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Marius M, Fernandez C. Non-Microbiological Mycobacterial Detection Techniques for Quality Control of Biological Products: A Comprehensive Review. Microorganisms 2024; 12:788. [PMID: 38674732 PMCID: PMC11052345 DOI: 10.3390/microorganisms12040788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/05/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
Mycobacteria can be one of the main contaminants of biological products, and their presence can have serious consequences on patients' health. For this reason, the European Pharmacopoeia mandates the specific testing of biological products for mycobacteria, a critical regulatory requirement aimed at ensuring the safety of these products before they are released to the market. The current pharmacopeial reference, i.e., microbial culture method, cannot ensure an exhaustive detection of mycobacteria due to their growth characteristics. Additionally, the method is time consuming and requires a continuous supply of culture media, posing logistical challenges. Thus, to overcome these issues, pharmaceutical industries need to consider alternative non-microbiological techniques to detect these fastidious, slow-growing contaminating agents. This review provides an overview of alternative methods, which could be applied within a quality control environment for biological products and underlines their advantages and limitations. Nucleic acid amplification techniques or direct measurement of mycobacteria stand out as the most suitable alternatives for mycobacterial testing in biological products.
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Affiliation(s)
- Marine Marius
- Sanofi, 1541 Ave. Marcel Mérieux, 69280 Marcy l’Etoile, France;
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Hozalski RM, Zhao X, Kim T, LaPara TM. On-site filtration of large sample volumes improves the detection of opportunistic pathogens in drinking water distribution systems. Appl Environ Microbiol 2024; 90:e0165823. [PMID: 38236032 PMCID: PMC10880612 DOI: 10.1128/aem.01658-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/06/2023] [Indexed: 01/19/2024] Open
Abstract
In this study, we compared conventional vacuum filtration of small volumes through disc membranes (effective sample volumes for potable water: 0.3-1.0 L) with filtration of high volumes using ultrafiltration (UF) modules (effective sample volumes for potable water: 10.6-84.5 L) for collecting bacterial biomass from raw, finished, and tap water at seven drinking water systems. Total bacteria, Legionella spp., Legionella pneumophila, Mycobacterium spp., and Mycobacterium avium complex in these samples were enumerated using both conventional quantitative PCR (qPCR) and viability qPCR (using propidium monoazide). In addition, PCR-amplified gene fragments were sequenced for microbial community analysis. The frequency of detection (FOD) of Legionella spp. in finished and tap water samples was much greater using UF modules (83% and 77%, respectively) than disc filters (24% and 33%, respectively). The FODs for Mycobacterium spp. in raw, finished, and tap water samples were also consistently greater using UF modules than disc filters. Furthermore, the number of observed operational taxonomic units and diversity index values for finished and tap water samples were often substantially greater when using UF modules as compared to disc filters. Conventional and viability qPCR yielded similar results, suggesting that membrane-compromised cells represented a minor fraction of total bacterial biomass. In conclusion, our research demonstrates that large-volume filtration using UF modules improved the detection of opportunistic pathogens at the low concentrations typically found in public drinking water systems and that the majority of bacteria in these systems appear to be viable in spite of disinfection with free chlorine and/or chloramine.IMPORTANCEOpportunistic pathogens, such as Legionella pneumophila, are a growing public health concern. In this study, we compared sample collection and enumeration methods on raw, finished, and tap water at seven water systems throughout the State of Minnesota, USA. The results showed that on-site filtration of large water volumes (i.e., 500-1,000 L) using ultrafiltration membrane modules improved the frequency of detection of relatively rare organisms, including opportunistic pathogens, compared to the common approach of filtering about 1 L using disc membranes. Furthermore, results from viability quantitative PCR (qPCR) with propidium monoazide were similar to conventional qPCR, suggesting that membrane-compromised cells represent an insignificant fraction of microorganisms. Results from these ultrafiltration membrane modules should lead to a better understanding of the microbial ecology of drinking water distribution systems and their potential to inoculate premise plumbing systems with opportunistic pathogens where conditions are more favorable for their growth.
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Affiliation(s)
- Raymond M. Hozalski
- Department of Civil, Environmental, and Geo- Engineering, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
- Biotechnology Institute, University of Minnesota Twin Cities, St. Paul, Minnesota, USA
| | - Xiaotian Zhao
- Department of Civil, Environmental, and Geo- Engineering, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Taegyu Kim
- Department of Civil, Environmental, and Geo- Engineering, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Timothy M. LaPara
- Department of Civil, Environmental, and Geo- Engineering, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
- Biotechnology Institute, University of Minnesota Twin Cities, St. Paul, Minnesota, USA
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3
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Kim T, Zhao X, LaPara TM, Hozalski RM. Flushing Temporarily Improves Microbiological Water Quality for Buildings Supplied with Chloraminated Surface Water but Has Little Effect for Groundwater Supplies. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2023; 57:5453-5463. [PMID: 36952669 DOI: 10.1021/acs.est.2c08123] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Microbial communities in premise plumbing systems were investigated after more than 2 months of long-term stagnation, during a subsequent flushing event, and during post-flush stagnation. Water samples were collected from showers in buildings supplied with chlorinated groundwater, untreated groundwater, and chloraminated surface water. The building supplied with chlorinated groundwater generally had the lowest bacterial concentrations across all sites (ranging from below quantification limit to 5.2 log copies/L). For buildings supplied with untreated groundwater, bacterial concentrations (5.0 to 7.6 log copies/L) and microbial community diversity index (ACE) values were consistent throughout sampling. Nontuberculous mycobacteria (NTM) and Legionella pneumophila were not detected in any groundwater-supplied buildings. Total bacteria, Legionella spp., and NTM were abundant in the surface water-supplied buildings following long-term stagnation (up to 7.6, 6.2, and 7.6 log copies/L, respectively). Flushing decreased these concentrations by ∼1 to >4 log units and reduced microbial community diversity, but the communities largely recovered within a week of post-flush stagnation. The results suggest that buildings supplied with disinfected surface water are more likely than buildings supplied with treated or untreated groundwater to experience deleterious changes in microbiological water quality during stagnation and that the water quality improvements from flushing with chloraminated water, while substantial, are short-lived.
