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Mani V, Wang S, Inci F, De Libero G, Singhal A, Demirci U. Emerging technologies for monitoring drug-resistant tuberculosis at the point-of-care. Adv Drug Deliv Rev 2014; 78:105-17. [PMID: 24882226 DOI: 10.1016/j.addr.2014.05.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 04/29/2014] [Accepted: 05/25/2014] [Indexed: 01/18/2023]
Abstract
Infectious diseases are the leading cause of death worldwide. Among them, tuberculosis (TB) remains a major threat to public health, exacerbated by the emergence of multiple drug-resistant (MDR) and extensively drug-resistant (XDR) Mycobacterium tuberculosis (Mtb). MDR-Mtb strains are resistant to first-line anti-TB drugs such as isoniazid and rifampicin; whereas XDR-Mtb strains are resistant to additional drugs including at least to any fluoroquinolone and one of the second-line anti-TB injectable drugs such as kanamycin, capreomycin, or amikacin. Clinically, these strains have significantly impacted the management of TB in high-incidence developing countries, where systemic surveillance of TB drug resistance is lacking. For effective management of TB on-site, early detection of drug resistance is critical to initiate treatment, to reduce mortality, and to thwart drug-resistant TB transmission. In this review, we discuss the diagnostic challenges to detect drug-resistant TB at the point-of-care (POC). Moreover, we present the latest advances in nano/microscale technologies that can potentially detect TB drug resistance to improve on-site patient care.
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252
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Standardization of Nucleic Acid Tests for Clinical Measurements of Bacteria and Viruses. J Clin Microbiol 2014; 53:2008-14. [PMID: 25392365 DOI: 10.1128/jcm.02136-14] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Nucleic acid-based tests for infectious diseases currently used in the clinical laboratory and in point-of-care devices are diverse. Measurement challenges associated with standardization of quantitative viral load testing are discussed in relation to human cytomegalovirus, BK virus, and Epstein-Barr virus, while the importance of defining the performance of qualitative methods is illustrated with Mycobacterium tuberculosis and influenza virus. The development of certified reference materials whose values are traceable to higher-order standards and reference measurement procedures, using, for instance, digital PCR, will further contribute to the understanding of analytical performance characteristics and promote clinical data comparability.
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253
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Abstract
Genomics research has enabled crucial insights into the adaptive evolution of Mycobacterium tuberculosis as an obligate human pathogen. Here, we highlight major recent advances and evaluate the potential for genomics approaches to inform tuberculosis control efforts in high-burden settings.
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254
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A feasibility study of the Xpert MTB/RIF test at the peripheral level laboratory in China. Int J Infect Dis 2014; 31:41-6. [PMID: 25447720 DOI: 10.1016/j.ijid.2014.09.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 08/28/2014] [Accepted: 09/20/2014] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To evaluate the performance of Xpert MTB/RIF (MTB/RIF) in the county-level tuberculosis (TB) laboratory in China. METHODS From April 2011 to January 2012, patients with suspected multidrug-resistant tuberculosis (MDR-TB) and non-MDR-TB were enrolled consecutively from four county-level TB laboratories. The detection of Mycobacterium tuberculosis (MTB) by MTB/RIF was compared to detection by Löwenstein-Jensen culture. The detection of rifampin resistance was compared to detection by conventional drug-susceptibility testing. The impact of multiple specimens on the performance of MTB/RIF was also evaluated. RESULTS A total of 2142 suspected non-MDR-TB cases and 312 suspected MDR-TB cases were enrolled. For MTB detection in suspected non-MDR-TB cases, the sensitivity and specificity of MTB/RIF were 94.4% and 90.2%, respectively. The sensitivity in smear-negative patients was 88.8%. For the detection of rifampin resistance in suspected non-MDR-TB cases, the sensitivity and specificity of MTB/RIF were 87.1% and 97.9%, respectively. For the detection of rifampin resistance in suspected MDR-TB cases, the sensitivity and specificity of MTB/RIF were 87.1% and 91.0%, respectively. Using multiple sputum specimens had no significant influence on the performance of MTB/RIF for MTB detection. CONCLUSIONS The introduction of MTB/RIF could increase the accuracy of detection of MTB and rifampin resistance in peripheral-level TB laboratories in China. One single specimen is adequate for TB diagnosis by MTB/RIF.
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255
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Gonzalez JM, Francis B, Burda S, Hess K, Behera D, Gupta D, Agarwal AN, Verma I, Verma A, Myneedu VP, Niedbala S, Laal S. Development of a POC test for TB based on multiple immunodominant epitopes of M. tuberculosis specific cell-wall proteins. PLoS One 2014; 9:e106279. [PMID: 25247820 PMCID: PMC4172486 DOI: 10.1371/journal.pone.0106279] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 07/29/2014] [Indexed: 11/30/2022] Open
Abstract
The need for an accurate, rapid, simple and affordable point-of-care (POC) test for Tuberculosis (TB) that can be implemented in microscopy centers and other peripheral health-care settings in the TB-endemic countries remains unmet. This manuscript describes preliminary results of a new prototype rapid lateral flow TB test based on detection of antibodies to immunodominant epitopes (peptides) derived from carefully selected, highly immunogenic M. tuberculosis cell-wall proteins. Peptide selection was initially based on recognition by antibodies in sera from TB patients but not in PPD-/PPD+/BCG-vaccinated individuals from TB-endemic settings. The peptides were conjugated to BSA; the purified peptide-BSA conjugates striped onto nitrocellulose membrane and adsorbed onto colloidal gold particles to devise the prototype test, and evaluated for reactivity with sera from 3 PPD-, 29 PPD+, 15 PPD-unknown healthy subjects, 10 patients with non-TB lung disease and 124 smear-positive TB patients. The assay parameters were adjusted to determine positive/negative status within 15 minutes via visual or instrumented assessment. There was minimal or no reactivity of sera from non-TB subjects with the striped BSA-peptides demonstrating the lack of anti-peptide antibodies in subjects with latent TB and/or BCG vaccination. Sera from most TB patients demonstrated reactivity with one or more peptides. The sensitivity of antibody detection ranged from 28–85% with the 9 BSA-peptides. Three peptides were further evaluated with sera from 400 subjects, including additional PPD-/PPD+/PPD-unknown healthy contacts, close hospital contacts and household contacts of untreated TB patients, patients with non-TB lung disease, and HIV+TB- patients. Combination of the 3 peptides provided sensitivity and specificity>90%. While the final fully optimized lateral flow POC test for TB is under development, these preliminary results demonstrate that an antibody-detection based rapid POC lateral flow test based on select combinations of immunodominant M. tb-specific epitopes may potentially replace microscopy for TB diagnosis in TB-endemic settings.
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Affiliation(s)
- Jesus M. Gonzalez
- Department of Chemistry, Lehigh University, Bethlehem, Pennsylvania, United States of America
| | - Bryan Francis
- TB Biosciences, Bethlehem, Pennsylvania, United States of America
| | - Sherri Burda
- Department of Pathology, New York University Langone Medical Center, New York, NewYork, United States of America
| | - Kaitlyn Hess
- Department of Chemistry, Lehigh University, Bethlehem, Pennsylvania, United States of America
| | - Digamber Behera
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Dheeraj Gupta
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Indu Verma
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajoy Verma
- National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | | | - Sam Niedbala
- Department of Chemistry, Lehigh University, Bethlehem, Pennsylvania, United States of America
- TB Biosciences, Bethlehem, Pennsylvania, United States of America
| | - Suman Laal
- Department of Pathology, New York University Langone Medical Center, New York, NewYork, United States of America
- Veterans Affairs New York Harbor Healthcare System, New York, New York, United States of America
- * E-mail:
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256
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Wikman-Jorgensen P, Llenas-García J, Hobbins M, Ehmer J, Abellana R, Gonçalves AQ, Pérez-Porcuna TM, Ascaso C. Microscopic observation drug susceptibility assay for the diagnosis of TB and MDR-TB in HIV-infected patients: a systematic review and meta-analysis. Eur Respir J 2014; 44:973-84. [PMID: 25186265 DOI: 10.1183/09031936.00079614] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The objective of the present study was to assess the diagnostic accuracy of the microscopic observation drug susceptibility (MODS) assay for tuberculosis (TB) diagnosis in HIV-infected patients. MEDLINE, EMBASE, LILACS, the Cochrane Central Register of Controlled Trials, African Index Medicus, ResearchGate, SciELO, and the abstracts of the main conferences on infectious diseases and tropical medicine were searched, and other sources investigated. Only studies including HIV-infected patients evaluating MODS for the diagnosis of TB and using culture-based diagnostic tests as a gold standard were analysed. Summary sensitivity and specificity were calculated with a bivariate model. 3259 citations were found, 29 were selected for full-text review and 10 studies including 3075 samples were finally analysed. Overall diagnostic accuracy of MODS for the diagnosis of TB was a sensitivity of 88.3% (95% CI 86.18-90.2%) and specificity 98.2% (95% CI 97.75-98.55%). For multidrug-resistant (MDR)-TB, sensitivity was 89% (95% CI 66.07-97%) and specificity was 100% (95 CI 94.81-100%). For smear-negative pulmonary TB, a sensitivity of 88.2% (95% CI 86.1-89.9%) and specificity of 98.2% (95% CI 96.8-98.9%) were found. Costs varied between USD 0.72 and 7.31 per sample. Mean time to positivity was 8.24 days. MODS was found to have a good accuracy for the diagnosis of TB and MDR-TB in HIV-infected patients with low cost and fast results.
