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Thell R, Kallab V, Weinhappel W, Mueckstein W, Heschl L, Heschl M, Korsatko S, Toedling F, Blaschke A, Herzog T, Klicpera A, Koeller C, Haugk M, Kreil A, Spiel A, Kreuzer P, Krause R, Sebesta C, Winkler S, Laky B, Szell M. Evaluation of a novel, rapid antigen detection test for the diagnosis of SARS-CoV-2. PLoS One 2021; 16:e0259527. [PMID: 34843505 PMCID: PMC8629250 DOI: 10.1371/journal.pone.0259527] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 10/20/2021] [Indexed: 11/18/2022] Open
Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing coronavirus disease 2019 (COVID-19) is currently finally determined in laboratory settings by real-time reverse-transcription polymerase-chain-reaction (rt-PCR). However, simple testing with immediately available results are crucial to gain control over COVID-19. The aim was to evaluate such a point-of-care antigen rapid test (AG-rt) device in its performance compared to laboratory-based rt-PCR testing in COVID-19 suspected, symptomatic patients. Methods For this prospective study, two specimens each of 541 symptomatic female (54.7%) and male (45.3%) patients aged between 18 and 95 years tested at five emergency departments (ED, n = 296) and four primary healthcare centres (PHC, n = 245), were compared, using AG-rt (positive/negative/invalid) and rt-PCR (positive/negative and cycle threshold, Ct) to diagnose SARS-CoV-2. Diagnostic accuracy, sensitivity, specificity, positive predictive values (PPV), negative predictive value (NPV), and likelihood ratios (LR+/-) of the AG-rt were assessed. Results Differences between ED and PHC were detected regarding gender, age, symptoms, disease prevalence, and diagnostic performance. Overall, 174 (32.2%) were tested positive on AG-rt and 213 (39.4%) on rt-PCR. AG correctly classified 91.7% of all rt-PCR positive cases with a sensitivity of 80.3%, specificity of 99.1%, PPV of 98.3, NPV of 88.6%, LR(+) of 87.8, and LR(-) of 0.20. The highest sensitivities and specificities of AG-rt were detected in PHC (sensitivity: 84.4%, specificity: 100.0%), when using Ct of 30 as cut-off (sensitivity: 92.5%, specificity: 97.8%), and when symptom onset was within the first three days (sensitivity: 82.9%, specificity: 99.6%). Conclusions The highest sensitivity was detected with a high viral load. Our findings suggest that AG-rt are comparable to rt-PCR to diagnose SARS-CoV-2 in COVID-19 suspected symptomatic patients presenting both at emergency departments and primary health care centres.
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Affiliation(s)
- Rainer Thell
- Wiener Gesundheitsverbund, Vienna, Australia
- Department of Internal Medicine 2, Emergency Department, Klinik Donaustadt, Vienna, Austria
- * E-mail: (RT); (MS)
| | - Verena Kallab
- Wiener Gesundheitsverbund, Vienna, Australia
- Department of Internal Medicine 2, Emergency Department, Klinik Donaustadt, Vienna, Austria
| | | | | | - Lukas Heschl
- Primary Health Care Centre Landarztteam, Oed, Austria
| | | | | | - Franz Toedling
- Primary Health Care Centre Praxis Dr Toedling, Probstdorf, Austria
| | - Amelie Blaschke
- Wiener Gesundheitsverbund, Vienna, Australia
- Department of Internal Medicine 2, Emergency Department, Klinik Donaustadt, Vienna, Austria
| | - Theresa Herzog
- Wiener Gesundheitsverbund, Vienna, Australia
- Department of Internal Medicine 2, Emergency Department, Klinik Donaustadt, Vienna, Austria
| | - Anna Klicpera
