Volume 10,Issue 1
Fall 2025
Background: The disease burden caused by the Mycobacterium tuberculosis (Mtb) complex (MTC) continues to decrease in most countries. However, the diseases caused by nontuberculous mycobacteria (NTM) become a public health problem. This study aimed to compare the diagnostic accuracy of three real-time PCR assays: AdvanSureTM TB/NTM real-time PCR kit (AdvanSure; LG Chem., Korea), Genedia® MTB/NTM detection kit (Genedia; Green Cross MS, Korea), and PowerChekTM MTB/NTM real-time PCR kit (Power Chek; Kogenebiotech, Korea) for the detection of MTC and NTM. Methods: A total of 102 acid-fast bacilli (AFB) smear-positive and 177 smear-negative specimens from Korea University Medical Center, Guro Hospital, were enrolled. The AFB smear-positive and negative specimens were collected from November 2016 to October 2017 and November to December 2018, respectively. DNA extraction was performed using Genedia Mycobacteria DNA Prep Kit (Green Cross MS, Korea). The statistical analysis was performed using MedCalc18.11.6 (MedCalc Software, Belgium). Results: Among 261 specimens, 64 showed MTC growth and 28 exhibited NTM growth. The sensitivity, specificity, positive predictive value, and negative predictive value of AdvanSure/Genedia/PowerChek kits for Mtb were 96.9%/95.3%/96.9%,98.5%/99.5%/98.5%, 58.9%/80.9%/58.9%, and 99.9%/99.9%/99.9%, respectively; whereas those for NTM detection were 81.5%/44.4%/88.9%,99.6%/100.0%/98.7%, 57.3%/100.0%/32.8%, and 99.9%/99.6%/99.9%, respectively. The area under the receiver operating characteristic curve of AdvanSure and PowerChek for NTM detection was statistically different from that of Genedia (P < 0.0001). Conclusion: Three real-time PCR assays were reliable for Mtb detection in AFB-positive and-negative specimens. There was a difference between these three reagents for the accuracy of NTM detection.
1. World Health Organization. Global Tuberculosis Report 2019, World Health Organization, 2019, viewed 18 November 2019, http://www.who.int/tb/publications/global_report/en/
2. Yoo JW, Jo KW, Kim MN, et al., 2012, Increasing Trend of Isolation of Non-tuberculous Mycobacteria in a Tertiary University Hospital in South Korea. Tuberc Respir Dis, 72: 409–415.
3. Koh WJ, Chang B, Jeong BH, et al., 2013, Increasing Recovery of Nontuberculous Mycobacteria from Respiratory Specimens over a 10-Year Period in a Tertiary Referral Hospital in South Korea. Tuberc Respir Dis, 75: 199–204.
4. Park YS, Lee CH, Lee SM, et al., 2010, Rapid Increase of Nontuberculous Mycobacterial Lung Diseases at a Tertiary Referral Hospital in South Korea. Int J Tuberc Lung Dis, 14: 1069–1071.
5. Kwon YS, Koh WJ, 2016, Diagnosis and Treatment of Nontuberculous Mycobacterial Lung Disease. J Korean Med Sci, 31: 649–659.
6. Ryu YJ, Koh WJ, Daley CL, 2016, Diagnosis and Treatment of Nontuberculous Mycobacterial Lung Disease: Clinicians’ Perspectives. Tuberc Respir Dis, 79: 74–84.
7. Lewinsohn DM, Leonard MK, LoBue PA, et al., 2017, Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention Clinical Practice Guidelines: Diagnosis of Tuberculosis in Adults and Children. Clin Infect Dis, 64: 111–115.
8. Centers for Disease Control and Prevention, 2009, Updated Guidelines for the Use of Nucleic Acid Amplification Tests in the Diagnosis of Tuberculosis. Morb Mortal Wkly Rep, 58: 7–10.
9. Koh WJ, Kwon OJ, Lee KS, 2005, Diagnosis and Treatment of Nontuberculous Mycobacterial Pulmonary Diseases: A Korean Perspective. J Korean Med Sci, 20: 913–925.
10. Choi YJ, Kim HJ, Shin HB, et al., 2012, Evaluation of Peptide Nucleic Acid Probe-Based Real-Time PCR for Detection of Mycobacterium tuberculosis Complex and Nontuberculous Mycobacteria in Respiratory Specimens. Ann Lab Med, 32: 257–263.
11. Lim JH, Kim CK, Bae MH, 2019, Evaluation of the Performance of Two Real-Time PCR Assays for Detecting Mycobacterium Species. J Clin Lab Anal, 33: e22645.
12. Choe W, Kim E, Park SY, et al., 2015, Performance Evaluation of Anyplex Plus MTB/NTM and AdvanSure TB/NTM for the Detection of Mycobacterium tuberculosis and Nontuberculous Mycobacteria. Ann Clin Microbiol, 18: 44–51.
13. American Thoracic Society and Centers for Disease Control, 1990, Diagnostic Standards and Classification of Tuberculosis. Am Rev Respir Dis, 142: 725–735.
14. Gaillard T, Fabre M, Martinaud C, et al., 2011, Assessment of the SD Bioline Ag MPT64 Rapid and the MGIT TBc Identification Tests for the Diagnosis of Tuberculosis. Diagn Microbiol Infect Dis, 70: 154–156.
15. User Protocol for Evaluation of Qualitative Test Performance EP12-A2. Clinical and Laboratory Standards Institute (CLSI), 2008, Wayne.
16. Kong KA, 2017, Statistical Methods: Reliability Assessment and Method Comparison. Ewha Med J, 40: 9.
17. Huh HJ, Kwon HJ, Ki CS, et al., 2015, Comparison of the Genedia MTB Detection Kit and the Cobas TaqMan MTB Assay for Detection of Mycobacterium tuberculosis in Respiratory Specimens. J Clin Microbiol, 53: 1012–1014.
18. Cho WH, Won EJ, Choi HJ, et al., 2015, Comparison of AdvanSure TB/NTM PCR and COBAS TaqMan MTB PCR for Detection of Mycobacterium tuberculosis Complex in Routine Clinical Practice. Ann Lab Med, 35: 356–361.
19. Kee SJ, Suh SP, 2017, Increasing Burden of Nontuberculous Mycobacteria in Korea. J Korean Med Sci, 32: 1215–1216.
20. Xpert MTB/RIF Implementation Manual: Technical and Operational ‘How-To’: Practical Considerations. World Health Organization, 2014, Geneva.
21. Jeong JY, Lee SH, Jang S, 2014, A Systematic Review on the Effectiveness of Detection of M. tuberculosis and Rifampin Resistance Using Xpert MTB/RIF. Ann Clin Microbiol, 17: 42–49.
22. Li S, Liu B, Peng M, et al., 2017, Diagnostic Accuracy of Xpert MTB/RIF for Tuberculosis Detection in Different Regions with Different Endemic Burden: A Systematic Review and Meta-Analysis. PLoS One, 12: e0180725.
23. Jung CL, Kim M, Seo D, et al., 2008, Clinical Usefulness of Real-Time PCR and Amplicor MTB PCR Assays for Diagnosis of Tuberculosis. Korean J Clin Microbiol, 11: 29–33.