Ligase chain reaction assay is clinically useful in the discrimination of smear-positive pulmonary tuberculosis from atypical mycobacterioses

We evaluated the usefulness of the ligase chain reaction (LCR) (Abbott LCx Mycobacterium tuberculosis assay) during the initial diagnosis of tuberculo sis. LCx was carried out in parallel with conventional methods for the anal ysis of clinical samples. Out of 86 patients who were examined clinically, 53 were suspected of having pulmonary tuberculosis, eight had residual X-ra y scars from previous tuberculosis and 25 served as asymptomatic controls. Ten bronchoscopy samples and 237 sputum samples were analysed by direct mic roscopy, culture and LCx. All 11 smear-positive and two of three smear-nega tive tuberculosis patients had at least one LCx-positive specimen. All samp les that were both LCx- and smear-positive were culture-positive for M. tub erculosis. The smear-positive samples from the five patients with atypical mycobacteriosis were LCx-negative. There were three false-positive results: one in a smear-negative sample from a patient with M. malmoense infection and two from two pneumonia patients. All samples from controls and patients with previous tuberculosis were LCx-negative. The sensitivity, specificity and the positive and negative predictive values of LCx in patient analysis were 92.9%, 95.8%, 81.3% and 98.6%, respectively. LCx assay of M. tubercul osis is useful in rapid confirmation of tuberculosis or atypical mycobacter iosis from a smear-positive sample and may aid in diagnosing smear-negative tuberculosis.