Source: Annual Congress 2011 - Tuberculosis in immunocompromised hosts
Disease area: Respiratory infections, Thoracic oncology

Abstract

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.

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Citations should be made in the following way:
V. Zhuravlev, K. Vladimirov, I. Vasilieva (St. Petersburg, Russian Federation). The molecular-genetic methods in the express diagnostics of tuberculous pleurisy (PTB) in HIV-infected patients. Eur Respir J 2011; 38: Suppl. 55, 1938

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