림프절 결핵에서 rpoB 유전자 염기서열 분석의 임상적 유용성
Clinical Usefulness of rpoB Gene Sequence Analysis in Lymph Node Tuberculosis
3
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background: Lymph node tuberculosis (LN-TB), the most common extra-pulmonary tuberculosis, frequently shows a paradoxical response (PR) during treatment. Differential diagnosis between PR and treatment failure in LN-TB is a challenging task because drug susceptibility test (DST) is rarely performed and can be delayed due to low culture yield and a long process. The rpoB gene mutation analysis is a rapid method for detection of rifampin resistance, however, its clinical usefulness has not yet been evaluated in LN-TB. Materials and Methods: DNA extracts from LN with Mycobacterium tuberculosis polymerase chain reaction (MTB-PCR) positive were gathered and direct sequencing of rpoB gene was performed. A retrospective review of clinical and microbiologic data was performed. To evaluate the clinical usefulness of rpoB gene analysis in LN-TB, the change to a second line anti-tuberculosis regimen was used due to insufficient rifampin DST data. Results: A total of 21 DNA extracts from 25 LN-TB patients were enrolled. Three rpoB mutations (Asp516Tyr, Ser522Leu, and Ser522Ala) were observed; the Asp516Tyr mutation showed rifampin resistance, however, the DST data were not available for the other two mutations. Compared with the change to the second line regimen, the sensitivity and specificity of rpoB gene mutation anaysis were 50% and 94.4%, respectively, in 20 available cases. Compared with the change to the second line regimen, the sensitivity and specificity of the rpoB gene mutation anaysis were 100% and 100%, respectively, in nine available cases with PR. Conclusions: Despite development of PR, keeping the first line regimen in LNTB cases without rpoB gene mutations may be recommended. Conduct of a prospective, well designed, further study with a larger scale is warranted.
Abstract
Background: Lymph node tuberculosis (LN-TB), the most common extra-pulmonary tuberculosis, frequently shows a paradoxical response (PR) during treatment. Differential diagnosis between PR and treatment failure in LN-TB is a challenging task because drug susceptibility test (DST) is rarely performed and can be delayed due to low culture yield and a long process. The rpoB gene mutation analysis is a rapid method for detection of rifampin resistance, however, its clinical usefulness has not yet been evaluated in LN-TB. Materials and Methods: DNA extracts from LN with Mycobacterium tuberculosis polymerase chain reaction (MTB-PCR) positive were gathered and direct sequencing of rpoB gene was performed. A retrospective review of clinical and microbiologic data was performed. To evaluate the clinical usefulness of rpoB gene analysis in LN-TB, the change to a second line anti-tuberculosis regimen was used due to insufficient rifampin DST data. Results: A total of 21 DNA extracts from 25 LN-TB patients were enrolled. Three rpoB mutations (Asp516Tyr, Ser522Leu, and Ser522Ala) were observed; the Asp516Tyr mutation showed rifampin resistance, however, the DST data were not available for the other two mutations. Compared with the change to the second line regimen, the sensitivity and specificity of rpoB gene mutation anaysis were 50% and 94.4%, respectively, in 20 available cases. Compared with the change to the second line regimen, the sensitivity and specificity of the rpoB gene mutation anaysis were 100% and 100%, respectively, in nine available cases with PR. Conclusions: Despite development of PR, keeping the first line regimen in LNTB cases without rpoB gene mutations may be recommended. Conduct of a prospective, well designed, further study with a larger scale is warranted.
참고문헌 (17)
- Peto HM., "Epidemiology of extrapulmonary tuberculosis in the United States, 1993-2006", Clin Infect Dis, 49, pp.1350~1357 (2009)
- Korea Centers for Disease Control and Prevention, "Korean Guidelines for Tuberculosis. 1st ed", ~ (2011)
- Hawkey CR., "Characterization and management of paradoxical upgrading reactions in HIVuninfected patients with lymph node tuberculosis", Clin Infect Dis, 40, pp.1368~1371 (2005)
- Cho OH., "Paradoxical responses in non-HIV-infected patients with peripheral lymph node tuberculosis", JOURNAL OF INFECTION, 59(1), pp.56~61 (2009), W B SAUNDERS CO LTD
- Joon Sung Joh, "The Interval Between Initiation of Anti-tuberculosis Treatment in Patients with Culture-positive Pulmonary Tuberculosis and Receipt of Drug-susceptibility Test Results", Journal of Korean Medical Science, 22(1), pp.26~29 (2007), 대한의학회
- Gong G., "Nested PCR for diagnosis of tuberculous lymphadenitis and PCRSSCP for identification of rifampicin resistance in fine-needle aspirates", Diagn Cytopathol, 26, pp.228~231 (2002)
- Bártfai Z., "Molecular characterization of rifampin-resistant isolates of Mycobacterium tuberculosis from Hungary by DNA sequencing and the line probe assay", J Clin Microbiol, 39, pp.3736~3739 (2001)
- Musser JM., "Characterization of the catalaseperoxidase gene(katG)and inhA locus in isoniazid-resistant and-susceptible strains of Mycobacterium tuberculosis by automated DNA sequencing : restricted array of mutations associated with drug resistance", J Infect Dis, 173, pp.196~202 (1996)
- Telenti A., "Detection of rifampicinresistance mutations in Mycobacterium tuberculosis", Lancet, 341, pp.647~650 (1993)
- 조은해, "Detection of Isoniazid and Rifampicin Resistance by Sequencing of katG, inhA, and rpoB Genes in Korea", Annals of Laboratory Medicine, 29(5), pp.455~460 (2009), 대한진단검사의학회
- Cooksey RC., "Evaluation of a line probe assay kit for characterization of rpoB mutations in rifampin-resistant Mycobacterium tuberculosis isolates from New York City", J Clin Microbiol, 35, pp.1281~1283 (1997)
- Hillemann D., "Evaluation of the GenoType MTBDRplus assay for rifampin and isoniazid susceptibility testing of Mycobacterium tuberculosis strains and clinical specimens", J Clin Microbiol, 45, pp.2635~2640 (2007)
- Lee H., "Molecular analysis of rifampin-resistant Mycobacterium tuberculosis isolated from Korea by polymerase chain reaction-single strand conformation polymorphism sequence analysis", Int J Tuberc Lung Dis, 2, pp.585~589 (1998)
- Park H., "Comparison of a conventional antimicrobial susceptibility assay to an oligonucleotide chip system for detection of drug resistance in Mycobacterium tuberculosis isolates", J Clin Microbiol, 44, pp.1619~1624 (2006)
- Boehme CC., "Rapid molecular detection of tuberculosis and rifampin resistance", N Engl J Med, 363, pp.1005~1015 (2010)
- Bai GH., "Trend of anti-tuberculosis drug resistance in Korea, 1994-2004", Int J Tuberc Lung Dis, 11, pp.571~576 (2007)
- 조오현, "폐외결핵 환자에서의 항결핵제 내성", Infection and Chemotherapy, 43(3), pp.258~261 (2011), 대한감염학회