Abstract
Background
The diagnosis and treatment of drug resistant tuberculosis (TB) especially multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis are the critical and difficult factors in the prevention and control of tuberculosis. The development of rapid molecular diagnostic tools become more and more significant to improve the cure rate, decrease the risk of recurrence and death rate. Currently, molecular mechanisms of drug resistance and major drug-resistant genes of Mycobacterium tuberculosis (MTB) have been analyzed and elucidated. We put into use PCR-fluorescent probes to detect the mutation gene associated with XDR-TB and evaluate the clinical value of PCR-fluorescent probes.
Methods
The molecular species identification of 900 sputum specimens was performed with the use of PCR-fluorescent probe method, wherein the mutations of the drug resistance genes including rpoB, katG, inhA, embB, rpsL, rrs and gyrA were detected, and the conventional drug susceptibility testing(DST)and PCR-directed sequencing(PCR-DS) was carried out as control.
Results
Among the 900 positive sputum specimens, the result of DST demonstrated that there were 501 strains of rifampicin-resistance, 451 strains of isoniazid-resistance, 293 strains of quinolone-resistance, 425 strains of streptomycin-resistance, 235 strains of ethambutol-resistance, and 204 strains of Amikacin-resistance. 427(47.44%) strains were MDR-TB. 146 (16.22%) strains were XDR-TB. The mutations of the rpoB, katG, inhA, embB, rpsL, rrs, and gyrA genes were detected in 751 of 900 specimens of MTB by PCR-fluorescent probe method, and the detection rate of drug resistance was 751/900 (83.44%). No mutant genes were detected in the other 149 specimens. Compared with DST, the mutant detection rate of rpoB, katG/inhA, rpsL, rrs, embB, and gyrA of six drugs (RIF,INH,SM,AM,EMB,FQs) were larger than 88%, five of six drugs were larger than 90% except for SM༈88.11%༉. The MDR mutant gene types were found in 398 specimens (42.22%), and XDR mutant gene types were found in 137 specimens (15.22%). PCR-DS was also employed and confirmed the PCR-fluorescent probe method with the accordance rate of 100%.
Conclusion
The PCR-fluorescent probe method is simple and rapid in detection of genotypes of XDR-TB and is worthy to be applied in the hospital.