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Evaluation of EZplex MTBC/NTM Real-Time PCR kit: diagnostic accuracy and efficacy in vaccination

  • Lee, Suengmok (Department of Biotechnology, The Catholic University of Korea) ;
  • Hwang, Kyung-A (Department of Research and Development, Genetree Research) ;
  • Ahn, Ji-Hoon (Department of Research and Development, Genetree Research) ;
  • Nam, Jae-Hwan (Department of Biotechnology, The Catholic University of Korea)
  • Received : 2018.07.23
  • Accepted : 2018.07.30
  • Published : 2018.07.31

Abstract

Purpose: Tuberculosis (TB) is mainly caused by Mycobacterium tuberculosis, which is a pathogenic mycobacterial species grouped under Mycobacterium tuberculosis complex (MTBC) with four other pathogenic mycobacterial species. The mycobacteria not included in MTBC are known as nontuberculous mycobacteria (NTM), and cause several pulmonary diseases including pneumonia. Currently, NTM occurrences in TB-suspected respiratory specimens have increased, due to which, precise detection of MTBC and NTM is considered critical for the diagnosis and vaccination of TB. Among the various methods available, realtime PCR is frequently adopted for MTBC/NTM detection due to its rapidness, accuracy, and ease of handling. In this study, we evaluated a new real-time PCR kit for analytical and clinical performance on sputum, bronchial washing, and culture specimens. Materials and Methods: For assessing its analytical performance, limit of detection (LOD), reactivity, and repeatability test were performed using DNA samples. To evaluate clinical performance, 612 samples were collected and clinically tested at a tertiary hospital. Results: LOD was confirmed as $0.584copies/{\mu}L$ for MTBC and $47.836copies/{\mu}L$ for NTM by probit analysis (95% positive). For the reactivity test, all intended strains were detected and, in the repeatability test, stable and steady results were confirmed with coefficient of variation ranging from 0.36 to 1.59. For the clinical test, sensitivity and specificity were 98.6%-100% and 98.8%-100% for MTBC and NTM, respectively. Conclusion: The results proved the usefulness of the kit in TB diagnosis. Furthermore, it could be adopted for the assessment of vaccine efficacy.

