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Risso K, Michelangeli C, Gaudart A, Buscot M, Chamorey E, Courjon J, Carles M. Time-to-detection in culture of Mycobacterium tuberculosis: performance for assessing index cases contact-positivity. Int J Infect Dis 2023; 134:280-284. [PMID: 37433381 DOI: 10.1016/j.ijid.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 07/04/2023] [Accepted: 07/04/2023] [Indexed: 07/13/2023] Open
Abstract
OBJECTIVES Time-to-detection (TTD) in culture on liquid media is inversely correlated to bacillary load and should be a contributing factor for assessing tuberculosis transmission. We wanted to assess if TTD was a better alternative than smear status to estimate transmission risk. METHODS From October 2015 to June 2022, we retrospectively studied a cohort of index cases (IC) with pulmonary tuberculosis (tuberculosis disease [TD]) from which samples were culture-positive before treatment. We studied the correlation between TTD and contact-positivity (CP) of IC contacts: CP was defined as CP = 1 (CP group) in case of TD or latent tuberculosis infection (LTI) in at least one screened contact of an IC, and CP = 0 otherwise (contact-negativity [CN] group). Univariate and multivariable analyses (logistic regression) were done. RESULTS Of the 185 IC, 122 were included, generating 846 contact cases of which 705 were assessed. A transmission event (LTI or TD) was identified in 193 contact cases (transmission rate: 27%). At day 9, 66% and 35% of the IC had their sample positive in culture for CP and CN groups, respectively. Age and TTD ≤9 days were independent criteria of CP (odds ratio 0.97, confidence interval [0.95-0.98], P = 0.002 and odds ratio 3.52, confidence interval [1.59-7.83], P = 0.001, respectively). CONCLUSION TTD was a more discriminating parameter than smear status to evaluate the transmission risk of an IC with pulmonary tuberculosis. Therefore, TTD should be considered in the contact-screening strategy around an IC.
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Affiliation(s)
- Karine Risso
- Centre de Lutte Anti Tuberculeuse, Hôpital Pasteur 1, CHU de Nice, France; Service de Maladies Infectieuses et Tropicales, Hôpital l'Archet 1, CHU de Nice, France
| | - Céline Michelangeli
- Centre de Lutte Anti Tuberculeuse, Hôpital Pasteur 1, CHU de Nice, France; Service de Maladies Infectieuses et Tropicales, Hôpital l'Archet 1, CHU de Nice, France
| | - Alice Gaudart
- Service de bactériologie, Hôpital l'Archet 2, CHU de Nice, France
| | - Mathieu Buscot
- Service de Maladies Infectieuses et Tropicales, Hôpital l'Archet 1, CHU de Nice, France
| | - Emmanuel Chamorey
- Département d'Epidémiologie & Biostatistiques, Centre Antoine Lacassagne, Nice, France; Université Côte d'Azur, Inserm, C3M, Nice, France
| | - Johan Courjon
- Service de Maladies Infectieuses et Tropicales, Hôpital l'Archet 1, CHU de Nice, France; Université Côte d'Azur, Inserm, C3M, Nice, France
| | - Michel Carles
- Service de Maladies Infectieuses et Tropicales, Hôpital l'Archet 1, CHU de Nice, France; Université Côte d'Azur, Inserm, C3M, Nice, France.
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Chen H, Tang M, Yao L, Zhang D, Zhang Y, Zhao Y, Xia H, Chen T, Zheng J. Early application of metagenomics next-generation sequencing may significantly reduce unnecessary consumption of antibiotics in patients with fever of unknown origin. BMC Infect Dis 2023; 23:478. [PMID: 37464295 DOI: 10.1186/s12879-023-08417-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 06/22/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Metagenomic next-generation sequencing (mNGS) is a novel nucleic acid method for the detection of unknown and difficult pathogenic microorganisms, and its application in the etiological diagnosis of fever of unknown origin (FUO) is less reported. We aimed to comprehensively assess the value of mNGS in the etiologic diagnosis of FUO by the pathogen spectrum and diagnostic performance, and to investigate whether it is different in the time to diagnosis, length of hospitalization, antibiotic consumption and cost between FUO patients with and without early application of mNGS. METHODS A total of 149 FUO inpatients underwent both mNGS and routine pathogen detection was retrospectively analyzed. The diagnostic performance of mNGS, culture and CMTs for the final clinical diagnosis was evaluated by using sensitivity, specificity, positive predictive value, negative predictive value and total conforming rate. Patients were furtherly divided into two groups: the earlier mNGS detection group (sampling time: 0 to 3 days of the admission) and the later mNGS detection group (sampling time: after 3 days of the admission). The length of hospital stay, time spent on diagnosis, cost and consumption of antibiotics were compared between the two groups. RESULTS Compared with the conventional microbiological methods, mNGS detected much more species and had the higher negative predictive (67.6%) and total conforming rate (65.1%). Patients with mNGS sampled earlier had a significantly shorter time to diagnosis (6.05+/-6.23 vs. 10.5+/-6.4 days, P < 0.001) and days of hospital stay (13.7+/-20.0 vs. 30.3 +/-26.9, P < 0.001), as well as a significantly less consumption (13.3+/-7.8 vs. 19.5+/-8.0, P < 0.001) and cost (4543+/-7326 vs. 9873 +/- 9958 China Yuan [CNY], P = 0.001) of antibiotics compared with the patients sampled later. CONCLUSIONS mNGS could significantly improve the detected pathogen spectrum, clinical conforming rate of pathogens while having good negative predictive value for ruling out infections. Early mNGS detection may shorten the diagnosis time and hospitalization days and reduce unnecessary consumption of antibiotics.
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Affiliation(s)
- Hongmei Chen
- Department of Infectious Diseases, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Mingze Tang
- Department of Scientific Affairs, Hugobiotech Co., Ltd, Beijing, China
| | - Lemeng Yao
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Di Zhang
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yubin Zhang
- Department of Clinical Laboratory, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yingren Zhao
- Department of Infectious Diseases, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Han Xia
- Department of Scientific Affairs, Hugobiotech Co., Ltd, Beijing, China.
| | - Tianyan Chen
- Department of Infectious Diseases, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
| | - Jie Zheng
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
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Solans BP, Imperial MZ, Olugbosi M, Savic RM. Analysis of Dynamic Efficacy Endpoints of the Nix-TB Trial. Clin Infect Dis 2023; 76:1903-1910. [PMID: 36804834 PMCID: PMC10249992 DOI: 10.1093/cid/ciad051] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Safer, better, and shorter treatments for multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) are an urgent global health need. The phase 3 clinical trial Nix-TB (NCT02333799) tested a 6-month treatment of MDR and XDR-TB consisting of high-dose linezolid, bedaquiline, and pretomanid (BPaL). In this study, we investigate the relationship between the pharmacokinetic characteristics of the drugs, patient characteristics and efficacy endpoints from Nix-TB. METHODS Pharmacokinetic data were collected at weeks 2, 8, and 16. Efficacy endpoints including treatment outcomes, time to stable culture conversion, and longitudinal time to positivity in the mycobacterial growth indicator tube assay were each characterized using nonlinear mixed-effects modeling. Relationships between patient, treatment pharmacokinetics, and disease characteristics and efficacy endpoints were evaluated. RESULTS Data from 93 (85% of the total) participants were analyzed. Higher body mass index was associated with a lower incidence of unfavorable treatment outcomes. Median time to stable culture conversion was 3 months in patients with lower baseline burden compared with 4.5 months in patients with high baseline burden. Participants with minimal disease had steeper time to positivity trajectories compared with participants with high-risk phenotypes. No relationship between any drugs' pharmacokinetics (drug concentration or exposure metrics) and any efficacy outcomes was observed. CONCLUSIONS We have successfully described efficacy endpoints of a BPaL regimen from the Nix-TB trial. Participants with high-risk phenotypes significantly delayed time to culture conversion and bacterial clearance. The lack of a relationship between pharmacokinetic exposures and pharmacodynamic biomarkers opens the possibility to use lower, safer doses, particularly for toxicity-prone linezolid. CLINICAL TRIALS REGISTRATION NCT02333799.
