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Bailon N, Ramos E, Alvarado K, Bernaola L, Wilson J, Montoya R, Valencia T, Evans CA, Datta S. A controlled evaluation of filter paper use during staining of sputum smears for tuberculosis microscopy. Wellcome Open Res 2023; 8:171. [PMID: 37766850 PMCID: PMC10521092 DOI: 10.12688/wellcomeopenres.18827.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2023] [Indexed: 09/29/2023] Open
Abstract
Background: Some sputum smear microscopy protocols recommend placing filter paper over sputum smears during staining for Mycobacterium tuberculosis (TB) . We found no published evidence assessing whether this is beneficial. We aimed to evaluate the effect of filter paper on sputum smear microscopy results. Methods: Sputum samples were collected from 30 patients with confirmed pulmonary TB and 4 healthy control participants. From each sputum sample, six smears (204 smears in total) were prepared for staining with Ziehl-Neelsen (ZN), auramine or viability staining with fluorescein diacetate (FDA). Half of the slides subjected to each staining protocol were randomly selected to have Whatman grade 3 filter paper placed over the dried smears prior to stain application and removed prior to stain washing. The counts of acid-fast bacilli (AFB) and precipitates per 100 high-power microscopy fields of view, and the proportion of smear that appeared to have been washed away were recorded. Statistical analysis used a linear regression model adjusted by staining technique with a random effects term to correct for between-sample variability. Results: The inclusion of filter paper in the staining protocol significantly decreased microscopy positivity independent of staining with ZN, auramine or FDA (p=0.01). Consistent with this finding, there were lower smear grades in slides stained using filter paper versus without (p=0.04), and filter paper use reduced AFB counts by 0.28 logarithms (95% confidence intervals, CI=0.018, 0.54, p=0.04) independent of staining technique. In all analyses, auramine was consistently more sensitive with higher AFB counts versus ZN (p=0.001), whereas FDA had lower sensitivity and lower AFB counts (p<0.0001). Filter paper use was not associated with the presence of any precipitate (p=0.5) or the probability of any smear washing away (p=0.6) during the staining process. Conclusions: Filter paper reduced the sensitivity of AFB microscopy and had no detectable beneficial effects so is not recommended.
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Affiliation(s)
- Nataly Bailon
- IFHAD: Innovation For Health And Development, Universidad Peruana Cayetano Heredia LID 416, Lima, Peru
- IPSYD: Innovacion Por la Salud Y el Desarollo, Asociación Benéfica Prisma, Lima, Peru
| | - Eric Ramos
- IFHAD: Innovation For Health And Development, Universidad Peruana Cayetano Heredia LID 416, Lima, Peru
- IPSYD: Innovacion Por la Salud Y el Desarollo, Asociación Benéfica Prisma, Lima, Peru
| | - Keren Alvarado
- IFHAD: Innovation For Health And Development, Universidad Peruana Cayetano Heredia LID 416, Lima, Peru
- IPSYD: Innovacion Por la Salud Y el Desarollo, Asociación Benéfica Prisma, Lima, Peru
| | - Lenin Bernaola
- IFHAD: Innovation For Health And Development, Universidad Peruana Cayetano Heredia LID 416, Lima, Peru
- IPSYD: Innovacion Por la Salud Y el Desarollo, Asociación Benéfica Prisma, Lima, Peru
| | - James Wilson
- IFHAD: Innovation For Health And Development, Universidad Peruana Cayetano Heredia LID 416, Lima, Peru
- IPSYD: Innovacion Por la Salud Y el Desarollo, Asociación Benéfica Prisma, Lima, Peru
| | - Rosario Montoya
- IFHAD: Innovation For Health And Development, Universidad Peruana Cayetano Heredia LID 416, Lima, Peru
- IPSYD: Innovacion Por la Salud Y el Desarollo, Asociación Benéfica Prisma, Lima, Peru
| | - Teresa Valencia
- IFHAD: Innovation For Health And Development, Universidad Peruana Cayetano Heredia LID 416, Lima, Peru
- IPSYD: Innovacion Por la Salud Y el Desarollo, Asociación Benéfica Prisma, Lima, Peru
| | - Carlton A Evans
- IFHAD: Innovation For Health And Development, Universidad Peruana Cayetano Heredia LID 416, Lima, Peru
- IPSYD: Innovacion Por la Salud Y el Desarollo, Asociación Benéfica Prisma, Lima, Peru
- IFHAD: Innovation For Health And Development, Department of Infectious Disease, Imperial College London, London, W12 0NN, UK
| | - Sumona Datta
- IFHAD: Innovation For Health And Development, Universidad Peruana Cayetano Heredia LID 416, Lima, Peru
- IPSYD: Innovacion Por la Salud Y el Desarollo, Asociación Benéfica Prisma, Lima, Peru
