Dual color fluorescence in situ hybridization (FISH) assays for detecting Mycobacterium tuberculosis and Mycobacterium avium complexes and related pathogens in cultures.

Two rapid dual color fluorescence in situ hybridization (FISH) assays were evaluated for detecting M. tuberculosis and related pathogens in cultures. The MN Genus-MTBC FISH assay uses an orange fluorescent probe specific for the Mycobacterium tuberculosis complex (MTBC) and a green fluorescent probe specific for the Mycobacterium and Nocardia genera (MN Genus) to detect and distinguish MTBC from other Mycobacteria and Nocardia. A complementary MTBC-MAC FISH assay uses green and orange fluorescent probes specific for the MTBC and M. avium complex (MAC) respectively to identify and differentiate the two species complexes. The assays are performed on acid-fast staining bacteria from liquid or solid cultures in less than two hours. Forty-three of 44 reference mycobacterial isolates were correctly identified by the MN Genus-specific probe as Mycobacterium species, with six of these correctly identified as MTBC with the MTBC-specific probe and 14 correctly as MAC by the MAC-specific probe. Of the 25 reference isolates of clinically relevant pathogens of other genera tested, only four isolates representing two species of Corynebacterium gave a positive signal with the MN Genus probe. None of these 25 isolates were detected by the MTBC and MAC specific probes. A total of 248 cultures of clinical mycobacterial isolates originating in India, Peru and the USA were also tested by FISH assays. DNA sequence of a part of the 23S ribosomal RNA gene amplified by PCR was obtained from 243 of the 248 clinical isolates. All 243 were confirmed by DNA sequencing as Mycobacterium species, with 157 and 50 of these identified as belonging to the MTBC and the MAC, respectively. The accuracy of the MN Genus-, MTBC-and MAC -specific probes in identifying these 243 cultures in relation to their DNA sequence-based identification was 100%. All ten isolates of Nocardia, (three reference strains and seven clinical isolates) tested were detected by the MN Genus-specific probe but not the MTBC- or MAC-specific probes. The limit of detection for M. tuberculosis was determined to be 5.1x104 cfu per ml and for M. avium 1.5x104 cfu per ml in liquid cultures with the respective MTBC- and MAC-specific probes in both the MN Genus-MTBC and MTBC-MAC FISH assays. The only specialized equipment needed for the FISH assays is a standard light microscope fitted with a LED light source and appropriate filters. The two FISH assays meet an important diagnostic need in peripheral laboratories of resource-limited tuberculosis-endemic countries.

The glycan-rich outer layer of the cell wall of Mycobacterium tuberculosis acts as an antiphagocytic capsule limiting the association of the bacterium with macrophages.

Mycobacterium tuberculosis, the causative agent of tuberculosis, is a facultative intracellular pathogen that infects macrophages and other host cells. We show that sonication of M. tuberculosis results in the removal of material from the surface capsule-like layer of the bacteria, resulting in an enhanced propensity of the bacteria to bind to macrophages. This effect is observed with disparate murine and human macrophage populations though, interestingly, not with freshly explanted alveolar macrophages. Enhanced binding to macrophages following sonication is significantly greater within members of the M. tuberculosis family (pathogens) than within the Mycobacterium avium complex (opportunistic pathogens) or for Mycobacterium smegmatis (saprophyte). Sonication does not affect the viability or the surface hydrophobicity of M. tuberculosis but does result in changes in surface charge and in the binding of mannose-specific lectins to the bacterial surface. The increased binding of sonicated M. tuberculosis was not mediated through complement receptor 3. These results provide evidence that the surface capsule on members of the M. tuberculosis family may be an important virulence factor involved in the survival of M. tuberculosis in the mammalian host. They also question the view that M. tuberculosis is readily ingested by any macrophage it encounters and support the contention that M. tuberculosis, like many other microbial pathogens, has an antiphagocytic capsule that limits and controls the interaction of the bacterium with macrophages.

The white morphotype of Mycobacterium avium-intracellulare is common in infected humans and virulent in infection models.

Isolates of Mycobacterium avium-intracellulare (MAI) form multiple colony types named red-opaque, white-opaque, red-transparent (RT), and white-transparent (WT). The newly discovered WT morphotype is multidrug resistant relative to other variants in vitro. To determine whether the WT morphotype occurs in humans, 32 MAI-positive clinical samples from 2 sites were plated directly onto indicator agar without prior passage in vitro. WT was the predominant morphotype in 26 (81%) of these samples and was absent in only 2 samples. WT variants grew better than isogenic RT variants in mouse and human macrophage models of infection, and RT clones that passed through such systems underwent rapid shifts to the WT morphotype. The RT morphotype was heterogeneous with regard to infectivity. In summary, the white morphotype was common in humans and was favored in disease models. It may play an important role in the establishment and persistence of MAI infection.

Comparison of algorithms for selective use of nucleic-acid probes for identification of Mycobacterium tuberculosis from BACTEC 12B bottles.

