Abstract
The aim of this study was to evaluate the in situ detection of living mycobacterium TB rRNA by the mycobacterium TB direct assay (MTD) and its clinical significance in the early diagnosis of extrapulmonary TB. Eighty-six patients were recruited from the Shanghai Public Health Clinical Center from June to November in 2010, having been diagnosed with extrapulmonary TB, including tuberculous peritonitis (n=22), lymphatic TB (n=21), tuberculous meningitis (n=15), HIV-associated TB (n=13), nephroTB (n=9), spinal TB (n=2), cutaneous TB (n=13), parotid TB (n=1), chest wall TB (n=1), intestinal TB (n=1). One hundred and five extrapulmonary specimens, including CSF, puncture fluid, drainage, pleural fluid, urine, secretion, ascites, lymphatic tissue and marrow were collected from the patients. The samples were examined using acid-fast stain, solid culture, liquid culture and MTD in parallel. In MTD, the target segments of MTB rRNA in either cultures or clinical specimens were amplified prior to being qualitatively detected with the hybridization protection assay (HPA). The sensitivities of MTD and acid-fast staining in liquid and solid cultures were 48.6%, 41.9%, 20.0% and 14.3%, respectively. MTD sensitivity was higher than that of the others and its specificity was 100%. We concluded that MTD rRNA detection is an effective, rapid, convenient, sensitive and reliable method for the early diagnosis of extrapulmonary TB.
Highlights
Mycobacterium TB (MTB) is the causative agent of tuberculosis (TB)
The mycobacterium TB direct assay (MTD) kit was purchased from Gen-Probe UK
Gen-Probe MTD is a molecular diagnostic reagent approved by the FDA and SFDA to identify MTB
Summary
Successful disease control relies on early identification of suspicious subjects and rapid detection of MTB. Traditional diagnostic methods include smear staining of acid-fast bacilli (AFB) in liquid or solid culture. Culture results are usually not available before to 3 weeks, whereas AFB staining lacks sensitivity and specificity. Several kits that use 16S rRNA sequences as probes or amplification primers are commercially available for the identification of mycobacteria (Drobniewski et al, 2000; St Amand et al, 2005; Tottey, 2013; Lazzeri et al.,2012). We selected the quickest methodology for the detection of mycobacteria in both culture and extrapulmonary tissue in situ (St Amand et al, 2005) and compared it with other conventional methods, hoping to improve the early diagnosis and treatment of extrapulmonary TB
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