1
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Park K, Shin BM. Comparative evaluation of two molecular multiplex syndromic panels with acute gastroenteritis. Diagn Microbiol Infect Dis 2024; 109:116211. [PMID: 38447492 DOI: 10.1016/j.diagmicrobio.2024.116211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/02/2024] [Accepted: 02/09/2024] [Indexed: 03/08/2024]
Abstract
We compared the Allplex Gastrointestinal V/B1/B2 Assays and Seeplex Diarrhea V/B1/B2 ACE Detection Assays in patients with acute gastroenteritis (AGE). Of the total 432 specimens, 48.8% and 54.9% samples were positive for any bacterial or viral target using Seeplex and Allplex, respectively (P = 0.002). The overall percent agreement (OPA) between the two panels was >95% and the lowest OPA was 95.4% for CdB. Allplex identified 40 samples positive for Salmonella spp., while Seeplex and OBC identified only 27 (67.5%) and 8 (20%), respectively. Shigella spp. were detected by assays in six samples, but none were identified using culture. Clostridium perfringens with Seeplex was detected in 70 (16.2%). It remained an informative species in identifying AGE although cpe gene showed only 9.8% positivity. Pathogenic Escherichia coli with Allplex could be detected in 40 (9.3%) samples, which could provide valuable information for the diagnosis of AGE.
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Affiliation(s)
- Kuenyoul Park
- Department of Laboratory Medicine, Sanggye Paik Hospital, School of Medicine, Inje University, 1342, Dongil-ro, Nowon-gu, Seoul 01757, Korea
| | - Bo-Moon Shin
- Department of Laboratory Medicine, Sanggye Paik Hospital, School of Medicine, Inje University, 1342, Dongil-ro, Nowon-gu, Seoul 01757, Korea.
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2
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Chatterjee R, Chowdhury AR, Mukherjee D, Chakravortty D. From Eberthella typhi to Salmonella Typhi: The Fascinating Journey of the Virulence and Pathogenicity of Salmonella Typhi. ACS OMEGA 2023; 8:25674-25697. [PMID: 37521659 PMCID: PMC10373206 DOI: 10.1021/acsomega.3c02386] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 06/30/2023] [Indexed: 08/01/2023]
Abstract
Salmonella Typhi (S. Typhi), the invasive typhoidal serovar of Salmonella enterica that causes typhoid fever in humans, is a severe threat to global health. It is one of the major causes of high morbidity and mortality in developing countries. According to recent WHO estimates, approximately 11-21 million typhoid fever illnesses occur annually worldwide, accounting for 0.12-0.16 million deaths. Salmonella infection can spread to healthy individuals by the consumption of contaminated food and water. Typhoid fever in humans sometimes is accompanied by several other critical extraintestinal complications related to the central nervous system, cardiovascular system, pulmonary system, and hepatobiliary system. Salmonella Pathogenicity Island-1 and Salmonella Pathogenicity Island-2 are the two genomic segments containing genes encoding virulent factors that regulate its invasion and systemic pathogenesis. This Review aims to shed light on a comparative analysis of the virulence and pathogenesis of the typhoidal and nontyphoidal serovars of S. enterica.
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Affiliation(s)
- Ritika Chatterjee
- Department
of Microbiology and Cell Biology, Division of Biological Sciences, Indian Institute of Science, Bangalore, Karnataka 560012, India
| | - Atish Roy Chowdhury
- Department
of Microbiology and Cell Biology, Division of Biological Sciences, Indian Institute of Science, Bangalore, Karnataka 560012, India
| | - Debapriya Mukherjee
- Department
of Microbiology and Cell Biology, Division of Biological Sciences, Indian Institute of Science, Bangalore, Karnataka 560012, India
| | - Dipshikha Chakravortty
- Department
of Microbiology and Cell Biology, Division of Biological Sciences, Indian Institute of Science, Bangalore, Karnataka 560012, India
- Centre
for Biosystems Science and Engineering, Indian Institute of Science, Bangalore, Karnataka 560012, India
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3
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Köffer J, Frontzek A, Eigner U. Development and validation of a bacterial gastrointestinal multiplex RT-PCR assay for use on a fully automated molecular system. J Microbiol Methods 2023; 210:106754. [PMID: 37263528 DOI: 10.1016/j.mimet.2023.106754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/26/2023] [Accepted: 05/28/2023] [Indexed: 06/03/2023]
Abstract
PCR-based enteric multiplex panels represent a rapid and reliable alternative to conventional "classical" phenotypic stool diagnostics. The aim of this study was to establish a laboratory-developed non-commercial multiplex Real-Time-PCR panel for the detection of the most important bacterial stool pathogens, Salmonella spp., Shigella spp., Yersinia enterocolitica/ pseudotuberculosis and Campylobacter jejuni/coli. on the "open" cobas omni Utility Channel (UC) of the cobas 6800 system (Roche). The aim was to replace the laborious phenotypical stool diagnostics with a high throughput Real-Time PCR method. The respective primers and probes were designed to cover conserved genomic regions of the pathogens and validated using Ultramer oligonucleotides, positive stool material and reference strains. To further validate the multiplex PCR-assay, the following parameters were evaluated: analytical-sensitivity and -specificity, cross-reactivity, linearity and inter- and intra-assay variance as well as limit of detection (LOD). In addition a retrospective analysis of culture positive and negative samples from daily routine was performed using 745 native stool samples. The Gastro assay was linear over a 5-log-unit and within the expected dynamic range with amplification efficiencies ranging from 94.6% to 120%. In addition, all targets showed excellent coefficients of repeatability (≤ 1.11%), intermediate precision (≤ 1.02%) and total variance (≤ 1.39%). In terms of analytical sensitivity the assay demonstrated detection limits ranging from 7.83 copies per reaction to 14.4 copies per reaction. The assay showed excellent agreement with culture methods (>95%) and a 100% sensitivity and specificity after resolution of discrepant results. The multiplex-PCR assay provides a comprehensive, rapid and sensitive alternative to conventional methods for the detection of the major bacterial stool pathogens in diagnostic laboratories.
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Affiliation(s)
| | - André Frontzek
- Roche Diagnostics (formerly, during study: Labor Stein, Mönchengladbach, Germany), Mannheim, Germany
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Thilakarathna SH, Chui L. A Pilot Study to Detect Viable Salmonella spp. in Diarrheal Stool Using Viability Real-Time PCR as a Culture-Independent Diagnostic Tool in a Clinical Setting. Int J Mol Sci 2023; 24:9979. [PMID: 37373127 DOI: 10.3390/ijms24129979] [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: 05/15/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
Frontline laboratories are adopting culture-independent diagnostic testing (CIDT) such as nucleic acid amplification tests (NAATs) due to numerous advantages over culture-based testing methods. Paradoxically, the viability of pathogens, a crucial factor determining active infections, cannot be confirmed with current NAATs alone. A recent development of viability PCR (vPCR) was introduced to mitigate this limitation associated with real-time PCR (qPCR) by using a DNA-intercalating dye to remove residual and dead cell DNA. This study assessed the applicability of the vPCR assay on diarrheal stools. Eighty-five diarrheal stools confirmed for Salmonellosis were tested via qPCR and vPCR using in-house primers and probe targeting the invA gene. vPCR-negative stools (Ct cut off > 31) were enriched in mannitol selenite broth (MSB) to verify low bacterial loads. vPCR assay showed ~89% sensitivity (qPCR- and vPCR-positive stools: 76/85). vPCR-negative stools (9/85; qPCR-positive: 5; qPCR-negative: 4) were qPCR- and culture-positive post-MSB-enrichment and confirmed the presence of low viable bacterial loads. Random sampling error, low bacterial loads, and receiving stools in batches could contribute to false negatives. This is a pilot study and further investigations are warranted to explore vPCR to assess pathogen viability in a clinical setting, especially when culture-based testing is unavailable.
