L, Diogo J, Fonseca A, Lito L, Lopes J, Pacheco T, Pessanha M, Quirim J, Sancho L, Salfinger M, Amaral L. Direct application of the INNO-LiPA Rif.TB line-probe assay for rapid identification of Mycobacterium tuberculosis complex strains and detection of rifampin resistance in 360 smear-positive respiratory specimens from an area of high incidence of multidrug-resistant tuberculosis. J Clin Microbiol 2005; 43:4880-4. [PMID: 16145166 PMCID: PMC1234138 DOI: 10.1128/jcm.43.9.4880-4884.2005] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The INNO-LiPA Rif.TB assay for the identification of Mycobacterium tuberculosis complex strains and the detection of rifampin (RIF) resistance has been evaluated with 360 smear-positive respiratory specimens from an area of high incidence of multidrug-resistant tuberculosis (MDR-TB). The sensitivity when compared to conventional identification/culture methods was 82.2%, and the specificity was 66.7%; the sensitivity and specificity were 100.0% and 96.9%, respectively, for the detection of RIF resistance. This assay has the potential to provide rapid information that is essential for the effective management of MDR-TB.
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Affiliation(s)
- Miguel Viveiros
- Unidade de Micobacterias do Instituto de Higiene e Medicina Tropical, Lisboa, Portugal
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32
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Abstract
Every 10 seconds, one person in the world dies of tuberculosis (TB). It is estimated that one third of the world's population is latently infected with Mycobacterium tuberculosis. The proportion of multidrug-resistant strains of M. tuberculosis is increasing at an alarming rate in some parts of the world linked in part with the human immunodeficiency virus epidemic. For these reasons, TB remains a major public health problem, both in less-developed countries and in many industrialized countries, with 8-10 million new cases and 2 million deaths yearly in the world. Clinical, radiological and histological signs are not specific for tuberculosis or for other mycobacterial infections and allow only a presumptive diagnosis. In the same way, the tuberculin skin test is useful if the reaction is strong or phlyctenular because this test depends on various factors as previous BCG vaccination, contact or primary infection and host immune responses. The diagnosis of mycobacterial infection is proved only when bacilli are present in biological samples. Nevertheless, only 50% of cases in adults and 30% in infants have a positive bacteriological result. It seems necessary to develop new methods for a rapid and efficient diagnosis to optimize the therapy and the control of the epidemic. Laboratory testing in the mycobacterium field is experiencing more changes today than ever before. Determining what assays will be most useful to the clinician is a challenge, and acceptance of the new technology is under discussion. Progress in future will be linked probably to the progress of the genomic area. However the incidence rate is higher in less-developed countries, it is also important to develop now techniques possible to use in these countries. This review focuses on the current state-of-the-art resources useful for accurate and rapid laboratory diagnosis of mycobacterial infections.
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Affiliation(s)
- V Martinez
- Unité de génétique des mycobactéries, Institut Pasteur, 75015 Paris, France.
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33
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Fegou E, Jelastopulu E, Sevdali M, Anastassiou ED, Dimitracopoulos G, Spiliopoulou I. Sensitivity of the Cobas Amplicor system for detection of Mycobacterium tuberculosis in respiratory and extrapulmonary specimens. Clin Microbiol Infect 2005; 11:593-6. [PMID: 15966983 DOI: 10.1111/j.1469-0691.2005.01185.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The Cobas Amplicor PCR system (CA-PCR) was compared with culture and staining for acid-fast bacilli (AFB) for the early detection of Mycobacterium tuberculosis in respiratory clinical specimens and otherwise normal sterile body fluids. The sensitivity, specificity and positive and negative predictive values of CA-PCR were determined with AFB-positive and AFB-negative specimens. The sensitivity of CA-PCR ranged from 73.6% to 100% for AFB-positive samples, while sputa collected after bronchoscopy were the most useful specimens, with 70% sensitivity and 98.6% specificity among the AFB-negative samples.
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Affiliation(s)
- E Fegou
- Department of Microbiology, School of Medicine, University of Patras, Greece
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34
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Lesić A, Bumbasirević M, Savić B, Cobeljić G, Pesut D. [Current diagnosis and treatment of the osteoarticular tuberculosis]. SRP ARK CELOK LEK 2005; 132:345-51. [PMID: 15794059 DOI: 10.2298/sarh0410345l] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
In 1993, tuberculosis was recognized as global medical problem by WHO. Recurring flare-up of this disease was triggered by difficult socioeconomic situation of the countries in transition, current development of immunocompromising diseases, and some other factors have contributed, too. The osteoarticular tuberculosis has been always postprimary and localized form of the disease, which, due to certain similarity to some other osteoarticular diseases, has been challenge for orthopaedic surgeons both from diagnostic and treatment aspects. Bacteriological diagnostics has had a limited value due to application of recommended tuberculostatic medication before obtaining specimens from bones or joints; and, on the other hand, rapid bacteriological methods, because of their expensive equipment, could be carried out in large mycobacteriology laboratories only. New visualizing methods, CT and MRI, have been particularly important for detection and monitoring of tuberculosis process in the spine during the early stage of the disease, what is impossible to achieve with native radiograms. Programmed administration of tuberculostatic drugs both in non-operative and surgical treatment has been proven necessary.
