Skip to content
1887

Journal of Medical Microbiology logo Journal of Medical Microbiology

Volume 74, Issue 4

Interpreting diagnosis outcomes for tuberculosis to timely and reliably predict non-tuberculosis mycobacteria isolation Open Access

Abstract

Timely distinguishing non-tuberculous mycobacteria (NTM) from is needed, but it is challenging.

Smear-positive and tuberculosis (TB) molecular-test-negative outcomes could timely and accurately predict NTM existence in the clinical specimen.

Laboratory outcomes of the smear test and TB molecular test outcomes were evaluated in a high TB and NTM prevalence setting. Additionally, the interferon-gamma release assay (IGRA) outcome was scrutinized to assess its supplementary value to the above strategy.

The smear-positive/Xpert MTB/RIF (Cepheid, USA) outcomes accurately predicted 91.67% (198/216) of the NTM isolation, while that of smear-positive/Simultaneous Amplification and Testing method (SAT-TB) (Rendu Biotechnology, China) negative outcomes was 84.5% (169/200). Applying these indicators to rule out TB could achieve an accuracy of up to 99.49% (3435/3453). Combining smear-positive, Xpert-negative and SAT-TB-negative outcomes increased the accuracy up to 95%. Adding a negative IGRA outcome to the indicators further increased the accuracy to over 96%, albeit at the cost of losing prediction sensitivity. When evaluating the strategy in NTM isolates, the indicators successfully predicted about 40% of these isolations with over 92% accuracy.

A smear-positive/molecular TB test-negative outcome could timely and accurately predict NTM isolation in the given setting. This strategy could predict ~40% of the NTM isolations of the patients on their first day of hospital visit.

  • Received:
  • Accepted:
  • Published Online:
Keyword(s): accuracy , differential diagnosis , indicator , non-tuberculous mycobacteria (NTM) and tuberculosis (TB)
Funding
This study was supported by the:
  • the Beijing Public Health Experts Project (Award G2023-2-002, G2022-2-010)
    • Principal Award Recipient: HairongHuang
  • The National Key Research and Development Program of China (Award 2022YFC2305203)
    • Principal Award Recipient: HairongHuang
  • the Science and Technology Program of Guangzhou (Award 2023A03J0991)
    • Principal Award Recipient: YaojuTan
  • the Natural Science Fund of China (Award 82072328)
    • Principal Award Recipient: HairongHuang
© 2025 The Authors
  • This is an open-access article distributed under the terms of the Creative Commons Attribution License.
Loading

Article metrics loading...

/content/journal/jmm/10.1099/jmm.0.002009
2025-04-28
2026-04-16

Metrics

Loading full text...

Full text loading...

/deliver/fulltext/jmm/74/4/jmm002009.html?itemId=/content/journal/jmm/10.1099/jmm.0.002009&mimeType=html&fmt=ahah