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Affiliation(s)
- Surangi H Thilakarathna
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Linda Chui
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB T6G 1C9, Canada
- Alberta Precision Laboratories, Public Health Laboratory (ProvLab), Edmonton, AB T6G 2J2, Canada
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5
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Tast Lahti E, Karamehmedovic N, Riedel H, Blom L, Boel J, Delibato E, Denis M, van Essen-Zandbergen A, Garcia-Fernandez A, Hendriksen R, Heydecke A, van Hoek AHAM, Huby T, Kwit R, Lucarelli C, Lundin K, Michelacci V, Owczarek S, Ring I, Sejer Kjeldgaard J, Sjögren I, Skóra M, Torpdahl M, Ugarte-Ruiz M, Veldman K, Ventola E, Zajac M, Jernberg C. One Health surveillance-A cross-sectoral detection, characterization, and notification of foodborne pathogens. Front Public Health 2023; 11:1129083. [PMID: 36969662 PMCID: PMC10034719 DOI: 10.3389/fpubh.2023.1129083] [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: 12/21/2022] [Accepted: 02/16/2023] [Indexed: 03/29/2023] Open
Abstract
Introduction Several Proficiency Test (PT) or External Quality Assessment (EQA) schemes are currently available for assessing the ability of laboratories to detect and characterize enteropathogenic bacteria, but they are usually targeting one sector, covering either public health, food safety or animal health. In addition to sector-specific PTs/EQAs for detection, cross-sectoral panels would be useful for assessment of the capacity to detect and characterize foodborne pathogens in a One Health (OH) perspective and further improving food safety and interpretation of cross-sectoral surveillance data. The aims of the study were to assess the cross-sectoral capability of European public health, animal health and food safety laboratories to detect, characterize and notify findings of the foodborne pathogens Campylobacter spp., Salmonella spp. and Yersinia enterocolitica, and to develop recommendations for future cross-sectoral PTs and EQAs within OH. The PT/EQA scheme developed within this study consisted of a test panel of five samples, designed to represent a theoretical outbreak scenario. Methods A total of 15 laboratories from animal health, public health and food safety sectors were enrolled in eight countries: Denmark, France, Italy, the Netherlands, Poland, Spain, Sweden, and the United Kingdom. The laboratories analyzed the samples according to the methods used in the laboratory and reported the target organisms at species level, and if applicable, serovar for Salmonella and bioserotype for Yersinia. Results All 15 laboratories analyzed the samples for Salmonella, 13 for Campylobacter and 11 for Yersinia. Analytical errors were predominately false negative results. One sample (S. Stockholm and Y. enterocolitica O:3/BT4) with lower concentrations of target organisms was especially challenging, resulting in six out of seven false negative results. These findings were associated with laboratories using smaller sample sizes and not using enrichment methods. Detection of Salmonella was most commonly mandatory to notify within the three sectors in the eight countries participating in the pilot whereas findings of Campylobacter and Y. enterocolitica were notifiable from human samples, but less commonly from animal and food samples. Discussion The results of the pilot PT/EQA conducted in this study confirmed the possibility to apply a cross-sectoral approach for assessment of the joint OH capacity to detect and characterize foodborne pathogens.
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Affiliation(s)
- Elina Tast Lahti
- Department of Epidemiology and Disease Control, National Veterinary Institute (SVA), Uppsala, Sweden
- *Correspondence: Elina Tast Lahti
| | | | - Hilde Riedel
- Department of Biology, Swedish Food Agency, Uppsala, Sweden
| | - Linnea Blom
- Department of Biology, Swedish Food Agency, Uppsala, Sweden
| | - Jeppe Boel
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut (SSI), Copenhagen, Denmark
| | - Elisabetta Delibato
- Department of Food Safety, Nutrition and Veterinary Public Health, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - Martine Denis
- Research Unit of Hygiene and Quality of Poultry and Pork Products, French Agency for Food, Environmental and Occupational Health and Safety (ANSES), Ploufragan, France
| | - Alieda van Essen-Zandbergen
- Department of Bacteriology, Host-Pathogen Interaction, and Diagnostics Development, Wageningen Bioveterinary Research (WBVR) Part of Wageningen University and Research (WUR), Lelystad, Netherlands
| | | | - Rene Hendriksen
- Technical University of Denmark, The National Food Institute (DTU Food), Copenhagen, Denmark
| | - Anna Heydecke
- Center for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
| | - Angela H. A. M. van Hoek
- Centre for Infectious Disease Control (Department Zoonoses and Environmental Microbiology), Dutch National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Tom Huby
- Animal and Plant Health Agency (APHA), Weybridge, United Kingdom
| | - Renata Kwit
- Department of Microbiology, National Veterinary Research Institute (PIWet), Pulawy, Poland
| | - Claudia Lucarelli
- Department of Infectious Diseases, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - Karl Lundin
- Clinical Microbiology, Uppsala University Hospital, Uppsala, Sweden
| | - Valeria Michelacci
- Department of Food Safety, Nutrition and Veterinary Public Health, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - Slawomir Owczarek
- Department of Infectious Diseases, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - Isaac Ring
- Animal and Plant Health Agency (APHA), Weybridge, United Kingdom
| | - Jette Sejer Kjeldgaard
- Technical University of Denmark, The National Food Institute (DTU Food), Copenhagen, Denmark
| | | | - Milena Skóra
- Department of Microbiology, National Veterinary Research Institute (PIWet), Pulawy, Poland
| | - Mia Torpdahl
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut (SSI), Copenhagen, Denmark
| | - María Ugarte-Ruiz
- VISAVET Health Surveillance Centre, Universidad Complutense Madrid, Madrid, Spain
| | - Kees Veldman
- Department of Bacteriology, Host-Pathogen Interaction, and Diagnostics Development, Wageningen Bioveterinary Research (WBVR) Part of Wageningen University and Research (WUR), Lelystad, Netherlands
| | - Eleonora Ventola
- Department of Food Safety, Nutrition and Veterinary Public Health, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - Magdalena Zajac
- Department of Microbiology, National Veterinary Research Institute (PIWet), Pulawy, Poland
| | - Cecilia Jernberg
- Department of Microbiology, Public Health Agency of Sweden, Solna, Sweden
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6
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Evaluation of the clinical sensitivity and specificity of the BD Max™ Enteric Bacterial Panel for molecular detection of pathogens for acute gastroenteritis in the Singaporean population. METHODS IN MICROBIOLOGY 2022; 197:106478. [DOI: 10.1016/j.mimet.2022.106478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 11/19/2022]
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7
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Harder CB, Persson S, Christensen J, Ljubic A, Nielsen EM, Hoorfar J. Molecular diagnostics of Salmonella and Campylobacter in human/animal fecal samples remain feasible after long-term sample storage without specific requirements. AIMS Microbiol 2022; 7:399-414. [PMID: 35071939 PMCID: PMC8712530 DOI: 10.3934/microbiol.2021024] [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: 03/17/2021] [Accepted: 09/05/2021] [Indexed: 11/27/2022] Open
Abstract
Rapid advances in the development of sequencing technologies, numbers of commercial providers and diminishing costs have made DNA-based identification and diagnostics increasingly accessible to doctors and laboratories, eliminating the need for local investments in expensive technology and training or hiring of skilled technicians. However, reliable and comparable molecular analyses of bacteria in stool samples are dependent on storage and workflow conditions that do not introduce post-sampling bias, the most important factor being the need to keep the DNA at a stable detectable level. For that reason, there may remain other prohibitively costly requirements for cooling or freezing equipment or special chemical additives. This study investigates the diagnostic detectability of Salmonella and Campylobacter DNA in human, pig and chicken stool samples, stored at different temperatures and with different preservation methods. Stool samples were spiked with 106 CFU/mL of both Salmonella and Campylobacter strains stored at −20 °C, 5 °C and 20 °C (Room temperature, RT) and treated with either RNAlater, EDTA or Silica/ethanol. DNA was extracted at 9 different time points within 30 days and quantified by Qubit (total DNA) and qPCR (Salmonella and Campylobacter DNA). We found no statistically significant differences among the different preservation methods, and DNA from both species was easily detected at all time points and at all temperatures, both with and without preservation. This suggests that infections by these bacteria can be diagnosed and possibly also analysed in further detail simply by taking a stool sample in any suitable sealed container that can be transported to laboratory analysis without special storage or preservation requirements. We briefly discuss how this finding can benefit infection control in both developed and developing countries.
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Affiliation(s)
- C B Harder
- Statens Serum institut, Dept. Bacteriology, Parasitology and Fungi, Artillerivej 5, 2300 Copenhagen, Denmark.,Molecular Ecology, Microbial Ecology and Evolutionary Genetics, Lund University, Sölvegatan 37, 223 62 Lund
| | - S Persson
- Statens Serum institut, Dept. Bacteriology, Parasitology and Fungi, Artillerivej 5, 2300 Copenhagen, Denmark
| | - J Christensen
- Danish Veterinary and Food Administration, Microbiological department, Søndervang 4, 4100 Ringsted
| | - A Ljubic
- AGC Biologics, Process Transfer, Vandtårnsvej 83, 2860 Søborg, Denmark
| | - E M Nielsen
- Statens Serum institut, Dept. Bacteriology, Parasitology and Fungi, Artillerivej 5, 2300 Copenhagen, Denmark
| | - J Hoorfar
- Technical University of Denmark, National Food Institute, 2800 Kgs. Lyngby, Denmark
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8
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Sood N, Carbell G, Greenwald HS, Friedenberg FK. Is the Medium Still the Message? Culture-Independent Diagnosis of Gastrointestinal Infections. Dig Dis Sci 2022; 67:16-25. [PMID: 34846676 DOI: 10.1007/s10620-021-07330-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2021] [Indexed: 12/09/2022]
Abstract
Infectious diarrhea is caused by a variety of pathogens, including viruses, bacteria, and parasitic organisms. Though the causative agent of diarrhea has historically been evaluated via stool cultures, recently, culture-independent diagnostic tests (CIDT) have been developed and utilized with increasing frequency. Current practice guidelines recommend their use as adjuncts to stool cultures for diagnosing acute and chronic diarrhea. The three principal CIDT are microscopy, enzyme-based immunoassays (EIAs), and molecular based polymerase chain reaction (PCR). This review explores the common causes of infectious diarrhea, the basics of stool culture, the diagnostic utility of these three culture-independent modalities, and the strengths and weaknesses of all currently available clinical techniques. It also outlines considerations for specific populations including returning travelers and those with inflammatory bowel disease.
