Mycobacteria and Nocardia Culture
Detection and identification of Mycobacteria species, Nocardia species and other aerobic actinomycetes
Identification is performed using the Hologic/GenProbe AccuProbes for selected Mycobacteria species, MALDI-TOF mass spectrometry, or 500 base pair 16S rRNA gene sequencing.
Mycobacterium tuberculosis complex species identification can be done upon request using rapid PCR targeting the regions of difference (RD) genomic areas.
Testing Algorithm Delineates situation(s) when tests are added to the initial order. This includes reflex and additional tests.
When this test is ordered, a reflex test may be performed and charged.
See Mycobacterial Culture Algorithm in Special Instructions.
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Mycobacteria species are responsible for significant morbidity and mortality in both immunocompromised and immunocompetent hosts. Mycobacterium tuberculosis is the causative agent of tuberculosis and it kills nearly 2 million people in the world each year. Nontuberculous mycobacteria such as Mycobacterium avium complex and Mycobacterium abscessus cause a variety of infections (eg, respiratory, skin, and soft tissue) and are important to detect and correctly identify in order to aid in clinical decision making. There are more than 170 recognized species of mycobacteria and identification of these organisms to the species level is often required to help guide appropriate therapy. Although there are direct detection methods available for Mycobacterium tuberculosis, growth of the organism on culture media is still necessary to allow for antimicrobial susceptibility testing. At this time, direct molecular detection methods are lacking for the nontuberculous mycobacteria and growth in culture is critical for identification and antimicrobial susceptibility testing.
Nocardia species and other aerobic actinomycetes (eg, Tsukamurella species, Gordonia species, Rhodococcus species) are also important causes of disease and isolation on culture media is important to facilitate identification and antimicrobial susceptibility testing. Nocardia and the other aerobic actinomycetes grow well on mycobacterial medium and, therefore, ordering a mycobacterial culture is recommended when infection with this group of organisms is suspected.
Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
A final negative report is issued after 60 days incubation.
Positive cultures are reported as soon as detected.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
Recovery of mycobacteria is dependent on the number of organisms present in the specimen, specimen collection methods, methods of processing, and patient factors such as the use of antimycobacteria therapy.
The use of BBL MGIT PANTA antibiotic mixture, although necessary for all nonsterile specimens, may have inhibitory effects on some mycobacteria.
Alert the laboratory if Mycobacterium genavense is suspected, as this species requires addition of mycobactin J to the culture medium for optimal growth and recovery.
The Bactec 460 and Bactec MGIT 960 systems were compared. A total of 1,963 patient specimens, including 1,519 respiratory tract specimens that required decontamination with sodium hydroxide, and 444 sterile specimens that did not need to be decontaminated, were cultured. A total of 168 cultures grew acid-fast bacilli in 1 or both systems (8.5% positivity rate). The contamination rate for respiratory tract specimens positive in the Bactec 460 was 3.8% and 7.9% in the MGIT. Contamination of sterile specimens was 6.3% in the Bactec 460 and 10.1% in the MGIT. Combined rates were 4.3% for the Bactec 460 and 8.4% for the MGIT. The overall recovery rates for mycobacterial species, excluding Mycobacterium gordonae, were 82.8%, 79.1%, and 78.4% for the Bactec 460, MGIT 960, and solid media respectively. Recovery rates for the Bactec 460 and MGIT 960 were considered to be equivalent.
Clinical Reference Provides recommendations for further in-depth reading of a clinical nature
1. Pfyffer GE, Palicova F: Mycobacterium: general characteristics; laboratory detection, and staining procedures. In Manual of Clinical Microbiology. 10th edition. Vol 1, Edited by J Versalovic, KC Carroll, G Funke, et al: Washington, DC: ASM Press. 2011 pp 472-502
2. Tortoli E: Microbiological features and clinical relevance of new species of the genus Mycobacterium. Clin Microbiol Rev 2014;27(4):727-752 doi:10.1128/CMR.00035-14
3. Wilson WW: Nocardiosis: updates and clinical overview. Mayo Clin Proc 2012;87(7):403-407