Multicentre laboratory validation of the colorimetric redox indicator (CRI) assay for the rapid detection of extensively drug-resistant (XDR) Mycobacterium tuberculosis.

OBJECTIVES: To perform a multicentre study to evaluate the performance of the colorimetric redox indicator (CRI) assay and to establish the MICs and critical concentrations of rifampicin, isoniazid, ofloxacin, kanamycin and capreomycin. METHODS: The study was carried out in two phases. Phase I determined the MIC of each drug. Phase II established critical concentrations for the five drugs tested by the CRI assay compared with the conventional proportion method. RESULTS: Phase I: a strain was considered resistant by the CRI assay if the MIC was ≥0.5 mg/L for rifampicin, ≥0.25 mg/L for isoniazid, ≥4.0 mg/L for ofloxacin and ≥5.0 mg/L for kanamycin and capreomycin. Sensitivity was 99.1% for isoniazid and 100% for the other drugs and specificity was 97.9% for capreomycin and 100% for the other drugs. Phase II: the critical concentration was 0.5 mg/L for rifampicin, 0.25 mg/L for isoniazid, 2.0 mg/L for ofloxacin and 2.5 mg/L for kanamycin and capreomycin giving an overall accuracy of 98.4%, 96.6%, 96.7%, 98.3% and 90%, respectively. CONCLUSIONS: Results demonstrate that the CRI assay is an accurate method for the rapid detection of XDR Mycobacterium tuberculosis. The CRI assay is faster than the conventional drug susceptibility testing method using solid medium, has the same turnaround time as the BACTEC MGIT 960 system, but is less expensive, and could be an adequate method for low-income countries.

Anti-tubercular screening of natural products from Colombian plants: 3-methoxynordomesticine, an inhibitor of MurE ligase of Mycobacterium tuberculosis.

OBJECTIVES: New anti-mycobacterial entities with novel mechanisms of action are clinically needed for treating resistant forms of tuberculosis. The purpose of this study was to evaluate anti-tubercular activity and selectivity of seven recently isolated natural products from Colombian plants. METHODS: MICs were determined using a liquid medium growth inhibition assay for Mycobacterium tuberculosis H(37)Rv and both solid and liquid media growth inhibition assays for Mycobacterium bovis BCG. Escherichia coli growth inhibition and mammalian macrophage cell toxicity were evaluated to establish the degree of selectivity of the natural product against whole cell organisms. Enzymatic inhibition of ATP-dependent MurE ligase from M. tuberculosis was assayed using a colorimetric phosphate detection method. The most active compound, 3-methoxynordomesticine hydrochloride, was further investigated on M. bovis BCG for its inhibition of sigmoidal growth, acid-fast staining and viability counting analysis. RESULTS: Aporphine alkaloids were found to be potent inhibitors of slow-growing mycobacterial pathogens showing favourable selectivity and cytotoxicity. In terms of their endogenous action, the aporphine alkaloids were found inhibitory to M. tuberculosis ATP-dependent MurE ligase at micromolar concentrations. A significantly low MIC was detected for 3-methoxynordomesticine hydrochloride against both M. bovis BCG and M. tuberculosis H(37)Rv. CONCLUSIONS: Considering all the data, 3-methoxynordomesticine hydrochloride was found to be a potent anti-tubercular compound with a favourable specificity profile. The alkaloid showed MurE inhibition and is considered an initial hit for exploring related chemical space.

Anti-tubercular activity of eleven aromatic and medicinal plants occurring in Colombia.

