Tüberküloz şüpheli hastalardan mycobacterium tuberculosis kompleks izolasyon oranı ve suşların BACTEC NAP ve immünokromatografik TB Ag MPT64 Rapid testleri ile tanımlanması
Küçük Resim Yok
Tarih
2011
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Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Tüberküloz (TB), morbidite ve mortalitesi oldukça yüksek enfeksiyon hastalıklarından biri olarak tüm dünyada ve ülkemizde halen önemini korumaktadır. TB kontrol programının en önemli aşaması olan aktif olguların tespiti için Mycobacterium tuberculosis’in izolasyonu, tiplendirilmesi ve ilaç direncinin saptanmasında klinik mikobakteriyoloji laboratuvarları büyük role sahiptir. Bu çalışmada, TB şüpheli hastaların klinik örneklerinden M.tuberculosis kompleks (MTC) izolasyon oranının araştırılması ve katı ve/veya sıvı besiyerinde üretilen mikobakterilerin BACTEC NAP ve immünokromatografik TB Ag MPT64 hızlı testi ile karşılaştırmalı olarak tanımlanması amaçlanmıştır. Çalışmaya, hastanemizin çeşitli servislerine başvuran ve tüberküloz ön tanısıyla izlenen anti-HIV seronegatif 1670 hastaya ait klinik örnek dahil edilmiştir. Örneklerin dekontaminasyon/ homojenizasyonu NALC-NaOH yöntemi ile yapılmış; hazırlanan preparatlar Erlich-Ziehl-Neelsen yöntemiyle boyanarak aside dirençli basil (ARB) yönünden direkt mikroskobik olarak incelenmiştir. Kültür için tüm örnekler, BACTEC MGIT-960 (Becton Dickinson, ABD) ve Löwenstein-Jensen besiyerlerine ekilmiştir. 37C’de 6-8 haftalık inkübasyondan sonra üreyen mikobakterilerin tanımlanması BACTEC NAP (Becton Dickinson, ABD) ve TB Ag MPT64 hızlı testi (SD Bioline Ag MPT64 Rapid; Standard Diagnostics, Kore) ile yapılmıştır. Çalışmamızda, tüberküloz şüpheli hastalara ait klinik örneklerin %3.7 (63/1670)’sinde Löwenstein-Jensen ve/veya MGIT-960 ile kültür pozitifliği saptanmış; örneklerde ARB pozitifliği ise %1.6 (28/1670) olarak bulunmuştur. Mikobakteri üremesi saptanan 63 örneğin 53 (%84)’ü BACTEC NAP testi ile; 61 (%97)’i ise TB MPT64 testi ile MTC olarak tanımlanmıştır. BACTEC NAP testi referans kabul edildiğinde, TB MPT64 testinin tüm MTC izolatlarını doğru olarak tanımladığı (duyarlılık %100), buna karşın yalancı pozitiflik oranının %12.7 olduğu (özgüllük %87) görülmüştür. MTC üremesi saptanan 53 örneğin 36’sı balgam, dördü bronkoalveoler lavaj, dördü idrar, üçü açlık mide suyu, üçü plevral sıvı ve birer adedi olmak üzere apse, periton sıvısı ve beyin omurilik sıvısı örneğidir. Kültürlerinde MTC üreyen örneklerde ARB pozitifliğinin ise %41.5 (22/53) olduğu saptanmıştır. MTC suşlarının izole edildiği hastalar incelendiğinde; %72 (38/53)’sinin erkek ve %98 (52/53)’inin erişkin (yaş aralığı: 20-85 yıl) olduğu belirlenmiştir. Sonuç olarak, bölgemizde TB şüpheli hastalarda saptanan MTC pozitiflik oranı %3.1 (53/1670) olarak bulunmuş ve bu oranın ülkemizde yapılan diğer çalışmalarla uyumlu olduğu izlenmiştir. İmmünokromatografik TB MPT64 testinin ise, aynı günde sonuç vermesi nedeniyle hızlı, uygulaması kolay ve duyarlı bir yöntem olarak katı ve/veya sıvı besiyerinde üretilen mikobakterilerin tanımlanmasında kullanılabileceği, ancak bulgularımızın, ülkemizde yapılacak daha geniş kapsamlı çalışmalarla desteklenmesi gerektiği kanısına varılmıştır.