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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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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Coleman M, Martinez L, Theron G, Wood R, Marais B. Mycobacterium tuberculosis Transmission in High-Incidence Settings-New Paradigms and Insights. Pathogens 2022; 11:1228. [PMID: 36364978 PMCID: PMC9695830 DOI: 10.3390/pathogens11111228] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/20/2022] [Accepted: 10/21/2022] [Indexed: 12/01/2023] Open
Abstract
Tuberculosis has affected humankind for thousands of years, but a deeper understanding of its cause and transmission only arose after Robert Koch discovered Mycobacterium tuberculosis in 1882. Valuable insight has been gained since, but the accumulation of knowledge has been frustratingly slow and incomplete for a pathogen that remains the number one infectious disease killer on the planet. Contrast that to the rapid progress that has been made in our understanding SARS-CoV-2 (the cause of COVID-19) aerobiology and transmission. In this Review, we discuss important historical and contemporary insights into M. tuberculosis transmission. Historical insights describing the principles of aerosol transmission, as well as relevant pathogen, host and environment factors are described. Furthermore, novel insights into asymptomatic and subclinical tuberculosis, and the potential role this may play in population-level transmission is discussed. Progress towards understanding the full spectrum of M. tuberculosis transmission in high-burden settings has been hampered by sub-optimal diagnostic tools, limited basic science exploration and inadequate study designs. We propose that, as a tuberculosis field, we must learn from and capitalize on the novel insights and methods that have been developed to investigate SARS-CoV-2 transmission to limit ongoing tuberculosis transmission, which sustains the global pandemic.
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Affiliation(s)
- Mikaela Coleman
- WHO Collaborating Centre for Tuberculosis and the Sydney Institute for Infectious Diseases, The University of Sydney, Sydney 2006, Australia
- Tuberculosis Research Program, Centenary Institute, The University of Sydney, Sydney 2050, Australia
| | - Leonardo Martinez
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
| | - Grant Theron
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7602, South Africa
| | - Robin Wood
- Desmond Tutu Health Foundation and Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town 7700, South Africa
| | - Ben Marais
- WHO Collaborating Centre for Tuberculosis and the Sydney Institute for Infectious Diseases, The University of Sydney, Sydney 2006, Australia
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Fellag M, Loukil A, Drancourt M. The puzzle of the evolutionary natural history of tuberculosis. New Microbes New Infect 2021; 41:100712. [PMID: 33996102 PMCID: PMC8094893 DOI: 10.1016/j.nmni.2020.100712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/05/2020] [Accepted: 06/09/2020] [Indexed: 12/02/2022] Open
Abstract
Several pieces of the puzzle of the natural history of tuberculosis are assembled in this review to illustrate the potential reservoirs and sources of the Mycobacterium tuberculosis complex (MTBC) mycobacteria, their transmission to animals and humans, and their fate in populations, in a co-evolutionary perspective. Millennia-old companions of mammalian and human populations, MTBC are detected in the soil, in which they infect and survive within vegetative amoebae and cysts, except for Mycobacterium canettii. Never detected in the sphere of plants, they are transmissible by transcutaneous, digestive and respiratory routes and cause an infection of the lymphatic system with secondary dissemination in most tissues, in which they determine a specific and non-pathognomonic granulomatous inflammatory reaction; in which MTBC survives in dormant form irrespective of MTBC species and mammalian species; indicating that the current epidemiology in mammalian populations is essentially governed by the probabilities of contact between mammalian species and MTBC species. Individual variabilities in clinical expression of tuberculosis are related to MTBC species, strain and inoculum; host genetic factors; acquired modulations of the inflammatory response; and probably human microbiota. This review of the literature suggests an evolutionary natural history of telluric environmental mycobacteria, satellites of unicellular eukaryotes, transmissible to mammals via the digestive and then respiratory tracts, in which they determine a fatal contagious infection that is primarily lymphatic and a quiescence-mimicking encysted form. This review opens perspectives for microbiological and translational medical research.
