1
|
Anthwal D, Gupta RK, Singhal R, Bhalla M, Verma AK, Khayyam KU, Myneedu VP, Sarin R, Gupta A, Gupta NK, Singh M, Sivaswami Tyagi J, Haldar S. Compatibility of a novel filter paper-based bio-safe sputum transport kit with line probe assay for diagnosing drug-resistant tuberculosis: a single-site evaluation study. ERJ Open Res 2021; 7:00137-2021. [PMID: 34350282 PMCID: PMC8326685 DOI: 10.1183/23120541.00137-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/08/2021] [Indexed: 01/29/2023] Open
Abstract
Background Near-patient access to appropriate tests is a major obstacle for the efficient diagnosis of tuberculosis (TB) and associated drug resistance. Methods We recently developed the “TB Concentration & Transport” kit for bio-safe, ambient-temperature transportation of dried sputum on Trans-Filter, and the “TB DNA Extraction” kit for DNA extraction from Trans-Filter for determining drug resistance by DNA sequencing. In the present study, we evaluated the compatibility of Kit-extracted DNA with Hain's line probe assays (LPAs), which are endorsed by National TB programmes for the detection of drug resistance in sputum collected from presumptive multidrug-resistant TB patients (n=207). Results Trans-Filter-extracted DNA was seamlessly integrated with the LPA protocol (Kit-LPA). The sensitivity of Kit-LPA for determining drug resistance was 83.3% for rifampicin (95% CI 52–98%), 77.7% for isoniazid (95% CI 52–94%), 85.7% for fluoroquinolones (95% CI 42–100%) and 66.6% for aminoglycosides (95% CI 9–99%), with a specificity range of 93.7% (95% CI 87–97) to 99.1% (95% CI 95–100) using phenotypic drug susceptibility testing (DST) as a reference standard. A high degree of concordance was noted between results obtained from Kit-LPA and LPA (99% to 100% (κ value: 0.83–1.0)). Conclusions This study demonstrates successful integration of our developed kits with LPA. The adoption of these kits across Designated Microscopy Centres in India can potentially overcome the existing challenge of transporting infectious sputum at controlled temperature to centralised testing laboratories and can provide rapid near-patient cost-effective “Universal DST” services to TB subjects residing in remote areas. The adoption of bio-safe “TB Concentration & Transport” kit by Microscopy Centres can potentially overcome the challenge of transporting infectious sputum to central laboratories and provide universal DST services to TB subjects residing in remote areas.https://bit.ly/2QrQ5qL
Collapse
Affiliation(s)
- Divya Anthwal
- Dept of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.,Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, India
| | - Rakesh Kumar Gupta
- Dept of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.,Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, India
| | - Ritu Singhal
- Dept of Microbiology, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - Manpreet Bhalla
- Dept of Microbiology, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - Ajoy Kumar Verma
- Dept of Microbiology, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - Khalid Umar Khayyam
- Dept of Microbiology, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - Vithal Prasad Myneedu
- Dept of Microbiology, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - Rohit Sarin
- Dept of Microbiology, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | | | | | - Manjula Singh
- India TB Research Consortium, Indian Council of Medical Research, New Delhi, India
| | - Jaya Sivaswami Tyagi
- Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, India.,Dept of Biotechnology, All India Institute of Medical Sciences, New Delhi, India
| | - Sagarika Haldar
- Dept of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.,Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, India
| |
Collapse
|
2
|
Molina-Moya B, Ciobanu N, Hernandez M, Prat-Aymerich C, Crudu V, Adams ER, Codreanu A, Sloan DJ, Cuevas LE, Dominguez J. Molecular Detection of Mycobacterium tuberculosis in Oral Mucosa from Patients with Presumptive Tuberculosis. J Clin Med 2020; 9:jcm9124124. [PMID: 33371314 PMCID: PMC7767357 DOI: 10.3390/jcm9124124] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/04/2020] [Accepted: 12/16/2020] [Indexed: 01/29/2023] Open
Abstract
Tuberculosis (TB) diagnosis is increasingly based on the detection of Mycobacterium tuberculosis complex (MTBC) DNA in sputum using molecular diagnostic tests as the first test for diagnosis. However, sputum can be difficult to obtain in children, patients without productive cough, and the elderly and approaches testing non-sputum samples are needed. We evaluated whether TB can be detected from the oral mucosa of patients with TB. Adults with presumptive TB were examined using culture, Xpert MTB/RIF, smear microscopy and X-Rays. Oral mucosa swabs collected on PrimeStore-MTM, stored at room temperature if tested within 30 days or at -20 °C if examined at a later time. RT-PCR was performed to detect M. tuberculosis DNA. Eighty patients had bacteriologically-confirmed TB, 34 had bacteriologically-negative TB (negative tests but abnormal X-rays) and 152 were considered not to have TB (not TB). Oral swabs RT-PCR were positive in 29/80 (36.3%) bacteriologically-confirmed, 9/34 (26.5%) bacteriologically-negative and 29/152 (19.1%) not TB. The yield varied among samples stored for less and more than 30 days (p = 0.013) from 61% (11/18) and 29% (18/62) among bacteriologically confirmed, and 30.8% (4/13) and 23.8% (5/21) among bacteriologically-negative participants. Among not TB patients, the specificity was 80.9% (123/152), being 78.3% (18/23) among samples stored less than 30 days and 81.4% (105/129) among samples stored for more than 30 days (p = 0.46). The detection of M. tuberculosis in oral mucosa samples is feasible, but storage conditions may affect the yield.