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Affiliation(s)
- Taegyu Kim
- Department of Civil, Environmental, and Geo- Engineering, University of Minnesota Twin Cities, 500 Pillsbury Drive S.E., Minneapolis, Minnesota 55455, United States
| | - Xiaotian Zhao
- Department of Civil, Environmental, and Geo- Engineering, University of Minnesota Twin Cities, 500 Pillsbury Drive S.E., Minneapolis, Minnesota 55455, United States
| | - Timothy M LaPara
- Department of Civil, Environmental, and Geo- Engineering, University of Minnesota Twin Cities, 500 Pillsbury Drive S.E., Minneapolis, Minnesota 55455, United States
- Biotechnology Institute, University of Minnesota Twin Cities, 1479 Gortner Avenue, St. Paul, Minnesota 55108, United States
| | - Raymond M Hozalski
- Department of Civil, Environmental, and Geo- Engineering, University of Minnesota Twin Cities, 500 Pillsbury Drive S.E., Minneapolis, Minnesota 55455, United States
- Biotechnology Institute, University of Minnesota Twin Cities, 1479 Gortner Avenue, St. Paul, Minnesota 55108, United States
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Nick JA, Malcolm KC, Hisert KB, Wheeler EA, Rysavy NM, Poch K, Caceres S, Lovell VK, Armantrout E, Saavedra MT, Calhoun K, Chatterjee D, Aboellail I, De P, Martiniano SL, Jia F, Davidson RM. Culture independent markers of nontuberculous mycobacterial (NTM) lung infection and disease in the cystic fibrosis airway. Tuberculosis (Edinb) 2023; 138:102276. [PMID: 36417800 PMCID: PMC10965158 DOI: 10.1016/j.tube.2022.102276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/12/2022] [Accepted: 11/15/2022] [Indexed: 11/18/2022]
Abstract
Nontuberculous mycobacteria (NTM) are opportunistic pathogens that affect a relatively small but significant portion of the people with cystic fibrosis (CF), and may cause increased morbidity and mortality in this population. Cultures from the airway are the only test currently in clinical use for detecting NTM. Culture techniques used in clinical laboratories are insensitive and poorly suited for population screening or to follow progression of disease or treatment response. The lack of sensitive and quantitative markers of NTM in the airway impedes patient care and clinical trial design, and has limited our understanding of patterns of acquisition, latency and pathogenesis of disease. Culture-independent markers of NTM infection have the potential to overcome many of the limitations of standard NTM cultures, especially the very slow growth, inability to quantitate bacterial burden, and low sensitivity due to required decontamination procedures. A range of markers have been identified in sputum, saliva, breath, blood, urine, as well as radiographic studies. Proposed markers to detect presence of NTM or transition to NTM disease include bacterial cell wall products and DNA, as well as markers of host immune response such as immunoglobulins and the gene expression of circulating leukocytes. In all cases the sensitivity of culture-independent markers is greater than standard cultures; however, most do not discriminate between various NTM species. Thus, each marker may be best suited for a specific clinical application, or combined with other markers and traditional cultures to improve diagnosis and monitoring of treatment response.
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Affiliation(s)
- Jerry A Nick
- Department of Medicine, National Jewish Health, Denver, CO, 80206, USA; Department of Medicine, University of Colorado School of Medicine, Aurora, CO, 80045, USA.