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Affiliation(s)
- M. Fellag
- Aix-Marseille-Université, IRD, MEPHI, IHU Méditerranée Infection, Marseille, France
- IHU Méditerranée Infection, Marseille, France
| | - A. Loukil
- Aix-Marseille-Université, IRD, MEPHI, IHU Méditerranée Infection, Marseille, France
| | - M. Drancourt
- Aix-Marseille-Université, IRD, MEPHI, IHU Méditerranée Infection, Marseille, France
- IHU Méditerranée Infection, Marseille, France
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Pala L, Sirec T, Spitz U. Modified Enzyme Substrates for the Detection of Bacteria: A Review. Molecules 2020; 25:E3690. [PMID: 32823590 PMCID: PMC7465704 DOI: 10.3390/molecules25163690] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/05/2020] [Accepted: 08/11/2020] [Indexed: 12/13/2022] Open
Abstract
The ability to detect, identify and quantify bacteria is crucial in clinical diagnostics, environmental testing, food security settings and in microbiology research. Recently, the threat of multidrug-resistant bacterial pathogens pushed the global scientific community to develop fast, reliable, specific and affordable methods to detect bacterial species. The use of synthetically modified enzyme substrates is a convenient approach to detect bacteria in a specific, economic and rapid manner. The method is based on the use of specific enzyme substrates for a given bacterial marker enzyme, conjugated to a signalogenic moiety. Following enzymatic reaction, the signalophor is released from the synthetic substrate, generating a specific and measurable signal. Several types of signalophors have been described and are defined by the type of signal they generate, such as chromogenic, fluorogenic, luminogenic, electrogenic and redox. Signalophors are further subdivided into groups based on their solubility in water, which is key in defining their application on solid or liquid media for bacterial culturing. This comprehensive review describes synthetic enzyme substrates and their applications for bacterial detection, showing their mechanism of action and their synthetic routes.
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Affiliation(s)
| | | | - Urs Spitz
- Biosynth Carbosynth, Axis House, High Street, Compton, Berkshire RG20 6NL, UK; (L.P.); (T.S.)
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Saunders MJ, Wingfield T, Datta S, Montoya R, Ramos E, Baldwin MR, Tovar MA, Evans BEW, Gilman RH, Evans CA. A household-level score to predict the risk of tuberculosis among contacts of patients with tuberculosis: a derivation and external validation prospective cohort study. THE LANCET. INFECTIOUS DISEASES 2020; 20:110-122. [PMID: 31678031 PMCID: PMC6928575 DOI: 10.1016/s1473-3099(19)30423-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 06/21/2019] [Accepted: 07/29/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The epidemiological impact and cost-effectiveness of social protection and biomedical interventions for tuberculosis-affected households might be improved by risk stratification. We therefore derived and externally validated a household-level risk score to predict tuberculosis among contacts of patients with tuberculosis. METHODS In this prospective cohort study, we recruited tuberculosis-affected households from 15 desert shanty towns in Ventanilla and 17 urban communities in Callao, Lima, Peru. Tuberculosis-affected households included index patients with a new diagnosis of tuberculosis and their contacts who reported being in the same house as the index patient for more than 6 h per week in the 2 weeks preceding index patient diagnosis. Tuberculosis-affected households were not included if the index patient had no eligible contacts or lived alone. We followed contacts until 2018 and defined household tuberculosis, the primary outcome, as any contact having any form of tuberculosis within 3 years. We used logistic regression to identify characteristics of index patients, contacts, and households that were predictive of household tuberculosis, and used these to derive and externally validate a household-level score. FINDINGS Between Dec 12, 2007, and Dec 31, 2015, 16 505 contacts from 3 301 households in Ventanilla were included in a derivation cohort. During the 3-year follow-up, tuberculosis occurred in contacts of index patients in 430 (13%, 95% CI 12-14) households. Index patient predictors were pulmonary tuberculosis and sputum smear grade, age, and the maximum number of hours any contact had spent with the index patient while they had any cough. Household predictors were drug use, schooling of the female head of a household, and lower food spending. Contact predictors were if any of the contacts were children, number of lower-weight (body-mass index [BMI] <20·0 kg/m2) adult contacts, number of normal-weight (BMI 20·0-24·9 kg/m2) adult