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Prevalence of mycobacteremia in Indian HIV-infected patients detected by the MB/BacT automated culture system

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Abstract

The use of automated blood cultures system, such as MB/BacT, has provided a novel opportunity for laboratories to diagnose mycobacteremia in HIV-infected patients. However, no such study has been carried out in India so far. This prospective study was conducted on 52 HIV-positive patients with suspected tuberculosis who were referred to our tertiary care hospital in New Delhi. In these patients, the prevalence of mycobacteremia was evaluated using the MB/BacT automated culture system (bioMérieux, France). Twenty-seven HIV-negative but suspected tuberculosis patients were also included for comparison. Mycobacteria could be isolated from sputa or fecal samples of 20 HIV-positive patients (38.4%), and in nine (45%) of these 20 cases, mycobacteria could also be isolated simultaneously from their blood specimens. In the remaining 32 patients, all relevant non-hematological clinical samples remained negative for mycobacteria, but the pathogen could be detected from the blood samples of seven (21.87%) of these 32 patients. Therefore, only 25 (48%) clinically suspected patients remained negative in both Löwenstein-Jensen (L-J) and MB/BacT culture methods, and 12 of these responded to anti-tubercular treatment, while in the rest either non-tubercular diagnosis was established or they were lost to follow-up. The study revealed that low \( {\text{CD}}^{ + }_{4} \) counts and poor or no reactivity to purified protein derivative (PPD) were the best clinical predictors for the occurrence of mycobacteremia in HIV-positive patients. Of the 16 isolates from blood, 13 were diagnosed as Mycobacterium tuberculosis and one each were identified as M. avium, M. kansasii, and a mixed infection of M. tuberculosis and M. avium complex. The prevalence rate of mycobacteremia was significantly low (11.1%) in HIV-negative patients. In conclusion, this study showed that blood culture could be an important adjunct investigation for confirming the clinical diagnosis of tuberculosis in HIV-positive patients.

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References

  1. Barnes PF, Bloch AB, Davidson PT, Snider DE Jr (1991) Tuberculosis in patients with human immunodeficiency virus infection. N Engl J Med 324:1644–1650

    Article  PubMed  CAS  Google Scholar 

  2. Havlir DV, Barnes PF (1999) Tuberculosis in patients with human immunodeficiency virus infection. N Engl J Med 340:367–373

    Article  PubMed  CAS  Google Scholar 

  3. Gopinath K, Manisankar M, Kumar S, Singh S (2007) Controlling multidrug-resistant tuberculosis in India. Lancet 369:741–742

    Article  PubMed  Google Scholar 

  4. Flynn JL, Chan J (2003) Immune evasion by Mycobacterium tuberculosis: living with the enemy. Curr Opin Immunol 15:450–455

    Article  PubMed  CAS  Google Scholar 

  5. Condos R, McClune A, Rom WN, Schluger NW (1996) Peripheral-blood-based PCR assay to identify patients with active pulmonary tuberculosis. Lancet 347:1082–1085

    Article  PubMed  CAS  Google Scholar 

  6. Crump JA, Tanner DC, Mirrett S, McKnight CM, Reller LB (2003) Controlled comparison of BACTEC 13A, MYCO/F LYTIC, BacT/ALERT MB, and ISOLATOR 10 systems for detection of mycobacteremia. J Clin Microbiol 41:1987–1990

    Article  PubMed  Google Scholar 

  7. Hanscheid T, Monteiro C, Cristino JM, Lito LM, Salgado MJ (2005) Growth of Mycobacterium tuberculosis in conventional BacT/ALERT FA blood culture bottles allows reliable diagnosis of Mycobacteremia. J Clin Microbiol 43:890–891

    Article  PubMed  CAS  Google Scholar 

  8. d’Arminio Monforte A, Vago L, Gori A, Antinori S, Franzetti F, Antonacci CM, Sala E, Catozzi L, Testa L, Esposito R, Nebuloni M, Moroni M (1996) Clinical diagnosis of mycobacterial diseases versus autopsy findings in 350 patients with AIDS. Eur J Clin Microbiol Infect Dis 15:453–458

    Article  PubMed  CAS  Google Scholar 

  9. Rosas RC, Salomão R, da Matta DA, Lopes HV, Pignatari AC, Colombo AL (2003) Bloodstream infections in late-stage acquired immunodeficiency syndrome patients evaluated by a lysis centrifugation system. Mem Inst Oswaldo Cruz 98:529–532

    Article  PubMed  CAS  Google Scholar 

  10. McDonald LC, Archibald LK, Rheanpumikankit S, Tansuphaswadikul S, Eampokalap B, Nwanyanawu O, Kazembe P, Dobbie H, Reller LB, Jarvis WR (1999) Unrecognised Mycobacterium tuberculosis bacteraemia among hospital inpatients in less developed countries. Lancet 354:1159–1163

