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Amadou MLH, Abdoulaye O, Amadou O, Biraïma A, Kadri S, Amoussa AAK, Lawan IM, Tari L, Daou M, Brah S, Adehossi E. [Epidemiological, clinical and evolutionary profile of patients with tuberculosis at the Regional Hospital of Maradi, Republic of the Niger]. Pan Afr Med J 2019; 33:120. [PMID: 31489098 PMCID: PMC6711699 DOI: 10.11604/pamj.2019.33.120.17715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 05/07/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction Il s'agissait de décrire le profil épidémiologique, clinique et évolutif des patients suivis pour tuberculose au Centre Hospitalier Régional de Maradi. Méthodes Nous avions mené une étude rétrospective, descriptive et analytique à partir des dossiers des patients suivis pour tuberculose du 1er janvier 2015 au 31 décembre 2017. Résultats Au total 595 patients ont été suivis dont 406 hommes (68,24%) pour 189 femmes (31,76%) et une prévalence de 27,71%. L'âge moyen était de 42,3 ans avec des extrêmes de 13 mois à 85 ans. 70,5% des patients provenaient du milieu urbain. Les commerçants représentaient 36,9% des cas. La recherche bactériologique était positive dans 64,7% des cas. Les signes fonctionnels étaient représentés par: la toux (99,5%), la fièvre (79,5%), et la douleur thoracique. La tuberculose pulmonaire avait représenté 78,7%. Le succès thérapeutique a été 81,28%. La prévalence du VIH était de 13,6% et une létalité de 10,42% dont 40,4% des patients décédés avaient une co-infection TB/VIH. Conclusion Avec 10,42% de décès, la tuberculose demeure un fléau dans les pays à faible revenu. L'infection à VIH/SIDA a négativement influencé ces décès au cours de cette étude. La recherche des facteurs de co-morbidités chez tout patient tuberculeux devrait être systématique afin d'améliorer leur prise en charge globale.
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Affiliation(s)
- Mahaman Laouali Harouna Amadou
- Service d'Infectiologie, Hôpital Régional de Maradi, Faculté des Sciences de la Santé de l'Université de Maradi, Maradi, Niger
| | - Ousmane Abdoulaye
- Service de Biologie Médicale, Hôpital Régional de Maradi, Faculté des Sciences de la Santé de l'Université de Maradi, Maradi, Niger
| | - Oumarou Amadou
- Service d'Infectiologie, Hôpital Régional de Maradi, Faculté des Sciences de la Santé de l'Université de Maradi, Maradi, Niger
| | - Ahamadou Biraïma
- Service de Médecine Interne, Hôpital Régional de Maradi, Faculté des Sciences de la Santé de l'Université de Maradi, Maradi, Niger
| | - Sani Kadri
- Service d'Infectiologie, Hôpital Régional de Maradi, Maradi, Niger
| | | | | | - Laouali Tari
- Centre Antituberculeux, Hôpital Régional de Maradi, Maradi, Niger
| | - Maman Daou
- Service de Médecine Interne, Hôpital National de Niamey, Faculté des Sciences de la Santé de l'UAM de Niamey, Niamey, Niger
| | - Souleymane Brah
- Service de Médecine Interne, Hôpital Général de Référence Niamey, Faculté des Sciences de la Santé de l'UAM de Niamey, Niamey, Niger
| | - Eric Adehossi
- Service de Médecine Interne, Hôpital Général de Référence Niamey, Faculté des Sciences de la Santé de l'UAM de Niamey, Niamey, Niger
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Achkar JM, Lawn SD, Moosa MYS, Wright CA, Kasprowicz VO. Adjunctive tests for diagnosis of tuberculosis: serology, ELISPOT for site-specific lymphocytes, urinary lipoarabinomannan, string test, and fine needle aspiration. J Infect Dis 2011; 204 Suppl 4:S1130-41. [PMID: 21996695 PMCID: PMC3192548 DOI: 10.1093/infdis/jir450] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The diagnostic gold standard for active tuberculosis (TB) is the detection of Mycobacterium tuberculosis (MTB) by culture or molecular methods. However, despite its limited sensitivity, sputum smear microscopy is still the mainstay of TB diagnosis in resource-limited settings. Consequently, diagnosis of smear-negative pulmonary and extrapulmonary TB remains challenging in such settings. A number of novel or alternative techniques could provide adjunctive diagnostic use in the context of difficult-to-diagnose TB. These may be especially useful in certain patient groups such as persons infected with human immunodeficiency virus (HIV) and children, who are disproportionably affected by smear-negative and extrapulmonary disease and who are also most adversely affected by delays in TB diagnosis and treatment. We review a selection of these methods that are independent of nucleic acid amplification techniques and could largely be implemented in resource-limited settings in current or adapted versions. Specifically, we discuss the diagnostic use and potential of serologic tests based on detection of antibodies to MTB antigens; interferon gamma release assays using site-specific lymphocytes; detection of lipoarabinomannan, a glycolipid of MTB, in urine; the string test, a novel technique to retrieve lower respiratory tract samples; and fine needle aspiration biopsy of lymph nodes.