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Affiliation(s)
- Neil Sood
- Department of Internal Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Gary Carbell
- Department of Internal Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Holly S Greenwald
- Section of Gastroenterology and Hepatology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Frank K Friedenberg
- Section of Gastroenterology and Hepatology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.
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9
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ZHAO Y, TALHA M. Evaluation of food safety problems based on the fuzzy comprehensive analysis method. FOOD SCIENCE AND TECHNOLOGY 2021. [DOI: 10.1590/fst.47321] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Yingwen ZHAO
- Guizhou Rural Economy and Culture Institute, China
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10
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Evaluation of the eazyplex® EHEC complete (Amplex) assay for the differentiation of stx1 and stx2 positivity in stool samples. J Microbiol Methods 2021; 188:106291. [PMID: 34311019 DOI: 10.1016/j.mimet.2021.106291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/15/2021] [Accepted: 07/15/2021] [Indexed: 11/20/2022]
Abstract
The performance of the eazyplex® EHEC complete (Amplex) for the detection of Shiga toxin genes in stool samples was evaluated. The assay performed well in distinguishing between stx1 and stx2 but suboptimal sensitivity may limit its use to complementary testing rather than primary diagnosis of Shiga toxin-producing Escherichia coli infections.
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11
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Maldonado-Garza HJ, Garza-González E, Bocanegra-Ibarias P, Flores-Treviño S. Diagnostic syndromic multiplex approaches for gastrointestinal infections. Expert Rev Gastroenterol Hepatol 2021; 15:743-757. [PMID: 33682566 DOI: 10.1080/17474124.2021.1899807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Gastrointestinal diseases due to infectious pathogens currently represent an important global health concern, especially in children and developing countries. Early and accurate detection of gastrointestinal pathogens is important to initiate the appropriate type of therapy. Multiplex molecular gastrointestinal panels rapidly detect several gastrointestinal pathogens at once with high sensitivity.Areas covered: We assess the scope and limitations of several multiplex gastrointestinal panels approved by the Food and Drug Administration or marked by Conformité Européenne-in vitro diagnostic. We compare 10 syndromic gastrointestinal panels, 14 bacteria-specific multiplex panels, seven parasite-specific multiplex panels, and eight virus-specific multiplex panels.Expert opinion: Thanks to the advances made in the diagnostic approaches for gastrointestinal infections, there are various panels to choose. The choice of a specific syndromic gastrointestinal multiplex panel should be made to improve patient care. Diagnostic syndromic multiplex approaches for gastrointestinal infections should be customized; each hospital should develop its diagnostic algorithm for gastrointestinal infections tailored to its setting, study population, and geographical site. Current multiplex gastrointestinal panels could be improved by including the detection of antimicrobial resistance, toxigenic Clostridioides difficile, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, the virus responsible for the COVID-19 pandemic).
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Affiliation(s)
- Héctor Jesús Maldonado-Garza
- Departamento de Medicina Interna, Universidad Autónoma De Nuevo León, Hospital Universitario Dr. José Eleuterio González Y Facultad De Medicina, Servicio De Gastroenterología, Monterrey, Nuevo León, Mexico
| | - Elvira Garza-González
- Departamento de Medicina Interna, Universidad Autónoma De Nuevo León, Hospital Universitario Dr. José Eleuterio González Y Facultad De Medicina, Servicio De Gastroenterología, Monterrey, Nuevo León, Mexico
| | - Paola Bocanegra-Ibarias
- Departamento de Medicina Interna, Universidad Autónoma De Nuevo León, Hospital Universitario Dr. José Eleuterio González Y Facultad De Medicina, Servicio De Gastroenterología, Monterrey, Nuevo León, Mexico
| | - Samantha Flores-Treviño
- Departamento de Medicina Interna, Universidad Autónoma De Nuevo León, Hospital Universitario Dr. José Eleuterio González Y Facultad De Medicina, Servicio De Gastroenterología, Monterrey, Nuevo León, Mexico
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12
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Zhang X, Das S, Dunbar S, Tang YW. Molecular and non-molecular approaches to etiologic diagnosis of gastroenteritis. Adv Clin Chem 2020; 99:49-85. [PMID: 32951639 DOI: 10.1016/bs.acc.2020.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Gastroenteritis is a major cause of mortality and morbidity globally and rapid identification of the causative pathogen is important for appropriate treatment and patient management, implementation of effective infection control measures, reducing hospital length of stay, and reducing overall medical costs. Although stool culture and microscopic examination of diarrheal stool has been the primary method for laboratory diagnosis, culture-independent proteomic and genomic tests are receiving increased attention. Antigen tests for stool pathogens are routinely implemented as rapid and simple analytics whereas molecular tests are now available in various formats from high complexity to waived point-of-care tests. In addition, metagenomic next-generation sequencing stands poised for use as a method for both diagnosis and routine characterization of the gut microbiome in the very near future. Analysis of host biomarkers as indicators of infection status and pathogenesis may also become important for prediction, diagnosis, and monitoring of gastrointestinal infection. Here we review current methods and emerging technologies for the etiologic diagnosis of gastroenteritis in the clinical laboratory. Benefits and limitations of these evolving methods are highlighted.
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Affiliation(s)
- Xin Zhang
- Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China; Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | | | | | - Yi-Wei Tang
- Memorial Sloan Kettering Cancer Center, New York, NY, United States; Weill Medical College of Cornell University, New York, NY, United States; Cepheid, Danaher Diagnostic Platform, Shanghai, China.
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13
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Performance Evaluation of the Novodiag Bacterial GE+ Multiplex PCR Assay. J Clin Microbiol 2020; 58:JCM.01033-20. [PMID: 32719031 DOI: 10.1128/jcm.01033-20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 07/15/2020] [Indexed: 11/20/2022] Open
Abstract
The bacteriological diagnosis of intestinal bacterial infections has historically been based on culture on agar plates. However, culture may lack sensitivity, and some enteropathogens, such as pathovars of Escherichia coli, may escape routine diagnosis. Our goal was to evaluate the analytical performance of the Novodiag Bacterial GE+ kit for the detection of enteropathogenic bacteria in acute community diarrhea. We included 251 stools in this study (198 retrospective and 53 prospective). The analytical performance was calculated using a composite reference standard (CRS) in the absence of a perfect gold standard (lack of sensitivity of culture). The CRS was defined as positive if culture was positive or, in case of a negative culture, if the BD Max extended enteric bacterial panel and/or other real-time PCR (RT-PCR) tests were positive. Of the 251 samples, 200 were positive, and 51 were negative. Overall sensitivities of the Novodiag Bacterial GE+ kit for Campylobacter sp., Salmonella sp., Shigella sp./enteroinvasive E. coli (EIEC), Yersinia enterocolitica, enterohemorrhagic E. coli (EHEC), and enterotoxigenic E. coli (ETEC) ranged from 98.98 to 100%, specificities ranged from 98.08 to 100%, positive predictive values (PPVs) ranged from 88.24 to 100%, and negative predictive values (NVPs) ranged from 99.36 to 100%. The analytical performance of the Novodiag Bacterial GE+ kit is excellent. It can be used as a routine tool in the rapid diagnosis of bacterial gastroenteritis. Despite the eNAT tube dilution of the primary sample, the detection of Salmonella sp. and EHEC was perfect. The kit has the advantage of only detecting pathogenic Y. enterocolitica Its performance for Campylobacter is very satisfactory.