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Affiliation(s)
- Belén P Solans
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco Schools of Pharmacy and Medicine, San Francisco, California, USA
- UCSF Center for Tuberculosis, University of California San Francisco, San Francisco, California, USA
| | - Marjorie Z Imperial
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco Schools of Pharmacy and Medicine, San Francisco, California, USA
- UCSF Center for Tuberculosis, University of California San Francisco, San Francisco, California, USA
| | | | - Rada M Savic
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco Schools of Pharmacy and Medicine, San Francisco, California, USA
- UCSF Center for Tuberculosis, University of California San Francisco, San Francisco, California, USA
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Weidmann MD, Wu Y, Wu F, Hapani DD, Green DA, Aaron JG, Berry GJ. A case of novel, rapidly-growing Mycolicibacter kumamotonensis infection in a patient with severe pulmonary disease treated in New York City. BMC Infect Dis 2023; 23:26. [PMID: 36639740 PMCID: PMC9840340 DOI: 10.1186/s12879-022-07959-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 12/20/2022] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Mycolicibacter kumamotonensis is a slowly growing, non-chromogenic non-tuberculous mycobacteria (NTM) that was initially distinguished from the M. terrae complex in 2006. Since then it has been rarely reported as the cause of pulmonary and soft-tissue infections in both immunocompromised and immunocompetent patients. CASE PRESENTATION We present a case of severe pulmonary disease due to Mycolicibacter kumamotonensis in a 57-year-old male who was immunocompetent at time of diagnosis, with a history of interstitial lung disease and a prior diagnosis of tuberculosis (TB). After initial treatment for TB in 2017, his condition stabilized until a recurrence in September 2021, leading to an evaluation for lung transplant in the setting of pulmonary fibrosis and emphysema which led to the identification of Mycolicibacter kumamotonensis. A lung transplant was completed, and the patient was successfully treated with a combination of Ethambutol, Azithromycin, and Rifabutin. CONCLUSIONS This represents the first case reported of M. kumamotonensis in a patient undergoing lung transplant, and the first case with rapid culture growth during identification of the organism (4 days). This report highlights the need for consideration of M. kumamotonensis as a pathogen in humans, with the potential for rapid growth in liquid media, and the importance of early identification to inform empiric therapy.
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Affiliation(s)
- Maxwell D. Weidmann
- grid.239585.00000 0001 2285 2675Department of Pathology and Cell Biology, Columbia University Irving Medical Center, 3959 Broadway, CHC 3-324, New York, NY 10032 USA
| | - Yuexiu Wu
- grid.239585.00000 0001 2285 2675Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY USA
| | - Fann Wu
- grid.239585.00000 0001 2285 2675Department of Pathology and Cell Biology, Columbia University Irving Medical Center, 3959 Broadway, CHC 3-324, New York, NY 10032 USA
| | - Dhrupa D. Hapani
- grid.239585.00000 0001 2285 2675Department of Pathology and Cell Biology, Columbia University Irving Medical Center, 3959 Broadway, CHC 3-324, New York, NY 10032 USA
| | - Daniel A. Green
- grid.239585.00000 0001 2285 2675Department of Pathology and Cell Biology, Columbia University Irving Medical Center, 3959 Broadway, CHC 3-324, New York, NY 10032 USA
| | - Justin G. Aaron
- grid.239585.00000 0001 2285 2675Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY USA
| | - Gregory J. Berry
- grid.239585.00000 0001 2285 2675Department of Pathology and Cell Biology, Columbia University Irving Medical Center, 3959 Broadway, CHC 3-324, New York, NY 10032 USA
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5
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Lau A, Lin C, Barrie J, Winter C, Armstrong G, Egedahl ML, Doroshenko A, Heffernan C, Asadi L, Fisher D, Paulsen C, Moolji J, Huang Y, Long R. A comparison of the chest radiographic and computed tomographic features of subclinical pulmonary tuberculosis. Sci Rep 2022; 12:16567. [PMID: 36195738 PMCID: PMC9531232 DOI: 10.1038/s41598-022-21016-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 09/21/2022] [Indexed: 11/23/2022] Open
Abstract
Subclinical pulmonary tuberculosis (PTB) is a recently described intermediate state of great interest, but about which little is known. This study sought to describe and compare the frequency of key radiologic features of subclinical PTB on chest radiograph (CXR) versus computed tomographic scan (CT), and to interpret the clinical and public health relevance of the differences. Diagnostic CXRs and CT scans of the thorax and neck in a 16-year cohort of subclinical PTB patients in Canada were re-acquired and read by two independent readers and arbitrated by a third reader. Logistic regression models were fit to determine how likely CXR features can be detected by CT scan versus CXR after adjustment for age and sex. Among 296 subclinical patients, CXRs were available in 286 (96.6%) and CT scans in 94 (32.9%). CXR features in patients with and without CT scans were comparable. Lung cavitation was 4.77 times (95% CI 1.95–11.66), endobronchial spread 19.36 times (95% CI 8.05–46.52), and moderate/far-advanced parenchymal disease 3.23 times (95% CI 1.66–6.30), more common on CT scan than CXR. We conclude that the extent to which CXRs under-detect key radiologic features in subclinical PTB is substantial. This may have public health and treatment implications.
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Affiliation(s)
- Angela Lau
- The Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Room 8325, Aberhart Centre, 11402 University Avenue, Edmonton, AB, T6G 2J3, Canada
| | - Christopher Lin
- The Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - James Barrie
- The Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Christopher Winter
- The Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Gavin Armstrong
- The Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Mary Lou Egedahl
- The Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Room 8325, Aberhart Centre, 11402 University Avenue, Edmonton, AB, T6G 2J3, Canada
| | - Alexander Doroshenko
- The Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Room 8325, Aberhart Centre, 11402 University Avenue, Edmonton, AB, T6G 2J3, Canada
| | - Courtney Heffernan
- The Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Room 8325, Aberhart Centre, 11402 University Avenue, Edmonton, AB, T6G 2J3, Canada
| | - Leyla Asadi
- The Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Room 8325, Aberhart Centre, 11402 University Avenue, Edmonton, AB, T6G 2J3, Canada
| | - Dina Fisher
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Catherine Paulsen
- The Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Room 8325, Aberhart Centre, 11402 University Avenue, Edmonton, AB, T6G 2J3, Canada
| | - Jalal Moolji
- The Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Room 8325, Aberhart Centre, 11402 University Avenue, Edmonton, AB, T6G 2J3, Canada
| | - Yiming Huang
- The Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Room 8325, Aberhart Centre, 11402 University Avenue, Edmonton, AB, T6G 2J3, Canada
| | - Richard Long
- The Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Room 8325, Aberhart Centre, 11402 University Avenue, Edmonton, AB, T6G 2J3, Canada.
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Lau A, Lin C, Barrie J, Winter C, Armstrong G, Egedahl ML, Doroshenko A, Heffernan C, Asadi L, Fisher D, Paulsen C, Moolji J, Long R. The Radiographic and Mycobacteriologic Correlates of Subclinical Pulmonary TB in Canada: A Retrospective Cohort Study. Chest 2022; 162:309-320. [PMID: 35122750 DOI: 10.1016/j.chest.2022.01.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 01/13/2022] [Accepted: 01/22/2022] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Very little is known about subclinical pulmonary TB (PTB), a recently described intermediate state, in high-income countries. RESEARCH QUESTION What is the prevalence of subclinical PTB in Canada? What are its diagnostic chest radiography features? What is the relationship between those features and time to culture positivity, and what is the association between DNA fingerprint clustering, a measure of local transmission, and radiographic or other features in the foreign-born? STUDY DESIGN AND METHODS We used primary source data to identify a 16-year retrospective cohort of patients with PTB. Demographic and mycobacteriologic features in patients with subclinical and clinical disease were compared, and the reason for assessment of patients with subclinical disease was described. Diagnostic chest radiographs in patients with subclinical disease were read by two independent readers and were arbitrated by a third reader. Linear regression was used to compute time to culture positivity (in days) in relationship to the change in chest radiograph findings from normal or minimally abnormal to moderately or far advanced, adjusted for age and sex and stratified by reason for assessment. Multivariate logistic regression was used in foreign-born patients with subclinical disease to determine associations between DNA fingerprint clustering of Mycobacterium TB isolates and age, sex, chest radiograph features, and time since arrival. RESULTS We identified 1,656 patients with PTB, 347 of whom (21%) were subclinical. Compared with patients with clinical disease, patients with subclinical disease were more likely to be foreign-born (90.2% vs 79.6%) and to demonstrate negative smear results (88.2% vs 43.5%). The median time to culture-positivity was 18 days (interquartile range [IQR], 14-25 days) vs 12 days (IQR, 7-17 days). Most patients with PTB (75.2%) were identified during active case finding. Parenchymal disease was absent or minimal on chest radiography in 86.4% of patients. More advanced disease on chest radiography was associated with shorter times to culture positivity in nonstratified (by 3.3 days) and stratified (by 4.5-5.8 days) analysis (active case-finding groups). DNA fingerprint clustering was associated with male sex and a longer time between arrival and diagnosis. INTERPRETATION Subclinical patients with PTB constitute a substantial and heterogeneous minority of patients with PTB in high-income countries. DNA fingerprint clustering is consistent with some, albeit limited, local transmission.
