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Huddart S, Asege L, Jaganath D, Golla M, Dang H, Lovelina L, Derendinger B, Andama A, Christopher DJ, Nhung NV, Theron G, Denkinger CM, Nahid P, Cattamanchi A, Yu C. Continuous cough monitoring: a novel digital biomarker for TB diagnosis and treatment response monitoring. Int J Tuberc Lung Dis 2023; 27:221-222. [PMID: 36855045 PMCID: PMC9983626 DOI: 10.5588/ijtld.22.0511] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 10/20/2022] [Indexed: 03/02/2023] Open
Affiliation(s)
- S Huddart
- UCSF Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA, Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
| | - L Asege
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - D Jaganath
- UCSF Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA, Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
| | - M Golla
- De La Salle Medical and Health Sciences Institute, Center for Tuberculosis Research, City of Dasmariñas, Cavite, The Philippines
| | - H Dang
- Hanoi Lung Hospital, Hanoi, Vietnam
| | - L Lovelina
- Department of Pulmonary Medicine, Christian Medical College, Vellore, India
| | - B Derendinger
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, and SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - A Andama
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - D J Christopher
- Department of Pulmonary Medicine, Christian Medical College, Vellore, India
| | - N V Nhung
- Vietnam National Tuberculosis Control Program, Hanoi, Vietnam
| | - G Theron
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, and SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - C M Denkinger
- Division of Infectious Diseases and Tropical Medicine, Center of Infectious Diseases, Heidelberg University, Heidelberg, Germany, German Center for Infection Research (DZIF), Heidelberg University Hospital Partner Site, Heidelberg, Germany
| | - P Nahid
- UCSF Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA, Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
| | - A Cattamanchi
- UCSF Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA, Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
| | - C Yu
- De La Salle Medical and Health Sciences Institute, Center for Tuberculosis Research, City of Dasmariñas, Cavite, The Philippines
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Andama A, Jaganath D, Crowder R, Asege L, Nakaye M, Katumba D, Mukwatamundu J, Mwebe S, Semitala CF, Worodria W, Joloba M, Mohanty S, Somoskovi A, Cattamanchi A. The transition to Xpert MTB/RIF ultra: diagnostic accuracy for pulmonary tuberculosis in Kampala, Uganda. BMC Infect Dis 2021; 21:49. [PMID: 33430790 PMCID: PMC7802232 DOI: 10.1186/s12879-020-05727-8] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 12/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The World Health Organization (WHO) has endorsed the next-generation Xpert MTB/RIF Ultra (Ultra) cartridge, and Uganda is currently transitioning from the older generation Xpert MTB/RIF (Xpert) cartridge to Ultra as the initial diagnostic test for pulmonary tuberculosis (TB). We assessed the diagnostic accuracy of Ultra for pulmonary TB among adults in Kampala, Uganda. METHODS We sampled adults referred for Xpert testing at two hospitals and a health center over a 12-month period. We enrolled adults with positive Xpert and a random 1:1 sample with negative Xpert results. Expectorated sputum was collected for Ultra, and for solid and liquid culture testing for Xpert-negative patients. We measured sensitivity and specificity of Ultra overall and by HIV status, prior history of TB, and hospitalization, in reference to Xpert and culture results. We also assessed how classification of results in the new "trace" category affects Ultra accuracy. RESULTS Among 698 participants included, 211 (30%) were HIV-positive and 336 (48%) had TB. The sensitivity of Ultra was 90.5% (95% CI 86.8-93.4) and specificity was 98.1% (95% CI 96.1-99.2). There were no significant differences in sensitivity and specificity by HIV status, prior history of TB or hospitalization. Xpert and Ultra results were concordant in 670 (96%) participants, with Ultra having a small reduction in specificity (difference 1.9, 95% CI 0.2 to 3.6, p=0.01). When "trace" results were considered positive for all patients, sensitivity increased by 2.1% (95% CI 0.3 to 3.9, p=0.01) without a significant reduction in specificity (- 0.8, 95% CI - 0.3 to 2.0, p=0.08). CONCLUSIONS After 1 year of implementation, Ultra had similar performance to Xpert. Considering "trace" results to be positive in all patients increased case detection without significant loss of specificity. Longitudinal studies are needed to compare the benefit of greater diagnoses to the cost of overtreatment.