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Gingras BA, Maggiore JA. Performance of a new molecular assay for the detection of gastrointestinal pathogens. Access Microbiol 2020; 2:acmi000160. [PMID: 33195974 PMCID: PMC7660239 DOI: 10.1099/acmi.0.000160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 07/24/2020] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Conventional diagnostic laboratory algorithms for determining the cause of infectious gastroenteritis include culture, biochemical identification and immunoassays. In addition, multiplex PCR-based testing has advanced into the gastroenterology diagnostic arena in recent years. AIM The purpose of this study was to evaluate the performance of a new molecular test (Diagnostics Solutions Laboratory GI-MAP) for the detection of bacterial and parasitic pathogens in stool samples spiked with known organisms. METHODOLOGY Faeces from a healthy human subject were pooled into a standard matrix and screened for the absence of bacteria, parasites and Helicobacter pylori antigen. Once confirmed negative single faecal aliquots from the matrix were spiked with solely one pathogen-type from a panel of 14 bacterial pathogens or one of 2 parasitic pathogens at a density of 5×106 organisms ml-1. Sixteen spiked samples in appropriate transport media were sent to two testing labs, specifically a reference site using the PCR-based BioFire FilmArray Gastrointestinal Panel, and a second lab using the GI-MAP assay. Seven negative control samples comprised solely of stool matrix were also submitted. RESULTS Significant variability was found when the GI-MAP assay was used to test normal stool matrix with and without known bacteria and parasites at densities well within the expected limits of detection. The GI-MAP assay displayed a sensitivity of 80 % and a specificity of only 26 % due to many false positive results. This assay also reported quantitative numbers for pathogens. The BioFire FilmArray Gastrointestinal Panel achieved a sensitivity and specificity of 100 %. CONCLUSION The highly variable results for the GI-MAP assay were unexpected due to the precise pre-spike analysis and the overall maturation of nucleic acid amplification methods within the industry. Problematic to this assay is the poor level of specificity displayed by this assay reporting the presence of several pathogens, which could cause clinicians to treat with antibacterial and/or antiparasitic agents in the absence of any true pathogens.
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15
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Mizusawa M. Updates on Rapid Diagnostic Tests in Infectious Diseases. MISSOURI MEDICINE 2020; 117:328-337. [PMID: 32848269 PMCID: PMC7431065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In the last two decades there have been dramatic advances in development of rapid diagnostic tests. Turnaround time of the assays have significantly been shortened which led to reductions in time to appropriate antimicrobial therapy and improvement of patient clinical outcomes. Molecular-based assays generally have better sensitivity than conventional methods, but the cost is higher. The results need to be interpreted cautiously as detection of colonized organisms, pathogen detection in asymptomatic patients, and false negative/positive can occur. Indications and cost-effectiveness need to be considered for appropriate utilization of rapid diagnostic tests.
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Affiliation(s)
- Masako Mizusawa
- Section of Infectious Diseases, Department of Internal Medicine, University of Missouri - Kansas City, Kansas City, Missouri
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16
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Rapid culture-based identification of Shiga toxin-producing Escherichia coli and Shigella spp./Enteroinvasive E. coli using the eazyplex® EHEC complete assay. Eur J Clin Microbiol Infect Dis 2019; 39:151-158. [PMID: 31529306 DOI: 10.1007/s10096-019-03704-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 09/04/2019] [Indexed: 12/14/2022]
Abstract
Shiga toxin-producing Escherichia coli (STEC) and Shigella spp./enteroinvasive E. coli (EIEC) are common diarrheagenic bacteria that cause sporadic diseases and outbreaks. Clinical manifestations vary from mild symptoms to severe complications. For microbiological diagnosis, culture confirmation of a positive stool screening PCR test is challenging because of time-consuming methods for isolation of strains, wide variety of STEC pathotypes, and increased emergence of non-classical strains with unusual serotypes. Therefore, molecular assays for the rapid identification of suspect colonies growing on selective media are very useful. In this study, the performance of the newly introduced eazyplex® EHEC assay based on loop-mediated isothermal amplification (LAMP) was evaluated using 18 representative STEC and Shigella strains and 31 isolates or positive-enrichment broths that were collected from clinical stool samples following screening by BD MAX™ EBP PCR. Results were compared to real-time PCR as a reference standard. Overall, sensitivities and specificities of the eazyplex® EHEC were as follows: 94.7% and 100% for Shiga toxin 1 (stx1), 100% and 100% for stx2, 93.3% and 97.1% for intimin (eae), 100% and 100% for enterohemolysin A (ehlyA), and 100% and 100% for invasion-associated plasmid antigen H (ipaH) as Shigella spp./EIEC target, respectively. Sample preparation for LAMP took only some minutes, and the time to result of the assay ranged from 8.5 to 13 min. This study shows that eazyplex® EHEC is a very fast and easy to perform molecular assay that provides reliable results as a culture confirmation assay for the diagnosis of STEC and Shigella spp./EIEC infections.
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Stokes W, Simner PJ, Mortensen J, Oethinger M, Stellrecht K, Lockamy E, Lay T, Bouchy P, Pillai DR. Multicenter Clinical Validation of the Molecular BD Max Enteric Viral Panel for Detection of Enteric Pathogens. J Clin Microbiol 2019; 57:e00306-19. [PMID: 31270179 PMCID: PMC6711915 DOI: 10.1128/jcm.00306-19] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 06/13/2019] [Indexed: 12/25/2022] Open
Abstract
The conventional methodology for gastrointestinal pathogen detection remains time-consuming, expensive, and of limited sensitivity. The objective of this study was to evaluate the performance of the BD Max enteric viral panel (Max EVP) assay for identification of viral pathogens in stool specimens from individuals with symptoms of acute gastroenteritis, enteritis, or colitis. Prospective and archival stool specimens from adult and pediatric patients with diarrhea were collected in Cary-Blair medium or unpreserved containers. The results for specimens tested by the Max EVP (on the BD Max platform) were compared to those obtained by the reference method (alternate PCR assays, followed by bidirectional sequencing). Positive percent agreement (PPA) and negative percent agreement (NPA) were calculated. A total of 2,239 specimens were collected, with 2,148 being included for analysis. In this population, 39.6% of specimens were from outpatients, 42.1% were from patients <21 years old, and 49.7% were from females. Prevalence rates for prospective specimens were 7.3%, 4.5%, 3.5%, 2.4%, and 1.2% for norovirus, sapovirus, astrovirus, rotavirus, and adenovirus, respectively. PPA was 92.8%, 84.9%, 93.0%, 100%, and 95.6%, for norovirus, sapovirus, astrovirus, rotavirus, and adenovirus, respectively. NPA was ≥99.4% for all targets. In conjunction with the clinical presentation, laboratory findings, and epidemiological information, the Max EVP assay is effective for the differential diagnosis of enteric disease caused by norovirus, sapovirus, astrovirus, rotavirus, and adenovirus. This assay can be used individually for patients at high risk for a viral enteropathogen (e.g., in outbreak settings) or as an adjunct to other enteric bacterial panels.
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Affiliation(s)
- William Stokes
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Patricia J Simner
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Joel Mortensen
- Department of Pathology and Laboratory Medicine, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Margret Oethinger
- Providence Regional Laboratory, Oregon Region, Portland, Oregon, USA
| | - Kathleen Stellrecht
- Department of Pathology and Laboratory Medicine, Albany Medical Center, Albany, New York, USA
- Center for Immunology and Microbial Diseases, Albany Medical College, Albany, New York, USA
| | - Elizabeth Lockamy
- Becton, Dickinson and Company, BD Life Sciences, Sparks, Maryland, USA
| | - Tricia Lay
- Becton, Dickinson and Company, BD Life Sciences, Sparks, Maryland, USA
| | - Peggy Bouchy
- Becton, Dickinson and Company, BD Life Sciences, Quebec, Quebec, Canada
| | - Dylan R Pillai
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Microbiology, Immunology, and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Detection of Salmonella, Campylobacter, Shiga toxin-producing E. coli and Shigella/EIEC by culture and a multiplex PCR panel in pediatric patients with acute diarrheal illness. J LAB MED 2019. [DOI: 10.1515/labmed-2019-0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Acute diarrhea is the second most common cause of child deaths worldwide. We investigated Salmonella species (spp.), Campylobacter spp., Shiga toxin-producing Escherichia coli (STEC) and Shigella spp./enteroinvasive E. coli (EIEC) in stool samples of 741 pediatric patients with acute diarrheal illness.
Methods
Between January 2017 and October 2017, 741 stool specimens were tested by the BD Max Enteric Bacterial Panel (EBP) assay and conventional culture.
Results
Campylobacter spp., Salmonella spp. and E. coli O157:H7 were detected in 10 (1.3%), 20 (2.7%) and two (0.3%) stool specimens by culture, respectively. Campylobacter spp., Salmonella spp., Shiga toxin and Shigella/EIEC were detected in 46 (6.2%), 37 (5.0%), 20 (2.7%) and three (0.4%) stool specimens by the BD Max EBP assay, respectively. The percentage of detected pathogens was 4.3% (32/741) by culture. Use of the BD Max EBP assay identified an additional 112 pathogens, thereby increasing the frequency to 15.1% (112/741). Empirically, 58 patients received antibiotics and 43 patients underwent probiotic and/or symptomatic therapy.
Conclusions
We concluded that nucleic acid amplification testing markedly improves the detection rates of bacterial stool pathogens and offers rapid results.