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Affiliation(s)
- Philip Wikman-Jorgensen
- SolidarMed Mozambique, Pemba, Mozambique University of Barcelona, Dept of Public Health, Barcelona, Spain
| | | | | | | | - Rosa Abellana
- University of Barcelona, Dept of Public Health, Barcelona, Spain
| | | | - Tomàs Maria Pérez-Porcuna
- University of Barcelona, Dept of Public Health, Barcelona, Spain Pediathrics department, CAP Valldoreix, Research Unit, Mútua Terrassa Foundation, Mútua Terrassa University Hospital, Terrassa, Spain
| | - Carlos Ascaso
- University of Barcelona, Dept of Public Health, Barcelona, Spain
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Zumla A, Al-Tawfiq JA, Enne VI, Kidd M, Drosten C, Breuer J, Muller MA, Hui D, Maeurer M, Bates M, Mwaba P, Al-Hakeem R, Gray G, Gautret P, Al-Rabeeah AA, Memish ZA, Gant V. Rapid point of care diagnostic tests for viral and bacterial respiratory tract infections--needs, advances, and future prospects. THE LANCET. INFECTIOUS DISEASES 2014; 14:1123-1135. [PMID: 25189349 PMCID: PMC7106435 DOI: 10.1016/s1473-3099(14)70827-8] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Respiratory tract infections rank second as causes of adult and paediatric morbidity and mortality worldwide. Respiratory tract infections are caused by many different bacteria (including mycobacteria) and viruses, and rapid detection of pathogens in individual cases is crucial in achieving the best clinical management, public health surveillance, and control outcomes. Further challenges in improving management outcomes for respiratory tract infections exist: rapid identification of drug resistant pathogens; more widespread surveillance of infections, locally and internationally; and global responses to infections with pandemic potential. Developments in genome amplification have led to the discovery of several new respiratory pathogens, and sensitive PCR methods for the diagnostic work-up of these are available. Advances in technology have allowed for development of single and multiplexed PCR techniques that provide rapid detection of respiratory viruses in clinical specimens. Microarray-based multiplexing and nucleic-acid-based deep-sequencing methods allow simultaneous detection of pathogen nucleic acid and multiple antibiotic resistance, providing further hope in revolutionising rapid point of care respiratory tract infection diagnostics.
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Affiliation(s)
- Alimuddin Zumla
- Division of Infection and Immunity, University College London, London, UK; NIHR Biomedical Research Center, University College London Hospitals, London, UK; Department of Medical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK; Global Center for Mass Gatherings Medicine, Ministry of Health, Riyadh, Kingdom of Saudi Arabia; UNZA-UCLMS Research and Training Project, University Teaching Hospital, Lusaka, Zambia.
| | | | - Virve I Enne
- Division of Infection and Immunity, University College London, London, UK
| | - Mike Kidd
- Division of Infection and Immunity, University College London, London, UK; Department of Medical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Christian Drosten
- Institute of Virology, University of Bonn Medical Centre, Bonn, Germany
| | - Judy Breuer
- Division of Infection and Immunity, University College London, London, UK; NIHR Biomedical Research Center, University College London Hospitals, London, UK; Department of Medical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Marcel A Muller
- Institute of Virology, University of Bonn Medical Centre, Bonn, Germany
| | - David Hui
- Division of Respiratory Medicine and Stanley Ho Center for emerging Infectious Diseases, The Chinese University of Hong Kong, Prince of Wales Hospital, New Territories, Hong Kong
| | - Markus Maeurer
- Therapeutic Immunology, Departments of Laboratory Medicine and Microbiology, Tumour and Cell Biology, Karolinska Institute, Stockholm, Sweden
| | - Matthew Bates
- Division of Infection and Immunity, University College London, London, UK; UNZA-UCLMS Research and Training Project, University Teaching Hospital, Lusaka, Zambia
| | - Peter Mwaba
- UNZA-UCLMS Research and Training Project, University Teaching Hospital, Lusaka, Zambia
| | - Rafaat Al-Hakeem
- Global Center for Mass Gatherings Medicine, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Gregory Gray
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Philippe Gautret
- Assistance Publique Hôpitaux de Marseille, CHU Nord, Pôle Infectieux, Institut Hospitalo-Universitaire Méditerranée Infection & Aix Marseille Université, Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes (URMITE), Marseille, France
| | - Abdullah A Al-Rabeeah
- Global Center for Mass Gatherings Medicine, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Ziad A Memish
- Global Center for Mass Gatherings Medicine, Ministry of Health, Riyadh, Kingdom of Saudi Arabia; Al-Faisal University, Riyadh, Saudi Arabia
| | - Vanya Gant
- Department of Medical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK
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258
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Lyra JMAD, Maruza M, Verza M, Carneiro MM, Albuquerque MDFMD, Rossetti ML, Ximenes R, Braga MC, Lucena-Silva N. Evaluation of four molecular methods for the diagnosis of tuberculosis in pulmonary and blood samples from immunocompromised patients. Mem Inst Oswaldo Cruz 2014; 109:805-13. [PMID: 25317709 PMCID: PMC4238774 DOI: 10.1590/0074-0276130542] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 06/20/2014] [Indexed: 11/21/2022] Open
Abstract
The present study analysed the concordance among four different molecular diagnostic
methods for tuberculosis (TB) in pulmonary and blood samples from immunocompromised
patients. A total of 165 blood and 194 sputum samples were collected from 181 human
immunodeficiency virus (HIV)-infected patients with upper respiratory complaints,
regardless of suspicious for TB. The samples were submitted for smear microscopy,
culture and molecular tests: a laboratory-developed conventional polymerase chain
reaction (PCR) and real-time quantitative PCR (qPCR) and the Gen-Probe and Detect-TB
Ampligenix kits. The samples were handled blindly by all the technicians involved,
from sample processing to results analysis. For sputum, the sensitivity and
specificity were 100% and 96.7% for qPCR, 81.8% and 94.5% for Gen-Probe and 100% and
66.3% for Detect-TB, respectively. qPCR presented the best concordance with sputum
culture [kappa (k) = 0.864)], followed by Gen-Probe (k = 0.682). For blood samples,
qPCR showed 100% sensitivity and 92.3% specificity, with a substantial correlation
with sputum culture (k = 0.754) and with the qPCR results obtained from sputum of the
corresponding patient (k = 0.630). Conventional PCR demonstrated the worst results
for sputa and blood, with a sensitivity of 100% vs. 88.9% and a specificity of 46.3%
vs. 32%, respectively. Commercial or laboratory-developed molecular assays can
overcome the difficulties in the diagnosis of TB in paucibacillary patients using
conventional methods available in most laboratories.
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Affiliation(s)
| | - Magda Maruza
- Hospital Correia Picanço, Secretaria do Estado de Pernambuco, Recife, PE, Brasil
| | - Mirela Verza
- Fundação Estadual de Produção e Pesquisa em Saúde, Porto Alegre, RS, Brasil
| | | | | | | | - Ricardo Ximenes
- Departamento de Medicina Tropical, Universidade Federal de Pernambuco, Recife, PE, Brasil
| | - Maria Cynthia Braga
- Departamento de Parasitologia, Centro de Pesquisas Aggeu Magalhães-Fiocruz, Recife, PE, Brasil
| | - Norma Lucena-Silva
- Departamento de Imunologia, Centro de Pesquisas Aggeu Magalhães-Fiocruz, Recife, PE, Brasil
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259
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Marquez C, Davis JL, Katamba A, Haguma P, Ochom E, Ayakaka I, Chamie G, Dorsey G, Kamya MR, Charlebois E, Havlir DV, Cattamanchi A. Assessing the quality of tuberculosis evaluation for children with prolonged cough presenting to routine community health care settings in rural Uganda. PLoS One 2014; 9:e105935. [PMID: 25170875 PMCID: PMC4149493 DOI: 10.1371/journal.pone.0105935] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 07/28/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Improving childhood tuberculosis (TB) evaluation and care is a global priority, but data on performance at community health centers in TB endemic regions are sparse. OBJECTIVE To describe the current practices and quality of TB evaluation for children with cough ≥2 weeks' duration presenting to community health centers in Uganda. METHODS Cross-sectional analysis of children (<15 years) receiving care at five Level IV community health centers in rural Uganda for any reason between 2009-2012. Quality of TB care was assessed using indicators derived from the International Standards of Tuberculosis Care (ISTC). RESULTS From 2009-2012, 1713 of 187,601 (0.9%, 95% CI: 0.4-1.4%) children presenting to community health centers had cough ≥ 2 weeks' duration. Of those children, only 299 (17.5%, 95% CI: 15.7-19.3%) were referred for sputum microscopy, but 251 (84%, 95% CI: 79.8-88.1%) completed sputum examination if referred. The yield of sputum microscopy was only 3.6% (95% CI: 1.3-5.9%), and only 55.6% (95% CI: 21.2-86.3%) of children with acid-fast bacilli positive sputum were started on treatment. Children under age 5 were less likely to be referred for sputum examination and to receive care in accordance with ISTC. The proportion of children evaluated in accordance with ISTC increased over time (4.6% in 2009 to 27.9% in 2012, p = 0.03), though this did not result in increased case-detection. CONCLUSION The quality of TB evaluation was poor for children with cough ≥2 weeks' duration presenting for health care. Referrals for sputum smear microscopy and linkage to TB treatment were key gaps in the TB evaluation process, especially for children under the age of five.
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Affiliation(s)
- Carina Marquez
- Division of HIV/AIDS, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America
| | - J. Lucian Davis
- Division of Pulmonary and Critical Care Medicine and Curry International Tuberculosis Center, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America
| | - Achilles Katamba
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | | | | | | | - Gabriel Chamie
- Division of HIV/AIDS, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America
| | - Grant Dorsey
- Division of Infectious Diseases, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America
| | - Moses R. Kamya
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Edwin Charlebois
- Division of HIV/AIDS, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Diane V. Havlir
- Division of HIV/AIDS, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America
| | - Adithya Cattamanchi
- Division of Pulmonary and Critical Care Medicine and Curry International Tuberculosis Center, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America
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260
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Olaru ID, Heyckendorf J, Grossmann S, Lange C. Time to culture positivity and sputum smear microscopy during tuberculosis therapy. PLoS One 2014; 9:e106075. [PMID: 25171337 PMCID: PMC4149502 DOI: 10.1371/journal.pone.0106075] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 08/01/2014] [Indexed: 12/11/2022] Open
Abstract
Sputum smear microscopy is widely used for tuberculosis diagnosis and treatment monitoring. We evaluated the correlation between smear microscopy and time to liquid culture positivity during early tuberculosis treatment. The study included patients with smear-positive pulmonary tuberculosis hospitalized at a tuberculosis reference centre in Germany between 01/2012 and 05/2013. Patient records were reviewed and clinical, radiological and microbiological data were analysed. Sputum samples were collected before treatment initiation and weekly thereafter. A number of 310 sputum samples from 30 patients were analysed. Time to liquid culture positivity inversely correlated with smear grade (Spearman's rho -0.439, p<0.001). There was a better correlation within the first two months vs. after two months of therapy (-0.519 vs. -0.416) with a trend to a more rapid increase in time to positivity between baseline and week 2 in patients who culture-converted within the first two months (5.9 days vs. 9.4 days, p = 0.3). In conclusion, the numbers of acid-fast bacilli in sputum smears of patients with pulmonary tuberculosis and time to culture positivity for M. tuberculosis cultures from sputum are correlated before and during tuberculosis treatment. A considerable proportion of patients with culture conversion after two months of therapy continued to have detectable acid-fast bacilli on sputum smears.
