Tuberculosis

Join the global initiative to reduce the incidence and deaths caused by Mycobacterium Tuberculosis (MTB) and limit the rise in nontuberculous mycobacterium (NTM) infections

The World Health Organisation's (WHO) End TB strategy1 is focused on ending the tuberculosis (TB) epidemic by 2030 with one of the targets being the mobilization of at least $13 billion annually for universal access to diagnosis, treatment and care by 2022.

With the rise in multi-drug resistant TB, antimicrobial stewardship plays a critical role in prescribing the most appropriate treatment, at the right dose, for the correct length of time to preserve the effectiveness of the remaining drug options.

NTM infections are on the increase globally2 and represent a significant threat to patients with cystic fibrosis (CF)3 and those who are immunocompromised4, thereby necessitating correct diagnosis along with accurate and reliable antimicrobial susceptibility testing (AST) for limited treatment options. For Nocardia spp., broth microdilution (BMD) is the recommended method for AST7.


Mycobacterium facts

Lung

Mycobacteria can cause either tuberculosis or non-tuberculosis lung disease. Tuberculosis is a contagious disease transmitted from an infected person to an uninfected person when droplets of phlegm containing tuberculous bacilli (most often MTB) are inhaled, while notuberculous mycobacteria are for the most part noncontagious and are common in the environment.5

World

TB is one of the top 10 causes of death worldwide, killing almost 30,000 people each week1.

Bacteria

There are more than 150 species of NTM identified but not all people with NTM lung infection need to be treated.5

Microscope

The most common type of NTM lung infection that causes pulmonary disease in the United States is due to a group of bacteria in the M. avium complex (MAC).5

Pill drug

Drug-resistant TB is caused by tuberculous bacilli that are resistant to at least one first-line anti-TB drug. Multidrug-resistant TB (MDR TB) is resistant to more than one anti-TB drug and at least isoniazid (INH) and rifampin (RIF). Extensively drug-resistant TB (XDR TB) is caused by, currently less common, strains of tuberculous bacilli that are resistant to isoniazid and rifampin, plus any fluoroquinolone and at least one of three injectable second-line drugs (i.e., amikacin, kanamycin, or capreomycin).

Clinical Medical

Treating and curing drug-resistant TB is complicated. Inappropriate management can have life-threatening results. Drug-resistant TB should be managed by, or in close consultation with, an expert in the disease.

Hospital

An MDR-TB outbreak in the United States could have serious consequences due to the costs associated with treating drug-resistant MTB. In the United States, the cost to treat and care for a patient with TB averages $17,000 for drug-susceptible TB, $150,000 for MDR-TB, and $482,000 for XDR-TB.6


Our manual mycobacterium BMD plates, MYCOTB, NOCARDIA, RAPMYCO2 and SLOMYCO2, provide the most recognisable drugs available for treating both TB and clinically significant NTMs7. All plate formats provide on-scale QC testing together with up-to-date breakpoints issued by the Clinical Laboratory Standards Institute (CLSI).

Thermo Scientific Sensititre Systems utilize MIC results generated through direct measurement rather than extrapolated (MIC) results, and offer flexible, customizable testing options to accommodate formularies and laboratories of all sizes conducting antimicrobial susceptibility and identification testing. Sensititre plates can be inoculated with our multichannel pipette or automated inoculation delivery system, then read manually with either a mirrored viewbox or using the Thermo Scientific Sensititre Vizion Digital MIC Viewing System.

Manual workflow

CLSI document – susceptibility testing standard M24—For manual interpretation of results refer to the Clinical and Laboratory Standards Institute M62-ED1:2018 document on 'Performance Standards for Susceptibility Testing of Mycobacteria, Nocardia spp., and Other Aerobic Actinomycetes'. This document includes updated breakpoint and quality control tables for the CLSI susceptibility testing standard M24.

CLSI document – susceptibility testing standard M24—For manual interpretation of results refer to the Clinical and Laboratory Standards Institute M62-ED1:2018 document on 'Performance Standards for Susceptibility Testing of Mycobacteria, Nocardia spp., and Other Aerobic Actinomycetes'. This document includes updated breakpoint and quality control tables for the CLSI susceptibility testing standard M24.

References

1. World Health Organization Global Tuberculosis Report 2019: http://www.who.int/tb/publications/global_report/en/
2. In Vitro Synergy between Clofazimine and Amikacin in Treatment of Nontuberculous Mycobacterial Disease. Jakko van Ingen, Sarah E. Totten, Niels K. Helstrom, Leonid B. Heifets, Martin J. Boeree, and Charles L. Daley
3. Epidemiology of Pulmonary Nontuberculous Mycobacterial Sputum Positivity in Patients with Cystic Fibrosis in the United States, 2010-2014. Adjemian J, Olivier KN, Prevots DR
4. Nontuberculous mycobacteria infections in immunosuppressed hosts. Henkle E, Winthrop KL.
5. Nontuberculous Mycobacterial (NTM) Lung Disease Symptoms, Treatment, Side Effects. Medical Author: Tauseef Qureshi, MD Medical Editor: William C. Shiel Jr., MD, FACP, FACR
6. CDC Factsheet on Tuberculosis: http://www.cdc.gov/tb/publications/infographic/pdf/take-on-tuberculosis-infographic.pdf updated to 2014 dollars from Treatment Practices, Outcomes, and Costs of Multidrug-Resistant and Extensively drugResistant Tuberculosis, United States, 2005–2007, S. M. Marks, et al., Emerging Infectious Disease Journal (2014)
7. CLSI. Susceptibility Testing of Mycobacteria, Nocardia spp., and Other Aerobic Actinomycetes. 3rd ed. CLSI standard M24. Wayne, PA: Clinical and Laboratory Standards Institute; 2018.