Keywords

Acknowledgement

Supported by : Ministry of Health & Welfare, NRF

References

  1. Global tuberculosis report 2017 [Internet]. Geneva: World Health Organization; 2017 [cited 2018 Jul 23]. Available from: http://www.who.int/tb/publications/global_report/en/.
  2. Korean Guidelines for Tuberculosis Third Edition 2017 [Internet]. Seoul: Joint Committee for the Revision of Korean Guidleines for Tuberculosis; 2017. Available from: http://www.lungkorea.org/bbs/skin/guide/download.php?code=guide&number=9939.
  3. Gordon SV, Parish T. Microbe profile: Mycobacterium tuberculosis: humanity’s deadly microbial foe. Microbiology 2018;164:437-9. https://doi.org/10.1099/mic.0.000601
  4. van Soolingen D, Hoogenboezem T, de Haas PE, et al. A novel pathogenic taxon of the Mycobacterium tuberculosis complex, Canetti: characterization of an exceptional isolate from Africa. Int J Syst Bacteriol 1997;47:1236-45. https://doi.org/10.1099/00207713-47-4-1236
  5. Niemann S, Rusch-Gerdes S, Joloba ML, et al. Mycobacterium africanum subtype II is associated with two distinct genotypes and is a major cause of human tuberculosis in Kampala, Uganda. J Clin Microbiol 2002;40:3398-405. https://doi.org/10.1128/JCM.40.9.3398-3405.2002
  6. Niobe-Eyangoh SN, Kuaban C, Sorlin P, et al. Genetic biodiversity of Mycobacterium tuberculosis complex strains from patients with pulmonary tuberculosis in Cameroon. J Clin Microbiol 2003;41:2547-53. https://doi.org/10.1128/JCM.41.6.2547-2553.2003
  7. Pfyffer GE, Auckenthaler R, van Embden JD, van Soolingen D. Mycobacterium canettii, the smooth variant of M. tuberculosis, isolated from a Swiss patient exposed in Africa. Emerg Infect Dis 1998;4:631-4. https://doi.org/10.3201/eid0404.980414
  8. Panteix G, Gutierrez MC, Boschiroli ML, et al. Pulmonary tuberculosis due to Mycobacterium microti: a study of six recent cases in France. J Med Microbiol 2010;59:984-9. https://doi.org/10.1099/jmm.0.019372-0
  9. Diagnosis and treatment of disease caused by nontuberculous mycobacteria. This official statement of the American Thoracic Society was approved by the Board of Directors, March 1997. Medical Section of the American Lung Association. Am J Respir Crit Care Med 1997;156(2 Pt 2): S1-25. https://doi.org/10.1164/ajrccm.156.2.atsstatement
  10. Kwon YS, Koh WJ. Diagnosis and treatment of nontuberculous Mycobacterial lung disease. J Korean Med Sci 2016; 31:649-59. https://doi.org/10.3346/jkms.2016.31.5.649
  11. Koh WJ, Kwon OJ, Lee KS. Diagnosis and treatment of nontuberculous mycobacterial pulmonary diseases: a Korean perspective. J Korean Med Sci 2005;20:913-25. https://doi.org/10.3346/jkms.2005.20.6.913
  12. Koh WJ, Kwon OJ, Jeon K, et al. Clinical significance of nontuberculous mycobacteria isolated from respiratory specimens in Korea. Chest 2006;129:341-8. https://doi.org/10.1378/chest.129.2.341
  13. Park YS, Lee CH, Lee SM, et al. Rapid increase of non-tuberculous mycobacterial lung diseases at a tertiary referral hospital in South Korea. Int J Tuberc Lung Dis 2010;14: 1069-71.
  14. Escalante P. In the clinic: tuberculosis. Ann Intern Med 2009;150:ITC61-614. https://doi.org/10.7326/0003-4819-150-11-200906020-01006
  15. Metcalfe JZ, Everett CK, Steingart KR, et al. Interferon-gamma release assays for active pulmonary tuberculosis diagnosis in adults in low- and middle-income countries: systematic review and meta-analysis. J Infect Dis 2011;204 Suppl 4:S1120-9. https://doi.org/10.1093/infdis/jir410
  16. Diagnostics for tuberculosis: global demand and market potential/TDR, FIND SA [Internet]. Geneva: World Health Organization; 2006 [cited 2018 Jul 23]. Available from: http: //apps.who.int/iris/handle/10665/43543.
  17. Sester M, Sotgiu G, Lange C, et al. Interferon-gamma release assays for the diagnosis of active tuberculosis: a systematic review and meta-analysis. Eur Respir J 2011;37:100-11. https://doi.org/10.1183/09031936.00114810
  18. Darban-Sarokhalil D, Imani Fooladi AA, Maleknejad P, et al. Comparison of smear microscopy, culture, and real-time PCR for quantitative detection of Mycobacterium tuberculosis in clinical respiratory specimens. Scand J Infect Dis 2013;45:250-5. https://doi.org/10.3109/00365548.2012.727465
  19. Huh HJ, Kwon HJ, Ki CS, Lee NY. Comparison of the genedia MTB detection kit and the cobas TaqMan MTB assay for detection of Mycobacterium tuberculosis in respiratory specimens. J Clin Microbiol 2015;53:1012-4. https://doi.org/10.1128/JCM.03163-14
  20. Perng CL, Chen HY, Chiueh TS, Wang WY, Huang CT, Sun JR. Identification of non-tuberculous mycobacteria by real-time PCR coupled with a high-resolution melting system. J Med Microbiol 2012;61:944-51. https://doi.org/10.1099/jmm.0.042424-0
