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Banik S, Ozay B, Trejo M, Zhu Y, Kanna C, Santellan C, Shaw B, Chandrasekaran S, Chaturvedi S, Vejar L, Chakravorty S, Alland D, Banada P. A simple and sensitive test for Candida auris colonization, surveillance, and infection control suitable for near patient use. J Clin Microbiol 2024; 62:e0052524. [PMID: 38888304 PMCID: PMC11250521 DOI: 10.1128/jcm.00525-24] [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: 04/04/2024] [Accepted: 05/22/2024] [Indexed: 06/20/2024] Open
Abstract
Candida auris is a multidrug-resistant fungal pathogen with a propensity to colonize humans and persist on environmental surfaces. C. auris invasive fungal disease is being increasingly identified in acute and long-term care settings. We have developed a prototype cartridge-based C. auris surveillance assay (CaurisSurV cartridge; "research use only") that includes integrated sample processing and nucleic acid amplification to detect C. auris from surveillance skin swabs in the GeneXpert instrument and is designed for point-of-care use. The assay limit of detection (LoD) in the skin swab matrix was 10.5 and 14.8 CFU/mL for non-aggregative (AR0388) and aggregative (AR0382) strains of C. auris, respectively. All five known clades of C. auris were detected at 2-3-5× (31.5-52.5 CFU/mL) the LoD. The assay was validated using a total of 85 clinical swab samples banked at two different institutions (University of California Los Angeles, CA and Wadsworth Center, NY). Compared to culture, sensitivity was 96.8% (30/31) and 100% (10/10) in the UCLA and Wadsworth cohorts, respectively, providing a combined sensitivity of 97.5% (40/41), and compared to PCR, the combined sensitivity was 92% (46/50). Specificity was 100% with both clinical (C. auris negative matrix, N = 31) and analytical (non-C. auris strains, N = 32) samples. An additional blinded study with N = 60 samples from Wadsworth Center, NY yielded 97% (29/30) sensitivity and 100% (28/28) specificity. We have developed a completely integrated, sensitive, specific, and 58-min prototype test, which can be used for routine surveillance of C. auris and might help prevent colonization and outbreaks in acute and chronic healthcare settings. IMPORTANCE This study has the potential to offer a better solution to healthcare providers at hospitals and long-term care facilities in their ongoing efforts for effective and timely control of Candida auris infection and hence quicker response for any potential future outbreaks.
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Affiliation(s)
- Sukalyani Banik
- Center for Emerging Pathogens, Department of Medicine, Public Health Research Institute, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Burcu Ozay
- Research and Development, Cepheid, Sunnyvale, California, USA
| | - Marisol Trejo
- UCLA DGSOM Pathology & Lab Medicine, UCLA, Los Angeles, California, USA
| | - YanChun Zhu
- Mycology laboratory, Wadsworth Center, Albany, New York, USA
| | - Charan Kanna
- Center for Emerging Pathogens, Department of Medicine, Public Health Research Institute, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Cynthia Santellan
- UCLA DGSOM Pathology & Lab Medicine, UCLA, Los Angeles, California, USA
| | - Bennett Shaw
- UCLA DGSOM Pathology & Lab Medicine, UCLA, Los Angeles, California, USA
| | | | | | - Lindy Vejar
- Research and Development, Cepheid, Sunnyvale, California, USA
| | - Soumitesh Chakravorty
- Center for Emerging Pathogens, Department of Medicine, Public Health Research Institute, Rutgers New Jersey Medical School, Newark, New Jersey, USA
- Research and Development, Cepheid, Sunnyvale, California, USA
| | - David Alland
- Center for Emerging Pathogens, Department of Medicine, Public Health Research Institute, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Padmapriya Banada
- Center for Emerging Pathogens, Department of Medicine, Public Health Research Institute, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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Blacksell SD, Dhawan S, Kusumoto M, Le KK, Summermatter K, O'Keefe J, Kozlovac J, Almuhairi SS, Sendow I, Scheel CM, Ahumibe A, Masuku ZM, Bennett AM, Kojima K, Harper DR, Hamilton K. The Biosafety Research Road Map: The Search for Evidence to Support Practices in the Laboratory- Bacillus anthracis and Brucella melitensis. APPLIED BIOSAFETY 2023; 28:72-86. [PMID: 37342513 PMCID: PMC10278026 DOI: 10.1089/apb.2022.0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
Introduction Brucella melitensis and Bacillus anthracis are zoonoses transmitted from animals and animal products. Scientific information is provided in this article to support biosafety precautions necessary to protect laboratory workers and individuals who are potentially exposed to these pathogens in the workplace or other settings, and gaps in information are also reported. There is a lack of information on the appropriate effective concentration for many chemical disinfectants for this agent. Controversies related to B. anthracis include infectious dose for skin and gastrointestinal infections, proper use of personal protective equipment (PPE) during the slaughter of infected animals, and handling of contaminated materials. B. melitensis is reported to have the highest number of laboratory-acquired infections (LAIs) to date in laboratory workers. Methods A literature search was conducted to identify potential gaps in biosafety and focused on five main sections including the route of inoculation/modes of transmission, infectious dose, LAIs, containment releases, and disinfection and decontamination strategies. Results Scientific literature currently lacks information on the effective concentration of many chemical disinfectants for this agent and in the variety of matrices where it may be found. Controversies related to B. anthracis include infectious dose for skin and gastrointestinal infections, proper use of PPE during the slaughter of infected animals, and handling contaminated materials. Discussion Clarified vulnerabilities based on specific scientific evidence will contribute to the prevention of unwanted and unpredictable infections, improving the biosafety processes and procedures for laboratory staff and other professionals such as veterinarians, individuals associated with the agricultural industry, and those working with susceptible wildlife species.
