Genotype MTBDR plus assay for molecular detection of rifampicin and isoniazid resistance in Mycobacterium tuberculosis.

Aim: This study was performed for the rapid identification of Mycobacterium tuberculosis complex and its resistance to rifampicin and isoniazid, directly from the sputum samples of pulmonary tuberculosis patients. Materials and Methods: A commercially available genotype MTBDR plus assay was used for the identification and detection of mutations in Mycobacterial isolates. A total of 100 sputum samples of pulmonary tuberculosis patients were analyzed by using the genotype MTBDR plus assay. The MTBDR plus assay is designed to detect the mutations in the hotspot region of rpoB gene, katG and regulatory region of inhA gene. Results: The genotype MTBDR plus assay detected 22% multidrug resistant (MDR), 2% rifampicin (RMP) monoresistant and 1% isoniazid (INH) monoresistant isolates. In 22 MDR isolates, the codons most frequently involved in RMP-associated mutations were codon 531 (54.55%), 516 (31.82%) and 526 (13.63%), and 90.90% of MDR isolates showed KatG S315T mutations and 9.1% showed inhA C-15T mutations associated with INH resistance. Conclusion: The new genotype MTBDR plus assay represents a rapid, reliable tool for the detection of MDR-TB, wherein results are obtained in 5 h allowing early and appropriate treatment, which is essential to cut the transmission path and reduce the spread of MDR-TB. The genotype MTBDR plus assay can readily be included in a routine laboratory work for the early diagnosis and control of MDR-TB.

Paratyphoid sepsis.

A large for gestational age male baby was born to a healthy young primigravida, on L-thyroxime, at 40 weeks by caesarean delivery in a tertiary care hospital. The baby had episodes of hypoglycemia during his immediate four postnatal days in the nursery that were successfully managed with intravenous glucose administration. The baby became unwell on day 5 and had a positive sepsis-screening test. Blood culture revealed a multidrug susceptible S. Paratyphi A strain, which he probably acquired on the first or second postnatal day from the contaminated expressed breast milk or the formula feed.

Eumycetoma due to Madurella grisea--a case report.

Mycetoma due to Madurella grisea has not been previously reported from Gujarat. We report a case in whom identification of the strain was made through the structure and texture of grains, morphology in Sabouraud's dextrose agar and histopathology.

Spinal tuberculosis due to dissemination of atypical mycobacteria.

There has been an increase in disease caused by Non Tuberculous Mycobacteria (NTM) since the early 1980s. Though ubiquitous in environment, they may act as clinically important pathogens in various conditions. More importantly they are resistant to the conventional anti-tuberculous therapy (ATT) and respond to antibiotics such as quinolones and aminoglycosides and need an aggressive surgical intervention. Missing these atypical mycobacteria may lead to unnecessary administration of ATT and hence delay in proper management of the case. We report a case of spinal tuberculosis due to a Non Tuberculous Mycobacteria, M. fortuitum (Rapid grower). Relevant literature is also reviewed.