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Affiliation(s)
- Jacqueline M Achkar
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York 10461, USA.
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Brust B, Lecoufle M, Tuaillon E, Dedieu L, Canaan S, Valverde V, Kremer L. Mycobacterium tuberculosis lipolytic enzymes as potential biomarkers for the diagnosis of active tuberculosis. PLoS One 2011; 6:e25078. [PMID: 21966416 PMCID: PMC3178603 DOI: 10.1371/journal.pone.0025078] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Accepted: 08/26/2011] [Indexed: 11/19/2022] Open
Abstract
Background New diagnosis tests are urgently needed to address the global tuberculosis (TB) burden and to improve control programs especially in resource-limited settings. An effective in vitro diagnostic of TB based on serological methods would be regarded as an attractive progress because immunoassays are simple, rapid, inexpensive, and may offer the possibility to detect cases missed by standard sputum smear microscopy. However, currently available serology tests for TB are highly variable in sensitivity and specificity. Lipolytic enzymes have recently emerged as key factors in lipid metabolization during dormancy and/or exit of the non-replicating growth phase, a prerequisite step of TB reactivation. The focus of this study was to analyze and compare the potential of four Mycobacterium tuberculosis lipolytic enzymes (LipY, Rv0183, Rv1984c and Rv3452) as new markers in the serodiagnosis of active TB. Methods Recombinant proteins were produced and used in optimized ELISA aimed to detect IgG and IgM serum antibodies against the four lipolytic enzymes. The capacity of the assays to identify infection was evaluated in patients with either active TB or latent TB and compared with two distinct control groups consisting of BCG-vaccinated blood donors and hospitalized non-TB individuals. Results A robust humoral response was detected in patients with active TB whereas antibodies against lipolytic enzymes were infrequently detected in either uninfected groups or in subjects with latent infection. High specifity levels, ranging from 93.9% to 97.5%, were obtained for all four antigens with sensitivity values ranging from 73.4% to 90.5%, with Rv3452 displaying the highest performances. Patients with active TB usually exhibited strong IgG responses but poor IgM responses. Conclusion These results clearly indicate that the lipolytic enzymes tested are strongly immunogenic allowing to distinguish active from latent TB infections. They appear as potent biomarkers providing high sensitivity and specificity levels for the immunodiagnosis of active TB.
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Affiliation(s)
- Belinda Brust
- Laboratoire de Dynamique des Interactions Membranaires Normales et Pathologiques, Universités de Montpellier II et I, CNRS UMR 5235, Montpellier, France
- Clinical Microbiology Division, Bio-Rad Laboratories, Steenvoorde, France
| | - Mélanie Lecoufle
- Clinical Microbiology Division, Bio-Rad Laboratories, Steenvoorde, France
| | - Edouard Tuaillon
- INSERM U1058, Université de Montpellier I, Département de Bactériologie-Virologie, Institut de Recherche en Biothérapie, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Luc Dedieu
- CNRS UPR 9025, Université Aix-Marseille, Enzymologie Interfaciale et Physiologie de la Lipolyse, Marseille, France
| | - Stéphane Canaan
- CNRS UPR 9025, Université Aix-Marseille, Enzymologie Interfaciale et Physiologie de la Lipolyse, Marseille, France
| | - Viviane Valverde
- Clinical Microbiology Division, Bio-Rad Laboratories, Steenvoorde, France
| | - Laurent Kremer
- Laboratoire de Dynamique des Interactions Membranaires Normales et Pathologiques, Universités de Montpellier II et I, CNRS UMR 5235, Montpellier, France
- INSERM, DIMNP, Montpellier, France
- * E-mail:
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Steingart KR, Flores LL, Dendukuri N, Schiller I, Laal S, Ramsay A, Hopewell PC, Pai M. Commercial serological tests for the diagnosis of active pulmonary and extrapulmonary tuberculosis: an updated systematic review and meta-analysis. PLoS Med 2011; 8:e1001062. [PMID: 21857806 PMCID: PMC3153457 DOI: 10.1371/journal.pmed.1001062] [Citation(s) in RCA: 163] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Accepted: 06/09/2011] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Serological (antibody detection) tests for tuberculosis (TB) are widely used in developing countries. As part of a World Health Organization policy process, we performed an updated systematic review to assess the diagnostic accuracy of commercial serological tests for pulmonary and extrapulmonary TB with a focus on the relevance of these tests in low- and middle-income countries. METHODS AND FINDINGS We used methods recommended by the Cochrane Collaboration and GRADE approach for rating quality of evidence. In a previous review, we searched multiple databases for papers published from 1 January 1990 to 30 May 2006, and in this update, we add additional papers