Collapse
Affiliation(s)
- Barbara Molina-Moya
- Institut d’Investigació Germans Trias i Pujol, CIBER Enfermedades Respiratorias (CIBERES), Carretera del Canyet s/n, Camí de les Escoles s/n, Badalona, 08916 Barcelona, Spain; (B.M.-M.); (C.P.-A.)
- Departament de Genètica i Microbiologia, Universitat Autònoma de Barcelona, Carretera del Canyet s/n Badalona, 08916 Barcelona, Spain;
| | - Nelly Ciobanu
- Institutia Medico-Sanitara Publica, Institutul de Ftiziopneumologie “Chiril Draganiuc”, Strada Constantin Vârnav 13, 2025 Chișinău, Moldova; (N.C.); (V.C.); (A.C.)
| | - Marta Hernandez
- Departament de Genètica i Microbiologia, Universitat Autònoma de Barcelona, Carretera del Canyet s/n Badalona, 08916 Barcelona, Spain;
| | - Cristina Prat-Aymerich
- Institut d’Investigació Germans Trias i Pujol, CIBER Enfermedades Respiratorias (CIBERES), Carretera del Canyet s/n, Camí de les Escoles s/n, Badalona, 08916 Barcelona, Spain; (B.M.-M.); (C.P.-A.)
- Departament de Genètica i Microbiologia, Universitat Autònoma de Barcelona, Carretera del Canyet s/n Badalona, 08916 Barcelona, Spain;
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, 3584 CG Utrecht, The Netherlands
| | - Valeriu Crudu
- Institutia Medico-Sanitara Publica, Institutul de Ftiziopneumologie “Chiril Draganiuc”, Strada Constantin Vârnav 13, 2025 Chișinău, Moldova; (N.C.); (V.C.); (A.C.)
| | - Emily R. Adams
- Centre for Drugs and Diagnostics, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK; (E.R.A.); (L.E.C.)
| | - Alexandru Codreanu
- Institutia Medico-Sanitara Publica, Institutul de Ftiziopneumologie “Chiril Draganiuc”, Strada Constantin Vârnav 13, 2025 Chișinău, Moldova; (N.C.); (V.C.); (A.C.)
| | - Derek J. Sloan
- School of Medicine, University of St Andrews, North Haugh, St Andrews KY16 9TF, UK;
| | - Luis E. Cuevas
- Centre for Drugs and Diagnostics, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK; (E.R.A.); (L.E.C.)
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Jose Dominguez
- Institut d’Investigació Germans Trias i Pujol, CIBER Enfermedades Respiratorias (CIBERES), Carretera del Canyet s/n, Camí de les Escoles s/n, Badalona, 08916 Barcelona, Spain; (B.M.-M.); (C.P.-A.)
- Departament de Genètica i Microbiologia, Universitat Autònoma de Barcelona, Carretera del Canyet s/n Badalona, 08916 Barcelona, Spain;
- Correspondence: ; Tel.: +34-93-033-0537
| |
Collapse
|
3
|
Mboneni TA, Eales OO, Mosina NL, Fourie PB. Molecular detection of Mycobacterium tuberculosis in poor-quality cough specimens. J Med Microbiol 2020; 69:1179-1182. [PMID: 32755530 DOI: 10.1099/jmm.0.001239] [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: 11/18/2022] Open
Abstract
Clinical specimens unfit for laboratory processing represent missed opportunities for diagnosing tuberculosis. Poor-quality cough specimens (n=61) from presumptive tuberculosis cases were cultured and GeneXpert MTB/RIF (Xpert) successfully performed on samples transferred by flocked swab into PrimeStore molecular transport medium (PS-MTM). Mycobacterium tuberculosis was grown in culture from 13 (21.3 %) and Xpert reported 15 (24.2 %) positive, of which 10 concordant. RT-PCR of PS-MTM samples showed enhanced sensitivity; three positives were missed by Xpert, five by culture and three more detected for a total of 21 positives (34.4 %).
