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Baye N, Atnafu A, Girma S, Belete Y, Yimam S, Getachew B, Ayalew S, Bobosha K, Chanyalew Z, Gize A, Chaniyalew M. Evaluation of molecular and bacteriological detection methods performed on the formalin-fixed paraffin-embedded biopsy samples collected from endometrial and lymph node tuberculosis suspected patients. BMC Infect Dis 2024; 24:1021. [PMID: 39304809 DOI: 10.1186/s12879-024-09908-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2024] [Accepted: 09/09/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND Endometrial Tuberculosis is one of the most common gynecological problems known to have serious implications for the quality of life like infertility. The commonly practiced histopathology solely relies on the suggestive feature of Tuberculosis (TB) with low specificity. Regarding the alternative bacteriological and molecular detection tools, little evidence was generated on their utility in the diagnosis of endometrial tuberculosis in Ethiopia. Therefore, we aim to investigate the detection rate of molecular and bacteriological detection methods on formalin-fixed paraffin-embedded biopsy samples for the diagnosis of endometrial and lymph node TB. METHODS A retrospective cross-sectional study was conducted on 90 formalin fixed paraffin embedded biopsy samples from patients with gynecologic and lymph problems collected between 2018 and 2022 at St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia. SPSS version 26 was used for statistical analysis. The diagnostic performance was calculated using the histopathology method as the reference standard. Cohen's Kappa value was used to measure the level of agreement. A test with a P-value of < 0.05 was considered statistically significant. RESULTS A total of 90 samples were analyzed in the current study. Auramine O, GeneXpert MTB/RIF assay, and Real-Time PCR tests have shown a detection rate of 32/90 (36%), 43/90 (47.8%), and 54/90 (60%) respectively (P ≤ 0.01). The sensitivity and specificity of AO were 38.1% and 95% respectively. RT PCR showed superior sensitivity followed by GeneXpert MTB/RIF assay, 70% and 58.6%. AO and molecular methods have shown a similarly low level of agreement with histopathology (Kappa value = 0.2). CONCLUSIONS In a resource-limited setting, the selection of diagnostic tools needs careful attention. Putting the patients on anti-TB treatments based solely on histopathological findings may lead to undesired and adverse complications. Therefore, applying molecular and bacteriological detection methods along with histopathology, could help minimize inappropriate antimicrobial use.
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Affiliation(s)
- Negash Baye
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia.
- Department of Microbiology, Immunology and Parasitology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
| | - Abay Atnafu
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Selfu Girma
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Yerega Belete
- Department of Microbiology, Immunology and Parasitology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Sofia Yimam
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | | | - Sosina Ayalew
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Kidist Bobosha
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Zewditu Chanyalew
- Department of Pathology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Addisu Gize
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
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Li K, Hu Q, Liu J, Liu S, He Y. Effects of sputum bacillary load and age on GeneXpert and traditional methods in pulmonary tuberculosis: a 4-year retrospective comparative study. BMC Infect Dis 2023; 23:831. [PMID: 38012541 PMCID: PMC10680317 DOI: 10.1186/s12879-023-08832-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 11/18/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the diagnostic value of the GeneXpert® MTB/RIF (Xpert®), Auramine O staining method, and Lowenstein-Jensen medium for bacteriologically confirmed pulmonary tuberculosis and explore the effects of the sputum bacillary load (SBL) and qRT‒PCR threshold cycle (Ct) value on the detection methods. METHODS We retrospectively analysed the results in the Department of Infectious Disease for 49 months. The χ2 test was used to compare the performances of each method, receiver operating characteristic curve analysis was used to determine the optimal cut-off values, and the factors associated with a false-negative result from Xpert® were analysed by logistic regression. RESULTS Simultaneous analysis of 980 sputum specimens showed that the positive detection rate of Xpert® did not increase with increasing SBL, and there were differences between the three when SBL ≤ 1 + (all P < 0.05). There was a good negative correlation between the Ct value and the SBL (P < 0.0001). Age was an independent risk factor for false-negative Xpert® results (P = 0.029), and when Ct < 16, the diagnostic sensitivity and specificity were both 100.00%. The optimal cut-off Ct values for resegmentation based on the drug resistance classification were < 18.6, 18.6-34.1, and > 34.1 cycles. CONCLUSIONS Xpert® was not affected by SBL but it was by age, and it is more advantageous when SBL ≤ 1 + . The results regarding rifampicin resistance were reliable, and the novel Ct segmentation was a practical and more clinically meaningful classification method for diagnosing rifampicin resistance. These findings will help improve physicians' ability to accurately diagnose TB.