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Hapuarachchi CT, Jeffery KJM, Bowler ICJW. Stool PCR may not be a substitute for enrichment culture for the detection of salmonella. J Med Microbiol 2019; 68:395-397. [DOI: 10.1099/jmm.0.000923] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- C. T. Hapuarachchi
- 1 Department of Microbiology, Level 6, The John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Katie J. M. Jeffery
- 1 Department of Microbiology, Level 6, The John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - I. C. J. W. Bowler
- 1 Department of Microbiology, Level 6, The John Radcliffe Hospital, Oxford, OX3 9DU, UK
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Buss JE, Cresse M, Doyle S, Buchan BW, Craft DW, Young S. Campylobacter culture fails to correctly detect Campylobacter in 30% of positive patient stool specimens compared to non-cultural methods. Eur J Clin Microbiol Infect Dis 2019; 38:1087-1093. [PMID: 30783889 PMCID: PMC6520473 DOI: 10.1007/s10096-019-03499-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 01/27/2019] [Indexed: 12/19/2022]
Abstract
Campylobacter diagnosis is hampered because many laboratories continue to use traditional stool culture, which is slow and suffers false-negative results. This large multi-site study used a composite reference method consisting of a new FDA-cleared immunoassay and four molecular techniques to compare to culture. Prospectively collected patient fecal specimens (1552) were first preliminarily categorized as positive or negative by traditional culture. All specimens were also tested by EIA, and any EIA-positive or culture-discrepant results were further characterized by 16S rRNA qPCR, eight species-specific PCR assays, bidirectional sequencing, and an FDA-cleared multiplex PCR panel. The five non-culture methods showed complete agreement on all positive and discrepant specimens which were then assigned as true-positive or true-negative specimens. Among 47 true-positive specimens, culture incorrectly identified 13 (28%) as negative, and 1 true-negative specimen as positive, for a sensitivity of 72.3%. Unexpectedly, among the true-positive specimens, 4 (8%) were the pathogenic species C. upsaliensis. Culture had a 30% false result rate compared to immunoassay and molecular methods. More accurate results lead to better diagnosis and treatment of suspected campylobacteriosis.
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Affiliation(s)
| | | | | | - Blake W Buchan
- Wisconsin Diagnostic Laboratories, Medical College of Wisconsin, Milwaukee, WI, USA
| | - David W Craft
- Penn State Milton S. Hershey Medical Center and College of Medicine, Pathology and Laboratory Medicine, Hershey, PA, USA
| | - Steve Young
- TriCore Reference Laboratories, Albuquerque, NM, USA
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21
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Yoo J, Park J, Lee HK, Yu JK, Lee GD, Park KG, Oak HC, Park YJ. Comparative Evaluation of Seegene Allplex Gastrointestinal, Luminex xTAG Gastrointestinal Pathogen Panel, and BD MAX Enteric Assays for Detection of Gastrointestinal Pathogens in Clinical Stool Specimens. Arch Pathol Lab Med 2019; 143:999-1005. [PMID: 30763118 DOI: 10.5858/arpa.2018-0002-oa] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Infectious gastroenteritis is caused by various pathogens, including bacteria, viruses, and parasites. OBJECTIVE.— To compare the performance of Seegene Allplex Gastrointestinal (24 targets: 13 bacteria, 5 viruses, and 6 parasites in 4 panels), Luminex xTAG Gastrointestinal Pathogen Panel (15 targets: 9 bacteria, 3 viruses, and 3 parasites), and BD MAX Enteric panel (5 bacteria and 3 parasites). We estimated the agreement among 3 molecular assays. DESIGN.— A total of 858 stool samples (554 bacterial/parasite and 304 viral pathogens) were included. A consensus positive/negative was defined as concordant results from at least 2 tests. To evaluate the agreement among the assays, κ value was calculated. RESULTS.— The overall positive percentage agreements of Seegene, Luminex, and BD MAX were 94% (258 of 275), 92% (254 of 275), and 78% (46 of 59), respectfully. For Salmonella, Luminex showed low negative percentage agreement because of frequent false positives (n = 31) showing low median fluorescent intensity. For viruses, positive/negative percentage agreements of Seegene and Luminex were 99%/96% and 93%/99%, respectively. Compared with routine microbiology testing, Seegene, Luminex, and BD MAX additionally identified 39, 40, and 12 pathogens, respectively. Sixty-one cases (16 cases with Seegene, 51 cases with Luminex, and 1 case with BD MAX) showed positive results for multiple pathogens, but only 3 were consensus positive. CONCLUSIONS.— These multiplex molecular assays appear to be promising tools for the detection and identification of multiple gastrointestinal pathogens simultaneously. However, careful interpretation of positive results for multiple pathogens is required.
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Affiliation(s)
- Jaeeun Yoo
- From the Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea (Drs Yoo, J. Park, H. K. Lee, and Y.-J. Park); the Department of Laboratory Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Korea (Mss Yu and K. G. Park and Mr G. D. Lee); and the Department of Brain and Cognitive Science, Massachusetts Institute of Technology, Cambridge (Ms Oak)
| | - Joonhong Park
- From the Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea (Drs Yoo, J. Park, H. K. Lee, and Y.-J. Park); the Department of Laboratory Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Korea (Mss Yu and K. G. Park and Mr G. D. Lee); and the Department of Brain and Cognitive Science, Massachusetts Institute of Technology, Cambridge (Ms Oak)
| | - Hae Kyung Lee
- From the Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea (Drs Yoo, J. Park, H. K. Lee, and Y.-J. Park); the Department of Laboratory Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Korea (Mss Yu and K. G. Park and Mr G. D. Lee); and the Department of Brain and Cognitive Science, Massachusetts Institute of Technology, Cambridge (Ms Oak)
| | - Jin Kyung Yu
- From the Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea (Drs Yoo, J. Park, H. K. Lee, and Y.-J. Park); the Department of Laboratory Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Korea (Mss Yu and K. G. Park and Mr G. D. Lee); and the Department of Brain and Cognitive Science, Massachusetts Institute of Technology, Cambridge (Ms Oak)
| | - Gun Dong Lee
- From the Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea (Drs Yoo, J. Park, H. K. Lee, and Y.-J. Park); the Department of Laboratory Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Korea (Mss Yu and K. G. Park and Mr G. D. Lee); and the Department of Brain and Cognitive Science, Massachusetts Institute of Technology, Cambridge (Ms Oak)
| | - Kang Gyun Park
- From the Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea (Drs Yoo, J. Park, H. K. Lee, and Y.-J. Park); the Department of Laboratory Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Korea (Mss Yu and K. G. Park and Mr G. D. Lee); and the Department of Brain and Cognitive Science, Massachusetts Institute of Technology, Cambridge (Ms Oak)
| | - Hayeon Caitlyn Oak
- From the Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea (Drs Yoo, J. Park, H. K. Lee, and Y.-J. Park); the Department of Laboratory Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Korea (Mss Yu and K. G. Park and Mr G. D. Lee); and the Department of Brain and Cognitive Science, Massachusetts Institute of Technology, Cambridge (Ms Oak)
| | - Yeon-Joon Park
- From the Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea (Drs Yoo, J. Park, H. K. Lee, and Y.-J. Park); the Department of Laboratory Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Korea (Mss Yu and K. G. Park and Mr G. D. Lee); and the Department of Brain and Cognitive Science, Massachusetts Institute of Technology, Cambridge (Ms Oak)
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22
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Gal-Mor O. Persistent Infection and Long-Term Carriage of Typhoidal and Nontyphoidal Salmonellae. Clin Microbiol Rev 2019; 32:e00088-18. [PMID: 30487167 PMCID: PMC6302356 DOI: 10.1128/cmr.00088-18] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The ability of pathogenic bacteria to affect higher organisms and cause disease is one of the most dramatic properties of microorganisms. Some pathogens can establish transient colonization only, but others are capable of infecting their host for many years or even for a lifetime. Long-term infection is called persistence, and this phenotype is fundamental for the biology of important human pathogens, including Helicobacter pylori, Mycobacterium tuberculosis, and Salmonella enterica Both typhoidal and nontyphoidal serovars of the species Salmonella enterica can cause persistent infection in humans; however, as these two Salmonella groups cause clinically distinct diseases, the characteristics of their persistent infections in humans differ significantly. Here, following a general summary of Salmonella pathogenicity, host specificity, epidemiology, and laboratory diagnosis, I review the current knowledge about Salmonella persistence and discuss the relevant epidemiology of persistence (including carrier rate, duration of shedding, and host and pathogen risk factors), the host response to Salmonella persistence, Salmonella genes involved in this lifestyle, as well as genetic and phenotypic changes acquired during prolonged infection within the host. Additionally, I highlight differences between the persistence of typhoidal and nontyphoidal Salmonella strains in humans and summarize the current gaps and limitations in our understanding, diagnosis, and curing of persistent Salmonella infections.
