Introduction:Tuberculosis (TB) remains one of the leading infectious causes of mortality worldwide. The interaction between lipid metabolism and immune response plays a crucial role in TB pathogenesis. High-density lipoprotein (HDL) and other lipid parameters have increasingly attracted attention for their associations with inflammatory markers and survival. This study aimed to investigate the relationship between serum lipid levels, inflammatory markers, and survival in patients with TB. Materials and Methods:Data from TB and non-tuberculous mycobacteria (NTM) patients followed at Ege University Faculty of Medicine Hospital between January 2017 and January 2024 were retrospectively analyzed. Lipid profile [HDL, low-density lipoprotein (LDL), total cholesterol, triglycerides] and inflammatory parameters (C-reactive protein, erythrocyte sedimentation rate, ferritin, albumin, lymphocyte count) were recorded at diagnosis. Lipid levels were categorized into tertiles based on interquartile distribution. Groups were compared in terms of inflammatory response, clinical features, and survival. Result:A total of 148 patients were included in the study, comprising 127 TB and 21 NTM cases. Median age was 59.0 years [Interquartile range (IQR): 45.0-71.0] in the TB group and 64.0 years (IQR: 38.0-72.0) in the NTM group. Among TB patients, 62.2% were male (n= 79). Mortality among TB patients was 17.3% (n= 22). Patients with low HDL levels had significantly higher CRP and ferritin levels and lower albumin levels (p< 0.05). LDL and total cholesterol levels were similarly associated with CRP, albumin, and lymphocyte count. A significant association was observed between HDL levels and sex, with low HDL levels being more frequent among males (p< 0.001). Increasing HDL and triglyceride levels were associated with a trend toward improved survival (p= 0.063; linear trend p= 0.041). No significant associations were found between lipid levels and cavity formation, pulmonary versus extrapulmonary involvement, or acid-fast bacilli smear results (p< 0.05). In multivariable analysis, older age and lower serum albumin levels were independently and significantly associated with mortality (p< 0.005). Conclusions:In patients with TB, serum lipid profiles show significant associations with systemic inflammatory markers. Low HDL levels were accompanied by a more pronounced inflammatory response. However, lipid biomarkers were not independently associated with mortality, suggesting that they may serve as complementary markers in the assessment of the inflammatory process rather than as direct prognostic indicators.

Mycobacterium tuberculosis remains a significant public health problem, particularly in developing countries. The fact that tuberculosis can affect any organ, particularly the lungs, and presents with different symptoms depending on the organ involved makes its diagnosis challenging. The varied presentations of extrapulmonary tuberculosis can pose challenges in differential diagnosis. This article discusses a case of tuberculous lymphadenitis to highlight the diagnostic difficulties associated with the condition.

Bacteria other than Mycobacterium tuberculosis and Mycobacterium leprae are known as nontuberculous mycobacteria (NTM), and the frequency of clinically symptomatic forms is increasing day by day. Mycobacterium fortuitum, a rapidly reproducing NTM, causes various clinical signs such as skin soft-tissue infection, surgical site infection, and disseminated infection in immunosuppressed patients. Although progress can be made in terms of diagnosis when growth is detected in culture, it is quite difficult to distinguish between infection and contamination. There is no place for antituberculosis treatment in the treatment of M. fortuitum. Antibiotics such as quinolones, trimethoprim-sulfamethoxazole, linezolid, doxycycline, clarithromycin, azithromycin, imipenem, tigecycline, linezolid, and amikacin are recommended at least in dual combination therapy. In this case presentation, the diagnosis and treatment of a 2-year skin soft-tissue infection with M. fortuitum growth in culture will be discussed.