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Affiliation(s)
- Stuart D. Blacksell
- Mahidol-Oxford Tropical Research Medicine Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Nuffield Department of Medicine Research Building, University of Oxford, Oxford, United Kingdom
| | - Sandhya Dhawan
- Mahidol-Oxford Tropical Research Medicine Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Marina Kusumoto
- Mahidol-Oxford Tropical Research Medicine Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Kim Khanh Le
- Mahidol-Oxford Tropical Research Medicine Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | - Joseph O'Keefe
- Ministry for Primary Industries, Wellington, New Zealand
| | - Joseph Kozlovac
- United States Department of Agriculture, Agricultural Research Service, Beltsville, Maryland, USA
| | | | - Indrawati Sendow
- Research Center for Veterinary Science, National Research and Innovation Agency, Indonesia
| | - Christina M. Scheel
- WHO Collaborating Center for Biosafety and Biosecurity, Office of the Associate Director for Laboratory Science, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Anthony Ahumibe
- Nigeria Centre for Disease Control and Prevention, Abuja, Nigeria
| | - Zibusiso M. Masuku
- National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
| | - Allan M. Bennett
- UK Health Security Agency, Porton Down, Salisbury, United Kingdom
| | - Kazunobu Kojima
- Department of Epidemic and Pandemic Preparedness and Prevention, World Health Organization (WHO), Geneva, Switzerland
| | - David R. Harper
- The Royal Institute of International Affairs, London, United Kingdom
| | - Keith Hamilton
- World Organisation for Animal Health (OIE), Paris, France
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Gates-Hollingsworth MA, Kolton CB, Hoffmaster AR, Meister GT, Moore AE, Green HR, Pogoda JM, Pillai SP, Kozel TR. Rapid Capsular Antigen Immunoassay for Diagnosis of Inhalational Anthrax: Preclinical Studies and Evaluation in a Nonhuman Primate Model. mBio 2022; 13:e0093122. [PMID: 35546539 PMCID: PMC9239138 DOI: 10.1128/mbio.00931-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 04/15/2022] [Indexed: 11/20/2022] Open
Abstract
Inhalational anthrax is a fatal infectious disease. Rapid and effective treatment is critically dependent on early and accurate diagnosis. Blood culture followed by identification and confirmation may take days to provide clinically relevant information. In contrast, immunoassay for a shed antigen, the capsular polypeptide gamma-d-polyglutamate (γDPGA), can provide rapid results at the point of care. In this study, a lateral flow immunoassay for γDPGA was evaluated in a robust nonhuman primate model of inhalational anthrax. The results showed that the time to a positive result with the rapid test using either serum or blood as a clinical specimen was similar to the time after infection when a blood culture became positive. In vitro testing showed that the test was equally sensitive with cultures of the three major clades of Bacillus anthracis. Cultures from other Bacillus spp. that are known to produce γDPGA also produced positive results. The test was negative with human sera from 200 normal subjects and 45 subjects with culture-confirmed nonanthrax bacterial or fungal sepsis. Taken together, the results showed that immunoassay for γDPGA is an effective surrogate for blood culture in a relevant cynomolgus monkey model of inhalational anthrax. The test would be a valuable aid in early diagnosis of anthrax, which is critical for rapid intervention and a positive outcome. Use of the test could facilitate triage of patients with signs and symptoms of anthrax in a mass-exposure incident and in low-resource settings where laboratory resources are not readily available. IMPORTANCE Patient outcome in anthrax is critically dependent on early diagnosis followed by effective treatment. We describe a rapid lateral flow immunoassay that detects capsular antigen of Bacillus anthracis that is shed into blood during infection. The test was evaluated in a robust cynomolgus monkey model of inhalational anthrax. Rapid detection of capsular antigen is an effective surrogate for the time-consuming and laboratory-intensive diagnosis by blood culture, direct fluorescent antibody staining, or other molecular testing. The test can be performed at the point of patient contact, is rapid and inexpensive, and can be used by individuals with minimal training.
