Clinical Usefulness of rpoB Gene Sequence Analysis in Lymph Node Tuberculosis

Ji-Young Park; Ki Tae Kwon

doi:10.3947/ic.2012.44.5.357

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Park and Kwon: Clinical Usefulness of rpoB Gene Sequence Analysis in Lymph Node Tuberculosis

Original Article

Infection & Chemotherapy

Infection & Chemotherapy 2012; 44(5): 357-361.

Published online: 31 October 2012

DOI: https://doi.org/10.3947/ic.2012.44.5.357

Clinical Usefulness of rpoB Gene Sequence Analysis in Lymph Node Tuberculosis

Ji-Young Park¹, Ki Tae Kwon²

¹Department of Pathology, Kyungpook National University, School of Medicine, Daegu, Korea.

²Division of Infectious Diseases, Daegu Fatima Hospital, Daegu, Korea.

Correspondence to Ki Tae Kwon, M.D., Ph.D. Division of Infectious Diseases, Daegu Fatima Hospital, 99 Ayangro, Dong-Gu, Daegu 701-010, Korea. Tel: +82-53-940-7923, Fax: +82-53-940-7924, ktkwon@fatima.or.kr

Received 1 February 2012 Revised 3 September 2012 Accepted 25 September 2012

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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 LN-TB cases without rpoB gene mutations may be recommended. Conduct of a prospective, well designed, further study with a larger scale is warranted.

Keywords: Tuberculosis, Lymph node, Rifampin, rpoB

Figures and Tables

Table 1

Oligonucloetide Primers Used in This Study

The underlined codons show frequently mutated codons (513, 516, 526, and 531) in the 81-bp hot-spot region of the rpoB gene.

Table 2

Characteristics of 25 Patients with Lymph Node Tuberculosis

Values indicate number/available cases (%).

LN, lymph node

Table 3

Sensitivity and Specificity of rpoB Gene Mutation Analysis for Change to Second Line Regimen

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