THE GROWTH RATE PHENOTYPIC PROPERTY OF MYCOBACTERIUM TUBERCULOSIS CLINICAL STRAINS: DEPENDENCE ON TUBERCULOSIS LOCALIZATION, TREATMENT, DRUG SUSCEPTIBILITY

The phenotypic properties of the M. tuberculosis strains obtained from patients with pulmonary or extra-pulmonary tuberculosis are  determined by a complex set of factors: the genetic characteristics  of the pathogen, its ability to adapt in vivo and in vitro, the influence of the host’s immune system and chemotherapy. The growth rate as  the phenotypic property is the most accessible for the study of the  host-pathogen relationships at the level of host/strain population  interactions. The aim of the study is to assess in vitro of the growth  rate of M. tuberculosis strains isolated from patients with pulmonary  and extra-pulmonary tuberculosis: untreated and treated (with  surgical and non-surgical treatment) and also sensitive and resistant isolates in comparison with the reference strain H37Rv. To estimate  the growth rate of 116 clinical isolates we have used the modified  method originally developed by von Groll and co-authors: to get the  bacteria growth curve the fluorescence intensity of growing strains  (with indicator resazurin) has been measured daily for 8 days in 96- well plate. The growth rate is determined as the slope of the growth  curve. The mean values of the growth rate have been calculated in  the following groups of patients: 1 — untreated patients with  pulmonary tuberculosis (PT), respiratory material; 2 — non-surgical  treated PT patients, respiratory material; 3 — surgical treated PT  patients (mainly with chronic and hyperchronic process), respiratory  material; 4 — patients like in 3rd group, surgical material; 5 — bone  and joint tuberculosis (BJT), surgical material. In addition, groups of  sensitive and resistant strains have been examined, but there are no  significant differences in growth rates. It has been obtained that  the growth rate of strains isolated from the PT patients is higher than in BJT patients: it can be explained less favorable  conditions for the pathogen vegetation in the BJT. In the case of a  closed tuberculous lesion where the pathogen transmission to  another host is impossible, then the selection of strains with the  property to survive in the tissues of the osteoarticular system is  impossible too, therefor it should be observed only an adaptation of  the pathogen strain population to the individual host. The growth  rate of isolates from untreated PT patients is higher than that of the  treated ones. Comparison of the growth parameters of only MDR  strains 1–5 groups to eliminate the influence of the  sensitivity/resistance has resulted in the same conclusions. We  suggest that the decrease in the growth rate of strains from the  treated PT patients is in not only result of the treatment, but also is  conditioned by adaptation of the pathogen to its external  environment, which is the internal environment of the  macroorganism. To confirm this assumption, the bacterial load of  1,083 diagnostic specimens grouped in a similar manner has been  estimated, taking into account only MDR/XDR strains. In the group  of treated patients the frequency of high bacterial load (CFU ≥ 100)  reached 52.5–63.8% that shows the conserved fitness of bacteria in  such patients. The mean values of the growth rate of the strain  H37Rv non-adapted to the macroorganism (due to numerous  passages on artificial media) are higher than in all groups of clinical  strains. Thus, heterogeneity of phenotypic properties of M.  tuberculosis clinical strains on the basis of growth rate has been  obtained. The growth rate of M. tuberculosis clinical strains is  depended on the tuberculosis localization (PT, BJT) and on the joint  effect of patient treatment and pathogen adaptation to the host. 

[Influence of cultivation conditions on the proteomic profile of Mycobacterium tuberculosis H37RV]

Comparative proteomic profiling of M. tuberculosis H37Rv strains cultured on two different nutrient media, Levenstein-Jensen and Middlebrook 7H11, was performed using a label-free LC-MS/MS approach. It was shown that results obtained from two media possessed high convergence. The only difference was observed in the representation of fumarate reductase FrdB, its abundance was higher in the mycobacterial cells cultured on Levenstein-Jensen medium. The correlation analysis of biological repeats revealed the high convergence of the results obtained from Middlebrook 7H11 medium. Thus, we can conclude that the use of the Middlebrook 7H11 medium is most appropriate in the scientific laboratory.