References

  1. Johansen MD, Herrmann JL, Kremer L. Non-tuberculous mycobacteria and the rise of Mycobacterium abscessus. Nat Rev Microbiol 2020; 18:392–407 [View Article] [PubMed]
     [Google Scholar]
  2. Henkle E, Winthrop KL. Nontuberculous mycobacteria infections in immunosuppressed hosts. Clin Chest Med 2015; 36:91–99 [View Article] [PubMed]
     [Google Scholar]
  3. Casanova JL, Abel L. Genetic dissection of immunity to mycobacteria: the human model. Annu Rev Immunol 2002; 20:581–620 [View Article] [PubMed]
     [Google Scholar]
  4. Wu UI, Holland SM. Host susceptibility to non-tuberculous mycobacterial infections. Lancet Infect Dis 2015; 15:968–980 [View Article] [PubMed]
     [Google Scholar]
  5. Gordin FM, Masur H. Current approaches to tuberculosis in the United States. JAMA 2012; 308:283–289 [View Article] [PubMed]
     [Google Scholar]
  6. Adjemian J, Olivier KN, Seitz AE, Holland SM, Prevots DR. Prevalence of nontuberculous mycobacterial lung disease in U.S. Medicare beneficiaries. Am J Respir Crit Care Med 2012; 185:881–886 [View Article] [PubMed]
     [Google Scholar]
  7. Baldwin SL, Larsen SE, Ordway D, Cassell G, Coler RN. The complexities and challenges of preventing and treating nontuberculous mycobacterial diseases. PLoS Negl Trop Dis 2019; 13:e0007083 [View Article]
     [Google Scholar]
  8. Shahraki AH, Heidarieh P, Bostanabad SZ, Khosravi AD, Hashemzadeh M et al. “Multidrug-resistant tuberculosis” may be nontuberculous mycobacteria. Eur J Intern Med 2015; 26:279–284 [View Article] [PubMed]
     [Google Scholar]
  9. Wang X, Li H, Jiang G, Zhao L, Ma Y et al. Prevalence and drug resistance of nontuberculous mycobacteria, northern China, 2008-2011. Emerg Infect Dis 2014; 20:1252–1253 [View Article] [PubMed]
     [Google Scholar]
  10. World Health Organization Global Tuberculosis Annual Report 2022. Geneva, Sweaterhland: WHO; 2023
  11. Yu X, Liu P, Liu G, Zhao L, Hu Y et al. The prevalence of non-tuberculous mycobacterial infections in mainland China: systematic review and meta-analysis. J Infect 2016; 73:558–567 [View Article] [PubMed]
     [Google Scholar]
  12. Pantoja A, Fitzpatrick C, Vassall A, Weyer K, Floyd K. Xpert MTB/RIF for diagnosis of tuberculosis and drug-resistant tuberculosis: a cost and affordability analysis. Eur Respir J 2013; 42:708–720 [View Article] [PubMed]
     [Google Scholar]
  13. Liang Q, Jiang X, Jia J, Zhao L, Li Y et al. An early and trustable indicator suggestive of non-tuberculosis mycobacteria isolation in a high tuberculosis burden setting. J Infect 2024; 88:106149 [View Article] [PubMed]
     [Google Scholar]
  14. Zhou L, Xu D, Liu H, Wan K, Wang R et al. Trends in the prevalence and antibiotic resistance of non-tuberculous Mycobacteria in Mainland China, 2000-2019: systematic review and meta-analysis. Front Public Health 2020; 8:295 [View Article] [PubMed]
     [Google Scholar]
  15. Cui Z, Wang Y, Fang L, Zheng R, Huang X et al. Novel real-time simultaneous amplification and testing method to accurately and rapidly detect Mycobacterium tuberculosis complex. J Clin Microbiol 2012; 50:646–650 [View Article] [PubMed]
     [Google Scholar]
  16. Leyten EMS, Prins C, Bossink AWJ, Thijsen S, Ottenhoff THM et al. Effect of tuberculin skin testing on a Mycobacterium tuberculosis-specific interferon-gamma assay. Eur Respir J 2007; 29:1212–1216 [View Article] [PubMed]
     [Google Scholar]
  17. Chikamatsu K, Aono A, Yamada H, Sugamoto T, Kato T et al. Comparative evaluation of three immunochromatographic identification tests for culture confirmation of Mycobacterium tuberculosis complex. BMC Infect Dis 2014; 14:54 [View Article] [PubMed]
     [Google Scholar]
  18. Guo Y, Zhou Y, Wang C, Zhu L, Wang S et al. Rapid, accurate determination of multidrug resistance in M. tuberculosis isolates and sputum using a biochip system. Int J Tuberc Lung Dis 2009; 13:914–920 [PubMed]
     [Google Scholar]
  19. Seki M, Kim C-K, Hayakawa S, Mitarai S. Recent advances in tuberculosis diagnostics in resource-limited settings. Eur J Clin Microbiol Infect Dis 2018; 37:1405–1410 [View Article] [PubMed]
     [Google Scholar]
  20. Helb D, Jones M, Story E, Boehme C, Wallace E et al. Rapid detection of Mycobacterium tuberculosis and rifampin resistance by use of on-demand, near-patient technology. J Clin Microbiol 2010; 48:229–237 [View Article] [PubMed]
     [Google Scholar]
  21. Steingart KR, Schiller I, Horne DJ, Pai M, Boehme CC et al. Xpert® MTB/RIF assay for pulmonary tuberculosis and rifampicin resistance in adults. Cochrane Database Syst Rev 2014; 2014:CD009593 [View Article] [PubMed]
     [Google Scholar]
  22. Wang G, Wang S, Jiang G, Fu Y, Shang Y et al. Incremental cost-effectiveness of the second Xpert MTB/RIF assay to detect Mycobacterium tuberculosis. J Thorac Dis 2018; 10:1689–1695 [View Article] [PubMed]
     [Google Scholar]
  23. Gao L, Lu W, Bai L, Wang X, Xu J et al. Latent tuberculosis infection in rural China: baseline results of a population-based, multicentre, prospective cohort study. Lancet Infect Dis 2015; 15:310–319 [View Article] [PubMed]
     [Google Scholar]
  24. Simons S, van Ingen J, Hsueh P-R, Van Hung N, Dekhuijzen PNR et al. Nontuberculous Mycobacteria in respiratory tract infections, Eastern Asia. Emerg Infect Dis 2011; 17:343–349 [View Article] [PubMed]
     [Google Scholar]
  25. Haworth CS, Banks J, Capstick T, Fisher AJ, Gorsuch T et al. British thoracic society guidelines for the management of non-tuberculous Mycobacterial pulmonary disease (NTM-PD). Thorax 2017; 72:ii1–ii64 [View Article] [PubMed]
     [Google Scholar]
  26. Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro A, Daley C et al. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med 2007; 175:367–416 [View Article] [PubMed]
     [Google Scholar]
/content/journal/jmm/10.1099/jmm.0.002009
Loading
Interpreting diagnosis outcomes for tuberculosis to timely and reliably predict non-tuberculosis mycobacteria isolation
J. Med. Microbiol. 74, 002009 (2025); https://doi.org/10.1099/jmm.0.002009
/content/journal/jmm/10.1099/jmm.0.002009
/content/journal/jmm/10.1099/jmm.0.002009
Loading

Data & Media loading...

Most cited Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An error occurred
Approval was partially successful, following selected items could not be processed due to error