We retrospectively compared the sensitivity of two approaches, a time-to-detection algorithm and the presence of serpentine cords of acid-fast bacilli, for discriminating between BACTEC 12B cultures containing either Mycobacterium tuberculosis complex (MTB) or Mycobacterium avium complex (MAC). From January 1996 through March 1997 a total of 217 of 2089 respiratory specimens received in our laboratory were positive in the BACTEC 12B radiometric culture system for either MTB (120 specimens) or MAC (97 specimens). Use of a previously published time-to-positivity algorithm would have resulted in the correct use of the MTB probe on 109 of 120 cultures (91% sensitivity), and the MAC probe on 52 of 97 cultures (54% sensitivity). The presence of serpentine cords was detected in 58 of 120 cultures containing MTB (48%), and in 3 of 97 (3%) cultures containing MAC. Using a combination of time to positivity and cord formation to determine initial probe selection would have resulted in first use of the MTB probe in 116 of 120 (97%) instances in which MTB was present in the culture. In only 49 of 97 (51%) cultures, however, from which MAC was recovered would the correct probe have been selected. These results indicate that limiting the initial use of the MTB probe to those cultures that are either identified by the time-to-detection algorithm or demonstrate serpentine cords on acid-fast smear would eliminate a considerable amount of unnecessary probe use without compromising the efficiency of identification of isolates of MTB.

Mycobacterium avium complex endocarditis: spurious diagnosis resulting from laboratory cross contamination.

Contamination between specimens within clinical microbiology laboratories may be responsible for spurious outbreaks of mycobacterial infections. We report the case of a patient who had culture-negative endocarditis and whose cardiac tissue obtained at surgery yielded Mycobacterium avium complex (MAC). Epidemiologic investigation suggested cross contamination probably occurred during processing of the sputum specimens of a patient with pulmonary MAC disease and the cardiac samples from our patient; molecular strain typing showed the isolates from both patients to be identical. When mycobacterial infection rates increase or an unexpected case of mycobacterial infection occurs, the clinician should be alert to the possibility of cross contamination in the laboratory as a possible explanation.

Pathobiological significance of colony morphology in Mycobacterium avium complex.

Mycobacterium avium complex (MAC) strains are known to exhibit variation in colony morphology. In addition to the smooth transparent (ST), smooth opaque (SO) and rough opaque (RO), which are the most common morphological forms, intermediate (IM) and pin point (PP) forms were also occasionally observed. In order to understand the pathobiological significance of these different colony forms, we investigated their virulence in beige mice, ability to bind to plastic and epithelial cells, differences in the lipids, and modulation of macrophage functions by the bacillary extracts. ST variants, the most common form seen in AIDS patients, were more virulent with increased multiplication in lungs, livers and spleens of beige mice and showed increased adherence to plastic and epithelial cells. SO, RO, PP colonial forms did not show increase in growth in any of the organs over a period of 4 weeks. IM colonial variants showed increased growth in lungs and spleens but not in livers. Thin layer chromatographic (TLC) analysis of lipid extracts showed one specific component in the high polar lipids of the SO variant, while ST variant did not show any specific component in any of the three families of lipids (high, intermediate and low polarity). The RO variant either expressed low levels or lost many of the components of lipids of high and intermediate polarity, however produced increased levels of lipids of low polarity. One of the components of low polar lipids was specific for RO variant and was produced in large quantity. The isogenic variants differed in the total lipid and sugar contents and also differed in their ability to modulate macrophage functions.

Comparison of virulence of Mycobacterium avium complex (MAC) strains isolated from AIDS and non-AIDS patients.

Mycobacterium avium complex (MAC) strains from AIDS and non-AIDS patients and from the environment were studied for their colony morphology and virulence in beige mice. The majority of the MAC isolates from AIDS patients, in contrast to those from non-AIDS patients and the environment, showed increased virulence. Similarly, the majority of the MAC isolates from AIDS patients formed smooth transparent (ST) colonies, whereas most of the non-AIDS isolates formed smooth opaque (SO) or intermediate (IM) type of colonies. MAC isolates from the same AIDS patient obtained at different times were found to be heterogenic with respect to serotype, RFLP and glycolipid patterns, suggesting that these patients might be infected with more than one strain of MAC.

The use of paraffin wax metabolism in the speciation of Mycobacterium avium-intracellulare.

Paraffin-wax utilisation or baiting of Mycobacterium avium-intracellulare (MAI) complex organisms and other 'atypical mycobacteria' and the inability of Mycobacterium tuberculosis to utilise paraffin are known and useful if forgotten facts. Strains of possible AIDS-related MAI have been introduced into Czapek broth devoid of any carbon source other than paraffin-wax coated slides. Replicate slides showing 'in situ' growth were subjected to the following battery of tests: acid alcohol fast staining and microscopic examination of 'in situ' growth, tellurite reduction in 3 days, absence of urea hydrolysis, inability to reduce nitrates and inability to hydrolyse Tween 80. The system has been utilised to isolate and identify MAI organisms in blood from AIDS patients. The simplicity, low cost, and reduced risk of contamination make the system especially suitable for small rural laboratories and field stations as well as laboratories in developing countries.

Evidence suggesting that the life span of Mycobacterium avium complex is longer than that of other mycobacteria.

Mycobacterium avium complex strains often contain considerably more numbers of viable bacterial units per mg wet weight than other mycobacteria, especially other slowly growing ones. This finding suggests that the life span of M. avium complex strains is often longer than the life span of other mycobacteria. The other mycobacteria, especially slowly growing ones seem to die more rapidly after their multiplication.