  21. Centers for Disease Control and Prevention (CDC). Availability of an assay for detecting Mycobacterium tuberculosis, including rifampin-resistant strains, and considerations for its use, United States, 2013. MMWR Morb Mortal Wkly Rep 2013;62:821-7.
  22. Yang HY, Lee HJ, Park SY, Lee KK, Suh JT. Comparison of In-house polymerase chain reaction assay with conventional techniques for the detection of Mycobacterium tuberculosis. Korean J Lab Med 2006;26:174-8. https://doi.org/10.3343/kjlm.2006.26.3.174
  23. Park CM, Heo SR, Park KU, et al. Isolation of nontuberculous mycobacteria using polymerase chain reaction-restriction fragment length polymorphism. Korean J Lab Med 2006;26:161-7. https://doi.org/10.3343/kjlm.2006.26.3.161
  24. Nagy A, Vitaskova E, Cernikova L, et al. Evaluation of TaqMan qPCR system integrating two identically labelled hydrolysis probes in single assay. Sci Rep 2017;7:41392. https://doi.org/10.1038/srep41392
  25. Armstrong PM, Prince N, Andreadis TG. Development of a multi-target TaqMan assay to detect eastern equine encephalitis virus variants in mosquitoes. Vector Borne Zoonotic Dis 2012;12:872-6. https://doi.org/10.1089/vbz.2012.1008
  26. Wang HY, Jin H, Bang H, et al. Evaluation of MolecuTech Real MTB-ID for MTB/NTM detection using direct specimens. Korean J Clin Microbiol 2011;14:103-9. https://doi.org/10.5145/KJCM.2011.14.3.103
  27. Baek YK. The evaluation of tuberculosis examination kit using a real-time PCR [thesis]. Cheongju: Chungbuk National University Graduate School of Biology; 2014.
  28. Park KS, Kim JY, Lee JW, et al. Comparison of the Xpert MTB/RIF and Cobas TaqMan MTB assays for detection of Mycobacterium tuberculosis in respiratory specimens. J Clin Microbiol 2013;51:3225-7. https://doi.org/10.1128/JCM.01335-13
  29. Yang YC, Lu PL, Huang SC, Jenh YS, Jou R, Chang TC. Evaluation of the Cobas TaqMan MTB test for direct detection of Mycobacterium tuberculosis complex in respiratory specimens. J Clin Microbiol 2011;49:797-801. https://doi.org/10.1128/JCM.01839-10
  30. Lim J, Kim J, Kim JW, et al. Multicenter evaluation of Seegene Anyplex TB PCR for the detection of Mycobacterium tuberculosis in respiratory specimens. J Microbiol Biotechnol 2014;24:1004-7. https://doi.org/10.4014/jmb.1403.03071
  31. Lee MR, Chung KP, Wang HC, et al. Evaluation of the Cobas TaqMan MTB real-time PCR assay for direct detection of Mycobacterium tuberculosis in respiratory specimens. J Med Microbiol 2013;62:1160-4. https://doi.org/10.1099/jmm.0.052043-0
  32. Choe W, Kim E, Park SY, Chae JD. Performance evaluation of Anyplex plus MTB/NTM and AdvanSure TB/NTM for the detection of Mycobacterium tuberculosis and nontuberculous mycobacteria. Ann Clin Microbiol 2015;18: 44-51. https://doi.org/10.5145/ACM.2015.18.2.44
  33. Lee JH, Kim BH, Lee MK. Performance evaluation of Anyplex Plus MTB/NTM and MDR-TB detection kit for detection of mycobacteria and for anti-tuberculosis drug susceptibility test. Ann Clin Microbiol 2014;17:115-22. https://doi.org/10.5145/ACM.2014.17.4.115
  34. Ahn YO. Concepts and necessity of preventive medical services for the 21st century. J Korean Med Assoc 2011;54: 246-9. https://doi.org/10.5124/jkma.2011.54.3.246
  35. Global Vaccine Action Plan 2011-2020 [Internet]. Geneva: World Health Organization; 2012 [cited 2018 Jul 23]. Available from: http://www.who.int/immunization/global_vaccine_action_plan/GVAP_doc_2011_2020/.
  36. Nguipdop-Djomo P, Heldal E, Rodrigues LC, Abubakar I, Mangtani P. Duration of BCG protection against tuberculosis and change in effectiveness with time since vaccination in Norway: a retrospective population-based cohort study. Lancet Infect Dis 2016;16:219-26. https://doi.org/10.1016/S1473-3099(15)00400-4
  37. Orme IM. Tuberculosis vaccine types and timings. Clin Vaccine Immunol 2015;22:249-57. https://doi.org/10.1128/CVI.00718-14
  38. Kaufmann SH, Fortune S, Pepponi I, Ruhwald M, Schrager LK, Ottenhoff TH. TB biomarkers, TB correlates and human challenge models: New tools for improving assessment of new TB vaccines. Tuberculosis (Edinb) 2016;99 Suppl 1:S8-11. https://doi.org/10.1016/j.tube.2016.05.010
  39. Bedwell J, Kairo SK, Behr MA, Bygraves JA. Identification of substrains of BCG vaccine using multiplex PCR. Vaccine 2001;19:2146-51. https://doi.org/10.1016/S0264-410X(00)00369-8
  40. Minassian AM, Satti I, Poulton ID, Meyer J, Hill AV, McShane H. A human challenge model for Mycobacterium tuberculosis using Mycobacterium bovis bacille Calmette-Guerin. J Infect Dis 2012;205:1035-42. https://doi.org/10.1093/infdis/jis012

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