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Mittal V, Kumar M, Singh AK. TB LAMP assay, a beneficial tool for the diagnosis of Tubercular meningitis in resource-limited settings. J Infect Dev Ctries 2024; 18:435-440. [PMID: 38635619 DOI: 10.3855/jidc.18115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 07/03/2023] [Indexed: 04/20/2024] Open
Abstract
INTRODUCTION Tubercular meningitis (TBM) is a serious public health problem in developing countries as it leads to significant mortality and residual neurological sequelae. The estimated mortality due to TBM in India is 1.5 per 100,000 population. In resource-limited settings, only the Ziehl-Neelsen (ZN) stain, which has very little sensitivity, is available. The World Health Organization recommended the Loop Mediated Isothermal Amplification (TB LAMP) assay for pulmonary tuberculosis only. We evaluated this test for tubercular meningitis as well. METHODOLOGY In a cross-sectional study of 2-year duration, we have taken 239 cerebrospinal fluid samples from suspected cases of tubercular meningitis patients. ZN staining along with Mycobacteria Growth Indicator Tube (MGIT) TB culture, Xpert MTB/RIF Ultra assay, and commercial TB LAMP assay were performed for each sample. RESULTS Out of 239 samples, 40 samples (16.73%) were found TB LAMP assay positive, 48 samples (20.08%) were found Xpert ultra-assay positive, 12 samples (5.02%) were MGIT TB culture positive and acid-fast bacillus smear positive in ten samples (4.18 %). Out of 12 MGIT-positive samples, all samples (100%) were TB LAMP and Xpert ultra positive and one sample (8.33%) was ZN smear positive. In 199 negative samples from the TB LAMP assay, eight samples were positive by Xpert, none by MGIT TB culture and AFB smear. Sensitivity and specificity were found as 100% and 87.66%, respectively, for the TB LAMP assay. CONCLUSION TB LAMP assay is a rapid, cost-effective, sensitive, and specific test for tubercular meningitis infection in resource-limited settings.
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Affiliation(s)
- Vineeta Mittal
- Department of Microbiology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Manoj Kumar
- Department of Microbiology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Ajay Kumar Singh
- Department of Neurology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
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Pastrone L, Curtoni A, Criscione G, Scaiola F, Bottino P, Guarrasi L, Iannaccone M, Timke M, Costa C, Cavallo R. Evaluation of Two Different Preparation Protocols for MALDI-TOF MS Nontuberculous Mycobacteria Identification from Liquid and Solid Media. Microorganisms 2023; 11:microorganisms11010120. [PMID: 36677412 PMCID: PMC9866535 DOI: 10.3390/microorganisms11010120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 12/29/2022] [Accepted: 12/30/2022] [Indexed: 01/04/2023] Open
Abstract
Nontuberculous mycobacteria (NTM) identification is essential for establishing the relevance of the isolate and for appropriate antimicrobial therapy. Traditionally, NTM identification is performed by using Line Probe Assays (LPA), a costly and time-consuming technique requiring trained personnel. MALDI-TOF MS is a promising tool for NTM identification, and its use is rapidly growing. We evaluated the newly introduced MBT Mycobacteria kit (MBT) and the MycoEx preparation protocol (Bruker Daltonics, Germany) for NTM MALDI-TOF MS identification using LPA results as a reference. Fifty NTM grown on 7H11 agar and MGIT broth were analyzed with both protocols using the Bruker Microflex® LT MALDI-TOF MS (Bruker Daltonics) instrument. MBT and MycoEx provided identification results in 97.0% and 95.0% of the cases, respectively. With both protocols, 100% of the provided results agreed with LPA with no registered mismatch. MBT achieved an elevated number of highly probable identifications (88.0% vs. 83.0%) and a higher reproducibility rate of correct results (86.6% vs. 75.8%) in comparison to MycoEx. This study provides results about MBT performance for liquid and solid media, underlining the strengths and weakness under different conditions. Our results suggest that MALDI-TOF MS could provide a great advantage for timely and cost-saving NTM identification with potential implications for patient outcome.
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Affiliation(s)
- Lisa Pastrone
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Antonio Curtoni
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, 10126 Turin, Italy
- Correspondence: ; Tel.: +39-011-633-7005
| | - Giulia Criscione
- Department of Public Health and Paediatrics, University of Turin, 10126 Turin, Italy
| | - Francesca Scaiola
- Department of Public Health and Paediatrics, University of Turin, 10126 Turin, Italy
| | - Paolo Bottino
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Luisa Guarrasi
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Marco Iannaccone
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Markus Timke
- Bruker Daltonics GmbH & Co. KG, 28359 Bremen, Germany
| | - Cristina Costa
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, 10126 Turin, Italy
- Department of Public Health and Paediatrics, University of Turin, 10126 Turin, Italy
| | - Rossana Cavallo
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, 10126 Turin, Italy
- Department of Public Health and Paediatrics, University of Turin, 10126 Turin, Italy
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Sharma G, Malhotra B, John PJ, Gautam S, Bhargava S. Evaluation of GeneXpert and liquid culture for detection of Mycobacterium tuberculosis in pediatric patients. Indian J Med Microbiol 2022; 40:547-551. [PMID: 35985872 DOI: 10.1016/j.ijmmb.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 07/15/2022] [Accepted: 07/16/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE Evaluation of GeneXpert in comparison to liquid culture using Mycobacteria Growth Indicator Tube (MGIT) as gold standard for detection of Mycobacterium tuberculosis (MTB) in children. METHODS A total of 8123 samples, both pulmonary (5830) and extra pulmonary (2293) received from pediatric patients were processed for Acid Fast Bacilli (AFB) smear, GeneXpert and MGIT culture simultaneously. RESULTS Out of 8123 samples, 493 (6.1%) samples were found positive by GeneXpert and 508 (6.2%) samples by MGIT culture, 371 (4.6%) were found positive by both GeneXpert and MGIT culture. MGIT detected 137 (1.7%) extra positive than GeneXpert while GeneXpert detected 122 (1.5%) extra samples more positive than by MGIT. Sensitivity of GeneXpert was 73% and concordance between both methods was 96.8%. Rifampicin resistance was found in 49 (9.9%) samples among MTB positive by GeneXpert. Turnaround time for GeneXpert was approx. 2 h and for MGIT, it was 12-28 days. CONCLUSION Good sensitivity (73%) and concordance (96.8%) were observed for GeneXpert against MGIT culture in this study. GeneXpert can simultaneously detect MTB and rifampicin resistance in less than 2 h while MGIT takes 12-28 days for MTB detection only.
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Affiliation(s)
- Gaurav Sharma
- Department of Microbiology and Immunology, SMS Medical College, Jaipur, Rajasthan, India; Department of Zoology, University of Rajasthan, Jaipur, Rajasthan, India.
| | - Bharti Malhotra
- Department of Microbiology and Immunology, SMS Medical College, Jaipur, Rajasthan, India.
| | - P J John
- Department of Zoology, University of Rajasthan, Jaipur, Rajasthan, India.
| | - Swati Gautam
- Department of Microbiology and Immunology, SMS Medical College, Jaipur, Rajasthan, India.
| | - Shipra Bhargava
- International Centre for Excellence in Laboratory Training (ICELT), National Tuberculosis Institute, Bengaluru, India.