- Wiener Gesundheitsverbund, Vienna, Australia
- Department of Internal Medicine 2, Emergency Department, Klinik Donaustadt, Vienna, Austria
| | - Clara Koeller
- Emergency Department, Klinik Hietzing, Vienna, Austria
- Semmelweis University Budapest, Hungary
| | - Moritz Haugk
- Wiener Gesundheitsverbund, Vienna, Australia
- Emergency Department, Klinik Hietzing, Vienna, Austria
| | - Anna Kreil
- Wiener Gesundheitsverbund, Vienna, Australia
- Emergency Department, Klinik Landstrasse, Vienna, Austria
| | - Alexander Spiel
- Wiener Gesundheitsverbund, Vienna, Australia
- Emergency Department, Klinik Ottakring, Vienna, Austria
| | - Philipp Kreuzer
- Emergency Department, Univ. Clinic of Internal Medicine, Medical University Graz, Graz, Austria
| | - Robert Krause
- Univ. Clinic of Internal Medicine, Section of Infectiology and Tropical Medicine, Medical University Graz, Graz, Austria
| | - Christian Sebesta
- Wiener Gesundheitsverbund, Vienna, Australia
- Department of Internal Medicine 2, Emergency Department, Klinik Donaustadt, Vienna, Austria
| | - Stefan Winkler
- Department of Infectiology and Tropical Medicine, University Clinic of Internal Medicine I, Medical University Vienna, Austria
| | - Brenda Laky
- MedSciCare, Vienna, Austria
- Competence Centre Clinical Research, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Marton Szell
- Wiener Gesundheitsverbund, Vienna, Australia
- Department of Internal Medicine 2, Emergency Department, Klinik Donaustadt, Vienna, Austria
- * E-mail: (RT); (MS)
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Groger M, Veletzky L, Lalremruata A, Cattaneo C, Mischlinger J, Manego Zoleko R, Kim J, Klicpera A, Meyer EL, Blessborn D, Winterberg M, Adegnika AA, Agnandji ST, Kremsner PG, Mordmüller B, Mombo-Ngoma G, Fuehrer HP, Ramharter M. Prospective Clinical and Molecular Evaluation of Potential Plasmodium ovale curtisi and wallikeri Relapses in a High-transmission Setting. Clin Infect Dis 2020; 69:2119-2126. [PMID: 31066448 PMCID: PMC6880329 DOI: 10.1093/cid/ciz131] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Indexed: 01/02/2023] Open
Abstract
Background Plasmodium ovale curtisi and wallikeri are perceived as relapsing malarial parasites. Contrary to Plasmodium vivax, direct evidence for this hypothesis is scarce. The aim of this prospective study was to characterize the reappearance patterns of ovale parasites. Methods P. ovale spp. infected patients were treated with artemether-lumefantrine and followed biweekly for up to 1 year for the detection of reappearing parasitemia. Molecular analysis of reappearing isolates was performed to identify homologous isolates by genotyping and to define cases of relapse following predefined criteria. Results At inclusion, 26 participants were positive for P. ovale curtisi and/or P. ovale wallikeri. The median duration of follow-up was 35 weeks. Reappearance of the same P. ovale species was observed in 46% of participants; 61% of P. ovale curtisi and 19% of P. ovale wallikeri infection-free intervals were estimated to end with reappearance by week 32. Based on the predefined criteria, 23% of participants were identified with 1 or 2 relapses, all induced by P. ovale curtisi. Conclusion These findings are in line with the currently accepted relapse theory inasmuch as the reappearance of P. ovale curtisi strains following initial blood clearance was conclusively demonstrated. Interestingly, no relapse of P. ovale wallikeri was observed.
