Fluorescence in situ hybridization microscopic detection of Bacilli Calmette Guérin mycobacteria in aortic lesions

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Abstract

Rationale:

To improve the diagnosis of life-threatening Bacilli Calmette Guérin (BCG) arterial aneurysm in patients treated by intravesical instillation of BCG vaccine as adjunctive therapy for non-muscular bladder carcinoma, is a life-threatening condition. Its diagnosis remains cumbersome.

Patient concerns:

One patient with a history of intravesical BCG installation presented with aortic aneurysm with routine microscopic examination after Ziehl-Neelsen staining remaining negative.

Diagnoses:

We used fluorescence in situ hybridization (FISH) to target the Mycobacterium tuberculosis complex rpob gene in a fresh aortic specimen. FISH yielded fluorescent mycobacteria in aortic lesions; mycobacteria were further confirmed as Mycobacterium bovis BCG mycobacteria by polymerase chain reaction (PCR) sequencing.

Interventions:

The patient benefited from an antituberculous treatment combining rifampicin, isoniazid, and ethambunol.

Outcome:

A 9-month follow-up indicated a favorable outcome.

Lessons:

This case report teaches that FISH targeting the M tuberculosis complex rpoB gene should be incorporated in the laboratory investigation of aortic aneurysm in patients with a history of bladder carcinoma.

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Most cited references 19

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Bladder cancer.

Ashish Kamat, Noah M Hahn, Jason Efstathiou … (2016)

Bladder cancer is a complex disease associated with high morbidity and mortality rates if not treated optimally. Awareness of haematuria as the major presenting symptom is paramount, and early diagnosis with individualised treatment and follow-up is the key to a successful outcome. For non-muscle-invasive bladder cancer, the mainstay of treatment is complete resection of the tumour followed by induction and maintenance immunotherapy with intravesical BCG vaccine or intravesical chemotherapy. For muscle-invasive bladder cancer, multimodal treatment involving radical cystectomy with neoadjuvant chemotherapy offers the best chance for cure. Selected patients with muscle-invasive tumours can be offered bladder-sparing trimodality treatment consisting of transurethral resection with chemoradiation. Advanced disease is best treated with systemic cisplatin-based chemotherapy; immunotherapy is emerging as a viable salvage treatment for patients in whom first-line chemotherapy cannot control the disease. Developments in the past 2 years have shed light on genetic subtypes of bladder cancer that might differ from one another in response to various treatments.

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Recurrence and progression of disease in non-muscle-invasive bladder cancer: from epidemiology to treatment strategy.

Bas W.G. van Rhijn, Maximilian Burger, Yair Lotan … (2009)

This review focuses on the prediction of recurrence and progression in non-muscle invasive bladder cancer (NMIBC) and the treatments advocated for this disease. To review the current status of epidemiology, recurrence, and progression of NMIBC and the state-of-the art treatment for this disease. A literature search in English was performed using PubMed and the guidelines of the European Association of Urology and the American Urological Association. Relevant papers on epidemiology, recurrence, progression, and management of NMIBC were selected. Special attention was given to fluorescent cystoscopy, the new World Health Organisation 2004 classification system for grade, and the role of substaging of T1 NMIBC. In NMIBC, approximately 70% of patients present as pTa, 20% as pT1, and 10% with carcinoma in situ (CIS) lesions. Bladder cancer (BCa) is the fifth most frequent type of cancer in western society and the most expensive cancer per patient. Recurrence (in < or = 80% of patients) is the main problem for pTa NMIBC patients, whereas progression (in < or = 45% of patients) is the main threat in pT1 and CIS NMIBC. In a recent European Organisation for Research and Treatment of Cancer analysis, multiplicity, tumour size, and prior recurrence rate are the most important variables for recurrence. Tumour grade, stage, and CIS are the most important variables for progression. Treatment ranges from transurethral resection (TUR) followed by a single chemotherapy instillation in low-risk NMIBC to, sometimes, re-TUR and adjuvant intravesical therapy in intermediate- and high-risk patients to early cystectomy for treatment-refractory high-risk NMIBC. NMIBC is a heterogeneous disease with varying therapies, follow-up strategies, and oncologic outcomes for an individual patient.

