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Diagnostic value of nucleic acid amplification tests on bronchoalveolar lavage fluid for smear-negative pulmonary tuberculosis: a meta-analysis. Biosci Rep 2015; 35:BSR20140186. [PMID: 25965982 PMCID: PMC4613677 DOI: 10.1042/bsr20140186] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 05/06/2015] [Indexed: 02/05/2023] Open
Abstract
Based on current available evidence, NAAT on BALF plays a role in the diagnosis of smear-negative pulmonary tuberculosis, and further studies should be performed to confirm our findings.. The diagnosis of smear-negative pulmonary tuberculosis (SNPT) remains a clinical challenge. Many studies suggest that nucleic acid amplification tests (NAATs) on bronchoalveolar lavage fluid (BALF) plays a role in diagnosing SNPT, but with considerable varying results. The current study aimed to summarize the overall diagnostic accuracy of NAATs assay on BALF for SNPT. A systematic literature search was performed and data were retrieved. Pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR) and diagnostic odds ratio (DOR) were calculated. A summary receiver operating characteristic curve and area under the curve (AUC) were used to evaluate the overall diagnostic performance. All the statistical analysis was performed by using STATA 12.0 and Meta-DiSc 1.4 software. A total of nine studies with 1214 subjects were included this meta-analysis. The pooled sensitivity, specificity, PLR, NLR and DOR were 0.54 [95% CI (confidence interval): 0.48–0.59], 0.97 (95% CI: 0.95–0.98), 12.13 (95% CI: 8.23–17.88), 0.36 (95% CI: 0.23–0.56) and 44.71 (95% CI: 22.30–89.63) respectively. The AUC was 0.96. Estimated positive and negative post-probability values for a SNPT prevalence of 20% were 82% and 7% respectively. No publication bias was identified. Current available evidence indicated that NAATs on BALF may play a role in diagnosing SNPT, whereas the results should be interpreted in parallel with clinical information of patients and the results of traditional tests. Further studies should be performed to confirm our findings.
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Hung HC, Chan CH, Tsao SM, Chen SC, Wu TC, Lu MC, Wu DJ, Huang SJ, Lee YT. Effectiveness of the BDProbeTec ET system for detection of Mycobacterium tuberculosis complex in sputum and bronchoalveolar lavage specimens. Braz J Infect Dis 2012. [DOI: 10.1016/s1413-8670(12)70318-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Sankar S, Ramamurthy M, Nandagopal B, Sridharan G. An appraisal of PCR-based technology in the detection of Mycobacterium tuberculosis. Mol Diagn Ther 2011; 15:1-11. [PMID: 21250760 DOI: 10.1007/bf03257188] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Tuberculosis is an under-recognized yet catastrophic health problem, particularly in developing countries. The HIV pandemic has served to increase the number of susceptible individuals, and multidrug-resistance and poor socioeconomic conditions also augment the prevalence and the consequences of the disease. To control the disease and its spread, it is vital that tuberculosis diagnostics are accurate and rapid. Whereas microscopy and culture have several limitations (low sensitivity is a problem for the former, while the latter has a delayed turnaround time), PCR-based techniques targeting regions of the Mycobacterium tuberculosis genome such as IS6110 have proved to be useful. The purpose of this review is to assess the use of PCR-RFLP, nested PCR and real-time PCR protocols and the choice of target regions for the detection of M. tuberculosis. Real-time PCR for the detection of M. tuberculosis target genes in clinical specimens has contributed to improving diagnosis and epidemiologic surveillance in the past decade. However, targeting one genome sequence such as IS6110 may not by itself be sufficiently sensitive to reach 100% diagnosis, especially in the case of pulmonary tuberculosis. Additional testing for target genome sequences such as hsp65 seems encouraging. An interesting approach would be a multiplex real-time PCR targeting both IS6110 and hsp65 to achieve comprehensive and specific molecular diagnosis. This technology needs development and adequate field testing before it becomes the acceptable gold standard for diagnosis.
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Affiliation(s)
- Sathish Sankar
- Division of Biomedical Research, Sri Narayani Hospital and Research Centre, Thirumalaikodi, Sripuram, Vellore, Tamil Nadu, India.