INTRODUCTION: Human tuberculosis is a contagious-infectious disease mainly caused by Mycobacterium tuberculosis. Although regimens exist for treating tuberculosis, they are far from ideal. Development of effective strategies for treatment of human tuberculosis has posed a challenge, considering the increase in infections associated with the human immunodeficiency virus and immunocompromised patients. Essential oils--volatile, aromatic oil extracts from plants--have been used in traditional treatment of many diseases; however careful investigation of these oils has not been undertaken with respect to treatments of tuberculosis. OBJECTIVE: The in vitro antitubercular activity of essential oils from 11 medicinal plants grown in Colombia were assessed for efficacy as new medications (phytomedicines) for treatment of M. tuberculosis H37Rv. MATERIAL AND METHODS: Essential oil extraction and analysis were performed as described Stashenko et al. (2004). Minimal inhibitory concentrations were determined by a colorimetric macrodilution method, following the protocol described by Abate et al. (1998). Isoniazide and rifampin were used as control treatments. Bactericidal and bacteriostatic activity was measured using the method developed by the Clinical and Laboratory Standards Institute consigned in the M26-A protocol. RESULTS: Essential oils from Achyrocline alata and Swinglea glutinosa were the most active with minimal inhibitory concentrations of 62.5 +/- 0.1 and 100 +/- 36 microg ml(-1), respectively. Carvacrol, thymol, p-cymene, 1,8-cineole, limonene, and beta-pinene were the major components, most often identified in the 11 plant extracts of essential oils. Time-kill curve assays demonstrated the bacteriostatic activity of these essential oils. CONCLUSIONS: The essential oils from A. alata and S. glutinosa plants, and the components identified therein, are candidates as potential phytotherapeutic agents for human tuberculosis control.

Human Mycobacterium bovis infection in ten Latin American countries.

The aim of this work was to obtain the best possible estimate of the relevance of bovine tuberculosis (BTB) in humans in Argentina, Brazil, Chile, Colombia, Costa Rica, Dominican Republic, Ecuador, Peru, Uruguay and Venezuela. Sources of information were a questionnaire filled by the participant laboratories, and a search of published literature (1970-2007). Only four of these countries reported bacteriologically confirmed cases of BTB in humans. Most of these were diagnosed in Argentina, where the mean percentage of Mycobacterium bovis cases in relation to those due to Mycobacterium tuberculosis (2000-2006) ranged from 0.34% to 1.0%, according to the region. A slowly decreasing trend was observed in non HIV as well as in HIV/AIDS patients in Buenos Aires. In most of these countries, the low coverage of culture methods, especially of those including pyruvate-containing media, appropriate to isolate M. bovis, contributes to an underestimate of the problem. It was confirmed that BTB in humans exists, even though its relevance seems to be low. Milk pasteurization, sanitary controls to dairy products, and meat inspection at slaughterhouses contribute to the protection of human health. However, occupational aerogenous exposure to TB cattle and their carcasses remains a source of infection in the region.

[Molecular identification of non-tuberculous mycobacteria]. / Identificación molecular de micobacterias no tuberculosas mediante el análisis de los patrones de restricción, Colombia 1995-2005.

INTRODUCTION: Nontuberculous mycobacteria can be saprophytic, pathogenic or opportunistic. The most common diseases produced by these microorganisms are the post-surgical infections due to anesthetic procedures, infections associated with catheters, disseminated cutaneous diseases and pulmonary and central nervous system diseases that especially affect HIV patients. Identification of the nontuberculous mycobacteria can take several weeks and even then, differentiation of complex members is not possible. OBJECTIVE: The PCR-restriction analysis (PRA) technique was evaluated as a method for genotypic identification of nontuberculous mycobacteria isolated of clinical samples located in the culture collection of the Instituto Nacional de Salud (National Institute of Health), Bogotá, Colombia. MATERIALS AND METHODS: Seventy clinical isolates of nontuberculous mycobacteria stored in 50% glycerol at -70 degrees C were identified by phenotypic techniques. The genotypic identification was made using the PCR-restriction analysis (PRA) using the restriction enzymes BstEII and HseIII, the restriction products were visualized on gels of agarose to 3%, and the concordance between the methodologies was evaluated. RESULTS: A matching of 100% was obtained in the identification of Mycobacterium terrae, M. szulgai, M. avium, M. chelonae and M. scrofulaceum, the matching between M. fortuitum species, M. abscessus, M. gordonae and M. intracellulare varied from 44 to 89%; there was no concurrence in the identification of species M. flavescens and M. malmoense. CONCLUSIONS: PRA provided a fast, inexpensive and accurate alternative for the identification of nontuberculous mycobacteria that permited the differentiation among species of a complex and determining the subtype of each species sample.