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Rafael LL, Raquel MS, Rogelio FA, Miroslava FP, Alejandra-Isabel JG, Paola RTS. Discordant results between genotypic and phenotypic assays (Xpert MTB/RIF vs. BACTEC MGIT 960 system) for detection of RIF-resistant Mycobacterium tuberculosis isolates in a high burden region. Infect Genet Evol 2021; 96:105142. [PMID: 34800711 DOI: 10.1016/j.meegid.2021.105142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/31/2021] [Accepted: 11/12/2021] [Indexed: 06/13/2023]
Abstract
Clinical isolates with discordant phenotypic and genotypic results were submitted to DNA sequencing to identify which were genuinely resistant to rifampin and determine the frequency of silent and disputed mutations in our region. We present the retrospective analysis of all the culture-proven TB cases tested with the Xpert®MTB/RIF assay at the Tuberculosis Clinic and Laboratory of the Tijuana General Hospital, Mexico. Clinical isolates showing a discrepancy between phenotypic and molecular tests were analyzed by DNA sequencing. Thirteen isolates tested as rifampin susceptible on the MGIT system were rifampin-resistant according to Xpert®MTB/RIF assay. DNA sequencing showed that seven (53.8%) isolates had a silent (P514P) mutation; three isolates showed different missense (L511P, D516Y, and S531L) mutations. Three isolates showed no mutations. The existence of heteroresistance and silent or disputed mutations warrants that all rifampin-resistance cases diagnosed with the Xpert®MTB/RIF should be referred to specialized centers for DNA sequencing.
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Affiliation(s)
- Laniado-Laborín Rafael
- Clínica y Laboratorio de Tuberculosis Hospital General Tijuana, ISESALUD, Tijuana, Baja California, Mexico; Facultad de Medicina y Psicología, Universidad Autónoma de Baja California, Tijuana, Baja California, Mexico; Regional Green Light Committee for the Americas (rGLC), World Health Organization, United States of America.
| | - Muñiz-Salazar Raquel
- Laboratorio de Epidemiología y Ecología Molecular, Escuela de Ciencias de la Salud, Universidad Autónoma de Baja California, Ensenada, Baja California, Mexico
| | - Flores-Acosta Rogelio
- Clínica y Laboratorio de Tuberculosis Hospital General Tijuana, ISESALUD, Tijuana, Baja California, Mexico; Facultad de Medicina y Psicología, Universidad Autónoma de Baja California, Tijuana, Baja California, Mexico
| | - Félix-Ponce Miroslava
- Clínica y Laboratorio de Tuberculosis Hospital General Tijuana, ISESALUD, Tijuana, Baja California, Mexico; Facultad de Medicina y Psicología, Universidad Autónoma de Baja California, Tijuana, Baja California, Mexico
| | - Jiménez-Gracia Alejandra-Isabel
- Clínica y Laboratorio de Tuberculosis Hospital General Tijuana, ISESALUD, Tijuana, Baja California, Mexico; Facultad de Medicina y Psicología, Universidad Autónoma de Baja California, Tijuana, Baja California, Mexico
| | - Ruiz-Tamayo Saritzia Paola
- Laboratorio de Epidemiología y Ecología Molecular, Escuela de Ciencias de la Salud, Universidad Autónoma de Baja California, Ensenada, Baja California, Mexico
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Machowski EE, Letutu M, Lebina L, Waja Z, Msandiwa R, Milovanovic M, Gordhan BG, Otwombe K, Friedrich SO, Chaisson R, Diacon AH, Kana B, Martinson N. Comparing rates of mycobacterial clearance in sputum smear-negative and smear-positive adults living with HIV. BMC Infect Dis 2021; 21:466. [PMID: 34022850 PMCID: PMC8141145 DOI: 10.1186/s12879-021-06133-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 09/18/2020] [Accepted: 05/04/2021] [Indexed: 12/03/2022] Open
Abstract
Background Pulmonary tuberculosis (TB) in people living with HIV (PLH) frequently presents as sputum smear-negative. However, clinical trials of TB in adults often use smear-positive individuals to ensure measurable bacterial responses following initiation of treatment, thereby excluding HIV-infected patients from trials. Methods In this prospective case cohort study, 118 HIV-seropositive TB patients were assessed prior to initiation of standard four-drug TB therapy and at several time points through 35 days. Sputum bacillary load, as a marker of treatment response, was determined serially by: smear microscopy, Xpert MTB/RIF, liquid culture, and colony counts on agar medium. Results By all four measures, patients who were baseline smear-positive had higher bacterial loads than those presenting as smear-negative, until day 35. However, most smear-negative PLH had significant bacillary load at enrolment and their mycobacteria were cleared more rapidly than smear-positive patients. Smear-negative patients’ decline in bacillary load, determined by colony counts, was linear to day 7 suggesting measurable bactericidal activity. Moreover, the decrease in bacterial counts was comparable to smear-positive individuals. Increasing cycle threshold values (Ct) on the Xpert assay in smear-positive patients to day 14 implied decreasing bacterial load. Conclusion Our data suggest that smear-negative PLH can be included in clinical trials of novel treatment regimens as they contain sufficient viable bacteria, but allowances for late exclusions would have to be made in sample size estimations. We also show that increases in Ct in smear-positive patients to day 14 reflect treatment responses and the Xpert MTB/RIF assay could be used as biomarker for early treatment response. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06133-4.
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Affiliation(s)
- Edith E Machowski
- Department of Science and Technology/National Research Foundation Centre of Excellence for Biomedical TB Research (CBTBR), University of the Witwatersrand, National Health Laboratory Service, Johannesburg, South Africa.
| | - Matebogo Letutu
- Perinatal HIV Research Unit (PHRU), SAMRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Limakatso Lebina
- Perinatal HIV Research Unit (PHRU), SAMRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ziyaad Waja
- Perinatal HIV Research Unit (PHRU), SAMRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Reginah Msandiwa
- Perinatal HIV Research Unit (PHRU), SAMRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Minja Milovanovic
- Perinatal HIV Research Unit (PHRU), SAMRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Bhavna G Gordhan
- Department of Science and Technology/National Research Foundation Centre of Excellence for Biomedical TB Research (CBTBR), University of the Witwatersrand, National Health Laboratory Service, Johannesburg, South Africa
| | - Kennedy Otwombe
- Perinatal HIV Research Unit (PHRU), SAMRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sven O Friedrich
- TASK Applied Science, Bellville, Cape Town, South Africa and Pulmonology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | | | - Andreas H Diacon
- TASK Applied Science, Bellville, Cape Town, South Africa and Pulmonology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Bavesh Kana
- Department of Science and Technology/National Research Foundation Centre of Excellence for Biomedical TB Research (CBTBR), University of the Witwatersrand, National Health Laboratory Service, Johannesburg, South Africa
| | - Neil Martinson
- Department of Science and Technology/National Research Foundation Centre of Excellence for Biomedical TB Research (CBTBR), University of the Witwatersrand, National Health Laboratory Service, Johannesburg, South Africa.,Perinatal HIV Research Unit (PHRU), SAMRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Yigzaw WB, Torrelles JB, Wang SH, Tessema B. Magnitude of Phenotypic and MTBDRplus Line Probe Assay First-Line Anti-Tuberculosis Drug Resistance Among Tuberculosis Patients; Northwest Ethiopia. Infect Drug Resist 2021; 14:497-505. [PMID: 33603414 PMCID: PMC7882791 DOI: 10.2147/idr.s292058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/28/2021] [Indexed: 12/03/2022] Open
Abstract
Background Mycobacterium tuberculosis (Mtb) drug resistance is a key challenge in ending TB. Objective The study aimed to determine anti-TB drug resistance and compare the discordance between phenotypic and genotypic drug-susceptibility testing (DST). Methods Prospective enrollment and sputum collection from patients suspected of active pulmonary TB from May 2018 to December 2019 at the University of Gondar Hospital. Phenotypic DST study for streptomycin, isoniazid, rifampin, and ethambutol was done by MGIT 360 SIRE Kit. Genotypic resistance for isoniazid and rifampin was performed by MTBDRplus v2 line probe assay (LPA) and compared to phenotypic drug resistance. Results A total of 376 patients, median age 32 years, and 53.7% male were enrolled. Mtb was isolated from 126 patients. 106/126 (84%) patients were newly diagnosed with TB and 20 patients with prior TB treatment. Seventy (66.0%) were susceptible to all anti‐TB drugs tested. Twenty-five (19.8%) of the isolates were resistant to isoniazid, 12 (9.5%) to rifampicin and six (5%) were multidrug resistant. Among previously treated TB patients, 4 (20.0%) and 5 (25.0%) were mono-resistant and poly-resistant, respectively. The sensitivity and specificity of LPA resistance for isoniazid were 94.4% and 100%, and for rifampin was 75.0% and 100%, respectively. Conclusion The frequency of mono- and poly-drug resistance among both newly diagnosed and previously treated TB patients was high to the rest of the nation. MTBDRplus showed excellent concordance for isoniazid and rifampin. We concluded that DST should be performed for all patients to improve management and decrease spread of drug-resistant Mtb strains in the community.