Objective:This study aimed to identify subspecies of Mycobacterium abscessus complex (MABC) isolates from clinical samples by a molecular technique and to determine mutations responsible for macrolide and aminoglycoside resistance. We also aimed to investigate the correlation of phenotypic and molecular test results by examining the resistance to antimicrobial agents according to CLSI standard using the liquid microdilution test. Methods: 27 MABC isolates from clinical samples were examined. Molecular subspecies identification and mutations responsible for aminoglycoside (rrs mutation) and macrolide resistance (rrl mutation) were determined using the GenoType NTM-DR test. The resistance phenotypes of the strains to various antimicrobial agents were investigated by the Sensititre (TM) RAPMYCOI AST microdilution test. Results: Of the 27 isolates tested, 21 were M. abscessus subsp. abscessus, three were M. abscessus subsp. bolletii, and three were M. abscessus subsp. massiliense; rrs and rrl mutations were not observed in any strains. Except for one isolate, all M. abscessus subsp. abscessus strains showed the erm(41) T28 genotype, which indicates inducible macrolide resistance. The correlation between the GenoType NTM-DR and phenotypic susceptibility test results was 81% (k=0.5, p=0.02) for inducible macrolide resistance and 89% for acquired macrolide resistance. The most effective antimicrobial agents were amikacin, cefoxitin, imipenem, linezolid, and tigecycline. Conclusion: Although the GenoType NTM-DR test is reliable in identifying and detecting molecular macrolide and aminoglycoside resistance, there were discrepancies in the results. We recommend confirming the results with the phenotypic susceptibility method after growth on culture. Although the M. abscessus complex is resistant to many antimicrobial agents, it has shown high sensitivity to amikacin, cefoxitin, imipenem, linezolid, and tigecycline. High levels of inducible macrolide resistance in isolates indicate the importance of subtyping and sensitivity testing of iso-lates in patients where culture conversion has not been achieved.

BACKGROUND AND AIM: Advances in molecular diagnostic tools for tuberculosis (TB) have improved the typing of TB. Leading to the identification of infection origins in populations and early detection of resistant TB strains. In this study, we used molecular techniques to identify, genotype, and determine the drug resistance of TB bacilli in samples from patients with pulmonary and extra-pulmonary TB at Ege University Hospital. Data were analyzed for correlations with biochemistry, clinical, and radiological aspects of the disease. METHODS: Molecular typing was performed using the Spacer Oligonucleotide Typing (spoligotyping) method on samples from 402 patients diagnosed with pulmonary and extra-pulmonary TB at Ege University Hospital between 2009 and 2014. We retrospectively extracted demographic data from patient files, including clinical and radiological findings, case origin, diagnosis date, gamma release test, length of hospital stay, and one-year mortality. RESULTS: The study included 402 patients (238 males/164 females, mean age: 52 +/- 18.4 years) with a microbiological diagnosis of TB. The patients predominantly originated from the Aegean province (203; 50.5%). Comorbidities were present in 146 (36.3%) patients, with 85 (21.1%) in an immunosuppressed state. The bacilli family was not identified in 52 (12.9%) patients' samples. The most frequently identified family was T1 (40%), followed by H3 (8.2%), LAM7-TUR (7%), H1 (5%), LAM3-S (complex) (4%), and U family (4%). No correlation was found between bacilli families in terms of age, radiological and clinical data, and laboratory findings. Drug resistance patterns were investigated within the families, with the Beijing family showing 55.6% resistance to Rifampicin (R), Isoniazid (H) (1 mg/mL and 0.2 mg/mL), and Streptomycin (S). Hospitalization occurred in 71.6% of patients, and one-year mortality was 17.6%. No differences in hospitalization and mortality rates were found between the families. CONCLUSIONS: This study revealed that the T1 family is dominant in our community, with a higher percentage of resistant bacilli found in the Beijing family. Further studies on the clinical aspects of these families and those from other areas are necessary to better understand the behavior of TB in our community.