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Affiliation(s)
- Kui Li
- Department of Infectious Diseases, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West YantaRoad, Xi'an, Shaanxi Province, 710061, China
- Department of Infectious Diseases, Ankang Central Hospital, 85 South Jinzhou Road, Ankang, Shaanxi Province, 725000, China
| | - Qianqian Hu
- Laboratory of Molecular Pathology and Tuberculosis Diseases, Ankang Central Hospital, 85 South Jinzhou Road, Ankang, Shaanxi Province, 725000, China
| | - Jun Liu
- Laboratory of Molecular Pathology and Tuberculosis Diseases, Ankang Central Hospital, 85 South Jinzhou Road, Ankang, Shaanxi Province, 725000, China
| | - Siyi Liu
- Department of Infectious Diseases, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West YantaRoad, Xi'an, Shaanxi Province, 710061, China
| | - Yingli He
- Department of Infectious Diseases, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West YantaRoad, Xi'an, Shaanxi Province, 710061, China.
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Coulibaly G, Georges Togo AC, Somboro AM, Kone M, Traore FG, Diallo F, Degoga B, Somboro A, Dramé HM, Sanogo M, Kodio O, Baya B, Tolofoudie M, Maiga A, Maiga M, Saliba-Shaw K, Diallo S, Doumbia S, Maiga II, Samaké F, Diarra B. Use of light-emitting diode fluorescence microscopy to detect acid-fast bacilli in sputum as proficient alternative tool in the diagnosis of pulmonary tuberculosis in countries with limited resource settings. Int J Mycobacteriol 2023; 12:144-150. [PMID: 37338475 DOI: 10.4103/ijmy.ijmy_13_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
Background Despite recent advances in the development of more sensitive technologies for the diagnosis of tuberculosis (TB), in resource-limited settings, the diagnosis continues to rely on sputum smear microscopy. This is because smear microscopy is simple, cost-efficient and the most accessible tool for the diagnosis of TB. Our study evaluated the performance of light-emitting diode fluorescence microscopy (LED-FM) using auramine/rhodamine (auramine) and the fluorescein di-acetate (FDA) vital stain in the diagnostic of pulmonary TB in Bamako, Mali. Methods Sputum smear microscopy was conducted using the FDA and auramine/rhodamine staining procedures on fresh samples using LED-FM to evaluate the Mycobacterium TB (MTB) metabolic activity and to predict contagiousness. Mycobacterial culture assay was utilized as a gold standard method. Results Out of 1401 TB suspected patients, 1354 (96.65%) were retrieved from database, which were MTB complex culture positive, and 47 (3.40%) were culture negative (no mycobacterial growth observed). Out of the 1354 included patients, 1343 (95.86%), were acid-fast bacillus (AFB) positive after direct FDA staining, 1352 (96.50%) AFB positive after direct Auramine, and 1354 (96.65%) AFB positive with indirect auramine after digestion and centrifugation. Overall, the FDA staining method has a sensitivity of 98.82%, while the sensitivity of Auramine with direct observation was 99.48%, and 99.56% with the indirect examination. Conclusion This study showed that, using fresh sputum both auramine/rhodamine and FDA are highly sensitive methods in diagnosing pulmonary TB and could be easily used in countries with limited resource settings.
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Affiliation(s)
- Gagni Coulibaly
- University Clinical Research Center-SEREFO Laboratory, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Antièmé Combo Georges Togo
- University Clinical Research Center-SEREFO Laboratory, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Anou Moise Somboro
- University Clinical Research Center-SEREFO Laboratory, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali; Medical Biochemistry, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Mahamadou Kone
- University Clinical Research Center-SEREFO Laboratory, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Fah Gaoussou Traore
- University Clinical Research Center-SEREFO Laboratory, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Fatimata Diallo
- University Clinical Research Center-SEREFO Laboratory, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Boureima Degoga
- University Clinical Research Center-SEREFO Laboratory, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Amadou Somboro
- University Clinical Research Center-SEREFO Laboratory, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Hawa M'baye Dramé
- University Clinical Research Center-SEREFO Laboratory, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Moumine Sanogo
- University Clinical Research Center-SEREFO Laboratory, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Ousmane Kodio
- University Clinical Research Center-SEREFO Laboratory, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Bocar Baya
- University Clinical Research Center-SEREFO Laboratory, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Mohamed Tolofoudie
- University Clinical Research Center-SEREFO Laboratory, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Aminata Maiga
- Laboratory and Hospital Hygiene Services, University Teaching Hospital of Point G, Bamako, Mali
| | - Mamoudou Maiga
- University Clinical Research Center-SEREFO Laboratory, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali; Center for Innovation in Global Health Technology, Northwestern University, Chicago, Illinois, USA
| | - Katy Saliba-Shaw
- Collaborative Clinical Research Branch, Division of Clinical Research, NIAID/NIH, Bethesda, Maryland, USA
