VIDRL Mycobacterium Reference Laboratory
Quarterly Surveillance Report Sept - Dec 2004

*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
September
33
8
25
466
524
October
17
6
29
506
552
November
38
12
9
461
508
December
30
10
17
511
558
Referred Specimens 
September
22
12
46
68
October
21
17
38
59
November
24
17
53
77
December
36
26
46
82
           
Total
221
108*
263
1944
2428

* Included in M. tb isolates column

 

 

Site details of M. tuberculosis isolates and resistant isolates by month

 
September
October
November
December
Site
 
Pulmonary
10*
1 also blood
& ascitic fluid
10*
1 also pleural biopsy
15*
1 also blood& urine
17*
1 also lymph node
Extrapulmonary
10
13
14
18
         
Extrapulmonary Site Details

Lymph node (x5),
Adrenal gland (x1),
Foot asp. (x1),
Pleural tis. (x1)
Chest wall absc (x1)
Sacral abscess (x1)

Lymph node (x7),
Paravert. asp. (x1),
Peritoneal tis. (x1),
Ankle swab (x1),
Buttock cyst (x1),
Urine (x1)
Gastric asp. (x1)

 Lymph node (x10), Endometrial tissue(x1),
CSF (x1),
Pleural fluid (x1),
Small bowel (x1),		 Lymph node (x13), Pleural fl. (x1),
Caecal bx .(x1),
Buttock absc. (x1),
Ileum (x1)
Thyroid tis. (x1)
Resistance

1x resistance to Isoniazid, Rifampicin, Ethambutol & Streptomycin1x resistance to Isoniazid, Rifampicin & Streptomycin

1x resistance to Isoniazid, Rifampicin, Ethambutol , Streptomycin & Pyrazinamide1x resistance to Isoniazid & Streptomycin

1x resistance to Isoniazid & Streptomycin2x low resistance to Isoniazid

 

Direct Amplification (PCR)

 
September
October
November
December
Fresh Specimens        
Positive - Culture positive
5
6
3
8
Equivocal - Culture negative
4
-
2 (1 old TB)
1
Negative - culture positive
1
2
2
2
Negative
60
75
73
78
Total
70
83
80
89
Paraffin Embedded Specimens
Positive (MTBC)
2
-
1
-
Negative (MTBC)
6
5
6
5
Total
8
5
7
5

 

Comments

M. abscessus was isolated from breast tissue of a 44 year old female from the Northern Territory. The organism was also isolated from sputum specimens of 4 patients. Two have had several isolations, one since 2002.

M. bovis BCG was recovered from urine of an 82 year old male and from two infants following BCG vaccination.

M. chelonae was isolated from the liver, lungs and kidneys of a dwarf bearded dragon from Melbourne zoo.

M. fortuitum was isolated from a chest ulcer of a 95 year old female, the right thigh of a 37 year old male and an abdominal wall abscess of a 75 year old male. The first two patients reside in the Northern Territory.

M. kansasii was isolated from 3 patients, one 35 year old female had the organism isolated on several occasions. M. kansasii was also recovered from a quokka from the Melbourne zoo.

M. marinum was recovered from the fingers of 2 patients, one a 36 year old male and the other a 48 year old female.

M. ulcerans PCR was requested on 181 specimens. There were 41 positive results from 13 patients. This represents 12 new patients, six were associated with Pt. Lonsdale, 2 were from the Northern Territory and the remaining 4 were from different locations in Victoria. To date PCR results from all but the two most recent cases have been confirmed by culture.

Molecular methods were used to identify or confirm identification of 45 isolates, of which 36 were mycobacterial species including 4 M.lentiflavum, 3 M.shimoidei, 2 each of M.celatum and M. obuense, 1 each of M. kansasii, M. gastri, M. interjectum, M. intracellulare, M. triplex and M. szulgai.

Mycobacterium generic PCR was performed on 37 specimens, including 11 paraffin embedded tissues and a variety of fresh tissues and respiratory specimens. MAC was detected in 2 specimens, a paraffin embedded forearm tissue and a fresh cervical tissue. M. kansasii was also detected in 2 specimens, a sputum and necrotic tissue from a quokka. M marinum was detected in liver tissue of a bearded dragon and M. chelonae was detected in liver, lung and kidney tissues from a dwarf bearded dragon..