New technology for diagnosis of bacterial vaginosis

Identification of volatile compounds from bacteria by spectrometric methods in medicine diagnostic and other areas: current state and perspectives

Diagnosis of bacterial infections until today mostly relies on conventional microbiological methods. The resulting long turnaround times can lead to delayed initiation of adequate antibiotic therapy and prolonged periods of empiric antibiotic therapy (e.g., in intensive care medicine). Therewith, they contribute to the mortality of bacterial infections and the induction of multidrug resistances. The detection of species specific volatile organic compounds (VOCs) emitted by bacteria has been proposed as a possible diagnostic approach with the potential to serve as an innovative point-of-care diagnostic tool with very short turnaround times. A range of spectrometric methods are available which allow the detection and quantification of bacterial VOCs down to a range of part per trillion. This narrative review introduces the application of spectrometric analytical methods for the purpose of detecting VOCs of bacterial origin and their clinical use for diagnosing different infectious conditions over the last decade. KEY POINTS: • Detection of VOCs enables bacterial differentiation in various medical conditions. • Spectrometric methods may function as point-of-care diagnostics in near future.

Nitrogen oxides as dopants for the detection of aromatic compounds with ion mobility spectrometry

Limits of detection (LODs) in ion mobility spectrometry (IMS) strictly depend on ionization of the analyte. Especially challenging is ionization of compounds with relatively low proton affinity (PA) such as aromatic compounds. To change the course of ion-molecule reactions and enhance the performance of the IMS spectrometer, substances called dopants are introduced into the carrier gas. In this work, we present the results of studies of detection using nitrogen oxides (NOx) dopants. Three aromatic compounds, benzene, toluene, toluene diisocyanate and, for comparison, two compounds with high PA, dimethyl methylphosphonate (DMMP) and triethyl phosphate (TEP), were selected as analytes. The influence of water vapour on these analyses was also studied. Experiments were carried out with a generator of gas mixtures that allowed for the simultaneous introduction of three substances into the carrier gas. The experiments showed that the use of NOx dopants significantly decreases LODs for aromatic compounds and does not affect the detection of compounds with high PA. The water vapour significantly disturbs the detection of aromatic compounds; however, doping with NOx allows to reduce the effect of humidity. Graphical Abstract Two possible ionization mechanisms of aromatic compounds in ion mobility spectrometry: proton transfer reaction and adduct formation.

Review on ion mobility spectrometry. Part 2: hyphenated methods and effects of experimental parameters

Ion Mobility Spectrometry (IMS) is a widely used and 'well-known' technique of ion separation in the gaseous phase based on the differences of ion mobilities under an electric field. This technique has received increased interest over the last several decades as evidenced by the pace and advances of new IMS devices available. In this review we explore the hyphenated techniques that are used with IMS, specifically mass spectrometry as an identification approach and a multi-capillary column as a pre-separation approach. Also, we will pay special attention to the key figures of merit of the ion mobility spectrum and how data sets are treated, and the influences of the experimental parameters on both conventional drift time IMS (DTIMS) and miniaturized IMS also known as high Field Asymmetric IMS (FAIMS) in the planar configuration. The present review article is preceded by a companion review article which details the current instrumentation and contains the sections that configure both conventional DTIMS and FAIMS devices. These reviews will give the reader an insightful view of the main characteristics and aspects of the IMS technique.

Tandem differential mobility spectrometry in purified air for high-speed selective vapor detection

A tandem ion mobility instrument based on differential mobility spectrometry (DMS) was used to demonstrate selectivity in response through differences in field dependence of mobility for ions in purified air at ambient pressure. The concept of chemical selectivity solely from characteristic dispersion curves or from field dependence of ion mobility was experimentally demonstrated in three steps with mixtures of increasing complexity. In a mixture of four alcohols with carbon numbers four and below, distinct pairs of separation voltage and compensation voltage, applied to the first and second DMS stages, permitted isolation of ions from individual substances without detectable levels of other substances. In a three-component mixture of a ketone, alcohol, and organophosphorus compound, the same level of ion isolation was observed using specific and characteristic separation and compensation voltages on each DMS stage. In the last experiment, the isolation of product ions of individual substances from a mixture of 23 volatile organic compounds from four chemical groups was incomplete though the improvement in the ratio of analyte signal to chemical noise was calculated as 31 for DMMP and 106 for 1-hexanol. These findings demonstrate that chemical information available in dispersion curves can be accessed in response times below 100 ms through a tandem DMS measurement.