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Affiliation(s)
| | - Cari B. Kolton
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | - Addie E. Moore
- Battelle Biomedical Research Center, Columbus, Ohio, USA
| | - Heather R. Green
- Department of Microbiology and Immunology, University of Nevada, Reno School of Medicine, Reno, Nevada, USA
| | | | - Segaran P. Pillai
- Office of the Commissioner, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Thomas R. Kozel
- Department of Microbiology and Immunology, University of Nevada, Reno School of Medicine, Reno, Nevada, USA
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Ehret R, Harb K, Breuer S, Obermeier M. Performance assessment of the new Xpert® HIV-1 Viral Load XC assay for quantification of HIV-1 viral loads. J Clin Virol 2022; 149:105127. [DOI: 10.1016/j.jcv.2022.105127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/07/2022] [Accepted: 03/07/2022] [Indexed: 11/28/2022]
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Long CM, Marzi A. Biodefence research two decades on: worth the investment? THE LANCET. INFECTIOUS DISEASES 2021; 21:e222-e233. [PMID: 34331891 DOI: 10.1016/s1473-3099(21)00382-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/13/2021] [Accepted: 06/14/2021] [Indexed: 12/15/2022]
Abstract
For the past 20 years, the notion of bioterror has been a source of considerable fear and panic worldwide. In response to the terror attacks of 2001 in the USA, extensive research funding was awarded to investigate bioterror-related pathogens. The global scientific legacy of this funding has extended into the present day, highlighted by the ongoing COVID-19 pandemic. Unsurprisingly, the surge in biodefence-related research and preparedness has been met with considerable apprehension and opposition. Here, we briefly outline the history of modern bioterror threats and biodefence research, describe the scientific legacy of biodefence research by highlighting advances pertaining to specific bacterial and viral pathogens, and summarise the future of biodefence research and its relevance today. We sought to address the sizeable question: have the past 20 years of investment into biodefence research and preparedness been worth it? The legacy of modern biodefence funding includes advancements in biosecurity, biosurveillence, diagnostics, medical countermeasures, and vaccines. In summary, we feel that these advances justify the substantial biodefence funding trend of the past two decades and set a precedent for future funding.
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Affiliation(s)
- Carrie M Long
- Laboratory of Bacteriology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
| | - Andrea Marzi
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA.
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Forbes JD. Clinically Important Toxins in Bacterial Infection: Utility of Laboratory Detection. CLINICAL MICROBIOLOGY NEWSLETTER 2020; 42:163-170. [PMID: 33046946 PMCID: PMC7541054 DOI: 10.1016/j.clinmicnews.2020.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The elaboration of proteins that damage host cells is fundamental to the pathogenesis of many bacterial pathogens. The clinical significance of many bacterial toxins is well recognized, and routine detection is necessary to confirm definitive diagnosis for some types of infectious diseases. Determining the clinical significance of a toxin involves many factors, including the toxin's prevalence, virulence, and role in disease pathogenesis. While essential from a diagnostic perspective, toxin detection has the potential to be important for patient management decision making, as well as infection prevention and control measures. This review focuses on the history, epidemiology, pathogenesis, clinical presentation, and management of infections associated with well-defined, clinically important toxins (such as Shiga toxin-producing Escherichia coli), as well as those that are less well defined (such as Staphylococcus aureus' Panton-Valentine leukocidin) where detection may yield clinically important information.
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Affiliation(s)
- Jessica D Forbes
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
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Banada PP, Deshpande S, Banik S, Shah D, Koshy R, Patel B, Kwiatkowski R, Persing D, Alland D. Multiplex Detection of Three Select Agents Directly from Blood by Use of the GeneXpert System. J Clin Microbiol 2019; 57:e00036-19. [PMID: 30842226 PMCID: PMC6498027 DOI: 10.1128/jcm.00036-19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 02/25/2019] [Indexed: 12/20/2022] Open
Abstract
Francisella tularensis, Bacillus anthracis, and Yersinia pestis are tier 1 select agents with the potential to rapidly cause severe disease. Rapid detection of these bacteria from patient samples at the point of care could contribute to improved clinical outcomes in the event of a bioterrorism attack. A multiplex nested PCR assay for detection of F. tularensis, B. anthracis, and Y. pestis directly from patient blood samples was developed using the GeneXpert system. The multiplex GeneXpert cartridge-based assay includes all necessary sample processing and amplification reagents. Blood samples spiked with different numbers of CFU were used to measure the analytical limit of detection (LOD) and dynamic range. Sensitivity was determined by testing spiked blood samples and negative-control blood in a blind manner. Specificity was determined by testing against nontarget pathogens and blood samples from clinical patients. The assay LOD was 8.5 CFU/ml for F. tularensis, 10 CFU/ml for B. anthracis, and 4.5 CFU/ml for Y. pestis The sensitivity was 100% at the LOD for all three select agent bacteria in spiked patient blood samples. The assay specificity was 100% when it was tested against both nontarget pathogens and clinical patient blood samples. The total assay time was approximately 100 min. This automated assay, which is suitable for use at the point of care, identifies three select agents directly in blood without the need for enrichment with a high sensitivity within 100 min. This assay may enable rapid detection and treatment of patients infected with the target organisms in the event of a bioterrorism attack.
