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Discordance between MTB/RIF and Real-Time Tuberculosis-Specific Polymerase Chain Reaction Assay in Bronchial Washing Specimen and Its Clinical Implications. PLoS One 2016; 11:e0164923. [PMID: 27760181 PMCID: PMC5070776 DOI: 10.1371/journal.pone.0164923] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 10/03/2016] [Indexed: 11/19/2022] Open
Abstract
The prevalence and clinical implications of discordance between Xpert MTB/RIF assays and the AdvanSure TB/NTM real-time polymerase chain reaction (PCR) for bronchial washing specimens have not been studied in pulmonary TB (PTB) patients. The discordant proportion and its clinical impact were evaluated in 320 patients from the bronchoscopy registry whose bronchial washing specimens were tested simultaneously with Xpert MTB/RIF and the TB/NTM PCR assay for three years, and the accuracy of the assays, including the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), were studied. The clinical risk factors for discordance and false positivity of assays were also studied. Among 130 patients who were clinically diagnosed with PTB, 64 patients showed positive acid-fast bacilli culture results, 56 patients showed positive results in molecular methods and clinician diagnosed PTB without results of microbiology in 10 patients. The sensitivity, specificity, PPV, and NPV were 80.0%, 98.95%, 98.1%, and 87.9%, respectively, for Xpert MTB/RIF and 81.5%, 92.6%, 88.3%, and 88.0%, respectively, for TB/NTM PCR. The discordant proportion was 16.9% and was higher in culture-negative PTB compared to culture-confirmed PTB (24.3% vs. 9.4%, p = 0.024). However, there were no significant differences in the clinical characteristics, regardless of the discordance. The diagnostic yield increased with an additional assay (7.7% for Xpert MTB/RIF and 9.2% for TB/NTM PCR). False positivity was less common in patients tested with Xpert MTB/RIF (1.05% vs. 7.37%, p = 0.0035). No host-related risk factor for false positivity was identified. The Xpert MTB/RIF and TB/NTM PCR assay in bronchial washing specimens can improve the diagnostic yields for PTB, although there were considerable discordant results without any patient-related risk factors.
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Choe W, Kim E, Park SY, Chae JD. Performance Evaluation of Anyplex plus MTB/NTM and AdvanSure TB/NTM for the Detection of Mycobacterium tuberculosisand Nontuberculous Mycobacteria. ANNALS OF CLINICAL MICROBIOLOGY 2015. [DOI: 10.5145/acm.2015.18.2.44] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Wonho Choe
- Department of Laboratory Medicine, Eulji General Hospital, Eulji University College of Medicine, Seoul, Korea
| | - Ehwa Kim
- Department of Laboratory Medicine, Eulji General Hospital, Eulji University College of Medicine, Seoul, Korea
| | - Seo Yeon Park
- Department of Laboratory Medicine, Eulji General Hospital, Eulji University College of Medicine, Seoul, Korea
| | - Jeong Don Chae
- Department of Laboratory Medicine, Eulji General Hospital, Eulji University College of Medicine, Seoul, Korea
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Kim YJ, Lee SM, Park BK, Kim SS, Yi J, Kim HH, Lee EY, Chang CL. Evaluation of propidium monoazide real-time PCR for early detection of viable Mycobacterium tuberculosis in clinical respiratory specimens. Ann Lab Med 2014; 34:203-9. [PMID: 24790907 PMCID: PMC3999318 DOI: 10.3343/alm.2014.34.3.203] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 12/17/2013] [Accepted: 02/14/2014] [Indexed: 12/02/2022] Open
Abstract
Background Conventional acid-fast bacilli (AFB) staining cannot differentiate viable from dead cells. Propidium monoazide (PMA) is a photoreactive DNA-binding dye that inhibits PCR amplification by DNA modification. We evaluated whether PMA real-time PCR is suitable for the early detection of viable Mycobacterium tuberculosis (MTB) in clinical respiratory specimens. Methods A total of 15 diluted suspensions from 5 clinical MTB isolates were quadruplicated and subjected to PMA treatment and/or heat inactivation. Eighty-three AFB-positive sputum samples were also tested to compare the ΔCT values (CT value in PMA-treated sputum samples-CT value in non-PMA-treated sputum samples) between culture-positive and culture-negative specimens. Real-time PCR was performed using Anyplex MTB/NTM Real-Time Detection (Seegene, Korea), and the CT value changes after PMA treatment were compared between culture-positive and culture-negative groups. Results In MTB suspensions, the increase in the CT value after PMA treatment was significant in dead cells (P=0.0001) but not in live cells (P=0.1070). In 14 culture-negative sputum samples, the median ΔCT value was 5.3 (95% confidence interval [CI], 4.1-8.2; P<0.0001), whereas that in 69 culture-positive sputum samples was 1.1 (95% CI, 0.7-2.0). In the ROC curve analysis, the cutoff ΔCT value for maximum sensitivity (89.9%) and specificity (85.7%) for differentiating dead from live cells was 3.4. Conclusions PMA real-time PCR is a useful approach for differentiating dead from live bacilli in AFB smear-positive sputum samples.