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Affiliation(s)
- Wubet Birhan Yigzaw
- Department of Medical Microbiology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Jordi B Torrelles
- Population Health Program, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - Shu-Hua Wang
- Department of Internal Medicine, Division of Infectious Diseases, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Belay Tessema
- Department of Medical Microbiology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Abstract
Culture remains the gold standard for tuberculosis (TB) diagnosis, and the mycobacteria growth indicator tube (MGIT), endorsed by the World Health Organization (WHO), is widely used. Further identification of a positive culture is done with the help of an immunochromatography assay, which often shows faint bands that are difficult to interpret. We analysed 125 BACTEC MGIT culture positive results, of which 11/16 (68.7%) of the doubtful assays, analysed by MGIT™ TBc Identification test (TBcId), were positive for Mycobacterium tuberculosis complex (MTBC), the remaining being non-tuberculous mycobacteria as determined by an in-house duplex polymerase chain reaction and line probe assay. Guidelines on faint or doubtful bands in immunochromatography assays are important so as not to overlook true-positive cases of TB.
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Affiliation(s)
- Chanchal Kumar
- Senior Research Fellow, Department of Microbiology, 72916Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi, India
| | - Kamal Shrivastava
- Senior Research Fellow, Department of Microbiology, 72916Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi, India
| | - Anupriya Singh
- Research Assistant, Department of Microbiology, 72916Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi, India
| | - Naresh Kumar Sharma
- Senior Research Fellow, Department of Microbiology, 72916Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi, India
| | - Jitender Yadav
- Senior Technical Assistant, Department of Microbiology, 72916Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi, India
| | - Mandira Varma-Basil
- Professor, Department of Microbiology, 72916Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi, India
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Sharma S, Shulania A, Achra A, Jeram H, Kansra S, Duggal N. Diagnosis of pulmonary tuberculosis from gastric aspirate samples in nonexpectorating pediatric patients in a tertiary care hospital. INDIAN J PATHOL MICR 2020; 63:210-213. [PMID: 32317517 DOI: 10.4103/ijpm.ijpm_694_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objectives The aim of this study was to assess the utility of Xpert assay, Ziehl-Neelsen (ZN) staining, and Mycobacteria Growth Indicator Tube (MGIT™) culture for diagnosis of pediatric pulmonary tuberculosis from gastric aspirate (GA) samples and to compare Xpert assay and ZN staining with MGIT rapid liquid culture. Materials and Methods GA samples from 210 nonexpectorating children, aged between 6 months to 12 years, presenting to the pediatric out-patient department (OPD) with clinical suspicion of tuberculosis (TB) were collected. The samples were tested by GeneXpert, ZN staining, and MGIT liquid culture. Results GeneXpert is a more sensitive method for rapid and early diagnosis of pediatric TB when compared with microscopy.
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Affiliation(s)
- Shiwangi Sharma
- Department of Microbiology, ABVIMS, Dr. RML Hospital, New Delhi, India
| | - Anuradha Shulania
- Department of Microbiology, ABVIMS, Dr. RML Hospital, New Delhi, India
| | - Arvind Achra
- Department of Microbiology, ABVIMS, Dr. RML Hospital, New Delhi, India
| | - Hishmi Jeram
- Department of Microbiology, ABVIMS, Dr. RML Hospital, New Delhi, India
| | - Stuti Kansra
- Department of Microbiology, ABVIMS, Dr. RML Hospital, New Delhi, India
| | - Nandini Duggal
- Department of Microbiology, ABVIMS, Dr. RML Hospital, New Delhi, India
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Kant K, Baveja CP, Sarkar J, Juyal D. Microbiological evaluation of clinically suspected cases of tubercular lymphadenopathy by cytology, culture, and smear microscopy - A hospital-based study from Northern India. J Family Med Prim Care 2019; 8:828-833. [PMID: 31041209 PMCID: PMC6482784 DOI: 10.4103/jfmpc.jfmpc_20_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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] [Indexed: 01/03/2023] Open
Abstract
Introduction: Over the past few years, the incidence of extrapulmonary tuberculosis (EPTB), particularly of tubercular lymphadenitis (TBLN), is on the rise. TBLN, which contributes to 20–40% of EPTB cases, often poses a diagnostic and therapeutic challenge for clinicians more so in resource-constrained settings where laboratory confirmation is not available. In this study, we aimed to study if fine-needle aspiration cytology (FNAC) combined with Ziehl–Neelsen (ZN) staining and mycobacterial culture could improve the diagnostic accuracy in patients clinically suspected of TBLN. Materials and Methods: This cross-sectional study involved 120 patients (>12 years of age), clinically suspected of peripheral TBLN. Direct examination of the samples with ZN staining and culture on Lowenstein–Jensen (LJ) slants and Bactec MGIT 960 vials (MGIT 960 medium) was performed on previously collected fine-needle aspirates. Results: Out of total 120 patients included in study, 43.3% were males and 56.7% were females. Maximum numbers of cases were observed in age group 13–21 (56%). On ZN staining, 21.7% samples were found positive, whereas FNAC findings were suggestive of tuberculosis (TB) in 455 patients. Culture on LJ media showed 33.3% samples to be positive, whereas Bactec MGIT 960 system showed positivity of 35%. Out of 54 samples suggestive of TB on FNAC, only 30 (55.6%) were found positive on Bactec culture. Also out of 66 samples which were not suggestive of TB in FNAC, 12 (18.2%) were found positive in Bactec culture. Conclusion: Accurate diagnosis of TBLN requires a multifaceted approach involving microbiology, pathology, radiology, and clinical presentation of the disease. FNAC and ZN staining along with the culture can result in better diagnostic yield and will be helpful in reducing the burden of TB.