Mycobacterium tuberculosis Genotypes Determined by Spoligotyping to Be Circulating in Colombia between 1999 and 2012 and Their Possible Associations with Transmission and Susceptibility to First-Line Drugs.

INTRODUCTION: Tuberculosis (TB) remains a primary public health problem worldwide. The number of multidrug-resistant tuberculosis (MDR TB) cases has increased in recent years in Colombia. Knowledge of M. tuberculosis genotypes defined by spoligotyping can help determine the circulation of genotypes that must be controlled to prevent the spread of TB. OBJECTIVE: To describe the genotypes of M. tuberculosis using spoligotyping in resistant and drug-sensitive isolates and their possible associations with susceptibility to first-line drugs. METHODS: An analytical observational study was conducted that included 741 isolates of M. tuberculosis from patients. The isolates originated from 31 departments and were obtained by systematic surveillance between 1999 and 2012. RESULTS: In total 61.94% of the isolates were resistant to 1 or more drugs, and 147 isolates were MDR. In total, 170 genotypes were found in the population structure of Colombian M. tuberculosis isolates. The isolates were mainly represented by four families: LAM (39.9%), Haarlem (19%), Orphan (17%) and T (9%). The SIT42 (LAM 9) was the most common genotype and contained 24.7% of the isolates, followed by the genotypes SIT62 (Haarlem1), SIT53 (T1), and SIT50 (H3). A high clustering of isolates was evident with 79.8% of the isolates classified into 32 groups. The Beijing family was associated with resistant isolates, whereas the Haarlem and T families were associated with sensitive isolates. The Haarlem family was also associated with grouped isolates (p = 0.031). CONCLUSIONS: A high proportion (approximately 80%) of isolates was found in clusters; these clusters were not associated with resistance to first-line drugs. The Beijing family was associated with drug resistance, whereas the T and Haarlem families were associated with susceptibility in the Colombian isolates studied.

Molecular epidemiology of tuberculosis: methodology and applications.

The resurgence of tuberculosis around the world has renewed interest in understanding the epidemiology and pathogenesis of this disease. A revolutionary advance in the field of tuberculosis research has been the development of molecular techniques that permit identification and tracking of individual strains of Mycobacterium tuberculosis. With these techniques, molecular epidemiology has been established as a new discipline that adds another dimension to the classical epidemiology of tuberculosis and has increased our understanding of the transmission dynamics of M. tuberculosis. The increased epidemiological knowledge has led to discovery of inadequacies in tuberculosis control programs; this information has helped garner resources for program improvement and has highlighted the need for the continuous surveillance of tuberculosis. Additional genetic methods are being developed based on the knowledge of the genome sequence of M. tuberculosis. These simpler and less costly genotyping techniques promise to expand the application of molecular epidemiology to developing nations (where 90% of the disease burden occurs) in support of national tuberculosis programs. Furthermore, these tools permit ever more effective probes into the dynamics of transmission, the population structure, evolution and pathogenesis of M. tuberculosis.

Population structure among mycobacterium tuberculosis isolates from pulmonary tuberculosis patients in Colombia.