Amaç: Çalışmamızda, Ocak 2018- Ocak 2023 yılları arasında üçüncü basamak bir üniversite hastanesi mikobakteriyoloji laboratuvarında klinik örneklerde M.tuberculosis complex üremesi saptanan hastaların direnç profilleri ve klinik özelliklerinin retrospektif olarak değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: 2018-2023 yılları arasında kabul edilen klinik örneklerden (balgam, bronkoalveolar lavaj, doku vb.) M.tuberculosis compleks üremesi olan hastaların demografik verileri, enfeksiyon tutulum yeri ve ilaç direnç paternleri hastane veri tabanındaki kayıtlarından retrospektif olarak incelenmiştir. Bulgular : Çalışmaya 204 hasta dahil edilmiştir, hastaların %6,86’sında (n= 14) izoniyazid (INH) direnci, %2,45’inde (n= 5) streptomisin direnci saptanmıştır. Bu hastaların ikisinde izoniyazid ve streptomisin direnci birlikte saptanmıştır. Rifampisin direnci, etambutol direnci ve ÇİD-TB saptanmamıştır. Tüberküloz tutulum yeri en sık %68,1 (n= 139) ile akciğer olarak saptanmıştır Sonuç: Tüm dünyada morbidite ve mortalitenin önemli nedenlerinde biri olmaya devam eden tüberküloz gelişen tıp teknolojisine rağmen hala eradike edilememiştir. Tedavi süresi, hasta uyumu ve gereksiz antibiyotik kullanımı nedeniyle gün geçtikçe artan ilaç direnci, klinik pratikte hekimleri zorlamaktadır. Tüberkülozun Edinilmiş Bağışık Eksikliği Sendromu tanımlayıcı hastalıklar arasında olması nedeniyle, ilaç direnci sorununun yanında İnsan Bağışıklık Yetmezliği Virüsü enfeksiyonu da her hekimin dikkat etmesi gereken diğer bir konudur. Çalışmamızda tüberküloz hastalarında HIV serolojisine yeteri kadar bakılmadığı görülmüştür.

Mycobacterium abscessus complex (MABSC) is one of the most resistant bacteria against antimicrobial agents. The number of agents that can be used by oral route, such as macrolides, is limited in antimicrobial therapy. In recent years, rifabutin and clofazimine have gained importance as they can be administered by oral route and have shown synergistic effects with macrolides and aminoglycosides. The aim of this study was to determine the in vitro activity of rifabutin and clofazimine against clinical isolates of MABSC resistant to macrolides. A total of 48 MABSC isolates obtained from respiratory tract and other clinical samples in the Tuberculosis Laboratories of the Faculty of Medicine of Manisa Celal Bayar and Ege Universities were included in the study. Subspecies differentiation and aminoglycoside and macrolide resistance of the isolates were determined by GenoType NTM-DR test. Rifabutin and clofazimine susceptibilities were determined by standard broth microdilution method. Of the MABSC isolates 42 were identified as M.abscessus subsp. abscessus, three as M.abscessus subsp. bolletii and three as M.abscessus subsp. massiliense. None of the isolates exhibited rrs and rrl mutations indicating acquired macrolide resistance and aminoglycoside resistance. However, the erm(41) T28 genotype which is associated with inducible macrolide resistance was detected in 41 (85%) of the strains. All M.abscessus subsp. massiliense isolates were found to be genotypically susceptible to macrolides. The minimum inhibitory concentration (MIC) range values for rifabutin were 0.0625 to 32 µg/mL, while for clofazimine, the range was 0.0625 to 1 µg/mL. Rifabutin MIC values were significantly higher (mean 5.98 µg/mL vs 0.5 µg/mL, p= 0.026) in the isolates with macrolide resistance. There was no correlation between macrolide resistance and clofazimine MIC values (mean 0.25 µg/mL vs. 0.214 µg/mL, p= 0.758). The MIC50 and MIC90 values for rifabutin were 1 and 8 µg/mL, respectively, while for clofazimine they were 0.25 and 0.5 µg/mL. Macrolide resistance was found to be higher in isolates with rifabutin MIC values above the MIC50 value (p= 0.045). In conclusion, the determination of higher rifabutin MIC values in isolates resistant to macrolides suggested that susceptibility testing should be performed before adding rifabutin to the treatment regimen. The low MIC values of clofazimine in all strains indicated that it may be used as a first choice in the combination therapy. However, further studies using a larger number of clinical isolates and applying genotypic and phenotypic susceptibility tests are needed to determine threshold MIC values to assist clinicians in making treatment decisions.

