DETECTION OF TUBERCULOUS MYCOBACTERIA IN THE BLOOD OF PATIENTS WHEN SUSPECTING TUBERCULOUS SEPSIS
https://doi.org/10.21292/2075-1230-2016-94-8-5-13
Abstract
The increase in HIV patients manifesting clinical signs of sepsis requires up-to-date, rapid and reliable techniques for etiologic diagnostics.
The analysis has included 53 publications related to various aspects of tuberculous bacteriemia, resources for its detection and their efficiency. According to the publications tuberculous mycobacteria in blood can be detected in HIV-positive patients with severe immune suppression (CD4: 17-18 cells/mcl) and presence of the following clinical and laboratory and X-ray signs: fever, severe anemia, paratracheal lymphoadenopathy, miliary dissemination. It is feasible to test the blood in order to detect tuberculous mycobacteria only in the very ill HIV positive patients in whom tuberculosis is suspected and it is impossible to collect sputum and there are no obvious signs of pulmonary lesions.
The presence oftuberculous mycobacteria in blood isrelated to the high mortality level (up to 60%) and the immediate prescription of anti-tuberculosis therapy can reduce it. Antiretroviral therapy can reduce the chances of tuberculous sepsis development. Development and optimization of test systems for rapid detection of DNA of tuberculous mycobacteria in blood can be fairly promising for the diagnostics of the urgent tuberculosis.
About the Authors
V. N. ZiminaRussian Federation
Doctor of Medical Sciences, Associate Professor at the infectious Diseases Department with training Courses on Epidemiology and Phthisiatry of the Medical institute,
6, Miklukho-Maklaya St., Moscow, 117198
O. E. Mikova
Russian Federation
Deputy Head Doctor on treatment,
21, Sviyazeva St., Perm, 614088
D. A. Oborin
Russian Federation
Bacteriologist,
21, Sviyazeva St., Perm, 614088
S. Yu. Degtyareva
Russian Federation
15, 8 Sokolinaya Gora St., Moscow, 105275
I. B. Viktorova
Russian Federation
Candidate of Medical Sciences, Associate Professor of Phthisiopulmonology Department,
5, Stroiteley Ave., Novokuznetsk, 654005
References
1. Litvinov V.I., Moroz А.M. Laboratornaya diagnostika tuberkuleza. [Laboratory diagnostics of tuberculosis]. Moscow, MNPTsBT Publ., 2001, 184 p.
2. Edict no. 951 by RF MoH as of 12.12.2014 On Approval of Guidelines for Improvement of Respiratory Tuberculosis Diagnostics and Treatment. (In Russ.)
3. Solovieva N.S., Otten T.F., Zhuravlev V.Yu. et al. Bacteriological and molecular-genetic verification of bactereimia in HIV patients. Klin. Mikrobiologiya i Antimikrobnaya Khimioterapiya, 2014, no. 4, pp. 248-253. (In Russ.)
4. Chebotkevich V.N., Kaytandzhan E.I., Burylev V.V., Schetinkina E.E. Current techniques of laboratory diagnostics of sepsis. Klin. Mikrobiologiya i antimikrobnaya Khimioterapiya, 2013, vol. 15, no. 4. pp. 295-300. (In Russ.)
5. Chernousova L.N., Sevastyanova E.V., Larionova E.E. et al. Federal’nye klinicheskie rekomendatsii po organizatsii i provedeniyu mikrobiologicheskoy i molekulyarno-geneticheskoy diagnostiki tuberkuleza. [Federal clinical recommendations in organisation and implementation of microbiological and molecular-genetic diagnostics of tuberculosis]. Moscow, 2014, 36 p.
6. Chuchalin А.G., Sinopalnikov А.I., Kozlov R.S. et al. Klinicheskie rekomendatsii po diagnostike, lecheniyu i profilaktike tyazheloy vnebolnichnoy pnevmonii u vzroslykh. [Clinical recommendations for diagnostics, treatment and prevention ofsevere community-acquired pneumonia in adults]. Consilium Medicum. 2015, no. 3, pp. 8-37. (In Russ.)
7. Ahmed N., Mohanty A.K., Mukhopadhyay U. et al. PCR-based rapid detection of Mycobacterium tuberculosis in blood from immunocompetent patients with pulmonary tuberculosis. J. Clin. Microbiol., 1998, vol. 36, no. 10, pp. 3094-3095.