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Affiliation(s)
- Ioana D. Olaru
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany
- German Center for Infection Research (DZIF), Research Center Borstel, Borstel, Germany
| | - Jan Heyckendorf
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany
- German Center for Infection Research (DZIF), Research Center Borstel, Borstel, Germany
| | - Susanne Grossmann
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany
| | - Christoph Lange
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany
- German Center for Infection Research (DZIF), Research Center Borstel, Borstel, Germany
- International Health/Infectious Diseases, University of Lübeck, Lübeck, Germany
- Department of Medicine, University of Namibia School of Medicine, Windhoek, Namibia
- * E-mail:
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261
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Xu B, Zhao Q, Hu Y, Shi Y, Wang W, Diwan VK. Experiences in anti-tuberculosis treatment in patients with multiple previous treatments and its impact on drug resistant tuberculosis epidemics. Glob Health Action 2014; 7:24593. [PMID: 25138531 PMCID: PMC4138495 DOI: 10.3402/gha.v7.24593] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 06/12/2014] [Accepted: 07/02/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) patients with a history of multiple anti-TB treatments are the 'neglected' group to the free anti-TB treatment policy in China. OBJECTIVE To understand the experiences of TB patients with multiple previous treatments with regard to bacteriological diagnosis and treatment regimens, especially for second-line anti-TB drugs, and how this might influence the risks of multidrug and extensively drug-resistant TB (M/XDR-TB). DESIGN A cross-sectional study was conducted in 10 county/district TB clinics in five provinces of China. The study participants were TB patients that had at least two previous treatment episodes that lasted longer than 1 month each. Face-to-face interviews and drug susceptibility testing (DST) were conducted with the consenting participants. RESULTS A total of 328 TB patients were recruited. The proportion of multidrug-resistant tuberculosis (MDR-TB) was 58.2% in the 287 DST-confirmed patients. Forty-two percent of the patients did not complete their first treatment course. About 23.8% of the participants had a history of taking second-line drugs, and more than 77.8% of them were treated in county TB dispensaries where only sputum microscopy was applied. Multivariate analysis found that the use of second-line drugs was significantly associated with frequency of previous treatments (p<0.01), but not with drug resistance profiles of patients. CONCLUSIONS Patients with multiple previous treatments are at extremely high risk of MDR-TB in China. The unregulated use of second-line drugs bring about the threat of XDR-TB epidemic. DST-guided treatment and strict regulations of anti-TB treatment should be assured for the high-risk TB patients for the prevention and control of M/XDR-TB.
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Affiliation(s)
- Biao Xu
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China;
| | - Qi Zhao
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
| | - Yi Hu
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
| | - Ying Shi
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China; The Department of Tuberculosis Prevention and Control, Ministry of Health, Beijing, China
| | - Weibing Wang
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
| | - Vinod K Diwan
- School of Public Health, Centre for Global Health, Karolinska Institutet, Stockholm, Sweden
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262
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Surineni G, Yogeeswari P, Sriram D, Kantevari S. Rational design, synthesis and evaluation of novel-substituted 1,2,3-triazolylmethyl carbazoles as potent inhibitors of Mycobacterium tuberculosis. Med Chem Res 2014. [DOI: 10.1007/s00044-014-1210-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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263
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Kerkhoff AD, Wood R, Vogt M, Lawn SD. Prognostic value of a quantitative analysis of lipoarabinomannan in urine from patients with HIV-associated tuberculosis. PLoS One 2014; 9:e103285. [PMID: 25075867 PMCID: PMC4116167 DOI: 10.1371/journal.pone.0103285] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 06/28/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Detection of the mycobacterial cell wall antigen lipoarabinomannan (LAM) in urine can be used to diagnose HIV-associated tuberculosis (TB) using a qualitative (positive/negative) read-out. However, it is not known whether the quantity of LAM present in urine provides additional prognostic information. METHODS/FINDINGS Consecutively recruited adult outpatients initiating antiretroviral therapy (ART) in South Africa were investigated for TB regardless of clinical symptoms using sputum smear microscopy and liquid culture (reference standard). Urine samples were tested using the Clearview TB-ELISA for LAM and the Xpert MTB/RIF assay. The ELISA optical densities (OD) were used as a quantitative assessment of urine LAM. Among 514 patients with complete sputum and urine LAM OD results, culture-confirmed TB was diagnosed in 84 patients. Twenty-three (27.3%) were LAM-positive with a median LAM OD of 0.68 (IQR 0.16-2.43; range, 0.10-3.29) and 61 (72.6%) were LAM negative (LAM OD <0.1 above background). Higher LAM ODs were associated with a range of prognostic indices, including lower CD4 cell counts, lower haemoglobin levels, higher blood neutrophil counts and higher mycobacterial load as assessed using both sputum and urine samples. The median LAM OD among patients who died was more than 6.8-fold higher than that of patients who remained alive at 3 months (P<0.001). The small number of deaths, however, precluded adequate assessment of mortality risk stratified according to urine LAM OD. CONCLUSIONS In patients with HIV-associated TB, concentrations of LAM in urine were strongly associated with a range of poor prognostic characteristics known to be associated with mortality risk. Urine LAM assays with a semi-quantitative (negative vs. low-positive vs. high-positive) read-out may have improved clinical utility over assays with a simple binary result.
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Affiliation(s)
- Andrew D. Kerkhoff
- George Washington University School of Medicine and Health Sciences, Washington, DC, United States of America
- Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Department of Global Health and Amsterdam Institute for Global Health and Development, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Robin Wood
- Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Monica Vogt
- Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Stephen D. Lawn
- Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- * E-mail:
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264
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Aston SJ. The role of rapid diagnostic tests in managing adults with pneumonia in low-resource settings. Pneumonia (Nathan) 2014; 5:8-17. [PMID: 26290807 PMCID: PMC4538792 DOI: 10.15172/pneu.2014.5/444] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
In well-resourced settings the systematic use of rapid diagnostics tests (e.g. pneumococcal urinary antigen test) that define the causal pathogen to direct therapy has not resulted in significantly improved outcomes in adults withpneumonia. The management of pneumonia in many low-resource settings is complicated by a substantial burden of tuberculosis and HIV-associated opportunistic infections, in addition to the usual spectrum of pathogens seenin well-resourced settings. Clinical features alone do not reliably distinguish between these different aetiologiesand physicians often have to treat empirically. Given the limitations in diagnostic laboratory capability present inmost low-resource settings, rapid and point-of-care diagnostic tests could become valuable tools to guide treatment decisions. Pneumococcal and Legionella urinary antigen tests are specific and moderately sensitive, but their utilityin low-resource settings is uncertain. The Xpert MTB/RIF (Cepheid, USA) platform and rapid assays for urinary lipoarabinomannan can substantially speed up tuberculosis diagnosis; the current challenge is to translate this intoearlier treatment and hopefully improve patient outcome. In HIV-infected patients, 1-3-β-D-glucan is a serum marker of Pneumocystis jirovecii infection with excellent sensitivity. Further studies are needed to assess the clinical utilityand cost-effectiveness of these rapid diagnostic assays when they are incorporated into treatment algorithms.
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Affiliation(s)
- Stephen J Aston
- Malawi Liverpool Wellcome Trust Clinical Research Facility, Blantyre, Malawi; Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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265
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Ramos-Rincón JM, Cuadros-González J, Malmierca-Corral E, de Górgolas-Hernández M. Medical diagnosis in resource-poor tropical countries. Rev Clin Esp 2014; 215:43-9. [PMID: 25012088 DOI: 10.1016/j.rce.2014.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Revised: 04/21/2014] [Accepted: 05/07/2014] [Indexed: 01/02/2023]
Abstract
When working in healthcare centers in developing countries where diagnostic resources are limited, clinical skills are of considerable importance. This study presents the diagnostic tools available in resource-poor areas. Anamnesis and physical examination are key components for reaching a correct diagnosis. The laboratory has at its disposal hemograms, basic blood chemistry and urinalysis. The available basic microbiological tests are the study of fresh feces, smears for malaria, direct smears for bacilli in sputum and Gram staining of clinical exudates. Basic radiography of the chest, abdomen, bones and soft tissues are of considerable usefulness but are not available in all centers. Ultrasonography can be of considerable usefulness due to its simplicity and versatility. The diagnosis in low resource conditions should sharpen our clinical skills and should be supported by the use of additional basic tests.