[MOLECULAR CHARACTERISTICS OF THE MULTIDRUG-RESISTANT MYCOBACTERIUM TUBERCULOSIS STRAINS IN THE NORTHWEST RUSSIA]

The goal of this work was to study the genotypic characteristics of the multidrug-resistant (MDR, i.e., resistant to at least rifampicine and isoniazid) Mycobacterium tuberculosis strains isolated in 2011-2012 from tuberculosis (TB) patients in the Northwest Russia. Spoligotyping of 195 M. tuberculosis isolates identified 14 different spoligotypes and assigned isolates to the genetic families Beijing (n = 162, 83%), LAM (n = 15), H3/URAL (n = 14), as well as T, Haarlem and X. Spoligotypes SIT1 (Beijing), SIT42 (LAM) and SIT262 (H3/URAL) were the most prevalent. Irrespective to the genotype, all the isolates were resistant to streptomycin. The multidrug resistance was accompanied by the resistance to ethionamide (56%), amikacin (31%), kanamycin (40%), and capreomycin (33%). The ethambutol resistance was found in 71% (n = 115) and 42% (n = 14) of the Beijing and non-Beijing strains, respectively (p < 0.05). In conclusion, the multidrug resistant M. tuberculosis population circulating in the Northwest Russia continues to be dominated by the Beijing family strains.

[The dependence of the inflammatory reaction on the properties of mycobacterium tuberculosis and the course of specific pulmonary process]

The systemic analysis of the inflammatory process in untreated patients with newly diagnosed infiltrative-destructive tuberculosis has been performed in the context of host mycobacterium interaction. Variability of acute phase proteins (APP) reflecting mobilization of nonspecific protective systems of the body did not depend on cytotoxicity of Mycobacterium tuberculosis (MBT). In 87.5% of patients the dependence between effectiveness of antitubercular chemotherapy (for three months) and combination of MBT characteristics and initial APP levels was found. Patients with effectiveness of therapy, which was inadequate to MBT cytotoxicity, were characterized by its dependence on the APP level and MBT sensitivity to antitubercular agents. Results of multifactorial analysis of parameters reflecting intensity of the inflammatory response, pathological process in the lungs, and characteristics of MBT suggest that the overall result of the host-pathogen interactions primarily depend on adequateness of protective systems of the body

[The effectiveness of BACTEC MGIT 960 system hit analysis of surgery material of patients with tubercular spondylitis]

The article considers the comparison of effectiveness of cultivation of 290 surgery samples from focus of destruction in patients with tubercular spondylitis in liquid medium Middlebrook 7119 with fluorescent detection of growth and two dense egg medium -Levenschtein-Yensen and Finn-II. The sensitivity of methods of inoculation in liquid medium Middlebrook 7H9 and in dense egg mediums has no difference (38.2% and 43.1%, p = 0.271). The duration of growth consisted 2 +/- 2.3 days for liquid mediums and 40.6 +/- 3.2 days for dense mediums. The method of pre-inoculation processing of surgery material. In case of inoculation of 440 samples in liquid mediums contamination consisted 3.9%. In case of inoculation of bone fragments of focus of destruction in liquid medium Middlebrook 7119 the culture was isolated in 43.5% of samples of patients with tubercular spondylitis.

[Molecular-genetic characteristics of Mycobacterium tuberculosis strains isolated from patients with tuberculous spondylitis]

AIM

Molecular-genetic characteristic of M. tuberculosis strains isolated from operation material of patients with tuberculous spondylitis.

MATERIALS AND METHODS

107 strains of M. tuberculosis isolated in 2007 - 2011 from patients with spine tuberculosis were studied by methods of spoligotyping and MIRU-VNTR by 12 and 24 loci.

RESULTS

Strains of genetic family Beijing dominated (n = 80), 78% of those had multiple drug resistance (MDR). Strains of genetic families T, H3 (Ural), LAM, Manu, H4 and S were also detected. Differentiating of 80 strains of Beijing genotype by MIRU-VNTR method by 24 loci revealed 24 variants (HGI = 0.83) including 7 clusters, the largest of those (100-32) included 23 strains (87% MDR).

CONCLUSION

The leading role of Beijing genotype M. tuberculosis strains in development of tuberculous spondylitis with multiple drug resistance of the causative agent is shown.