contacts, and number of past or present household members who previously had tuberculosis. In this derivation cohort, the score c statistic was 0·77 and the risk of household tuberculosis in the highest scoring quintile was 31% (95% CI 25-38; 65 of 211) versus 2% (95% CI 0-4; four of 231) in the lowest scoring quintile. We externally validated the risk score in a cohort of 4248 contacts from 924 households in Callao recruited between April 23, 2014, and Dec 31, 2015. During follow-up, tuberculosis occurred in contacts of index patients in 120 (13%, 95% CI 11-15) households. The score c statistic in this cohort was 0·75 and the risk of household tuberculosis in the highest scoring quintile was 28% (95% CI 21-36; 43 of 154) versus 1% (95% CI 0-5; two of 148) in the lowest scoring quintile. The highest-scoring third of households captured around 70% of all tuberculosis among contacts. A simplified risk score including only five variables performed similarly, with only a small reduction in performance. INTERPRETATION This externally validated score will enable comprehensive biosocial, household-level interventions to be targeted to tuberculosis-affected households that are most likely to benefit. FUNDING Wellcome Trust, Medical Research Council, Department of Health and Social Care, Department for International Development, Joint Global Health Trials consortium, Bill & Melinda Gates Foundation, Innovation for Health and Development.
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Affiliation(s)
- Matthew J Saunders
- Department of Infectious Diseases, Imperial College London, London, UK; Innovation For Health And Development, Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru; Innovación Por la Salud Y Desarrollo, Asociación Benéfica PRISMA, Lima, Peru.
| | - Tom Wingfield
- Innovation For Health And Development, Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru; Innovación Por la Salud Y Desarrollo, Asociación Benéfica PRISMA, Lima, Peru; Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, UK; LIV-TB Collaboration and Department of Clinical Science, Liverpool School of Tropical Medicine, Liverpool, UK; Social Medicine, Infectious Diseases and Migration Group, Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
| | - Sumona Datta
- Department of Infectious Diseases, Imperial College London, London, UK; Innovation For Health And Development, Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru; Innovación Por la Salud Y Desarrollo, Asociación Benéfica PRISMA, Lima, Peru
| | - Rosario Montoya
- Innovation For Health And Development, Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru; Innovación Por la Salud Y Desarrollo, Asociación Benéfica PRISMA, Lima, Peru
| | - Eric Ramos
- Innovation For Health And Development, Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru; Innovación Por la Salud Y Desarrollo, Asociación Benéfica PRISMA, Lima, Peru
| | - Matthew R Baldwin
- Innovation For Health And Development, Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru; Innovación Por la Salud Y Desarrollo, Asociación Benéfica PRISMA, Lima, Peru; College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Marco A Tovar
- Innovation For Health And Development, Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru; Innovación Por la Salud Y Desarrollo, Asociación Benéfica PRISMA, Lima, Peru
| | - Benjamin E W Evans
- Innovation For Health And Development, Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Robert H Gilman
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carlton A Evans
- Department of Infectious Diseases, Imperial College London, London, UK; Innovation For Health And Development, Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru; Innovación Por la Salud Y Desarrollo, Asociación Benéfica PRISMA, Lima, Peru
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Datta S, Alvarado K, Gilman RH, Valencia T, Aparicio C, Ramos ES, Montoya R, Evans CA. Optimising fluorescein diacetate sputum smear microscopy for assessing patients with pulmonary tuberculosis. PLoS One 2019; 14:e0214131. [PMID: 31039160 PMCID: PMC6490897 DOI: 10.1371/journal.pone.0214131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 03/07/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Assessing Mycobacterium tuberculosis (TB) viability by fluorescein diacetate (FDA) microscopy can predict TB culture results, treatment response and infectiousness. However, diverse methods have been published. We aimed to optimise FDA microscopy, minimising sputum processing, biohazard and complexity for use in resource-constrained settings. METHODS AND RESULTS Optimization: Patients with smear-positive pulmonary TB before treatment and healthy control participants provided sputa. These were divided into equal aliquots that were tested directly or after NaOH centrifuge-decontamination. Each