Tuberculosis (TB) which is still one of the important infectious diseases in the world as well as Turkey, results in high morbidity and mortality. Clinical mycobacteriology laboratories have crucial roles in the identification, typing and susceptibility testing of Mycobacterium tuberculosis. The aims of this study were the investigation of the isolation rate of M.tuberculosis complex (MTC) from the clinical specimens of TB-suspected patients and to compare identification of mycobacteria isolated from solid and/or liquid media by using BACTEC NAP and immunochromatographic TB Ag MPT64 rapid test. A total of 1670 patients who were admitted to outpatients clinics of our hospital and prediagnosed as TB, have been included in the study. All the patients were anti-HIV seronegative. NALC-NaOH method were used for decontamination/ homogenization, and preparations from samples were stained with Erlich-Ziehl-Neelsen method to detect acid-resistant bacilli (ARB) in direct microscopy. All of the samples were inoculated into BACTEC™ MGIT-960 (Becton Dickinson, USA) and Löwenstein-Jensen (LJ) media for cultivation and incubated at 37°C for 6-8 weeks. Mycobacteria that were grown in the media have been identified by BACTEC™ NAP (Becton Dickinson, USA) and TB Ag MPT64 rapid test (SD Bioline Ag MPT64 Rapid™; Standard Diagnostics, Korea). The culture positivity in the samples of TB-suspected patients was found to be 3.7% (63/1670) with LJ and/or MGIT-960 methods, whereas ARB positivity rate was 1.6% (28/1670). Fifty-three (84%) out of culture positive 63 samples have been identified as MTC by BACTEC NAP test, while 61 (97%) were found as MTC by TB MPT64 test. Considering BACTEC NAP test as the reference method, TB MPT64 test identified all the MTC strains correctly (sensitivity: 100%), however the false positivity rate was estimated as 12.7% (specificity: 87%). Of 53 MTC positive samples, 36 were sputum, four were bronchoalveolar lavage, four were urine, three were gastric fluid, three were pleural fluid, and one of each were abscess, peritoneal fluid and cerebrospinal fluid samples. ARB positivity rate was detected as 41.5% (22/53) among MTC culture positive samples. Of the patients who were infected with MTC, 72% (38/53) were male and 98% (52/53) were adults (age range: 20-85 years). Our data indicating 3.1% (53/1670) isolation rate of MTC from TB-suspected patients in our region were in concordance with the other results reported from Turkey. In conclusion, immunochromatographic TB Ag MPT64 test which seemed to be useful for the rapid identification of mycobacteria grown on solid and/or liquid, was practical to perform and had high sensitivity, however further larger-scaled studies are needed to support our data in our country.
Tuberculosis (TB) which is still one of the important infectious diseases in the world as well as Turkey, results in high morbidity and mortality. Clinical mycobacteriology laboratories have crucial roles in the identification, typing and susceptibility testing of Mycobacterium tuberculosis. The aims of this study were the investigation of the isolation rate of M.tuberculosis complex (MTC) from the clinical specimens of TB-suspected patients and to compare identification of mycobacteria isolated from solid and/or liquid media by using BACTEC NAP and immunochromatographic TB Ag MPT64 rapid test. A total of 1670 patients who were admitted to outpatients clinics of our hospital and prediagnosed as TB, have been included in the study. All the patients were anti-HIV seronegative. NALC-NaOH method were used for decontamination/ homogenization, and preparations from samples were stained with Erlich-Ziehl-Neelsen method to detect acid-resistant bacilli (ARB) in direct microscopy. All of the samples were inoculated into BACTEC™ MGIT-960 (Becton Dickinson, USA) and Löwenstein-Jensen (LJ) media for cultivation and incubated at 37°C for 6-8 weeks. Mycobacteria that were grown in the media have been identified by BACTEC™ NAP (Becton Dickinson, USA) and TB Ag MPT64 rapid test (SD Bioline Ag MPT64 Rapid™; Standard Diagnostics, Korea). The culture positivity in the samples of TB-suspected patients was found to be 3.7% (63/1670) with LJ and/or MGIT-960 methods, whereas ARB positivity rate was 1.6% (28/1670). Fifty-three (84%) out of culture positive 63 samples have been identified as MTC by BACTEC NAP test, while 61 (97%) were found as MTC by TB MPT64 test. Considering BACTEC NAP test as the reference method, TB MPT64 test identified all the MTC strains correctly (sensitivity: 100%), however the false positivity rate was estimated as 12.7% (specificity: 87%). Of 53 MTC positive samples, 36 were sputum, four were bronchoalveolar lavage, four were urine, three were gastric fluid, three were pleural fluid, and one of each were abscess, peritoneal fluid and cerebrospinal fluid samples. ARB positivity rate was detected as 41.5% (22/53) among MTC culture positive samples. Of the patients who were infected with MTC, 72% (38/53) were male and 98% (52/53) were adults (age range: 20-85 years). Our data indicating 3.1% (53/1670) isolation rate of MTC from TB-suspected patients in our region were in concordance with the other results reported from Turkey. In conclusion, immunochromatographic TB Ag MPT64 test which seemed to be useful for the rapid identification of mycobacteria grown on solid and/or liquid, was practical to perform and had high sensitivity, however further larger-scaled studies are needed to support our data in our country.
Açıklama
Anahtar Kelimeler
Mikrobiyoloji
Kaynak
Mikrobiyoloji Bülteni
WoS Q Değeri
Scopus Q Değeri
Cilt
45
Sayı
2