8. Archibald L.K., den Dulk M.O., Pallangyo K.J., Reller L.B. Fatal Mycobacterium tuberculosis bloodstream infections in febrile hospitalized adults in Dar es Salaam, Tanzania. Clin. Infect. Dis., 1998, vol. 26, no. 2, pp. 290-296.
9. Banada P.P., Koshy R., Alland D. Detection of Mycobacterium tuberculosis in Blood by Use of the Xpert MTB/RIF Assay. J. Clin. Microbiol., 2013, vol. 51, no. 7, pp. 2317-2322.
10. Bouza E., Díaz-López M.D., Moreno S. et al. Mycobacterium tuberculosis bacteremia in patients with and without human immunodeficiency virus infection. Arch. Intern. Med., 1993, vol. 22, no. 1534, pp. 496-500.
11. Chiu Y.S., Wang J.T., Chang S.C. et al. Mycobacterium tuberculosis bacteremia in HIV-negative patients. J. Formos. Med. Assoc., 2007, vol. 106, no. 5, pp. 355-364.
12. Clark R.A., Blakley S.L., Greer D. et al. Hematogenous dissemination of Mycobacterium tuberculosis in patients with AIDS. Rev. Infect. Dis., 1991, vol. 13, no. 6, pp. 1089-1092.
13. Clough M.C. The cultivation of tubercle bacilli from the circulating blood in miliary tuberculosis. Am. Rev. Tuberc., 1917, vol. 1, pp. 598-621.
14. Crump J.A., Morrissey A.B., Ramadhani H.O. et al. Controlled comparison of BacT/Alert MB system, manual Myco/F lytic procedure, and isolator 10 system for diagnosis of Mycobacterium tuberculosis Bacteremia. J. Clin. Microbiol., 2011, vol. 49, no. 8, pp. 3054-3057.
15. Crump J.A., Ramadhani H.O., Morrissey A.B. et al. Bacteremic disseminated tuberculosis in sub-saharan Africa: a prospective cohort study. Clin.Infect. Dis., 2012, vol. 55, no. 2, pp. 242-250.
16. Crump J.A., Tanner D.C., Mirrett S. et al. Controlled comparison of BACTEC 13A, MYCO/F LYTIC, BacT/ALERT MB, and ISOLATOR 10 systems for detection of mycobacteremia. J. Clin. Microbiol., 2003, vol. 41, no. 5, pp. 1987-1990.
17. Crump J.A., Wu X., Kendall M.A. et al. Predictors and outcomes of Mycobacterium tuberculosis bacteremia among patients with HIV and tuberculosis co-infection enrolled in the ACTG A5221 STRIDE study. BMC Infect. Dis., 2015, vol. 13, no. 15, pp. 12.
18. Doucette K., Fishman J.A. Nontuberculous mycobacterial infection in hematopoietic stemcell and solid organ transplant recipients. Clin. Infect. Dis., 2004, vol. 38, no. 10, pp. 1428-1439.
19. Drancourt M., Carrieri P., Gevaudan M.J., Raoult D. Blood agar and Mycobacterium tuberculosis: the end of a dogma. J. Clin. Microbiol., 2003, vol. 41, no. 4, pp. 1710-1711.
20. Dronda F., Chaves F., González López A. et al. Bacteremia due to Mycobacterium tuberculosis in patients coinfected with the human immunodeficiency virus. Med. Clin. (Barc), 1993, vol. 101, no. 14, pp. 534-537.
21. El Sahly H.M., Teeter L.D., James M.M., Graviss E.A. Mycobacterium tuberculosis bacteraemia: experience from a non-endemic urban center. Clin. Microbiol. Infect., 2014, vol. 20, no. 3, pp. 263-268.
22. Eng R.H., Bishburg E., Smith S.M., Mangia A. Diagnosis of Mycobacterium bacteremia in patients with acquired immunodeficiency syndrome by direct examination of blood films. J. Clin. Microbiol., 1989, vol. 27, no. 4, pp. 768-769.
23. Esteban J., Fernández-Roblas R., Cabria F., Soriano F. Usefulness oftheBACTEC MYCO/F lytic system for detection of mycobacteremia in a clinical microbiology laboratory. J. Microbiol. Methods, 2000, vol. 40, no. 1, pp. 63-66.