Detection and validation of volatile metabolic patterns over different strains of two human pathogenic bacteria during their growth in a complex medium using multi-capillary column-ion mobility spectrometry (MCC-IMS)

Headspace analyses over microbial cultures using multi-capillary column-ion mobility spectrometry (MCC-IMS) could lead to a faster, safe and cost-effective method for the identification of pathogens. Recent studies have shown that MCC-IMS allows identification of bacteria and fungi, but no information is available from when on during their growth a differentiation between bacteria is possible. Therefore, we analysed the headspace over human pathogenic reference strains of Escherichia coli and Pseudomonas aeruginosa at four time points during their growth in a complex fluid medium. In order to validate our findings and to answer the question if the results of one bacterial strain can be transferred to other strains of the same species, we also analysed the headspace over cultures from isolates of random clinical origin. We detected 19 different volatile organic compounds (VOCs) that appeared or changed their signal intensity during bacterial growth. These included six VOCs exclusively changing over E. coli cultures and seven exclusively changing over P. aeruginosa cultures. Most changes occurred in the late logarithmic or static growth phases. We did not find differences in timing or trends in signal intensity between VOC patterns of different strains of one species. Our results show that differentiation of human pathogenic bacteria by headspace analyses using MCC-IMS technology is best possible during the late phases of bacterial growth. Our findings also show that VOC patterns of a bacterial strain can be transferred to other strains of the same species.

Efficacy of methods used for the diagnosis of bacterial vaginosis

INTRODUCTION

Bacterial vaginosis (BV) has been associated with pelvic inflammatory disease, adverse pregnancy outcomes, increased susceptibility to sexually transmitted infections and infertility. Diagnosis of BV should be rapid, reliable and safe. This is especially vital in pregnant women where intervention may be necessary for the well-being of both the mother and the foetus.

AREAS COVERED

This paper consulted PUBMED, LISTA and Web of Science for point-of-care and laboratory-based tests commonly used for the diagnosis and management of BV in pregnant women. An overview of strengths and weaknesses of the methods used may partially explain why treatment plans have failed. Differences in sampling and detection methods, time of gestation, inter-examiner variability and interpretation of data, and the use of different reference tests, amongst many other factors, complicated a meta-analysis of the data.

EXPERT OPINION

Inconsistencies found in clinical and laboratory detection methods used for the monitoring of treatment have a direct impact on success rates. With current advances in technology, the diagnosis of BV is taking on a new perspective. New information implicating specific vaginal biofilms in adverse pregnancy outcomes through the application of advanced technology promises to change the way we view the aetiology, diagnosis and management of BV.

A peptide receptor-based bioelectronic nose for the real-time determination of seafood quality

We herein report a peptide receptor-based bioelectronic nose (PRBN) that can determine the quality of seafood in real-time through measuring the amount of trimethylamine (TMA) generated from spoiled seafood. The PRBN was developed using single walled-carbon nanotube field-effect transistors (SWNT-FETs) functionalized with olfactory receptor-derived peptides (ORPs) which can recognize TMA and it allowed us to sensitively and selectively detect TMA in real-time at concentrations as low as 10fM. Utilizing these properties, we were able to not only determine the quality of three kinds of seafood (oyster, shrimp, and lobster), but were also able to distinguish spoiled seafood from other types of spoiled foods without any pretreatment processes. Especially, the use of small synthetic peptide rather than the whole protein allowed PRBNs to be simply manufactured through a single-step process and to be reused with high reproducibility due to no requirement of lipid bilayers. Furthermore, the PRBN was produced on a portable scale making it effectively useful for the food industry where the on-site measurement of seafood quality is required.

Diagnosing vaginal infections through measurement of biogenic amines by ion mobility spectrometry

OBJECTIVE

To compare diagnosis of bacterial vaginosis according to the Amsel criteria with measurement by ion mobility spectrometry (IMS) of the biogenic amines that are present in vaginal discharge fluid.

STUDY DESIGN

Duplicate samples of vaginal fluid were collected from 115 unselected and consecutive patients in a vaginitis clinic in Detroit. All samples were evaluated using Amsel criteria and the results were compared with the diagnosis based on the IMS results.

RESULTS

The incidence rate of vaginal infections was assessed on the basis of both tests and the frequency of BV was found to be 17.4%. The sensitivity and specificity for bacterial vaginosis diagnosis using IMS determination were 95.5% and 98.9%, respectively, with an accuracy of 94.4%.