| | - Souleymane Diallo
- University Clinical Research Center-SEREFO Laboratory, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Seydou Doumbia
- University Clinical Research Center-SEREFO Laboratory, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | | | - Fassé Samaké
- Microbial Biotechnology Laboratory, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Bassirou Diarra
- University Clinical Research Center-SEREFO Laboratory, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
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Khan MK, Islam MN, Hassan J, Paul SK, Islam MA, Pateras K, Kostoulas P, Ward MP, Rahman AKMA, Alam MM. Hierarchical true prevalence, risk factors and clinical symptoms of tuberculosis among suspects in Bangladesh. PLoS One 2022; 17:e0262978. [PMID: 35819968 PMCID: PMC9275716 DOI: 10.1371/journal.pone.0262978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 06/27/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The study was aimed to estimate the true prevalence of human tuberculosis (TB); identify risk factors and clinical symptoms of TB; and detect rifampicin (RIF) sensitivity in three study areas of Bangladesh. METHODS The cross-sectional study was conducted in three Bangladesh districts during 2018. Potential risk factors, clinical symptoms, and comorbidities were collected from 684 TB suspects. Sputum specimens were examined by LED microscopy. TB hierarchical true prevalence, risk factors and clinical symptoms were estimated and identified using a Bayesian analysis framework. Rifampicin sensitivity of M. tuberculosis (MTB) was detected by GeneXpert MTB/RIF assay. RESULTS The median TB true prevalence was 14.2% (3.8; 34.5). Although overall clustering of prevalence was not found, several DOTS centers were identified with high prevalence (22.3% to 43.7%). Risk factors for TB identified (odds ratio) were age (> 25 to 45 years 2.67 (1.09; 6.99), > 45 to 60 years 3.43 (1.38; 9.19) and individuals in families/neighborhoods where a TB patient(s) has (ve) already been present (12.31 (6.79; 22.60)). Fatigue, night sweat, fever and hemoptysis were identified as important clinical symptoms. Seven of the GeneXpert MTB/RIF positive sputum specimens (65) were resistant to rifampicin. CONCLUSIONS About one in every seven TB suspects was affected with TB. A number of the TB patients carry multi drug resistant MTB. Hierarchical true prevalence estimation allowed identifying DOTS centers with high TB burden. Insights from this study will enable more efficient use of DOTScenters-based TB surveillance to end the TB epidemic in Bangladesh by 2035.
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Affiliation(s)
- Mohammad Kamruzzaman Khan
- Faculty of Veterinary Science, Department of Medicine, Bangladesh Agricultural University, Mymensingh, Bangladesh
- Department of Community Medicine, Mymensingh Medical College, Mymensingh, Bangladesh
| | - Md. Nazimul Islam
- Faculty of Veterinary Science, Department of Medicine, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Jayedul Hassan
- Faculty of Veterinary Science, Department of Microbiology and Hygiene, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Shaymal Kumar Paul
- Department of Microbiology, Netrokona Medical College, Netrokona, Bangladesh
| | - M. Ariful Islam
- Faculty of Veterinary Science, Department of Medicine, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Konstantinos Pateras
- Laboratory of Epidemiology & Artificial Intelligence, Faculty of Public Health, University of Thessaly, Volos, Greece
| | - Polychronis Kostoulas
- Laboratory of Epidemiology & Artificial Intelligence, Faculty of Public Health, University of Thessaly, Volos, Greece
| | - Michael P. Ward
- Sydney School of Veterinary Science, The University of Sydney, Camden, New South Wales, Australia
| | - A. K. M. Anisur Rahman
- Faculty of Veterinary Science, Department of Medicine, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Md. Mahbub Alam
- Faculty of Veterinary Science, Department of Medicine, Bangladesh Agricultural University, Mymensingh, Bangladesh
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Paul DC, Ngeow YF, Yap SF, Dony JF, Avoi R, Mohammad R, Ng HF. Concentrated specimen smear microscopy utilising a polymer membrane sandwich filtration vessel for the detection of acid-fast bacilli in health facilities in Sabah, East Malaysia. Tuberculosis (Edinb) 2022; 133:102183. [PMID: 35180496 DOI: 10.1016/j.tube.2022.102183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/30/2022] [Accepted: 02/06/2022] [Indexed: 10/19/2022]
Abstract
A simple, ready-to-use concentrated specimen smear microscopy method employing a nanometer silicon polyvinylidene fluoride (PVDF) polymer membrane sandwich filtration vessel to concentrate acid-fast bacilli (AFB) in samples (SFV-CSSM, Hunan-Tech New Medical System Co. Ltd. China) was compared with direct sputum smear microscopy (DSSM) to determine its performance using culture on modified Ogawa agar as reference. The results for 4114 clinical samples collected from health facilities in Sabah were interpreted with reference to culture results, sample collection-transportation conditions and clinical data including responses to anti-TB drug treatment. The SFV-CSSM showed higher sensitivity than DSSM (79.4% versus 60.5%) and less background interference. Its ability to detect low levels of AFB at an affordable cost makes it an excellent tool for the screening of pauci-bacillary samples as well as for active case finding in TB control programs.
