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Journal of Clinical Microbiology, August 2003, p. 4008, Vol. 41, No. 8
0095-1137/03/$08.00+0     DOI: 10.1128/JCM.41.8.4008.2003

LETTER TO THE EDITOR

Blood Agar, Chocolate Agar, and Mycobacterium tuberculosis


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LETTER
 
We have read with interest the recent paper by Drancourt et al. in which they reviewed the use of blood agar medium for the primary isolation of Mycobacterium tuberculosis (2). They state that to their knowledge "no comparative study comparing the efficacy of blood-based agars and egg-based agars has been carried out, and even the ability of blood agar to support growth of M. tuberculosis was forgotten." In December 2000, we published a letter (PubMed PMID: 11198009) concerning the isolation of M. tuberculosis on both blood and chocolate agar media from a synovial fluid sample following prolonged incubation (5). In recent years, we have been routinely recovering M. tuberculosis in our laboratory from blood samples that have been cultured initially in liquid media and then subcultured onto chocolate agar and from skin biopsy samples directly cultured on to chocolate agar.

The use of blood agar media for the recovery of M. tuberculosis was reported early in the last century but has been removed from contemporary microbiology manuals (4, 6). However, there have been more recent reports, including one from 1998 in which Arvand et al. isolated M. tuberculosis from a lymph node when investigating a diagnosis of cat scratch disease (1). Even earlier, a comparative study of different media conducted in 1977 suggested that penicillin blood agar would be at least as good as, if not better than, Löwenstein-Jensen medium for recovering M. tuberculosis (3).

The study of Drancourt et al. with clinical samples is very useful in once again highlighting the ability of these media to grow M. tuberculosis, in particular when this is not the organism being sought. Moreover, we agree with Drancourt et al. in highlighting the importance of handling in a secure manner culture media which are not specific for mycobacteria but require prolonged incubation, as we have already stated in our paper. Sealing the agar plates with adhesive tape (Micropore surgical tape; 3M, St. Paul, Minn.) is a simple way to avoid risks.


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REFERENCES
 
    1
  1. Arvand, M., M. E. Mielke, T. Weinke, T. Regnath, and H. Hahn. 1998. Primary isolation of Mycobacterium tuberculosis on blood agar during the diagnostic process for cat scratch disease. Infection 26:254.[Medline]
    2. 2
  2. Drancourt, M., P. Carrieri, M. Gévaudan, and D. Raoult. 2003. Blood agar and Mycobacterium tuberculosis: the end of a dogma. J. Clin. Microbiol. 41:1710-1811.[Abstract/Free Full Text]
    3. 3
  3. Kilicturgay, K., E. Gumrukcu, F. Tubluk, and M. Saglam. 1977. [The results in our tuberculosis laboratory with penicillin blood agar medium]. Mikrobiyol. Bul. 11:29-33. (In Turkish.)[Medline]
    4. 4
  4. Lambi, E. A. 1993. Medium selection and incubation for the isolation of Mycobacteria, p. 3.6.1-3.6.8. In H. D. Isenberg (ed.), Clinical microbiology procedures handbook, vol. 1. American Society for Microbiology, Washington, D.C.
    5. 5
  5. Mazón, A., A. Gil-Setas, J. Alfaro, and P. Idigoras. 2000. [Diagnosis of tuberculous arthritis from the isolation of Mycobacterium tuberculosis in blood agar and chocolate agar]. Enferm. Infecc. Microbiol. Clin. 18:527-528. (In Spanish.)[Medline]
    6. 6
  6. Metchock, B. G., F. S. Nolte, and R. J. Wallace, Jr. 1999. Mycobacterium, p. 399-437. In P. R. Murray, E. J. Baron, M. A. Pfaller, F. C. Tenover, and R. H. Yolken (ed.), Manual of clinical microbiology, 7th ed. American Society for Microbiology, Washington, D.C.
Alberto Gil-Setas*
Ana Mazon
Microbiología

Jesus Alfaro
Traumatologia
Servicio Navarro de Salud
Ambulatorio General Solchaga
Sevicio Navarro de Salud
C/San Fermín 29
31004 Pamplona (NA), Spain

Pedro Idigoras
Microbiologia
Complejo Hospitalario Donosti
Servicio Vasco de Salud
Osakidetza, Spain

* Phone: 34 948429225
Fax: 34 948429219
E-mail: agilseta{at}cfnavarra.es


Authors' Reply


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LETTER 
 
We agree that anecdotal reports mentioned that Mycobacterium tuberculosis was occasionally isolated on blood agar. Our research was limited to English and found only one such reference, as mentioned in our paper. Moreover, our purpose was to demonstrate that this was not a sporadic event but that blood agar can replace egg-based media. This had never been demonstrated before to the best of our knowledge. In our clinical microbiology laboratory, we routinely inoculate 10,000 samples for the diagnosis of tuberculosis every year. Now, we have replaced egg-based media with blood agar. Instead of using plates, we now use tubes, which avoid desiccation. We believe that this is a major change for clinical microbiology laboratories.

M. Drancourt
D. Raoult
Unité des Rickettsies CNRS 6020
Faculté de Médecine
Marseilles, France

Journal of Clinical Microbiology, August 2003, p. 4008, Vol. 41, No. 8
0095-1137/03/$08.00+0     DOI: 10.1128/JCM.41.8.4008.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.



This article has been cited by other articles:

  • Coban, A. Y., Bilgin, K., Uzun, M., Akgunes, A., Yusof, A., Durupinar, B. (2008). Comparative Study for Determination of Mycobacterium tuberculosis Susceptibility to First- and Second-Line Antituberculosis Drugs by the Etest Using 7H11, Blood, and Chocolate Agar. J. Clin. Microbiol. 46: 4095-4098 [Abstract] [Full Text]  
  • Coban, A. Y., Bilgin, K., Uzun, M., Fisgin, N. T., Akgunes, A., Cihan, C. C., Birinci, A., Durupinar, B. (2005). Susceptibilities of Mycobacterium tuberculosis to Isoniazid and Rifampin on Blood Agar. J. Clin. Microbiol. 43: 1930-1931 [Abstract] [Full Text]  

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