| | - Kenneth C Malcolm
- Department of Medicine, National Jewish Health, Denver, CO, 80206, USA
| | - Katherine B Hisert
- Department of Medicine, National Jewish Health, Denver, CO, 80206, USA; Department of Medicine, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Emily A Wheeler
- Department of Medicine, National Jewish Health, Denver, CO, 80206, USA
| | - Noel M Rysavy
- Department of Medicine, National Jewish Health, Denver, CO, 80206, USA
| | - Katie Poch
- Department of Medicine, National Jewish Health, Denver, CO, 80206, USA
| | - Silvia Caceres
- Department of Medicine, National Jewish Health, Denver, CO, 80206, USA
| | - Valerie K Lovell
- Department of Medicine, National Jewish Health, Denver, CO, 80206, USA
| | - Emily Armantrout
- Department of Medicine, National Jewish Health, Denver, CO, 80206, USA
| | - Milene T Saavedra
- Department of Medicine, National Jewish Health, Denver, CO, 80206, USA; Department of Medicine, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Kara Calhoun
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Delphi Chatterjee
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, 1682 Campus Delivery, Fort Collins, CO, 80523, USA
| | - Ibrahim Aboellail
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, 1682 Campus Delivery, Fort Collins, CO, 80523, USA
| | - Prithwiraj De
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, 1682 Campus Delivery, Fort Collins, CO, 80523, USA
| | - Stacey L Martiniano
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Fan Jia
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, 80206, USA
| | - Rebecca M Davidson
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, 80206, USA
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Nishii Y, Furuhashi K, Nakamura S, Nishio M, Nakamura Y, Ushiro K, Ito K, Sakaguchi T, Suzuki Y, Fujiwara K, Yasuma T, Kobayashi T, D'Alessandro-Gabazza C, Gabazza EC, Taguchi O, Hataji O. The Potential of Digital Polymerase Chain Reaction for Improving Diagnostic Yield of Nontuberculous Mycobacteria Pulmonary Disease. Infect Drug Resist 2021; 14:5079-5087. [PMID: 34880633 PMCID: PMC8646858 DOI: 10.2147/idr.s338165] [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: 09/07/2021] [Accepted: 10/30/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Many patients with nontuberculous mycobacteria pulmonary disease are asymptomatic. The disease diagnosis is confirmed in only a small proportion of patients with radiological findings suspicious for nontuberculous mycobacteria pulmonary disease. Thus, many patients remained undiagnosed. Here, we evaluated the diagnostic value of digital polymerase chain reaction (PCR) in nontuberculous mycobacteria pulmonary disease. Methods We prospectively evaluated 123 patients with radiological findings suspicious for nontuberculous mycobacteria pulmonary disease. Digital PCR was performed using bronchial lavage fluid, sputum, saliva, blood, and urine. Results The culture of bronchial washing fluid was positive for nontuberculous mycobacteria in 53 patients and negative in 70. The positive detection rate of nontuberculous mycobacteria by digital PCR in patients with positive culture (n = 53) was as follows: bronchial lavage fluid 100%, sputum 62.9%, saliva 41.5%, blood 7.5%, and urine 3.8%. All patients with two or more positive partitions for nontuberculous mycobacteria in the digital PCR of bronchial lavage fluid showed nontuberculous mycobacteria growth in the bronchial lavage fluid culture. The digital PCR analysis of the bronchial lavage fluid showed a high sensitivity (100%), specificity (85.7%), positive predictive value (84.1%), negative predictive value (100%), and a high concordance rate (91.9%) with the bronchial lavage fluid culture results. In addition, the culture of bronchial lavage fluid was positive for nontuberculous mycobacteria in patients with two or more positive partitions in the digital PCR of sputum and saliva with a combined positive predictive value of 81.1%. Conclusion Digital PCR analysis of nontuberculous mycobacteria in bronchial lavage fluid shows a high concordance rate with the bronchial lavage fluid culture results and a high positive predictive value using both sputum and saliva, suggesting the potential usefulness of dPCR for diagnosis of nontuberculous mycobacteria pulmonary disease in clinical practice.
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Affiliation(s)
- Yoichi Nishii
- Respiratory Center, Matsusaka Municipal Hospital, Matsusaka, Mie, Japan
| | - Kazuki Furuhashi
- Respiratory Center, Matsusaka Municipal Hospital, Matsusaka, Mie, Japan
| | - Saki Nakamura
- Respiratory Center, Matsusaka Municipal Hospital, Matsusaka, Mie, Japan
| | - Miho Nishio
- Respiratory Center, Matsusaka Municipal Hospital, Matsusaka, Mie, Japan
| | - Yuki Nakamura
- Respiratory Center, Matsusaka Municipal Hospital, Matsusaka, Mie, Japan
| | - Kengo Ushiro
- Respiratory Center, Matsusaka Municipal Hospital, Matsusaka, Mie, Japan
| | - Kentaro Ito
- Respiratory Center, Matsusaka Municipal Hospital, Matsusaka, Mie, Japan
| | - Tadashi Sakaguchi
- Respiratory Center, Matsusaka Municipal Hospital, Matsusaka, Mie, Japan
| | - Yuta Suzuki
- Respiratory Center, Matsusaka Municipal Hospital, Matsusaka, Mie, Japan
| | - Kentaro Fujiwara
- Respiratory Center, Matsusaka Municipal Hospital, Matsusaka, Mie, Japan
| | - Taro Yasuma
- Department of Immunology, Faculty and Graduate School of Medicine, Mie University, Tsu-city, Mie, Japan
| | - Tetsu Kobayashi
- Department of Pulmonary and Critical Care Medicine, Faculty and Graduate School of Medicine, Mie University, Tsu-city, Mie, Japan
| | | | - Esteban C Gabazza
- Department of Immunology, Faculty and Graduate School of Medicine, Mie University, Tsu-city, Mie, Japan
| | - Osamu Taguchi
- Respiratory Center, Matsusaka Municipal Hospital, Matsusaka, Mie, Japan
| | - Osamu Hataji
- Respiratory Center, Matsusaka Municipal Hospital, Matsusaka, Mie, Japan
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Anand AR, Biswas J. TB or NTM: Can a new multiplex PCR assay be the answer? EBioMedicine 2021; 71:103552. [PMID: 34455392 PMCID: PMC8399081 DOI: 10.1016/j.ebiom.2021.103552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 08/11/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Appakkudal R Anand
- L & T Microbiology Research Centre, Medical Research Foundation, 41, College Road, Chennai, India 600006.
| | - Jyotirmay Biswas
- Department of Uvea and Ophthalmic pathology, Medical Research Foundation, 41, College Road, Chennai, India 600006.