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Affiliation(s)
- Ohad Gal-Mor
- Infectious Diseases Research Laboratory, Sheba Medical Center, Tel-Hashomer, Israel
- Department of Clinical Microbiology and Immunology, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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23
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Anderson NW, Tarr PI. Multiplex Nucleic Acid Amplification Testing to Diagnose Gut Infections: Challenges, Opportunities, and Result Interpretation. Gastroenterol Clin North Am 2018; 47:793-812. [PMID: 30337033 DOI: 10.1016/j.gtc.2018.07.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Multiplex nucleic acid testing is increasingly used to diagnose childhood gastroenteritis. The advantages of this disruptive technology include rapidity, sensitivity, and ability to detect pathogenic viruses, bacteria, and parasites simultaneously. The drawbacks are its capacity to identify organisms of uncertain clinical significance in North American children, cost, and inability to provide viable bacteria for strain typing by public health authorities. However, this technology will certainly improve our knowledge of the causes of human gut infections. As data emerge, physicians should interpret results cautiously, and, most important, consider the context of the presentation before making clinical decisions based on the readouts.
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Affiliation(s)
- Neil W Anderson
- Division of Laboratory and Genomic Medicine, Barnes Jewish Hospital, Washington University in St. Louis School of Medicine, 660 South Euclid Avenue, CB 8118, St Louis, MO 63110, USA
| | - Phillip I Tarr
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Washington University in St. Louis School of Medicine, 660 South Euclid Avenue, CB 8208, St Louis, MO 63110, USA.
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Moure Z, Rando-Segura A, Gimferrer L, Roig G, Pumarola T, Rodriguez-Garrido V. Evaluation of the novel DiaSorin LIAISON ® Campylobacter assay for the rapid detection of Campylobacter spp. Enferm Infecc Microbiol Clin 2018; 36:293-295. [DOI: 10.1016/j.eimc.2017.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 03/21/2017] [Accepted: 03/25/2017] [Indexed: 11/24/2022]
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New Technologies for the Diagnosis of Infection. DIAGNOSTIC PATHOLOGY OF INFECTIOUS DISEASE 2018. [PMCID: PMC7152403 DOI: 10.1016/b978-0-323-44585-6.00006-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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26
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Perry MD, Corden SA, Lewis White P. Evaluation of the BD MAX Enteric Parasite Panel for the detection of Cryptosporidium parvum/hominis, Giardia duodenalis and Entamoeba histolytica. J Med Microbiol 2017; 66:1118-1123. [DOI: 10.1099/jmm.0.000558] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Michael D. Perry
- Public Health Wales Microbiology Cardiff, University Hospital of Wales, Heath Park, Cardiff, UK
| | - Sally A. Corden
- Public Health Wales Microbiology Cardiff, University Hospital of Wales, Heath Park, Cardiff, UK
| | - P. Lewis White
- Public Health Wales Microbiology Cardiff, University Hospital of Wales, Heath Park, Cardiff, UK
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Van Der Pol B. Profile of the triplex assay for detection of chlamydia, gonorrhea and trichomonas using the BD MAX™ System. Expert Rev Mol Diagn 2017; 17:539-547. [PMID: 28425774 DOI: 10.1080/14737159.2017.1321988] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Chlamydia, gonorrhea and trichomonas are the most common curable STI. improved access to testing could reduce infection rates and prevent sequelae. nucleic acid amplification tests are the recommend class of diagnostic assay for these infections which are often asymptomatic. Areas covered: A description of the BD MAX™ System (MAX) and the BD MAX CT/GC/TV assay is provided along with data from a large US clinical trial. The capacity of the system for other tests and for lab developed assays is also described. Expert commentary: The CT/GC/TV assay on the MAX is a triplex PCR assay suitable for use with female urine and vaginal or endocervical swab samples. Male urine can be tested by ordering the CT/GC results but has not yet been evaluated for trichomonas. The assay performance characteristics are similar to those of assays run on high-throughput platforms with sensitivity ≥91.5% and specificity ≥98.6% for all analytes. Screening with the CT/GC/TV assay can be combined with testing for vaginitis which would provide a greater depth of coverage for common co-infections. The throughput is moderate (1-48 samples per 8-hour shift) but the menu includes assays beyond STI pathogens making this a suitable platform for moderate volume laboratories.
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Affiliation(s)
- Barbara Van Der Pol
- a Infectious Diseases , University of Alabama at Birmingham , Birmingham , AL , USA
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28
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Clinical Evaluation and Cost Analysis of Great Basin Shiga Toxin Direct Molecular Assay for Detection of Shiga Toxin-Producing Escherichia coli in Diarrheal Stool Specimens. J Clin Microbiol 2016; 55:519-525. [PMID: 27927919 DOI: 10.1128/jcm.01939-16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 11/24/2016] [Indexed: 12/17/2022] Open
Abstract
The Shiga Toxin Direct molecular assay (ST Direct) relies on nucleic acid amplification and solid array-based amplicon detection to identify Shiga toxin-producing Escherichia coli (STEC) in preserved stool specimens. Genes encoding Shiga toxin (stx1 and stx2), as well as the E. coli serotype O:157-specific marker rfbE, are simultaneously detected within 2 h. ST Direct was evaluated using 1,084 prospectively collected preserved stool specimens across five clinical centers. An additional 55 retrospectively collected, frozen specimens were included to increase the number of positive specimens evaluated. Results were compared to results from routine culture and an enzyme immunoassay (EIA) specific for the recovery and identification of STEC. ST Direct was found to be 93.2% sensitive and 99.3% specific for detection of stx1 and stx2 and 95.7% sensitive and 99.3% specific for detection of E. coli serotype O:157. All specimens with false-positive results were found to contain stx1 or stx2 or were found to be positive for serotype O:157 when analyzed using alternative molecular methods. All 4 false-negative stx1 or stx2 results were reported for frozen, retrospectively tested specimens. In all cases, the specimens tested positive for stx by an alternative FDA-cleared nucleic acid amplification test (NAAT) but were negative for stx1 and stx2 following nucleic acid sequence analysis. Based on these data, culture and EIA-based methods for detection of STEC are only 33% sensitive compared to molecular tests. A retrospective cost analysis demonstrated 59% of the cost of routine stool culture to be attributable to the identification of STEC. Taken together, these data suggest that ST Direct may provide a cost-effective, rapid molecular alternative to routine culture for the identification of STEC in preserved stool specimens.
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Rintala A, Munukka E, Weintraub A, Ullberg M, Eerola E. Evaluation of a multiplex real-time PCR kit Amplidiag® Bacterial GE in the detection of bacterial pathogens from stool samples. J Microbiol Methods 2016; 128:61-65. [DOI: 10.1016/j.mimet.2016.07.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 07/13/2016] [Accepted: 07/14/2016] [Indexed: 02/04/2023]
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Using Multiplex Molecular Testing to Determine the Etiology of Acute Gastroenteritis in Children. J Pediatr 2016; 176:50-56.e2. [PMID: 27329497 PMCID: PMC5215462 DOI: 10.1016/j.jpeds.2016.05.068] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 04/04/2016] [Accepted: 05/19/2016] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To detect the etiologic agents of acute gastroenteritis (AGE) in children using broad molecular-based techniques, and compare clinical presentations among etiologies. STUDY DESIGN This was a prospective population-based surveillance study of children aged <6 years with AGE conducted between 2008 and 2011 as part of the New Vaccine Surveillance Network. Stools from patients and healthy controls were tested for 21 gastrointestinal pathogens using the analyte-specific reagent Gastrointestinal Pathogen Panel and an additional reverse transcription real-time polymerase chain reaction assay for sapovirus and astrovirus. RESULTS Of the 216 stool samples from patients with AGE, 152 (70.4%) tested positive for a pathogen, with norovirus genogroup II (n = 78; 36.1%) and Clostridium difficile (n = 35; 16.2%) the most common pathogens detected. Forty-nine patients (22.7%) tested positive for more than 1 pathogen, including 25 (71%) with a C difficile detection. There were no significant clinical differences among the patients with no pathogen detected, those with a single pathogen detected, and those with ≥2 pathogens detected. CONCLUSION Using a broad molecular testing approach, high rates of enteropathogens were detected in children with AGE, dominated by norovirus genogroup II and C difficile. Coinfections were common but had no identifiable impact on clinical manifestations. As routine diagnostics of AGE progressively evolve toward nucleic acid-based pathogen detection, ongoing systematic studies are needed to better analyze the clinical significance of results.
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Abstract
Alteration in the host microbiome at skin and mucosal surfaces plays a role in the function of the immune system, and may predispose immunocompromised patients to infection. Because obligate anaerobes are the predominant type of bacteria present in humans at skin and mucosal surfaces, immunocompromised patients are at increased risk for serious invasive infection due to anaerobes. Laboratory approaches to the diagnosis of anaerobe infections that occur due to pyogenic, polymicrobial, or toxin-producing organisms are described. The clinical interpretation and limitations of anaerobe recovery from specimens, anaerobe-identification procedures, and antibiotic-susceptibility testing are outlined. Bacteriotherapy following analysis of disruption of the host microbiome has been effective for treatment of refractory or recurrent Clostridium difficile infection, and may become feasible for other conditions in the future.