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Affiliation(s)
- Angela Lau
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Christopher Lin
- Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - James Barrie
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Christopher Winter
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Gavin Armstrong
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Mary Lou Egedahl
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Alexander Doroshenko
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Courtney Heffernan
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Leyla Asadi
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Dina Fisher
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Catherine Paulsen
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Jalal Moolji
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Richard Long
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
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Mingora CM, Garcia BA, Mange KC, Yuen DW, Ciesielska M, van Ingen J, Flume PA, Dorman SE. Time-to-positivity of Mycobacterium avium complex in broth culture associates with culture conversion. BMC Infect Dis 2022; 22:246. [PMID: 35279081 PMCID: PMC8918293 DOI: 10.1186/s12879-022-07250-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 02/28/2022] [Indexed: 12/01/2022] Open
Abstract
Background Mycobacterial time to positivity (TTP) in liquid culture media has predictive value for longer term outcomes in pulmonary tuberculosis, but has not been thoroughly studied in nontuberculous mycobacterial pulmonary disease. This study sought to evaluate for association between TTP and sputum culture conversion to negative in pulmonary disease caused by Mycobacterium avium complex (MAC). Methods Data from the CONVERT trial (NCT02344004) that evaluated efficacy of guideline-based-therapy with or without amikacin liposome inhalation suspension in adults with refractory MAC-PD (Mycobacterium avium complex pulmonary disease) were analyzed. We evaluated TTP measures for sputum obtained prior to study treatment initiation and at monthly visits, assessing reproducibility of measures as well as association of TTP with culture conversion on treatment. Results Data from 71 participants with at least one screening visit TTP value were analyzed. For participants who provided more than one sputum sample at a given visit, there was moderate between-sample reliability, with median intraclass correlation coefficient 0.62 (IQR 0.50, 0.70). Median TTP at screening was longer in those participants who subsequently achieved vs. did not achieve culture conversion (10.5 [IQR 9.4] days vs. 4.2 [IQR 2.8] days, p = 0.0002). Individuals with culture conversion by study treatment month 6 were more likely to have a screening TTP > 5 days compared to those who did not achieve culture conversion (OR 15.4, 95% CI 1.9, 716.7, p = 0.0037) and had increasing TTPs over time. Conclusions TTP prior to and on treatment is associated with microbiological treatment response in patients with MAC-PD. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07250-4.
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Time to Positive Culture Detection Predicts Mycobacterium avium Pulmonary Disease Severity and Treatment Initiation. Ann Am Thorac Soc 2021; 19:925-932. [PMID: 34851813 DOI: 10.1513/annalsats.202107-765oc] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Additional biomarkers are needed to guide initiation of treatment for Mycobacterium avium pulmonary disease (Mav-PD). Time to positive sputum culture detection (TTP) may offer potential prognostic and monitoring value. OBJECTIVE To determine whether TTP is associated with infection severity and early treatment response in Mav-PD? METHODS We undertook a retrospective cohort study of patients with ≥2 sputum cultures positive for M. avium, an 'index' sputum M. avium isolate during 2015-2019, a CT scan within 6 months, and no treatment for ≥6 months prior to index sputum. TTP was estimated from the date of laboratory receipt of the specimen to the date of culture positivity confirmation. TTP was tested for association with markers of infection severity (Mav-PD, bronchiectasis, cavitary disease, treatment initiation by 3 and 6 months, AFB smear) and treatment response using Mann-Whitney U, Spearman's Correlation Coefficient, and Wilcoxon signed-rank tests. We explored a threshold TTP that could identify significant M. avium disease. RESULTS We included 125 patients with mean (SD) age 68.5 (12.5) years and 65% fulfilled disease criteria. Median TTP was 12 days (IQR 10-15; range 6-44). TTP and AFB smear grade were negatively correlated (ρ -0.58, p<0.001). TTP was associated with NTM disease (p=0.03), AFB smear positivity (p<0.001), and treatment initiation by three (p=0.01) and six (p=0.03) months. A threshold TTP of ≤10 days was associated with Mav-PD (80.6% vs 58.4%; ð (95%CI) 22.1 (5.6-38.6)%,p=0.02), AFB smear positivity (83.3% vs 20.2%, ð (95%CI) 63.1(48.3-77.9)%, p<0.001), treatment by three (38.9% vs 13.5%; ð (95%CI) 25.4 (8.0-42.8)%, p=0.003) and six (47.2% vs 19.1%; ð (95%CI) 28.1 (9.9-46.4)%,p=0.003) months. After three and six months of treatment, the median (IQR) change in TTP was +8 (1-undefined; p<0.001) and +7 (0-undefined; p=0.001) days respectively. CONCLUSION TTP is associated with bacterial burden and infection severity and increases in response to treatment. A threshold of ≤10 days may be useful in predicting significant Mav-PD. As a readily available biomarker, further exploration of TTP is imperative.
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Vongthilath-Moeung R, Poncet A, Renzi G, Schrenzel J, Janssens JP. Time to Detection of Growth for Mycobacterium tuberculosis in a Low Incidence Area. Front Cell Infect Microbiol 2021; 11:704169. [PMID: 34490143 PMCID: PMC8418320 DOI: 10.3389/fcimb.2021.704169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 08/04/2021] [Indexed: 01/29/2023] Open
Abstract
Background Diagnosis of Mycobacterium tuberculosis (MTB) infection can be confirmed by Xpert assays within hours. However, when sample size does not allow performing both culture and Xpert, or if Xpert is negative, then formal diagnosis of MTB relies on culture and time to detection of growth (TDG) becomes critical for clinical management. Objectives To determine TDG in Xpert negative samples, or in samples in which Xpert could not be performed, in a low-incidence area for MTB. Methods Retrospective analysis (2015-2020) of a database including all cultures for mycobacteria in a University Hospital covering approximately 500'000 inhabitants. Analysis was restricted to culture positive (C+) samples for MTB for which 1/Xpert was negative or could not be performed because of limited sample volume, and 2/collected from subjects treated less than 24 hours. TDG was analyzed according to microscopy, origin of sample (pulmonary or not) and presence of cavitation. Results Among 837 C+ samples for MTB, 236 samples (80% of respiratory origin) from 147 patients fulfilled study criteria; 78 samples (49 patients, 33%) were acid-fast bacilli (AFB) positive. Median (IQR) TDG was 25 (17; 40) days for all samples. TDG exceeded 28 days in 43% of samples and was significantly shorter in AFB+ vs AFB- samples, and samples from cavitary vs non cavitary or extra-thoracic disease. Conclusions In Xpert negative samples, or samples for which Xpert could not be performed, TDG exceeded 4 weeks in 43% of samples. AFB+ and samples from cavitary lung disease had a significantly shorter TDG.
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Affiliation(s)
| | - Antoine Poncet
- Center for Clinical Research & Division of Clinical-Epidemiology, Department of Health and Community Medicine, University of Geneva, University Hospitals of Geneva, Geneva, Switzerland
| | - Gesuele Renzi
- Bacteriology Laboratory, Division of Laboratory Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Jacques Schrenzel
- Bacteriology Laboratory, Division of Laboratory Medicine, Geneva University Hospitals, Geneva, Switzerland
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Jean-Paul Janssens
- Division of Pulmonary Diseases, Geneva University Hospitals, Geneva, Switzerland
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A Longitudinal Model-Based Biomarker Analysis of Exposure Response in Adults with Pulmonary Tuberculosis. Antimicrob Agents Chemother 2021; 65:e0179420. [PMID: 34252302 PMCID: PMC8448095 DOI: 10.1128/aac.01794-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The identification of sensitive, specific, and reliable biomarkers that can be quantified in the early phases of tuberculosis treatment and predictive of long-term outcome is key for the development of an effective short-course treatment regimen. Time to positivity (TTP), a biomarker of treatment outcome against Mycobacterium tuberculosis, measures longitudinal bacterial growth in mycobacterial growth indicator tube broth culture and may be predictive of standard time to stable culture conversion (TSCC). In two randomized phase 2b trials investigating dose-ranging rifapentine (Studies 29 and 29X), 662 participants had sputum collected over 6 months where TTP, TSCC, and time to culture conversion were quantified. The goals of this post hoc study were to characterize longitudinal TTP profiles and to identify individual patient characteristics associated with delayed time to culture conversion. In order to do so, a nonlinear mixed-effects model describing longitudinal TTP was built. Independent variables associated with increased bacterial clearance (increased TTP), assessed by subject-specific and population-level trajectories, were higher rifapentine exposure, lower baseline grade of sputum acid-fast bacillus smear, absence of productive cough, and lower extent of lung infiltrates on radiographs. Importantly, sensitivity analysis revealed that major learning milestones in phase 2b trials, such as significant exposure-response and covariate relationships, could be detected using truncated TTP data as early as 6 weeks from start of treatment, suggesting alternative phase 2b study designs. The TTP model built depicts a novel phase 2b surrogate endpoint that can inform early assessment of experimental treatment efficacy and treatment failure or relapse in patients treated with shorter and novel TB treatment regimens, improving efficiency of phase 2 clinical trials. (The studies discussed in this paper have been registered at ClinicalTrials.gov under identifiers NCT00694629 and NCT01043575.)