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rpoB-based identification of nonpigmented and late-pigmenting rapidly growing mycobacteria.

Toidi Adekambi, Philippe Colson, Michel Drancourt (2003)

Nonpigmented and late-pigmenting rapidly growing mycobacteria (RGM) are increasingly isolated in clinical microbiology laboratories. Their accurate identification remains problematic because classification is labor intensive work and because new taxa are not often incorporated into classification databases. Also, 16S rRNA gene sequence analysis underestimates RGM diversity and does not distinguish between all taxa. We determined the complete nucleotide sequence of the rpoB gene, which encodes the bacterial beta subunit of the RNA polymerase, for 20 RGM type strains. After using in-house software which analyzes and graphically represents variability stretches of 60 bp along the nucleotide sequence, our analysis focused on a 723-bp variable region exhibiting 83.9 to 97% interspecies similarity and 0 to 1.7% intraspecific divergence. Primer pair Myco-F-Myco-R was designed as a tool for both PCR amplification and sequencing of this region for molecular identification of RGM. This tool was used for identification of 63 RGM clinical isolates previously identified at the species level on the basis of phenotypic characteristics and by 16S rRNA gene sequence analysis. Of 63 clinical isolates, 59 (94%) exhibited 3% partial rpoB gene sequence divergence from the corresponding type strain; they belonged to three taxa related to M. mucogenicum, Mycobacterium smegmatis, and Mycobacterium porcinum. For M. abscessus and M. mucogenicum, this partial sequence yielded a high genetic heterogeneity within the clinical isolates. We conclude that molecular identification by analysis of the 723-bp rpoB sequence is a rapid and accurate tool for identification of RGM.

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Author and article information

Journal

Journal ID (nlm-ta): Medicine (Baltimore)

Journal ID (iso-abbrev): Medicine (Baltimore)

Journal ID (publisher-id): MEDI

Title: Medicine

Publisher: Wolters Kluwer Health

ISSN (Print): 0025-7974

ISSN (Electronic): 1536-5964

Publication date Collection: July 2018

Publication date (Electronic): 27 July 2018

Volume: 97

Issue: 30

Electronic Location Identifier: e11321

Affiliations

[a ]Microbiology Laboratory

[b ]Infectious Disease Department, Assistance Publique -Hôpitaux de Marseille

[c ]Aix-Marseille University, Institut de Recherche pour le Développement, Microbes, Evolution, Phylogénie, Infections, Institut Hospitalier Universitaire Méditerranée-Infection, Marseille, France.

Author notes

[∗ ]Correspondence: Michel Drancourt, Institut Hospitalier Universitaire Méditerranée Infection, 19–21 Bd Jean Moulin, 13005 Marseille, France (e-mail: michel.drancourt@ 123456univ-amu.fr ).

Article

Publisher ID: MD-D-18-01011 Accession ID: 11321

DOI: 10.1097/MD.0000000000011321

PMC ID: 6078740

PubMed ID: 30045257

SO-VID: 8fc86b96-1b91-4cdc-a319-916bb9bba2b8

License:

This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0

History

Date received : 30 March 2018

Date accepted : 28 May 2018

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Keywords: aortic aneurysm,bacilli calmette guérin,bladder cancer,fluorescence in situ hybridization,mycobacterium bovis

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Keywords: aortic aneurysm, bacilli calmette guérin, bladder cancer, fluorescence in situ hybridization, mycobacterium bovis

Fluorescence in situ hybridization microscopic detection of Bacilli Calmette Guérin mycobacteria in aortic lesions : A case report

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Abstract

Rationale:

Patient concerns:

Diagnoses:

Interventions:

Outcome:

Lessons:

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Network Medicine

Most cited references 19

Bladder cancer.

Recurrence and progression of disease in non-muscle-invasive bladder cancer: from epidemiology to treatment strategy.

rpoB-based identification of nonpigmented and late-pigmenting rapidly growing mycobacteria.

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