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King EM, Weaver VK, Kestler MH. Treatment Dilemmas in Disseminated Nontuberculous Mycobacterial Infections With Interferon-gamma Autoantibodies. Open Forum Infect Dis 2021; 8:ofab253. [PMID: 34250191 PMCID: PMC8266671 DOI: 10.1093/ofid/ofab253] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/22/2021] [Indexed: 11/14/2022] Open
Abstract
Disseminated Mycobacterium avium complex (dMAC) is typically seen in individuals with impaired cell-mediated immunity and is best described in those with HIV. Recently, cases have been described in otherwise healthy individuals with neutralizing antibodies to interferon-gamma (nIFNγ-autoAb), especially in patients of Southeast Asian descent. Treatment is often refractory to mycobacterial therapies, and the use of rituximab and other immunomodulatory agents has been explored. We report 3 cases of dMAC with nIFN-γ-autoAb and review the available literature on treatment strategies to provide a framework for the management of patients with refractory infections in the context of neutralizing antibodies to interferon-gamma.
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Affiliation(s)
- Elizabeth M King
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Mary H Kestler
- University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
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Bordin A, Pandey S, Coulter C, Syrmis M, Pardo C, Hackett H, Bell SC, Wainwright CE, Nimmo GR, Jennison AV, Clark JE, Whiley DM. Rapid macrolide and amikacin resistance testing for Mycobacterium abscessus in people with cystic fibrosis. J Med Microbiol 2021; 70. [PMID: 33909552 DOI: 10.1099/jmm.0.001349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Introduction. Mycobacterium abscessus complex (MABSC) is an environmental organism and opportunistic pathogen. MABSC pulmonary infections in people with cystic fibrosis are of growing clinical concern. Resistance data guide the use of macrolides and amikacin in MABSC pulmonary disease treatment. MABSC can acquire resistance against macrolides or amikacin via 23S or 16S rRNA gene mutations, respectively.Gap Statement. Current culture-based methods for MABSC detection and antibiotic resistance characterization are typically prolonged, limiting their utility to directly inform treatment or clinical trials. Culture-independent molecular methods may help address this limitation.Aim. To develop real-time PCR assays for characterization of key 23S or 16S rRNA gene mutations associated with constitutive resistance in MABSC.Methodology. We designed two real-time PCR assays to detect the key 23S and 16S rRNA gene mutations. The highly conserved nature of rRNA genes was a major design challenge. To reduce potential cross-reactivity, primers included non-template bases and targeted single-nucleotide polymorphisms unique to MABSC. We applied these assays, as well as a previously developed real-time PCR assay for MABSC detection, to 968 respiratory samples from people with cystic fibrosis. The results from the molecular methods were compared to those for gold standard culture methods and 23S and 16S rRNA gene sequencing.Results.The real-time PCR MABSC detection assay provided a sensitivity of 83.8 % and a specificity of 97.8 % compared to culture. The results from the real-time PCR resistance detection assays were mostly concordant (>77.4 %) with cultured isolate sequencing. The real-time PCR resistance detection assays identified several samples harbouring both resistant and susceptible MABSC, while culture-dependent methods only identified susceptible MABSC in these samples.Conclusion. Using the molecular methods described here, results for health care providers or researchers could be available days or weeks earlier than is currently possible via culture-based antibiotic susceptibility testing.
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Affiliation(s)
- Amanda Bordin
- The University of Queensland Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia
| | - Sushil Pandey
- Queensland Mycobacterium Reference Laboratory, Pathology Queensland, Brisbane, Queensland, Australia
| | - Christopher Coulter
- Queensland Mycobacterium Reference Laboratory, Pathology Queensland, Brisbane, Queensland, Australia
| | - Melanie Syrmis
- Queensland Mycobacterium Reference Laboratory, Pathology Queensland, Brisbane, Queensland, Australia.,The University of Queensland Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia
| | - Carolyn Pardo
- The University of Queensland Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia
| | - Hazel Hackett
- The University of Queensland Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia
| | - Scott C Bell
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Lung Bacteria Group, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,The Prince Charles Hospital, Department of Thoracic Medicine, Brisbane, Queensland, Australia
| | - Claire E Wainwright
- Respiratory and Sleep Medicine Department, Queensland Children's Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Graeme R Nimmo
- Central Laboratory, Pathology Queensland, Brisbane, Queensland, Australia
| | - Amy V Jennison
- Forensic and Scientific Services, Queensland Health, Brisbane, Queensland, Australia
| | - Julia E Clark
- Infection Management and Prevention Service, Queensland Children's Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - David M Whiley
- The University of Queensland Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia.,Central Laboratory, Pathology Queensland, Brisbane, Queensland, Australia
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Hozalski RM, LaPara TM, Zhao X, Kim T, Waak MB, Burch T, McCarty M. Flushing of Stagnant Premise Water Systems after the COVID-19 Shutdown Can Reduce Infection Risk by Legionella and Mycobacterium spp. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2020; 54:15914-15924. [PMID: 33232602 DOI: 10.1021/acs.est.0c06357] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
There is concern about potential exposure to opportunistic pathogens when reopening buildings closed due to the COVID-19 pandemic. In this study, water samples were collected before, during, and after flushing showers in five unoccupied (i.e., for ∼2 months) university buildings with quantification of opportunists via a cultivation-based assay (Legionella pneumophila only) and quantitative PCR. L. pneumophila were not detected by either method; Legionella spp., nontuberculous mycobacteria (NTM), and Mycobacterium avium complex (MAC), however, were widespread. Using quantitative microbial risk assessment (QMRA), the estimated risks of illness from exposure to L. pneumophila and MAC via showering were generally low (i.e., less than a 10-7 daily risk threshold), with the exception of systemic infection risk from MAC exposure in some buildings. Flushing rapidly restored the total chlorine (as chloramine) residual and decreased bacterial gene targets to building inlet concentrations within 30 min. During the postflush stagnation period, the residual chlorine dissipated within a few days and bacteria rebounded, approaching preflush concentrations after 6-7 days. These results suggest that flushing can quickly improve water quality in unoccupied buildings, but the improvement may only last a few days.