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Ernest JP, Strydom N, Wang Q, Zhang N, Nuermberger E, Dartois V, Savic RM. Development of New Tuberculosis Drugs: Translation to Regimen Composition for Drug-Sensitive and Multidrug-Resistant Tuberculosis. Annu Rev Pharmacol Toxicol 2020; 61:495-516. [PMID: 32806997 DOI: 10.1146/annurev-pharmtox-030920-011143] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Tuberculosis (TB) kills more people than any other infectious disease. Challenges for developing better treatments include the complex pathology due to within-host immune dynamics, interpatient variability in disease severity and drug pharmacokinetics-pharmacodynamics (PK-PD), and the growing emergence of resistance. Model-informed drug development using quantitative and translational pharmacology has become increasingly recognized as a method capable of drug prioritization and regimen optimization to efficiently progress compounds through TB drug development phases. In this review, we examine translational models and tools, including plasma PK scaling, site-of-disease lesion PK, host-immune and bacteria interplay, combination PK-PD models of multidrug regimens, resistance formation, and integration of data across nonclinical and clinical phases.We propose a workflow that integrates these tools with computational platforms to identify drug combinations that have the potential to accelerate sterilization, reduce relapse rates, and limit the emergence of resistance.
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Affiliation(s)
- Jacqueline P Ernest
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, California 94158, USA;
| | - Natasha Strydom
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, California 94158, USA;
| | - Qianwen Wang
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, California 94158, USA;
| | - Nan Zhang
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, California 94158, USA;
| | - Eric Nuermberger
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, Maryland 21231, USA
| | - Véronique Dartois
- Center for Discovery and Innovation, Hackensack Meridian School of Medicine at Seton Hall University, Nutley, New Jersey 07110, USA
| | - Rada M Savic
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, California 94158, USA;
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Dooley KE, Miyahara S, von Groote-Bidlingmaier F, Sun X, Hafner R, Rosenkranz SL, Ignatius EH, Nuermberger EL, Moran L, Donahue K, Swindells S, Vanker N. Early Bactericidal Activity of Different Isoniazid Doses for Drug-Resistant Tuberculosis (INHindsight): A Randomized, Open-Label Clinical Trial. Am J Respir Crit Care Med 2020; 201:1416-1424. [PMID: 31945300 PMCID: PMC7258626 DOI: 10.1164/rccm.201910-1960oc] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 01/15/2020] [Indexed: 11/16/2022] Open
Abstract
Rationale: High-dose isoniazid is recommended in short-course regimens for multidrug-resistant tuberculosis (TB). The optimal dose of isoniazid and its individual contribution to efficacy against TB strains with inhA or katG mutations are unknown.Objectives: To define the optimal dose of isoniazid for patients with isoniazid-resistant TB mediated by inhA mutations.Methods: AIDS Clinical Trials Group A5312 is a phase 2A, open-label trial in which individuals with smear-positive pulmonary TB with isoniazid resistance mediated by an inhA mutation were randomized to receive isoniazid 5, 10, or 15 mg/kg daily for 7 days (inhA group), and control subjects with drug-sensitive TB received the standard dose (5 mg/kg/d). Overnight sputum cultures were collected daily. The 7-day early bactericidal activity (EBA) of isoniazid was estimated as the average daily change in log10 cfu on solid media (EBAcfu0-7) or as time to positivity (TTP) in liquid media in hours (EBATTP0-7) using nonlinear mixed-effects models.Measurements and Main Results: Fifty-nine participants (88% with cavitary disease, 20% HIV-positive, 16 with isoniazid-sensitive TB, and 43 with isoniazid-monoresistant or multidrug-resistant TB) were enrolled at one site in South Africa. The mean EBAcfu0-7 at doses of 5, 10, and 15 mg/kg in the inhA group was 0.07, 0.17, and 0.22 log10 cfu/ml/d, respectively, and 0.16 log10 cfu/ml/d in control subjects. EBATTP0-7 patterns were similar. There were no drug-related grade ≥3 adverse events.Conclusions: Isoniazid 10-15 mg/kg daily had activity against TB strains with inhA mutations similar to that of 5 mg/kg against drug-sensitive strains. The activity of high-dose isoniazid against strains with katG mutations will be explored next.Clinical trial registered with www.clinicaltrials.gov (NCT01936831).
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Affiliation(s)
- Kelly E. Dooley
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sachiko Miyahara
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | | | - Xin Sun
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Richard Hafner
- Division of AIDS, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
| | - Susan L. Rosenkranz
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Frontier Science and Technology Research Foundation, Amherst, New York
| | - Elisa H. Ignatius
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eric L. Nuermberger
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Laura Moran
- Social & Scientific Systems, Inc., Silver Spring, Maryland; and
| | - Kathleen Donahue
- Frontier Science and Technology Research Foundation, Amherst, New York
| | - Susan Swindells
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Naadira Vanker
- TASK Applied Science and Stellenbosch University, Cape Town, South Africa
| | - on behalf of the A5312 Study Team
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- TASK Applied Science and Stellenbosch University, Cape Town, South Africa
- Division of AIDS, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
- Frontier Science and Technology Research Foundation, Amherst, New York
- Social & Scientific Systems, Inc., Silver Spring, Maryland; and
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
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Advancing the development of new tuberculosis treatment regimens: The essential role of translational and clinical pharmacology and microbiology. PLoS Med 2019; 16:e1002842. [PMID: 31276490 PMCID: PMC6611566 DOI: 10.1371/journal.pmed.1002842] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Efficacy and safety of delamanid in combination with an optimised background regimen for treatment of multidrug-resistant tuberculosis: a multicentre, randomised, double-blind, placebo-controlled, parallel group phase 3 trial. THE LANCET RESPIRATORY MEDICINE 2019; 7:249-259. [PMID: 30630778 DOI: 10.1016/s2213-2600(18)30426-0] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 10/05/2018] [Accepted: 10/09/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Delamanid is one of two recently approved drugs for the treatment of multidrug-resistant tuberculosis. We aimed to evaluate the safety and efficacy of delamanid in the first 6 months of treatment. METHODS This randomised, double-blind, placebo-controlled, phase 3 trial was done at 17 sites in seven countries (Estonia, Latvia, Lithuania, Moldova, Peru, the Philippines, and South Africa). We enrolled eligible adults (>18 years) with pulmonary multidrug-resistant tuberculosis to receive, in combination with an optimised background regimen developed according to WHO and national guidelines, either oral delamanid (100 mg twice daily) for 2 months followed by 200 mg once daily for 4 months or placebo (same regimen). Patients were centrally randomised (2:1) and stratified by risk category for delayed sputum culture conversion. Primary outcomes were the time to sputum culture conversion over 6 months and the difference in the distribution of time to sputum culture conversion over 6 months between the two groups, as assessed in the modified intention-to-treat population. The trial is registered at ClinicalTrials.gov, number NCT01424670. FINDINGS Between Sept 2, 2011, and Nov 27, 2013, we screened 714 patients, of whom 511 were randomly assigned (341 to delamanid plus optimised background regimen [delamanid group] and 170 to placebo plus optimised background regimen [placebo group]) and formed the safety analysis population. 327 patients were culture-positive for multidrug-resistant tuberculosis at baseline and comprised the efficacy analysis population (226 in the delamanid group and 101 in the placebo group). Median time to sputum culture conversion did not differ between the two groups (p=0·0562; modified Peto-Peto), with 51 days (IQR 29-98) in the delamanid group and 57 days (43-85) in the placebo group; the hazard ratio was 1·17 (95% CI 0·91-1·51, p=0·2157). 501 (98·0%) of 511 patients had at least one treatment-emergent adverse event. 136 (26·6%) of 511 patients had at least one serious treatment-emergent adverse event; the incidence was similar between treatment groups (89 [26·1%] of 341 patients for delamanid and 47 [27·6%] of 170 for placebo). Deaths related to treatment-emergent adverse events were similar between groups (15 [4·4%] of 341 for delamanid and six [3·5%] of 170 for placebo). No deaths were considered to be related to delamanid. INTERPRETATION The reduction in median time to sputum culture conversion over 6 months was not significant in the primary analysis. Delamanid was well tolerated with a highly characterised safety profile. Further evaluation of delamanid is needed to determine its role in a rapidly evolving standard of care. FUNDING Otsuka Pharmaceutical.
