VIDRL Mycobacterium Reference Laboratory
Quarterly Surveillance Report
May - August 2006
*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 |
|
| May | 8 |
3 |
22 |
457 |
487 |
| June | 20 |
7 |
11 |
440 |
471 |
| July | 23 |
11 |
12 |
453 |
488 |
| August | 21 |
7 |
21 |
595 |
637 |
| Referred Specimens | |||||
| May | 20 |
14 |
72 |
92 |
|
| June | 23 |
13 |
53 |
76 |
|
| July | 19 |
14 |
54 |
73 |
|
| August | 38 |
25 |
39 |
77 |
|
| Total | 172 |
94* |
284 |
1945 |
2401 |
* Included in M.tb isolates column
Site details of M. tuberculosis isolates and resistant isolates by month
| May |
June |
July |
August |
|
| Site | ||||
| Pulmonary |
11 |
7 |
14* 1 also L. node, 1 also Psoas abs 1 also Pleural fluid |
19* 1 also L. node, 1 also CSF |
| Extrapulmonary | 6 |
9 |
11 |
13 |
| Extrapulmonary Site Details | Lymph node, |
Lymph node (x4), |
Lymph
node (x5), Pleural fl, Paraspinal mass, Urine (x2), Sternum, Neck pus |
Lymph node (x4), Pleural fl, Pleural tissue, Urine, Skull pus, Ankle, Ileo-colonic tissue, Retroperit. pus, Thigh |
| Resistance | 1x
resistance to Isoniazid, Rifampicin, & Streptomycin |
1x resistance to Isoniazid
&
Streptomycin |
1x
resistance to Isoniazid, Rifampicin, Ethambutol, Pyrazinamide & Streptomycin 1x resistance to Isoniazid, Rifampicin, & Streptomycin 2x resistance to Isoniazid & Streptomycin 1x resistance to Isoniazid |
1x resistance to Isoniazid & Streptomycin |
Direct Amplification (PCR)
| May |
June |
July |
August |
|
| Fresh Specimens | ||||
| Positive - Culture positive | 7 |
8 (6 pts) |
11 (8 pts) |
13 (9 pts) |
| Positive - Culture negative | - |
1 |
1 (same pt. & same result April 2006) |
2 |
| Negative - culture positive | - |
- |
- |
- |
| Negative | 85 |
71 |
71 |
83 |
| Total | 92 |
80 |
83 |
98 |
| Paraffin Embedded Specimens | ||||
| Positive (MTBC) | - |
- |
2 |
- |
| Negative (MTBC) | 5 |
3 |
3 |
3 |
| Total | 5 |
3 |
5 |
3 |
Comments
M.abscessus was isolated from respiratory specimens of 6 patients, 3 have had previous isolations of this organism. One of these patients also had M.abscessus recovered from a chest wound. One 44 year old female had the organism isolated from a (R) calf wound.
M.bovis BCG was recovered from urine of a 68 year old male and from a vaccination site of a 31 year old female.
M.chelonae was isolated from the (R) thigh of a 65 year old female.
M.fortuitum was recovered from a non
healing ulcer of a 42 year old female. The organism was also isolated from faeces
of a brolga which also had MAC isolated from intestinal lesions.
M.kansasii was isolated from respiratory
specimens for the first time from 4 patients, one had MAC isolated from sputum
in 2003.
M.marinum was isolated from the hands of two patients, a 33 year old male and a 75 year old female with a previous history of M.marinum infection.
M.ulcerans PCR was performed on 215 specimens. There were 60 positive results from 40 individuals representing 34 new cases, including one horse from Mallacoota. 19 were associated with Point Lonsdale, 4 with Barwon Heads, 3 with Ocean Grove and the remaining patients came from various locations in Victoria.
Molecular methods were used to identify or to confirm identification of 70 isolates, of which 52 were mycobacterial species including 6 M.intracellulare, 2 each of M.parafinnicum and M.mucogenicum and one each of M.asiaticum, M.heckeshornense, M.kansasii and M.lentiflavum. There were also two nvel mycobacterial species that could not be identified. Nine isolates were identified as various Nocardia sp. and 4 were identified as non-mycobacterial sp.
Mycobacterium generic PCR was performed on 31 specimens including 11 paraffin embedded sections. M avium was detected in sputum, a neck swab, a lymph node and a paraffin embedded tissue (site not specified) and M.chelonae was detected in a skin swab. M.tuberculosis complex