    Article  PubMed  CAS  Google Scholar 

  11. Bouza E, Díaz-López MD, Moreno S, Bernaldo de Quirós JC, Vicente T, Berenguer J (1993) Mycobacterium tuberculosis bacteremia in patients with and without human immunodeficiency virus infection. Arch Intern Med 153:496–500

    Article  PubMed  CAS  Google Scholar 

  12. Archibald LK, den Dulk MO, Pallangyo KJ, Reller LB (1998) Fatal Mycobacterium tuberculosis bloodstream infections in febrile hospitalized adults in Dar es Salaam, Tanzania. Clin Infect Dis 26:290–296

    Article  PubMed  CAS  Google Scholar 

  13. von Gottberg A, Sacks L, Machala S, Blumberg L (2001) 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 5:80–86

    Google Scholar 

  14. Bacha HA, Cimerman S, de Souza SA, Hadad DJ, Mendes CM (2004) Prevalence of mycobacteremia in patients with AIDS and persistent fever. Braz J Infect Dis 8:290–295

    Article  PubMed  Google Scholar 

  15. David ST, Mukundan U, Brahmadathan, John TJ (2004) Detecting mycobacteraemia for diagnosing tuberculosis. Indian J Med Res 119:259–266

    PubMed  Google Scholar 

  16. Gopinath K, Kumar S, Mani Sankar M, Singh S (2007) Novel method for clearing red blood cell debris from BacT/ALERT blood culture medium for improved microscopic and antimycobacterial drug susceptibility test results. J Clin Lab Anal 21(4):220–226

    Article  PubMed  CAS  Google Scholar 

  17. Reves RR, Reichman LB, Simone PM, Starke JR, Vernon AA (2003) American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: treatment of tuberculosis. Am J Respir Crit Care Med 167:603–662

    Article  PubMed  Google Scholar 

  18. [No authors listed] (2000) Diagnostic Standards and Classification of Tuberculosis in Adults and Children. This official statement of the American Thoracic Society and the Centers for Disease Control and Prevention was adopted by the ATS Board of Directors, July 1999. This statement was endorsed by the Council of the Infectious Disease Society of America, September 1999. Am J Respir Crit Care Med 161:1376–1395

  19. Kent PT, Kubica GP (1985) Public health mycobacteriology. A guide for the level III laboratory. Centers for Disease Control and Prevention, Atlanta, Georgia

  20. Khan IU, Yadav JS (2004) Development of a single-tube, cell lysis-based, genus-specific PCR method for rapid identification of mycobacteria: optimization of cell lysis, PCR primers and conditions, and restriction pattern analysis. J Clin Microbiol 42:453–457

    Article  PubMed  CAS  Google Scholar 

  21. Telenti A, Marchesi F, Balz M, Bally F, Böttger EC, Bodmer T (1993) Rapid identification of mycobacteria to the species level by polymerase chain reaction and restriction enzyme analysis. J Clin Microbiol 31:175–178

    PubMed  CAS  Google Scholar 

  22. Park H, Jang H, Kim C, Chung B, Chang CL, Park SK, Song S (2000) Detection and identification of mycobacteria by amplification of the internal transcribed spacer regions with genus- and species-specific PCR primers. J Clin Microbiol 38:4080–4085

    PubMed  CAS  Google Scholar 

  23. Rohner P, Ninet B, Metral C, Emler S, Auckenthaler R (1997) Evaluation of the MB/BacT system and comparison to the BACTEC 460 system and solid media for isolation of mycobacteria from clinical specimens. J Clin Microbiol 35:3127–3131

    PubMed  CAS  Google Scholar 

  24. Gil-Setas A, Torroba L, Fernandez JL, Martinez-Artola V, Olite J (2004) Evaluation of the MB/BacT system compared with Middlebrook 7H11 and Löwenstein-Jensen media for detection and recovery of mycobacteria from clinical specimens. Clin Microbiol Infect 10:224–228

    Article  PubMed  CAS  Google Scholar 

  25. Singh S, Raju GV, Samantaray JC (1993) Parasitic gut flora in a north Indian population with gastrointestinal symptoms. Trop Gastroenterol 14:104–108

    PubMed  CAS  Google Scholar 

  26. Mtei L, Matee M, Herfort O, Bakari M, Horsburgh CR, Waddell R, Cole BF, Vuola JM, Tvaroha S, Kreiswirth B, Pallangyo K, von Reyn CF (2005) High rates of clinical and subclinical tuberculosis among HIV-infected ambulatory subjects in Tanzania. Clin Inf Dis 40:1500–1507