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35
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Cordonnier C, Martino R, Trabasso P, Held TK, Akan H, Ward MS, Fabian K, Ullmann AJ, Wulffraat N, Ljungman P, Alessandrino EP, Pretnar J, Gmür J, Varela R, Vitek A, Sica S, Rovira M. Mycobacterial Infection: A Difficult and Late Diagnosis in Stem Cell Transplant Recipients. Clin Infect Dis 2004; 38:1229-36. [PMID: 15127333 DOI: 10.1086/383307] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2001] [Accepted: 12/15/2003] [Indexed: 12/17/2022] Open
Abstract
The Infectious Diseases Working Party of the European Blood and Marrow Transplant Group conducted a survey to obtain information about the frequency, presentation, and treatment of mycobacterial infection (MBI) in stem cell transplant (SCT) recipients. Among 29 centers, MBI was diagnosed in 0.79% of 1513 allogeneic and 0.23% of 3012 autologous SCT recipients during 1994-1998 a median of 160 days after transplantation. The mean interval between first symptoms and diagnosis was 29 days and was still longer for patients with atypical MBI or recipients of corticosteroid therapy. The prevalence of MBI was highest among those who received matched unrelated or mismatched STCs from related donors. Of 31 patients, 20 had tuberculosis, 8 had atypical MBI, and 3 had diagnoses based on histological findings only. Five patients (16%) died, all of whom had received an allogeneic SCT. Because of the increased numbers of unmatched donors and transplantation programs in countries with a high prevalence of tuberculosis, constant vigilance is required to early detect MBI in SCT recipients.
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Affiliation(s)
- C Cordonnier
- Department of Hematology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France.
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36
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Fox LP, Geyer AS, Husain S, Della-Latta P, Grossman ME. Mycobacterium abscessus cellulitis and multifocal abscesses of the breasts in a transsexual from illicit intramammary injections of silicone. J Am Acad Dermatol 2004; 50:450-4. [PMID: 14988690 DOI: 10.1016/j.jaad.2003.09.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We report the case of a 29-year-old transsexual who developed Mycobacterium abscessus infection after receiving intramammary liquid silicone injections in the nonphysician office setting. Our patient represents 1 of 14 confirmed and 11 suspected cases in New York City of M abscessus infection after illicit cosmetic procedures. As injectable cosmetic procedures are becoming increasingly popular, dermatologists should be aware of both the common and unusual complications. Furthermore, all physicians should be alerted to the current cluster of M abscessus infections after injections for cosmetic purposes by nonmedical practitioners in New York City.
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Affiliation(s)
- Lindy Peta Fox
- Department of Dermatology, College of Physicians and Surgeons, Columbia University, New York City, NY, USA
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37
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Improved real-time PCR for rapid detection of rifampin and isoniazid resistance in Mycobacterium tuberculosis clinical isolates. Diagn Microbiol Infect Dis 2003; 45:207-12. [PMID: 12663163 DOI: 10.1016/s0732-8893(02)00521-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In this study we designed two pairs of probes for the detection of rifampin and isoniazid resistance in Mycobacterium tuberculosis with real-time PCR procedures. One pair of probes spans the region between codon 510 and 528 of the rpoB gene, and the other one screens for mutation at the regulatory region of the inhA gene. We have evaluated these probes in combination with two other pairs of probes previously described to detect mutations in 20 susceptible and 53 unique resistant M. tuberculosis clinical isolates. We were able to detect nine different mutations affecting five codons of the rpoB gene, two different mutations at codon 315 of the katG gene and a nucleotide substitution (C209T) in the regulatory region of the inhA gene within two hours turnaround.
