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Órgano oficial de difusión de la Federación Mexicana de Patología Clínica, AC y de la Asociación Latinoamericana de Patología Clínica/Medicina de Laboratorio

2014, Number 3

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Rev Mex Patol Clin Med Lab 2014; 61 (3)

Experience of a third level attention laboratory in the diagnosis of mycobacterial infections

Barriga AG, López ÁL, Ramírez CF, Monzalvo HME, Villagrán GJA, Rodríguez AE, Hernández SEA

Language: Spanish
References: 25
Page: 156-162
PDF size: 155.95 Kb.


ABSTRACT

Introduction: Tuberculosis is the second ranked cause of global mortality for infectious agents. In 2011, throughout Mexico, there were 19,445 new incidents reported, with a frequency of 17.4 cases per 100,000 inhabitants. In this work, we analyzed the sensitivity, specificity, advantages, and disadvantages of diverse laboratory techniques in the diagnosis, of 6,470 samples from the same number of patients displaying the clinical symptoms of tuberculosis. Material and methods: We analyzed the results of one sputum smear microscopy technique (Ziehl Neelsen), two different culture media (Lowestein Jensen bioMerieux and Middlebrook broth base 7H9 Becton Dickinson), two tipification test (Accuprobe, Gen Probe, Genotype HAIN CM/N, MTBc, MTBRD, MTBRs, Hain Life Science GmbH) and two antimicrobial sensitivity methods (MGIT System, Becton Dickinson, Genotype MTBDR, Hain Life Science, GmbH) in 6,470 pulmonary and extrapulmonary samples from the same number of patients. The specimens were collected at the four hospitals of «La Raza» Medical Center Mexican Institute of Social Security, with clinical characteristics of mycobacterial infection. Results: 623 samples were positive by culture. The liquid culture media with continuous monitoring was the most sensitive method (94.8%), with positive results in a media of 12 days. Most isolates correspond to a Mycobacterium tuberculosis complex (75.5%) and Mycobacterium avium (17.1%). Four strains were simultaneously resistant to rifampicin and isoniazid, and five only to rifampicin. Most of the positive patients were males (62.7%). AIDS was the most frequent predisponent factor. Conclusions: With the data obtained in this study, we recommend a simultaneous culture in solid and liquid media. The liquid media with continuous monitoring system reduces the time of isolation to 20 days, in comparison with the solid media. Despite that the typification and antibiotic susceptibility techniques have similar sensitivity, the polymerase reaction and typification strip techniques have a more wide menu of species and antibiotics, are easy to do, and do not require instrumentation. All patients with predisponent factors for tuberculosis must be monitored combined with preventive and surveillance measures.


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