Utilization of whole genome sequencing for resolution of discrepant Mycobacterium tuberculosis drug susceptibility results: A case report

Susan Realegeno; Oladunni Adeyiga; Drew J. Winston; Omer E. Beaird; Omai B. Garner; Shangxin Yang

IDCases (Jan 2021)

Utilization of whole genome sequencing for resolution of discrepant Mycobacterium tuberculosis drug susceptibility results: A case report

Susan Realegeno,
Oladunni Adeyiga,
Drew J. Winston,
Omer E. Beaird,
Omai B. Garner,
Shangxin Yang

Affiliations

Susan Realegeno: UCLA Clinical Microbiology Laboratory, Department of Pathology & Laboratory Medicine, University of California, Los Angeles, Los Angeles, CA, USA
Oladunni Adeyiga: Division of Infectious Diseases, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
Drew J. Winston: Division of Hematology and Oncology, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
Omer E. Beaird: Division of Infectious Diseases, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
Omai B. Garner: UCLA Clinical Microbiology Laboratory, Department of Pathology & Laboratory Medicine, University of California, Los Angeles, Los Angeles, CA, USA
Shangxin Yang: UCLA Clinical Microbiology Laboratory, Department of Pathology & Laboratory Medicine, University of California, Los Angeles, Los Angeles, CA, USA; Correspondence to: UCLA Clinical Microbiology Laboratory, 11633 San Vicente Blvd, Los Angeles, CA 90049, USA.

Journal volume & issue: Vol. 26
p. e01308

Abstract

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A 44-year-old woman undergoing therapy for acute promyelocytic leukemia (APL) developed disseminated tuberculosis. Mycobacterium tuberculosis (TB) was isolated from the blood and sputum. Initial drug susceptibility testing (DST) of the blood isolate revealed resistance to isoniazid and ethambutol but the sputum isolate showed no resistance. Due to drug resistance concerns, the patient was treated with multiple second and third-line drugs, and suffered from drug side effects. To further investigate the DST discrepancies, whole genome sequencing (WGS) was performed on both isolates. No known resistance mutations to first line or second line drugs were identified in either isolate, which was confirmed by additional susceptibility testing performed by a different reference laboratory and the California Department of Public Health (CDPH) laboratory. Treatment was reduced to a simpler and less toxic regimen due to these investigations. WGS is shown to be a valuable tool for resolving discordant phenotypic DST results of TB isolates and has the potential to provide accurate and timely results guiding appropriate therapy in the clinical setting.

Published in IDCases

ISSN: 2214-2509 (Online)
Publisher: Elsevier
Country of publisher: United Kingdom
LCC subjects: Medicine: Internal medicine: Infectious and parasitic diseases
Website: http://www.journals.elsevier.com/idcases/

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