Multiplex PCR-based detection of Mycobacterium tuberculosis and Mycobacterium avium in a single host: One coloniser or dual infection?

Description

A 65-year-old male, chronic smoker with chronic obstructive pulmonary disease on steroids, presented to the emergency services with decreased urine output and altered sensorium for a day. However, soon after admission, the patient sustained cardiorespiratory arrest and died. On autopsy, the lungs were heavy and consolidated with randomly distributed miliary nodules of 0.2–0.5 cm on the pleural and the cut surface of the lung parenchyma (figure 1). Perihilar, paratracheal and subcarinal lymph nodes were enlarged with caseous necrosis. Microscopically, these were composed of aggregates of macrophages along with neutrophilic infiltrates and nuclear debris (figure 2). No well-formed epithelioid cell granulomas were seen. Ziehl Neelsen stain showed numerous intracellular aggregates of acid-fast bacilli in the macrophages (figure 3). Based on histopathological features of macrophage-rich infiltrate with intracellular AFB, atypical mycobacterial infection was suspected. Multiplex PCR was performed by using IS6110 primers specific for...

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