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Morais FCL, Bello GL, Costi C, Schmid KB, Soares TDS, Barcellos RB, Unis G, Dias CF, da Silva PEA, Rossetti ML. Detection of non-tuberculosus mycobacteria (NTMs) in lung samples using 16S rRNA. Mem Inst Oswaldo Cruz 2022; 117:e220031. [PMID: 35920498 PMCID: PMC9337835 DOI: 10.1590/0074-02760220031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 07/11/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Non-tuberculous mycobacteria (NTMs) cause diseases known as mycobacteriosis
and are an important cause of morbidity and mortality. The diagnosis of
pulmonary disease caused by NTM is hampered by its clinical similarity with
tuberculosis (TB) and by the lack of an accurate and rapid laboratory
diagnosis. OBJECTIVES Detect DNA from NTMs directly from lung samples using real-time polymerase
chain reaction (qPCR) for amplification of 16S rRNA. Additionally, DNA
sequencing (hsp65 and rpoB genes) was used
to identify the species of MNTs. METHODS A total of 68 sputum samples (54 with suspected NTMs and 14 with TB) from
patients treated at a referral hospital were used. FINDINGS Of these, 27/54 (50%) were qPCR positive for NTMs and 14/14 TB patients
(controls) were qPCR negative with an almost perfect concordance
(Kappa of 0.93) with the Mycobacterium
spp. culture. Sequencing confirmed the presence of NTM in all positive
samples. The most common species was Mycobacterium gordonae
(33%), followed by Mycobacterium abscessus (26%),
Mycobacterium fortuitum (22%), Mycobacterium
avium (15%) and Mycobacterium peregrinum
(4%). MAIN CONCLUSIONS The qPCR technique for detecting NTMs targeting 16S rRNA has the potential
to detect NTMs and rapidly differentiate from Mycobacterium
tuberculosis. However, it is necessary to identify the species
to help in the differential diagnosis between disease and contamination, and
to guide the choice of the therapeutic scheme.
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Affiliation(s)
- Franciele Costa Leite Morais
- Universidade Luterana do Brasil, Programa de Pós-Graduação em Biologia Celular e Molecular Aplicada à Saúde, Canoas, RS, Brasil
| | - Graziele Lima Bello
- Instituto Nacional de Ciência e Tecnologia em Tuberculose, Programa Institutos Nacionais de Ciência e Tecnologia, Porto Alegre, RS, Brasil
| | - Cíntia Costi
- Secretaria da Saúde do Rio Grande do Sul, Centro de Desenvolvimento Científico e Tecnológico, Porto Alegre, RS, Brasil.,Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Biologia Celular e Molecular, Porto Alegre, RS, Brasil
| | - Karen Barros Schmid
- Secretaria da Saúde do Rio Grande do Sul, Centro de Desenvolvimento Científico e Tecnológico, Porto Alegre, RS, Brasil.,Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Biologia Celular e Molecular, Porto Alegre, RS, Brasil
| | - Tainá Dos Santos Soares
- Universidade Luterana do Brasil, Programa de Pós-Graduação em Biologia Celular e Molecular Aplicada à Saúde, Canoas, RS, Brasil.,Secretaria da Saúde do Rio Grande do Sul, Centro de Desenvolvimento Científico e Tecnológico, Porto Alegre, RS, Brasil
| | - Regina Bones Barcellos
- Secretaria da Saúde do Rio Grande do Sul, Centro de Desenvolvimento Científico e Tecnológico, Porto Alegre, RS, Brasil.,Universidade Federal do Rio de Janeiro, Programa de Pós-Graduação em Clínica Médica, Rio de Janeiro, RJ, Brasil
| | - Gisela Unis
- Secretaria da Saúde do Rio Grande do Sul, Hospital Sanatório Partenon, Porto Alegre, RS, Brasil
| | - Claudia Fontoura Dias
- Secretaria da Saúde do Rio Grande do Sul, Hospital Sanatório Partenon, Porto Alegre, RS, Brasil
| | - Pedro Eduardo Almeida da Silva
- Universidade Federal do Rio Grande, Faculdade de Medicina, Centro de Pesquisas em Microbiologia Médica, Rio Grande, RS, Brasil
| | - Maria Lucia Rossetti
- Universidade Luterana do Brasil, Programa de Pós-Graduação em Biologia Celular e Molecular Aplicada à Saúde, Canoas, RS, Brasil.,Instituto Nacional de Ciência e Tecnologia em Tuberculose, Programa Institutos Nacionais de Ciência e Tecnologia, Porto Alegre, RS, Brasil.,Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Biologia Celular e Molecular, Porto Alegre, RS, Brasil