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Affiliation(s)
- Kamla Kant
- Department of Microbiology, The Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Karaikal, Puducherry, India
| | | | - Jyoti Sarkar
- Department of Microbiology, Govt. Doon Medical College, Dehradun, Uttarakhand, India
| | - Deepak Juyal
- Department of Microbiology, Govt. Doon Medical College, Dehradun, Uttarakhand, India
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Rotcheewaphan S, Odusanya OE, Henderson CM, Stephenson D, Olivier KN, Perry JD, Zelazny AM. Performance of RGM Medium for Isolation of Nontuberculous Mycobacteria from Respiratory Specimens from Non-Cystic Fibrosis Patients. J Clin Microbiol 2019; 57:e01519-18. [PMID: 30487305 DOI: 10.1128/JCM.01519-18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 11/20/2018] [Indexed: 11/20/2022] Open
Abstract
A new selective medium for rapidly growing mycobacteria (RGM medium) was evaluated on respiratory specimens from non-cystic fibrosis patients and compared to the mycobacterial growth indicator tube (MGIT) system and Middlebrook 7H11 agar for the isolation of all nontuberculous mycobacteria (NTM). A total of 203 mucolyzed respiratory specimens collected from 163 patients were inoculated on RGM medium and incubated at both 30°C (RGM30) and 35°C (RGM35) over a 28-day period. N-Acetyl-l-cysteine-sodium hydroxide (NALC-NaOH)-decontaminated specimens were inoculated into MGIT and Middlebrook 7H11 agar and incubated at 35°C for 42 days. NTM were identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) or gene sequencing. A total of 133 NTM isolates were recovered overall from 101 (49.8%) specimens collected from 85 (52.1%) patients by a combination of all culture methods. The sensitivity of RGM30 for the recovery of NTM was significantly higher than that of either the MGIT system (76.7% versus 59.4%; P = 0.01) or Middlebrook 7H11 agar (76.7% versus 47.4%; P = 0.0001) alone, but it was not significantly different from that of an acid-fast bacillus culture (AFC) which includes both MGIT and Middlebrook 7H11 agar (76.7% versus 63.9%; P = 0.0647). RGM35 had significantly lower sensitivity than the MGIT system (49.6% versus 59.4%; P = 0.0367) and AFC (49.6% versus 63.9%; P = 0.0023). RGM medium was highly effective at inhibiting the growth of nonmycobacterial organisms in the respiratory specimens, with breakthrough contamination rates of 5.4% and 4.4% for RGM30 and RGM35, respectively.
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Sng LH, Peh JWL, Kee MTL, Ya'akob NBM, Ong RTH, Wong CW, Chee CBE, Wang YT. Clofazimine drug susceptibility testing for Mycobacterium tuberculosis: the case of using the right diluent. Pathology 2018; 50:549-553. [PMID: 29891191 DOI: 10.1016/j.pathol.2018.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 01/05/2018] [Accepted: 01/22/2018] [Indexed: 11/19/2022]
Abstract
Accurate and reliable drug susceptibility testing (DST) is essential for the effective treatment and control of tuberculosis. With the increase in drug-resistant organisms, newer and less conventional antimicrobial agents are used for treatment. Recently, we found an unprecedented rise in the number of clofazimine-resistant Mycobacterium tuberculosis isolates in our laboratory. An investigation found that this phenomenon was due to a change in the method of drug preparation. We performed studies to assess the impact of water and dimethyl sulfoxide (DMSO) as a final diluent for clofazimine drug testing. Based on our findings, the use of DMSO as a solvent for M. tuberculosis DST was optimised using the BACTEC MGIT 960 platform.
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Affiliation(s)
- Li-Hwei Sng
- Central Tuberculosis Laboratory, Singapore General Hospital, Singapore.
| | | | | | | | - Rick Twee-Hee Ong
- Saw Swee Hock School of Public Health, National University Health Singapore, National University of Singapore, Singapore
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12
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Phillips PPJ, Mendel CM, Nunn AJ, McHugh TD, Crook AM, Hunt R, Bateson A, Gillespie SH. A comparison of liquid and solid culture for determining relapse and durable cure in phase III TB trials for new regimens. BMC Med 2017; 15:207. [PMID: 29169355 PMCID: PMC5701316 DOI: 10.1186/s12916-017-0955-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 10/10/2017] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Tuberculosis kills more people than any other infectious disease, and new regimens are essential. The primary endpoint for confirmatory phase III trials for new regimens is a composite outcome that includes bacteriological treatment failure and relapse. Culture methodology is critical to the primary trial outcome. Patients in clinical trials can have positive cultures after treatment ends that may not necessarily indicate relapse, which was ascribed previously to laboratory cross-contamination or breakdown of old lesions. Löwenstein-Jensen (LJ) medium was the previous standard in clinical trials, but almost all current and future trials will use the Mycobacteria Growth Indicator Tube (MGIT) system due to its simplicity and consistency of use, which will affect phase III trial results. LJ was used for the definition of the primary endpoint in the REMoxTB trial, but every culture was also inoculated in parallel into the MGIT system. The data from this trial, therefore, provide a unique opportunity to investigate and compare the incidence of false 'isolated positives' in liquid and solid media and their potential impact on the primary efficacy results. METHODS All post-treatment positive cultures were reviewed in the REMoxTB clinical trial. Logistic regression models were used to model the incidence of isolated positive cultures on MGIT and LJ. RESULTS A total of 12,209 sputum samples were available from 1652 patients; cultures were more often positive on MGIT than LJ. In 1322 patients with a favourable trial outcome, 126 (9.5%) had cultures that were positive in MGIT compared to 34 (2.6%) patients with positive cultures on LJ. Among patients with a favourable outcome, the incidence of isolated positives on MGIT differed by study laboratory (p < 0.0001) with 21.9% of these coming from one laboratory investigating only 4.9% of patients. No other baseline factors predicted isolated positives on MGIT after adjusting for laboratory. There was evidence of clustering of isolated positive cultures in some patients even after adjusting for laboratory, p < 0.0001. The incidence of isolated positives on MGIT did not differ by treatment arm (p = 0.845, unadjusted). Compared to negative MGIT cultures, positive MGIT cultures were more likely to be associated with higher grade TB symptoms reported within 7 days either side of sputum collection in patients with an unfavourable primary outcome (p < 0.0001) but not in patients with a favourable outcome (p = 0.481). CONCLUSIONS Laboratory cross-contamination was a likely cause of isolated positive MGIT cultures which were clustered in some laboratories. Certain patients had repeated positive MGIT cultures that did not meet the definition of a relapse. This pattern was too common to be explained by cross-contamination only, suggesting that host factors were also responsible. We conclude that MGIT can replace LJ in phase III TB trials, but there are implications for the definition of the primary outcome and patient management in trials in such settings. Most importantly, the methodologies differ in the incidence of isolated positives and in their capacity for capturing non-tuberculosis mycobacteria. It emphasises the importance of effective medical monitoring after treatment ends and consideration of clinical signs and symptoms for determining treatment failure and relapse.