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Affiliation(s)
- Raymond M Hozalski
- Department of Civil, Environmental, and Geo-Engineering, University of Minnesota, Minneapolis 55455, Minnesota, United States
| | - Timothy M LaPara
- Department of Civil, Environmental, and Geo-Engineering, University of Minnesota, Minneapolis 55455, Minnesota, United States
| | - Xiaotian Zhao
- Department of Civil, Environmental, and Geo-Engineering, University of Minnesota, Minneapolis 55455, Minnesota, United States
| | - Taegyu Kim
- Department of Civil, Environmental, and Geo-Engineering, University of Minnesota, Minneapolis 55455, Minnesota, United States
| | - Michael B Waak
- Norwegian University of Science and Technology, Trondheim 7031, Norway
- Department of Infrastructure, SINTEF Community, Trondheim 7031, Norway
| | - Tucker Burch
- Agricultural Research Service, U.S. Department of Agriculture, Marshfield, Wisconsin 54449, United States
| | - Michael McCarty
- School of Public Health, University of Minnesota, Minneapolis 55455, Minnesota, United States
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Abstract
Molecular tests for tuberculosis (TB) have the potential to help reach the three million people with TB who are undiagnosed or not reported each year and to improve the quality of care TB patients receive by providing accurate, quick results, including rapid drug-susceptibility testing. The World Health Organization (WHO) has recommended the use of molecular nucleic acid amplification tests (NAATs) tests for TB detection instead of smear microscopy, as they are able to detect TB more accurately, particularly in patients with paucibacillary disease and in people living with HIV. Importantly, some of these WHO-endorsed tests can detect mycobacterial gene mutations associated with anti-TB drug resistance, allowing clinicians to tailor effective TB treatment. Currently, a wide array of molecular tests for TB detection is being developed and evaluated, and while some tests are intended for reference laboratory use, others are being aimed at the point-of-care and peripheral health care settings. Notably, there is an emergence of molecular tests designed, manufactured, and rolled out in countries with high TB burden, of which some are explicitly aimed for near-patient placement. These developments should increase access to molecular TB testing for larger patient populations. With respect to drug susceptibility testing, NAATs and next-generation sequencing can provide results substantially faster than traditional phenotypic culture. Here, we review recent advances and developments in molecular tests for detecting TB as well as anti-TB drug resistance.
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Kalaiarasan E, Thangavelu K, Krishnapriya K, Muthuraj M, Jose M, Joseph NM. Diagnostic performance of real time PCR and MALDI-TOF in the detection of nontuberculous mycobacteria from clinical isolates. Tuberculosis (Edinb) 2020; 125:101988. [PMID: 32916384 DOI: 10.1016/j.tube.2020.101988] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/20/2020] [Accepted: 08/22/2020] [Indexed: 02/07/2023]
Abstract
This study aimed to evaluate the performance of real-time PCR (qPCR) and MALDI-TOF for accurate and timely detection of nontuberculous mycobacterium (NTM) from clinical isolates. We collected fifty NTM suspected Mycobacteria Growth Indicator Tube (MGIT) cultures and analysed the diagnostic performance of qPCR and VITEK MS using Line Probe Assay (LPA) GenoType CM (Common Mycobacteria) as gold standard. The qPCR assays targeting 16S rRNA, ITS and IS6110 genes were developed for the identification of NTM and Mycobacterium tuberculosis complex (MTBC). LPA GenoType CM, a PCR technique targeting 23S rRNA gene, followed by reverse hybridization and line probe technology identified 90% of Mycobacterium species including M. fortuitum (16%,n = 8), M. intracellulare (10%,n = 5), M. gordonae (10%,n = 5), M. xenopi (4%,n = 2), M. scrofulaceum (4%,n = 2), Mycobacterium additional species (AS) (32%,n = 16) and MTBC (14%,n = 7), qPCR detected 80% of Mycobacterium species (NTM, 66% (n = 33) and MTBC, 14% (n = 7)) and MALDI-TOF, 52% (M. fortuitum (12%,n = 6), M. intracellulare (10%, n = 5), M. simiae (8%,n = 4), M. gordonae (8%,n = 4), and MTBC (14%,n = 7)). Sensitivity of qPCR and MALDI-TOF was 88.9% and 57.8%, respectively with 100% specificity. The combination of qPCR and MALDI-TOF remains an appropriate test for timely diagnosis of Mycobacterium species. This may eventually assist to detect the cases that may have been missed by phenotypic tests and enhance the NTM diagnosis capability to improve effective patient management.