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Lopes CVS, Fernandes BP, Rosa MG, Bahia RCO. Diagnosis of goat tuberculosis using tuberculinization and molecular techniques. ARQUIVOS DO INSTITUTO BIOLÓGICO 2022. [DOI: 10.1590/1808-1657000582020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Riello FN, Brígido RTS, Araújo S, Moreira TA, Goulart LR, Goulart IMB. Diagnosis of mycobacterial infections based on acid-fast bacilli test and bacterial growth time and implications on treatment and disease outcome. BMC Infect Dis 2016; 16:142. [PMID: 27039183 PMCID: PMC4818481 DOI: 10.1186/s12879-016-1474-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 03/17/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The establishment of therapeutic regimens for mycobacteriosis depends on the accurate identification of Mycobacterium species, and misdiagnosis can result in inappropriate treatment and increased mortality of patients. Differential diagnosis among Mycobacterium species has been made by conventional phenotypic and biochemical tests after a long culture period. Specialized molecular diagnostics of mycobacteria allows rapid detection and species identification; however, such tests are not available in public health programs. Our aim was to demonstrate the clinical implications of erroneous diagnosis by performing molecular genotyping of mycobacterial infections in patients that were diagnosed based on symptoms, culture and bacilloscopy. METHODS Culture samples of mycobacterial infections from 55 patients clinically diagnosed as tuberculosis in 2013 and 2014, based on conventional methods, were identified by PCR -RFLP and results are discussed. RESULTS We have confirmed 35 (63.6%) positive samples as M. tuberculosis, but 18 (32.7%) were identified as non-tuberculous mycobacteria (M. avium type 1, M. avium type 2, M. kansasii type 1 type 1, M. mucogenicum, M. chelonae, M. terrae type 3, and 1 unknown RFLP pattern) and two were negative. Regarding clinical diagnosis, 61.8% (34/55) was classified as pulmonary tuberculosis. It is important to emphasize that 36.4% (20/55) of samples were misdiagnosed by conventional methods, and 11 (61.1%) of the HIV positive patients (18/55) were NTM-coinfected. CONCLUSION The identification of species in mycobacterial infections is essential for correct diagnosis and choice of treatment regimen, and misdiagnosis by conventional tools can lead to chronic disease, increased resistance and death.
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Affiliation(s)
- Fabiane N. Riello
- />National Reference Center for Sanitary Dermatology and Leprosy (CREDESH) Clinical Hospital Federal University of Uberlândia, Uberlândia, Minas Gerais Brazil
| | - Rebecca T. S. Brígido
- />National Reference Center for Sanitary Dermatology and Leprosy (CREDESH) Clinical Hospital Federal University of Uberlândia, Uberlândia, Minas Gerais Brazil
| | - Sergio Araújo
- />National Reference Center for Sanitary Dermatology and Leprosy (CREDESH) Clinical Hospital Federal University of Uberlândia, Uberlândia, Minas Gerais Brazil
| | - Tomaz A. Moreira
- />Laboratory of Clinical Analysis, Clinics’ Hospital of the Federal University of Uberlândia, Uberlândia, Minas Gerais Brazil
| | - Luiz Ricardo Goulart
- />Federal University of Uberlandia, Institute of Genetics and Biochemistry, Laboratory of Nanobiotechnology, Campus Umuarama, Block 2E, Room 248, CEP 38400-902 Uberlandia, Minas Gerais Brazil
| | - Isabela M. B. Goulart
- />National Reference Center for Sanitary Dermatology and Leprosy (CREDESH) Clinical Hospital Federal University of Uberlândia, Uberlândia, Minas Gerais Brazil
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Murback NDN, Higa Júnior MG, Pompílio MA, Cury ESJ, Hans Filho G, Takita LC. Disseminated cutaneous atypical mycobacteriosis by M. chelonae after sclerotherapy of varicose veins in a immunocompetent patient: a case report. An Bras Dermatol 2016; 90:138-42. [PMID: 26312697 PMCID: PMC4540531 DOI: 10.1590/abd1806-4841.20153504] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 06/30/2014] [Indexed: 11/21/2022] Open
Abstract
Atypical mycobacteria are saprophytic organisms not transmitted from person to person, which affect mainly immunosuppressed but also immunocompetent individuals. We present a case of atypical mycobacteriosis after a vascular procedure, with widespread cutaneous lesions associated with polyarthralgia. Mycobacterium chelonae was identified by the polymerase chain reaction (PCR) method. The patient showed improvement after treatment with three antibiotics. Mycobacterium chelonae causes skin lesions after invasive procedures. The clinical form depends on the immune state of the host and on the entry points. The diagnosis is based essentially on culture and the mycobacteria is identified by PCR. We highlight the importance of investigating atypical mycobacteriosis when faced with granulomatous lesions associated with a history of invasive procedures.