published from that period until 29 June 2010. We prespecified subgroups to address heterogeneity and summarized test performance using bivariate random effects meta-analysis. For pulmonary TB, we included 67 studies (48% from low- and middle-income countries) with 5,147 participants. For all tests, estimates were variable for sensitivity (0% to 100%) and specificity (31% to 100%). For anda-TB IgG, the only test with enough studies for meta-analysis, pooled sensitivity was 76% (95% CI 63%-87%) in smear-positive (seven studies) and 59% (95% CI 10%-96%) in smear-negative (four studies) patients; pooled specificities were 92% (95% CI 74%-98%) and 91% (95% CI 79%-96%), respectively. Compared with ELISA (pooled sensitivity 60% [95% CI 6%-65%]; pooled specificity 98% [95% CI 96%-99%]), immunochromatographic tests yielded lower pooled sensitivity (53%, 95% CI 42%-64%) and comparable pooled specificity (98%, 95% CI 94%-99%). For extrapulmonary TB, we included 25 studies (40% from low- and middle-income countries) with 1,809 participants. For all tests, estimates were variable for sensitivity (0% to 100%) and specificity (59% to 100%). Overall, quality of evidence was graded very low for studies of pulmonary and extrapulmonary TB. CONCLUSIONS Despite expansion of the literature since 2006, commercial serological tests continue to produce inconsistent and imprecise estimates of sensitivity and specificity. Quality of evidence remains very low. These data informed a recently published World Health Organization policy statement against serological tests. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Karen R. Steingart
- Department of Health Services, University of Washington School of Public Health, Seattle, Washington, United States of America
| | - Laura L. Flores
- Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California, San Francisco, California, United States of America
- Curry International Tuberculosis Center, University of California, San Francisco, California, United States of America
| | - Nandini Dendukuri
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University & Montreal, Chest Institute, Montreal, Quebec, Canada
| | - Ian Schiller
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University & Montreal, Chest Institute, Montreal, Quebec, Canada
| | - Suman Laal
- Department of Pathology, New York University Langone Medical Center, New York, New York, United States of America
- Department of Microbiology, New York University Langone Medical Center, New York, New York, United States of America
- Veterans Affairs Medical Center, New York, New York, United States of America
| | - Andrew Ramsay
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Philip C. Hopewell
- Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California, San Francisco, California, United States of America
- Curry International Tuberculosis Center, University of California, San Francisco, California, United States of America
| | - Madhukar Pai
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University & Montreal, Chest Institute, Montreal, Quebec, Canada
- * E-mail:
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Rv1985c, a promising novel antigen for diagnosis of tuberculosis infection from BCG-vaccinated controls. BMC Infect Dis 2010; 10:273. [PMID: 20849593 PMCID: PMC2949761 DOI: 10.1186/1471-2334-10-273] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2009] [Accepted: 09/17/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Antigens encoded in the region of difference (RD) of Mycobacterium tuberculosis constitute a potential source of specific antigens for immunodiagnosis. In the present study, recombinant protein Rv1985c from RD2 was cloned, expressed, purified, immunologically characterized and investigated for its potentially diagnostic value for tuberculosis (TB) infection among BCG-vaccinated individuals. METHODS T-cell response to Rv1985c was evaluated by IFN-γ ELISPOT in 56 TB patients, 20 latent TB infection (LTBI) and 30 BCG-vaccinated controls in comparison with the commercial T-SPOT. TB kit. Humoral response was evaluated by ELISA in 117 TB patients, 45 LTBI and 67 BCG-vaccinated controls, including all those who had T-cell assay, in comparison with a commercial IgG kit. RESULTS Rv1985c was specifically recognized by cellular and humoral responses from both TB and LTBI groups compared with healthy controls. Rv1985c IgG-ELISA achieved 52% and 62% sensitivity respectively, which outperformed the sensitivity of PATHOZYME-MYCO kit (34%) in detecting active TB (P = 0.011), whereas IFN-γ Rv1985c-ELISPOT achieved 71% and 55% sensitivity in detecting active and LTBI, respectively. Addition of Rv1985c increased sensitivities of ESAT-6, CFP-10 and ESAT-6/CFP-10 combination in detecting TB from 82.1% to 89.2% (P = 0.125), 67.9% to 87.5% (P < 0.001) and 85.7% to 92.9% (P = 0.125), respectively. CONCLUSIONS In conclusion, Rv1985c is a novel antigen which can be used to immunologically diagnose TB infection along with other immunodominant antigens among BCG-vaccinated population.