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Affiliation(s)
- Patrick P J Phillips
- MRC Clinical Trials Unit at UCL, London, UK. .,Division of Pulmonary & Critical Care Medicine, University of California, San Francisco, San Francisco, USA. .,Division of Biostatistics, University of California, San Francisco, San Francisco, USA.
| | - Carl M Mendel
- Global Alliance for TB Drug Development, New York, NY, USA
| | | | | | | | - Robert Hunt
- Centre for Clinical Microbiology, UCL, London, UK
| | - Anna Bateson
- Centre for Clinical Microbiology, UCL, London, UK
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Kumar K, Giribhattanavar P, Sagar C, Patil S. A rapid and simple resazurin assay to detect minimum inhibitory concentrations of first-line drugs for Mycobacterium tuberculosis isolated from cerebrospinal fluid. J Glob Antimicrob Resist 2017; 12:157-161. [PMID: 28964954 DOI: 10.1016/j.jgar.2017.09.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 07/13/2017] [Accepted: 09/20/2017] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES Central nervous system tuberculosis (CNS-TB) is a devastating manifestation of TB. The most common form of CNS-TB is tuberculous meningitis. Drug-resistant TB poses a major threat to the control of TB worldwide. Timely treatment dramatically improves the outcome. Colorimetric techniques for drug susceptibility testing based on the oxidation-reduction principle give results quick and are less expensive. The objectives of this study were to compare the susceptibility of Mycobacterium tuberculosis isolated from cerebrospinal fluid to four first-line drugs using the MGIT automated mycobacterial detection system and the resazurin assay (RA) as well as to estimate the minimum inhibitory concentrations (MICs) by RA. METHODS A total of 42 M. tuberculosis isolates were analysed for their susceptibilities by MGIT and RA. RESULTS Of the 42 isolates, 35 gave concordant results with both methods. Agreement between the two tests for streptomycin and rifampicin was 100% with a Fleiss' kappa (κ) value of 1, whereas for isoniazid and ethambutol agreement was 92.86% and 90.48%, respectively, with κ values of 0.853 and 0.738. CONCLUSION The RA appears to be a good alternative to the automated MGIT technique in resource-limited settings.
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Affiliation(s)
- Kavitha Kumar
- Department of Neuromicrobiology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka 560029, India
| | - Prashant Giribhattanavar
- Department of Neuromicrobiology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka 560029, India
| | - Chandrasekhar Sagar
- Department of Neuropathology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka 560029, India.
| | - Shripad Patil
- Department of Neuromicrobiology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka 560029, India.
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Shea J, Halse TA, Lapierre P, Shudt M, Kohlerschmidt D, Van Roey P, Limberger R, Taylor J, Escuyer V, Musser KA. Comprehensive Whole-Genome Sequencing and Reporting of Drug Resistance Profiles on Clinical Cases of Mycobacterium tuberculosis in New York State. J Clin Microbiol 2017; 55:1871-1882. [PMID: 28381603 PMCID: PMC5442544 DOI: 10.1128/jcm.00298-17] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 03/28/2017] [Indexed: 12/19/2022] Open
Abstract
Whole-genome sequencing (WGS) is a newer alternative for tuberculosis (TB) diagnostics and is capable of providing rapid drug resistance profiles while performing species identification and capturing the data necessary for genotyping. Our laboratory developed and validated a comprehensive and sensitive WGS assay to characterize Mycobacterium tuberculosis and other M. tuberculosis complex (MTBC) strains, composed of a novel DNA extraction, optimized library preparation, paired-end WGS, and an in-house-developed bioinformatics pipeline. This new assay was assessed using 608 MTBC isolates, with 146 isolates during the validation portion of this study and 462 samples received prospectively. In February 2016, this assay was implemented to test all clinical cases of MTBC in New York State, including isolates and early positive Bactec mycobacterial growth indicator tube (MGIT) 960 cultures from primary specimens. Since the inception of the assay, we have assessed the accuracy of identification of MTBC strains to the species level, concordance with culture-based drug susceptibility testing (DST), and turnaround time. Species identification by WGS was determined to be 99% accurate. Concordance between drug resistance profiles generated by WGS and culture-based DST methods was 96% for eight drugs, with an average resistance-predictive value of 93% and susceptible-predictive value of 96%. This single comprehensive WGS assay has replaced seven molecular assays and has resulted in resistance profiles being reported to physicians an average of 9 days sooner than with culture-based DST for first-line drugs and 32 days sooner for second-line drugs.
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Affiliation(s)
- Joseph Shea
- Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Tanya A Halse
- Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Pascal Lapierre
- Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Matthew Shudt
- Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Donna Kohlerschmidt
- Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Patrick Van Roey
- Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Ronald Limberger
- Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Jill Taylor
- Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Vincent Escuyer
- Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Kimberlee A Musser
- Wadsworth Center, New York State Department of Health, Albany, New York, USA
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Yates GF, Price-Carter M, Bland K, Joyce MA, Khan F, Surrey M, de Lisle GW. Comparison of the BBL mycobacteria growth indicator tube, the BACTEC 12B, and solid media for the isolation of Mycobacterium bovis. J Vet Diagn Invest 2017; 29:508-512. [PMID: 28460600 DOI: 10.1177/1040638717697763] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We compared different methods for their ability to isolate Mycobacterium bovis from tissue samples from animals with lesions resembling bovine tuberculosis. In the first trial, M. bovis was isolated from 86 of 200 tissue samples that were cultured using 2 liquid media, BACTEC 12B and BBL mycobacteria growth indicator tube (MGIT), and a solid medium, Middlebrook 7H11 supplemented with pyruvate (7H11P). M. bovis was isolated from 2 samples with MGIT but not BACTEC 12B. M. bovis was isolated from 9 samples with BACTEC but not MGIT; these 9 samples came from the North Canterbury/Marlborough region of New Zealand. The proportion of tissues from which M. bovis was isolated with BACTEC 12B or MGIT and the mean time for isolation was different for samples from the North Canterbury/Marlborough region but not the rest of New Zealand. In the second trial, M. bovis was isolated from 401 of 1,033 tissues that were cultured using MGIT, Middlebrook 7H9 broth, or solid 7H11P. The proportion of isolates of M. bovis and the mean time for their isolation with MGIT was different for the North Canterbury/Marlborough and the rest of New Zealand. The reason for this difference was not determined but may be related to the genotypes present in this region. Genotyping using variable number tandem repeats (VNTRs) of 197 isolates of M. bovis revealed that the 44 isolates from North Canterbury/Marlborough were represented by 2 closely related VNTR types that were not found in 153 isolates from the remainder of New Zealand.
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Affiliation(s)
- Gary F Yates
- AgResearch Limited, Hopkirk Research Institute, Grasslands Research Centre, Palmerston North, New Zealand
| | - Marian Price-Carter
- AgResearch Limited, Hopkirk Research Institute, Grasslands Research Centre, Palmerston North, New Zealand
| | - Kirstie Bland
- AgResearch Limited, Hopkirk Research Institute, Grasslands Research Centre, Palmerston North, New Zealand
| | - Maree A Joyce
- AgResearch Limited, Hopkirk Research Institute, Grasslands Research Centre, Palmerston North, New Zealand
| | - Farina Khan
- AgResearch Limited, Hopkirk Research Institute, Grasslands Research Centre, Palmerston North, New Zealand
| | - Melissa Surrey
- AgResearch Limited, Hopkirk Research Institute, Grasslands Research Centre, Palmerston North, New Zealand
| | - Geoffrey W de Lisle
- AgResearch Limited, Hopkirk Research Institute, Grasslands Research Centre, Palmerston North, New Zealand
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16
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Kelly-Cirino CD, Musisi E, Byanyima P, Kaswabuli S, Andama A, Sessolo A, Sanyu I, Zawedde J, Curry PS, Huang L. Investigation of OMNIgene·SPUTUM performance in delayed tuberculosis testing by smear, culture, and Xpert MTB/RIF assays in Uganda. J Epidemiol Glob Health 2017; 7:103-109. [PMID: 28413105 PMCID: PMC7320428 DOI: 10.1016/j.jegh.2017.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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] [Indexed: 11/30/2022] Open
Abstract
OMNIgene·SPUTUM (OM-S) is a sample transport reagent designed to work with all tuberculosis diagnostics while eliminating the need for cold chain. OM-S-treated sputum samples were assayed in several tests after multiday holds. Raw sputa from 100 patients underwent direct smear microscopy, were manually split and assigned to the OM-S group [OM-S added at collection (no other processing required) and tested after 0- to 5-day holds at room temperature] or standard-of-care (SOC) group (NaOH/N-acetyl l-cysteine decontamination, all tested on day of collection). Concentrated smear microscopy, Lowenstein Jensen (LJ) culture, and mycobacteria growth indicator tube (MGIT) culture were performed. For patients with negative direct smear, a second sample was split, with SOC (raw sputum) and OM-S portions (sediment) tested in the Xpert MTB/RIF (Xpert) assay. OM-S group and SOC group results were strongly concordant on all four tests [range, 89% (MGIT)–97% (Xpert)]. OM-S MGIT, LJ, and Xpert tests were in statistical agreement with SOC MGIT as reference. OM-S specimens had lower culture contamination rates (3% vs. 10% LJ; 2% vs. 5% MGIT) but required, on average, 5.6 additional days to become MGIT-positive. The findings suggest that samples held/transported in OM-S are compatible with smear microscopy, LJ or MGIT culture, and Xpert, and perform comparably to fresh sputum samples. Larger feasibility studies are warranted.
