Abstract
A PCR and a reverse cross blot hybridization assay were developed for the detection and identification of mycobacteria in clinical samples. The PCR amplifies a part of the DNA coding for 16S rRNA with a set of primers that is specific for the genus Mycobacterium and that flanks species-specific sequences within the genes coding for 16S rRNA. The PCR product is analyzed in a reverse cross blot hybridization assay with probes specific for M. tuberculosis complex (pTub1), M. avium (pAvi3), M. intracellulare (pInt5 and pInt7), M. kansasii complex-M. scrofulaceum complex (pKan1), M. xenopi (pXen1), M. fortuitum (pFor1), M. smegmatis (pSme1), and Mycobacterium spp. (pMyc5a). The PCR assay can detect 10 fg of DNA, the equivalent of two mycobacteria. The specificities of the probes were tested with 108 mycobacterial strains (33 species) and 31 nonmycobacterial strains (of 17 genera). The probes pAvi3, pInt5, pInt7, pKan1, pXen1, and pMyc5a were specific. With probes pTub1, pFor1, and pSme1, slight cross hybridization occurred. However, the mycobacterial strains from which the cross-hybridizing PCR products were derived belonged to nonpathogenic or nonopportunistic species which do not occur in clinical samples. The test was used on 31 different clinical specimens obtained from patients suspected of having mycobacterial disease, including a patient with a double mycobacterial infection. The samples included sputum, bronchoalveolar lavage, tissue biopsy samples, cerebrospinal fluid, pus, peritoneal fluid, pleural fluid, and blood. The results of the PCR assay agreed with those of conventional identification methods or with clinical data, showing that the test can be used for the direct and rapid detection and identification of mycobacteria in clinical samples.
Full Text
The Full Text of this article is available as a PDF (295.5 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Anargyros P., Astill D. S., Lim I. S. Comparison of improved BACTEC and Lowenstein-Jensen media for culture of mycobacteria from clinical specimens. J Clin Microbiol. 1990 Jun;28(6):1288–1291. doi: 10.1128/jcm.28.6.1288-1291.1990. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Bloom B. R., Murray C. J. Tuberculosis: commentary on a reemergent killer. Science. 1992 Aug 21;257(5073):1055–1064. doi: 10.1126/science.257.5073.1055. [DOI] [PubMed] [Google Scholar]
- Braun M. M., Byers R. H., Heyward W. L., Ciesielski C. A., Bloch A. B., Berkelman R. L., Snider D. E. Acquired immunodeficiency syndrome and extrapulmonary tuberculosis in the United States. Arch Intern Med. 1990 Sep;150(9):1913–1916. [PubMed] [Google Scholar]
- Brisson-Noel A., Aznar C., Chureau C., Nguyen S., Pierre C., Bartoli M., Bonete R., Pialoux G., Gicquel B., Garrigue G. Diagnosis of tuberculosis by DNA amplification in clinical practice evaluation. Lancet. 1991 Aug 10;338(8763):364–366. doi: 10.1016/0140-6736(91)90492-8. [DOI] [PubMed] [Google Scholar]
- Butler W. R., Jost K. C., Jr, Kilburn J. O. Identification of mycobacteria by high-performance liquid chromatography. J Clin Microbiol. 1991 Nov;29(11):2468–2472. doi: 10.1128/jcm.29.11.2468-2472.1991. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Böddinghaus B., Rogall T., Flohr T., Blöcker H., Böttger E. C. Detection and identification of mycobacteria by amplification of rRNA. J Clin Microbiol. 1990 Aug;28(8):1751–1759. doi: 10.1128/jcm.28.8.1751-1759.1990. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Böddinghaus B., Wolters J., Heikens W., Böttger E. C. Phylogenetic analysis and identification of different serovars of Mycobacterium intracellulare at the molecular level. FEMS Microbiol Lett. 1990 Jul;58(2):197–203. doi: 10.1111/j.1574-6968.1990.tb13978.x. [DOI] [PubMed] [Google Scholar]
