Polymerase chain reaction in the diagnosis of urinary tract tuberculosis

Vollenhoven, P. Van; Heyns, Chris F.; P, Beer; Whitaker, Paul; Helden, Paul D. van; Victor, Thomas C.

doi:10.1007/bf00431088

Cited by 36 publications

(17 citation statements)

References 14 publications

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“…51 Polymerase chain reaction in detecting M. tuberculosis in urine have a sensitivity that varies from 25% to 93% and a high specificity (95-100%). [52][53][54][55] TREATMENT All patients with active or latent TB needs specific treatment. The first-choice drugs include isoniazide, rifampicin, pirazinamide, ethambutol, and streptomycin.…”

Section: Evaluation Of Laboratory Diagnosismentioning

confidence: 99%

Renal Tuberculosis in the Modern Era

Daher¹,

Silva²,

Barros³

2013

The American Society of Tropical Medicine and Hygiene

110

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Abstract. Tuberculosis (TB) is a disease caused by Mycobacterium tuberculosis. The disease remains as an important public health problem in developing countries. Extrapulmonary TB became more common with the advent of infection with human immunodeficiency virus and by the increase in the number of organ transplantation, which also leads to immunosuppression of thousand of persons. Urogenital TB represents 27% of extrapulmonary cases. Renal involvement in TB can be part of a disseminated infection or a localized genitourinary disease. Renal involvement by TB infection is underdiagnosed in most health care centers. Most patients with renal TB have sterile pyuria, which can be accompanied by microscopic hematuria. The diagnosis of urinary tract TB is based on the finding of pyuria in the absence of common bacterial infection. The first choice drugs include isoniazide, rifampicin, pirazinamide, ethambutol, and streptomycin. Awareness of renal TB is urgently needed by physicians for suspecting this disease in patients with unexplained urinary tract abnormalities, mainly in those with any immunosuppression and those coming from TB-endemic areas.

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Section: Evaluation Of Laboratory Diagnosismentioning

confidence: 99%

Renal Tuberculosis in the Modern Era

Daher¹,

Silva²,

Barros³

2013

The American Society of Tropical Medicine and Hygiene

110

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“…Inexpensive methods, such as boiling, have been effective with urine samples (32) and partially effective with cerebrospinal fluid, depending on the protein level (24,25,26). Notably, boiling can also cause inhibition (1).…”

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confidence: 99%

Removal of PCR Inhibitors by Silica Membranes: Evaluating the Amplicor Mycobacterium tuberculosis Kit

et al. 2001

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The effectiveness of PCR inhibitor removal by silica membranes in combination with the Amplicor Mycobacterium tuberculosis kit was analyzed for 655 respiratory and nonrespiratory specimens. The overall inhibition rate was reduced from 12.5%, when applying the Amplicor kit alone, to 1.1% with the addition of silica membrane DNA purification.Clinical specimens sometimes contain inhibiting substances (inhibitors) that interfere with the performance of the PCR (7, 34). Therefore, a routine procedure suitable for removal of all inhibitors simultaneously is highly desirable (28,29). Owing to the extremely variable nature of inhibitors, however, no single ideal procedure exists yet (2,3,15).The binding of specimen DNA to silica membranes represents a strategy for eliminating a variety of inhibitors simultaneously (18, 22). The Amplicor Mycobacterium tuberculosis kit is especially susceptible to inhibition (30), inasmuch as it does not provide for cleaning of the extracted DNA. As such, this kit is suited for studying the effectiveness of inhibitor removal. The present study had a twofold aim: (i) to analyze the efficiency of PCR inhibitor removal via silica membranes on various types of clinical materials and (ii) to investigate the validity of the PCR results obtained from the Amplicor M. tuberculosis kit in combination with silica membrane columns.Six hundred fifty-five clinical samples were analyzed by PCR in a prospective study over 14 months (P. Charache, Editorial, Clin. Infect. Dis. 23:1107-1108, 1996). All samples except primarily sterile materials were processed for decontamination by the N-acetyl-L-cysteine NaOH method (23). Aliquots (0.2 ml) of this suspension were used (i) to prepare auramine-rhodamine fluorochrome-stained smears (12), (ii) for cultures including radiometric broth (12), and (iii) for PCR-enzymelinked immunosorbent assay as described by the Amplicor protocol (Amplicor Mycobacterium tuberculosis [MTB] Test; Hoffmann-LaRoche, Grenzach-Wyhlen, Germany) with detection of both the M. tuberculosis and the internal control (IC) oligonucleotide probes. The resulting preamplification sample contained a 200-l solution of extracted DNA, 50 l of which was used for continuing with the Amplicor protocol. A PCR was considered to be inhibited when the IC generated an optical density (OD) of Ͻ0.35. These inhibited samples were subjected to the "silica membrane protocol." To remove the inhibitors, 100 l of the remaining preamplification solution was transferred to a silica membrane (QIAamp DNA Mini Kit; Qiagen, Heidelberg, Germany) and eluted in 50 l of elution buffer. Twenty-five microliters of this purified sample was reamplified by adding 50 l of Amplicor master mix, 10 l of 10ϫ PCR buffer, 8 l of 50 mM MgCl 2 , and 17 l of H 2 O. When this PCR again was inhibited, we classified the final result as inhibited. Because the IC samples (n ϭ 20) gave ODs similar to those observed with the Amplicor kit (mean, 2.7; standard deviation, 0.15) and the silica membrane protocol (mean, 2.5; standard deviation, 0.25), w...