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Fradejas I, Ontañón B, Muñoz-Gallego I, Ramírez-Vela M, López-Roa P. The value of xpert MTB/RIF-generated CT values for predicting the smear status of patients with pulmonary tuberculosis. J Clin Tuberc Other Mycobact Dis 2018; 13:9-12. [PMID: 31720405 PMCID: PMC6830157 DOI: 10.1016/j.jctube.2018.04.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 03/12/2018] [Accepted: 04/09/2018] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Smear microscopy is used to assess the patient's infectiousness at the time of initial diagnosis of pulmonary tuberculosis. However, its limited sensitivity and specificity highlights the need for new diagnostic strategies. The aim of our study was to assess the diagnostic accuracy of GX Ct value as a predictor of smear status and its usefulness to quantify mycobacterial load. METHODS All GX-positive sputum samples during a seven-year period were included in the study. Correlations among Ct values, smear status and TTD on liquid culture were calculated. An optimal Ct value for ruling in infectious patients was established. Clinical and radiological variables were also analyzed. RESULTS Sixty-eight samples from 65 patients were included. Ct value and TTD yielded a positive correlation (ρ = 0.714; p < 0.05), while Ct and smear grade yielded an inverse correlation (r = -0.71). An optimal Ct value for ruling in smear positive patients was established at 21.1 cycles (90.5% sensitivity, 61% specificity, 81% PPV and 78% NPV). CONCLUSIONS Our study confirms the value of GX Ct levels for quantifying mycobacterial load and demonstrates the added value of Ct as a predictor of positive smear status, especially at Ct values below 21.
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Affiliation(s)
- Isabel Fradejas
- Department of Clinical Microbiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Belén Ontañón
- Department of Clinical Laboratory, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Irene Muñoz-Gallego
- Department of Clinical Microbiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - M.J. Ramírez-Vela
- Department of Clinical Microbiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Paula López-Roa
- Department of Clinical Microbiology, Hospital Universitario 12 de Octubre, Madrid, Spain
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16
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Murphy ME, Phillips PPJ, Mendel CM, Bongard E, Bateson ALC, Hunt R, Murthy S, Singh KP, Brown M, Crook AM, Nunn AJ, Meredith SK, Lipman M, McHugh TD, Gillespie SH. Spot sputum samples are at least as good as early morning samples for identifying Mycobacterium tuberculosis. BMC Med 2017; 15:192. [PMID: 29073910 PMCID: PMC5658986 DOI: 10.1186/s12916-017-0947-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 09/25/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The use of early morning sputum samples (EMS) to diagnose tuberculosis (TB) can result in treatment delay given the need for the patient to return to the clinic with the EMS, increasing the chance of patients being lost during their diagnostic workup. However, there is little evidence to support the superiority of EMS over spot sputum samples. In this new analysis of the REMoxTB study, we compare the diagnostic accuracy of EMS with spot samples for identifying Mycobacterium tuberculosis pre- and post-treatment. METHODS Patients who were smear positive at screening were enrolled into the study. Paired sputum samples (one EMS and one spot) were collected at each trial visit pre- and post-treatment. Microscopy and culture on solid LJ and liquid MGIT media were performed on all samples; those missing corresponding paired results were excluded from the analyses. RESULTS Data from 1115 pre- and 2995 post-treatment paired samples from 1931 patients enrolled in the REMoxTB study were analysed. Patients were recruited from South Africa (47%), East Africa (21%), India (20%), Asia (11%), and North America (1%); 70% were male, median age 31 years (IQR 24-41), 139 (7%) co-infected with HIV with a median CD4 cell count of 399 cells/μL (IQR 318-535). Pre-treatment spot samples had a higher yield of positive Ziehl-Neelsen smears (98% vs. 97%, P = 0.02) and LJ cultures (87% vs. 82%, P = 0.006) than EMS, but there was no difference for positivity by MGIT (93% vs. 95%, P = 0.18). Contaminated and false-positive MGIT were found more often with EMS rather than spot samples. Surprisingly, pre-treatment EMS had a higher smear grading and shorter time-to-positivity, by 1 day, than spot samples in MGIT culture (4.5 vs. 5.5 days, P < 0.001). There were no differences in time to positivity in pre-treatment LJ culture, or in post-treatment MGIT or LJ cultures. Comparing EMS and spot samples in those with unfavourable outcomes, there were no differences in smear or culture results, and positive results were not detected earlier in Kaplan-Meier analyses in either EMS or spot samples. CONCLUSIONS Our data do not support the hypothesis that EMS samples are superior to spot sputum samples in a clinical trial of patients with smear positive pulmonary TB. Observed small differences in mycobacterial burden are of uncertain significance and EMS samples do not detect post-treatment positives any sooner than spot samples.
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Affiliation(s)
- Michael E Murphy
- UCL Centre for Clinical Microbiology, Department of Infection, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK.
| | - Patrick P J Phillips
- Medical Research Council UK Clinical Trials Unit at University College London, Aviation House, 125 Kingsway, London, WC2B 6NH, UK
| | - Carl M Mendel
- Global Alliance for Tuberculosis Drug Development, New York, NY, 10005, USA
| | - Emily Bongard
- UCL Centre for Clinical Microbiology, Department of Infection, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - Anna L C Bateson
- UCL Centre for Clinical Microbiology, Department of Infection, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - Robert Hunt
- UCL Centre for Clinical Microbiology, Department of Infection, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - Saraswathi Murthy
- UCL Centre for Clinical Microbiology, Department of Infection, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - Kasha P Singh
- UCL Centre for Clinical Microbiology, Department of Infection, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - Michael Brown
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Angela M Crook
- Medical Research Council UK Clinical Trials Unit at University College London, Aviation House, 125 Kingsway, London, WC2B 6NH, UK
| | - Andrew J Nunn
- Medical Research Council UK Clinical Trials Unit at University College London, Aviation House, 125 Kingsway, London, WC2B 6NH, UK
| | - Sarah K Meredith
- Medical Research Council UK Clinical Trials Unit at University College London, Aviation House, 125 Kingsway, London, WC2B 6NH, UK
| | - Marc Lipman
- UCL Respiratory, Division of Medicine, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - Timothy D McHugh
- UCL Centre for Clinical Microbiology, Department of Infection, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - Stephen H Gillespie
- School of Medicine, Medical and Biological Sciences, University of St Andrews, North Haugh, St Andrews, KY16 9TF, UK.
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Diedrich CR, O'Hern J, Gutierrez MG, Allie N, Papier P, Meintjes G, Coussens AK, Wainwright H, Wilkinson RJ. Relationship Between HIV Coinfection, Interleukin 10 Production, and Mycobacterium tuberculosis in Human Lymph Node Granulomas. J Infect Dis 2016; 214:1309-1318. [PMID: 27462092 PMCID: PMC5079364 DOI: 10.1093/infdis/jiw313] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 06/16/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Human immunodeficiency virus type 1 (HIV)-infected persons are more susceptible to tuberculosis than HIV-uninfected persons. Low peripheral CD4+ T-cell count is not the sole cause of higher susceptibility, because HIV-infected persons with a high peripheral CD4+ T-cell count and those prescribed successful antiretroviral therapy (ART) remain more prone to active tuberculosis than HIV-uninfected persons. We hypothesized that the increase in susceptibility is caused by the ability of HIV to manipulate Mycobacterium tuberculosis-associated granulomas. METHODS We examined 71 excised cervical lymph nodes (LNs) from persons with HIV and M. tuberculosis coinfection, those with HIV monoinfection, and those with M. tuberculosis monoinfection with a spectrum of peripheral CD4+ T-cell counts and ART statuses. We quantified differences in M. tuberculosis levels, HIV p24 levels, cellular response, and cytokine presence within granulomas. RESULTS HIV increased M. tuberculosis numbers and reduced CD4+ T-cell counts within granulomas. Peripheral CD4+ T-cell depletion correlated with granulomas that contained fewer CD4+ and CD8+ T cells, less interferon γ, more neutrophils, more interleukin 10 (IL-10), and increased M. tuberculosis numbers. M. tuberculosis numbers correlated positively with IL-10 and interferon α levels and fewer CD4+ and CD8+ T cells. ART reduced IL-10 production. CONCLUSIONS Peripheral CD4+ T-cell depletion correlated with increased M. tuberculosis presence, increased IL-10 production, and other phenotypic changes within granulomas, demonstrating the HIV infection progressively changes these granulomas.
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Affiliation(s)
- Collin R Diedrich
- Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine
| | - Jennifer O'Hern
- Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine
| | | | | | | | - Graeme Meintjes
- Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine
- Department of Medicine, University of Cape Town, South Africa
| | - Anna K Coussens
- Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine
| | - Helen Wainwright
- Division of Anatomical Pathology
- Department of Medicine, University of Cape Town, South Africa
| | - Robert J Wilkinson
- Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine
- Department of Medicine, University of Cape Town, South Africa
- Francis Crick Institute Mill Hill Laboratory
- Department of Medicine, Imperial College London, United Kingdom
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Yang AL, Schmidt TE, Stibitz S, Derrick SC, Morris SL, Parra M. A simplified mycobacterial growth inhibition assay (MGIA) using direct infection of mouse splenocytes and the MGIT system. J Microbiol Methods 2016; 131:7-9. [PMID: 27650198 DOI: 10.1016/j.mimet.2016.09.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 09/15/2016] [Accepted: 09/15/2016] [Indexed: 10/21/2022]
Abstract
We describe a simplified Mycobacterial Growth Inhibition Assay (MGIA) for pre-clinical assessment of vaccine-mediated protection in mice. The assay is accomplished by directly infecting splenocytes from vaccinated mice with Mycobacterium tuberculosis and quantifying mycobacteria using Mycobacterial Growth Indicator Tubes (MGIT). Vaccine-mediated immunogenicity detected by this assay correlated with protection.