- Clarridge J. E., 3rd, Shawar R. M., Shinnick T. M., Plikaytis B. B. Large-scale use of polymerase chain reaction for detection of Mycobacterium tuberculosis in a routine mycobacteriology laboratory. J Clin Microbiol. 1993 Aug;31(8):2049–2056. doi: 10.1128/jcm.31.8.2049-2056.1993. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Eisenach K. D., Sifford M. D., Cave M. D., Bates J. H., Crawford J. T. Detection of Mycobacterium tuberculosis in sputum samples using a polymerase chain reaction. Am Rev Respir Dis. 1991 Nov;144(5):1160–1163. doi: 10.1164/ajrccm/144.5.1160. [DOI] [PubMed] [Google Scholar]
- Ellner J. J., Hinman A. R., Dooley S. W., Fischl M. A., Sepkowitz K. A., Goldberger M. J., Shinnick T. M., Iseman M. D., Jacobs W. R., Jr Tuberculosis symposium: emerging problems and promise. J Infect Dis. 1993 Sep;168(3):537–551. doi: 10.1093/infdis/168.3.537. [DOI] [PubMed] [Google Scholar]
- Floyd M. M., Silcox V. A., Jones W. D., Jr, Butler W. R., Kilburn J. O. Separation of Mycobacterium bovis BCG from Mycobacterium tuberculosis and Mycobacterium bovis by using high-performance liquid chromatography of mycolic acids. J Clin Microbiol. 1992 May;30(5):1327–1330. doi: 10.1128/jcm.30.5.1327-1330.1992. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Ford E. G., Snead S. J., Todd J., Warren N. G. Strains of Mycobacterium terrae complex which react with DNA probes for M. tuberculosis complex. J Clin Microbiol. 1993 Oct;31(10):2805–2806. doi: 10.1128/jcm.31.10.2805-2806.1993. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Goto M., Oka S., Okuzumi K., Kimura S., Shimada K. Evaluation of acridinium-ester-labeled DNA probes for identification of Mycobacterium tuberculosis and Mycobacterium avium-Mycobacterium intracellulare complex in culture. J Clin Microbiol. 1991 Nov;29(11):2473–2476. doi: 10.1128/jcm.29.11.2473-2476.1991. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hampson S. J., Portaels F., Thompson J., Green E. P., Moss M. T., Hermon-Taylor J., McFadden J. J. DNA probes demonstrate a single highly conserved strain of Mycobacterium avium infecting AIDS patients. Lancet. 1989 Jan 14;1(8629):65–68. doi: 10.1016/s0140-6736(89)91427-x. [DOI] [PubMed] [Google Scholar]
- Hermans P. W., van Soolingen D., Dale J. W., Schuitema A. R., McAdam R. A., Catty D., van Embden J. D. Insertion element IS986 from Mycobacterium tuberculosis: a useful tool for diagnosis and epidemiology of tuberculosis. J Clin Microbiol. 1990 Sep;28(9):2051–2058. doi: 10.1128/jcm.28.9.2051-2058.1990. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hoffner S. E., Haile M., Källenius G. A biphasic system for primary isolation of mycobacteria compared to solid medium and broth culture. J Med Microbiol. 1992 Nov;37(5):332–334. doi: 10.1099/00222615-37-5-332. [DOI] [PubMed] [Google Scholar]
- Hoffner S. E. Pulmonary infections caused by less frequently encountered slow-growing environmental mycobacteria. Eur J Clin Microbiol Infect Dis. 1994 Nov;13(11):937–941. doi: 10.1007/BF02111495. [DOI] [PubMed] [Google Scholar]
- Horsburgh C. R., Jr Mycobacterium avium complex infection in the acquired immunodeficiency syndrome. N Engl J Med. 1991 May 9;324(19):1332–1338. doi: 10.1056/NEJM199105093241906. [DOI] [PubMed] [Google Scholar]