BACKGROUND: Phylogeographic composition of M. tuberculosis populations reveals associations between lineages and human populations that might have implications for the development of strategies to control the disease. In Latin America, lineage 4 or the Euro-American, is predominant with considerable variations among and within countries. In Colombia, although few studies from specific localities have revealed differences in M. tuberculosis populations, there are still areas of the country where this information is lacking, as is a comparison of Colombian isolates with those from the rest of the world. PRINCIPAL FINDINGS: A total of 414 M. tuberculosis isolates from adult pulmonary tuberculosis cases from three Colombian states were studied. Isolates were genotyped using IS6110-restriction fragment length polymorphism (RFLP), spoligotyping, and 24-locus Mycobacterial interspersed repetitive units variable number tandem repeats (MIRU-VNTRs). SIT42 (LAM9) and SIT62 (H1) represented 53.3% of isolates, followed by 8.21% SIT50 (H3), 5.07% SIT53 (T1), and 3.14% SIT727 (H1). Composite spoligotyping and 24-locus MIRU- VNTR minimum spanning tree analysis suggest a recent expansion of SIT42 and SIT62 evolved originally from SIT53 (T1). The proportion of Haarlem sublineage (44.3%) was significantly higher than that in neighboring countries. Associations were found between M. tuberculosis MDR and SIT45 (H1), as well as HIV-positive serology with SIT727 (H1) and SIT53 (T1). CONCLUSIONS: This study showed the population structure of M. tuberculosis in several regions from Colombia with a dominance of the LAM and Haarlem sublineages, particularly in two major urban settings (Medellín and Cali). Dominant spoligotypes were LAM9 (SIT 42) and Haarlem (SIT62). The proportion of the Haarlem sublineage was higher in Colombia compared to that in neighboring countries, suggesting particular conditions of co-evolution with the corresponding human population that favor the success of this sublineage.

The molecular diagnosis of pelvic tuberculosis: a case report.

Tuberculosis is a re-emerging infectious disease. A retrospective analysis was made of the clinical history of a 48-year-old woman in April 2009; she was a secretary at a third-level hospital living in an urban area. Pelvic tubercular infection was suggested as a possible diagnosis; spoligotyping molecular methodology was used on a peritoneal secretion sample to confirm such diagnosis and confirmed the presence of Mycobacterium tuberculosis (octal code 777777777760771, SIT 53, Family T1).

El olvido de una buena educación [Editorial] / Forgetting a good education [Editorial]

No sorprende que en instituciones de educación superior como las universidades,y particularmente aquellas reconocidas como las más destacadas alma máter anivel mundial, el olvido de una buena educación haya llegado a las aulas de clase.Tampoco asombra que entre sus principales propósitos se encuentre la formaciónde personas con los más altos niveles éticos, culturales, políticos y profesionales,herramientas de gran valor, a las cuales se suman las cualidades humanas,capacidades de sus empleados y la excelencia académica de sus profesores.Indiscutiblemente se cuenta con un exquisito cuerpo docente, hombres y mujeresDEPARTAMENTO DE POSIBILIDADES EDITORIALESREVISTA MÉDICAS UISaltamente calificados y con experiencia, en ocasiones superior a la requerida,para ilustrar a la comunidad aprendiz con el contenido de determinadosprogramas. Dado que actualmente se cuenta con acceso rápido a la información yal conocimiento, los estándares para la selección de profesores y alumnos incluyeun alto grado de competencias, habilidades, conceptos y destrezas que desplazanel dominio y capacidad para transmitir el conocimiento aprendido por parte de losdocentes y el interés de los estudiantes por aprender determinada profesión,quienes enfrentan situaciones difíciles por la falta de oportunidades...

No wonder that in higher education institutions such as universities, particularlythose recognized as the leading worldwide alma mater, forgetfulness of goodeducation has come to the classroom. Nor wonder that its main purpose thetraining of people with the highest ethical, cultural, political and professional,valuable tools, to which human qualities, abilities of its employees and academicexcellence add be their teachers. Unquestionably it has an exquisite faculty, menand highly qualified and experienced women, sometimes greater than thatrequired to illustrate the learner community with the content of certain programs.Since it now has quick access to information and knowledge, standards for theselection of teachers and students includes a high degree of competence, skills,concepts and skills that move the domain and the ability to transmit knowledgelearned by teachers and student interest in learning particular profession, who facedifficult situations due to lack of opportunities...