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Affiliation(s)
- Padmapriya P Banada
- Center for Emerging Pathogens, Division of Infectious Diseases, New Jersey Medical School, Rutgers Biomedical and Health Sciences University, Newark, New Jersey, USA
| | - Srinidhi Deshpande
- Center for Emerging Pathogens, Division of Infectious Diseases, New Jersey Medical School, Rutgers Biomedical and Health Sciences University, Newark, New Jersey, USA
| | - Sukalyani Banik
- Center for Emerging Pathogens, Division of Infectious Diseases, New Jersey Medical School, Rutgers Biomedical and Health Sciences University, Newark, New Jersey, USA
| | - Darshini Shah
- Department of Pathology and Laboratory Medicine, University Hospital, Newark, New Jersey, USA
| | - Ranie Koshy
- Blood Bank/Transfusion Service, University Hospital, Newark, New Jersey, USA
| | - Bhavana Patel
- Department of Pathology and Laboratory Medicine, University Hospital, Newark, New Jersey, USA
| | | | | | - David Alland
- Center for Emerging Pathogens, Division of Infectious Diseases, New Jersey Medical School, Rutgers Biomedical and Health Sciences University, Newark, New Jersey, USA
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Rastogi M, Singh SK. Advances in Molecular Diagnostic Approaches for Biothreat Agents. DEFENSE AGAINST BIOLOGICAL ATTACKS 2019. [PMCID: PMC7123646 DOI: 10.1007/978-3-030-03071-1_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
The advancement in Molecular techniques has been implicated in the development of sophisticated, high-end diagnostic platform and point-of-care (POC) devices for the detection of biothreat agents. Different molecular and immunological approaches such as Immunochromatographic and lateral flow assays, Enzyme-linked Immunosorbent assays (ELISA), Biosensors, Isothermal amplification assays, Nucleic acid amplification tests (NAATs), Next Generation Sequencers (NGS), Microarrays and Microfluidics have been used for a long time as detection strategies of the biothreat agents. In addition, several point of care (POC) devices have been approved by FDA and commercialized in markets. The high-end molecular platforms like NGS and Microarray are time-consuming, costly, and produce huge amount of data. Therefore, the future prospects of molecular based technique should focus on developing quick, user-friendly, cost-effective and portable devices against biological attacks and surveillance programs.
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Green MS, LeDuc J, Cohen D, Franz DR. Confronting the threat of bioterrorism: realities, challenges, and defensive strategies. THE LANCET. INFECTIOUS DISEASES 2018; 19:e2-e13. [PMID: 30340981 PMCID: PMC7106434 DOI: 10.1016/s1473-3099(18)30298-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/25/2018] [Accepted: 05/04/2018] [Indexed: 01/30/2023]
Abstract
Global terrorism is a rapidly growing threat to world security, and increases the risk of bioterrorism. In this Review, we discuss the potential threat of bioterrorism, agents that could be exploited, and recent developments in technologies and policy for detecting and controlling epidemics that have been initiated intentionally. The local and international response to infectious disease epidemics, such as the severe acute respiratory syndrome and west African Ebola virus epidemic, revealed serious shortcomings which bioterrorists might exploit when intentionally initiating an epidemic. Development of new vaccines and antimicrobial therapies remains a priority, including the need to expedite clinical trials using new methodologies. Better means to protect health-care workers operating in dangerous environments are also needed, particularly in areas with poor infrastructure. New and improved approaches should be developed for surveillance, early detection, response, effective isolation of patients, control of the movement of potentially infected people, and risk communication. Access to dangerous pathogens should be appropriately regulated, without reducing progress in the development of countermeasures. We conclude that preparedness for intentional outbreaks has the important added value of strengthening preparedness for natural epidemics, and vice versa.
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Affiliation(s)
- Manfred S Green
- School of Public Health, University of Haifa, Haifa, Israel.
| | - James LeDuc
- Galveston National Laboratory, University of Texas Medical Branch, Galveston, TX, USA
| | - Daniel Cohen
- School of Public Health, Tel Aviv University, Tel Aviv, Israel
| | - David R Franz
- College of Veterinary Medicine, Kansas State University, Manhattan, KS, USA
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