Review Article

Detection of Microorganisms in Granulomas That Have Been Formalin-Fixed: Review of the Literature Regarding Use of Molecular Methods

Table 2

Examples of detection of nontuberculosis mycobacteiria in patients with granulomatous inflammation.

CaseHistologySpecimenPrimerMycobacteriaReference

Lung cavity in a patient with hyperlipidemia and goutCaseous necrosis, sarcoidal granuloma, positive AFBFormalin-fixed, paraffin-embeddedhsp65 gene followed by sequencingM. avium complex and  
M. kansasii
[47]

Old cavitary tuberculosis (5 patients) and COPD (1)Caseous necrosis, bronchiectasis (2 of 6 with positive AFB)Formalin-fixed, paraffin-embeddedhsp65 gene followed by sequencingM. avium complex (one case with M. tuberculosis)[47]

Masses in 2 HIV positive patientsSpindle cell pseudotumor with abundant AFB stainingFormalin-fixed, paraffin-embeddedhsp65 gene followed by sequencing or restriction fragment polymorphismsM. avium-intracellulare [35]

Lymphadenitis in childrenCaseous granulomas (1 of 2 with positive AFB)Tissue16S rRNA gene and the IS1245 specific sequence for M. avium subsp. hominissuis using quantitative PCR; in one case RFLP was addedM. avium subsp.  hominissuis [50]

Lymphadenitis in childrenNecrotizing granulomas (3 of 22 positive with AFB) Culture Probe not specifiedM. avium complex
and M. fortuitum
[51]

Lymphadenitis (4 cases)Necrosis, lymphohistiocytic cells including epithelioid macrophages and giant cells, neutrophilsFine needle aspirate (frozen)JB21 and JB22M. bovis [38]

Granulomatous prostatitis after biopsy in 12 patientsSuppurative necrotizing granulomas with foamy histocytes and eosinophils, positive AFB in 5Culture in 8 patientsRandom amplified polymorphic DNA-PCRM. abscessus [49]

Hemoptysis in a patient with a bronchiectasis due to previous tuberculosisNo tissue available for study but AFBs present in stputumCulturerpoB and hsp65 and sequencing
RFLP of rpoB gene
M. abscessus [52]

5 patients with chronic skin lesions in extremities, recurrent, some thought to be sarcoid or swimming pool granulomasGranulomas, 2 of them with positive AFBFormalin-fixed, paraffin-embedded16S rRNA gene then sequencingM. haemophilum [53]

Multiple, progressive, painless, erythematous, nodular skin lesions in patient with liver transplant Suppurative granulomatous inflammation with numerous AFB TissuePCR of the hsp65 gene then sequencing of productM. haemophilum [54]

Chronic inflammation of hand skinGranulomatous inflammation, AFB positiveFormalin-fixed, paraffin-embedded16S rRNA gene then sequencingM. marinum [53]

Multiple, progressive, painless, erythematous, ulcerated, nodular skin lesions in patient with liver transplant and diabetes Florid histiocytic infiltrates with scattered multinucleated giant cells surrounded by lymphocytes (negative AFB). CulturePCR of the hsp65 gene then sequencing of productM. marinum [54]

Granuloma in eyelidGranulomatous inflammation (corpus alienum); AFB not doneFormalin-fixed, paraffin-embedded16S rRNA gene then sequencingM. gordonae [53]

Epithelial cystGranulomatous inflammation; AFB not doneFormalin-fixed, paraffin-embedded16S rRNA gene then sequencingM. malmoense [53]

Pulmonary nodule with spontaneous pneumothorax Granulomas with necrosis in lung tissue and faint staining AFB Culture16S rRNA PCR and sequencingM. heckeshornense [55]

Formalin-fixed, paraffin-embedded 16S 8–27 F primers and sequencing

Progressive enlargement of lung nodules in an afebrile patient with chronic obstructive pulmonary diseaseNecrotizing granulomatous inflammation, numerous AFB presentFresh tissueITS region of the rRNA gene, then sequencingM. chimaera [56]

Skin papules and nodules in patient with Hodgkin’s lymphoma Granulomas with AFB present CulturerpoB and hsp65 and sequencingNovel mycobacteria,
proposed M. shigaense
[48]

Granulomas in various tissues including respiratory tract, lymph nodes, gastrointestinal and genitourinary tracts, bone, skin
(no separation was given by mycobacteria)
Granulomas with and without caseous necrosis (presence of
AFB in only 4 cases)
Formalin-fixed, paraffin-embeddedhsp65 gene followed by sequencing or restriction fragment polymorphismsM. chelonae (13 cases);  
M. mucogenicum (8);   
M. fortuitum (7);  
M. peregrinum (1);  
M. gordonae (3);  
M. rhodesiae (1)
[35]

LeprosyNot describedTissue sectionsPeptide nucleic acid fluorescent in situ hybridization using MLEP primer M. leprae [39]