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Affiliation(s)
- C D Kelly-Cirino
- DNA Genotek, 500 Palladium Dr., Suite 3000, Ottawa, Ontario K2V 1C2, Canada.
| | - E Musisi
- Infectious Diseases Research Collaboration Kampala, 2C Nakasero Hill Road, PO Box 7475, Kampala, Uganda.
| | - P Byanyima
- Infectious Diseases Research Collaboration Kampala, 2C Nakasero Hill Road, PO Box 7475, Kampala, Uganda.
| | - S Kaswabuli
- Infectious Diseases Research Collaboration Kampala, 2C Nakasero Hill Road, PO Box 7475, Kampala, Uganda.
| | - A Andama
- Infectious Diseases Research Collaboration Kampala, 2C Nakasero Hill Road, PO Box 7475, Kampala, Uganda.
| | - A Sessolo
- Infectious Diseases Research Collaboration Kampala, 2C Nakasero Hill Road, PO Box 7475, Kampala, Uganda.
| | - I Sanyu
- Infectious Diseases Research Collaboration Kampala, 2C Nakasero Hill Road, PO Box 7475, Kampala, Uganda.
| | - J Zawedde
- Infectious Diseases Research Collaboration Kampala, 2C Nakasero Hill Road, PO Box 7475, Kampala, Uganda.
| | - P S Curry
- DNA Genotek, 500 Palladium Dr., Suite 3000, Ottawa, Ontario K2V 1C2, Canada.
| | - L Huang
- University of California San Francisco, HIV, Infectious Diseases, and Global Medicine Division and Division of Pulmonary and Critical Care Medicine - Ward 84, San Francisco General Hospital, 995 Potrero Avenue, San Francisco, CA 94110, USA.
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17
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Dayal R, Agarwal D, Pathak H, Feroz S, Kumar M, Chauhan DS, Bhatia R. PCR targeting IS6110 in diagnosing tuberculosis in children in comparison to MGIT culture. Indian J Tuberc 2016; 63:154-157. [PMID: 27865236 DOI: 10.1016/j.ijtb.2016.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 07/21/2016] [Accepted: 08/02/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Diagnosis of tuberculosis (TB) in children is difficult in children especially in extrapulmonary tuberculosis (EPTB). This study was conducted to evaluate the use of polymerase chain reaction (PCR) targeting IS6110 in the diagnosis of TB in children with pulmonary TB and EPTB and also to compare its performance with MGIT 960 culture and conventional microscopy. METHODS A total of 142 cases (50 pulmonary, 92 extrapulmonary) of suspected TB patients <15 years of age were included in the study. The clinical specimens obtained from these cases were subjected to Ziehl-Neelsen staining (ZN), MGIT 960 TB culture and PCR targeting insertion sequence IS6110. Sensitivity and specificity of PCR were calculated in pulmonary and extrapulmonary specimens. The results were compared to MGIT culture. RESULTS PCR targeting IS6110 sequence had sensitivity of 69.01% in various clinical specimens which was significantly more than MGIT culture showing a sensitivity of 47.41% (p<0.05). Sensitivity of PCR IS6110 in extrapulmonary specimens was 65.21% which was lower than sensitivity in pulmonary specimens (76%) but was not statistically significant (p>0.05). CONCLUSIONS Diagnostic efficacy of PCR IS6110 in pulmonary and extrapulmonary TB cases was similar. PCR using IS6110 primer had significantly better efficiency than MGIT culture in diagnosing TB in children.
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Affiliation(s)
- Rajeshwar Dayal
- Professor and Head, Department of Pediatrics, Sarojini Naidu Medical College, Agra, India
| | - Dipti Agarwal
- Assistant Professor, Department of Pediatrics, Sarojini Naidu Medical College, Agra, India.
| | - Harish Pathak
- Resident, Department of Pediatrics, Sarojini Naidu Medical College, Agra, India
| | - Shehraj Feroz
- Resident, Department of Pediatrics, Sarojini Naidu Medical College, Agra, India
| | - Manoj Kumar
- Assistant Professor, Department of Pediatrics, Sarojini Naidu Medical College, Agra, India
| | - Devendra S Chauhan
- Scientist D, National JALMA Institute for Leprosy & Other Mycobacterial Diseases (ICMR), India
| | - Rakesh Bhatia
- Professor, Department of Pediatrics, Sarojini Naidu Medical College, Agra, India
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Soo PC, Horng YT, Chen AT, Yang SC, Chang KC, Lee JJ, Peng WP. Validation of nanodiamond-extracted CFP-10 antigen as a biomarker in clinical isolates of Mycobacterium tuberculosis complex in broth culture media. Tuberculosis (Edinb) 2015; 95:620-4. [PMID: 26071665 DOI: 10.1016/j.tube.2015.05.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 05/13/2015] [Accepted: 05/15/2015] [Indexed: 10/23/2022]
Abstract
With detonation nanodiamonds (DNDs) and matrix-assisted laser desorption/ionization mass spectrometry (MALDI-TOF MS), we previously identified early secreted cell filtrate protein 10 (CFP-10) as a candidate Mycobacterium tuberculosis complex (MTC) biomarker. The performance of the CFP-10 biomarker was initially evaluated in relatively small mycobacterial samples (n = 42 samples) in our previous study. In this study, we conducted DND MALDI-TOF MS experiments to investigate the specificity and sensitivity of the MTC biomarker with 312 MTC and 52 nontuberculous mycobacteria (NTM) clinical samples. The frequency and intensity of the acquired CFP-10 mass-to-charge (m/z) peaks were checked with a program to validate that the singly and doubly charged CFP-10 antigen can be treated as a MTC biomarker. We confirmed that by detecting the singly charged species of CFP-10 antigen, the sensitivity and the specificity of MTC samples could reach 97.4% and 100% and no CFP-10 biomarker could be found in NTM samples. This indicates with CFP-10 biomarker it is easy to distinguish MTC from NTM. Besides, the observed intensity ratio of singly and doubly charged species of CFP-10 antigen was 3.3 ± 2.6 and the CFP-10 antigen could maintain good signal intensity for a week. Our results suggest that, with the DND MALDI-TOF mass spectrometry approach, CFP-10 antigen can be used as an early diagnosis biomarker in clinical practice.