[Monitoring of chemotherapy in patients with pulmonary tuberculosis by the blood bacteriostatic activity-determining test]

The paper gives the results of studies to determine blood bacteriostatic activity (BBA) in the use of a patient's autostrain and semiliquid medium versus the clinical and laboratory parameters of the course of a process in 101 patients with pulmonary tuberculosis. There is evidence for the relationship of the BBA to the sensitivity to isoniazid and the structure of drug resistance. The zero values of BBA correspond to the severest course of the disease. The efficiency of treatment is much higher in patients with high and moderate BBA. The latter's determination using the semiliquid medium permits an objective evaluation of the efficiency of chemotherapy, identification of patients with a poor prognosis, and then choice of an individual treatment regimen on day 7 after the test just before obtaining the data on drug sensitivity.

[Drug sensitivity in Mycobacterium tuberculosis versus its viability, cytotoxicity, genotype, and the course of the process in patients with pulmonary tuberculosis]

The authors studied drug sensitivity, mutations in the katG, in-hA, alpC, rpoB genes, virulence via the cytotoxicity test on THP-1 cells, and the viability and genetic affiliation of 53 clinical M. tuberculosis isolates versus data on the form and dynamics of a process. Sensitive and resistant strains did not significantly differ in viability and cytotoxicity. The highest death of infected macrophages was observed was seen with infection of M. tuberculosis of the Beijing B0 genotype, the least one seen with that of LAM with the similar rate of multiple drug resistance. There was a correlation of the changes in the count of lymphocytes in patients with the genetic affiliation of a causative agent. The severest course of the tuberculous process was observed in baseline lymphopenia (before treatment) in combination with multidrug resistance of mycobacteria, high and moderate cytotoxicity and high viability. Ser-Leu 531 mutation resulted in cross resistance to rifampicin and mycobutin in most cases.

[The specific features of bacterial isolation and drug resistance of Mycobacteria in extrapulmonary tuberculosis]

The reduced viability and enzymatic activity of the pathogen from the foci of extrapulmonary tuberculosis are twice more frequently than those in pulmonary tuberculosis. The isolation of mycobacterial L-forms and the use of polymerase chain reaction significantly enhance the efficiency of the etiological diagnosis of extrapulmonary tuberculosis. There are extremely poor trends for drug resistance to develop in mycobacteria, in 2005 the rate of which was 92.5% in pulmonary tuberculosis and 83.4% in extrapulmonary tuberculosis. However, multidrug resistance is much less common in extrapulmonary tuberculosis than in pulmonary tuberculosis; the rates were 33.9 and 73.9%, respectively. Levofloxacin resistance was also completely preserved so the reserves for the treatment of extrapulmonary tuberculosis are higher than those in pulmonary tuberculosis.

[Elastic materials in surgery for inflammatory diseases of the vertebral column]

When 17 patients were surgically treated for spinal tuberculosis and osteomyelitis, anterior spine fusion was performed by A. Ye. Garbuz's procedure that was based on the replacement of a spinal defect by a carbon-carbonic implant that had rifampicin containers in the frontal sections, as well as by autologous bone grafts. The carbon-carbonic implants reliably fix an operated spinal portion, prevent the progression of kyphotic deformity, and create good conditions for autologous bone grafts to knit. An osteocarbonic block forms in the late postoperative period.

[More rapid detection of multidrug resistance of Mycobacterium tuberculosis in the use of a semiliquid culture medium]

The paper the results of assays of 649 Mycobacterium tuberculosis strains for their drug resistance, by applying the Soton semiliquid medium, which were conducted in 1999 to 2004. The sensitivity and specificity of the assay of the strains for their resistance to streptomycin, isoniazid, rifampicin, and ethambutol have been estimated. These are 89.9 and 97.1%, 96.3 and 87.4%, 95.8 and 93.1%, and 65.8 and 89.2%, respectively. On day 7, resistance to streptomycin, isoniazid, and rifampicin was found by the semiliquid medium in 90.2% of the cases of 325 multidrug-resistant strains. Multidrug resistance could be determined in 80.2% of the strains by the first signs of their growth, i.e. on days 3-5. The proposed method is cost-effective and accessible to any practical laboratory.