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Affiliation(s)
- Dawn Carmel Paul
- Kota Kinabalu Public Health Laboratory, Sabah State Health Department, Sabah, Malaysia; Centre for Research on Communicable Diseases, Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Selangor, Malaysia
| | - Yun Fong Ngeow
- Centre for Research on Communicable Diseases, Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Selangor, Malaysia.
| | - Sook Fan Yap
- Centre for Research on Communicable Diseases, Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Selangor, Malaysia
| | - Jiloris F Dony
- Kota Kinabalu Public Health Laboratory, Sabah State Health Department, Sabah, Malaysia
| | - Richard Avoi
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Sabah, Malaysia
| | - Rashidah Mohammad
- Kota Kinabalu Public Health Laboratory, Sabah State Health Department, Sabah, Malaysia
| | - Hien Fuh Ng
- Centre for Research on Communicable Diseases, Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Selangor, Malaysia
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Kebede W, Gudina EK, Balay G, Abebe G. Diagnostic implications and inpatient mortality related to tuberculosis at Jimma Medical Center, southwest Ethiopia. J Clin Tuberc Other Mycobact Dis 2021; 23:100220. [PMID: 33553681 PMCID: PMC7846922 DOI: 10.1016/j.jctube.2021.100220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) is one of the major public health problems in Ethiopia. Determining discharge outcome of TB cases helps to understand the effectiveness of TB diagnosis effort to improve case management. The objective of this study was to assess discharge outcomes and factors associated with death among patients on TB treatment admitted in a referral hospital in southwest Ethiopia. METHODS A retrospective study was conducted in Jimma Medical Center by reviewing medical records of TB patients (age ≥15 years) admitted to medical wards from January 2015 to December 2017. Demographic and related data was collected using data collection format. The clinical evaluation outcome of an individual patient at discharge was recorded. Descriptive statistics were used to summarize participant characteristics. Multivariate logistic regression analyses were used to evaluate the risk factors for TB mortality. RESULTS Among 465 patients included in the review, 225 (48.4%) were pulmonary (PTB) and 240 (51.6%) extra-pulmonary TB (EPTB) cases. Overall, 190 (40.9%) had bacteriologically confirmed for TB. HIV status was documented for 340 (73.1%) of them; 93 (27.4%) were found to be positive. The prevalence of HIV infection among EPTB and PTB cases was 50/275 (18.2%) and 43/190 (22.8%), respectively. A quarter of the patient, 114 (24.5%), died in the hospital while the rest were discharged with clinical improvement. Compared to smear positive PTB, the risk of death was two times higher in patients with smear negative PTB cases (aOR 2.3, 95% CI: 1.3-4.2). TB patients with coronary obstructive pulmonary disease (COPD) (aOR 4.6, 95% CI: 1.3-16.7), diabetes mellitus (aOR 5.7, 95% CI: 1.5-23.7), heart disease (aOR 3.8, 95% CI: 1.4-10.4) had about four-fold increased risk of death. HIV-positive patients had a higher risk of mortality (aOR 2.9, 95% CI: 1.7-5.0) than HIV-negative patients. The risk of death was not affected by the type of TB diagnosed, as 27.6% of EPTB and 31.9% PTB were died (p = 0.457). CONCLUSION TB was associated with high inpatient mortality at Jimma Medical Center. Mortality was found to be higher among unconfirmed cases, those with COPD, diabetes mellitus, heart disease and HIV infection. Thus, any effort to curtail mortality in such high TB burden setting should focus on improving TB diagnosis and addressing major comorbid medical conditions.
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Affiliation(s)
- Wakjira Kebede
- Mycobacteriology Research Center, Jimma University, Ethiopia
- School of Medical Laboratory Science, Institute of Health, Jimma University, Ethiopia
| | - Esayas Kebede Gudina
- Department of Internal Medicine, Jimma University Medical Center, Jimma University, Ethiopia
| | - Getu Balay
- School of Medical Laboratory Science, Institute of Health, Jimma University, Ethiopia
| | - Gemeda Abebe
- Mycobacteriology Research Center, Jimma University, Ethiopia
- School of Medical Laboratory Science, Institute of Health, Jimma University, Ethiopia
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