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38
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Dietrich U, Arnold P, Guscetti F, Pfyffer GE, Spiess B. Ocular manifestation of disseminated Mycobacterium simiae infection in a cat. J Small Anim Pract 2003; 44:121-5. [PMID: 12653327 DOI: 10.1111/j.1748-5827.2003.tb00132.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Disseminated mycobacterial disease was diagnosed in an eight-year-old domestic shorthaired cat, with involvement of the skin, lungs, lymph nodes and one eye. Mycobacterium simiae was cultured from skin biopsies on solid agar and in liquid media. This organism is known to cause pulmonary, cutaneous or disseminated infection in human patients with acquired immunodeficiency syndrome but has never been encountered as a pathogen in companion animals. Combination treatment with rifampicin, enrofloxacin and clarithromycin resulted in complete clinical remission within six months, with no side effects. No recurrence was observed in a 22-month follow-up period.
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Affiliation(s)
- U Dietrich
- Department of Small Animal Surgery (Ophthalmology), University of Zurich, Winterthurerstrasse 260, CH-8057 Zurich, Switzerland
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39
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Kurth R, Haas WH. Epidemiology, diagnostic possibilities, and treatment of tuberculosis. Ann Rheum Dis 2002; 61 Suppl 2:ii59-61. [PMID: 12379624 PMCID: PMC1766698 DOI: 10.1136/ard.61.suppl_2.ii59] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- R Kurth
- Robert Koch-Institute, Nordufer 20, 13353 Berlin, Germany.
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40
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Han XY, Pham AS, Tarrand JJ, Sood PK, Luthra R. Rapid and accurate identification of mycobacteria by sequencing hypervariable regions of the 16S ribosomal RNA gene. Am J Clin Pathol 2002; 118:796-801. [PMID: 12428802 DOI: 10.1309/hn44-xqym-jmaq-2edl] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
We developed a method to identify mycobacteria by sequencing hypervariable regions of the polymerase chain reaction-amplified 16S ribosomal RNA gene. This method is nearly specific for mycobacteria and uses positive culture from liquid or solid medium without the needfor lengthy subculture. It shortens identification time to 3 days, which is much faster than the conventional biochemical method (mean, 8 weeks). It applies to all mycobacteria (approximately 100 species), unlike current nucleic acid hybridization methods, which probe only 4 species. The identifications are the same or are species specific for the well-characterized mycobacteria (59/68 [87%]) or more accurate for recently proposed species (9/68 [13%]). The method requires a single sequencing reaction, which is efficient and cost-effective. Therefore, this method is clinically and academically useful.
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Affiliation(s)
- Xiang Y Han
- Division of Pathology and Laboratory Medicine, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA
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41
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McElroy PD, Sterling TR, Driver CR, Kreiswirth B, Woodley CL, Cronin WA, Hardge DX, Shilkret KL, Ridzon R. Use of DNA fingerprinting to investigate a multiyear, multistate tuberculosis outbreak. Emerg Infect Dis 2002; 8:1252-6. [PMID: 12453351 PMCID: PMC2738549 DOI: 10.3201/eid0811.020424] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
In 1998-1999, the Baltimore TB control program detected a cluster of 21 tuberculosis (TB) cases. Patients reported frequent travel to various East Coast cities. An investigation was conducted to determine whether transmission of the same Mycobacterium tuberculosis strain was occurring in these other localities. A collaborative investigation among federal, state, and local TB controllers included TB record reviews, interviews of patients, and restriction fragment length polymorphism (RFLP) analysis of selected M. tuberculosis isolates from diagnosed TB patients in several cities in 1996-2001. A national TB genotyping database was searched for RFLP patterns that matched the outbreak pattern. Eighteen additional outbreak-related cases were detected outside of Baltimore-the earliest diagnosed in New Jersey in 1996, and the most recent in New York City in late 2001. The outbreak demonstrates the need for strategies to detect links among patients diagnosed with TB across multiple TB control jurisdictions.
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Affiliation(s)
- Peter D McElroy
- Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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42
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Somoskovi A, Mester J, Hale YM, Parsons LM, Salfinger M. Laboratory diagnosis of nontuberculous mycobacteria. Clin Chest Med 2002; 23:585-97. [PMID: 12370994 DOI: 10.1016/s0272-5231(02)00018-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In conclusion, it is important to realize that there is no "stand alone" assay for the identification of NTM. Many new species may not be recognized in all assays. Newer molecular tests are more accurate for identification than phenotypic tests and have significantly improved turnaround time. Clinical significance of an isolate should be determined, however, before committing resources for the identification of a mycobacterial isolate to the species level. In addition, there are significant differences in the range and quality of services provided by different laboratories. Today, techniques and equipment are increasingly complex and costly, making it more difficult to upgrade every local laboratory to perform these assays. But because specimen delivery and communication of results can be rapidly and easily achieved, utilization of reference laboratories for rarely performed sophisticated tests is a more practical approach.
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Affiliation(s)
- Akos Somoskovi
- Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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