Effect of an Oxadiazoline and a Lignan on Mycolic Acid Biosynthesis and Ultrastructural Changes of Mycobacterium tuberculosis.

Tuberculosis (TB) is an important disease that causes thousands of deaths around the world. Resistance against antitubercular available drugs has been reported; so, research on new effective antimycobacterial molecules is needed. Antimycobacterial activity of three lignans and two synthetic hydrazones was assessed against Mycobacterium tuberculosis H37Rv by antimycobacterial microdilution assay (TEMA). An oxadiazoline (AC451) and a lignan (ethoxycubebin) were the most active compounds (MIC 6.09 and 62.4 µM, resp.). Several changes in mycolic acid profile of treated bacteria were detected with both compounds by mass spectrometry analysis. Additionally, the level of reduction of mycolic acids in ethoxycubebin treatment was correlated to disruption in bacterial morphology.

Molecular tools for Mycobacterium tuberculosis genotyping.

OBJECTIVE: The present work studied molecular typing methods used for Mycobacterium tuberculosis characterization in order to learn about their advantages, disadvantages and discrimination power as regards the implementation of tuberculosis surveillance and control programs. METHODS: To analyze the discrimination power of each method we studied articles that included Hunter-Gaston discrimination index (HGDI) values or data allowing their calculation. RESULTS: The highest discrimination power was registered for LM-PCR followed by FLiP and 15-loci MIRU. The most frequently used methods showed an HGDI of 0.9491, 0.9519 and 0.8630 for 12-loci MIRU, RFLP-IS6110 and spoligotyping, respectively. CONCLUSION: M. tuberculosis isolates molecular characterization requires at least two molecular markers to discriminate non related isolates, as well as previous analysis to their implementation.

Cutaneous tuberculosis after mesotherapy: report of six cases.

INTRODUCTION: Cutaneous tuberculosis as a result of a needle injection is a rare event; it generally occurs among medical and laboratory personnel and among patients receiving percutaneous treatment. OBJECTIVE: Six patients are presented who developed cutaneous tuberculosis after mesotherapy cosmetic treatment. MATERIAL AND METHODS: One to four months after injection of an unknown product as treatment for obesity and cellulites, five women and a man developed papules, nodules and drainage of wax like material at the inoculated sites; this was interpreted clinically as a non tuberculous mycobacterium infection. Skin biopsies were taken for a histopathologic study; the biopsy and exudates were cultured to make a phenotypic identification. Polymerase chain reaction and restriction enzyme pattern analyses (PCR-restriction pattern analysis)) procedures were applied to the skin biopsies. RESULTS: Mycobacterium tuberculosis was confirmed in the culture and by PRA analysis in the paraffin-embedded biopsies. The patients had never had tuberculosis. Their thoracic X rays were normal and the size of the tuberculin reaction was 17 to 20 mm. Five patients recovered with antituberculosis treatment and the sixth spontaneously healed after the removal of the largest cutaneous module. No satellite adenopathy or recurrences were observed. CONCLUSIONS: A previously undescribed mode of acquisition cutaneous tuberculosis was described. This was the second incident of a demonstrated cutaneous tuberculosis following mesotherapy in Colombia. Skin lesions induced by injections must be tested to detect mycobacterias to include M. tuberculosis.

Specific bacterial genotypes of Mycobacterium tuberculosis cause extensive dissemination and brain infection in an experimental model.