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Affiliation(s)
- Mirjam Groger
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine and I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Germany.,Centre de Recherches Médicales de Lambaréné, Gabon.,Institut für Tropenmedizin, Universität Tübingen, Germany
| | - Luzia Veletzky
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine and I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Germany.,Centre de Recherches Médicales de Lambaréné, Gabon
| | | | | | - Johannes Mischlinger
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine and I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Germany.,Centre de Recherches Médicales de Lambaréné, Gabon.,Institut für Tropenmedizin, Universität Tübingen, Germany
| | - Rella Manego Zoleko
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine and I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Germany.,Centre de Recherches Médicales de Lambaréné, Gabon
| | - Johanna Kim
- Centre de Recherches Médicales de Lambaréné, Gabon
| | | | - Elias L Meyer
- Center for Medical Statistics, Informatics, and Intelligent Systems, Section for Medical Statistics, Medical University of Vienna, Austria
| | - Daniel Blessborn
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom.,Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Markus Winterberg
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom.,Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Ayola A Adegnika
- Centre de Recherches Médicales de Lambaréné, Gabon.,Institut für Tropenmedizin, Universität Tübingen, Germany.,German Center for Infection Research (DZIF), partner site Tübingen, Germany
| | | | - Peter G Kremsner
- Centre de Recherches Médicales de Lambaréné, Gabon.,Institut für Tropenmedizin, Universität Tübingen, Germany.,German Center for Infection Research (DZIF), partner site Tübingen, Germany
| | - Benjamin Mordmüller
- Centre de Recherches Médicales de Lambaréné, Gabon.,Institut für Tropenmedizin, Universität Tübingen, Germany.,German Center for Infection Research (DZIF), partner site Tübingen, Germany
| | - Ghyslain Mombo-Ngoma
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine and I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Germany.,Centre de Recherches Médicales de Lambaréné, Gabon
| | - Hans-Peter Fuehrer
- Institute of Parasitology, University of Veterinary Medicine Vienna, Austria
| | - Michael Ramharter
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine and I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Germany.,Centre de Recherches Médicales de Lambaréné, Gabon.,German Center for Infection Research (DZIF), partner site Hamburg-Luebeck-Borstel, Hamburg, Germany
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Witter S, Palmer N, Balabanova D, Mounier-Jack S, Martineau T, Klicpera A, Jensen C, Pugliese-Garcia M, Gilson L. Health system strengthening-Reflections on its meaning, assessment, and our state of knowledge. Int J Health Plann Manage 2019; 34:e1980-e1989. [PMID: 31386232 DOI: 10.1002/hpm.2882] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 07/29/2019] [Accepted: 07/30/2019] [Indexed: 11/06/2022] Open
Abstract
Comprehensive reviews of health system strengthening (HSS) interventions are rare, partly because of lack of clarity on definitions of the term but also the potentially huge scale of the evidence. We reflect on the process of undertaking such an evidence review recently, drawing out suggestions on definitions of HSS and approaches to assessment, as well as summarising some key conclusions from the current evidence base. The key elements of a clear definition include, in our view, consideration of scope (with effects cutting across building blocks in practice, even if not in intervention design, and also tackling more than one disease), scale (having national reach and cutting across levels of the system), sustainability (effects being sustained over time and addressing systemic blockages), and effects (impacting on health outcomes, equity, financial risk protection, and responsiveness). We also argue that agreeing a framework for design and evaluation of HSS is urgent. Most HSS interventions have theories of change relating to specific system blocks, but more work is needed on capturing their spillover effects and their contribution to meeting overarching health system process goals. We make some initial suggestions about such goals, to reflect the features that characterise a "strong health system." We highlight that current findings on "what works" are just indicative, given the limitations and biases in what has been studied and how, and argue that there is need to rethink evaluation methods for HSS beyond finite interventions and narrow outcomes. Clearer concepts, frameworks, and methods can support more coherent HSS investment.