aliquot was cultured and used to prepare slides (n = 80). FDA microscopy used: 1 or 3 drops of sputum; with/out acid-alcohol wash; with/out phenol sterilization; with 0/30/60 seconds KMnO4 quenching. Control samples all had negative culture and microscopy results. FDA microscopy had higher sensitivity when performed directly (without centrifuge-decontamination) on 1 drop of sputum (P<0.001), because 3 drops obscured microscopy. Acid-alcohol wash and KMnO4 quenching made bacilli easier to identity (P = 0.005). Phenol sterilization did not impair microscopy (P>0.1). Validation: The 2 protocols that performed best in the optimization experiments were reassessed operationally by comparing duplicate slides (n = 412) stained with KMnO4 quenching for 30 versus 60 seconds. FDA microscopy results were similar (P = 0.4) and highly reproducible, with 97% of counts agreeing within +/-1 logarithm. Storage: Smear microscopy slides and aliquots of the sputum from which they were made were stored for 4 weeks. Twice-weekly, paired slides (n = 80) were stained with freshly prepared versus stored FDA and read quantitatively. Storing sputum, microscopy slides or FDA solution at 4°C or room temperature had no effect on FDA microscopy results (all P>0.2). Cost: Material costs for each slide tested by FDA microscopy using reagents purchased locally were USD $0.05 and required the same equipment, time and skills as auramine acid-fast microscopy. CONCLUSIONS We recommend a simple, bio-secure protocol for FDA microscopy that provides sensitive and repeatable results without requiring centrifugation.
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Affiliation(s)
- Sumona Datta
- Infectious Diseases & Immunity, Wellcome Trust Centre for Global Health Research, Imperial College London, United Kingdom
- IFHAD: Innovation For Health And Development, Laboratory of research and development, Universidad Peruana Cayetano Heredia, Lima, Peru
- Innovacion Por la Salud Y el Desarollo (IPSYD), Asociación Benéfica Prisma, Lima, Peru
- * E-mail:
| | - Keren Alvarado
- IFHAD: Innovation For Health And Development, Laboratory of research and development, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Robert H. Gilman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Teresa Valencia
- IFHAD: Innovation For Health And Development, Laboratory of research and development, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Christian Aparicio
- IFHAD: Innovation For Health And Development, Laboratory of research and development, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Eric S. Ramos
- IFHAD: Innovation For Health And Development, Laboratory of research and development, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Rosario Montoya
- IFHAD: Innovation For Health And Development, Laboratory of research and development, Universidad Peruana Cayetano Heredia, Lima, Peru
- Innovacion Por la Salud Y el Desarollo (IPSYD), Asociación Benéfica Prisma, Lima, Peru
| | - Carlton A. Evans
- Infectious Diseases & Immunity, Wellcome Trust Centre for Global Health Research, Imperial College London, United Kingdom
- IFHAD: Innovation For Health And Development, Laboratory of research and development, Universidad Peruana Cayetano Heredia, Lima, Peru
- Innovacion Por la Salud Y el Desarollo (IPSYD), Asociación Benéfica Prisma, Lima, Peru
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Goletti D, Lindestam Arlehamn CS, Scriba TJ, Anthony R, Cirillo DM, Alonzi T, Denkinger CM, Cobelens F. Can we predict tuberculosis cure? What tools are available? Eur Respir J 2018; 52:13993003.01089-2018. [PMID: 30361242 DOI: 10.1183/13993003.01089-2018] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 09/24/2018] [Indexed: 01/08/2023]
Abstract
Antibiotic treatment of tuberculosis takes ≥6 months, putting a major burden on patients and health systems in large parts of the world. Treatment beyond 2 months is needed to prevent tuberculosis relapse by clearing remaining, drug-tolerant Mycobacterium tuberculosis bacilli. However, the majority of patients treated for only 2-3 months will cure without relapse and do not need prolonged treatment. Assays that can identify these patients at an early stage of treatment may significantly help reduce the treatment burden, while a test to identify those patients who will fail treatment may help target host-directed therapies.In this review we summarise the state of the art with regard to discovery of biomarkers that predict relapse-free cure for pulmonary tuberculosis. Positron emission tomography/computed tomography scanning to measure pulmonary inflammation enhances our understanding of "cure". Several microbiological and immunological markers seem promising; however, they still need a formal validation. In parallel, new research strategies are needed to generate reliable tests.
