Application of acid-fast staining combined with GeneXpert MTB/RIF in the diagnosis of non-tuberculous mycobacteria pulmonary disease

Kong, Luxia; Xie, Bangruan; Liu, Qian; Hua, Lijuan; Bhusal, Anish; Bao, Chen; Hu, Jiannan; Xu, Shuyun

doi:10.1016/j.ijid.2020.12.091

Cited by 9 publications

(8 citation statements)

References 27 publications

(33 reference statements)

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“…NTM detection was more likely among paucibacillary patients as determined by smear microscopy, corroborating findings from Nigeria where the AFB-smear grading was respectively lower for NTM cases than for MTBc patients (28) and was predictive for MTBc detection when it was higher (21)With age, the risk of developing NTMs infection increased, but we did not find a significant association between gender and NTM infection, contrary to other studies, where females have been more frequently associated with NTM infections, especially at older ages (6,29,30). Previous anti-TB treatment was another risk factor for NTM infection in our study, confirming findings from NTM pulmonary disease in China and South Africa (31,32).…”

Section: Discussionsupporting

confidence: 88%

“…All mycobacteria are acid-fast bacilli (AFB) detectable by microscopy after specific staining, yet an AFB-positive result by sputum smear cannot specify the species. A negative result for the MTBc by GeneXpert MTB/RIF (Xpert hereafter) when performed on AFB-positive sputum can suggest an NTM infection (6). Cases of NTM infection in Mali were described before the introduction of Xpert into the TB diagnostic algorithm, particularly in patients who have been previously treated for TB (7).…”

Section: Introductionmentioning

confidence: 99%

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Prevalence of non-tuberculous mycobacteria among people presumed to have tuberculosis, positive for acid-fast bacilli in Mali

Cisse,

Dean,

Van Deun

et al. 2024

Preprint

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Background: Non-tuberculosis mycobacteria (NTMs) are environmental agents that can cause opportunistic pulmonary disease in humans and animals which is often misdiagnosed as tuberculosis (TB). In this study, we describe the cases of NTMs identified during the first national anti-TB drug-resistance survey conducted in Mali, and associated risk factors. Methods: Sputum was collected from people presenting for pulmonary TB diagnosis, from April to December 2019, regardless of age. Microscopy-positive patients were enrolled and were tested by GeneXpert MTB/RIF. Cases that tested negative for the Mycobacterium tuberculosis complex (MTBc) were tested for presence of mycobacteria by amplification of the IS6110 and 16SrRNA genes through double quantitative real-time PCR, followed by nested PCR and Sanger sequencing of the IS6110-negative samples for NTM species identification. Results: A total of 1,418 sputum smear-positive patients were enrolled, including 1,199 new cases, 211 previously treated cases and 8 whose previous treatment history was unknown. Based on the results of GeneXpert MTB/RIF and in-house PCR methods, 1331 (93.9%) patients were positive for MTBc, 48 (3.4%) for NTMs and for 39 (2.7%) no species identification was possible. Advanced age (65 and over) (OR 8.8, p=0.001) and previous TB treatment (OR 3.4 and p=0.016) were the risk factors statistically associated with NTM detection. M. avium complex (MAC) was the predominant NTM species, detected in 20 cases. Conclusion: Detection of NTMs in people presumed to have TB is an ongoing challenge, confounding correct TB diagnosis. Concomitant use of microscopy and GeneXpert testing among at-risk individuals could lessen confusion.

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Prevalence of non-tuberculous mycobacteria among people presumed to have tuberculosis, positive for acid-fast bacilli in Mali

Cisse,

Dean,

Van Deun

et al. 2024

Preprint

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“… 12 Although auramine microscopy has poor sensitivity and specificity, it has been shown that a positive auramine, combined with a negative Xpert MTB/RIF, has an excellent specificity and positive predictive value (PPV) of 97.0% and 95.8%, respectively. 14 In our study, the patient who cultured M. intracellulare on 11 different occasions had a positive auramine and numerous negative Xpert Ultra results, which strongly indicate disease.…”

Section: Discussionmentioning

confidence: 50%

“…Importantly, it cannot reliably distinguish between NTM and MTB, nor can it determine viability. 12 , 14 Previously, NTM were identified using a series of biochemical reactions, growth rate, and pigmentation of colonies, but this was time-consuming and not consistent. 12 Now, molecular tests such as the GenoType ® Mycobacterium CM (Hain Lifescience, Germany) are widely used to identify NTM.…”