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Affiliation(s)
- Sophie Witter
- Institute of Global Health and Development, Queen Margaret University, Edinburgh, UK
| | | | - Dina Balabanova
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Sandra Mounier-Jack
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Tim Martineau
- International Public Health, Liverpool School of Tropical Medicine, London, UK
| | - Anna Klicpera
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Miguel Pugliese-Garcia
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Lucy Gilson
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.,Division of Health Policy and Systems, University of Cape Town, Cape Town, South Africa
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4
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Hede MS, Fjelstrup S, Lötsch F, Zoleko RM, Klicpera A, Groger M, Mischlinger J, Endame L, Veletzky L, Neher R, Simonsen AKW, Petersen E, Mombo-Ngoma G, Stougaard M, Ho YP, Labouriau R, Ramharter M, Knudsen BR. Detection of the Malaria causing Plasmodium Parasite in Saliva from Infected Patients using Topoisomerase I Activity as a Biomarker. Sci Rep 2018. [PMID: 29515150 PMCID: PMC5841400 DOI: 10.1038/s41598-018-22378-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Malaria is among the major threats to global health with the main burden of disease being in rural areas of developing countries where accurate diagnosis based on non-invasive samples is in high demand. We here present a novel molecular assay for detection of malaria parasites based on technology that may be adapted for low-resource settings. Moreover, we demonstrate the exploitation of this assay for detection of malaria in saliva. The setup relies on pump-free microfluidics enabled extraction combined with a DNA sensor substrate that is converted to a single-stranded DNA circle specifically by topoisomerase I expressed by the malaria causing Plasmodium parasite. Subsequent rolling circle amplification of the generated DNA circle in the presence of biotin conjugated deoxynucleotides resulted in long tandem repeat products that was visualized colorimetrically upon binding of horse radish peroxidase (HRP) and addition of 3,3′,5,5′-Tetramethylbenzidine that was converted to a blue colored product by HRP. The assay was directly quantitative, specific for Plasmodium parasites, and allowed detection of Plasmodium infection in a single drop of saliva from 35 out of 35 infected individuals tested. The results could be determined directly by the naked eye and documented by quantifying the color intensity using a standard paper scanner.
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Affiliation(s)
| | - Søren Fjelstrup
- Department of Molecular Biology and Genetics, University of Aarhus, Aarhus, Denmark
| | - Felix Lötsch
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,Department of Medicine, I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Anna Klicpera
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - Mirjam Groger
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - Johannes Mischlinger
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,Department of Medicine, I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria.,Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
| | - Lilian Endame
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - Luzia Veletzky
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - Ronja Neher
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
| | | | - Eskild Petersen
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark.,Department of Infectious Diseases, The Royal Hospital, Muscat, Oman
| | - Ghyslain Mombo-Ngoma
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
| | - Magnus Stougaard
- Department of Clinical Medicine, University of Aarhus, Aarhus, Denmark
| | - Yi-Ping Ho
- Division of Biomedical Engineering, Department of Electronic Engineering, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China
| | | | - Michael Ramharter
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,Department of Medicine, I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria.,Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
| | - Birgitta Ruth Knudsen
- Department of Molecular Biology and Genetics, University of Aarhus, Aarhus, Denmark.
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Cummins NW, Klicpera A, Sainski AM, Bren GD, Khosla S, Westendorf JJ, Badley AD. Human immunodeficiency virus envelope protein Gp120 induces proliferation but not apoptosis in osteoblasts at physiologic concentrations. PLoS One 2011; 6:e24876. [PMID: 21931863 PMCID: PMC3171487 DOI: 10.1371/journal.pone.0024876] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Accepted: 08/23/2011] [Indexed: 02/07/2023] Open
Abstract
Patients with HIV infection have decreased numbers of osteoblasts, decreased bone mineral density and increased risk of fracture compared to uninfected patients; however, the molecular mechanisms behind these associations remain unclear. We questioned whether Gp120, a component of the envelope protein of HIV capable of inducing apoptosis in many cell types, is able to induce cell death in bone-forming osteoblasts. We show that treatment of immortalized osteoblast-like cells and primary human osteoblasts with exogenous Gp120 in vitro at physiologic concentrations does not result in apoptosis. Instead, in the osteoblast-like U2OS cell line, cells expressing CXCR4, a receptor for Gp120, had increased proliferation when treated with Gp120 compared to control (P<0.05), which was inhibited by pretreatment with a CXCR4 inhibitor and a G-protein inhibitor. This suggests that Gp120 is not an inducer of apoptosis in human osteoblasts and likely does not directly contribute to osteoporosis in infected patients by this mechanism.
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Affiliation(s)
- Nathan W Cummins
- Division of Infectious Disease, Mayo Clinic, Rochester, Minnesota, United States of America.
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