Journal List > Infect Chemother > v.44(5) > 1035175

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

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.

Figures and Tables

Table 1
Oligonucloetide Primers Used in This Study
ic-44-357-i001

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
ic-44-357-i002

Values indicate number/available cases (%).

LN, lymph node

Table 3
Sensitivity and Specificity of rpoB Gene Mutation Analysis for Change to Second Line Regimen
ic-44-357-i003

References

1. Peto HM, Pratt RH, Harrington TA, LoBue PA, Armstrong LR. Epidemiology of extrapulmonary tuberculosis in the United States, 1993-2006. Clin Infect Dis. 2009. 49:1350–1357.
crossref
2. Korea Centers for Disease Control and Prevention. Korean Guidelines for Tuberculosis. 2011. 1st ed.
3. Hawkey CR, Yap T, Pereira J, Moore DA, Davidson RN, Pasvol G, Kon OM, Wall RA, Wilkinson RJ. Characterization and management of paradoxical upgrading reactions in HIV-uninfected patients with lymph node tuberculosis. Clin Infect Dis. 2005. 40:1368–1371.
crossref
4. Cho OH, Park KH, Kim T, Song EH, Jang EY, Lee EJ, Chong YP, Choi SH, Lee SO, Woo JH, Kim YS, Kim SH. Paradoxical responses in non-HIV-infected patients with peripheral lymph node tuberculosis. J Infect. 2009. 59:56–61.
crossref
5. Joh JS, Lee CH, Lee JE, Park YK, Bai GH, Kim EC, Han SK, Shim YS, Yim JJ. The interval between initiation of anti-tuberculosis treatment in patients with culture-positive pulmonary tuberculosis and receipt of drug-susceptibility test results. J Korean Med Sci. 2007. 22:26–29.
crossref
6. Gong G, Lee H, Kang GH, Shim YH, Huh J, Khang SK. Nested PCR for diagnosis of tuberculous lymphadenitis and PCR-SSCP for identification of rifampicin resistance in fine-needle aspirates. Diagn Cytopathol. 2002. 26:228–231.
crossref
7. Bártfai Z, Somoskövi A, Ködmön C, Szabó N, Puskás E, Kosztolányi L, Faragó E, Mester J, Parsons LM, Salfinger M. Molecular characterization of rifampin-resistant isolates of Mycobacterium tuberculosis from Hungary by DNA sequencing and the line probe assay. J Clin Microbiol. 2001. 39:3736–3739.
crossref
8. Musser JM, Kapur V, Williams DL, Kreiswirth BN, van Soolingen D, van Embden JD. Characterization of the catalase-peroxidase 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. 1996. 173:196–202.
crossref
9. Telenti A, Imboden P, Marchesi F, Lowrie D, Cole S, Colston MJ, Matter L, Schopfer K, Bodmer T. Detection of rifampicin-resistance mutations in Mycobacterium tuberculosis. Lancet. 1993. 341:647–650.
crossref
10. Cho EH, Bae HK, Kang SK, Lee EH. Detection of isoniazid and rifampin resistance by sequencing of katG, inhA, and rpoB genes in Korea. Korean J Lab Med. 2009. 29:455–460.
crossref
11. Cooksey RC, Morlock GP, Glickman S, Crawford JT. 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. 1997. 35:1281–1283.
crossref
12. Hillemann D, Rusch-Gerdes S, Richter E. Evaluation of the GenoType MTBDRplus assay for rifampin and isoniazid susceptibility testing of Mycobacterium tuberculosis strains and clinical specimens. J Clin Microbiol. 2007. 45:2635–2640.
crossref
13. Lee H, Cho SN, Bang HE, Lee JH, Bae GH, Kim SJ, Kim JD. 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. 1998. 2:585–589.
14. Park H, Song EJ, Song ES, Lee EY, Kim CM, Jeong SH, Shin JH, Jeong J, Kim S, Park YK, Bai GH, Chang CL. Comparison of a conventional antimicrobial susceptibility assay to an oligonucleotide chip system for detection of drug resistance in Mycobacterium tuberculosis isolates. J Clin Microbiol. 2006. 44:1619–1624.
crossref
15. Boehme CC, Nabeta P, Hillemann D, Nicol MP, Shenai S, Krapp F, Allen J, Tahirli R, Blakemore R, Rustomjee R, Milovic A, Jones M, O'Brien SM, Persing DH, Ruesch-Gerdes S, Gotuzzo E, Rodrigues C, Alland D, Perkins MD. Rapid molecular detection of tuberculosis and rifampin resistance. N Engl J Med. 2010. 363:1005–1015.
crossref
16. Bai GH, Park YK, Choi YW, Bai JI, Kim HJ, Chang CL, Lee JK, Kim SJ. Trend of anti-tuberculosis drug resistance in Korea, 1994-2004. Int J Tuberc Lung Dis. 2007. 11:571–576.
17. Cho OH, Park KH, Park SY, Moon SM, Chong YP, Kim MN, Lee SO, Choi SH, Woo JH, Kim YS, Kim SH. Drug-resistant extrapulmonary tuberculosis. Infect Chemother. 2011. 43:258–261.
crossref
TOOLS
Similar articles