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Affiliation(s)
- Amy L Yang
- Center for Biologics Evaluation and Research, United States Food and Drug Administration, Silver Spring, MD, USA
| | - Thomas E Schmidt
- Center for Biologics Evaluation and Research, United States Food and Drug Administration, Silver Spring, MD, USA
| | - Scott Stibitz
- Center for Biologics Evaluation and Research, United States Food and Drug Administration, Silver Spring, MD, USA
| | - Steven C Derrick
- Center for Biologics Evaluation and Research, United States Food and Drug Administration, Silver Spring, MD, USA.
| | - Sheldon L Morris
- Center for Biologics Evaluation and Research, United States Food and Drug Administration, Silver Spring, MD, USA
| | - Marcela Parra
- Center for Biologics Evaluation and Research, United States Food and Drug Administration, Silver Spring, MD, USA
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Dooley KE, Phillips PPJ, Nahid P, Hoelscher M. Challenges in the clinical assessment of novel tuberculosis drugs. Adv Drug Deliv Rev 2016; 102:116-22. [PMID: 26827911 DOI: 10.1016/j.addr.2016.01.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 12/29/2015] [Accepted: 01/21/2016] [Indexed: 11/18/2022]
Abstract
To tackle the global TB epidemic effectively, novel treatment strategies are critically needed to shorten the duration of TB therapy and treat drug-resistant TB. Drug development for TB, stymied for decades, has enjoyed a renaissance over the past several years. However, the development of new TB regimens is hindered by the limitations in our understanding and use of preclinical models; the paucity of accurate, early surrogate markers of cure, and challenges in untangling the individual contributions of drugs to multidrug regimens in a complex, multi-compartment disease. Lack of profit motive, advocacy, and imagination has contributed mightily to the dearth of drugs we have on the shelf to treat this ancient disease. Areas that will speed the development of new regimens for TB include novel murine and in vitro pharmacodynamics models, clinical endpoints that are not culture-based, innovative clinical trial designs, and an infusion of much-needed funding.
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Affiliation(s)
- Kelly E Dooley
- Divisions of Clinical Pharmacology & Infectious Diseases, Center for Tuberculosis Research, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Osler 527, Baltimore, MD, 2187, USA.
| | - Patrick P J Phillips
- MRC Clinical Trials Unit at UCL, Aviation House, 125 Kingsway, London WC1B 6NH, UK.
| | - Payam Nahid
- Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, at San Francisco General Hospital, 1001 Potrero Ave., 5K1, San Francisco, CA, USA.
| | - Michael Hoelscher
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Leopoldstrasse 5, 80802 Munich, Germany; German Centre for Infection Research (DZIF), Leopoldstrasse 5, 80802 Munich, Germany; German Centre for Infection Research, Leopoldstrasse 5, 80802 Munich, Germany.
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Lau A, Barrie J, Winter C, Elamy AH, Tyrrell G, Long R. Chest Radiographic Patterns and the Transmission of Tuberculosis: Implications for Automated Systems. PLoS One 2016; 11:e0154032. [PMID: 27105337 PMCID: PMC4841548 DOI: 10.1371/journal.pone.0154032] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 04/07/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Computer-aided detection to identify and diagnose pulmonary tuberculosis is being explored. While both cavitation on chest radiograph and smear-positivity on microscopy are independent risk factors for the infectiousness of pulmonary tuberculosis it is unknown which radiographic pattern, were it detectable, would provide the greatest public health benefit; i.e. reduced transmission. Herein we provide that evidence. OBJECTIVES 1) to determine whether pulmonary tuberculosis in a high income, low incidence country is more likely to present with "typical" adult-type pulmonary tuberculosis radiographic features and 2) to determine whether those with "typical" radiographic features are more likely than those without such features to transmit the organism and/or cause secondary cases. METHODS Over a three-year period beginning January 1, 2006 consecutive adults with smear-positive pulmonary tuberculosis in the Province of Alberta, Canada, were identified and their pre-treatment radiographs scored by three independent readers as "typical" (having an upper lung zone predominant infiltrate, with or without cavitation but no discernable adenopathy) or "atypical" (all others). Each patient's pre-treatment bacillary burden was carefully documented and, during a 30-month transmission window, each patient's transmission events were recorded. Mycobacteriology, radiology and transmission were compared in those with "typical" versus "atypical" radiographs. FINDINGS A total of 97 smear-positive pulmonary tuberculosis cases were identified, 69 (71.1%) with and 28 (28.9%) without "typical" chest radiographs. "Typical" cases were more likely to have high bacillary burdens and cavitation (Odds Ratios and 95% Confidence Intervals: 2.75 [1.04-7.31] and 9.10 [2.51-32.94], respectively). Typical cases were also responsible for most transmission events-78% of tuberculin skin test conversions (p<0.002) and 95% of secondary cases in reported close contacts (p<0.01); 94% of secondary cases in "unreported" contacts (p<0.02). CONCLUSION As a group, smear-positive pulmonary tuberculosis patients with typical radiographic features constitute the greatest public health risk. This may have implications for automated detection systems.
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Affiliation(s)
- Angela Lau
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - James Barrie
- Department of Radiology, University of Alberta, Edmonton, Alberta, Canada
| | - Christopher Winter
- Department of Radiology, University of Alberta, Edmonton, Alberta, Canada
| | - Abdel-Halim Elamy
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Gregory Tyrrell
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
- Provincial Laboratory for Public Health, Alberta Health Services, Edmonton and Calgary, Alberta, Canada
| | - Richard Long
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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Kaku T, Minamoto F, D'Meza R, Morose W, Boncy J, Bijou J, Geffrard H, Yoshida M, Mori T. Accuracy of LAMP-TB Method for Diagnosing Tuberculosis in Haiti. Jpn J Infect Dis 2016; 69:488-492. [PMID: 27000457 DOI: 10.7883/yoken.jjid.2015.519] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The procedure of ultra-rapid extraction (PURE) and loop-mediated isothermal amplification for tuberculosis (LAMP-TB) is a simple and rapid manual tuberculosis diagnostic with medium-throughput capability. Because of its simplicity, this method could be useful in resource-limited conditions such as microscopy centers in developing countries. This study was conducted to evaluate the clinical performance of this method in a point-of-care setting. The performance was compared to that of smear microscopy and liquid culture in a hospital laboratory in Haiti, which is considered a representative facility for the implementation of this method. The sensitivity, based on culture-positivity, was 86% (95% confidence interval: 81.3-90.3%) and that based on the smear-negative and culture-positive results was 51% (38.7-63.5%). The specificity based on sample negativity for both smear and culture was 98.4% (96.8-99.2). These results are nearly equivalent to those of a clinical study performed in Japan and are comparable with those of other nucleic acid amplification methods. Thus, approximately 18% more tuberculosis patients could be identified by adding the LAMP-TB method to routine smear microscopy in field settings in Haiti. In addition, it is suggested that local technicians could perform LAMP-TB after only short-term training.
