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BCG Infection due to MPT64-Negative Strain: A Diagnostic Challenge.

Parasmal Suresh¹, Lalitha Biswas¹, Vinitha Prasad²

¹1Centre for Nanosciences and Molecular Medicine, Amrita Institute of Medical Sciences and Research Centre, Amrita VishwaVidyapeetham, Kochi, India.

The American Journal of Tropical Medicine and Hygiene

|June 17, 2020

Summary

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False MPT64 test results can misidentify Mycobacterium bovis BCG infections as nontuberculous Mycobacterium. This highlights the importance of clinical correlation for accurate diagnosis and management of BCG-related conditions.

Area of Science:

Medical Microbiology
Infectious Diseases
Immunology

Background:

MPT64 protein is a key diagnostic marker for differentiating Mycobacterium tuberculosis complex (MTBC) from nontuberculous Mycobacterium (NTM).
Bacillus Calmette-Guerin (BCG) vaccine strains, unlike other Mycobacterium bovis, lack MPT64 secretion due to RD2 deletion.
This deficiency can lead to misidentification of BCG infections as NTM without clinical correlation.

Observation:

Two pediatric cases, BCG adenitis and osteitis, were initially misclassified as MPT64-negative Mycobacterium spp. (NTM).
Both cases were later confirmed as infections with the M. bovis BCG Danish 1331 strain.
Clinical samples were positive for MTBC by Xpert MTB/RIF, but cultures were MPT64 assay-negative.

Findings:

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The MPT64 assay's inability to detect MPT64 in BCG strains can result in false-negative results.

This diagnostic challenge can delay the correct identification of M. bovis BCG infections.

The study presents clinical cases illustrating this diagnostic pitfall.

Implications:

Accurate differentiation of MTBC from NTM is crucial for appropriate treatment, as M. bovis BCG is inherently resistant to pyrazinamide.
Disseminated BCG infection in children may indicate underlying immune deficiency, necessitating thorough investigation.
Clinical correlation alongside microbiological testing is essential for diagnosing BCG-related infections.