Section: Introductionmentioning

confidence: 99%

Characterisation and antimicrobial susceptibility pattern of non-tuberculous mycobacteria

le Roux,

van der Spoel van Dijk,

Maloba

2024

Southern African Journal of Infectious Diseases

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Background Non-tuberculous mycobacteria (NTM) management comprises prolonged therapy that includes macrolides. Non-tuberculous mycobacteria can cause disease in patients with predisposing conditions such as HIV and structural lung disease. Local data on NTM disease and macrolide resistance are scarce, and routine antimicrobial susceptibility testing is currently not performed for NTM in South Africa. Objectives This study aims to characterise NTM isolated at Tshepong National Health Laboratory Service (NHLS) according to species and antimicrobial susceptibility pattern. Method A retrospective data analysis of NTM isolates from Tshepong NHLS was performed from January to June 2020. GenoType ® NTM-DR was performed on selected isolates where the assay can confirm the species and determine resistance to macrolides and aminoglycosides. Results Of the 194 collected NTM isolates, 183 were included in the study. Patients’ ages ranged from 1 day to 81 years (median 36 years). The most common specimen was sputum (84.7%), followed by gastric aspirate (6.6%). The most common NTM isolated were Mycobacterium (M.) intracellulare (67.6%), M. fortuitum (12.6%), M. species (4.3%), M. kansasii (3.9%), and M. scrofulaceum (3.9%). Macrolide resistance occurred in 2.8% of tested isolates; no aminoglycoside resistance was detected. Although most isolates were from males (62.3%), resistance was observed only in females. Conclusion M. intracellulare predominated, with only two M. intracellulare and two M. abscessus isolates showing macrolide resistance; aminoglycoside resistance was absent. Contribution This study highlights the need for increased awareness of NTM, regular nationwide NTM surveillance, and monitoring of resistance trends to guide future patient management and ensure good treatment outcomes.

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“…Nontuberculous mycobacteria (NTM) is widely present in natural environments such as water, soil, and dust, and most are parasitic bacteria. Only a small number of NTM cause human pathogenicity, and more than 190 types of NTM have been discovered to date (1). NTM can invade human lungs, lymph nodes, bones, joints, skin and soft tissues, and other tissues and organs, and can cause systemic disseminated diseases (2).…”

Section: Introductionmentioning

confidence: 99%

The value of gene chip detection of bronchoalveolar lavage fluid in the diagnosis of nontuberculous mycobacterial lung disease

Huang¹,

Lin²,

Chen³

et al. 2021

Ann Palliat Med

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Background: Nontuberculous mycobacteria (NTM) are mycobacteria other than mycobacterium tuberculosis complex (MTBC) and mycobacterium leprae. NTM can cause infection in many human tissues and organs and is most commonly seen in the lungs. Clinically, the symptoms and signs of nontuberculous mycobacteria lung disease (NMLD) are very similar to those of tuberculosis (TB). Because most NTMs are resistant to conventional anti-TB drugs, the rapid diagnosis of NMLD is the key to treatment. This study aimed to use gene chip technology to examine bronchoalveolar lavage fluid (BALF) from NMLD patients to explore the value of this technique for the rapid diagnosis of NMLD in BALF.Methods: A retrospective analysis of 308 patients with NMLD treated at Fuzhou Pulmonary Hospital from January 2018 to June 2020 was performed. BALF was collected from the patients. Gene chip detection (Capital Bio Corporation, Chengdu, China) and BACTEC MGIT960 (Becton, Dickinson and Company, MD, USA) liquid culture were performed to compare the NTM positive detection rates between the two methods. The NTM strain isolated from liquid culture were identified by rDNA sequencing and the results of identification were compared with those of gene chip detection using BALF specimens.Results: A total of 221 cases of NTM were detected in 308 BALF specimens by the gene chip method; the positive rate was 71.75% (221/308). A total of 218 cases of NTM were detected by the liquid culture method, and the positive rate was 70.78% (218/308). There was no significant difference in the positive rate of NTM detected in BALF specimens between the two methods (χ 2 =0.138 P=0.804>0.05); 187 cases were detected with both sequencing and gene chip detection, and the coincidence rate of strain identification with the two methods reached 96.79% (181/187). Sequencing of 218 strains of NTM was carried out; eight species were identified, and the top four species were M. intracellulare (131/218,60.09%), M. avium (48/218,22.02%), M. abscessus (27/218,12.38%), and M. kansasii (5/218,2.29%). Conclusions: Gene chip technology can rapidly detect NTM in BALF and accurately identify bacterial species. It has important clinical value in the early diagnosis and treatment of NMLD.

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Application of acid-fast staining combined with GeneXpert MTB/RIF in the diagnosis of non-tuberculous mycobacteria pulmonary disease

Cited by 9 publications

References 27 publications

Prevalence of non-tuberculous mycobacteria among people presumed to have tuberculosis, positive for acid-fast bacilli in Mali

Prevalence of non-tuberculous mycobacteria among people presumed to have tuberculosis, positive for acid-fast bacilli in Mali

Characterisation and antimicrobial susceptibility pattern of non-tuberculous mycobacteria

The value of gene chip detection of bronchoalveolar lavage fluid in the diagnosis of nontuberculous mycobacterial lung disease

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