[Levofloxacin susceptibility of Mycobacterium tuberculosis]

Drug susceptibility of 195 M. tuberculosis clinical isolates was tested with the indirect method of absolute concentrations on the Löwenstein-Jensen medium. 151 and 44 M. tuberculosis strains were isolated from patients with respiratory tract tuberculosis and tuberculosis of extrapulmonary localization respectivily. The resistance of the isolates to the main and reserve antituberculosis drugs amounted to 79.5%, including 62.1% of the isolates with multiple drug resistance. Levofloxacin was used in a concentration of 10 mcg/ml. The resistance to levofloxacin was detected only in 4 isolates from the patients with respiratory tract tuberculosis (2.05%), whereas the resistance to ofloxacin amounted to 11.8%.

[Accelerated determination of the Mycobacterium tuberculosis drug resistance with a semiliquid culture medium]

A medium was worked out whose consistence is close to liquid ones (the terminal concentration of agar-agar is 0.08%) and which enable a visual registration of growth of Mycobacterium tuberculosis (MBT) on days 3-4 after culture inoculation. The medium is based on the liquid synthetic medium of Soton, which is added 0.35% of nutrition agar and 10% (medium 1) or 25% (medium 2) of horse serum. The elaborated semi-liquid medium was used simultaneously with the standard method of absolute concentrations base on Levenstein-Jensen's medium to determine the drug resistance of 294 MBT clinical strains. The highest coincidence rate of results, in percent, was found for medium 2: for streptomycin--90.1%, for isoniazid--96.7%, and for rifampycin--96.3%, therefore, the mentioned medium can be referred to as an optimal one in a fast determination of the MBT resistance to three main anti-TB drugs. The deadline of registering the results for sensitive strains is 7 days, and for resistant strains it is 3-4 days, i.e. after the onset of primary growth signs.

[Some aspects of determination of the sensitivity of Mycobacterium tuberculosis to ethambutol using a semiliquid medium]

In addition to the earlier developed rapid technique for determining the drug resistance of Mycobacterium tuberculosis (MBT) to essential antituberculous drugs by using semiliquid medium (SLM), the author proposes a procedure for determining their resistance to ethambutol. She shows it necessary to use the drug only as a powder. The mean minimum suppressing concentrations of ethambutol in the semiliquid medium have been determined for stock cultures, sensitive and resistant strains, which are 3.5 +/- 2.5, 4.5 +/- 1.4, 8.5 +/- 1.6 micrograms/ml. Parallel determination of the sensitivity of 91 MBT strains by using the standard Löwenstein-Jensen medium and SLM has yielded the optimum concentration of ethambutol (5 micrograms/ml), which is marked by the highest (84.4%) percent of coincidence of results.

[Pulmonary tuberculosis caused by Mycobacterium tuberculosis of different genotypes]

A relationship of the clinical picture of destructive pulmonary tuberculosis to the genotype, drug resistance, and virulence of Mycobacterium tuberculosis (MBT) strains was studied. As compared with the processes induced by individual genotypes, pulmonary tuberculosis caused by MBT from the family Beijing was found to be characterized by more marked clinical symptoms, multisegmental lung tissue lesions with multiple decay cavities, by low bacteriostatic blood activity, abundant bacterial isolation, and progression. MBT of the Beijing genotype were characterized by higher rates of resistance to antituberculous drugs and their combinations than were the strains of individual genotypes; they have a high virulence, which is likely to enhance their transmissibility and to determine the poor course of a specific process.

[Accelerated determination of blood bacteriostatic activity in patients with tuberculosis by using the semiliquid culture medium]

Blood bacteriostatic activity (BBA) was studied in 87 patients with respiratory tuberculosis. Clinical Mycobacterium tuberculosis (MBT) strains and different culture media, such as solid (Löwenstein-Jensen and Middlebrook), liquid (modified Soton) and semiliquid (SM developed for accelerated determination of drug resistance in MBT) media were used. With isoniazid-resistance of MBT, the use of solid media yielded underestimated BBA. The SM medium based on the Soton medium added by 0.35% of culture agar and 25% equine serum was optimal, which provided evidence for BBA on day 7 (visual recording of MBT growth). Examination of BBA by means of SM revealed a clear inverse correlation between the degree of BBA and the bacteriological parameters of sputum study. The small numbers of sputum MBT cultures (a high correlation, r = -0.88; p = 0.01) and short bacterial isolation (average correlation, r = -0.65; p = 0.01) corresponded to the high values of BBA.

