VIDRL Mycobacterium Reference Laboratory
Quarterly Surveillance Report - Fourth Quarter 2003
*Due to the slow growing
nature of Mycobacteria spp. this report will always be presented with
a one period delay to maintain accuracy
Specimen Analysis
|
Most
specimens (both primary & referred) and isolates are from Victorian
patients. The majority of non-Victorian patients originate in the Northern
Territory & the Solomon Islands
|
| Primary Specimens | |||||
|
M.
tb isolates
|
New
Victorian M tb isolates
|
Non
M. tb isolates
|
Negatives
|
Total
|
|
| October |
26
|
12
|
29
|
629
|
684
|
| November |
28
|
7
|
14
|
517
|
559
|
| December |
16
|
2
|
12
|
522
|
550
|
| Referred Specimens | |||||
| October |
36
|
19
|
65
|
101
|
|
| November |
29
|
22
|
45
|
74
|
|
| December |
30
|
23
|
39
|
69
|
|
| Total |
165
|
85
|
204
|
1668
|
2037
|
Site details of M. tuberculosis isolates and resistant isolates by month
|
October
|
November
|
December
|
|
| Site | |||
| Pulmonary |
13*
* 1 also lymph node * 1 also tonsil |
13*
* 1 also pleural fluid |
13
|
| Extrapulmonary |
17
|
16
|
12
|
| Extrapulmonary Site Details |
Lymph node (x8), |
Lymph
Node (x5), Neck Mass (x6), Peritoneal bx (x2), Pleural fluid (x2), Peripancreatic mass (x1) |
Lymph Node (x5), Pleural bx (x2), Peritoneal bx (x1) Neck mass (x1), sub-Mandibular abscess (x1), Buttock abscess (x1), Ascitic fluid (x1) |
| Resistance |
1x resistance
to |
1x
resistance to Isoniazid & Streptomycin 1x resistance to Isoniazid, Streptomycin, Pyrazinamide, Rifabutin & Ethambutol 1x resistance to Isoniazid, Streptomycin, Rifabutin & Ethambutol 1x resistance to Ethambutol |
2x resistance
to
|
Direct Amplification (PCR)
|
October
|
November
|
December
|
|
| Fresh Specimens | |||
| Positive - Culture positive |
11
(8pts)
|
5
|
8
|
| Equivocal - Culture negative |
2 (1pt)
|
-
|
1
|
| Positive - Culture negative |
-
|
2 (1pt)
|
1
|
| Negative - culture positive |
3
|
4
|
1
|
| Negative |
70
|
52
|
68
|
| Total |
86
|
63
|
79
|
| Paraffin Embedded Specimens | |||
| Positive |
-
|
-
|
-
|
| Negative |
3
|
4
|
1
|
| Negative - culture positive |
1
|
-
|
-
|
| Total |
4
|
4
|
1
|
Comments
M. abscessus was isolated from sputum specimens
of two individuals, one with concurrent M. tuberculosis infection.
M. bovis BCG was isolated from vaccination sites of two infants aged 13 and 14 months. The organism was also recovered from the Mantoux site of a 19 year old female.
M. fortuitum was recovered from a foot wound of a 44 year old male.
M. kansasii was isolated from respiratory specimens of 3 patients for the first time, 2 males & 1 female. The organism was also isolated from carpal tunnel tissue of a 52 year old male. Identification was confirmed by 16S rDNA sequencing as this isolate was negative with the Accuprobe.
M. marinum was recovered from synovial tissue of a 46 year old female and the left knee of a 17 year old male with a history of eczema.
M.ulcerans PCR was requested on 41 specimens, including 1 from a ringtail possum. There were 8 positive results from 6 patients. This represents 4 new cases and the PCR results from 3 of these were confirmed by culture. One isolate was overgrown by a contaminating organism and M. ulcerans was unable to be recovered.
Molecular identification techniques were employed to identify or confirm identification of 42 isolates. There were 38 mycobacterial species including 3 each of M. interjectum, M. cookii and M. simiae 2 each of M. marinum, M. lentiflavum, M. shimodei, M. intracellulare (negative with MAC Accuprobe) and one each of M. asiaticum, M. hiberniae, M. heckeshornense and M. malmoense.
Mycobacterium generic
PCR was performed on 43 specimens
including 9 paraffin embedded tissues, and a variety of fresh tissues and respiratory
specimens. M. intracellulare and M. avium were detected in 2 paraffin
embedded tissues. M. tuberculosis was detected in 4 fresh specimens,
1 bronchial washing, 2 FNAs and one lymph node biopsy. The latter gave a low
positive result, was negative in the M. tb PCR and is not as yet confirmed by
culture.
M. shimoidei was detected in a sputum, M. avium was detected in
2 further sputa and a lymph node biopsy, M. kansasii was detected in
a sputum, and an organism related to M. simiae was detected in a corneal
biopsy from a cat.