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Affiliation(s)
- J M Ramos-Rincón
- Servicio de Medicina Interna, Hospital General Universitario de Alicante, Universidad Miguel Hernández de Elche, Elche, Alicante, España.
| | - J Cuadros-González
- Servicio de Microbiología, Hospital Universitario Príncipe de Asturias, Universidad de Alcalá de Henares, Alcalá de Henares, Madrid, España
| | - E Malmierca-Corral
- Servicio de Medicina Interna, Hospital Infanta Sofía, San Sebastián de los Reyes, Madrid, España
| | - M de Górgolas-Hernández
- División de Enfermedades Infecciosas, Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, España
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266
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Desai N, Shihory N, Kotadiya G, Desai P. Synthesis, antibacterial and antitubercular activities of benzimidazole bearing substituted 2-pyridone motifs. Eur J Med Chem 2014; 82:480-9. [DOI: 10.1016/j.ejmech.2014.06.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 04/05/2014] [Accepted: 06/03/2014] [Indexed: 10/25/2022]
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267
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Mupfumi L, Makamure B, Chirehwa M, Sagonda T, Zinyowera S, Mason P, Metcalfe JZ, Mutetwa R. Impact of Xpert MTB/RIF on Antiretroviral Therapy-Associated Tuberculosis and Mortality: A Pragmatic Randomized Controlled Trial. Open Forum Infect Dis 2014; 1:ofu038. [PMID: 25734106 PMCID: PMC4324195 DOI: 10.1093/ofid/ofu038] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 05/27/2014] [Indexed: 01/19/2023] Open
Abstract
Introduction. GeneXpert® MTB/RIF (Xpert) is now widely distributed in high human immunodeficiency virus (HIV)/tuberculosis (TB)-burden countries. Yet, whether the test improves patient-important outcomes within HIV treatment programs in limited resource settings is unknown. Methods. To investigate whether use of Xpert for TB screening prior to initiation of antiretroviral treatment (ART) improves patient-important outcomes, in a pragmatic randomized controlled trial we assigned 424 patients to Xpert or fluorescence sputum smear microscopy (FM) at ART initiation. The primary endpoint was a composite of 3-month mortality and ART-associated TB. Results. There was no difference in overall TB diagnosis at ART initiation (20% [n = 43] Xpert vs 21% [n = 45] FM; P = .80), with most patients in both groups treated empirically. There was no difference in time to TB treatment initiation {5 days (interquartile range [IQR], 3–13) vs 8 days [IQR, 3–23; P = .26]} or loss to follow-up (32 [15%] vs 38 [18%]; P = 0.38). Although a nonsignificant reduction in mortality occurred in the Xpert group (11 [6%] vs 17 [10%]; 95% CI, −9% to 2%; P = .19), there was no difference in the composite outcome (9% [n = 17] Xpert vs 12% [n = 21] FM; difference −3%; 95% CI, −9% to 4%). Conclusions. Among HIV-infected initiating ART, centralized TB screening with Xpert did not reduce the rate of ART-associated TB and mortality, compared with fluorescence microscopy.
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Affiliation(s)
- L Mupfumi
- University of Zimbabwe College of Health Sciences , Harare , Zimbabwe ; Biomedical Research and Training Institute , Zimbabwe
| | - B Makamure
- University of Zimbabwe College of Health Sciences , Harare , Zimbabwe ; Biomedical Research and Training Institute , Zimbabwe
| | - M Chirehwa
- Biomedical Research and Training Institute , Zimbabwe
| | - T Sagonda
- Biomedical Research and Training Institute , Zimbabwe
| | - S Zinyowera
- National Microbiology Reference Laboratory , Harare , Zimbabwe
| | - P Mason
- University of Zimbabwe College of Health Sciences , Harare , Zimbabwe ; Biomedical Research and Training Institute , Zimbabwe
| | - J Z Metcalfe
- Division of Pulmonary and Critical Care Medicine , San Francisco General Hospital, and Francis J. Curry International Tuberculosis Center, University of California , San Francisco, California
| | - R Mutetwa
- Biomedical Research and Training Institute , Zimbabwe
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268
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Murrmann GB, van Vollenhoven FHM, Moodley L. Approach to a solid solitary pulmonary nodule in two different settings-"Common is common, rare is rare". J Thorac Dis 2014; 6:237-48. [PMID: 24624288 DOI: 10.3978/j.issn.2072-1439.2013.11.13] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 11/20/2013] [Indexed: 12/19/2022]
Abstract
A new solid solitary pulmonary nodule (SPN) is a common feature in the daily practice of physicians, pulmonologists and thoracic surgeons. The etiology and consequently the diagnostic approach is very different in various parts of the world. Identification of malignant nodules is the universal goal to proceed to a potential curable therapy. In countries with a low incidence of inflammatory disease and a high incidence of lung cancer the diagnostic work up includes a positron emission tomography (PET) scan or PET-computer tomography (CT) as a main pillar. In countries with a high incidence of inflammatory and infectious disease and a low incidence in lung cancer this diagnostic work up needs to be adapted. In these settings a PET scan has a limited role and tissue diagnosis, whether with a trans-thoracic, trans-bronchial biopsy or a video-assisted wedge resection is the most targeted approach to determine or exclude malignancy. The evaluation of a solid SPN in the two different situations is outlined in our algorithm. Recommendations stress the value of clinical judgement in different settings, determination of probabilities of malignancy, cost-effective use of diagnostic tools and evaluation of various management alternatives according to the risk profile and the patients preferences.
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Affiliation(s)
- Gabriele B Murrmann
- 1 Department of Surgery, 2 Department of Pulmonology, Medisch Centrum Leeuwarden, The Netherlands ; 3 Department of Cardio-Thoracic Surgery, Groote Schuur Hospital, University of Cape Town, South Africa
| | - Femke H M van Vollenhoven
- 1 Department of Surgery, 2 Department of Pulmonology, Medisch Centrum Leeuwarden, The Netherlands ; 3 Department of Cardio-Thoracic Surgery, Groote Schuur Hospital, University of Cape Town, South Africa
| | - Loven Moodley
- 1 Department of Surgery, 2 Department of Pulmonology, Medisch Centrum Leeuwarden, The Netherlands ; 3 Department of Cardio-Thoracic Surgery, Groote Schuur Hospital, University of Cape Town, South Africa
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269
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Pandie S, Peter JG, Kerbelker ZS, Meldau R, Theron G, Govender U, Ntsekhe M, Dheda K, Mayosi BM. Diagnostic accuracy of quantitative PCR (Xpert MTB/RIF) for tuberculous pericarditis compared to adenosine deaminase and unstimulated interferon-γ in a high burden setting: a prospective study. BMC Med 2014; 12:101. [PMID: 24942470 PMCID: PMC4073812 DOI: 10.1186/1741-7015-12-101] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 05/28/2014] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Tuberculous pericarditis (TBP) is associated with high morbidity and mortality, and is an important treatable cause of heart failure in developing countries. Tuberculous aetiology of pericarditis is difficult to diagnose promptly. The utility of the new quantitative PCR test (Xpert MTB/RIF) for the diagnosis of TBP is unknown. This study sought to evaluate the diagnostic accuracy of the Xpert MTB/RIF test compared to pericardial adenosine deaminase (ADA) and unstimulated interferon-gamma (uIFNγ) in suspected TBP. METHODS From October 2009 through September 2012, 151 consecutive patients with suspected TBP were enrolled at a single centre in Cape Town, South Africa. Mycobacterium tuberculosis culture and/or pericardial histology served as the reference standard for definite TBP. Receiver-operating-characteristic curve analysis was used for selection of ADA and uIFNγ cut-points. RESULTS Of the participants, 49% (74/151) were classified as definite TBP, 33% (50/151) as probable TBP and 18% (27/151) as non TBP. A total of 105 (74%) participants were human immunodeficiency virus (HIV) positive. Xpert-MTB/RIF had a sensitivity and specificity (95% confidence interval (CI)) of 63.8% (52.4% to 75.1%) and 100% (85.6% to 100%), respectively. Concentration of pericardial fluid by centrifugation and using standard sample processing did not improve Xpert MTB/RIF accuracy. ADA (≥35 IU/L) and uIFNγ (≥44 pg/ml) both had a sensitivity of 95.7% (88.1% to 98.5%) and a negative likelihood ratio of 0.05 (0.02 to 0.10). However, the specificity and positive likelihood ratio of uIFNγ was higher than ADA (96.3% (81.7% to 99.3%) and 25.8 (3.6 to 183.4) versus 84% (65.4% to 93.6%) and 6.0 (3.7 to 9.8); P = 0.03) at an estimated background prevalence of TB of 30%. The sensitivity and negative predictive value of both uIFNγ and ADA were higher than Xpert-MT/RIF (P < 0.001). CONCLUSIONS uIFNγ offers superior accuracy for the diagnosis of microbiologically confirmed TBP compared to the ADA assay and the Xpert MTB/RIF test.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Bongani M Mayosi
- The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Groote Schuur Drive, Observatory, Cape Town 7925, South Africa.
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270
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Availability and use of molecular microbiological and immunological tests for the diagnosis of tuberculosis in europe. PLoS One 2014; 9:e99129. [PMID: 24922084 PMCID: PMC4055680 DOI: 10.1371/journal.pone.0099129] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 05/09/2014] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Currently only limited data exist regarding the availability and clinical use of molecular and immunological tests for tuberculosis (TB) in the European setting. METHODS Web-based survey of Paediatric-Tuberculosis-Network-European-Trialsgroup (ptbnet) and Tuberculosis-Network-European-Trialsgroup (TBnet) members conducted June to December 2013. Both networks comprise clinicians, microbiologists, epidemiologists and researchers predominately based in Europe. RESULTS 191 healthcare professionals from 31 European countries participated. Overall, 26.8% of respondents did not have access to the Xpert MTB/RIF assay; only 44.6% had access to the assay in-house. However, a substantial proportion had access to other commercial and/or non-commercial PCR-based assays for TB (68.8% and 31.8%, respectively). Only 6.4% did not have access to any PCR-based assays for TB. A large proportion of participants with access to the Xpert MTB/RIF assay had used it for the analysis of non-respiratory samples [pleural fluid: 36.5%, gastric aspirates: 34.7%, cerebrospinal fluid: 34.7%, stool samples: 4.3%, blood/serum: 2.6%, 'other samples' (which included biopsy/tissue samples, lymph node aspirates, joint aspirates and urine samples): 16.5%]. Regarding interferon-gamma release assays, a greater proportion of respondents had access to the QuantiFERON-TB Gold assay (84.7%) than to the T-SPOT.TB assay (52.2%). CONCLUSIONS Both immunological and molecular TB tests are widely available across Europe. The QuantiFERON-TB Gold assay is more widely used than the T-SPOT.TB assay, which may reflect the difficulties of integrating an ELISPOT assay into the routine laboratory setting. Although Xpert MTB/RIF assays are optimised and solely licensed for the analysis of sputum samples, in clinical practice they are commonly used for non-respiratory samples. Further research is needed to establish how current molecular TB tests impact on patient care and outcome in the routine clinical setting.