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Matabane MMZ, Ismail F, Strydom KA, Onwuegbuna O, Omar SV, Ismail N. Performance evaluation of three commercial molecular assays for the detection of Mycobacterium tuberculosis from clinical specimens in a high TB-HIV-burden setting. BMC Infect Dis 2015; 15:508. [PMID: 26553046 PMCID: PMC4640418 DOI: 10.1186/s12879-015-1229-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 10/19/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND A major challenge faced by countries with a high burden of tuberculosis (TB) is early detection especially in individuals with paucibacillary disease which is common in HIV endemic settings. Remarkable efforts have been made globally to accelerate the development and expansion of new diagnostic technologies that allow better and earlier diagnosis of active tuberculosis particularly directly from clinical specimens with a few commercial options available. These include GenoType MTBDRplus Version 2.0 (Hain Lifescience), Xpert® MTB/RIF (Cepheid) and Anyplex™ plus MTB/NTM/DR-TB Real-time detection (Seegene). We evaluated the diagnostic performance of these three commercial molecular assays for the detection of Mycobacterium tuberculosis complex from clinical specimens in a high TB-HIV-burden setting. METHODS This was a retrospective laboratory-based study using stored remnant sediments from clinical specimens of presumptive pulmonary TB cases. A stratified sample of smear positive TB, smear negative TB and TB culture negatives was included. All the samples were tested on the three molecular assays following the manufacturers' instructions; except for Anyplex™plus, for which DNA extraction was performed using the NucliSENS® easyMAG® platform (bioMerieux). Samples were also processed for liquid TB culture and time-to-culture positivity was recorded. RESULTS Of the 90 sediments processed, 81 were analyzable across all three systems. The overall sensitivity was highest for Xpert® MTB/RIF (89.1%) followed by GenoType MTBDRplus (70.9%) and Anyplex™ plus (65.5%). The specificity and sensitivity in smear positive cases was comparable across all systems. There was a significant difference in sensitivity between Xpert® MTB/RIF and the other two assays for smear-negative cases (P < 0.05). The performance in cases where the time-to-culture positivity was ≥ 20 days was also significantly poorer for both Anyplex™ plus and GenoType MTBDRplus compared to Xpert® MTB/RIF (P < 0.05). Xpert® MTB/RIF achieved 100% specificity, while Anyplex™ plus and GenoType MTBDRplus achieved 96.2 and 92.3% respectively. CONCLUSION The Xpert® MTB/RIF was superior to the other two assays for the detection of TB in smear negative specimens notably when bacterial loads are very low in sputum. It is important that studies reporting on test performance stratify their results by time-to-culture positivity to accurately assess clinical performance especially in high HIV settings.
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Affiliation(s)
- M M Z Matabane
- Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa.
- National Health Laboratory Services, Tshwane Academic Division, Pretoria, South Africa.
| | - F Ismail
- Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa.
- National Health Laboratory Services, Tshwane Academic Division, Pretoria, South Africa.
| | - K A Strydom
- Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa.
- National Health Laboratory Services, Tshwane Academic Division, Pretoria, South Africa.
| | - O Onwuegbuna
- National Health Laboratory Services, Tshwane Academic Division, Pretoria, South Africa.
| | - S V Omar
- National Institute for Communicable Diseases: Centre for Tuberculosis, Johannesburg, South Africa.
| | - N Ismail
- Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa.
- National Institute for Communicable Diseases: Centre for Tuberculosis, Johannesburg, South Africa.
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Olaru ID, Heyckendorf J, Grossmann S, Lange C. Time to culture positivity and sputum smear microscopy during tuberculosis therapy. PLoS One 2014; 9:e106075. [PMID: 25171337 PMCID: PMC4149502 DOI: 10.1371/journal.pone.0106075] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 08/01/2014] [Indexed: 12/11/2022] Open
Abstract
Sputum smear microscopy is widely used for tuberculosis diagnosis and treatment monitoring. We evaluated the correlation between smear microscopy and time to liquid culture positivity during early tuberculosis treatment. The study included patients with smear-positive pulmonary tuberculosis hospitalized at a tuberculosis reference centre in Germany between 01/2012 and 05/2013. Patient records were reviewed and clinical, radiological and microbiological data were analysed. Sputum samples were collected before treatment initiation and weekly thereafter. A number of 310 sputum samples from 30 patients were analysed. Time to liquid culture positivity inversely correlated with smear grade (Spearman's rho -0.439, p<0.001). There was a better correlation within the first two months vs. after two months of therapy (-0.519 vs. -0.416) with a trend to a more rapid increase in time to positivity between baseline and week 2 in patients who culture-converted within the first two months (5.9 days vs. 9.4 days, p = 0.3). In conclusion, the numbers of acid-fast bacilli in sputum smears of patients with pulmonary tuberculosis and time to culture positivity for M. tuberculosis cultures from sputum are correlated before and during tuberculosis treatment. A considerable proportion of patients with culture conversion after two months of therapy continued to have detectable acid-fast bacilli on sputum smears.
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Affiliation(s)
- Ioana D. Olaru
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany
- German Center for Infection Research (DZIF), Research Center Borstel, Borstel, Germany
| | - Jan Heyckendorf
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany
- German Center for Infection Research (DZIF), Research Center Borstel, Borstel, Germany
| | - Susanne Grossmann
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany
| | - Christoph Lange
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany
- German Center for Infection Research (DZIF), Research Center Borstel, Borstel, Germany
- International Health/Infectious Diseases, University of Lübeck, Lübeck, Germany
- Department of Medicine, University of Namibia School of Medicine, Windhoek, Namibia
- * E-mail:
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O'Shea MK, Koh GCKW, Munang M, Smith G, Banerjee A, Dedicoat M. Time-to-detection in culture predicts risk of Mycobacterium tuberculosis transmission: a cohort study. Clin Infect Dis 2014; 59:177-85. [PMID: 24729491 DOI: 10.1093/cid/ciu244] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Contact screening is an essential component of all tuberculosis control strategies. We hypothesize that time-to-detection (TTD) in liquid culture of spontaneously produced sputum samples may help identify index cases at high risk of transmission. METHODS We studied retrospectively a cohort of patients with pulmonary tuberculosis in Birmingham, United Kingdom (January 2010-December 2012). We studied the correlation of TTD with the risk of transmission of infection from index cases to contacts and compared this with sputum microscopy. Chest radiographs (CXRs) were graded from 0 to 6 (0, no radiographic evidence of disease; 5, bilateral cavitation; and 6, miliary disease). RESULTS Of the 184 cases of pulmonary tuberculosis reported during the study period, 111 were included in the final study, and these generated 825 contacts. A transmission event (new latent or active tuberculosis) was identified in 165 contacts (transmission rate 0.20). Short TTD (<9 days) was associated with an increased risk of transmission (odds ratio, 2.56; P < .001), and this relationship persisted after adjusting for potential confounders. A 1-point increase in CXR grade correlated with a 3.2-day decrease in TTD (P < .001), and this correlation persisted after adjustment for potential confounders. CONCLUSIONS TTD < 9 days identifies patients at high risk of transmitting tuberculosis and is superior to sputum smear. CXR grade at diagnosis predicts patients with short TTD. Our findings have the potential to guide the organization and prioritization of contact investigations in similar settings.
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Affiliation(s)
- Matthew K O'Shea
- Department of Infectious Disease and Tropical Medicine, Heartlands Hospital, Birmingham The Jenner Institute, Nuffield Department of Medicine, University of Oxford
| | - Gavin C K W Koh
- Department of Infectious Disease and Tropical Medicine, Heartlands Hospital, Birmingham Warwick Medical School, University of Warwick, Coventry
| | - Melinda Munang
- Department of Infectious Disease and Tropical Medicine, Heartlands Hospital, Birmingham Warwick Medical School, University of Warwick, Coventry
| | - Grace Smith
- Public Health England Regional Centre for Mycobacteriology, West Midlands Public Health Laboratory, Heartlands Hospital
| | - Arpan Banerjee
- Department of Radiology, Heartlands Hospital, Birmingham, United Kingdom
| | - Martin Dedicoat
- Department of Infectious Disease and Tropical Medicine, Heartlands Hospital, Birmingham Warwick Medical School, University of Warwick, Coventry
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Phunpae P, Chanwong S, Tayapiwatana C, Apiratmateekul N, Makeudom A, Kasinrerk W. Rapid diagnosis of tuberculosis by identification of Antigen 85 in mycobacterial culture system. Diagn Microbiol Infect Dis 2014; 78:242-8. [DOI: 10.1016/j.diagmicrobio.2013.11.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 11/22/2013] [Accepted: 11/24/2013] [Indexed: 11/17/2022]
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Time to detection of Mycobacterium tuberculosis using the MGIT 320 system correlates with colony counting in preclinical testing of new vaccines. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2013; 21:453-5. [PMID: 24371256 DOI: 10.1128/cvi.00742-13] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Clinical studies have suggested that the enumeration of mycobacteria by using automated liquid systems is a faster and simpler alternative to quantitative cultures. Here, we show that the time to detection of M. tuberculosis growth as measured with the MGIT 320 liquid culture system inversely correlates with CFU determinations from culture on solid media and that mycobacterial quantification using the MGIT system is faster and easier to perform than CFU plating.
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PCR to detect Mycobacterium tuberculosis in respiratory tract samples: evaluation of clinical data. Epidemiol Infect 2013; 142:1517-23. [PMID: 24107314 DOI: 10.1017/s0950268813002598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Tuberculosis (TB) remains as an important public health problem worldwide. Therefore, the rapid detection of M. tuberculosis is of primary importance to effectively reduce transmission in patients. The aims of this study were to evaluate two in-house molecular tests: nested PCR (nPCR) and real-time PCR (rtPCR) to detect M. tuberculosis complex directly from clinical samples. The results were compared to the culture results and to the culture results plus clinical data of patients. The rtPCR and nPCR presented high sensitivity (Se) and specificity (Sp) (rtPCR 97·6% and 91·5%, nPCR 85·7% and 92·7%, respectively) compared to culture. When the results of the molecular tests were compared to the culture plus clinical data the Se and Sp were 90·2% and 97·3% for rtPCR and 80·4% and 98·6% for the nPCR, respectively. The results demonstrated that molecular assays of M. tuberculosis can provide a sensitive and rapid diagnostic of TB, and when used in addition to the clinical data of TB patients will help to improve the Sp of the diagnosis of pulmonary TB.