Background/aim: In tuberculsosis (TB), miRNA has been used as a biomarker to distinguish between healthy individuals and TB patients. The aim of this study was to investigate (i) the association of the miRNA and cytokine expression levels, the course of tuberculosis infection, clinical forms and response to treatment, and (ii) the effects of genotypic features of bacteria on the course of tuberculosis and the relationship between miRNA and cytokine expressions and bacterial genotypes. Materials and methods: A total of 200 cases (100: culture positive active tuberculosis, 50: quantiferon positive latent tuberculosis infection and 50: quantiferon negative healthy controls) were included in the study. For the tuberculosis group at the time of admission and after treatment, for the latent tuberculosis infection and healthy control groups at the time of admission, miRNA and cytokine expressions were determined. Genotyping of M.tuberculosis isolates was performed by spoligotyping method. Results: While, in the comparison of miRNA expressions between the pretreatment patient group and the healthy control group, there was a statistically significant decrease in the expression of miR-454-3p, miR-15a-5p, miR-590-5p, miR-381, and miR-449a in the Pulmonary TB group, there was no significant change in miRNA expression in extrapulmonary TB patients. When the cytokine expressions of the patient group and the healthy control group were compared before treatment, the expressions of all cytokines in the patient group decreased. However, the only cytokine that showed a significantly lower expression was IL12A in PTB patients. Conclusion: There is no significant relationship between the clinical course of the disease, cytokine and miRNA expression, and the genotype of the bacteria.

Introduction: Individuals co-infected with human immunodeficiency virus (HIV) and Mycobacterium tuberculosis have an increased risk of the reactivation of latent tuberculosis (TB) infection (LTBI) to active TB. The addition of peptides to stimulate CD8+ T cells is expected to increase the sensitivity of the QuantiFERON®-TB Gold Plus (QFT-Plus) assay in detecting LTBI and TB infection in patients. This study aimed to determine the prevalence of LTBI in patients with HIV infection in our region and to evaluate the possible factors that may interfere with the performance of the QFT-Plus assay in HIV infection. Materials and Methods: The study included 132 HIV-positive and 133 HIV-negative cases presented to the Ege University Medical Faculty Hospital between January 2016 and December 2019. Demographic and clinical data and laboratory/culture results were obtained from the mycobacteriology laboratory and hospital database. Results: QFT-Plus positivity rates were 30.1% (40/133) in the HIV-negative and 21.2% (28/132) in HIV-positive groups. The indeterminate results of the HIV-positive and HIV-negative groups were 4.5% and 3%, respectively. The CD4+ T cell count was below 200/mm3 in five of the six patients in the HIV-positive group with indeterminate results, and the median lymphocyte count was significantly lower. Although no significant difference was found between the median lymphocyte counts of the HIV-positive and HIV-negative group, the positivity rates and secreted interferon (IFN)-ɣ levels were lower, and the indeterminate results were higher in the HIV-positive group than in the HIV-negative group, but the difference was not significant. The rate of QFT-Plus positivity was 32.4% in patients with a viral load below 10,000 copies/ml and 16.1% in patients with a viral load above 10,000 copies/ml (p=0.047). Conclusion: The positivity rates and secreted IFN-ɣ levels were lower, and the indeterminate results were higher in the HIV-positive group than in the HIV-negative group. The addition of TB2 tube to the QFT-Plus assay could contribute to the sensitivity of the test in both HIV-positive and HIV-negative individuals with LTBI.