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271
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Advancing the portfolio of tuberculosis diagnostics, drugs, biomarkers, and vaccines. THE LANCET. INFECTIOUS DISEASES 2014; 14:267-9. [PMID: 24670623 DOI: 10.1016/s1473-3099(14)70028-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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272
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Rufai SB, Kumar P, Singh A, Prajapati S, Balooni V, Singh S. Comparison of Xpert MTB/RIF with line probe assay for detection of rifampin-monoresistant Mycobacterium tuberculosis. J Clin Microbiol 2014; 52:1846-52. [PMID: 24648554 PMCID: PMC4042801 DOI: 10.1128/jcm.03005-13] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The MTBDRplus line probe assay (LPA) and Xpert MTB/RIF have been endorsed by the World Health Organization for the rapid diagnosis of drug-resistant tuberculosis. However, there is no clarity regarding the superiority of one over the other. In a double-blinded prospective study, we evaluated the efficacy of the Xpert MTB/RIF on samples that were first tested by LPA under the revised national tuberculosis control program of India. A total of 405 sputum samples from suspected drug-resistant tuberculosis patients were included. Of these, 285 smear-positive samples were subjected to LPA. Seventy-two (25.8%) samples showed multidrug resistance, 62 (22.2%) showed rifampin monoresistance, 29 (10.3%) showed isoniazid monoresistance, and 116 (41.5%) were pan-susceptible. Six (2.1%) of the samples gave invalid results. Of the 62 rifampin-monoresistant samples by LPA, 38 (61.4%) showed rifampin resistance, while 21 (33.8%) were found susceptible to rifampin by Xpert MTB/RIF using cartridge version G4. Three (4.8%) samples gave an error. Of the 116 pan-susceptible samples, only 83 were available for Xpert MTB/RIF testing; 4 (5.1%) were rifampin resistant, 74 (94.8%) were susceptible, and 5 (6.0%) showed an error. The 25 discrepant samples were further subjected to MGIT960 drug susceptibility testing. The MGIT960 results showed 100% agreement with LPA results but only 64.4% agreement with Xpert MTB/RIF results. Sequencing analysis of discrepant samples showed 91.3% concordance with LPA but only 8.7% concordance with the Xpert MTB/RIF assay. These findings indicate that by using Xpert MTB/RIF testing we might be underestimating the burden of drug-resistant tuberculosis and indicate that country-specific probes need to be designed to increase the sensitivity of the Xpert MTB/RIF.
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Affiliation(s)
- Syed Beenish Rufai
- Division of Clinical Microbiology and Molecular Medicine, Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Parveen Kumar
- Division of Clinical Microbiology and Molecular Medicine, Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Amit Singh
- Division of Clinical Microbiology and Molecular Medicine, Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Suneel Prajapati
- Division of Clinical Microbiology and Molecular Medicine, Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Veena Balooni
- Division of Clinical Microbiology and Molecular Medicine, Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sarman Singh
- Division of Clinical Microbiology and Molecular Medicine, Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
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274
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Zammarchi L, Bartalesi F, Bartoloni A. Tuberculosis in tropical areas and immigrants. Mediterr J Hematol Infect Dis 2014; 6:e2014043. [PMID: 24959340 PMCID: PMC4063601 DOI: 10.4084/mjhid.2014.043] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 04/16/2014] [Indexed: 11/08/2022] Open
Abstract
About 95% of cases and 98% of deaths due to tuberculosis (TB) occur in tropical countries while, in temperate low incidence countries, a disproportionate portion of TB cases is diagnosed in immigrants. Urbanization, poverty, poor housing conditions and ventilation, poor nutritional status, low education level, the HIV co-epidemic, the growing impact of chronic conditions such as diabetes are the main determinants of the current TB epidemiology in tropical areas. TB care in these contests is complicated by several barriers such as geographical accessibility, educational, cultural, sociopsychological and gender issues. High quality microbiological and radiological facilities are not widely available, and erratic supply of anti-TB drugs may affect tropical areas from time to time. Nevertheless in recent years, TB control programs reached major achievements in tropical countries as demonstrated by several indicators. Migrants have a high risk of acquire TB before migration. Moreover, after migration, they are exposed to additional risk factors for acquiring or reactivating TB infection, such as poverty, stressful living conditions, social inequalities, overcrowded housing, malnutrition, substance abuse, and limited access to health care. TB mass screening programs for migrants have been implemented in low endemic countries but present several limitations. Screening programs should not represent a stand-alone intervention, but a component of a wider approach integrated with other healthcare activities to ensure the health of migrants.
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Affiliation(s)
- Lorenzo Zammarchi
- Infectious Diseases Unit, Department of Experimental & Clinical Medicine, University of Florence School of Medicine, Florence, Italy
| | | | - Alessandro Bartoloni
- Infectious Diseases Unit, Department of Experimental & Clinical Medicine, University of Florence School of Medicine, Florence, Italy
- SOD Malattie Infettive e Tropicali, AOU Careggi, Firenze, Italy
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275
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Lawn SD. Serological diagnostic assays for HIV-associated tuberculosis in sub-Saharan Africa? CLINICAL AND VACCINE IMMUNOLOGY : CVI 2014; 21:787-90. [PMID: 24739979 PMCID: PMC4054249 DOI: 10.1128/cvi.00201-14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In this issue of Clinical and Vaccine Immunology, Siev and colleagues present an evaluation of antibody responses to four immunodominant proteins of Mycobacterium tuberculosis in patients with HIV-associated pulmonary tuberculosis (TB) in South Africa (M. Siev, D. Wilson, S. Kainth, V. O. Kasprowicz, C. M. Feintuch, E. Jenny-Avital, and J. J. Achkar, 21:791-798, 2014, doi:http://dx.doi.org/10.1128/CVI.00805-13). This commentary discusses the enormous need for simple point-of-care assays for tuberculosis (TB) diagnosis in patients with and without HIV coinfection in high-burden settings and considers the potential role of serological assays and the huge challenges inherent in developing and validating such assays.
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Affiliation(s)
- Stephen D Lawn
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom, and The Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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276
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Desai NC, Kotadiya GM, Trivedi AR. Studies on molecular properties prediction, antitubercular and antimicrobial activities of novel quinoline based pyrimidine motifs. Bioorg Med Chem Lett 2014; 24:3126-30. [PMID: 24856067 DOI: 10.1016/j.bmcl.2014.05.002] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 04/30/2014] [Accepted: 05/02/2014] [Indexed: 11/18/2022]
Abstract
In the present study, a series of 3-((6-(2,6-dichloroquinolin-3-yl)-4-aryl-1,6-dihydro-pyrimidin-2-yl)thio)propanenitriles 5a-o were synthesized and subjected to molecular properties prediction and drug-likeness model score by Molinspiration property calculation toolkit and MolSoft software, respectively. Compound 5m (4-OCH3) was found to be maximum drug-likeness model score (0.42). Among the screened compounds, 5m showed the most promising antitubercular activity with MIC of 0.20 μg/mL, while compounds 5g, 5k and 5m displayed broad spectrum antibacterial activity against all the bacterial strains. Moreover, compound 5k was found to be the most potent antifungal agent. Further, the results of preliminary MTT cytotoxicity studies on HeLa cells suggested that potent antimicrobial activity of 5g, 5k and 5m was escorted by low cytotoxicity.
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Affiliation(s)
- N C Desai
- Division of Medicinal Chemistry, Department of Chemistry, (UGC NON-SAP & DST-FIST Sponsored), Maharaja Krishnakumarsinhji Bhavnagar University, Mahatma Gandhi Campus, Bhavnagar 364 002, Gujarat, India.
| | - G M Kotadiya
- Division of Medicinal Chemistry, Department of Chemistry, (UGC NON-SAP & DST-FIST Sponsored), Maharaja Krishnakumarsinhji Bhavnagar University, Mahatma Gandhi Campus, Bhavnagar 364 002, Gujarat, India
| | - A R Trivedi
- Division of Medicinal Chemistry, Department of Chemistry, (UGC NON-SAP & DST-FIST Sponsored), Maharaja Krishnakumarsinhji Bhavnagar University, Mahatma Gandhi Campus, Bhavnagar 364 002, Gujarat, India
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Ferreira Junior SLM, Dalla Costa ER, Santos PGD, Gomes HM, Silva MSN, Esteves LS, Oliveira MM, Maschmann RDA, Kritski AL, Suffys PN, Rossetti MLR. In house reverse membrane hybridisation assay versus GenoType MTBDRplus and their performance to detect mutations in the genes rpoB, katG and inhA. Mem Inst Oswaldo Cruz 2014; 109:307-14. [PMID: 24821057 PMCID: PMC4131782 DOI: 10.1590/0074-0276130469] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 01/15/2014] [Indexed: 02/04/2023] Open
Abstract
Drug-resistant tuberculosis (TB) threatens global TB control and is a major public
health concern in several countries. We therefore developed a multiplex assay
(LINE-TB/MDR) that is able to identify the most frequent mutations related to
rifampicin (RMP) and isoniazid (INH) resistance. The assay is based on multiplex
polymerase chain reaction, membrane hybridisation and colorimetric detection
targeting of rpoB and katG genes, as well as the
inhA promoter, which are all known to carry specific mutations
associated with multidrug-resistant TB (MDR-TB). The assay was validated on a
reference panel of 108 M. tuberculosis isolates that were characterised by the
proportion method and by DNA sequencing of the targets. When comparing the
performance of LINE-TB/MDR with DNA sequencing, the sensitivity, specificity and
agreement were 100%, 100% and 100%, respectively, for RMP and 77.6%, 90.6% and 88.9%,
respectively, for INH. Using drug sensibility testing as a reference standard, the
performance of LINE-TB/MDR regarding sensitivity, specificity and agreement was 100%,
100% and 100% (95%), respectively, for RMP and 77%, 100% and 88.7% (82.2-95.1),
respectively, for INH. LINE-TB/MDR was compared with GenoType MTBDRplus for 65
isolates, resulting in an agreement of 93.6% (86.7-97.5) for RIF and 87.4%
(84.3-96.2) for INH. LINE-TB/MDR warrants further clinical validation and may be an
affordable alternative for MDR-TB diagnosis.