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Affiliation(s)
- Young Jin Kim
- Department of Laboratory Medicine, Pusan National University School of Medicine, Yangsan, Korea
| | - Sun Min Lee
- Department of Laboratory Medicine, Pusan National University School of Medicine, Yangsan, Korea
| | - Byung Kyu Park
- Department of Physical Medicine & Rehabilitation, Korea University College of Medicine, Seoul, Korea
| | - Sung Soo Kim
- Department of Social Studies of Medicine, Pusan National University School of Medicine, Yangsan, Korea
| | - Jongyoun Yi
- Department of Laboratory Medicine, Pusan National University School of Medicine, Yangsan, Korea
| | - Hyung Hoi Kim
- Department of Laboratory Medicine, Pusan National University School of Medicine, Yangsan, Korea
| | - Eun Yup Lee
- Department of Laboratory Medicine, Pusan National University School of Medicine, Yangsan, Korea
| | - Chulhun Ludgerus Chang
- Department of Laboratory Medicine, Pusan National University School of Medicine, Yangsan, Korea. ; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
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Jeong JY, Lee SH, Jang S. A Systematic Review on the Effectiveness of Detection of M. tuberculosisand Rifampin Resistance Using Xpert MTB/RIF. ANNALS OF CLINICAL MICROBIOLOGY 2014. [DOI: 10.5145/acm.2014.17.2.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Ji-Young Jeong
- Health Technology Assessment Department, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Seon-Heui Lee
- Health Technology Assessment Department, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Sunyoung Jang
- Department of Nursing, Hanseo University, Seosan, Korea
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Park JS, Choi JI, Lim JH, Ahn JJ, Jegal Y, Seo KW, Ra SW, Jeon JB, Lee SH, Kim SR, Jeong J. The combination of real-time PCR and HPLC for the identification of non-tuberculous mycobacteria. Ann Lab Med 2013; 33:349-52. [PMID: 24003425 PMCID: PMC3756239 DOI: 10.3343/alm.2013.33.5.349] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 06/11/2013] [Accepted: 07/03/2013] [Indexed: 12/01/2022] Open
Abstract
We used HPLC and AdvanSure real-time PCR (LG Life Sciences, Korea) to retrospectively analyze non-tuberculous mycobacteria (NTM) in 133 clinical specimens. The specimens were culture-positive for NTM and the HPLC method identified 130 strains of mycobacteria from the cultures (97.7%) at the species level. Among the isolates, 48 Mycobacterium. kansasii (36.1%), 39 M. intracellulare (29.3%), 17 M. avium (12.8%), 16 M. abscessus (12.0%), 6 M. fortuitum (4.5%), 2 M. szulgai (1.5%), 2 M. gordonae (1.5%), and 3 unclassified NTM strains (2.3%) were identified. The real-time PCR assay identified 60 NTM-positive specimens (45.1%), 65 negative specimens (48.9%), and 8 M. tuberculosis (TB)-positive specimens (6.0%). The real-time PCR assay is advantageous because of its rapid identification of NTM. However, in our study, the real-time PCR assay showed relatively low sensitivity (45.1%) when using direct specimens including sputum and bronchoalveolar lavage (BAL) fluid. HPLC is useful as it discriminates NTM at the species level, although it is time-consuming and requires specific equipment and technical expertise. A combination of both methods will be helpful for the rapid and accurate identification of mycobacteria in clinical laboratories.