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Cho CH, Han SH, Chin BS, Choi SH, Lee HS, Kim CO, Kim MS, Choi JY, Song YG, Kim JM. Diagnosis and species identification of mycobacterial infections by polymerase chain reaction-restriction fragment length polymorphism analysis of sterile body fluids. Korean J Intern Med 2009; 24:135-8. [PMID: 19543492 PMCID: PMC2698622 DOI: 10.3904/kjim.2009.24.2.135] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2008] [Accepted: 05/13/2008] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS The development of effective, accurate, and rapid diagnostic methods for Mycobacterium infection and mycobacterial species identification is required. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) is an easy, rapid and inexpensive technique for identifying Mycobacterium spp. METHODS We performed PCR-RFLP to detect and identify Mycobacterium spp. from 10 sterile body fluids, including ascites, cerebrospinal fluid, pleural fluid, synovial fluid, and peritoneal dialysis fluid. Clinical samples were collected from patients with diagnoses of definite, probable or suspected mycobacterial infection. The conserved RNA polymerase genes of Mycobacterium spp. were amplified by PCR. RESULTS The amplified 360-bp region of rpoB was digested with the restriction enzyme MspI or HaeIII. The PCR-RFLP results for the clinical samples were identical to those for M. tuberculosis, M. fortuitum, M. intracellulare, and M. avium. In addition, the results of the PCR-RFLP were identical to those obtained by DNA sequencing. CONCLUSIONS PCR-RFLP analysis of sterile body fluids may be a useful method for the diagnosis of mycobacterial infections and for the differentiation of mycobacterial species.
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Affiliation(s)
- Cheong Ho Cho
- AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Hoon Han
- AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Bum Sik Chin
- AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Suk Hoon Choi
- AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Han Sung Lee
- AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Chang Oh Kim
- AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Myung Soo Kim
- AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jun Yong Choi
- AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Young Goo Song
- AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - June Myung Kim
- AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 Project for Medical Sciences, Yonsei University College of Medicine, Seoul, Korea
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Schulz S, Cabras AD, Kremer M, Weirich G, Miethke T, Bösmüller HC, Höfler H, Werner M, Fend F. Species identification of mycobacteria in paraffin-embedded tissues: frequent detection of nontuberculous mycobacteria. Mod Pathol 2005; 18:274-82. [PMID: 15475934 DOI: 10.1038/modpathol.3800289] [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: 11/09/2022]
Abstract
Diagnosis of infections caused by mycobacteria, especially nontuberculous mycobacteria still represents a difficult task both in microbiology and pathology. The aim of this study was to determine the frequency of mycobacterial DNA detectable by PCR in formalin-fixed paraffin-embedded tissues showing suspicious granulomatous lesions. A total of 190 archival specimens were analyzed, using a nested PCR protocol, which amplifies a fragment of the mycobacterial 65-kDa heat-shock protein gene. Restriction fragment-length polymorphisms and sequencing were utilized to further analyze the obtained PCR products. Corresponding microbiological culture results were available for 41 cases. We detected mycobacterial DNA in 119 cases (63%), of which 71 (60%) were positive for Mycobacterium tuberculosis complex DNA and 41 (34%) for DNA of nontuberculous mycobacteria. Seven cases (6%) could not be subtyped for technical reasons. The largest group of nontuberculous mycobacteria comprised 29 cases (25% of the 119 positive cases), which were assigned to Mycobacterium fortuitum complex. Mycobacterium avium-intracellulare complex was detected in eight (7%) cases, Mycobacterium gordonae in three (2.5%) and Mycobacterium rhodesiae in a single case (0.8%). All cases of Mycobacterium tuberculosis were unequivocally identified by restriction fragment-length polymorphism analysis. In contrast, sequencing provided a gain of information over restriction fragment-length polymorphism analysis in 37% of the nontuberculous mycobacteria cases (15 of 41). Alignment studies on DNA of nontuberculous mycobacteria showed frequent sequence variations, supporting the existence of sequevars. Comparison of molecular data to available results of microbiological culture assays showed a good concordance of 83%. In conclusion, amplification and sequencing of the mycobacterial 65-kDa heat-shock protein gene is an excellent tool for species identification of mycobacteria, especially nontuberculous mycobacteria, in formalin-fixed paraffin-embedded tissues.
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Affiliation(s)
- Stephan Schulz
- Institute of Pathology, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany.