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Affiliation(s)
| | - Elis Regina Dalla Costa
- Centro de Desenvolvimento Científico e Tecnológico, Fundação Estadual de Produção e Pesquisa em Saúde, Porto Alegre, RS, Brasil
| | - Paula Gonçalves dos Santos
- Instituto de Doenças do Tórax, Hospital Universitário Clementino Fraga Filho, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Harrison Magdinier Gomes
- Laboratório de Biologia Molecular Aplicada a Micobactérias, Instituto Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
| | - Marcia Susana Nunes Silva
- Centro de Desenvolvimento Científico e Tecnológico, Fundação Estadual de Produção e Pesquisa em Saúde, Porto Alegre, RS, Brasil
| | - Leonardo Souza Esteves
- Centro de Desenvolvimento Científico e Tecnológico, Fundação Estadual de Produção e Pesquisa em Saúde, Porto Alegre, RS, Brasil
| | - Martha Maria Oliveira
- Instituto de Doenças do Tórax, Hospital Universitário Clementino Fraga Filho, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Raquel de Abreu Maschmann
- Centro de Desenvolvimento Científico e Tecnológico, Fundação Estadual de Produção e Pesquisa em Saúde, Porto Alegre, RS, Brasil
| | - Afrânio Lineu Kritski
- Instituto de Doenças do Tórax, Hospital Universitário Clementino Fraga Filho, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Philip Noel Suffys
- Laboratório de Biologia Molecular Aplicada a Micobactérias, Instituto Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
| | - Maria Lucia Rosa Rossetti
- Centro de Desenvolvimento Científico e Tecnológico, Fundação Estadual de Produção e Pesquisa em Saúde, Porto Alegre, RS, Brasil
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278
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Kerkhoff AD, Wood R, Vogt M, Lawn SD. Predictive value of anemia for tuberculosis in HIV-infected patients in Sub-Saharan Africa: an indication for routine microbiological investigation using new rapid assays. J Acquir Immune Defic Syndr 2014; 66:33-40. [PMID: 24346639 PMCID: PMC3981888 DOI: 10.1097/qai.0000000000000091] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The relationship between anemia and undiagnosed tuberculosis (TB) in patients living with HIV in sub-Saharan Africa is incompletely defined. We assessed the prevalence of TB among those with HIV-related anemia and evaluated new means of rapid TB diagnosis. METHODS Blood hemoglobin levels were measured in unselected antiretroviral treatment-naive patients in Cape Town, South Africa, and anemia was classified according to World Health Organization criteria. All patients were screened for TB by testing paired sputum samples using liquid culture (reference standard), fluorescence microscopy, and Xpert MTB/RIF. Urine samples were tested for lipoarabinomannan (LAM) using the Determine TB-LAM diagnostic assay. RESULTS Of 602 adults screened, 485 had complete results. Normal hemoglobin levels were found in 44.5% (n = 216) of patients, and mild, moderate, or severe anemia were present in 24.9% (n = 121), 25.4% (n = 123) and 5.2% (n = 25) of patients, respectively. Culture-confirmed pulmonary TB was diagnosed in 8.8% (19/216) of those without anemia compared with 16.5% (20/121), 26.0% (32/123), and 40.0% (10/25) among those with mild, moderate, or severe anemia, respectively (P < 0.001). Anemia was a strong independent predictor of TB. The sensitivities of diagnostic assays were much higher among those with moderate/severe anemia compared with those with no/mild anemia using sputum microscopy (42.9% vs 15.4%), urine LAM (54.8% vs 0%), sputum microscopy plus urine LAM (71.4% vs 15.4%), and sputum Xpert (73.8% vs 41.0%) (P < 0.01 for all). CONCLUSIONS A very high prevalence of undiagnosed TB was found in patients with moderate or severe anemia. Such patients should be prioritized for routine microbiological investigation using rapid diagnostic assays.
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Affiliation(s)
- Andrew D. Kerkhoff
- School of Medicine and Health Sciences, The George Washington University, Washington DC, USA
- Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Robin Wood
- Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Monica Vogt
- Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Stephen D. Lawn
- Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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279
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Marais BJ. Urine lipoarabinomannan testing in children with tuberculosis. LANCET GLOBAL HEALTH 2014; 2:e245-6. [DOI: 10.1016/s2214-109x(14)70207-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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280
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Carman AS, Patel AG. Science with Societal Implications: Detecting Mycobacterium tuberculosis in Africa. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.clinmicnews.2014.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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281
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Seong GM, Lee J, Lee JH, Kim JH, Kim M. Usefulness of sputum induction with hypertonic saline in a real clinical practice for bacteriological yields of active pulmonary tuberculosis. Tuberc Respir Dis (Seoul) 2014; 76:163-8. [PMID: 24851129 PMCID: PMC4021263 DOI: 10.4046/trd.2014.76.4.163] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 01/07/2014] [Accepted: 02/19/2014] [Indexed: 11/24/2022] Open
Abstract
Background Mycobacterial identification in active pulmonary tuberculosis (APTB) is confirmative, even though successful rates using self-expectorated sputum are limited. Sputum specimens collected by hypertonic saline nebulization showed higher bacteriologic diagnostic sensitivities over those of self-expectoration, mostly studied in smear-negative or sputum-scarce patients. The efficacy of induced sputum was rarely assessed in real clinical settings. Methods A prospective randomized case-control study was performed in one hospital. The subjects highly suspicious of APTB were asked to provide 3 pairs of sputum specimens in 3 consecutive days. The first pairs of the specimens were obtained either by self-expectoration (ES) from the next day of the visit or sputum induction with 7% saline nebulization in clinic (SI), and the other specimens were collected in the same way. The samples were tested in microscopy, culture, and polymerase chain reaction (PCR). The outcomes of the bacteriological diagnosis were compared. Results Seventy six patients were assigned to either ES (38 subjects, median age of 51, 65.8% male) or SI (38 subjects, median age of 55, 52.6% male). APTB was clinically confirmed in 51 patients (70.8%), 27 in ES and 24 in SI. Among the APTB, more adequate specimens were collected from SI (41/65, 63.1%) than ES (34/80, 42.5%) (p=0.01). Bacteriological confirmation was achieved in 14 (58.3%) patients in SI, and 13 (48.1%) in ES (p=0.46). In the same-day bacteriological diagnosis with microscopy and PCR, there were positive results for 9 patients (37.5%) in SI and 7 patients (25.9%) in ES (p=0.37). Conclusion Sputum induction improves sputum specimen adequacy. It may be useful for the same-day bacteriological diagnosis with microscopic examination and PCR.
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Affiliation(s)
- Gil Myeong Seong
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Jaechun Lee
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Jong Hoo Lee
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Jeong Hong Kim
- Department of Otorhinolaryngology, Jeju National University School of Medicine, Jeju, Korea
| | - Miok Kim
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
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282
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Accuracy of polimerase chain reaction for the diagnosis of pleural tuberculosis. Respir Med 2014; 108:918-23. [PMID: 24803060 DOI: 10.1016/j.rmed.2014.04.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 02/21/2014] [Accepted: 04/09/2014] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Polymerase chain reaction (PCR)-based techniques to detect Mycobacterium tuberculosis DNA in respiratory specimens have been increasingly used to diagnose pulmonary tuberculosis. Their use in non-respiratory specimens to diagnose extrapulmonary tuberculosis is, however, controversial. In this study, we estimated the accuracy of three in-country commercialized PCR-based diagnostic techniques in pleural fluid samples for the diagnosis of pleural tuberculosis. METHODS Patients underwent thoracenthesis for diagnosis purposes; pleural fluid aliquots were frozen and subsequently submitted to two real time PCR tests (COBAS(®)TAQMAN(®)MTB and Xpert(®)MTB/Rif) and one conventional PCR test (Detect-TB(®)). Two different reference standards were considered: probable tuberculosis (based on clinical grounds) and confirmed tuberculosis (bacteriologically or histologically). RESULTS Ninety-three patients were included, of whom 65 with pleural tuberculosis, 35 of them confirmed. Sensitivities were 29% for COBAS(®)TAQMAN(®)MTB, 3% for Xpert(®)MTB/Rif and 3% for Detect-TB(®); specificities were 86%, 100% and 97% respectively, considering confirmed tuberculosis. Considering all cases, sensitivities were 16%, 3% and 2%, and specificities, 86%, 100%, and 97%. DISCUSSION Compared to the 95% sensitivity of adenosine deaminase, the most sensitive test for pleural tuberculosis, the sensitivities of the three PCR-based tests were very low. We conclude that at present, there is no major place for such tests in routine clinical use.
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283
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Getting health services to three million people with TB. J Int AIDS Soc 2014; 17:19079. [PMID: 24666595 PMCID: PMC3965710 DOI: 10.7448/ias.17.1.19079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 03/13/2014] [Accepted: 03/13/2014] [Indexed: 11/08/2022] Open
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284
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Norbis L, Alagna R, Tortoli E, Codecasa LR, Migliori GB, Cirillo DM. Challenges and perspectives in the diagnosis of extrapulmonary tuberculosis. Expert Rev Anti Infect Ther 2014; 12:633-47. [PMID: 24717112 DOI: 10.1586/14787210.2014.899900] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Extrapulmonary tuberculosis (EPTB) accounts for a significant proportion of tuberculosis cases worldwide. Nevertheless, the diagnosis is often delayed or even missed due to insidious clinical presentation and poor performance of diagnostic tests. Culture, the classical gold standard for tuberculosis, suffers from increased technical and logistical constraints in EPTB cases. In this review the authors outline current diagnostic options for the main forms of EPTB. The authors also discuss the opportunities and challenges linked in particular to microbiological diagnostics and to the attempts to find a new gold standard test for EPTB. Finally, new biomarkers and tests currently under evaluation are hopefully on the way to introduce significant improvements in EPTB diagnosis, for which clinical suspicion will nevertheless be essential.