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Affiliation(s)
- Jae Sun Park
- Department of Laboratory Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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Cho SY, Kim MJ, Suh JT, Lee HJ. Comparison of diagnostic performance of three real-time PCR kits for detecting Mycobacterium species. Yonsei Med J 2011; 52:301-6. [PMID: 21319350 PMCID: PMC3051208 DOI: 10.3349/ymj.2011.52.2.301] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE PCR is widely used for rapidly and accurately detecting Mycobacterium species. The purpose of this study was to assess the diagnostic performance of three real-time PCR kits and evaluate the concordance with two older PCR methods. MATERIALS AND METHODS Using 128 samples, the five PCR methods were assessed, including an in-house PCR protocol, the COBAS Amplicor MTB, the COBAS TaqMan MTB, the AdvanSure TB/NTM real-time PCR, and the Real-Q M. tuberculosis kit. The discrepant results were further examined by DNA sequencing and using the AdvanSure Mycobacteria Genotyping Chip for complete analysis. RESULTS For Mycobacterium tuberculosis (MTB) detection, all five kits showed 100% matching results (positive; N = 11 and negative; N = 80). In non-tuberculous mycobacterium (NTM) discrimination, the AdvanSure yielded two true-positive outcomes from M. intracellulare and one false positive outcome, while the Real-Q resulted in one true-positive outcome and one false negative outcome for each case and another false negative result using the provided DNA samples. CONCLUSION Real-time PCR, yielded results that were comparable to those of the older PCR methods for detecting MTB. However, there were disagreements among the applied kits in regard to the sample test results for detecting NTM. Therefore, we recommend that additional confirmatory measures such as DNA sequencing should be implemented in such cases, and further research with using a larger numbers of samples is warranted to improve the detection of NTM.
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Affiliation(s)
- Sun Young Cho
- Department of Laboratory Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Min Jin Kim
- Department of Laboratory Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jin-Tae Suh
- Department of Laboratory Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Hee Joo Lee
- Department of Laboratory Medicine, Kyung Hee University School of Medicine, Seoul, Korea
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Novel multiplex PCR using dual-priming oligonucleotides for detection and discrimination of the Mycobacterium tuberculosis complex and M. bovis BCG. J Clin Microbiol 2010; 48:4612-4. [PMID: 20943867 DOI: 10.1128/jcm.00872-10] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We developed a novel multiplex PCR assay using dual-priming oligonucleotide primers targeting the RD1 gene for simultaneous identification of the Mycobacterium tuberculosis complex and M. bovis bacillus Calmette-Guérin (BCG). This assay would be useful both for detection of the M. tuberculosis complex and for differentiation of M. bovis BCG from pathogenic M. tuberculosis complex species.
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Yun EY, Cho SH, Go SI, Baek JH, Kim YE, Ma JE, Lee GD, Cho YJ, Jeong YY, Kim HC, Lee JD, Kim SJ, Hwang YS. Usefulness of Real-time PCR to DetectMycobacterium tuberculosisand Nontuberculous Mycobacteria. Tuberc Respir Dis (Seoul) 2010. [DOI: 10.4046/trd.2010.69.4.250] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Eun Young Yun
- Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Su Hee Cho
- Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Se Il Go
- Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jong Ha Baek
- Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
| | - You Eun Kim
- Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jeong Eun Ma
- Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Gi Dong Lee
- Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Yu Ji Cho
- Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Yi Yeong Jeong
- Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
- Gyeongsang Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
| | - Ho Cheol Kim
- Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
- Gyeongsang Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
| | - Jong Deok Lee
- Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
- Gyeongsang Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
| | - Sun-Joo Kim
- Gyeongsang Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
- Department of Laboratory Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Young Sil Hwang
- Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
- Gyeongsang Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
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Usefulness of the whole-blood interferon-gamma release assay for diagnosis of extrapulmonary tuberculosis. Diagn Microbiol Infect Dis 2009; 63:182-7. [DOI: 10.1016/j.diagmicrobio.2008.10.013] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2008] [Revised: 10/07/2008] [Accepted: 10/20/2008] [Indexed: 11/22/2022]
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