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Affiliation(s)
- Ellappan Kalaiarasan
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Kalpana Thangavelu
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Krishnakumariamma Krishnapriya
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Muthaiah Muthuraj
- Intermediate Reference Laboratory, Government Hospital for Chest Diseases, Pondicherry, India
| | - Maria Jose
- Intermediate Reference Laboratory, Government Hospital for Chest Diseases, Pondicherry, India
| | - Noyal Mariya Joseph
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India.
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Roller M, Hansen S, Böhlken-Fascher S, Knauf-Witzens T, Czerny CP, Goethe R, Abd El Wahed A. Molecular and Serological Footprints of Mycobacterium avium Subspecies Infections in Zoo Animals. Vet Sci 2020; 7:vetsci7030117. [PMID: 32842515 PMCID: PMC7558821 DOI: 10.3390/vetsci7030117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/13/2020] [Accepted: 08/19/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Mycobacteria of the Mycobacterium avium complex (MAC) pose a significant risk to zoological collections. Mycobacterium avium subspecies paratuberculosis (MAP) is a member of MAC and the causative agent of Johne’s disease. Despite many reports in animals kept in zoological gardens, systemic surveillance has rarely been reported. Methods: In this study, archived serum samples collected from animal species at the Wilhelma Zoological and Botanical Gardens in Stuttgart, Germany, were screened for the presence of antibodies against MAC and MAP. In addition, molecular investigations were performed on necropsy, fecal, and environmental samples. Results: In total, 30/381 serum samples of various mammalian species were positive for MAC antibodies in ELISA, while one sample of a reticulated giraffe (Giraffa camelopardalis reticulata) was positive in MAP-specific ELISA. Samples from many species were positive in pan-Mycobacterium real-time PCR (40/43 fecal samples, 27/43 environmental samples, and 31/90 necropsy samples). Surprisingly, no sample was positive in the MAP-specific molecular assays. However, two environmental samples from primate enclosures were positive in Mycobacterium avium subspecies hominissuis (MAH)-specific real-time PCR. Conclusions: The results reveal serological indications of MAC infections in the zoological collection. However, the presence of a MAP-contaminated environment by a high-shedding individual animal or MAP-infected population is unlikely.
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Affiliation(s)
- Marco Roller
- Wilhelma Zoological-Botanical Gardens Stuttgart, Wilhelma 13, D-70376 Stuttgart, Germany; (M.R.); (T.K.-W.)
- Department of Animal Sciences, Division of Microbiology and Animal Hygiene, Faculty of Agricultural Science, Georg-August-University, Burckhardtweg 2, D-37077 Göttingen, Germany; (S.H.); (S.B.-F.); (C.-P.C.)
- Institute for Microbiology, University of Veterinary Medicine Hannover, Foundation, Bischofsholer Damm 15, D-30173 Hannover, Germany;
| | - Sören Hansen
- Department of Animal Sciences, Division of Microbiology and Animal Hygiene, Faculty of Agricultural Science, Georg-August-University, Burckhardtweg 2, D-37077 Göttingen, Germany; (S.H.); (S.B.-F.); (C.-P.C.)
| | - Susanne Böhlken-Fascher
- Department of Animal Sciences, Division of Microbiology and Animal Hygiene, Faculty of Agricultural Science, Georg-August-University, Burckhardtweg 2, D-37077 Göttingen, Germany; (S.H.); (S.B.-F.); (C.-P.C.)
| | - Tobias Knauf-Witzens
- Wilhelma Zoological-Botanical Gardens Stuttgart, Wilhelma 13, D-70376 Stuttgart, Germany; (M.R.); (T.K.-W.)
| | - Claus-Peter Czerny
- Department of Animal Sciences, Division of Microbiology and Animal Hygiene, Faculty of Agricultural Science, Georg-August-University, Burckhardtweg 2, D-37077 Göttingen, Germany; (S.H.); (S.B.-F.); (C.-P.C.)
| | - Ralph Goethe
- Institute for Microbiology, University of Veterinary Medicine Hannover, Foundation, Bischofsholer Damm 15, D-30173 Hannover, Germany;
| | - Ahmed Abd El Wahed
- Department of Animal Sciences, Division of Microbiology and Animal Hygiene, Faculty of Agricultural Science, Georg-August-University, Burckhardtweg 2, D-37077 Göttingen, Germany; (S.H.); (S.B.-F.); (C.-P.C.)