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Utility of a combination of RD1 and RD2 antigens as a diagnostic marker for tuberculosis. Diagn Microbiol Infect Dis 2009; 66:153-61. [PMID: 19833469 DOI: 10.1016/j.diagmicrobio.2009.09.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Revised: 07/31/2009] [Accepted: 09/02/2009] [Indexed: 11/20/2022]
Abstract
We evaluated the diagnostic potential of a cocktail of 4 antigens encoded by regions of difference (RD) 1 and 2 of Mycobacterium tuberculosis, that is, early secretory antigenic target-6, culture filtrate protein-10 (CFP-10), CFP-21, and mycobacterial protein from species tuberculosis-64 (MPT-64) on the basis of antigen and antibody detection by enzyme-linked immunosorbent assay. Parallel detection of antigens and antibodies in the serum samples of pulmonary tuberculosis (PTB) patients resulted in higher sensitivity as compared to either of the single tests in both smear-positive (90%) and smear-negative (60%) PTB patients. In addition, combined detection of antigens and antibodies in the fluids of extrapulmonary tuberculosis (EPTB) patients could detect >90% of the patients with high specificity. These results demonstrate the ability of the combination of antigen and antibody detection assays based on the cocktail of RD antigens to diagnose a substantial number of PTB and EPTB cases with high specificity.
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Hoff ST, Abebe M, Ravn P, Range N, Malenganisho W, Rodriques DS, Kallas EG, Søborg C, Mark Doherty T, Andersen P, Weldingh K. Evaluation of Mycobacterium tuberculosis--specific antibody responses in populations with different levels of exposure from Tanzania, Ethiopia, Brazil, and Denmark. Clin Infect Dis 2007; 45:575-82. [PMID: 17682991 DOI: 10.1086/520662] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2007] [Accepted: 05/29/2007] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND New, simple, and better-performing diagnostic tools are needed for the diagnosis of tuberculosis (TB). Much effort has been invested in developing an antibody-based test for TB, but to date, no such test has performed with sufficient sensitivity and specificity. A key question remaining is the extent to which the disappointing performance of current tests is associated with a high background prevalence of latent TB. METHODS We compared Mycobacterium tuberculosis-specific ESAT-6 and CFP-10 antibody responses in a total of 565 human serum samples from M. tuberculosis-uninfected donors and donors with latent infection, as well as samples from patients with active TB. Our study included samples from 4 countries, representing environments with low, intermediate, and high TB incidences. RESULTS We demonstrated significant increases in antibody levels in latently infected contacts, compared with M. tuberculosis-uninfected individuals, and in patients with active TB disease, compared with latently infected contacts. Furthermore, we found a striking increase in the magnitude of the antibody responses in samples obtained from infected Ethiopian individuals (with and without disease), compared with Danish and Brazilian infected individuals; this was presumably the result of higher exposure levels. CONCLUSIONS Our study confirms the presence of ESAT-6 and CFP-10 antibodies in patients with TB, and we demonstrate that significant antibody responses are not restricted to active TB disease but can reflect latent infection, particularly in areas with high levels of exposure to M. tuberculosis. This finding is important for the understanding of the poor discriminatory power of current serodiagnostic tests in regions of endemicity, and it may have major implications on the future development of serologic tests.
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Affiliation(s)
- Soren T Hoff
- Department of Infectious Diseases Immunology, Statens Serum Institute, Copenhagen S, Denmark.
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