24. Falkinham J.O. Epidemiology of infection by nontuberculous mycobacteria. Clin. Microbiol. Rev., 1996, vol. 9, no. 2, pp. 177-215.
25. Feasey N.A., Banada P.P., Howson W. et al. Evaluation of xpert MTB/RIF for detection of tuberculosis from blood samples of HIV-infected adults confirms Mycobacterium tuberculosis bacteremia as an indicator of poor prognosis. J. Clin. Microbiol., 2013, vol. 51, no. 7, pp. 2311-2316.
26. Folgueira L., Delgado R., Palenque E. et al. Rapid diagnosis of Mycobacterium tuberculosis bacteremia by PCR. J. Clin. Microbiol., 1996, vol. 34, no. 3, pp. 512-515.
27. Gopinath K., Kumar S., Singh S. Prevalence of mycobacteremia in Indian HIV-infected patients detected by the MB/BacT automated culture system. Eur. J. Clin. Microbiol. Infect. Dis., 2008, vol. 27, no. 6, pp. 423-431.
28. Gray K.D., Cunningham C.K., Clifton D.C. et al. Prevalence of mycobacteremia among HIV-infected infants and children in northern Tanzania. Pediatr.Infect. Dis. J., 2013, vol. 32, no. 7, pp. 754-756.
29. Griffith D.E. et al. An Official ATS/IDSA Statement: Diagnosis, treatment and prevention of nontuberculous mycobacterial diseases. Am. J. Respir. Crit. Care Med., 2007, vol. 175, pp. 367-416.
30. Grinsztejn B., Fandinho F.C., Veloso V.G. et al. Mycobacteremia in patients with the acquired immunodeficiency syndrome. Arch. Intern. Med., 1997, vol. 157, no. 20, pp. 2359-2363.
31. Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. September 2015. Available at http://aidsinfo.nih.gov/guidelines
32. Hadad D.J., Pignatari A.C., Machado M.A., Telles M.A. Mycobacterium tuberculosis bacteremia diagnosed in an HIV-negative patient in Brazil: a rare or an under-reported event? Braz. J. Infect. Dis., 2004, vol. 8, no. 2, pp. 184-185.
33. Hanscheid T., Monteiro C., Melo Cristino J. et al. Growth of Mycobacterium tuberculosis in Conventional BacT/ALERT FA Blood Culture Bottles Allows Reliable Diagnosis of Mycobacteremia. J. Clin. Microbiol., 2005, vol. 43, no. 2, pp. 890-891.
34. Hänscheid T., Monteiro C., Marques-Lito L. et al. Usefulness of Myco/F Lytic bloodcultures (Bactec 9050) in the detection of Mycobacterium tuberculosis bacteraemia in HIV-infected patients in Portugal. Int.J.Infect. Dis., 2004, vol. 8, no. 4, pp. 253-254.
35. Heysell S.K., Thomas T.A., Gandhi N.R. et al. Blood cultures for the diagnosis of multidrug-resistant and extensively drug-resistant tuberculosis among HIV-infected patients from rural South Africa: across-sectional study. BMC Infect. Dis., 2010, vol. 6, no. 10, pp. 344.
36. Jacob S.T., Pavlinac P.B., Nakiyingi L. et al. Mycobacterium tuberculosis bacteremia in a cohort of hiv-infected patients hospitalized with severe sepsis in Uganda – high frequency, low clinical suspicion [corrected] and derivation of a clinical prediction score. PLoSOne, 2013, vol. 8, no. 8, pp. 10.
37. Lima J.F., Montenegro L.M., de Albuquerque Montenegro R. et al. Performance of nested PCR in the specific detection of Mycobacterium tuberculosis complex in blood samples of pediatric patients. J. Bras. Pneumol., 2009, vol. 35, no. 7, pp. 690-697.
38. McDonald L.C., Archibald L.K., Rheanpumikankit S. et al. Unrecognised Mycobacteriumtuberculosis bacteraemia among hospital inpatients in less developed countries. Lancet, 1999, vol. 354, no. 9185, pp. 1159-1163.
39. Monkongdee P., McCarthy K.D., Cain K.P. et al. Yield of acid-fast smear and mycobacterial culture fortuberculosis diagnosis in people with HIV. Am. J. Respir. Crit. Care Med., 2009, vol. 180, no. 9, pp. 903-908.