Meningeal tuberculosis is a severe type of extrapulmonary disease, which is thought to begin with respiratory infection, followed by hematogenous dissemination and brain infection. Host genetic susceptibility factors and specific mycobacterial substrains could be involved in its development. From an epidemiological study in Colombia, we selected three Mycobacterium tuberculosis clinical strains isolated from the cerebrospinal fluid (CSF) of patients with meningeal tuberculosis, and used them to infect BALB/c mice through the intratracheal route. These strains showed a distinctive spoligotype pattern. The course of infection in terms of strain virulence (mice survival, bacillary loads in lungs), bacilli dissemination and extrapulmonary infection (bacilli loads in blood, brain, liver, kidney and spleen), and immune responses (cytokine expression determined by real time PCR in brain and lung) was studied and compared with that induced by the laboratory strain H37Rv and other five clinical strains isolated from patients with pulmonary TB. All the clinical isolates from meningeal TB patients disseminated extensively through the hematogenous route infecting the brain, producing inflammation in the cerebral parenchyma and meninges, whereas H37Rv and clinical isolates from pulmonary TB patients showed very limited efficiency to infect the brain. Thus, it seems that mycobacterial strains with a distinctive genotype are able to disseminate extensively after the respiratory infection and infect the brain.

Disseminated mycobacteriosis affecting a prosthetic aortic valve: first case of Mycobacterium peregrinum type III reported in Colombia.

Rapidly growing mycobacteria are non-tuberculous mycobacteria amply present in the environment. Although they are not usually pathogenic for humans, they are opportunistic in that they can cause disease in people with disadvantageous conditions or who are immunocompromised. Mycobacterium peregrinum, an opportunistic, rapidly growing mycobacteria, belongs to the M. fortuitum group and has been reported as responsible for human cases of mycobacteriosis. A case of M. peregrinum type III is herein reported as the first in Colombia. It presented as a disseminated disease involving a prosthetic aortic valve (endocarditis) in a seventeen-year-old girl with a well-established diagnosis of prosthetic aortic valve endocarditis who was referred for a surgical replacement. Due to a congenital heart disease (subaortic stenosis with valve insufficiency), she had two previous aortic valve implantation surgeries. One year after the second implantation, the patient presented with respiratory symptoms and weight lost indicative of lung tuberculosis. A chest X-ray did not show parenchymal compromise but several Ziehl-Neelsen stains were positive. An echocardiography showed a vegetation on the prosthetic aortic valve. In blood and sputum samples, M. peregrinum type III was identified through culture, biochemical tests and hsp65 gene molecular analysis (PRA). The patient underwent a valve replacement and received a multidrug antimycobacterial treatment. Progressive recovery ensued and further samples from respiratory tract and blood were negative for mycobacteria.

Mycobacteriosis in wild birds: the potential risk of disseminating a little-known infectious disease.

Avian mycobacteriosis is important for animal and human health; wild birds play an important role in mycobacterial species' ecology and movement. This review was aimed at reporting the role of birds in the spread of avian mycobacteriosis in human and animal populations at risk and thus a systematic review was made of PubMed, Science Direct, Scielo and Scirus databases. Mycobacteria are classified into the Mycobacterium tuberculosis complex and non-tuberculous mycobacteria; the Mycobacterium avium complex represents the most important part of the latter because it is primarily responsible for mycobacterial infection in wild birds and is a potential pathogen for mammals, especially for immunocompromised patients. The clinical signs in birds are variable as it is a chronic and debilitating disease, involving emaciated carcasses, white nodules in different organs and microscopically it presents granulomatosous multifocal inflammation. Diagnosis begins by suspicion based on clinical signs and finishes with microbiological confirmation. New diagnostic techniques include testing with DNA-RNA probes. No effective treatment is currently available and chemoprophylaxis on suspicion of infection is not recommended at the start; these factors increase the potential risk of mycobacteriosis becoming one of the most frequently documented zoonotic diseases which is difficult to treat in birds and humans. Recent concern regarding mycobacterial infection lies in the increased frequency of these opportunistic infections occurring in immunocompromised individuals and these infections' potential impact on bird conservation, this being increased by greater contact between humans and wild and captive birds.

Biosafety evaluation of the DNA extraction protocol for Mycobacterium tuberculosis complex species, as implemented at the Instituto Nacional de Salud, Colombia.