Amaç: Çalışmada sağlıklı, astımlı ve alerjik rinitli çocukların nazofaringeal bakteriyel mikrobiyotasının karşılaştırılması, hastalarda olası mikrobiyal disbiyozisin belirlenmesi amaçlanmıştır. Gereç ve Yöntem: Çalışmaya toplam 15 olgu alınmıştır. Olguların beşi astımlı, beşi alerjik rinitli ve beşi sağlıklı kontrol grubudur. Nazal lavaj örneklerinden 16S metagenomiks ile üst solunum yolu mikrobiyotası belirlenmiştir. Bulgular: Üst solunum yolu mikrobiyotasında en baskın şube astım hastalarında Firmucutes, sağlıklı kontrol grubu ve alerjik rinit grubunda ise Proteobacteria olarak saptanmıştır. Üst solunum yolu mikrobiyotasındaki en baskın cins ise astım hastalarında Dolosigranulum, sağlıklı kontrol grubunda Moraxella olarak saptanmıştır. Kontrol grubuyla karşılaştırıldığında astım hastalarında Moraxella cinsinin oranın azaldığı; Staphylococcus, Streptococcus ve Corynebacterium cinslerinin oranlarının arttığı belirlenmiştir. Sonuç: Sonuç olarak; çocukluk çağında üst solunum yolu mikrobiyotasının alerjik rinit ve astım patogenezini belirlemedeki rolü kesin olarak saptanamamıştır. Gruplar arası oransal fark bulunması, tüm havayolu mikrobiyomunun çalışılması durumunda olası bir farkın olabileceğini desteklemektedir.

While severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) continues to spread rapidly worldwide, some issues such as the uncertainty of the disease progress, whether intensive care will be needed, and risk classification are still important for clinicians. It is notable that in countries where latent tuberculosis infection (LTBI) is common and participating in the national Bacillus Calmette-Guerin (BCG) vaccination program, the case-fatality rates are relatively low throughout the world. In this study, it was aimed to evaluate the effects of the BCG vaccine and LTBI status on the course of the disease in patients diagnosed with coronavirus-19 (COVID-19) infection and to compare the LTBI rate with people with and without COVID-19 infection. The patients diagnosed with COVID-19 infection who were hospitalized during a period of seven months between May 1st to December 1st, 2020 were investigated by the QuantiFERON-TB Gold Plus (QFT-Plus) test in the blood samples for the presence of LTBI. For the comparison of the patients diagnosed with COVID-19 and people without COVID-19 infections in terms of LTBI rate retrospectively; all consecutive patients who were sent blood samples to the mycobacteriology laboratory for the QFT-Plus test between January 2016 and December 2019 were included in the study. Demographic, clinical, radiological, laboratory, and follow-up data of the patients were obtained from the electronic patient file. A total of 170 patients (n= 9 8 male [57.6%], n= 72 female [42.3%], mean age= 53.5 ± 15.8 years) were enrolled. Twenty-five patients' (25/170 [14.7%]) QFT-plus tests were positive. When the cases with positive QFT-Plus test (n= 25) and the cases with negative QFT-Plus test (n = 145) were compared in terms of disease severity respectively; it was determined that mild/moderate patients were 18/25 (72%) and 108/145 (74.5%), severe patients were 7/25 (28%) and 37/145 (25.5%) (p= 0.988). When these two groups were compared in terms of the clinical course respectively; the need for intensive care was 6/25 (24%) and 34/145 (23.4%) (p= 1.00), oxygen therapy requirement was 13/25 (52%) and 49/145 (33.8%) (p= 0.128), and death was 5/25 (20%) and 18/145 (12.4%) (p= 0.341). QFT-Plus positivity was 25/170 (14.7%) in patients diagnosed with COVID-19, while in control group it was 198/496 (39.9%) (OR= 0.259, 95% CI [0.164-0.411], p<0.001). When the values were evaluated quantitatively, in the COVID-19 patient group, QFT-Plus T1/T2 (IU/ml) interferon (IFN)-ɣ was 0.87 ± 1.52/0.62 ± 1.53, while in the control group it was 1.52 ± 3.69/1.50 ± 3.33 (p= 0.032, p= 0.04). There was no significant difference in the parameters investigated between 82 (48.2%) patients with BCG vaccine and those 88 (51.8%) without BCG vaccine. Although it was not statistically significant in our study, increased oxygen therapy requirement and higher mortality rates in the QFT-Plus positive group were remarkable. The detection of statistically significantly lower LTBI rates and T1-T2/IFN-ɣ values in the COVID-19 group supported that SARS-CoV-2 infection may suppress lymphocyte functions in patients and IFN-ɣ response. We believe that the results of our study are remarkably valuable, but more clinical studies are needed to elucidate the relationship between BCG vaccine, LTBI, and COVID-19 infection.