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Affiliation(s)
- Luca Norbis
- San Raffaele Scientific Institute, Via Olgettina 58, 20132, Milano, Italy
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285
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Lui G, Wong RYK, Li F, Lee MKP, Lai RWM, Li TCM, Kam JKM, Lee N. High mortality in adults hospitalized for active tuberculosis in a low HIV prevalence setting. PLoS One 2014; 9:e92077. [PMID: 24642794 PMCID: PMC3958438 DOI: 10.1371/journal.pone.0092077] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 02/17/2014] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND This study aims to evaluate the outcomes of adults hospitalized for tuberculosis in a higher-income region with low HIV prevalence. METHODS A retrospective cohort study was conducted on all adults hospitalized for pulmonary and/or extrapulmonary tuberculosis in an acute-care hospital in Hong Kong during a two-year period. Microscopy and solid-medium culture were routinely performed. The diagnosis of tuberculosis was made by: (1) positive culture of M. tuberculosis, (2) positive M. tuberculosis PCR result, (3) histology findings of tuberculosis infection, and/or (4) typical clinico-radiological manifestations of tuberculosis which resolved after anti-TB treatment, in the absence of alternative diagnoses. Time to treatment ('early', started during initial admission; 'late', subsequent periods), reasons for delay, and short- and long-term survival were analyzed. RESULTS Altogether 349 patients were studied [median(IQR) age 62(48-77) years; non-HIV immunocompromised conditions 36.7%; HIV/AIDS 2.0%]. 57.9%, 16.3%, and 25.8% had pulmonary, extrapulmonary, and pulmonary-extrapulmonary tuberculosis respectively. 58.2% was smear-negative; 0.6% multidrug-resistant. 43.4% developed hypoxemia. Crude 90-day and 1-year all-cause mortality was 13.8% and 24.1% respectively. 57.6% and 35.8% received 'early' and 'late' treatment respectively, latter mostly culture-guided [median(IQR) intervals, 5(3-9) vs. 43(25-61) days]. Diagnosis was unknown before death in 6.6%. Smear-negativity, malignancy, chronic lung diseases, and prior exposure to fluoroquinolones (adjusted-OR 10.6, 95%CI 1.3-85.2) delayed diagnosis of tuberculosis. Failure to receive 'early' treatment independently predicted higher mortality (Cox-model, adjusted-HR 1.8, 95%CI 1.1-3.0). CONCLUSIONS Mortality of hospitalized tuberculosis patients is high. Newer approaches incorporating methods for rapid diagnosis and initiation of anti-tuberculous treatment are urgently required to improve outcomes.
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MESH Headings
- Aged
- Antitubercular Agents/therapeutic use
- Coinfection
- Delayed Diagnosis
- Female
- Fluoroquinolones/therapeutic use
- HIV
- HIV Infections/diagnosis
- HIV Infections/drug therapy
- HIV Infections/mortality
- HIV Infections/virology
- Hospital Mortality
- Humans
- Male
- Middle Aged
- Mycobacterium tuberculosis/isolation & purification
- Retrospective Studies
- Survival Analysis
- Tuberculosis, Central Nervous System/diagnosis
- Tuberculosis, Central Nervous System/drug therapy
- Tuberculosis, Central Nervous System/microbiology
- Tuberculosis, Central Nervous System/mortality
- Tuberculosis, Lymph Node/diagnosis
- Tuberculosis, Lymph Node/drug therapy
- Tuberculosis, Lymph Node/microbiology
- Tuberculosis, Lymph Node/mortality
- Tuberculosis, Multidrug-Resistant/diagnosis
- Tuberculosis, Multidrug-Resistant/drug therapy
- Tuberculosis, Multidrug-Resistant/microbiology
- Tuberculosis, Multidrug-Resistant/mortality
- Tuberculosis, Pleural/diagnosis
- Tuberculosis, Pleural/drug therapy
- Tuberculosis, Pleural/microbiology
- Tuberculosis, Pleural/mortality
- Tuberculosis, Pulmonary/diagnosis
- Tuberculosis, Pulmonary/drug therapy
- Tuberculosis, Pulmonary/microbiology
- Tuberculosis, Pulmonary/mortality
- Tuberculosis, Urogenital/diagnosis
- Tuberculosis, Urogenital/drug therapy
- Tuberculosis, Urogenital/microbiology
- Tuberculosis, Urogenital/mortality
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Affiliation(s)
- Grace Lui
- Department of Medicine and Therapeutics, Division of Infectious Diseases, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Rity Y. K. Wong
- Department of Medicine and Therapeutics, Division of Infectious Diseases, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Florence Li
- Faculty of Medicine, University of Sheffield, Sheffield, United Kingdom
| | - May K. P. Lee
- Department of Microbiology, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Raymond W. M. Lai
- Department of Microbiology, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Timothy C. M. Li
- Department of Medicine and Therapeutics, Division of Infectious Diseases, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Joseph K. M. Kam
- Stanley Ho Centre for Emerging Infectious Diseases, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Nelson Lee
- Department of Medicine and Therapeutics, Division of Infectious Diseases, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China
- Stanley Ho Centre for Emerging Infectious Diseases, Chinese University of Hong Kong, Hong Kong SAR, China
- * E-mail:
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286
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Dhana AV, Howell P, Spencer D. When smear and molecular diagnostics fail: identification of tuberculosis in advanced HIV infection using the newly developed urine lipoarabinomannan lateral-flow assay. BMJ Case Rep 2014; 2014:bcr-2013-200696. [PMID: 24614769 DOI: 10.1136/bcr-2013-200696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
In HIV infection, progression of immunodeficiency is associated with increased risk of paucibacillary and disseminated forms of tuberculosis (TB). As a result, the clinical presentation may be atypical and the conventional diagnostic assays often unreliable, resulting in significant treatment delays. Here, we report a case of HIV-associated immune reconstitution inflammatory syndrome and TB meningitis. Although the smear and molecular assays were negative, Mycobacterium tuberculosis was identified in our patient using the new Determine-lipoarabinomannan (LAM) lateral-flow urine 'dip-stick' assay. This case report illustrates the clinical value of this assay for the diagnosis of TB in a subgroup of HIV-infected patients with advanced immunodeficiency. Also, although two recent studies have evaluated the use of the Determine TB-LAM assay in clinical settings, to the best of our knowledge, this is the first case report of TB diagnosed using this novel assay.
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Affiliation(s)
- Ashar Vijay Dhana
- Department of Infectious Diseases, Helen Joseph Academic Hospital, Johannesburg, Gauteng, South Africa
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287
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Siddiqui AB, Trivedi AR, Kataria VB, Shah VH. 4,5-Dihydro-1H-pyrazolo[3,4-d]pyrimidine containing phenothiazines as antitubercular agents. Bioorg Med Chem Lett 2014; 24:1493-5. [DOI: 10.1016/j.bmcl.2014.02.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 02/01/2014] [Accepted: 02/04/2014] [Indexed: 02/05/2023]
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288
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Corbett EL, MacPherson P. Tuberculosis screening in high human immunodeficiency virus prevalence settings: turning promise into reality. Int J Tuberc Lung Dis 2014; 17:1125-38. [PMID: 23928165 DOI: 10.5588/ijtld.13.0117] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Twenty years of sky-high tuberculosis (TB) incidence rates and high TB mortality in high human immunodeficiency virus (HIV) prevalence countries have so far not been matched by the same magnitude or breadth of responses as seen in malaria or HIV programmes. Instead, recommendations have been narrowly focused on people presenting to health facilities for investigation of TB symptoms, or for HIV testing and care. However, despite the recent major investment and scale-up of TB and HIV services, undiagnosed TB remains highly prevalent at community level, implying that diagnosis of TB remains slow and incomplete. This maintains high transmission rates and exposes people living with HIV to high rates of morbidity and mortality. More intensive use of TB screening, with broader definitions of target populations, expanded indications for screening both inside and outside of health facilities, and appropriate selection of new diagnostic tools, offers the prospect of rapidly improving population-level control of TB. Diagnostic accuracy of suitable (high throughput) algorithms remains the major barrier to realising this goal. In the present study, we review the evidence available to guide expanded TB screening in HIV-prevalent settings, ideally through combined TB-HIV interventions that provide screening for both TB and HIV, and maximise entry to HIV and TB care and prevention. Ideally, we would systematically test, treat and prevent TB and HIV comprehensively, offering both TB and HIV screening to all health facility attendees, TB households and all adults in the highest risk communities. However, we are still held back by inadequate diagnostics, financing and paucity of population-impact data. Relevant contemporary research showing the high need for potential gains, and pitfalls from expanded and intensified TB screening in high HIV prevalence settings are discussed in this review.
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Affiliation(s)
- E L Corbett
- London School of Hygiene & Tropical Medicine, London, UK.
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289
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McHugh TD. World TB Day 2014: Reach the three million: a TB test, treatment and cure for all. Trans R Soc Trop Med Hyg 2014; 108:119-20. [PMID: 24535148 DOI: 10.1093/trstmh/tru006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Timothy D McHugh
- Centre for Clinical Microbiology, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2QG
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290
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Affiliation(s)
- Christian Wejse
- GloHAU, Center for Global Health, Department of Public Health, Aarhus University, 8000 Aarhus C, Denmark; Bandim Health Project, INDEPTH Network, Guinea Bissau; Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark.