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Affiliation(s)
- Po-Chi Soo
- Department of Laboratory Medicine and Biotechnology, Tzu Chi University, Hualien, Taiwan
| | - Yu-Tze Horng
- Department of Laboratory Medicine and Biotechnology, Tzu Chi University, Hualien, Taiwan
| | - Ai-Ti Chen
- Department of Physics, National Dong Hwa University, Shoufeng, Hualien, 97401, Taiwan
| | - Shih-Chieh Yang
- Department of Physics, National Dong Hwa University, Shoufeng, Hualien, 97401, Taiwan
| | - Kai-Chih Chang
- Department of Laboratory Medicine and Biotechnology, Tzu Chi University, Hualien, Taiwan
| | - Jen-Jyh Lee
- Department of Internal Medicine, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Wen-Ping Peng
- Department of Physics, National Dong Hwa University, Shoufeng, Hualien, 97401, Taiwan.
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20
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Aktas AE, Yigit N, Ayyildiz A, Bastopcu A. Comparison of the mycobacterium growth indicator tube method and the method of proportion for drug susceptibility testing of mycobacterium tuberculosis. Eurasian J Med 2015; 46:96-101. [PMID: 25610306 DOI: 10.5152/eajm.2014.23] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 09/06/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Tuberculosis is an important public health problem in developed and, especially, developing countries. The incidence of multi-drug-resistant Mycobacterium tuberculosis (MDR-TB) has increased in recent years. Mycobacterial culture and susceptibility testing must be rapidly concluded for effective treatment and control of the disease. The present study evaluated the reliability of the Mycobacterium Growth Indicator Tube (MGIT) method for testing the susceptibility of M. tuberculosis to four first-line antimicrobial drugs by comparing MGIT results to those obtained by the method of proportion (MOP), which served as the reference method. MATERIALS AND METHODS A total of 60 clinical isolates (28 sputum, 7 bronchoalveolar lavage, 7 cerebrospinal fluid, 3 gastric aspirates, 5 urine, 4 pleural fluid and 6 other specimens) of M. tuberculosis were tested for susceptibility to streptomycin (SM), isoniazid (INH), ethambutol (EMB) and rifampin (RIF). MOP was carried out according to National Committe for Clinical Laboratory Standards (NCCLS) on Löwenstein-Jensen medium. MGIT susceptibility testing was performed according to the protocol provided by the manufacturer. RESULTS Resistance was detected in 18.3% and 16.7% of the isolates for INH, 13.3% and 10.0% for RIF, 16.7% and 11.7% for SM and 6.7% and 8.3% for EMB by MOP and MGIT, respectively. CONCLUSION MOP remains the method of choice, however, the correlation between MOP and MGIT suggested that MGIT can also be used routinely and that it is a reliable method for testing susceptibility of M. tuberculosis strains to first-line anti-tuberculosis drugs.
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Affiliation(s)
- Ayse Esin Aktas
- Department of Medical Microbiology, Ataturk University Faculty of Medicine, Erzurum, Turkey
| | - Nimet Yigit
- Department of Medical Laboratory, Ataturk University, Health Services Vocational School, Erzurum, Turkey
| | - Ahmet Ayyildiz
- Department of Medical Microbiology, Ataturk University Faculty of Medicine, Erzurum, Turkey
| | - Ayse Bastopcu
- Department of Medical Microbiology, Ataturk University Faculty of Medicine, Erzurum, Turkey
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Sarmiento JMH, Restrepo NB, Mejía GI, Zapata E, Restrepo MA, Robledo J. Rapid diagnosis of pulmonary tuberculosis. Pan Afr Med J 2014; 18:141. [PMID: 25419279 PMCID: PMC4236790 DOI: 10.11604/pamj.2014.18.141.2295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 12/18/2012] [Accepted: 05/02/2014] [Indexed: 11/30/2022] Open
Abstract
Introduction World Health Organization had estimated 9.4 million tuberculosis cases on 2009, with 1.7 million of deaths as consequence of treatment and diagnosis failures. Improving diagnostic methods for the rapid and timely detection of tuberculosis patients is critical to control the disease. The aim of this study was evaluating the accuracy of the cord factor detection on the solid medium Middlebrook 7H11 thin layer agar compared to the Lowenstein Jensen medium for the rapid tuberculosis diagnosis. Methods Patients with suspected tuberculosis were enrolled and their sputum samples were processed for direct smear and culture on Lowenstein Jensen and BACTEC MGIT 960, from which positive tubes were subcultured on Middlebrook 7H11 thin layer agar. Statistical analysis was performed comparing culture results from Lowenstein Jensen and the thin layer agar, and their corresponding average times for detecting Mycobacterium tuberculosis. The performance of cord factor detection was evaluated determining its sensitivity, specificity, positive and negative predictive value. Results 111 out of 260 patients were positive for M. tuberculosis by Lowenstein Jensen medium with an average time ± standard deviation for its detection of 22.3 ± 8.5 days. 115 patients were positive by the MGIT system identifying the cord factor by the Middlebrook 7H11 thin layer agar which average time ± standard deviation was 5.5 ± 2.6 days. Conclusion The cord factor detection by Middlebrook 7H11 thin layer agar allows early and accurate tuberculosis diagnosis during an average time of 5 days, making this rapid diagnosis particularly important in patients with negative sputum smear.
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Affiliation(s)
- José Mauricio Hernández Sarmiento
- School of Health Sciences, Universidad Pontificia Bolivariana (UPB), Medellín, Colombia ; Bacteriology and Mycobacteriology Unit, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia
| | - Natalia Builes Restrepo
- Bacteriology and Mycobacteriology Unit, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia
| | - Gloria Isabel Mejía
- School of Health Sciences, Universidad Pontificia Bolivariana (UPB), Medellín, Colombia ; Bacteriology and Mycobacteriology Unit, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia
| | - Elsa Zapata
- Bacteriology and Mycobacteriology Unit, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia
| | - Mary Alejandra Restrepo
- Bacteriology and Mycobacteriology Unit, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia
| | - Jaime Robledo
- School of Health Sciences, Universidad Pontificia Bolivariana (UPB), Medellín, Colombia ; Bacteriology and Mycobacteriology Unit, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia
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22
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Cambau E, Viveiros M, Machado D, Raskine L, Ritter C, Tortoli E, Matthys V, Hoffner S, Richter E, Perez Del Molino ML, Cirillo DM, van Soolingen D, Böttger EC. Revisiting susceptibility testing in MDR-TB by a standardized quantitative phenotypic assessment in a European multicentre study. J Antimicrob Chemother 2014; 70:686-96. [PMID: 25587993 DOI: 10.1093/jac/dku438] [Citation(s) in RCA: 73] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Treatment outcome of MDR-TB is critically dependent on the proper use of second-line drugs as per the result of in vitro drug susceptibility testing (DST). We aimed to establish a standardized DST procedure based on quantitative determination of drug resistance and compared the results with those of genotypes associated with drug resistance. METHODS The protocol, based on MGIT 960 and the TB eXiST software, was evaluated in nine European reference laboratories. Resistance detection at a screening drug concentration was followed by determination of resistance levels and estimation of the resistance proportion. Mutations in 14 gene regions were investigated using established techniques. RESULTS A total of 139 Mycobacterium tuberculosis isolates from patients with MDR-TB and resistance beyond MDR-TB were tested for 13 antituberculous drugs: isoniazid, rifampicin, rifabutin, ethambutol, pyrazinamide, streptomycin, para-aminosalicylic acid, ethionamide, amikacin, capreomycin, ofloxacin, moxifloxacin and linezolid. Concordance between phenotypic and genotypic resistance was >80%, except for ethambutol. Time to results was short (median 10 days). High-level resistance, which precludes the therapeutic use of an antituberculous drug, was observed in 49% of the isolates. The finding of a low or intermediate resistance level in 16% and 35% of the isolates, respectively, may help in designing an efficient personalized regimen for the treatment of MDR-TB patients. CONCLUSIONS The automated DST procedure permits accurate and rapid quantitative resistance profiling of first- and second-line antituberculous drugs. Prospective validation is warranted to determine the impact on patient care.
