Abstract
Pulmonary colonization and infection of patients with cystic fibrosis by Mycobacterium spp. has recently been recognized as a potentially important clinical problem. However, frequent contamination of mycobacterial cultures by pseudomonads has hampered efforts to define the extent of this problem. This study was done to evaluate current techniques and to establish a more efficient method of recovering mycobacteria from respiratory secretions of patients with cystic fibrosis. Decontamination of respiratory specimens (n = 121) with 0.25% N-acetyl-L-cysteine and 1% sodium hydroxide (NALC-NaOH) was associated with a high rate of pseudomonas overgrowth for both Lowenstein-Jensen slants (74%) and BacTec vials supplemented with PANTA (polymyxin B [50 U/ml], amphotericin B [5 micrograms/ml], nalidixic acid [20 micrograms/ml], trimethoprim [5 micrograms/ml], azlocillin [10 micrograms/ml]) (36%). This overgrowth limited recovery of mycobacteria to only 64% (9 of 14) of specimens positive by smear for acid-fast bacilli (AFB). Decontamination of specimens (n = 441) with NALC-NaOH, followed by 5% oxalic acid treatment, resulted in contamination of only 5% of Lowenstein-Jensen slants and 3% of BacTec vials. AFB were recovered from all 90 AFB smear-positive specimens following the use of this decontamination technique. We recommend that respiratory secretions be decontaminated with NALC-NaOH and oxalic acid to decrease the incidence of Pseudomonas aeruginosa overgrowth.
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- Boxerbaum B. Isolation of rapidly growing mycobacteria in patients with cystic fibrosis. J Pediatr. 1980 Apr;96(4):689–691. doi: 10.1016/s0022-3476(80)80743-8. [DOI] [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]
- Gilligan P. H. Microbiology of airway disease in patients with cystic fibrosis. Clin Microbiol Rev. 1991 Jan;4(1):35–51. doi: 10.1128/cmr.4.1.35. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hjelte L., Petrini B., Källenius G., Strandvik B. Prospective study of mycobacterial infections in patients with cystic fibrosis. Thorax. 1990 May;45(5):397–400. doi: 10.1136/thx.45.5.397. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kiehn T. E., Edwards F. F. Rapid identification using a specific DNA probe of Mycobacterium avium complex from patients with acquired immunodeficiency syndrome. J Clin Microbiol. 1987 Aug;25(8):1551–1552. doi: 10.1128/jcm.25.8.1551-1552.1987. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kilby J. M., Gilligan P. H., Yankaskas J. R., Highsmith W. E., Jr, Edwards L. J., Knowles M. R. Nontuberculous mycobacteria in adult patients with cystic fibrosis. Chest. 1992 Jul;102(1):70–75. doi: 10.1378/chest.102.1.70. [DOI] [PubMed] [Google Scholar]
- Kinney J. S., Little B. J., Yolken R. H., Rosenstein B. J. Mycobacterium avium complex in a patient with cystic fibrosis: disease vs. colonization. Pediatr Infect Dis J. 1989 Jun;8(6):393–396. doi: 10.1097/00006454-198906000-00013. [DOI] [PubMed] [Google Scholar]
- Sinnott J. T., 4th, Emmanuel P. J. Mycobacterial infections in the transplant patient. Semin Respir Infect. 1990 Mar;5(1):65–73. [PubMed] [Google Scholar]
- Smith M. J., Efthimiou J., Hodson M. E., Batten J. C. Mycobacterial isolations in young adults with cystic fibrosis. Thorax. 1984 May;39(5):369–375. doi: 10.1136/thx.39.5.369. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Wood R. E., Boat T. F., Doershuk C. F. Cystic fibrosis. Am Rev Respir Dis. 1976 Jun;113(6):833–878. doi: 10.1164/arrd.1976.113.6.833. [DOI] [PubMed] [Google Scholar]