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Wallis RS, Kim P, Cole S, Hanna D, Andrade BB, Maeurer M, Schito M, Zumla A. Tuberculosis biomarkers discovery: developments, needs, and challenges. THE LANCET. INFECTIOUS DISEASES 2013; 13:362-72. [DOI: 10.1016/s1473-3099(13)70034-3] [Citation(s) in RCA: 185] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Sun G, Luo T, Yang C, Dong X, Li J, Zhu Y, Zheng H, Tian W, Wang S, Barry CE, Mei J, Gao Q. Dynamic population changes in Mycobacterium tuberculosis during acquisition and fixation of drug resistance in patients. J Infect Dis 2012; 206:1724-33. [PMID: 22984115 DOI: 10.1093/infdis/jis601] [Citation(s) in RCA: 141] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Drug-resistant tuberculosis poses a growing challenge to global public health. However, the diversity and dynamics of the bacterial population during acquisition of drug resistance have yet to be carefully examined. METHODS Whole-genome sequencing was performed on 7 serial Mycobacterium tuberculosis (M. tuberculosis) populations from 3 patients during different stages in the development of drug resistance. The population diversity was assessed by the number and frequencies of unfixed mutations in each sample. RESULTS For each bacterial population, 8-41 unfixed mutations were monitored by the fraction of single-nucleotide polymorphisms at specific loci. Among them, as many as 4 to 5 resistance-conferring mutations were transiently detected in the same single sputum, but ultimately only a single type of mutant was fixed. In addition, we identified 14 potential compensatory mutations that occurred during or after the emergence of resistance-conferring mutations. CONCLUSIONS M. tuberculosis population within patients exhibited considerable genetic diversity, which underwent selections for most fit resistant mutant. These findings have important implications and emphasize the need for early diagnosis of tuberculosis to decrease the chance of evolving highly fit drug-resistant strains.
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Affiliation(s)
- Gang Sun
- Key Laboratory of Medical Molecular Virology, Institutes of Biomedical Sciences and Institute of Medical Microbiology, Fudan University, Shanghai, China
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Pretreatment time to detection of Mycobacterium tuberculosis in liquid culture is associated with relapse after therapy. J Clin Microbiol 2011; 50:538. [PMID: 22116143 DOI: 10.1128/jcm.06193-11] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Gomez DI, Mullin CS, Mora-Guzmán F, Crespo-Solis JG, Fisher-Hoch SP, McCormick JB, Restrepo BI. Rapid DNA extraction for specific detection and quantitation of Mycobacterium tuberculosis DNA in sputum specimens using Taqman assays. Tuberculosis (Edinb) 2011; 91 Suppl 1:S43-8. [PMID: 22088321 DOI: 10.1016/j.tube.2011.10.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Rapid tuberculosis (TB) detection is critical for disease control, and further quantitation of Mycobacterium tuberculosis (Mtb) in sputum is valuable for epidemiological and clinical studies. We evaluated a simple, robust and cost-efficient in-house DNA extraction and downstream Taqman approach for detection and quantitation of Mtb genomes from sputum of newly-diagnosed TB patients and non-TB controls. DNA was extracted using guanidine isothiocyanate and silica-based spin columns in less than 2 h, stored frozen, and Taqman assays were used to detect Mtb with IS6110 and quantify it targeting RD1 and IS1081. The Taqmans had a sensitivity >95% in 108 culture-confirmed TB patients and specificity of 100% in 43 non-TB controls. Genome counts were correlated with the Mycobacterial Growth Indicator Tubes' (MGIT) time-to-detection values (1/TTD × 1000; rho = 0.66; p < 0.001) in 91 TB patients (33 excluded with MGIT contamination). This linear relationship was nearly identical between mycobacteria isolated from sputum and H37Rv Mtb grown in-vitro to its log phase. TB treatment between 3 and 7 days was associated with lower 1/TTD × 1000 values but not with genome counts. Together, our protocol provides rapid, specific, inexpensive and quantitative detection of Mtb DNA in fresh or stored sputa making it a robust tool for prompt TB diagnosis, and with potential use for clinical and epidemiologic studies.
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Affiliation(s)
- Diana I Gomez
- Division of Epidemiology, School of Public Health in Brownsville, University of Texas Health Science Center at Houston, 80 Fort Brown, SPH Bldg, Brownsville, Texas 78520, USA
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Blakemore R, Nabeta P, Davidow AL, Vadwai V, Tahirli R, Munsamy V, Nicol M, Jones M, Persing DH, Hillemann D, Ruesch-Gerdes S, Leisegang F, Zamudio C, Rodrigues C, Boehme CC, Perkins MD, Alland D. A multisite assessment of the quantitative capabilities of the Xpert MTB/RIF assay. Am J Respir Crit Care Med 2011; 184:1076-84. [PMID: 21836139 PMCID: PMC3208646 DOI: 10.1164/rccm.201103-0536oc] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Accepted: 08/02/2011] [Indexed: 01/29/2023] Open
Abstract
RATIONALE The Xpert MTB/RIF is an automated molecular test for Mycobacterium tuberculosis that estimates bacterial burden by measuring the threshold-cycle (Ct) of its M. tuberculosis-specific real-time polymerase chain reaction. Bacterial burden is an important biomarker for disease severity, infection control risk, and response to therapy. OBJECTIVES Evaluate bacterial load quantitation by Xpert MTB/RIF compared with conventional quantitative methods. METHODS Xpert MTB/RIF results were compared with smear-microscopy, semiquantiative solid culture, and time-to-detection in liquid culture for 741 patients and 2,008 samples tested in a multisite clinical trial. An internal control real-time polymerase chain reaction was evaluated for its ability to identify inaccurate quantitative Xpert MTB/RIF results. MEASUREMENTS AND MAIN RESULTS Assays with an internal control Ct greater than 34 were likely to be inaccurately quantitated; this represented 15% of M. tuberculosis-positive tests. Excluding these, decreasing M. tuberculosis Ct was associated with increasing smear microscopy grade for smears of concentrated sputum pellets (r(s) = -0.77) and directly from sputum (r(s) =-0.71). A Ct cutoff of approximately 27.7 best predicted smear-positive status. The association between M. tuberculosis Ct and time-to-detection in liquid culture (r(s) = 0.68) and semiquantitative colony counts (r(s) = -0.56) was weaker than smear. Tests of paired same-patient sputum showed that high viscosity sputum samples contained ×32 more M. tuberculosis than nonviscous samples. Comparisons between the grade of the acid-fast bacilli smear and Xpert MTB/RIF quantitative data across study sites enabled us to identify a site outlier in microscopy. CONCLUSIONS Xpert MTB/RIF quantitation offers a new, standardized approach to measuring bacterial burden in the sputum of patients with tuberculosis.
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Affiliation(s)
- Robert Blakemore
- Division of Infectious Disease, Department of Medicine, University of Medicine and Dentistry of New Jersey, Newark, New Jersey
| | - Pamela Nabeta
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - Amy L. Davidow
- Department of Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey and Global TB Institute, Newark, New Jersey
| | - Viral Vadwai
- P.D. Hinduja National Hospital and Medical Research Centre (Hinduja), Mumbai, India
| | - Rasim Tahirli
- Special Treatment Institution for Detainees with Tuberculosis, Baku, Republic of Azerbaijan
| | - Vanisha Munsamy
- Unit for Clinical and Biomedical TB Research, South African Medical Research Council, Durban, South Africa
| | - Mark Nicol
- Department of Clinical Laboratory Sciences, University of Cape Town and National Health Laboratory Service, Cape Town, South Africa
| | | | | | | | | | - Felicity Leisegang
- Department of Clinical Laboratory Sciences, University of Cape Town and National Health Laboratory Service, Cape Town, South Africa
| | - Carlos Zamudio
- Instituto de Medicina Tropical “Alexander von Humboldt,” Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Camilla Rodrigues
- P.D. Hinduja National Hospital and Medical Research Centre (Hinduja), Mumbai, India
| | | | - Mark D. Perkins
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - David Alland
- Division of Infectious Disease, Department of Medicine, University of Medicine and Dentistry of New Jersey, Newark, New Jersey
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Fernandez Fabrellas E, Lucas Ramos PD. III Foro Nacional de Neumologos en Formacion. La formacion desde la participacion. Arch Bronconeumol 2011; 47 Suppl 8:1-2. [DOI: 10.1016/s0300-2896(11)70058-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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