INTRODUCTION: Manipulating Mycobacterium tuberculosis clinical specimens and cultures represents a risk factor for laboratory personnel. One of the processes that requires high concentrations of microorganisms is DNA extraction for molecular procedures. Pulmonary tuberculosis cases have occurred among professionals in charge of molecular procedures that require manipulation of massive quantities of microorganisms. This has prompted research studies on biosafety aspects of extraction protocols; however, as yet, no consensus has been reached regarding risks associated with the process. OBJECTIVE: The biosafety was evaluated for the DNA extraction protocol of van Soolingen, et al. 2002 by determining M. tuberculosis viability at each process stage. MATERIALS AND METHODS: Eight hundred eighty cultures were grown from 220 M. tuberculosis clinical isolates that had been processed through the first three DNA extraction stages. Molecular identifications of positive cultures used a PCR isolation of a fragment of the heat shock protein PRA-hsp65 and examination of its restriction enzyme profile (spoligotyping). RESULTS: Growth was seen in one culture with one of the procedures used. The molecular characterization did not correspond to the initially analyzed isolate, and therefore was deduced to be the product of a cross-contamination. CONCLUSION: The DNA extraction protocol, as described by van Soolingen, et al. 2002 and as implemented at the Instituto Nacional de Salud, was established to be safe for laboratory personnel as well as for the environment.

Tuberculosis Multidrogoresistente / Multidrug-resistant tuberculosis

La tuberculosis es una enfermedad infecciosa causada por el Mycobacterium tuberculosis. En el año 2010 se registraron 8.8 millones de casos incidentes en el mundo y en los últimos años han aparecido poblaciones bacterianas de micobacterias con resistencia a los fármacos de primera línea. Se ha definido la presencia de resistencia a rifampicina e isoniacida como multidrogoresistencia, estimándose una incidencia mundial aproximada de 3.6%. Esta revisión de tema se centrará en la situación de la tuberculosis multidrogoresistente en el mundo, incluyendo un análisis regional de la casuística Colombiana. Se comentarán los principales mecanismos de resistencia del microorganismo, los genes implicados en la misma y los factores de riesgo asociados a la generación de resistencia en algunas comunidades.

Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. In 2010, there were 8.8 million incident cases in the world, and, in recent years, populations of mycobacteria with resistance to first-line drugs have emerged. The resistance to rifampin and isoniazid has been defined as multidrugresistant tuberculosis (TB MDR). TB MDR has an incidence of approximately 3.6% in the world. This review will focus on the current stage TB MDR in the world, including a regional analysis of Colombian cases. It will discuss the mechanism of resistance of the microorganism, genes involved, and the risk factors associated with the generation of resistance in some communities.

Molecular tools for Mycobacterium tuberculosis genotyping / Herramientas moleculares empleadas en genotipificación de Mycobacterium tuberculosis

Objective The present work studied molecular typing methods used for Mycobacterium tuberculosis characterization in order to learn about their advantages, disadvantages and discrimination power as regards the implementation of tuberculosis surveillance and control programs. Methods To analyze the discrimination power of each method we studied articles that included Hunter-Gaston discrimination index (HGDI) values or data allowing their calculation. Results The highest discrimination power was registered for LM-PCR followed by FLiP and 15-loci MIRU. The most frequently used methods showed an HGDI of 0.9491, 0.9519 and 0.8630 for 12-loci MIRU, RFLP-IS6110 and spoligotyping, respectively. Conclusion M. tuberculosis isolates molecular characterization requires at least two molecular markers to discriminate non related isolates, as well as previous analysis to their implementation.