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Affiliation(s)
- A Andama
- Department of Internal Medicine, Makerere University College of Health Sciences, Ground Floor Pathology Building, Room A4, Kampala, Uganda. .,Infectious Diseases Research Collaboration, Kampala, Uganda.
| | - D Jaganath
- Department of Medicine, Division of Pulmonary & Critical Care Medicine, University of California San Francisco, San Francisco, California, USA.,Center for Tuberculosis, University of California San Francisco, San Francisco, California, USA.,Department of Pediatrics, Division of Pediatric Infectious Diseases, University of California San Francisco, San Francisco, California, USA
| | - R Crowder
- Department of Medicine, Division of Pulmonary & Critical Care Medicine, University of California San Francisco, San Francisco, California, USA.,Center for Tuberculosis, University of California San Francisco, San Francisco, California, USA
| | - L Asege
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - M Nakaye
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - D Katumba
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - J Mukwatamundu
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - S Mwebe
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - C F Semitala
- Department of Internal Medicine, Makerere University College of Health Sciences, Ground Floor Pathology Building, Room A4, Kampala, Uganda.,Infectious Diseases Research Collaboration, Kampala, Uganda
| | - W Worodria
- Department of Internal Medicine, Makerere University College of Health Sciences, Ground Floor Pathology Building, Room A4, Kampala, Uganda.,Mulago National Referral Hospital, Kampala, Uganda
| | - M Joloba
- Department of Medical Microbiology, Makerere University College of Health Sciences, Kampala, Uganda
| | - S Mohanty
- Department of Chemical Engineering, Department of Materials Science Engineering, University of Utah, Salt Lake City, USA
| | - A Somoskovi
- Global Good Intellectual Ventures Laboratory, Seattle, USA
| | - A Cattamanchi
- Department of Medicine, Division of Pulmonary & Critical Care Medicine, University of California San Francisco, San Francisco, California, USA.,Center for Tuberculosis, University of California San Francisco, San Francisco, California, USA.,Center for Vulnerable Populations, Department of Medicine, University of California San Francisco, San Francisco, USA.,Curry International Tuberculosis Center, University of California San Francisco, San Francisco, USA
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Andama A, Jaganath D, Crowder R, Asege L, Nakaye M, Katumba D, Mwebe S, Semitala F, Worodria W, Joloba M, Mohanty S, Somoskovi A, Cattamanchi A. Accuracy and incremental yield of urine Xpert MTB/RIF Ultra versus Determine TB-LAM for diagnosis of pulmonary tuberculosis. Diagn Microbiol Infect Dis 2019; 96:114892. [PMID: 31727376 DOI: 10.1016/j.diagmicrobio.2019.114892] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 05/21/2019] [Revised: 08/09/2019] [Accepted: 08/29/2019] [Indexed: 02/07/2023]
Abstract
The performance of urine Xpert MTB/RIF Ultra (Xpert Ultra) for pulmonary TB diagnosis is unknown. HIV-positive and HIV-negative adults were enrolled at two health facilities in Kampala, Uganda. We compared the accuracy of urine Xpert Ultra and Determine TB-LAM in reference to sputum-based testing (positive Xpert MTB/RIF or culture), and assessed incremental yield. Urine Xpert Ultra had low sensitivity (17.2%, 95% CI 12.3-23.2) but high specificity (98.1%, 95% CI 94.4-99.6). Sensitivity reached 50.0% (95% CI 28.2-71.8) among HIV-positive patients with CD4 <100 cells/μL. Compared to Determine TB-LAM, urine Xpert Ultra was 9.4% (95% CI 3.8-14.9, P = 0.01) more sensitive, and 17.2% (95% CI 4.5-29.8, P = 0.01) more sensitive among HIV-positive patients. However, the incremental sensitivity of urine Xpert Ultra relative to sputum Xpert MTB/RIF was only 1% (95% CI -0.9 to 2.8). Urine Xpert Ultra could be an alternative for patients with advanced HIV infection unable to produce sputum.
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Affiliation(s)
- A Andama
- Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Infectious Diseases Research Collaboration, Kampala, Uganda.
| | - D Jaganath
- University of California, San Francisco, Department of Medicine, Division of Pulmonary & Critical Care Medicine, San Francisco, California, USA; University of California, San Francisco, Department of Pediatrics, Division of Pediatric Infectious Diseases, San Francisco, California, USA; Center for Tuberculosis, University of California, San Francisco, San Francisco, California, USA
| | - R Crowder
- University of California, San Francisco, Department of Medicine, Division of Pulmonary & Critical Care Medicine, San Francisco, California, USA; Center for Tuberculosis, University of California, San Francisco, San Francisco, California, USA
| | - L Asege
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - M Nakaye
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - D Katumba
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - S Mwebe
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - F Semitala
- Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Infectious Diseases Research Collaboration, Kampala, Uganda
| | - W Worodria
- Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Mulago National Referral Hospital, Kampala, Uganda
| | - M Joloba
- Department of Medical Microbiology, Makerere University College of Health Sciences, Kampala, Uganda
| | - S Mohanty
- University of Utah, Department of Metallurgical Engineering, Department of Chemical Engineering, Salt Lake City, USA
| | - A Somoskovi
- Global Good Intellectual Ventures Laboratory, Seattle, USA
| | - A Cattamanchi
- University of California, San Francisco, Department of Medicine, Division of Pulmonary & Critical Care Medicine, San Francisco, California, USA; Center for Tuberculosis, University of California, San Francisco, San Francisco, California, USA; Center for Vulnerable Populations, Department of Medicine, University of California, San Francisco, USA; Curry International Tuberculosis Center, University of California, San Francisco, USA
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