CONCLUSIONS

The results show that IMS may be used to rapidly diagnose this common vaginal infection with high accuracy.

Recent Applications of Ion Mobility Spectrometry in Diagnosis of Vaginal Infections

Vaginal infections (vaginosis) globally affect more than 15% of the female population of reproductive age. However, diagnosis of vaginosis and differentiating between the three common types: bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), and trichomoniasis are challenging. Elevated levels of the biogenic amines, trimethylamine (TMA), putrescine, and cadaverine have been found in vaginal discharge fluid of women with vaginosis. Ion mobility spectrometry (IMS) is particularly suitable for measurement of amines even in complex biological matrices due to their high proton affinity and has been shown to be suitable for the diagnosis of vaginal infections. Recent developments that have increased the accuracy of the technique for diagnosis of BV and simplified sample introduction are described here.

Ion mobility spectrometry for microbial volatile organic compounds: a new identification tool for human pathogenic bacteria

Presently, 2 to 4 days elapse between sampling at infection suspicion and result of microbial diagnostics. This delay for the identification of pathogens causes quite often a late and/or inappropriate initiation of therapy for patients suffering from infections. Bad outcome and high hospitalization costs are the consequences of these currently existing limited pathogen identification possibilities. For this reason, we aimed to apply the innovative method multi-capillary column–ion mobility spectrometry (MCC-IMS) for a fast identification of human pathogenic bacteria by determination of their characteristic volatile metabolomes. We determined volatile organic compound (VOC) patterns in headspace of 15 human pathogenic bacteria, which were grown for 24 h on Columbia blood agar plates. Besides MCC-IMS determination, we also used thermal desorption–gas chromatography–mass spectrometry measurements to confirm and evaluate obtained MCC-IMS data and if possible to assign volatile compounds to unknown MCC-IMS signals. Up to 21 specific signals have been determined by MCC-IMS for Proteus mirabilis possessing the most VOCs of all investigated strains. Of particular importance is the result that all investigated strains showed different VOC patterns by MCC-IMS using positive and negative ion mode for every single strain. Thus, the discrimination of investigated bacteria is possible by detection of their volatile organic compounds in the chosen experimental setup with the fast and cost-effective method MCC-IMS. In a hospital routine, this method could enable the identification of pathogens already after 24 h with the consequence that a specific therapy could be initiated significantly earlier.

The vaginal microbiome in health and disease

Infections of the vaginal tract result from perturbations in the complex interactions between the microbiome and the host vaginal ecosystem. Recent data have linked specific vaginal microbes and urogenital infection with preterm birth. Here we discuss how next-generation sequencing-based approaches to study the vaginal microbiome will be important for defining what constitutes an imbalance of the microbiome and the associated host conditions that lead to subsequent infection and disease states. These studies will provide clinicians with reliable diagnostic tools and treatments for women who are at increased risk for vaginal infections, preterm birth, HIV and other sexually acquired diseases, and will provide opportunities for intervention.

Linearized equations for the reduced ion mobilities of polar aliphatic organic compounds

Over the years, ion mobility spectrometry has evolved into a powerful technique for rapid identification of analytes in very complex sample matrixes such as human breath. Every analyte detected has a characteristic ion mobility value (and a retention time when additional preseparation techniques are employed) which is used to identify the peaks in a spectrum either by comparison with reference analytes or by simultaneous mass spectrometric measurements. In this study, the mass-mobility correlations between compounds in three different homologous series are used to predict the mobilities of the other substances in the same series in a medium of synthetic air. The results show a very high accuracy (>99.5%) of the prognosis. The linear trend equations of ion mobilities, as a function of the number of carbon atoms, obtained from the different series were then generalized into one linear equation for the reduced ion mobility for the polar aliphatic compounds and is validated by comparing it with the traditional Mason-Schamp equation. To compare the empirical equation obtained from the prognosis and the Mason-Schamp equation, the collision integral term in the latter was split into two terms to linearize it. The resulting novel ion mobility equation could be the starting step to completely describe the relationship between ion collision integral and the ion mobility for polar aliphatic compounds. The splitting of the collision integral into two terms will also give new inputs to describe the various ion models and the different forces that act on the ions and the neutral gas molecules upon which the collision integral is dependent on. This prognosis method could, furthermore, be extended to all other classes of organic compounds and could serve as a useful tool for identification of unknowns in ion mobility spectra, thereby considerably reducing the time-consuming and costly reference measurements and other coupling techniques that are currently employed.