[Blood bacteriostatic activity in patients with respiratory tuberculosis]

Vertical diffusion on the Löwenstein-Jensen medium was used to study blood bacteriostatic activity (BBA) in 174 patients with respiratory tuberculosis in relation to the drug resistance of isolated Mycobacterium tuberculosis (MT) strains and to the course of a tuberculous process. There was a clear relationship of BBA to the sensitivity of MT cultures to isoniazid: BAC was high and moderate in 90.8-98.2% of cases if strain drug sensitivity was present and low or null in 98% with drug resistance. The high and medium values of BBA correlated with the clinical indices "improvement" and "significant improvement". Patients with zero and lower values of BBA and isoniazid resistance showed a progressive specific process in 22.0% of cases. Estimation of total BBA by using liquid media is the most informative method.

[Biological features and problems in detection of extrapulmonary tuberculosis pathogen]

The viability, enzymatic activity and Mycobacterium tuberculosis drug resistance was compared in pulmonary and extrapulmonary tuberculosis. To decrease oxygen in the culture medium baseline values and to use various oxidants as protectors were shown to be promising in enhancing the efficiency of cultural diagnosis of extrapulmonary tuberculosis.

[Diagnostic values of polymerase chain reaction test in females with genital tuberculosis]

The previously offered procedure for detecting. Mycobacterium tuberculosis, which is based on the polymerase chain reaction (PCR), has been tested for diagnosing genital tuberculosis in females. PCR was used to examine endometrial curettage specimens in 44 patients with different nosological entities, which showed a high sensitivity (80%) and a high specificity in the diagnosis of genital tuberculosis.

[Microbial flora in spinal hematogenous osteomyelitis]

The analysis of microbic flora of the pus and granulations of 155 patients, operated on hematogenic osteomyelitis of vertebral column. The microbic agents were detected in 81.2% of the patients in subacute stage of the disease, in 48.5% of the patients with chronic stage and duration of the disease less than one year, and in 74.3% of the patients with the duration of the disease exceeding one year. In all cases monoculture was detected with the domination of Staphilococcus (69.2%-83.0%). A comparative analyses of the rate of penetration of the infective agents into the spongeous bone of a damaged vertebra. In case of resection of one third of the height of a vertebra the frequency of detection of an infective agent in subacute stage of a disease decreases 2 times, and in chronic stage-in 4 times. These data provides an opportunity of verification of indications for the surgery.

[Evaluation of complex therapy efficiency for urogenital tuberculosis]

It is most expedient to develop effective modes of improving the etiotropic therapy of urogenital tuberculosis, by applying the multipronged approach which includes chemoenzyme therapy with native and immobilized terrilytine, enhanced activity of basic tuberculostatic agents through their combination with nonspecific antibiotics and the use of helium-neon laser, and delivery of drugs just to the focus of tuberculous inflammation by endolymphatic injection.

[Method of assessing the effect of preparations on the ulcerogenic action of reserpine in mice]

A method for intraperitoneal (2.5 mg/kg) or enteral (10 mg/kg) administration of reserpine to mice with subsequent keeping for 2 hours at a temperature of 7 degrees C and for 16 hours at a temperature maintained at the animal house has been suggested to induce lesions of the glandular part of the stomach. The lesions have been subjected to histological study. The influence of cooling, fasting and the animals' sex on the formation of lesions has been examined. It has been established by the method suggested that iproniazid almost completely prevents ulcerogenous action of reserpine, while atropine and ephedrine have pronounced protective properties. Of the flavonoids, quercetin has been found to manifest marked protective activity. It was more effective than hyperoxide or quercetin 3'-glucoside. Rutin has not averted lesions in the stomach. The method deserves attention since it enables one to evaluate antialterative activity of the minimal doses of the drugs with the different mechanism of action.