Objetivo En el presente trabajo se estudiaron las metodologías de tipificación molecular empleadas para caracterizar Mycobacterium tuberculosis con el objetivo de conocer las ventajas, desventajas y poder discriminatorio para ser consideradas al momento de la implementación en los programas de vigilancia y control de la tuberculosis. Métodos Para el análisis del poder discriminatorio de cada metodología se estudiaron los artículos que suministraban el valor del Hunter-Gaston discrimination index (HGDI) ó los datos que permitían su determinación. Resultados Se documentó que el LM-PCR tiene una mayor capacidad discriminatoria seguida de FLiP y MIRU de 15 loci. Las metodologías más comúnmente empleadas mostraron un HGDI de 0.9491, 0.9519 y 0.8630 para MIRU de 12 loci, RFLP-IS6110 y spoligotyping respectivamente. Conclusión La caracterización molecular de aislamientos de M. tuberculosis requiere mínimo el análisis de al menos dos marcadores moleculares para discriminar aislamientos no relacionados y la necesidad de realizar análisis previos a la implementación de estas metodologías.

Tuberculosis cutánea por mesoterapia, estudio de seis casos / Cutaneous tuberculosis after mesotherapy: report of six cases

Introducción. La tuberculosis cutánea secundaria a la inyección con agujas es rara; se presenta en personal médico y de laboratorio, y en pacientes que reciben tratamientos percutáneos.Objetivo. Presentar seis pacientes con tuberculosis cutánea secundaria a tratamiento por mesoterapia.Materiales y métodos. Entre 1 y 4 meses después de la inyección en la piel glútea y abdominal de material no precisado, como tratamiento para la obesidad y la celulitis, cinco mujeres y un hombre desarrollaron pápulas, nódulos y senos de drenaje de material seroso en los sitios de inoculación, interpretados clínicamente como infección por micobacterias no tuberculosas. Se practicaron cultivos de las secreciones y de las biopsias de piel para la identificación fenotípica y estudio de histopatología. Con los resultados iniciales se realizaron pruebas moleculares de PRA (PCR-restriction pattern analysis) en las biopsias de piel y estudio ampliado de los pacientes.Resultados. Se demostró Mycobacterium tuberculosis en los cultivos, hallazgo confirmado por la técnica de PRA en las biopsias incluidas en parafina. Los pacientes no habían padecido tuberculosis. Las placas de tórax fueron normales y la tuberculina midió entre 17 y 20 mm. Cinco curaron con terapia antituberculosa y otro curó espontáneamente luego de la resección-biopsia de la lesión más grande. No se encontraron adenopatías satélites ni recurrencias. Conclusiones. Se demostró una nueva forma de adquirir la tuberculosis cutánea. Esta es la segunda demostración de tuberculosis cutánea por mesoterapia en Colombia. El estudio de las lesiones de la piel en el sitio de la inyección cutánea debe incluir pruebas para detectar micobacterias, entre ellas M. tuberculosis. Las autoridades sanitarias deben prestar atención y prevenir esta modalidad de adquirir la tuberculosis.

Introduction. Cutaneous tuberculosis as a result of a needle injection is a rare event; it generally occurs among medical and laboratory personnel and among patients receiving percutaneous treatment. Objective. Six patients are presented who developed cutaneous tuberculosis after mesotherapy cosmetic treatment. Material and methods. One to four months after injection of an unknown product as treatment for obesity and cellulites, five women and a man developed papules, nodules and drainage of wax like material at the inoculated sites; this was interpreted clinically as a non tuberculous mycobacterium infection. Skin biopsies were taken for a histopathologic study; the biopsy and exudates were cultured to make a phenotypic identification. Polymerase chain reaction and restriction enzyme pattern analyses (PCR-restriction pattern analysis)) procedures were applied to the skin biopsies. Results. Mycobacterium tuberculosis was confirmed in the culture and by PRA analysis in the paraffin-embedded biopsies. The patients had never had tuberculosis. Their thoracic X rays were normal and the size of the tuberculin reaction was 17 to 20 mm. Five patients recovered with antituberculosis treatment and the sixth spontaneously healed after the removal of the largest cutaneous module. No satellite adenopathy or recurrences were observed. Conclusions. A previously undescribed mode of acquisition cutaneous tuberculosis was described. This was the second incident of a demonstrated cutaneous tuberculosis following mesotherapy in Colombia. Skin lesions induced by injections must be tested to detect mycobacterias to include M. tuberculosis.