The aim was to evaluate the sensitivity and the possible factors affecting the sensitivity of the QuantiFERON®-TB Gold Plus (QFT-Plus) assay in culture-positive active TB (Tuberculosis) patients, to investigate the possible causes of negative and indeterminate results in active TB patients, and to compare the QFT-Plus results of active TB patients and latent tuberculosis infection (LTBI) cases. The QFT-Plus assay was performed in 46 active TB patients and 64 LTBI. The sensitivity of the test was found as 79.5% in all culture-positive patients, 72.7% in the immunocompromised patients, and 86.4% in the non-immunocompromised patients. Compared to active TB, individuals with LTBI had a lower T-cell response and lower IFN-ɣ concentrations. It was determined that the immunocompromisation reduced the sensitivity of the test and the secreted IFN-ɣ concentrations and increased the indeterminate results in patients with active TB. There was no difference in secreted IFN-ɣ concentrations between M. tuberculosis clones, but higher IFN-ɣ concentrations in patients infected with M. tuberculosis strains compared to patients infected with zoonotic strains. Compared with active TB, response to "only to TB2" was significantly higher in LTBI. In conclusion, it was concluded that TB2 tube increased sensitivity in LTBI but may not contribute to sensitivity in active TB.

Background The bacteria that compose the Mycobacterium tuberculosis complex (MTBC) cause tuberculosis (TB) in humans and in different animals, including livestock. Much progress has been made in understanding the population structure of the human-adapted members of the MTBC by combining phylogenetics with genomics. Accompanying the discovery of new genetic diversity, a body of operational nomenclature has evolved to assist comparative and molecular epidemiological studies of human TB. By contrast, for the livestock-associated MTBC members, Mycobacterium bovis, M. caprae and M. orygis, there has been a lack of comprehensive nomenclature to accommodate new genetic diversity uncovered by emerging phylogenomic studies. We propose to fill this gap by putting forward a new nomenclature covering the main phylogenetic groups within M. bovis, M. caprae and M. orygis. Methods We gathered a total of 8,736 whole-genome sequences (WGS) from public sources and 39 newly sequenced strains, and selected a subset of 829 WGS, representative of the worldwide diversity of M. bovis, M. caprae and M. orygis. We used phylogenetics and genetic diversity patterns inferred from WGS to define groups. Results We propose to divide M. bovis, M. caprae and M. orygis in three main phylogenetic lineages, which we named La1, La2 and La3, respectively. Within La1, we identified several monophyletic groups, which we propose to classify into eight sublineages (La1.1-La1.8). These sublineages differed in geographic distribution, with some being geographically restricted and others globally widespread, suggesting different expansion abilities. To ease molecular characterization of these MTBC groups by the community, we provide phylogenetically informed, single nucleotide polymorphisms that can be used as barcodes for genotyping. These markers were implemented in KvarQ and TB-Profiler, which are platform-independent, open-source tools. Conclusions Our results contribute to an improved classification of the genetic diversity within the livestock-associated MTBC, which will benefit future molecular epidemiological and evolutionary studies.