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291
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Song Y, Gyarmati P, Araújo AC, Lundeberg J, Brumer H, Ståhl PL. Visual Detection of DNA on Paper Chips. Anal Chem 2014; 86:1575-82. [DOI: 10.1021/ac403196b] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Yajing Song
- Division of Gene
Technology, School of Biotechnology, Science for Life Laboratory, Royal Institute of Technology (KTH), SE-171 65 Solna, Sweden
| | - Péter Gyarmati
- Division of Gene
Technology, School of Biotechnology, Science for Life Laboratory, Royal Institute of Technology (KTH), SE-171 65 Solna, Sweden
| | - Ana Catarina Araújo
- Division
of Glycoscience,
School of Biotechnology, Royal Institute of Technology (KTH), AlbaNova University Centre, SE-106 91 Stockholm, Sweden
| | - Joakim Lundeberg
- Division of Gene
Technology, School of Biotechnology, Science for Life Laboratory, Royal Institute of Technology (KTH), SE-171 65 Solna, Sweden
| | - Harry Brumer
- Division
of Glycoscience,
School of Biotechnology, Royal Institute of Technology (KTH), AlbaNova University Centre, SE-106 91 Stockholm, Sweden
- Michael
Smith Laboratories and Department of Chemistry, University of British Columbia, 2185 East Mall, Vancouver V167T 1Z4, Canada
| | - Patrik L. Ståhl
- Department
of Cell and Molecular Biology, Karolinska Institutet, SE-171 77 Solna, Sweden
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292
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The changing culture of the microbiology laboratory. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2014; 24:125-8. [PMID: 24421822 DOI: 10.1155/2013/101630] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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293
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Results from early programmatic implementation of Xpert MTB/RIF testing in nine countries. BMC Infect Dis 2014; 14:2. [PMID: 24383553 PMCID: PMC3898850 DOI: 10.1186/1471-2334-14-2] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Accepted: 12/20/2013] [Indexed: 11/24/2022] Open
Abstract
Background The Xpert MTB/RIF assay has garnered significant interest as a sensitive and rapid diagnostic tool to improve detection of sensitive and drug resistant tuberculosis. However, most existing literature has described the performance of MTB/RIF testing only in study conditions; little information is available on its use in routine case finding. TB REACH is a multi-country initiative focusing on innovative ways to improve case notification. Methods We selected a convenience sample of nine TB REACH projects for inclusion to cover a range of implementers, regions and approaches. Standard quarterly reports and machine data from the first 12 months of MTB/RIF implementation in each project were utilized to analyze patient yields, rifampicin resistance, and failed tests. Data was collected from September 2011 to March 2013. A questionnaire was implemented and semi-structured interviews with project staff were conducted to gather information on user experiences and challenges. Results All projects used MTB/RIF testing for people with suspected TB, as opposed to testing for drug resistance among already diagnosed patients. The projects placed 65 machines (196 modules) in a variety of facilities and employed numerous case-finding strategies and testing algorithms. The projects consumed 47,973 MTB/RIF tests. Of valid tests, 7,195 (16.8%) were positive for MTB. A total of 982 rifampicin resistant results were found (13.6% of positive tests). Of all tests conducted, 10.6% failed. The need for continuous power supply was noted by all projects and most used locally procured solutions. There was considerable heterogeneity in how results were reported and recorded, reflecting the lack of standardized guidance in some countries. Conclusions The findings of this study begin to fill the gaps among guidelines, research findings, and real-world implementation of MTB/RIF testing. Testing with Xpert MTB/RIF detected a large number of people with TB that routine services failed to detect. The study demonstrates the versatility and impact of the technology, but also outlines various surmountable barriers to implementation. The study is not representative of all early implementer experiences with MTB/RIF testing but rather provides an overview of the shared issues as well as the many different approaches to programmatic MTB/RIF implementation.
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294
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Yempala T, Sridevi JP, Yogeeswari P, Sriram D, Kantevari S. Rational design and synthesis of novel dibenzo[b,d]furan-1,2,3-triazole conjugates as potent inhibitors of Mycobacterium tuberculosis. Eur J Med Chem 2014; 71:160-7. [DOI: 10.1016/j.ejmech.2013.10.082] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 10/10/2013] [Accepted: 10/31/2013] [Indexed: 11/30/2022]
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295
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Rational design, synthesis and antitubercular evaluation of novel 2-(trifluoromethyl)phenothiazine-[1,2,3]triazole hybrids. Bioorg Med Chem Lett 2014; 24:233-6. [DOI: 10.1016/j.bmcl.2013.11.031] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 10/29/2013] [Accepted: 11/14/2013] [Indexed: 12/20/2022]
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296
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Optimal triage test characteristics to improve the cost-effectiveness of the Xpert MTB/RIF assay for TB diagnosis: a decision analysis. PLoS One 2013; 8:e82786. [PMID: 24367555 PMCID: PMC3867409 DOI: 10.1371/journal.pone.0082786] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 10/28/2013] [Indexed: 01/31/2023] Open
Abstract
Background High costs are a limitation to scaling up the Xpert MTB/RIF assay (Xpert) for the diagnosis of tuberculosis in resource-constrained settings. A triaging strategy in which a sensitive but not necessarily highly specific rapid test is used to select patients for Xpert may result in a more affordable diagnostic algorithm. To inform the selection and development of particular diagnostics as a triage test we explored combinations of sensitivity, specificity and cost at which a hypothetical triage test will improve affordability of the Xpert assay. Methods In a decision analytical model parameterized for Uganda, India and South Africa, we compared a diagnostic algorithm in which a cohort of patients with presumptive TB received Xpert to a triage algorithm whereby only those with a positive triage test were tested by Xpert. Findings A triage test with sensitivity equal to Xpert, 75% specificity, and costs of US$5 per patient tested reduced total diagnostic costs by 42% in the Uganda setting, and by 34% and 39% respectively in the India and South Africa settings. When exploring triage algorithms with lower sensitivity, the use of an example triage test with 95% sensitivity relative to Xpert, 75% specificity and test costs $5 resulted in similar cost reduction, and was cost-effective by the WHO willingness-to-pay threshold compared to Xpert for all in Uganda, but not in India and South Africa. The gain in affordability of the examined triage algorithms increased with decreasing prevalence of tuberculosis among the cohort. Conclusions A triage test strategy could potentially improve the affordability of Xpert for TB diagnosis, particularly in low-income countries and with enhanced case-finding. Tests and markers with lower accuracy than desired of a diagnostic test may fall within the ranges of sensitivity, specificity and cost required for triage tests and be developed as such.
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297
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Lawn SD, Meintjes G, McIlleron H, Harries AD, Wood R. Management of HIV-associated tuberculosis in resource-limited settings: a state-of-the-art review. BMC Med 2013; 11:253. [PMID: 24295487 PMCID: PMC4220801 DOI: 10.1186/1741-7015-11-253] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 11/07/2013] [Indexed: 01/08/2023] Open
Abstract
The HIV-associated tuberculosis (TB) epidemic remains a huge challenge to public health in resource-limited settings. Reducing the nearly 0.5 million deaths that result each year has been identified as a key priority. Major progress has been made over the past 10 years in defining appropriate strategies and policy guidelines for early diagnosis and effective case management. Ascertainment of cases has been improved through a twofold strategy of provider-initiated HIV testing and counseling in TB patients and intensified TB case finding among those living with HIV. Outcomes of rifampicin-based TB treatment are greatly enhanced by concurrent co-trimoxazole prophylaxis and antiretroviral therapy (ART). ART reduces mortality across a spectrum of CD4 counts and randomized controlled trials have defined the optimum time to start ART. Good outcomes can be achieved when combining TB treatment with first-line ART, but use with second-line ART remains challenging due to pharmacokinetic drug interactions and cotoxicity. We review the frequency and spectrum of adverse drug reactions and immune reconstitution inflammatory syndrome (IRIS) resulting from combined treatment, and highlight the challenges of managing HIV-associated drug-resistant TB.
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Affiliation(s)
- Stephen D Lawn
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
- The Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Graeme Meintjes
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Helen McIlleron
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Anthony D Harries
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
- International Union against Tuberculosis and Lung Disease (The Union), Paris, France
| | - Robin Wood
- The Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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298
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Zumla A, George A, Sharma V, Herbert N. WHO's 2013 global report on tuberculosis: successes, threats, and opportunities. Lancet 2013; 382:1765-7. [PMID: 24269294 DOI: 10.1016/s0140-6736(13)62078-4] [Citation(s) in RCA: 137] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Alimuddin Zumla
- Division of Infection and Immunity, University College London, UCL Royal Free Campus and University College London Hospitals NHS Foundation Trust, London NW3 2PF, UK.
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299
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Pyrosequencing for rapid detection of extensively drug-resistant Mycobacterium tuberculosis in clinical isolates and clinical specimens. J Clin Microbiol 2013; 52:475-82. [PMID: 24478476 DOI: 10.1128/jcm.01821-13] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Treating extensively drug-resistant (XDR) tuberculosis (TB) is a serious challenge. Culture-based drug susceptibility testing (DST) may take 4 weeks or longer from specimen collection to the availability of results. We developed a pyrosequencing (PSQ) assay including eight subassays for the rapid identification of Mycobacterium tuberculosis complex (MTBC) and concurrent detection of mutations associated with resistance to drugs defining XDR TB. The entire procedure, from DNA extraction to the availability of results, was accomplished within 6 h. The assay was validated for testing clinical isolates and clinical specimens, which improves the turnaround time for molecular DST and maximizes the benefit of using molecular testing. A total of 130 clinical isolates and 129 clinical specimens were studied. The correlations between the PSQ results and the phenotypic DST results were 94.3% for isoniazid, 98.7% for rifampin, 97.6% for quinolones (ofloxacin, levofloxacin, or moxifloxacin), 99.2% for amikacin, 99.2% for capreomycin, and 96.4% for kanamycin. For testing clinical specimens, the PSQ assay yielded a 98.4% sensitivity for detecting MTBC and a 95.8% sensitivity for generating complete sequencing results from all subassays. The PSQ assay was able to rapidly and accurately detect drug resistance mutations with the sequence information provided, which allows further study of the association of drug resistance or susceptibility with each mutation and the accumulation of such knowledge for future interpretation of results. Thus, reporting of false resistance for mutations known not to confer resistance can be prevented, which is a significant benefit of the assay over existing molecular diagnostic methods endorsed by the World Health Organization.
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300
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Tuberculosis in hematopoietic stem cell transplant recipients. Mediterr J Hematol Infect Dis 2013; 5:e2013061. [PMID: 24363876 PMCID: PMC3867227 DOI: 10.4084/mjhid.2013.061] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 10/16/2013] [Indexed: 01/25/2023] Open
Abstract
Literature on tuberculosis (TB) occurring in recipients of Hematopoietic Stem Cell Transplant (HSCT) is scanty even in countries where TB is common. Most reports of TB in HSCT patients were from ASIA, in fact the TB incidence ranging from 0.0014 (USA) to 16% (Pakistan). There are few reports of TB diagnosis during the first two weeks after HSCT; most of cases described in the literature occurred after 90 days of HSCT, and the lung was the organ most involved. The mortality ranged from 0 to 50% and is higher in allogeneic HSCT than in autologous. There is no consensus regarding the screening with tuberculin skin test or QuantiFERON-TB gold, primary prophylaxis for latent TB, and whether the epidemiologic query should be emphasized in developing countries with high prevalence of TB.
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