Optimising cell temperature and dispersion field strength for the screening for putrescine and cadaverine with thermal desorption-gas chromatography-differential mobility spectrometry

Biogenic amines, and putrescine and cadaverine in particular, have significant importance in the area of food quality monitoring, and are also potentially important markers of infection, for cancer, diabetes, arthritis and cystic fibrosis. A thermal desorption-gas chromatograph-heated differential mobility spectrometer was constructed and the significant effect of interactions between cell temperature and dispersion field strength on the observed responses studied. The experiment design was a Box-Wilson central composite design (CCD) over the levels of 10-24 kVcm(-1) for dispersion field strength and 100-130 degrees C for cell temperature. The optimum values were estimated to be 16.22 kVcm(-1) and 116 degrees C for putrescine and 14.78 kVcm(-1) and 112 degrees C for cadaverine, respectively with an ammonia dopant at 19 mgm(-3). An amine test atmosphere generator was constructed and produced stable concentrations of putrescine (7 mgm(-3)) and cadaverine (4 mgm(-3)) vapours at 50+/-0.5 degrees C. Tenax TA-Carbotrap adsorbent tubes were used to sample putrescine and cadaverine vapour standards and a linear response function over the range of sample masses 5-20 ng was obtained at 15.0 kVcm(-1) 115 degrees C, with a R(2) of 0.99 for both putrescine and cadaverine. The sample mass at the limit of detection was estimated to be 3 ng for putrescine and cadaverine. Preliminary data from sampling the headspace of chicken meat revealed a 62% increase in the recovered masses of putrescine from 0.84 to 1.36 ng in the sampled air.

Direct Analysis of Pharmaceutical Drug Formulations Using Ion Mobility Spectrometry/Quadrupole-Time-of-Flight Mass Spectrometry Combined with Desorption Electrospray Ionization

A novel approach to the rapid analysis of pharmaceutical drug formulations using hyphenated ion mobility spectrometry (IMS) and time-of-flight mass spectrometry (ToF-MS) that requires no sample pretreatment or chromatographic separation is described. A modified quadrupole time-of-flight mass spectrometer containing an ion mobility drift cell was used for gas-phase electrophoretic separation of ions prior to ToF-MS detection. The generation of sample ions directly from tablets and cream formulations was effected by desorption electrospray ionization (DESI) using a modified electrospray ion source. The analysis of a range of over-the-counter and prescription tablet formulations is described, including histamine H2 receptor antagonist (ranitidine), analgesic (paracetamol), opiate (codeine), and aromatase inhibitor anticancer (anastrozole) drugs. The successful determination of active drugs from soft formulations, such as an antiseptic cream (chlorhexidine) and a nicotine-containing skin patch, is also presented. Limits of detection for the active drugs using the DESI/IMS/ToF-MS method fell within the high-picomole to nanomole range. In all cases, the use of ion mobility drift tube separation showed increased selectivity for active drug responses (present as low as 0.14% w/w) over excipient responses such as poly(ethylene glycol). Tandem mass spectrometric analysis of precursor ions separated by IMS allowed positive confirmation of active drugs with little loss of ion mobility efficiency. The ability to analyze hard or soft pharmaceutical formulations directly by DESI combined with ion mobility spectrometry/mass spectrometry in approximately 2 min demonstrates the potential applicability of this novel method to pharmaceutical screening of low-molecular-weight drug formulations with high selectivity over the formulation vehicle.

Bacterial vaginosis - a laboratory and clinical diagnostics enigma. Review article II

Diagnosing bacterial vaginosis (BV) has long been based on the clinical criteria of Amsel et al., whereby three of four defined criteria must be satisfied. Though there are other criteria and scoring methods which function well in comparison (i.e. Nugent scoring), it is not certain that they will always identify the same category of patients. Point-of-care methods based on various combinations of microbial products, presence of RNA, or more complex laboratory instrumentations such as sensor arrays, have also been introduced for the diagnosis of BV. No method for diagnosing BV can at present be regarded as the best. It could be that--based partly on tacit knowledge on the part of the clinical investigators scoring in the clinic--various scoring systems have been chosen to fit a particular BV-related problem in a particular population. In this review we critically examine these pertinent issues influencing clinical scoring and laboratory diagnostics of BV.