    Article  Google Scholar 

  27. Waddell RD, Lishimpi K, von Reyn CF, Chintu C, Baboo KS, Kreiswirth B, Talbot EA, Karagas MR; Dartmouth/UCLMS/UNZA Collaborative Study Group (2001) Bacteremia due to Mycobacterium tuberculosis or M. bovis, Bacille Calmette-Guérin (BCG) among HIV-positive children and adults in Zambia. AIDS 15:55–60

    Article  PubMed  CAS  Google Scholar 

  28. Graham NM, Nelson KE, Solomon L, Bonds M, Rizzo RT, Scavotto J, Astemborski J, Vlahov D (1992) Prevalence of tuberculin positivity and skin test anergy in HIV-1-seropositive and -seronegative intravenous drug users. JAMA 267:369–373

    Article  PubMed  CAS  Google Scholar 

  29. Angarano G, Carbonara S, Costa D, Gori A (1998) Drug-resistant tuberculosis in human immunodeficiency virus infected persons in Italy. The Italian Drug-Resistant Tuberculosis Study Group. Int J Tuberc Lung Dis 2:303–311

    PubMed  CAS  Google Scholar 

  30. Kilby JM, Marques MB, Jaye DL, Tabereaux PB, Reddy VB, Waites KB (1998) The yield of bone marrow biopsy and culture compared with blood culture in the evaluation of HIV-infected patients for mycobacterial and fungal infections. Am J Med 104:123–128

    Article  PubMed  CAS  Google Scholar 

  31. Bonard D, Aka K, Zahibo JC, You B, Combe P, Anglaret X (1999) HIV-associated mycobacteraemia in West Africa. Int J Tuberc Lung Dis 3:546

    PubMed  CAS  Google Scholar 

  32. von Reyn CF, Pestel M, Arbeit RD (1996) Clinical and epidemiologic implications of polyclonal infection due to Mycobacterium avium complex. Res Microbiol 147:24–30

    Article  Google Scholar 

  33. Pfyffer GE, Welscher HM, Kissling P, Cieslak C, Casal MJ, Gutierrez J, Rüsch-Gerdes S (1997) Comparison of the Mycobacteria Growth Indicator Tube (MGIT) with radiometric and solid culture for recovery of acid-fast bacilli. J Clin Microbiol 35:364–368

    PubMed  CAS  Google Scholar 

  34. Piersimoni C, Scarparo C, Cichero P, De Pezzo M, Covelli I, Gesu G, Nista D, Scagnelli M, Mandler F (1999) Multicenter evaluation of the MB-Redox medium compared with radiometric BACTEC system, Mycobacteria Growth Indicator Tube (MGIT), and Löwenstein-Jensen medium for detection and recovery of acid-fast bacilli. Diagn Microbiol Infect Dis 34:293–299

    Article  PubMed  CAS  Google Scholar 

  35. Runyon EH (1974) Ten mycobacterial pathogens. Tubercle 55:235–240

    Article  PubMed  CAS  Google Scholar 

  36. Kirschner P, Vogel U, Hein R, Böttger EC (1994) Bias of culture techniques for diagnosing mixed Mycobacterium genavense and Mycobacterium avium infection in AIDS. J Clin Microbiol 32:828–831

    PubMed  CAS  Google Scholar 

  37. Tortoli E, Simonetti MT, Dionisio D, Meli MG, Sterrantino G (1995) Mycobacterium genavense and Mycobacterium avium mixed infection in an AIDS patient. Clin Microbiol Newsl 17:175–176

    Article  Google Scholar 

  38. Kiehn TE, Cammarata R (1986) Laboratory diagnosis of mycobacterial infections in patients with acquired immunodeficiency syndrome. J Clin Microbiol 24:708–711

    PubMed  CAS  Google Scholar 

  39. Behr MA (2004) Tuberculosis due to multiple strains: a concern for the patient? A concern for tuberculosis control? Am J Respir Crit Care Med 169:554–555

    Article  PubMed  Google Scholar 

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Acknowledgments

This work was partially supported by the bioMérieux Foundation, France; bioMérieux (India) Pvt Ltd., and the Department of Biotechnology, Government of India.

The authors wish to thank Dr. V.M. Katoch, Director, National JALMA Institute for leprosy & other mycobacterial diseases, Agra, for his kind gift of the mycobacterial strains, and Mrs. Veena Balooni and Ms. R. Kumud for their technical assistance.

The authors also acknowledge the reviewers for their constructive criticism and suggestions.

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  1. Division of Clinical Microbiology, Department of Laboratory Medicine, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110 029, India

    K. Gopinath, S. Kumar & S. Singh

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  1. K. Gopinath
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  2. S. Kumar
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  3. S. Singh
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Correspondence to S. Singh.

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Conflict of interest statement: the authors have no conflict of interest.

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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 27, 423–431 (2008). https://doi.org/10.1007/s10096-007-0450-x

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