- Institute of Animal Hygiene and Veterinary Public Health, University of Leipzig, An den Tierkliniken 43, D-04103 Leipzig, Germany
- Correspondence: ; Tel.: +49-176-6136-0325
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Bazzi AM, Abulhamayel Y, Rabaan AA, Al-Tawfiq JA. The impact of the coexistence of mycobacterium avium with mycobacterium tuberculosis on the result of GeneXpert and MGIT susceptibility test. J Infect Public Health 2020; 13:827-829. [PMID: 32037200 DOI: 10.1016/j.jiph.2020.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 11/25/2019] [Accepted: 01/02/2020] [Indexed: 11/29/2022] Open
Abstract
Rapid tests to diagnose tuberculosis relies on molecular detection of the M. tuberculosis. GeneXpert MTB/RIF test identifies M. tuberculosis and rifampicin resistance. We present a case of simultaneous coinfection with M. tuberculosis and M. avium. M. tuberculosis was detected in the sputum by PCR GeneXpert method. Unrecognized coexistence of M. tuberculosis and M. avium modified the results of drug susceptibility tests making the primary identification of M. tuberculosis as multi-drug resistant strain. We performed in vitro experiments to investigate the effect of the coexistence of M. avium with M. tuberculosis on the results of GeneXpert method, and drug susceptibility test.
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Affiliation(s)
- Ali M Bazzi
- Microbiology Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Yem Abulhamayel
- Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Ali A Rabaan
- Molecular Diagnostic Lab, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Jaffar A Al-Tawfiq
- Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Gupta AK, Singh A, Singh S. Diagnosis of Tuberculosis: Nanodiagnostics Approaches. Nanobiomedicine (Rij) 2020. [PMCID: PMC7122355 DOI: 10.1007/978-981-32-9898-9_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Tuberculosis (TB) remains one of the most devastating infectious diseases worldwide. The burden of TB is alarmingly high in developing countries, where diagnosis latent TB infection (LTBI), Extra-pulmonary tuberculosis (EPTB), drug-resistant tuberculosis (DR-TB), HIV-associated TB, and paediatric TB is still a challenge. This is mainly due to delayed or misdiagnosis of TB, which continues to fuel its worldwide epidemic. The ideal diagnostic test is still unavailable, and conventional methods remain a necessity for TB diagnosis, though with poor diagnostic ability. The nanoparticles have shown potential for the improvement of drug delivery, reducing treatment frequency and diagnosis of various diseases. The engineering of antigens/antibody nanocarriers represents an exciting front in the field of diagnostics, potentially flagging the way toward development of better diagnostics for TB. This chapter discusses the presently available tests for TB diagnostics and also highlights the recent advancement in the nanotechnology-based detection tests for M. tuberculosis.
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Waak MB, LaPara TM, Hallé C, Hozalski RM. Nontuberculous Mycobacteria in Two Drinking Water Distribution Systems and the Role of Residual Disinfection. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2019; 53:8563-8573. [PMID: 31287948 DOI: 10.1021/acs.est.9b01945] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Nontuberculous mycobacteria (NTM) are frequently found in chloraminated drinking water distribution systems (DWDSs) due to their chloramine tolerance. NTM were investigated in the water-main biofilms and drinking water of a chloraminated DWDS in the United States (initial chloramine residual = 3.8 ± 0.1 mg L-1) and a DWDS in Norway with minimal residual disinfectant (0.08 ± 0.01 mg L-1). Total mycobacteria and Mycobacterium avium complex (MAC) were quantified by qPCR targeting, respectively, atpE genes and the internal transcribed spacer region. Mycobacteria concentrations in drinking water did not differ between the two systems (P = 0.09; up to 6 × 104 copies L-1) but were higher in the biofilms from the chloraminated DWDS (P = 5 × 10-9; up to 5 × 106 copies cm-2). MAC were not detected in either system. Sequencing of mycobacterial hsp65 genes indicated that the chloraminated DWDS lacked diversity and consisted almost exclusively of M. gordonae. In contrast, there were various novel mycobacteria in the no-residual DWDS. Finally, Mycobacterium- and Methylobacterium-like 16S rRNA genes were often detected simultaneously, though without correlation as previously observed. We conclude that, though residual chloramine may increase mycobacterial biomass in a DWDS, it may also decrease mycobacterial diversity.
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Affiliation(s)
- Michael B Waak
- Department of Civil, Environmental, and Geo-Engineering , University of Minnesota , 500 Pillsbury Dr. SE , Minneapolis , Minnesota 55455 , United States
- Department of Civil and Environmental Engineering , Norwegian University of Science and Technology , S.P. Andersens veg 5 , 7491 Trondheim , Norway
| | - Timothy M LaPara
- Department of Civil, Environmental, and Geo-Engineering , University of Minnesota , 500 Pillsbury Dr. SE , Minneapolis , Minnesota 55455 , United States
- BioTechnology Institute , University of Minnesota , 1479 Gortner Ave. , St. Paul , Minnesota 55108 , United States
| | - Cynthia Hallé
- Department of Civil and Environmental Engineering , Norwegian University of Science and Technology , S.P. Andersens veg 5 , 7491 Trondheim , Norway
| | - Raymond M Hozalski
- Department of Civil, Environmental, and Geo-Engineering , University of Minnesota , 500 Pillsbury Dr. SE , Minneapolis , Minnesota 55455 , United States
- BioTechnology Institute , University of Minnesota , 1479 Gortner Ave. , St. Paul , Minnesota 55108 , United States
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Nicol MP, Cox H. Recent developments in the diagnosis of drug-resistant tuberculosis. MICROBIOLOGY AUSTRALIA 2019. [DOI: 10.1071/ma19023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Urgent steps are required to control the drug-resistant tuberculosis (TB) epidemic worldwide. Individualised treatment, using detailed drug-susceptibility test results to guide choice of antibiotics, improves patient outcomes and minimises adverse effects. Recent years have seen substantial advances in our ability to provide rapid, detailed drug-resistance profiles using genotypic methods for detection of mutations conferring drug-resistance. Rapid testing using real-time PCR to target the most important drug-resistance mutations allows the diagnosis of drug resistance to be made with the first diagnostic test, even in low resource settings. The use of whole genome sequencing to infer resistance to a range of different drugs facilitates earlier tailoring of therapy and detection of resistant subpopulations in mixed infections. Low burden countries, such as Australia are well positioned to lead the development and refinement of these new methods, to accelerate the incorporation of these new tools into TB control programs in high burden countries.