- Hughes M. S., Skuce R. A., Beck L. A., Neill S. D. Identification of mycobacteria from animals by restriction enzyme analysis and direct DNA cycle sequencing of polymerase chain reaction-amplified 16S rRNA gene sequences. J Clin Microbiol. 1993 Dec;31(12):3216–3222. doi: 10.1128/jcm.31.12.3216-3222.1993. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Jonas V., Alden M. J., Curry J. I., Kamisango K., Knott C. A., Lankford R., Wolfe J. M., Moore D. F. Detection and identification of Mycobacterium tuberculosis directly from sputum sediments by amplification of rRNA. J Clin Microbiol. 1993 Sep;31(9):2410–2416. doi: 10.1128/jcm.31.9.2410-2416.1993. [DOI] [PMC free article] [PubMed] [Google Scholar]
- KUBICA G. P., DYE W. E., COHN M. L., MIDDLEBROOK G. Sputum digestion and decontamination with N-acetyl-L-cysteine-sodium hydroxide for culture of mycobacteria. Am Rev Respir Dis. 1963 May;87:775–779. doi: 10.1164/arrd.1963.87.5.775. [DOI] [PubMed] [Google Scholar]
- Kirschner P., Springer B., Vogel U., Meier A., Wrede A., Kiekenbeck M., Bange F. C., Böttger E. C. Genotypic identification of mycobacteria by nucleic acid sequence determination: report of a 2-year experience in a clinical laboratory. J Clin Microbiol. 1993 Nov;31(11):2882–2889. doi: 10.1128/jcm.31.11.2882-2889.1993. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kolk A. H., Noordhoek G. T., de Leeuw O., Kuijper S., van Embden J. D. Mycobacterium smegmatis strain for detection of Mycobacterium tuberculosis by PCR used as internal control for inhibition of amplification and for quantification of bacteria. J Clin Microbiol. 1994 May;32(5):1354–1356. doi: 10.1128/jcm.32.5.1354-1356.1994. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kolk A. H., Schuitema A. R., Kuijper S., van Leeuwen J., Hermans P. W., van Embden J. D., Hartskeerl R. A. Detection of Mycobacterium tuberculosis in clinical samples by using polymerase chain reaction and a nonradioactive detection system. J Clin Microbiol. 1992 Oct;30(10):2567–2575. doi: 10.1128/jcm.30.10.2567-2575.1992. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kotloff R. M. Infection caused by nontuberculous mycobacteria: clinical aspects. Semin Roentgenol. 1993 Apr;28(2):131–138. doi: 10.1016/s0037-198x(05)80102-6. [DOI] [PubMed] [Google Scholar]
- Kox L. F., Rhienthong D., Miranda A. M., Udomsantisuk N., Ellis K., van Leeuwen J., van Heusden S., Kuijper S., Kolk A. H. A more reliable PCR for detection of Mycobacterium tuberculosis in clinical samples. J Clin Microbiol. 1994 Mar;32(3):672–678. doi: 10.1128/jcm.32.3.672-678.1994. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kusunoki S., Ezaki T. Proposal of Mycobacterium peregrinum sp. nov., nom. rev., and elevation of Mycobacterium chelonae subsp. abscessus (Kubica et al.) to species status: Mycobacterium abscessus comb. nov. Int J Syst Bacteriol. 1992 Apr;42(2):240–245. doi: 10.1099/00207713-42-2-240. [DOI] [PubMed] [Google Scholar]
- Lebrun L., Espinasse F., Poveda J. D., Vincent-Levy-Frebault V. Evaluation of nonradioactive DNA probes for identification of mycobacteria. J Clin Microbiol. 1992 Sep;30(9):2476–2478. doi: 10.1128/jcm.30.9.2476-2478.1992. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Luquin M., Ausina V., López Calahorra F., Belda F., García Barceló M., Celma C., Prats G. Evaluation of practical chromatographic procedures for identification of clinical isolates of mycobacteria. J Clin Microbiol. 1991 Jan;29(1):120–130. doi: 10.1128/jcm.29.1.120-130.1991. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Lévy-Frébault V. V., Portaels F. Proposed minimal standards for the genus Mycobacterium and for description of new slowly growing Mycobacterium species. Int J Syst Bacteriol. 1992 Apr;42(2):315–323. doi: 10.1099/00207713-42-2-315. [DOI] [PubMed] [Google Scholar]