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Affiliation(s)
- Deirdre L Church
- Departments of Pathology & Laboratory Medicine and Medicine, University of Calgary, and Division of Microbiology, Calgary Laboratory Services, Calgary, Alberta, Canada T2N 1N4
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Evaluation of a Multiplex Real-Time PCR Assay for Detecting Major Bacterial Enteric Pathogens in Fecal Specimens: Intestinal Inflammation and Bacterial Load Are Correlated in Campylobacter Infections. J Clin Microbiol 2016; 54:2262-6. [PMID: 27307458 DOI: 10.1128/jcm.00558-16] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 06/07/2016] [Indexed: 12/13/2022] Open
Abstract
A total of 1,056 native or Cary-Blair-preserved stool specimens were simultaneously tested by conventional stool culturing and by enteric bacterial panel (EBP) multiplex real-time PCR for Campylobacter jejuni, Campylobacter coli, Salmonella spp., and shigellosis disease-causing agents (Shigella spp. and enteroinvasive Escherichia coli [EIEC]). Overall, 143 (13.5%) specimens tested positive by PCR for the targets named above; 3 coinfections and 109 (10.4%) Campylobacter spp., 17 (1.6%) Salmonella spp., and 20 (1.9%) Shigella spp./EIEC infections were detected. The respective positive stool culture rates were 75 (7.1%), 14 (1.3%), and 7 (0.7%). The median threshold cycle (CT) values of culture-positive specimens were significantly lower than those of culture-negative ones (CT values, 24.3 versus 28.7; P < 0.001), indicating that the relative bacterial load per fecal specimen was significantly associated with the culture results. In Campylobacter infections, the respective median fecal calprotectin concentrations in PCR-negative/culture-negative (n = 40), PCR-positive/culture-negative (n = 14), and PCR-positive/culture-positive (n = 15) specimens were 134 mg/kg (interquartile range [IQR], 30 to 1,374 mg/kg), 1,913 mg/kg (IQR, 165 to 3,813 mg/kg), and 5,327 mg/kg (IQR, 1,836 to 18,213 mg/kg). Significant differences were observed among the three groups (P < 0.001), and a significant linear trend was identified (P < 0.001). Furthermore, the fecal calprotectin concentrations and CT values were found to be correlated (r = -0.658). Our results demonstrate that molecular screening of Campylobacter spp., Salmonella spp., and Shigella spp./EIEC using the BD Max EBP assay will result in timely diagnosis and improved sensitivity. The determination of inflammatory markers, such as calprotectin, in fecal specimens may aid in the interpretation of PCR results, particularly for enteric pathogens associated with mucosal damage and colonic inflammation.
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Tajeddin E, Sherafat SJ, Majidi MRS, Alebouyeh M, Alizadeh AHM, Zali MR. Association of diverse bacterial communities in human bile samples with biliary tract disorders: a survey using culture and polymerase chain reaction-denaturing gradient gel electrophoresis methods. Eur J Clin Microbiol Infect Dis 2016; 35:1331-9. [DOI: 10.1007/s10096-016-2669-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 05/03/2016] [Indexed: 01/20/2023]
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Abstract
Campylobacter continues to be one of the most common bacterial causes of diarrheal illness in the United States and worldwide. Infection with Campylobacter causes a spectrum of diseases including acute enteritis, extraintestinal infections, and postinfectious complications. The most common species of Campylobacter associated with human illness is Campylobacter jejuni, but other Campylobacter species can also cause human infections. This comprehensive review includes discussion of the taxonomy, clinical manifestations of infection, epidemiology and the different methods of laboratory detection of Campylobacter.
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Affiliation(s)
- Collette Fitzgerald
- Enteric Diseases Laboratory Branch, Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, USA.
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Multicenter Evaluation of Clinical Diagnostic Methods for Detection and Isolation of Campylobacter spp. from Stool. J Clin Microbiol 2016; 54:1209-15. [PMID: 26962088 DOI: 10.1128/jcm.01925-15] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 01/24/2016] [Indexed: 02/04/2023] Open
Abstract
The use of culture-independent diagnostic tests (CIDTs), such as stool antigen tests, as standalone tests for the detection of Campylobacter in stool is increasing. We conducted a prospective, multicenter study to evaluate the performance of stool antigen CIDTs compared to culture and PCR for Campylobacter detection. Between July and October 2010, we tested 2,767 stool specimens from patients with gastrointestinal illness with the following methods: four types of Campylobacter selective media, four commercial stool antigen assays, and a commercial PCR assay. Illnesses from which specimens were positive by one or more culture media or at least one CIDT and PCR were designated "cases." A total of 95 specimens (3.4%) met the case definition. The stool antigen CIDTs ranged from 79.6% to 87.6% in sensitivity, 95.9 to 99.5% in specificity, and 41.3 to 84.3% in positive predictive value. Culture alone detected 80/89 (89.9% sensitivity) Campylobacter jejuni/Campylobacter coli-positive cases. Of the 209 noncases that were positive by at least one CIDT, only one (0.48%) was positive by all four stool antigen tests, and 73% were positive by just one stool antigen test. The questionable relevance of unconfirmed positive stool antigen CIDT results was supported by the finding that noncases were less likely than cases to have gastrointestinal symptoms. Thus, while the tests were convenient to use, the sensitivity, specificity, and positive predictive value of Campylobacter stool antigen tests were highly variable. Given the relatively low incidence of Campylobacter disease and the generally poor diagnostic test characteristics, this study calls into question the use of commercially available stool antigen CIDTs as standalone tests for direct detection of Campylobacter in stool.
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Molecular testing for viral and bacterial enteric pathogens: gold standard for viruses, but don't let culture go just yet? Pathology 2015; 47:227-33. [PMID: 25719855 DOI: 10.1097/pat.0000000000000233] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Contemporary diagnostic microbiology is increasingly adopting molecular methods as front line tests for a variety of samples. This trend holds true for detection of enteric pathogens (EP), where nucleic acid amplification tests (NAAT) for viruses are well established as the gold standard, and an increasing number of commercial multi-target assays are now available for bacteria and parasites. NAAT have significant sensitivity and turnaround time advantages over traditional methods, potentially returning same-day results. Multiplex panels offer an attractive 'one-stop shop' that may provide workflow and cost advantages to laboratories processing large sample volumes. However, there are a number of issues which need consideration. Reflex culture is required for antibiotic susceptibility testing and strain typing when needed for food safety and other epidemiological investigations. Surveillance systems will need to allow for differences in disease incidence due to the enhanced sensitivity of NAAT. Laboratories should be mindful of local epidemiology when selecting which pathogens to include in multiplex panels, and be thoughtful regarding which pathogens will not be detected. Multiplex panels may not be appropriate in certain situations, such as hospital-onset diarrhoea, where Clostridium difficile testing might be all that is required, and laboratories may wish to retain the flexibility to run single tests in such situations. The clinical impact of rapid results is also likely to be relatively minor, as infective diarrhoea is a self-limiting illness in the majority of cases. Laboratories will require strategies to assist users in the interpretation of the results produced by NAAT, particularly where pathogens are detected at low levels with uncertain clinical significance. These caveats aside, faecal NAAT are increasingly being used and introduce a new era of diagnosis of gastrointestinal infection.
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Comparison of the BD MAX® Enteric Bacterial Panel assay with conventional diagnostic procedures in diarrheal stool samples. Eur J Clin Microbiol Infect Dis 2015; 35:131-6. [PMID: 26563899 DOI: 10.1007/s10096-015-2517-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 10/30/2015] [Indexed: 12/21/2022]
Abstract
Although infectious diarrhea is one of the most predominant diseases around the world, the identification of the causative microorganism is still challenging. The aim of this study was the evaluation of the BD MAX® Enteric Bacterial Panel assay in comparison to conventional diagnostic procedures concerning the detection of the enteric pathogens Salmonella spp., Campylobacter spp., Shigella spp., and Shiga toxin-producing Escherichia coli. For this purpose, 971 prospectively collected stool samples were evaluated. Utilization of the BD MAX Enteric Bacterial Panel elevated the overall detection rate from 5.26 % to 8.06 %. The positive percent agreement of the BD MAX Enteric Bacterial Panel assay and stool culture or enzyme immunoassay was 0.97 for Campylobacter spp., 0.75 for Salmonella spp., 1.00 for Shigella spp., and 0.88 for Shiga toxins. Furthermore, a negative percent agreement of 0.98 for Campylobacter spp., 0.99 for Salmonella spp., 0.99 for Shigella spp., and 0.99 for Shiga toxins has been demonstrated. This study highlighted the superior detection rate of molecular assays compared to conventional diagnostic procedures.