Bovine tuberculosis is a zoonotic disease which should be emphasized in our country as in many countries. A large number of genotypes have been revealed by spoligotyping method of M . bovis in the world. M bovis SIT 482. BOV is one of these genotypes and it is also M. bovis genotype in which BCG vaccine is administered in humans. The BCG vaccine is obtained through multiple passages of this genotype. However, this genotype, like other genotypes, can cause serious infections in humans and animals. There are data on the isolation of M. bovis SIT 482 BOV from animal and human tuberculosis cases in the world. In our country, the isolation of this genotype has been reported only in humans and no data have been found in the animals. In this study, M. bovis SIT 482. BOV was isolated from the samples of six cattle with internal organ samples obtained from licensed slaughterhouses in Aksaray. While isolation is carried out with BACTEC MGIT 960 liquid media, spoligotyping was carried out according to the manufacturer's with kit (Isogen LifeScience, The Netherlands). This study aims to report M. bovis SIT 482 BOV from cattle in Turkey for the first time, to draw attention a very limited number reported in M. bovis cases in Turkey, highlight the importance of genotyping of tuberculosis factors and contribute to epidemiological studies. These and similar studies will contribute to the creation of genetic maps for eradication of M. bovis from cattle in our country. The study was also conducted to investigate whether M bovis SIT 482. BOV isolated from cattle in Aksaray province is BCG strain or another strain giving the same pattern.

Bacillus Calmette-Guérin (BCG) osteomyelitis in immunocompetent children is a rare complication of BCG immunization which presents with nonspecific findings and often leads to delayed diagnosis. We report a 1-year and 10-month-old male infant with complaining of knee pain and limping for 5 months. He received surgical debridement due to suspicion of malignancy but BCG osteomyelitis of the distal femur was diagnosed with the culture of the specimens which revealed to have Mycobacterium bovis-BCG strain. He was successfully treated with antituberculous therapy lasting for 1 year.

Tuberculosis is one of the oldest known diseases in the World, and it is still an important cause of mortality and morbidity in our country. Despite the improvements in diagnosis and treatment, resistance to anti-tuberculosis drugs still remains a serious problem. In this report, a multidrug-resistant bone-joint tuberculosis case was presented.

Tuberculosis is still one of the most important public health problems worldwide. Due to the increase of multidrug-resistant (MDR) tuberculosis and extensively drug-resistant (XDR) tuberculosis cases, fast, practical and standardized methods need to be developed for the determination of drug resistance in Mycobacterium tuberculosis complex. The aim of this study was to compare the Sensititre MycoTB plate method with the gold standard agar proportion method (APM); in order to determine if the Sensititre MycoTB plate method is effective enough to be used instead of the APM. A total of 100 M.tuberculosis complex isolates, 36 with different resistance patterns and 64 sensitive to all first-line agents stored in culture collection of Ege University Faculty of Medicine Microbiology Department Laboratory, were used in the study. The susceptibility of rifampin, isoniazid, ethambutol, streptomycin, ofloxacin, moxifloxacin, amikacin, rifabutin, para-aminosalicylic acid, ethionamide, cycloserine and kanamycin for all the isolates were determined by APM and Sensititre MycoTB plate methods. APM was performed as defined by CLSI, Sensititre MycoTB plate method was performed as instructed by the manufacturer. Results were assessed in 95% confidence interval and sensitivity, specificity and categorical agreement values were determined. Results were obtained in 14 days using the Sensititre MycoTB plate method. Sensitivity and the specificity of the Sensititre MycoTB was between 86-100% and 95-100% respectively, while the categorical agreement between the two methods were 95-100% for the drugs tested. The sensitivities of the drugs were 100% except ethambutol and ethionamide. The specificity values for both of the drugs and categorical agreement were over 95%. All the drugs were in the 95% confidence interval (p< 0.001) and the greatest difference between the lower and upper levels of sensitivity and specificity confidence limits was found in ethambutol and ethionamide. MDR was detected in 16 isolates with the APM and in 20 isolates with the Sensititre MycoTB plate method. None of the isolates had XDR [in addition to MDR resistance against any fluoroquinolones and at least one of the second-line parenteral drugs (amikacin, kanamycin or capreomycin)]. As a result, owing to the short incubation period (14 days), high sensitivity, specificity and categorical agreement values, and the possibility for evaluating both first- and second-line agents and the quantitative values of drugs; the Sensititre MycoTB method was determined as an effective method that can be used especially in laboratories where the rate of MDR-TB isolates are high.