- Mabilat C., Desvarenne S., Panteix G., Machabert N., Bernillon M. H., Guardiola G., Cros P. Routine identification of Mycobacterium tuberculosis complex isolates by automated hybridization. J Clin Microbiol. 1994 Nov;32(11):2702–2705. doi: 10.1128/jcm.32.11.2702-2705.1994. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Masur H. Recommendations on prophylaxis and therapy for disseminated Mycobacterium avium complex disease in patients infected with the human immunodeficiency virus. Public Health Service Task Force on Prophylaxis and Therapy for Mycobacterium avium Complex. N Engl J Med. 1993 Sep 16;329(12):898–904. doi: 10.1056/NEJM199309163291228. [DOI] [PubMed] [Google Scholar]
- Miller N., Hernandez S. G., Cleary T. J. Evaluation of Gen-Probe Amplified Mycobacterium Tuberculosis Direct Test and PCR for direct detection of Mycobacterium tuberculosis in clinical specimens. J Clin Microbiol. 1994 Feb;32(2):393–397. doi: 10.1128/jcm.32.2.393-397.1994. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Miller W. T., Jr, Miller W. T. Pulmonary infections with atypical mycobacteria in the normal host. Semin Roentgenol. 1993 Apr;28(2):139–149. doi: 10.1016/s0037-198x(05)80103-8. [DOI] [PubMed] [Google Scholar]
- Nolte F. S., Metchock B., McGowan J. E., Jr, Edwards A., Okwumabua O., Thurmond C., Mitchell P. S., Plikaytis B., Shinnick T. Direct detection of Mycobacterium tuberculosis in sputum by polymerase chain reaction and DNA hybridization. J Clin Microbiol. 1993 Jul;31(7):1777–1782. doi: 10.1128/jcm.31.7.1777-1782.1993. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Pfyffer G. E., Kissling P., Wirth R., Weber R. Direct detection of Mycobacterium tuberculosis complex in respiratory specimens by a target-amplified test system. J Clin Microbiol. 1994 Apr;32(4):918–923. doi: 10.1128/jcm.32.4.918-923.1994. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Plikaytis B. B., Plikaytis B. D., Yakrus M. A., Butler W. R., Woodley C. L., Silcox V. A., Shinnick T. M. Differentiation of slowly growing Mycobacterium species, including Mycobacterium tuberculosis, by gene amplification and restriction fragment length polymorphism analysis. J Clin Microbiol. 1992 Jul;30(7):1815–1822. doi: 10.1128/jcm.30.7.1815-1822.1992. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Roberts G. D., Goodman N. L., Heifets L., Larsh H. W., Lindner T. H., McClatchy J. K., McGinnis M. R., Siddiqi S. H., Wright P. Evaluation of the BACTEC radiometric method for recovery of mycobacteria and drug susceptibility testing of Mycobacterium tuberculosis from acid-fast smear-positive specimens. J Clin Microbiol. 1983 Sep;18(3):689–696. doi: 10.1128/jcm.18.3.689-696.1983. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Rogall T., Wolters J., Flohr T., Böttger E. C. Towards a phylogeny and definition of species at the molecular level within the genus Mycobacterium. Int J Syst Bacteriol. 1990 Oct;40(4):323–330. doi: 10.1099/00207713-40-4-323. [DOI] [PubMed] [Google Scholar]
- Saito H., Tomioka H., Sato K., Tasaka H., Dawson D. J. Identification of various serovar strains of Mycobacterium avium complex by using DNA probes specific for Mycobacterium avium and Mycobacterium intracellulare. J Clin Microbiol. 1990 Aug;28(8):1694–1697. doi: 10.1128/jcm.28.8.1694-1697.1990. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Schöningh R., Verstijnen C. P., Kuijper S., Kolk A. H. Enzyme immunoassay for identification of heat-killed mycobacteria belonging to the Mycobacterium tuberculosis and Mycobacterium avium complexes and derived from early cultures. J Clin Microbiol. 