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“…False-negative findings may result from the presence of inhibitors; nonhomogeneous distribution of bacteria in the specimen so that the fraction tested does not contain mycobacteria; or low numbers of mycobacteria in the specimen, which decreases the probability of the presence of organisms in the fraction analyzed by PCR. (16,18) In our study the sensitivity of Urinary PCR is high (67.5%) when compared to the sensitivities of urine for AFB staining (31.3%), MTb culture (41.1%) and bladder biopsy (48%). (17) Modern antitubercular chemotherapy remains the cornerstone of management of genitourinary tuberculosis.…”

Section: (24%)mentioning

confidence: 53%

“…(16) The high sensitivity of PCR is particularly useful in paucibacillary situations. PCR can provide much faster confirmation of the diagnosis (24-48 hrs) than MTb culture.…”

Section: (24%)mentioning

confidence: 99%

An Analysis of the Clinical Presentation , Diagnosis , Management Options and Outcome of the Patients With Genito - Urinary Tuberculosis

Bhagavan¹,

Jagadeeshwar²,

Ravichandar³

et al. 2015

jemds

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AIMS AND OBJECTIVES:To analyze various clinical presentations and the treatment options in the management of the patients with genitourinary tuberculosis and to evaluate the role of urinary PCR in the detection of mycobacterium tuberculosis in patients with a clinical suspicion of genito urinary tuberculosis and to compare its sensitivity with urine for AFB smear, urine for myc. tuberculosis culture and bladder biopsy. MATERIALS AND METHODS: This is a retrospective and prospective study of patients with a diagnosis of genitourinary tuberculosis who underwent treatment in Gandhi General Hospital between January 2009 to December 2014. 62 patients with a diagnosis of genitourinary tuberculosis who underwent treatment were taken initially into the study. Five patients lost follow up after initial visits. These patients were excluded from the study. The remaining 57 patients were managed. RESULTS: Irritative voiding symptoms (Frequency / Urgency / Dysuria) were the most common symptoms. Gross hematuria seen in 22(38.5%) patients and microscopic hematuria seen in 53% of patients. Urine for AFB attaining was positive in 16(31.3%) patients, urine for MTb culture was positive in 21(41.1%) patients and pus for MTb culture was positive in 4 of 7 cases. Urinary PCR to identify the mycobacterial DNA was performed in 37 patients and was positive in 25(67.5%) of 37 clinically suspected cases. The urinary PCR was falsely positive in 1(2.7%) and falsely negative in 12(32.5%) patients. Kidney was involved in 26(45.6%) cases and ureter in 24(42.1%), and bladder in 28(49.1%) cases. Overall surgical intervention was done in 36 patients. All patients received 4 to 8 weeks ATT before they were taken up for surgical intervention. In 24 patients who presented with ureteric strictures, 7 patients had nonfunctioning kidneys and subsequently underwent nephroureterectomy, 8 patients had subnormal renal function in whom DJ stenting was done in 6 patients and PCN was done in 2 patients where DJ stenting was not possible. CONCLUSION: The manifestations of genitourinary tuberculosis can be variable and cause a variety of clinical patterns that mimic other diseases. Most of the cases present with advanced disease and high index of suspicion is necessary for the early diagnosis of genitourinary tuberculosis. PCR presents an advance in the diagnosis of GUTB. Urinary PCR is the most sensitive indicator of all microbiological tests and in combination with radiological abnormalities provides much faster diagnosis of genitourinary tuberculosis. However, it is an elaborate test that requires meticulous care to avoid false-positive and false-negative results. Multidrug chemotherapy combined with judicious surgery as and when indicated is the ideal treatment.

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Polymerase chain reaction in the diagnosis of urinary tract tuberculosis

Cited by 36 publications

References 14 publications

Renal Tuberculosis in the Modern Era

Renal Tuberculosis in the Modern Era

Removal of PCR Inhibitors by Silica Membranes: Evaluating the Amplicor Mycobacterium tuberculosis Kit

An Analysis of the Clinical Presentation , Diagnosis , Management Options and Outcome of the Patients With Genito - Urinary Tuberculosis

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