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Affiliation(s)
- E Cambau
- AP-HP, Hôpital Lariboisière, Service de Bactériologie, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux; IAME UMR1137, INSERM, Université Paris Diderot, 75010 Paris, France
| | - M Viveiros
- Grupo de Micobactérias, Unidade de Microbiologia Médica, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa (IHMT/UNL), Rua da Junqueira 100, 1349-008 Lisboa, Portugal
| | - D Machado
- Grupo de Micobactérias, Unidade de Microbiologia Médica, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa (IHMT/UNL), Rua da Junqueira 100, 1349-008 Lisboa, Portugal
| | - L Raskine
- AP-HP, Hôpital Lariboisière, Service de Bactériologie, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux; IAME UMR1137, INSERM, Université Paris Diderot, 75010 Paris, France
| | - C Ritter
- Institut für Medizinische Mikrobiologie, Nationales Zentrum für Mykobakterien, Universität Zürich, Zürich, Switzerland
| | - E Tortoli
- IRCCS San Raffaele Scientific Institute, Emerging Bacterial Pathogens Unit Supranational Reference Laboratory, via Olgettina 60, 20132 Milan, Italy
| | - V Matthys
- National Reference Centre of Tuberculosis and Mycobacteria, Communicable and Infectious Diseases, Scientific Institute of Public Health (WIV-ISP), Brussels, Belgium
| | - S Hoffner
- Department of Microbiology, Public Health Agency of Sweden and Department of Microbiology, Cell and Tumor Biology, Karolinska Institute, Stockholm, Sweden
| | - E Richter
- National Reference Center for Mycobacteria, Forschungszentrum Borstel, Borstel, Germany
| | - M L Perez Del Molino
- Servicio de Microbiología, CH Universitario de Santiago, Centro de Referencia de Micobacterias de Galicia, Choupana S/N, 15705 Santiago de Compostela, Spain
| | - D M Cirillo
- IRCCS San Raffaele Scientific Institute, Emerging Bacterial Pathogens Unit Supranational Reference Laboratory, via Olgettina 60, 20132 Milan, Italy
| | - D van Soolingen
- Tuberculosis Reference Laboratory, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA Bilthoven, The Netherlands Department of Pulmonary Diseases/Department of Clinical Microbiology, Radboud University Medical Centre, PO Box 9101, Nijmegen, The Netherlands
| | - E C Böttger
- Institut für Medizinische Mikrobiologie, Nationales Zentrum für Mykobakterien, Universität Zürich, Zürich, Switzerland
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23
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Salgado M, Verdugo C, Heuer C, Castillo P, Zamorano P. A novel low-cost method for Mycobacterium avium subsp. paratuberculosis DNA extraction from an automated broth culture system for real-time PCR analysis. J Vet Sci 2013; 15:233-9. [PMID: 24136213 PMCID: PMC4087225 DOI: 10.4142/jvs.2014.15.2.233] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [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: 03/25/2013] [Accepted: 08/14/2013] [Indexed: 11/20/2022] Open
Abstract
PCR is a highly accurate technique for confirming the presence of Mycobacterium avium subsp. paratuberculosis (Map) in broth culture. In this study, a simple, efficient, and low-cost method of harvesting DNA from Map cultured in liquid medium was developed. The proposed protocol (Universidad Austral de Chile [UACH]) was evaluated by comparing its performance to that of two traditional techniques (a QIAamp DNA Stool Mini Kit and cethyltrimethylammonium bromide [CTAB] method). The results were statistically assessed by agreement analysis for which differences in the number of cycles to positive (CP) were compared by Student's t-test for paired samples and regression analysis. Twelve out of 104 fecal pools cultured were positive. The final PCR results for 11 samples analyzed with the QIAamp and UACH methods or ones examined with the QIAamp and CTAB methods were in agreement. Complete (100%) agreement was observed between data from the CTAB and UACH methods. CP values for the UACH and CTAB techniques were not significantly different, while the UACH method yielded significantly lower CP values compared to the QIAamp kit. The proposed extraction method combines reliability and efficiency with simplicity and lower cost.
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Affiliation(s)
- Miguel Salgado
- Department of Biochemistry and Microbiology, Faculty of Sciences, Austral University of Chile, Valdivia, Chile.
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Walusimbi S, Bwanga F, Costa AD, Haile M, Hoffner S, Joloba M. Evaluation of the Xpert® MTB/Rif test, microscopic observation drug susceptibility test and nitrate reductase assay, for rapid and accurate diagnosis of smear-negative tuberculosis in HIV patients. Int J Mycobacteriol 2013; 2:148-55. [PMID: 26785983 DOI: 10.1016/j.ijmyco.2013.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 06/23/2013] [Indexed: 10/26/2022] Open
Abstract
Diagnosis of smear-negative tuberculosis (TB), which is frequently seen in HIV-infected patients, is a challenge without conventional culture methods. Since 2007, the WHO (World Health Organization) has endorsed new or improved tests for increased and rapid diagnosis of TB. This study was undertaken in an effort to evaluate the accuracy of two rapid culture methods: the Microscopic Observation Drug Susceptibility assay (MODS) and Nitrate Reductase Assay (NRA), and the molecular based test Xpert® MTB/Rif (Xpert), for diagnosis of smear-negative TB in HIV patients using the mycobacteria growth indicator tube (MGIT) in the BACTEC(TM) MGIT(TM) 960 system as the reference test. 430 smear-negative patients with presumptive TB were enrolled in a cross-sectional study at a tertiary care facility in Uganda. Their sputum was tested on MODS, NRA, Xpert and MGIT. Of the 430 patients, 373 had complete results to compute test accuracy. Mycobacterium tuberculosis (MTB) was detected in 43 patients by MGIT. The sensitivity and specificity were 24.4% and 98.1% for MODS, 41.5% and 92% for NRA, 48.8% and 95.1% for Xpert, respectively. The low sensitivity of the tests implies that additional diagnostics such as chest X-ray and conventional liquid culture methods might still be needed to detect TB in smear-negative HIV patients. The high specificity of the tests is useful to confirm TB in HIV patients with symptoms suggestive of TB.
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Affiliation(s)
- Simon Walusimbi
- Department of Medical Microbiology, Makerere University, College of Health Sciences, Kampala, Uganda; Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
| | - Freddie Bwanga
- Department of Medical Microbiology, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Ayesha De Costa
- Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
| | - Melles Haile
- Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden; Department of Diagnostics and Vaccinology, Swedish Institute for Communicable Disease Control, Solna, Sweden.
| | - Sven Hoffner
- Department of Diagnostics and Vaccinology, Swedish Institute for Communicable Disease Control, Solna, Sweden; Department of Microbiology, Tumor and Cell Biology (MTC), Karolinska Institute, Stockholm, Sweden
| | - Moses Joloba
- Department of Medical Microbiology, Makerere University, College of Health Sciences, Kampala, Uganda
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