1990 Apr;28(4):708–713. doi: 10.1128/jcm.28.4.708-713.1990. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Sewell D. L., Rashad A. L., Rourke W. J., Jr, Poor S. L., McCarthy J. A., Pfaller M. A. Comparison of the Septi-Chek AFB and BACTEC systems and conventional culture for recovery of mycobacteria. J Clin Microbiol. 1993 Oct;31(10):2689–2691. doi: 10.1128/jcm.31.10.2689-2691.1993. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Shafer R. W., Sierra M. F. Mycobacterium xenopi, Mycobacterium fortuitum, Mycobacterium kansasii, and other nontuberculous mycobacteria in an area of endemicity for AIDS. Clin Infect Dis. 1992 Jul;15(1):161–162. doi: 10.1093/clinids/15.1.161. [DOI] [PubMed] [Google Scholar]
- Shinnick T. M., Good R. C. Mycobacterial taxonomy. Eur J Clin Microbiol Infect Dis. 1994 Nov;13(11):884–901. doi: 10.1007/BF02111489. [DOI] [PubMed] [Google Scholar]
- Stager C. E., Libonati J. P., Siddiqi S. H., Davis J. R., Hooper N. M., Baker J. F., Carter M. E. Role of solid media when used in conjunction with the BACTEC system for mycobacterial isolation and identification. J Clin Microbiol. 1991 Jan;29(1):154–157. doi: 10.1128/jcm.29.1.154-157.1991. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Thorel M. F., Krichevsky M., Lévy-Frébault V. V. Numerical taxonomy of mycobactin-dependent mycobacteria, emended description of Mycobacterium avium, and description of Mycobacterium avium subsp. avium subsp. nov., Mycobacterium avium subsp. paratuberculosis subsp. nov., and Mycobacterium avium subsp. silvaticum subsp. nov. Int J Syst Bacteriol. 1990 Jul;40(3):254–260. doi: 10.1099/00207713-40-3-254. [DOI] [PubMed] [Google Scholar]
- Tsukamura M. A review of the methods of identification and differentiation of mycobacteria. Rev Infect Dis. 1981 Sep-Oct;3(5):841–861. doi: 10.1093/clinids/3.5.841. [DOI] [PubMed] [Google Scholar]
- Vaneechoutte M., De Beenhouwer H., Claeys G., Verschraegen G., De Rouck A., Paepe N., Elaichouni A., Portaels F. Identification of Mycobacterium species by using amplified ribosomal DNA restriction analysis. J Clin Microbiol. 1993 Aug;31(8):2061–2065. doi: 10.1128/jcm.31.8.2061-2065.1993. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Verstijnen C. P., Ly H. M., Polman K., Richter C., Smits S. P., Maselle S. Y., Peerbooms P., Rienthong D., Montreewasuwat N., Koanjanart S. Enzyme-linked immunosorbent assay using monoclonal antibodies for identification of mycobacteria from early cultures. J Clin Microbiol. 1991 Jul;29(7):1372–1375. doi: 10.1128/jcm.29.7.1372-1375.1991. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Wolinsky E. Mycobacterial diseases other than tuberculosis. Clin Infect Dis. 1992 Jul;15(1):1–10. doi: 10.1093/clinids/15.1.1. [DOI] [PubMed] [Google Scholar]
- Woods G. L., Washington J. A., 2nd Mycobacteria other than Mycobacterium tuberculosis: review of microbiologic and clinical aspects. Rev Infect Dis. 1987 Mar-Apr;9(2):275–294. doi: 10.1093/clinids/9.2.275. [DOI] [PubMed] [Google Scholar]
- van Soolingen D., de Haas P. E., Hermans P. W., Groenen P. M., van Embden J. D. Comparison of various repetitive DNA elements as genetic markers for strain differentiation and epidemiology of Mycobacterium tuberculosis. J Clin Microbiol. 1993 Aug;31(8):1987–1995. doi: 10.1128/jcm.31.8.1987-1995.1993. [DOI] [PMC free article] [PubMed] [Google Scholar]
- van der Vliet G. M., Schukkink R. A., van Gemen B., Schepers P., Klatser P. R. Nucleic acid sequence-based amplification (NASBA) for the identification of mycobacteria. J Gen Microbiol. 1993 Oct;139(10):2423–2429. doi: 10.1099/00221287-139-10-2423. [DOI] [PubMed] [Google Scholar]