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Gong W, Yang Y, Luo Y, Li N, Bai X, Liu Y, Zhang J, Chen M, Zhang C, Wu X. An alert of Mycobacterium tuberculosis infection of rhesus macaques in a wild zoo in China. Exp Anim 2017; 66:357-365. [PMID: 28659540 PMCID: PMC5682348 DOI: 10.1538/expanim.16-0095] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Mycobacterium tuberculosis, the pathogen that causes tuberculosis (TB),
is becoming increasingly recognized as an important cause of fatal chronic illnesses in
China. In this study, we report an infectious disease among 84 rhesus macaques at a
Chinese zoo. Their clinical signs and symptoms were very similar with the manifestations
of TB in humans. To determine the potential pathogens of this outbreak, many methods were
used. First, tuberculin skin tests showed that none of the monkeys displayed significant
skin reactions. Subsequently, the sera were tested for specific antibody IgG; 29 (34.5%)
and 39 (46.4%) blood samples tested positive by TB-IgG and TB-DOT, respectively.
Radiographic examination showed characteristic imageology changes in 14 (16.7%) monkeys.
One individual determined as positive by the above three methods was euthanized, and
histopathological analysis demonstrated typical granulomas and caseous necrosis in the
lung, liver, spleen, and intestine. Furthermore, the pathogenic mycobacteria were isolated
from lung lobe, cultured on acidic Lowenstein-Jensen culture medium, and identified as
M. tuberculosis by real-time PCR and DNA sequencing. Nevertheless, the
origin of the infection remained unknown. These findings emphasize the need to strengthen
the management and training of staff, especially those working at animal shelters.
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Affiliation(s)
- Wenping Gong
- Army Tuberculosis Prevention and Control Key Laboratory/Beijing Key Laboratory of New Techniques of Tuberculosis Diagnosis and Treatment, Institute for Tuberculosis Research, 309th Hospital of Chinese PLA, Heishanhu Road 17#, Haidian District, Beijing 100091, P.R. China
| | - Yourong Yang
- Army Tuberculosis Prevention and Control Key Laboratory/Beijing Key Laboratory of New Techniques of Tuberculosis Diagnosis and Treatment, Institute for Tuberculosis Research, 309th Hospital of Chinese PLA, Heishanhu Road 17#, Haidian District, Beijing 100091, P.R. China
| | - Yi Luo
- Beijing Key Laboratory of Captive Wildlife Technologies, Beijing Zoo, Xizhimen Street 137#, Xicheng District, Beijing 100044, P.R. China
| | - Ning Li
- Department of Pathology, the 309th Hospital of Chinese PLA, Heishanhu Road 17#, Haidian District, Beijing 100091, P.R. China
| | - Xuejuan Bai
- Army Tuberculosis Prevention and Control Key Laboratory/Beijing Key Laboratory of New Techniques of Tuberculosis Diagnosis and Treatment, Institute for Tuberculosis Research, 309th Hospital of Chinese PLA, Heishanhu Road 17#, Haidian District, Beijing 100091, P.R. China
| | - Yinping Liu
- Army Tuberculosis Prevention and Control Key Laboratory/Beijing Key Laboratory of New Techniques of Tuberculosis Diagnosis and Treatment, Institute for Tuberculosis Research, 309th Hospital of Chinese PLA, Heishanhu Road 17#, Haidian District, Beijing 100091, P.R. China
| | - Junxian Zhang
- Army Tuberculosis Prevention and Control Key Laboratory/Beijing Key Laboratory of New Techniques of Tuberculosis Diagnosis and Treatment, Institute for Tuberculosis Research, 309th Hospital of Chinese PLA, Heishanhu Road 17#, Haidian District, Beijing 100091, P.R. China
| | - Ming Chen
- Department of Pharmacy, the 309th Hospital of Chinese PLA, Heishanhu Road 17#, Haidian District, Beijing 100091, P.R. China
| | - Chenglin Zhang
- Beijing Key Laboratory of Captive Wildlife Technologies, Beijing Zoo, Xizhimen Street 137#, Xicheng District, Beijing 100044, P.R. China
| | - Xueqiong Wu
- Army Tuberculosis Prevention and Control Key Laboratory/Beijing Key Laboratory of New Techniques of Tuberculosis Diagnosis and Treatment, Institute for Tuberculosis Research, 309th Hospital of Chinese PLA, Heishanhu Road 17#, Haidian District, Beijing 100091, P.R. China
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Evolution of Quality Assurance for Clinical Immunohistochemistry in the Era of Precision Medicine: Part 1: Fit-for-Purpose Approach to Classification of Clinical Immunohistochemistry Biomarkers. Appl Immunohistochem Mol Morphol 2017; 25:4-11. [DOI: 10.1097/pai.0000000000000451] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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