PERIPHERAL BLOOD-BASED POLYMERASE CHAIN REACTION IN DIAGNOSIS OF PULMONARY TUBERCULOSIS

Authors

  • Mumtaz Ahmad Khan
  • Sajjad Hussain Mirza
  • Shahid Ahmed Abbasi
  • Tariq Butt
  • Masood Anwar

Abstract

Background. The rapid diagnosis of infectious diseases, particularly those that represent a publichealth problem, like tuberculosis, is a challenging problem. By using nucleic acid amplificationtechniques like PCR, one may be able to diagnose, the disease on the day of arrival of specimen inthe laboratory. For diagnosis of tuberculosis by direct methods like PCR, specimens from site ofinfection are required. In certain cases it is difficult to get the specimens from site of infection andin such situations; some researchers have tried to detect the DNA of Mycobacterium tuberculosiscomplex from blood of these patients. The purposive of this study is to determine the diagnosticefficacy of peripheral blood-based polymerase chain reaction for diagnosis of pulmonarytuberculosis. Methods. This was a simple descriptive study, carried out in Department ofMicrobiology, Armed Forces Institute of Pathology, Rawalpindi from Jan 2004 to Dec 2004.Sputum and blood samples were collected from 96 suspected patients of pulmonary tuberculosis.Sputum samples processed for ZN staining and AFB culture (gold standard) and blood samplesprocessed for PCR. Results. Out of 96 cases, 60 (62.5%) were culture positive. PCR was positivein 14 (14.5%). AFB smear positive were 34 (35.4%). The overall sensitivity and specificity of thePCR assay was 20% and 94.4% respectively and the positive and negative predictive values were85.71% and 41.46% respectively. The overall efficiency of the test was 47.91%. Conclusion. Dueto low sensitivity; a negative PCR assay does not rule the disease. However, this test may behelpful in cases where specimens from the site of infection are not available.Key Words: PCR, peripheral blood, pulmonary tuberculosis

References

Soini H, Musser JM. Molecular diagnosis of mycobacteria.

Clin Chem 2001; 47: 809-14.2. Khan MA. TB: need to revitalize its control programme in

Pakistan. J Coll Physicians Surg Pak 1996; 6: 3.

Mazhar AU, Sarwar MSA, Mateen A. A survey of tuberculin

test after BCG vaccination in children. J Coll Physicians Surg

Pak 1995; 5: 64-6.

World Health Organization, WHO report on the tuberculosis

epidemic, Geneva: World Health Organization, 1997.

Saeed W, Ahmed J, Naseem A. Endoronchial TB: clinical and

diagnostic aspects. Pak Armed Forces Med J 2002; 52: 154-8.

Butt T, Karamat KA, Ahmad RN, Mahmood A. Advances in

diagnosis of tuberculosis. Pak J Pathol 2001; 12 (1): 1-3.

Pfyffer GE. Nucleic acid amplification for mycobaterial

diagnosis. J Infect Dis 1999; 39: 21-6.

Grange JM. Mycobaterium. In: Greenwood D, Slack RCB,

Peutherer F, editors. Medical microbiology. A guide to

microbiological infections: pathogenesis, immunity, laboratory

diagnosis and control. 16th ed. Edinburgh: Churchil

Livingstone, 2002: 200-13.9. Ahmed N, Mohanty AK, Mukhopadhyay U, Batish VK,

Grover S. PCR-based rapid detection of Mycobaterium

tuberculosis in blood from immunocompetent patients with

pulmonary tuberculosis. J Clin Microbiol 1998; 36: 3094-5.10. Robert GD, Koneman EW, Kim YK. Mycobacterium. In:

Balows A, Hausler Jr. WJ, Herrmann Kl, Isenburg HD,

Shadomy HJ, editors. Manual of clinical microbiology. 5th ed.

Washington, DC: American Society for Microbiology, 1991:

-39.

Bennedsen J, Thomsen VO, Pfyffer GE, Funke G, Feldmann

K, Beneke A, et al. Utility of PCR in diagnosing pulmonary

tuberculosis. J Clin Microbial 1996; 34: 1407-11.

Siddiqi SH. BACTEC TB System. Product and procedure

manual. Revision B. Becton Dickinson Diagnostic Instruments

Systems, Towson, Md. USA. 1989.

Siddiqi SH. BACTEC NAP test. In: Isenburg HD, editor.

Clinical microbiology procedures handbook. Vol 1.

Washington, DC: American Society for Microbiology, 1992:3.13.1-3.13.4.14. Butt T, Ahmad RN, Kazmi SY, Afzal RK ,Mahmood A. An up

date on the diagnosis of tuberculosis. J Coll Physicians Surg

Pak 2003; 13: 728-34.

Bennedsen J, Thomsen VO, Pfyffer GE, Funke G, Feldmann

K, Beneke A, et al. Utility of PCR in diagnosing pulmonary

tuberculosis. J Clin Microbial 1996; 34: 1407-11.

Pottumarthy S, Wells VC, Morris AJ. A comparison of seven

tests for serological diagnosis of tuberculosis. J Clin Microbiol

; 38: 2227-31.

Condos R, mcClune A, Room WN, Schluger NW. Peripheralblood-PCR assay to identify patients with active pulmonary

tuberculosis. Lancet 1996; 347: 1082-5.

Malik N, Karamat KA, Butt T, Abbasi S, Usman J. Prevalence

and drug susceptibility pattern of typical and atypical

mycobacteria in Rawalpindi/ Islamabad. Pak J Pathol 1998; 9:

-8

Most read articles by the same author(s)