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Lima AS, Duarte RS, Montenegro LML, Schindler HC. Rapid detection and differentiation of mycobacterial species using a multiplex PCR system. Rev Soc Bras Med Trop 2014; 46:447-52. [PMID: 23982098 DOI: 10.1590/0037-8682-0097-2013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 07/22/2013] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The early diagnosis of mycobacterial infections is a critical step for initiating treatment and curing the patient. Molecular analytical methods have led to considerable improvements in the speed and accuracy of mycobacteria detection. METHODS The purpose of this study was to evaluate a multiplex polymerase chain reaction system using mycobacterial strains as an auxiliary tool in the differential diagnosis of tuberculosis and diseases caused by nontuberculous mycobacteria (NTM) RESULTS: Forty mycobacterial strains isolated from pulmonary and extrapulmonary origin specimens from 37 patients diagnosed with tuberculosis were processed. Using phenotypic and biochemical characteristics of the 40 mycobacteria isolated in LJ medium, 57.5% (n=23) were characterized as the Mycobacterium tuberculosis complex (MTBC) and 20% (n=8) as nontuberculous mycobacteria (NTM), with 22.5% (n=9) of the results being inconclusive. When the results of the phenotypic and biochemical tests in 30 strains of mycobacteria were compared with the results of the multiplex PCR, there was 100% concordance in the identification of the MTBC and NTM species, respectively. A total of 32.5% (n=13) of the samples in multiplex PCR exhibited a molecular pattern consistent with NTM, thus disagreeing with the final diagnosis from the attending physician. CONCLUSIONS Multiplex PCR can be used as a differential method for determining TB infections caused by NTM a valuable tool in reducing the time necessary to make clinical diagnoses and begin treatment. It is also useful for identifying species that were previously not identifiable using conventional biochemical and phenotypic techniques.
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Affiliation(s)
- Andrea Santos Lima
- Departamento de Imunologia, Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz, Recife,
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Bensi EPA, Panunto PC, Ramos MDC. Incidence of tuberculous and non-tuberculous mycobacteria, differentiated by multiplex PCR, in clinical specimens of a large general hospital. Clinics (Sao Paulo) 2013; 68:179-84. [PMID: 23525313 PMCID: PMC3584283 DOI: 10.6061/clinics/2013(02)oa10] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 10/22/2012] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To determine the incidence of Mycobacterium tuberculosis complex and non-tuberculous mycobacterial isolates in the routine setting of a large general hospital using an "in-house" multiplex polymerase chain reaction method and to establish a paradigm for the definitive identification of mycobacteria isolated using semi-automated equipment. METHODS Established tests, including polymerase chain reaction restriction enzyme analysis, PNB, and NAP inhibition tests as the gold standard, showed 100% agreement with an IS6110/hsp65 multiplex polymerase chain reaction when used to identify stock strains (n = 117). RESULTS In a subsequent study, 8,790 clinical specimens producing 476 isolates were evaluated with multiplex PCR and also showed 100% agreement in identification using PRA-polymerase chain reaction as the gold standard. The application of this technique to routine analysis was demonstrated in this study. A method was established with the initial application of multiplex PCR for all positive liquid cultures and the subsequent identification of non-tuberculous mycobacteria by polymerase chain reaction restriction enzyme analysis. In total, 77% of isolates belonged to the Mycobacterium tuberculosis complex, and 23% were non-tuberculous mycobacteria. CONCLUSIONS Several non-tuberculous mycobacterial species were identified, primarily M. avium, but other potentially pathogenic species were also frequently observed, including M. fortuitum, M. abscessus, and M. kansasii. The expeditious communication of these data to the clinical staff was fundamental for the diagnosis of clinical cases. Even in settings where tuberculosis is of major importance, the incidence of non-tuberculous mycobacteria infection is substantial.
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