RT Journal Article
SR Electronic
T1 The molecular-genetic methods in the express diagnostics of tuberculous pleurisy (PTB) in HIV-infected patients
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP p1938
VO 38
IS Suppl 55
A1 Viacheslav Zhuravlev
A1 Kirill Vladimirov
A1 Irina Vasilieva
YR 2011
UL http://erj.ersjournals.com/content/38/Suppl_55/p1938.abstract
AB 84 HIV infected patients suffering with PTB admitted to TB hospitals. 42 had only PTB, 28 had suffered with pulmonary and PTB and 14 had multiorgan TB. All the patients had new TB cases and no one of them obtained anti-retroviral therapy prior to admission. We studied pleural fluid in 84 and pleural biopsies in 16 cases. In all the patients pleural fluid was obtained during needle aspiration in a routine fashion. In 16 cases with PTB a thoracoscopic pleural biopsy was made to verify the diagnosis. Real time polymerase chain reaction (PCR-RT) and TB-biochip (TBCh) were performed. TBCh identifies mutations in four MBT genes associated with drug resistance (DR) to rifampin (R) rpoB and to isoniazid (H) katG, inhA, ahpC. Sensitivity of PCR-RT was 55.9% (n=47) for pleural fluid and 75% (n=12) for the biopsies. Mutations in rpoB gene were found in 29 (61.7%) of cases, among them 22 (75.9%) due to replacement of the codon 531 (Ser-Leu). Other replaced codons were 511 (n=3), 516 (n=3), 526 (n=2) cases. We revealed DR to H, caused by mutations in katG gene in 25 (53.2%) cases, mostly in the codon 315 – 23 (92%). Mutations in other genes were rare: 4 (8.5%) in inhA and 1 (2.1%) in ahpC. Mutations associated with DR to both H and R were present in 22 (44.7%). High prevalence of strains with combination of rpoB531 and katG315 mutations confirms the continuing presence of the pool of DR strains of Beijing genotype at the territory of North-West region of Russia in conditions of wide application of R and H in TB treatment. Our data suggest that PCR-RT and TBCh of pleural fluid and biopsies are highly sensitive for express detection of DR TB in the patients suffering with pleurisy and HIV.