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Nakamura K, Kaneko M, Abe Y, Yamamoto N, Mori H, Yoshida A, Ohashi K, Miura S, Yang TT, Momoi N, Kanemitsu K. Outbreak of extended-spectrum β-lactamase-producing Escherichia coli transmitted through breast milk sharing in a neonatal intensive care unit. J Hosp Infect 2015; 92:42-6. [PMID: 26238662 DOI: 10.1016/j.jhin.2015.05.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 05/04/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Routine surveillance in a neonatal intensive care unit (NICU) showed an increased detection of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (ESBL-E. coli) in August 2012, following nearly a year without detection. AIM To describe the investigation and interventions by a hospital infection control team of an outbreak of ESBL-E. coli in a NICU. METHODS Six neonates with positive cultures of ESBL-E. coli (five with respiratory colonization, one with a urinary tract infection), control infants who were negative for ESBL-E. coli during the study period, and mothers who donated their breast milk were included. A case-control study was performed to identify possible risk factors for positive ESBL-E. coli cultures and molecular typing of isolated strains by pulsed-field gel electrophoresis. FINDINGS The odds ratio for ESBL-E. coli infection after receiving shared unpasteurized breast milk during the study period was 49.17 (95% confidence interval: 6.02-354.68; P < 0.05). The pulsed-field gel electrophoresis pattern showed that all strains were identical, and the same pathogen was detected in freshly expressed milk of a particular donor. After ceasing the breast milk sharing, the outbreak was successfully terminated. CONCLUSION This outbreak indicates that contamination of milk packs can result in transmission of a drug-resistant pathogen to newborn infants. Providers of human breast milk need to be aware of the necessity for low-temperature pasteurization and bacterial cultures, which should be conducted before and after freezing, before prescribing to infants.
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Affiliation(s)
- K Nakamura
- Department of Infection Control, Fukushima Medical University, Fukushima, Japan; Infection Control Unit, Fukushima Medical University Hospital, Fukushima, Japan.
| | - M Kaneko
- Department of Pediatrics, Fukushima Medical University, Fukushima, Japan
| | - Y Abe
- Department of Emergency and Critical Care Medicine, Fukushima Medical University, Fukushima, Japan
| | - N Yamamoto
- Department of Infection Control, Fukushima Medical University, Fukushima, Japan; Infection Control Unit, Fukushima Medical University Hospital, Fukushima, Japan
| | - H Mori
- Infection Control Unit, Fukushima Medical University Hospital, Fukushima, Japan
| | - A Yoshida
- Infection Control Unit, Fukushima Medical University Hospital, Fukushima, Japan
| | - K Ohashi
- Department of Clinical Laboratory Medicine, Fukushima Medical University Hospital, Fukushima, Japan
| | - S Miura
- Department of Infection Control, Fukushima Medical University, Fukushima, Japan
| | - T T Yang
- Department of Infection Control, Fukushima Medical University, Fukushima, Japan
| | - N Momoi
- Department of Pediatrics, Fukushima Medical University, Fukushima, Japan
| | - K Kanemitsu
- Department of Infection Control, Fukushima Medical University, Fukushima, Japan; Infection Control Unit, Fukushima Medical University Hospital, Fukushima, Japan
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Harrington SM, Buchan BW, Doern C, Fader R, Ferraro MJ, Pillai DR, Rychert J, Doyle L, Lainesse A, Karchmer T, Mortensen JE. Multicenter evaluation of the BD max enteric bacterial panel PCR assay for rapid detection of Salmonella spp., Shigella spp., Campylobacter spp. (C. jejuni and C. coli), and Shiga toxin 1 and 2 genes. J Clin Microbiol 2015; 53:1639-47. [PMID: 25740779 PMCID: PMC4400754 DOI: 10.1128/jcm.03480-14] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 03/02/2015] [Indexed: 12/13/2022] Open
Abstract
Diarrhea due to enteric bacterial pathogens causes significant morbidity and mortality in the United States and worldwide. However, bacterial pathogens may be infrequently identified. Currently, culture and enzyme immunoassays (EIAs) are the primary methods used by clinical laboratories to detect enteric bacterial pathogens. We conducted a multicenter evaluation of the BD Max enteric bacterial panel (EBP) PCR assay in comparison to culture for the detection of Salmonella spp., Shigella spp., Campylobacter jejuni, and Campylobacter coli and an EIA for Shiga toxins 1 and 2. A total of 4,242 preserved or unpreserved stool specimens, including 3,457 specimens collected prospectively and 785 frozen, retrospective samples, were evaluated. Compared to culture or EIA, the positive percent agreement (PPA) and negative percent agreement (NPA) values for the BD Max EBP assay for all specimens combined were as follows: 97.1% and 99.2% for Salmonella spp., 99.1% and 99.7% for Shigella spp., 97.2% and 98.4% for C. jejuni and C. coli, and 97.4% and 99.3% for Shiga toxins, respectively. Discrepant results for prospective samples were resolved with alternate PCR assays and bidirectional sequencing of amplicons. Following discrepant analysis, PPA and NPA values were as follows: 97.3% and 99.8% for Salmonella spp., 99.2% and 100% for Shigella spp., 97.5% and 99.0% for C. jejuni and C. coli, and 100% and 99.7% for Shiga toxins, respectively. No differences in detection were observed for samples preserved in Cary-Blair medium and unpreserved samples. In this large, multicenter study, the BD Max EBP assay showed superior sensitivity compared to conventional methods and excellent specificity for the detection of enteric bacterial pathogens in stool specimens.
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Affiliation(s)
- S M Harrington
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - B W Buchan
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - C Doern
- Children's Medical Center of Dallas, Dallas, Texas, USA
| | - R Fader
- Scott & White Memorial Hospital, Temple, Texas, USA
| | - M J Ferraro
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - D R Pillai
- Calgary Laboratory Services, Calgary, Alberta, Canada
| | - J Rychert
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - L Doyle
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - A Lainesse
- Becton, Dickinson and Company (BD Diagnostics), Quebec, QC, Canada
| | - T Karchmer
- Becton, Dickinson and Company (BD Diagnostics), Sparks, Maryland, USA
| | - J E Mortensen
- Cincinnati Children's Hospital, Cincinnati, Ohio, USA
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Abstract
Salmonella, Shigella, and Yersinia cause a well-characterized spectrum of disease in humans, ranging from asymptomatic carriage to hemorrhagic colitis and fatal typhoidal fever. These pathogens are responsible for millions of cases of food-borne illness in the United States each year, with substantial costs measured in hospitalizations and lost productivity. In the developing world, illness caused by these pathogens is not only more prevalent but also associated with a greater case-fatality rate. Classic methods for identification rely on selective media and serology, but newer methods based on mass spectrometry and polymerase chain reaction show great promise for routine clinical testing.
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Abstract
Shiga toxin-producing Escherichia coli (STEC) is among the common causes of foodborne gastroenteritis. STEC is defined by the production of specific toxins, but within this pathotype there is a diverse group of organisms. This diversity has important consequences for understanding the pathogenesis of the organism, as well as for selecting the optimum strategy for diagnostic testing in the clinical laboratory. This review includes discussions of the mechanisms of pathogenesis, the range of manifestations of infection, and the several different methods of laboratory detection of Shiga toxin-producing E coli.
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Biswas JS, Al-Ali A, Rajput P, Smith D, Goldenberg SD. A parallel diagnostic accuracy study of three molecular panels for the detection of bacterial gastroenteritis. Eur J Clin Microbiol Infect Dis 2014; 33:2075-81. [PMID: 24935616 DOI: 10.1007/s10096-014-2177-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 05/29/2014] [Indexed: 10/25/2022]
Abstract
Culture-dependent detection of gastroenteric bacteria is labour-intensive and does not provide results in a clinically relevant time frame. Several commercially available multiplex molecular panels are now available which may be more sensitive and could potentially provide rapid results. We compared the diagnostic accuracy, turnaround time and ease of use of three such molecular panels: the RIDA®GENE Bacterial Stool and EHEC/EPEC Panels (R-Biopharm AG, Darmstadt, Germany), the FTD® Bacterial Gastroenteritis Panel (Fast Track Diagnostics, Junglinster, Luxembourg) and the BD MAX™ Enteric Bacterial Panel (Becton Dickinson GmbH, Heidelberg, Germany). The results from 116 retrospective selected and 318 prospective unselected stool samples were compared with conventional culture-based techniques using a gold standard for a positive test of either culture or agreement in two of the three molecular panels. For most targets, the molecular panels were more sensitive than culture, detecting an additional 13 cases that culture missed. The laboratory turnaround time was under 3 h for all molecular panels, compared with 66.5 h for culture. The BD MAX™ panel was the fastest, easiest to use and most flexible.
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Affiliation(s)
- J S Biswas
- Centre for Clinical Infection and Diagnostics Research, King's College, London and Guy's and St Thomas' NHS Foundation Trust, London, UK
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