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Affiliation(s)
- Delia Goletti
- Translational Research Unit, National Institute for Infectious Diseases "L. Spallanzani" IRCCS, Dept of Epidemiology and Preclinical Research, Rome, Italy
| | | | - Thomas J Scriba
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, and Division of Immunology, Dept of Pathology, University of Cape Town, Cape Town, South Africa
| | - Richard Anthony
- National Institute for Public Health and the Environment (RIVM), Utrecht, The Netherlands
| | - Daniela Maria Cirillo
- Emerging Bacterial Pathogens Unit, San Raffaele Scientific Institute, HSR, Division of Immunology and Infectious Diseases Milan, Milan, Italy
| | - Tonino Alonzi
- Translational Research Unit, National Institute for Infectious Diseases "L. Spallanzani" IRCCS, Dept of Epidemiology and Preclinical Research, Rome, Italy
| | | | - Frank Cobelens
- Dept of Global Health and Amsterdam Institute for Global Health and Development, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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9
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Pulmonary Tuberculosis Conversion Documented by Microscopic Staining for Detection of Dynamic, Dormant, and Dead Mycobacteria (DDD Staining). J Clin Microbiol 2018; 56:JCM.01108-18. [PMID: 30045865 DOI: 10.1128/jcm.01108-18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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10
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Wang L, Zhang J, Guo X, Chen S, Cui Y, Yu Q, Yang L, Sun H, Gao D, Xie D. Highly stable and biocompatible zwitterionic dendrimer-encapsulated palladium nanoparticles that maintain their catalytic activity in bacterial solution. NEW J CHEM 2018. [DOI: 10.1039/c8nj04263b] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This study offers a method for constructing an artificial enzyme (Pdn-G5MC), which maintains its catalytic efficiency in bacterial solution.
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11
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Saunders MJ, Wingfield T, Tovar MA, Baldwin MR, Datta S, Evans CA. Prediction and prevention of tuberculosis in contacts - Authors' reply. THE LANCET. INFECTIOUS DISEASES 2017; 17:1238-1239. [PMID: 29173882 DOI: 10.1016/s1473-3099(17)30642-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 10/25/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Matthew J Saunders
- Section of Infectious Diseases and Immunity, and Wellcome Trust Imperial College Centre for Global Health Research, Imperial College London, London W12 0NN, UK; Innovation for Health and Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru; Innovación por la Salud y Desarrollo (IPSYD), Asociación Benéfica PRISMA, Lima, Peru.
| | - Tom Wingfield
- Section of Infectious Diseases and Immunity, and Wellcome Trust Imperial College Centre for Global Health Research, Imperial College London, London W12 0NN, UK; Innovation for Health and Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru; Innovación por la Salud y Desarrollo (IPSYD), Asociación Benéfica PRISMA, Lima, Peru; The Institute for Infection and Global Health, University of Liverpool, Liverpool, UK; Tropical and Infectious Diseases Unit, Royal Liverpool and Broadgreen University Hospitals Trust, Liverpool, UK; Department of Social Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Marco A Tovar
- Section of Infectious Diseases and Immunity, and Wellcome Trust Imperial College Centre for Global Health Research, Imperial College London, London W12 0NN, UK; Innovation for Health and Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Matthew R Baldwin
- Innovation for Health and Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru; Innovación por la Salud y Desarrollo (IPSYD), Asociación Benéfica PRISMA, Lima, Peru; College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Sumona Datta
- Section of Infectious Diseases and Immunity, and Wellcome Trust Imperial College Centre for Global Health Research, Imperial College London, London W12 0NN, UK; Innovación por la Salud y Desarrollo (IPSYD), Asociación Benéfica PRISMA, Lima, Peru
| | - Carlton A Evans
- Section of Infectious Diseases and Immunity, and Wellcome Trust Imperial College Centre for Global Health Research, Imperial College London, London W12 0NN, UK; Innovation for Health and Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru; Innovación por la Salud y Desarrollo (IPSYD), Asociación Benéfica PRISMA, Lima, Peru
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