Prospective Evaluation of the Utility of Molecular Techniques for Diagnosing Nosocomial Transmission of Multidrug-Resistant Tuberculosis

To compare molecular techniques with conventional diagnostic methods for evaluating nosocomial transmission of multidrug-resistant tuberculosis (MDR-TB). We conducted a 12-week postexposure inception cohort study of health-care personnel who had been exposed to a patient with MDR-TB. In addition to...

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Bibliographic Details
Published in:	Mayo Clinic proceedings 1996-03, Vol.71 (3), p.221-229
Main Authors:	Cockerill, Franklin R., Williams, David E., Eisenach, Kathleen D., Kline, Bruce C., Miller, Linda K., Stockman, Leslie, Voyles, Jane, Caron, Gail M., Bundy, Sharon K., Roberts, Glenn D., Wilson, Walter R., Whelen, A. Christian, Hunt, John M., Persing, David H.
Format:	Article
Language:	eng
Subjects:	Antitubercular Agents - therapeutic use Bacterial diseases Bacterial diseases of the respiratory system Base Sequence Biological and medical sciences Cross Infection - drug therapy Cross Infection - microbiology DNA, Bacterial - analysis Evaluation Studies as Topic Human bacterial diseases Humans Infectious Disease Transmission, Patient-to-Professional - analysis Infectious diseases Medical sciences Molecular Sequence Data Mycobacterium tuberculosis - genetics Mycobacterium tuberculosis - isolation & purification Polymerase Chain Reaction Prospective Studies Tuberculosis, Multidrug-Resistant - diagnosis Tuberculosis, Multidrug-Resistant - drug therapy Tuberculosis, Multidrug-Resistant - transmission
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Summary:	To compare molecular techniques with conventional diagnostic methods for evaluating nosocomial transmission of multidrug-resistant tuberculosis (MDR-TB). We conducted a 12-week postexposure inception cohort study of health-care personnel who had been exposed to a patient with MDR-TB. In addition to baseline and follow-up tuberculin skin tests and chest roentgenography, weekly pulmonary specimens were evaluated by (1) auramine-rhodamine fluorescent staining, (2) culture for mycobacteria, and (3) polymerase chain reaction (PCR) to amplify IS6110, a nucleic acid insertion sequence unique to the Mycobacterium tuberculosis complex. The index patient's isolate of M. tuberculosis showed a mutation in codon 531 of the RNA polymerase beta subunit (rpoB) gene of M. tuberculosis, which is associated with rifampin resistance and considered a marker for this MDR. TB strain. All pulmonary and gastric specimens from study participants had negative auramine stains and cultures for mycobacteria. One person, however, had separate specimens with repeatedly positive PCR results for IS6110 sequences, but the specimens contained a wild type M. tuberculosis rpoB codon 531 dissimilar from the index patient's strain. Although both molecular and conventional testing showed that no exposed person was infected with the MDR-TB strain, molecular test results were available sooner and seemed more sensitive for detecting M. tuberculosis in one exposed person, presumably in a preinfection or “colonized” stage. Molecular methods provided information that helped distinguish this person's M. tuberculosis strain from the index patient's MDR-TB strain. Additional prospective studies should assess the value of these molecular techniques in similar clinical settings.
ISSN:	0025-6196 1942-5546