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. AB, . HE, . BK, . RG. Comparison of Five DNA Extraction Methods for Detection of Mycobacterium
tuberculosis by PCR. JOURNAL OF MEDICAL SCIENCES 2004. [DOI: 10.3923/jms.2004.252.256] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Fukunaga H, Murakami T, Gondo T, Sugi K, Ishihara T. Sensitivity of acid-fast staining for Mycobacterium tuberculosis in formalin-fixed tissue. Am J Respir Crit Care Med 2002; 166:994-7. [PMID: 12359660 DOI: 10.1164/rccm.2111028] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Microscopic examination of tissue sections of mycobacterial lesions frequently results in few or no bacilli seen, even if the lesions appear active histologically. This might be due to the effects of the fixative fluid and/or organic solvent, both of which are conventionally used to make tissue sections for histopathology, on the acid-fast staining of bacteria. The present study was performed to examine how formalin and xylene lower the sensitivity of acid-fast staining for Mycobacterium tuberculosis and to clarify the meaning of the staining result in tissue sections. Microscopic observation of mycobacteria smeared on glass slides revealed that both of these agents greatly reduced the sensitivity of acid-fast staining. Moreover, the number of bacilli was calculated in 30 samples of paraffin-embedded granulomatous lesions using acid-fast microscopy and real-time polymerase chain reaction. The numbers of bacilli present that were estimated by real-time polymerase chain reaction were considerably higher than those counted with a microscope. These results suggest that the bacilli are frequently missed or underestimated with acid-fast microscopy on formalin-fixed, paraffin-embedded tissue.
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Affiliation(s)
- Hajime Fukunaga
- First Department of Pathology, Yamaguchi University School of Medicine, Yamaguchi, Japan.
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Abstract
Pulmonary infections due to mycobacterial organisms are increasing in incidence. Non-tuberculous (atypical) mycobacteria (NTM) represent a significant proportion of mycobacterial infections and may prove difficult to diagnose due to their non-specific clinical and radiographic presentations. An increasing volume of radiological data is now available for the more common non-tuberculous mycobacterial infections, and we have summarized the imaging features found in such cases, identifying radiographic features that would favour the diagnosis of a non-tuberculous mycobacterium and that, in some cases, suggest a specific organism.
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Affiliation(s)
- S M Ellis
- Department of Radiology, Royal Brompton Hospital, London, U.K
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Hilborn ED, Royster MO, Drabkowski DJ. Survey of US Public Health Laboratories: Microbial Pathogens on the CCL. ACTA ACUST UNITED AC 2002. [DOI: 10.1002/j.1551-8833.2002.tb09492.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Tobin MJ. Tuberculosis, lung infections, and interstitial lung disease in AJRCCM 2000. Am J Respir Crit Care Med 2001; 164:1774-88. [PMID: 11734425 DOI: 10.1164/ajrccm.164.10.2108127] [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: 11/16/2022] Open
MESH Headings
- AIDS-Related Opportunistic Infections/diagnosis
- AIDS-Related Opportunistic Infections/epidemiology
- AIDS-Related Opportunistic Infections/immunology
- AIDS-Related Opportunistic Infections/therapy
- Animals
- Biomarkers/analysis
- Bronchiectasis/diagnosis
- Bronchiectasis/therapy
- Critical Care/methods
- Critical Care/standards
- Critical Care/trends
- Disease Models, Animal
- HIV Infections/complications
- HIV Infections/diagnosis
- HIV Infections/epidemiology
- HIV Infections/immunology
- HIV Infections/therapy
- Humans
- Hypertension, Pulmonary/diagnosis
- Hypertension, Pulmonary/therapy
- Immunocompromised Host
- Infections/diagnosis
- Infections/therapy
- Lung Diseases/diagnosis
- Lung Diseases/therapy
- Lung Diseases, Interstitial/diagnosis
- Lung Diseases, Interstitial/therapy
- Mass Screening/methods
- Molecular Biology
- Periodicals as Topic
- Risk Factors
- Sarcoidosis/diagnosis
- Sarcoidosis/genetics
- Sarcoidosis/therapy
- Scleroderma, Systemic/diagnosis
- Scleroderma, Systemic/therapy
- Tuberculosis, Pulmonary/diagnosis
- Tuberculosis, Pulmonary/epidemiology
- Tuberculosis, Pulmonary/therapy
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Affiliation(s)
- M J Tobin
- Division of Pulmonary and Critical Care Medicine, Loyola University of Chicago Stritch School of Medicine, Hines, Illinois 60141, USA.
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Abstract
The cancer patient often presents with fever and pulmonary infiltrates, in particular during the course of chemotherapy or after bone marrow transplantation. In these conditions, specific diagnoses are mainly related to an infective cause, but noninfectious processes, malignant or not, are also found alone or in combination with infection. Identification of the pulmonary process can be achieved by bronchoscopic techniques, including bronchoalveolar lavage (BAL) and transbronchial biopsy (TBB). BAL may help identify opportunistic organisms but also bacterial pneumonia, provided quantitative cultures are performed, and TBB has been shown to increase the diagnostic yield of BAL. These two procedures should then be combined, provided there is no contraindication.
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Affiliation(s)
- V Ninane
- Chest Service, Saint-Pierre University Hospital, Brussels, Belgium.
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