[Evaluation of manpower, equipment and quality control standards in peripheral and intermediate laboratories assessment checklist within seven selected provinces in 2011]

Peripheral and intermediate laboratories have an important role in diagnosis, treatment and prevention of tuberculosis. Today, without these laboratories, maintaining health and preventing the spread of tuberculosis is not possible. The aim of this study was Evaluation of manpower, equipment and quality control standards in peripheral and intermediate laboratories assessment checklist within seven selected provinces in year 2011. This study was a cross-sectional survey. In this study eighty tow peripheral and intermediate laboratories from seven selected provinces were studied in year 2011. A standardized checklist was used to assess peripheral and intermediate laboratories. The result showed that Esfahan with 20 labs and 8870000 population had the highest number of labs and coverage people between other provinces. Khorasan Razavi with an average of 263 per month has the highest number of admission number and Golestan, with an average of 139 positive cases per month, had the highest number of positive cases between other provinces. In 82 labs 117 laboratory technicians were engaged providing services to patients. The results of this study showed that conditions of most peripheral and intermediate laboratories are optimum and nearly standard. Control and evaluation of peripheral and intermediate laboratories, expert personnel, facilities and equipment are necessary to improve the TB control program in the country

Mycobacterium aurum keratitis: an unusual etiology of a sight-threatening infection

Atypical fast-growing Mycobacterium species are usually identified after laser-assisted in situ keratomileusis, cosmetic surgeries, and catheter-related, pulmonary or soft tissue infections. We herein present the case of a 56-year-old man with purulent discharge, redness, and foreign body sensation in his left eye. He underwent two surgeries that partially controlled the infection but were not curative. Corneal transplantation was performed, and a biopsy of the excised cornea indicated Mycobacterium aurum infection, which was confirmed by polymerase chain reaction-restriction fragment length polymorphism analysis. This appears to be the first documented case of keratitis attributable to the non-tuberculous mycobateria M. aurum. The intractable extra-ocular progression of the disease in the absence of general signs or symptoms was notable. We suggest considering non-tuberculous mycobacteria among the probable causes of complicated keratitis or keratitis that does not respond to drug treatment, especially in regions where tuberculosis is endemic.

Characterization of Mycobacterium tuberculosis complex isolated from iranian and afghani patients by spoligotyping method / Caracterização do complexo Mycobacterium tuberculosis isolado de pacientes do Irã e Afeganistão pelo método de spoligotyping

Designing newer drugs, vaccines, and diagnostic techniques is dependent on better understanding of M. tuberculosis virulence mechanism. In this study the prevalence of pcaA gene was determined in M. tuberculosis strains typed by spoligotyping. The associated risk factors among patients with different nationalities residing in Iran were also determined. The isolated M. tuberculosis strains have been characterized by performing susceptibility tests against four first-line antituberculosis drugs and were then subjected to spoligotyping characterization. PCR was used for detection of pcaA gene and its nucleotide sequence was also determined. Spoligotyping of M. tuberculosis strains resulted in 140 different patterns. One hundred twenty two (87.1%) of these spoligotype isolates were unique and reported for the first time. The remaining18 (12.8%) spoligotype patterns were previously reported from other geographical regions of the world. Haarlem family was most prevalent than other genotype. Antibiotic resistances were higher in those isolated from the Iranian patients. The pcaA gene was detected in M. tuberculosis clinical isolates but not in saprophyte strains such as M. kansasi. The results showed that, spread of M. tuberculosis strains belonging to the Beijing family among Iranian patients has to be considered seriously. This study confirmed the widespread existenceof pcaA gene in almost all the clinical isolates. It is also important to undertake studiesto identify which factors are the most significant to considerin tuberculosis control program.

O desenvolvimento de novas drogas, vacinas e técnicas de diagnóstico depende de uma melhor compreensão dos mecanismos de virulência de Mycobacterium tuberculosis. Neste estudo, a prevalência do gene pcaA em cepas de M. tuberculosis foi avaliada através de da técnica de spoligotyping. Os fatores de risco associados nos pacientes de diferentes nacionalidades vivendo no Irã foram também determinados. As cepas de M. tuberculosis isoladas foram submetidas a testes de sensibilidade a quatro drogas anti-tuberculose de primeira linha e à caracterização por spoligotyping. Empregou-se PCR para detectar o gene pcaA, determinado-se também a sequencia de nucleotidios. A espoligotipagem resultou em 140 grupos diferentes, sendo 120 (87,1%) reportados pela primeira vez. Os demais espoligotipos (12,8%) já foram descritos em outras regiões geográficas no mundo. A família Haarlem foi mais comum que os demais genótipos. A resistencia a antibióticos foi maior nas cepas isoladas dos pacientes iranianos. O gene pcaA foi detectado em isolados clínicos de M. tuberculosis mas não em cepas saprófitas, como M. kansasi. Os resultados indicaram a existência de M. tuberculosis pertencente à família Beijing nos pacientes iranianos. Este estudo confirmou a presença do gene pcaA em quase todos os isolados clínicos. Estudos que identifiquem os fatores mais significantes nos programas de controle da tuberculose são necessários.

Recovery of mycobacteria from clinical specimens and assessing drug susceptibility test of mycobacterium tuberculosis specimens by mycobacteria growth indicator tube [MGIT]

Tuberculosis is a disease of global importance. Indeed, the lack of sensitive methods for the diagnosis and inappropriate therapy may lead to increased multidrug-resistance [MDR] cases. However, early detection and identification of acid fast bacilli [AFB] in clinical specimens can lead to effective intervention. The sputum specimens from 156 clinically suspected tuberculosis patients and 40 non- tuberculosis patients were digested, examined microscopically for acid- fast bacilli, and inoculated into "Mycobacterium Growth Indicator Tube" [MGIT], BACTEC -12B vial and onto Lowenstein- Jensen slants by standard procedures. The result showed that smear was positive in 82 [52.5%] and negative in 74 [47.5%] of 156 clinically suspected tuberculosis patients. The culture positive rate with Lowenstein- Jensen, MGIT, and BACTEC-12B vial were 122 [78%], 136 [87%], and 143 [91%], respectively. Thereafter, MGIT indirect and direct susceptibility tests were performed on 15 sputum-positive specimens and the results were compared with proportional method. The results have revealed that accordance with proportional method was higher in MGIT indirect [83.5%] than direct [75%] susceptibility test, the difference was significant [p< 0.05]. In another set of experiments, the indirect MGIT drug susceptibility test in 25 mycobacterium tuberculosis isolates were performed and compared with proportional method. The results showed that MGIT could correctly detect susceptibility to streptomycin, ethambutol, rifampin and isoniazid for 77.8%, 33%, 77.2% and 80%, respectively. Also, the agreements with proportional method for resistance were 88% for streptomycin, 80% for ethambutol, 80% for rifampin and 89% for isoniazid. Furthermore, by combining MGIT technology with L.J media, the mean time required for culture to grow for identification test was reduced from 22-28 to 12-16 days [p<0.05]. MGIT is an efficient system to be used in center/ referral mycobacteriology laboratories of developing countries along with routine solid or liquid culture media