40. Motyl M.R., Saltzman B., Levi M.H. et al. The recovery of Mycobacterium avium complex and Mycobacteriumtuberculosis from blood specimens ofAIDS patients using the nonradiometric Bactec NR 660 medium. Am.J. Clin. Pathol., 1990, vol. 94, no. 1, pp. 84-86.
41. Nakatani S.M., Messias-Reason I.J., Burger M., Cunha C.A. Prevalence of Mycobacterium avium and Mycobacteriumtuberculosis in blood cultures of Brazilian AIDS patients after introduction of highly active retroviral therapy. Braz.J.Infect. Dis., 2005, vol. 9, no. 6, pp. 459-463.
42. Nakiyingi L., Ssengooba W., Nakanjako D. et al. Predictors and outcomes of mycobacteremia among HIV-infected smear-negative presumptive tuberculosis patients in Uganda. BMC Infect. Dis., 2015, vol. 15, no. 15, pp. 62.
43. Negre L., Bretey J. Role ofMycobacteriumtuberculosis not completely developed in experimental tuberculous bactaremia in laboratory animals. CR Hebd. Seances. Acad. Sci., 1954, vol. 238, no. 1, pp. 171-172.
44. Pacios E., Alcalá L., Ruiz-Serrano M.J. et al. Evaluation of bone marrow and blood cultures for the recovery of mycobacteria in the diagnosis of disseminated mycobacterial infections. Clin. Microbiol.Infect., 2004, vol. 10, no. 8, pp. 734-737.
45. Pavlinac P.B., Naulikha J.M., John-Stewart G.C. et al. Mycobacterium tuberculosis bacteremia among acutely febrile children in Western Kenya. Am. J. Trop. Med. Hyg., 2015, vol. 93, no. 5, pp. 1087-1091.
46. Rebollo M.J., San Juan Garrido R., Folgueira D. et al. Blood and urine samples as useful sources for the direct detection of tuberculosis by polymerase chain reaction. Diagn. Microbiol. Infect. Dis., 2006, vol. 56, no. 2, pp. 141-146.
47. Richter C., Kox L.F., Van Leeuwen J.V. et al. PCR detection of mycobacteraemia in tanzanian patients with extrapulmonary tuberculosis. Eur. J. Clin. Microbiol. Infect. Dis., 1996, vol. 15, no. 10, pp. 813-817.
48. Shafer R.W., Goldberg R., Sierra M., Glatt A.E. Frequency of Mycobacteriumtuberculosis bacteremia in patients with tuberculosis in an area endemic forAIDS. Am. Rev. Respir. Dis., 1989, vol. 140, no. 6, pp. 1611-1613.
49. Siddiqi S.H., Rusch-Gerdes S. MGIT Procedure Manual. Maryland, 2006, 89 p.
50. Taci N., Yurdakul A.S., Ceyhan I. et al. Detection of Mycobacteriumtuberculosis DNA from peripheral blood in patients with HIV-seronegative and new cases of smear-positive pulmonary tuberculosis by polymerase chain reaction. Respir. Med., 2003, vol. 97, no. 6, pp. 676-681.
51. Varma J. K., Kimberly D., McCarthy et al. Bloodstream infections among HIV-infected outpatients, Southeast Asia. Emerg. Infect. Dis., 2010, vol. 16, no. 10, pp. 1569-1575.
52. von Gottberg A., Sacks L., Machala S., Blumberg L. Utility of blood cultures and incidence of mycobacteremia in patients with suspected tuberculosis in a South African infectious disease referral hospital. Int. J. Tuberc. Lung. Dis., 2001, vol. 5, no. 1, pp. 80-86.
53. WHO, Xpert MTB/RIF assay for the diagnosis of pulmonary and extrapulmonary TB in adults and children WHO Policy update. France, 2014. 97 p.
Review
For citations:
Zimina V.N., Mikova O.E., Oborin D.A., Degtyareva S.Yu., Viktorova I.B. DETECTION OF TUBERCULOUS MYCOBACTERIA IN THE BLOOD OF PATIENTS WHEN SUSPECTING TUBERCULOUS SEPSIS. Tuberculosis and Lung Diseases. 2016;94(8):5-13. (In Russ.) https://doi.org/10.21292/2075-1230-2016-94-8-5-13