Collapse
Affiliation(s)
- Tondani A Mboneni
- Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa
| | - Owen O Eales
- Department of Family Medicine, University of Pretoria, Pretoria, South Africa
| | - Ntsoaki L Mosina
- Department of Genetics, University of Pretoria, Pretoria, South Africa
| | - P Bernard Fourie
- Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa
| |
Collapse
|
4
|
PrimeStore MTM and OMNIgene Sputum for the Preservation of Sputum for Xpert MTB/RIF Testing in Nigeria. J Clin Med 2019; 8:jcm8122146. [PMID: 31817201 PMCID: PMC6947270 DOI: 10.3390/jcm8122146] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 11/29/2019] [Accepted: 12/01/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Xpert MTB/RIF (GX) for tuberculosis (TB) diagnosis is often located in reference laboratories, and sputum needs to be transported using a cold chain. Transport media to preserve sputum are available, but performance data under programmatic conditions are limited. METHODS Sputum samples were collected from patients with presumptive TB in Nigeria. One sputum was transported in a cold chain, tested immediately with GX and cultured. One sputum was swabbed and stored in PrimeStore-Molecular-Transport-Medium (Primestore), and the remainder was stored in OMNIGene-sputum (Omnigene), kept for seven days and tested with GX. RESULTS Of 248 patients, 63 were fresh-sputum culture-positive and 56 GX-positive (sensitivity 88.9%, 95% CI: 78.4-95.4%). Four of 185 culture-negative patients were GX-positive (specificity 97.8%, 94.6-99.4%). Omnigene GX and Primestore GX were positive in 56/62 (90.3%, 80.1-96.4%) and 49/62 (79.0%, 66.8-88.3%) culture-positive, respectively, and 1/185 (99.5%, 97.0-100.0%) and 3/185 (98.4%, 95.3-99.7%) were culture-negative patients. 14 Human Immunodeficiency Virus (HIV)-infected and 44 HIV-uninfected patients were culture-positive. Omnigene and Primestore detected 12/14 (85.7%, 57.2-98.2%) and 5/14 (35.7%, 12.8-64.9%) HIV-infected and 41/44 (93.2%, 81.3-98.6%) HIV-uninfected culture-positive patients. Interpretation: Omnigene stored and fresh sputum samples had similar GX results. The GX results of Primestore-stored samples were similar to those found in the fresh sputum of non-HIV infected patients, but GX-positivity was lower in HIV-infected patients. This was likely due to the lower amount of bacilli collected by the swab and transferred to PrimeStore.
Collapse
|
5
|
Antibiotic resistance of Mycobacterium tuberculosis complex in Africa: A systematic review of current reports of molecular epidemiology, mechanisms and diagnostics. J Infect 2019; 79:550-571. [DOI: 10.1016/j.jinf.2019.10.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 10/13/2019] [Indexed: 12/11/2022]
|
6
|
Hiza H, Doulla B, Sasamalo M, Hella J, Kamwela L, Mhimbira F, Reither K, Gagneux S, Jugheli L, Fenner L. Preservation of sputum samples with cetylpyridinium chloride (CPC) for tuberculosis cultures and Xpert MTB/RIF in a low-income country. BMC Infect Dis 2017; 17:542. [PMID: 28778186 PMCID: PMC5543576 DOI: 10.1186/s12879-017-2642-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 07/26/2017] [Indexed: 11/10/2022] Open
Abstract
Background Culture contamination with environmental bacteria is a major challenge in tuberculosis (TB) laboratories in hot and humid climate zones. We studied the effect of cetylpyridinium chloride (CPC) preservation on culture results and performance of Xpert MTB/RIF. Methods Consecutive sputum samples from microscopy smear-positive TB patients were collected. Two-hundred samples were equally split in two aliquots, one aliquot was treated with CPC and stored at ambient temperature for 7 days. The second aliquot was immediately processed. Samples were decontaminated for 20, 15 or 10 min, and subsequently cultured on Löwenstein-Jensen medium. Furthermore, 50 samples were stored for 7, 14 and 21 days, and 100 CPC-pretreated samples tested by Xpert MTB/RIF. Results CPC pretreated samples showed a higher culture yield compared to non-treated sputum samples across all decontamination times: 94% vs. 73% at 10 min (p = 0.01), 94% vs. 64% at 15 min (p = 0.004), and 90% vs. 52% at 20 min (p < 0.001). The quantitative culture grading was consistently higher in CPC treated compared to non-CPC treated samples. The proportion of contaminated cultures was lower in CPC pretreated samples across all decontamination times (range 2-6%) compared to non-CPC treated samples (15-16%). For storage times of CPC treated samples of 7, 14, and 21 days, 84, 86, and 84% of the respective cultures were positive. Of 91 CPC treated samples with a positive culture, 90 were also Xpert MTB/RIF positive. Conclusions CPC increases culture yield, decreases the proportion of contamination, and does not alter the performance of Xpert MTB/RIF.
Collapse
Affiliation(s)
- Hellen Hiza
- Ifakara Health Institute, Bagamoyo, Tanzania
| | - Basra Doulla
- National Tuberculosis and Leprosy Programme, Dar es Salaam, Tanzania
| | - Mohamed Sasamalo
- Ifakara Health Institute, Bagamoyo, Tanzania.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Jerry Hella
- Ifakara Health Institute, Bagamoyo, Tanzania.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | | | - Francis Mhimbira
- Ifakara Health Institute, Bagamoyo, Tanzania.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Klaus Reither
- Ifakara Health Institute, Bagamoyo, Tanzania.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Sebastien Gagneux
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Levan Jugheli
- Ifakara Health Institute, Bagamoyo, Tanzania.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Lukas Fenner
- Ifakara Health Institute, Bagamoyo, Tanzania. .,Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland. .,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
| |
Collapse
|