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Lu J, Xu Y, Li Z, Chen X, Lin H, Zhao Q. Diagnosis and Treatment Pathway of MDR/RR-TB in Taizhou, Zhejiang Province, China. Trop Med Infect Dis 2023; 8:tropicalmed8020079. [PMID: 36828495 PMCID: PMC9964905 DOI: 10.3390/tropicalmed8020079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/17/2023] [Accepted: 01/19/2023] [Indexed: 01/25/2023] Open
Abstract
This study aims to understand MDR/RR-TB patients' experience from seeking TB-related health care to diagnosis and treatment completion, as well as the social determinants with the waiting time for DST and treatment, pre-treatment attrition, and treatment outcome based on a retrospective cohort study. Univariate and multi-variate logistic regressions were used to analyze the associated factors. The median time of waiting time for DST and treatment was 24.00 and 30.00 days, respectively. Non-residential patients (aOR: 2.89, 95% CI: 1.14-7.70), registered before 2018 (aOR: 19.93, 95% CI: 8.99-48.51), first visited a county-level hospital (aOR: 4.65, 95% CI: 1.08-21.67), sputum smear-negative (aOR: 3.54, 95% CI: 1.28-10.16), and comorbid with pneumoconiosis (aOR: 7.10, 95% CI: 1.23-47.98) had a longer DST delay. The pre-treatment attrition was 26.9% (82/305). Elderly, non-residential patients and patients registered before 2018 were more likely to refuse MDR/RR treatment. However, in housekeeping/unemployment and farmer/fisherman, recurrent patients tended to take therapeutic measures actively. The successful treatment rate was 62.1% (105/169). Elderly, comorbidity with diabetes and sputum smear conversion time >1 month may lead to poorer outcomes. Immediate interventions should be taken to smooth diagnosis and treatment pathways and improve the social protections further so as to encourage patients to cooperate with the treatment actively.
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Affiliation(s)
- Jingting Lu
- School of Public Health, Fudan University, Shanghai 200032, China
- Key Laboratory of Public Health Safety, Ministry of Education, Shanghai 200032, China
| | - Yuanyuan Xu
- Taizhou Center for Disease Control and Prevention, Zhejiang 318000, China
| | - Zhipeng Li
- School of Public Health, Fudan University, Shanghai 200032, China
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China
| | - Xiaoxiao Chen
- Taizhou Center for Disease Control and Prevention, Zhejiang 318000, China
| | - Haijiang Lin
- Taizhou Center for Disease Control and Prevention, Zhejiang 318000, China
- Correspondence: (H.L.); (Q.Z.)
| | - Qi Zhao
- School of Public Health, Fudan University, Shanghai 200032, China
- Key Laboratory of Public Health Safety, Ministry of Education, Shanghai 200032, China
- Correspondence: (H.L.); (Q.Z.)
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Sun B, Sun Y. Diagnostic performance of DNA microarray for detecting rifampicin and isoniazid resistance in Mycobacterium tuberculosis. J Thorac Dis 2021; 13:4448-4454. [PMID: 34422371 PMCID: PMC8339777 DOI: 10.21037/jtd-21-913] [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: 04/30/2021] [Accepted: 07/06/2021] [Indexed: 12/04/2022]
Abstract
Background While rifampicin (RFP) and isoniazid (INH) are the most commonly used first-line antituberculosis drugs, multidrug resistance in Mycobacterium tuberculosis poses a threat to the success of tuberculosis (TB) control programs. Clinical practice guidelines and expert consensuses recommend drug susceptibility testing (DST) before the initiation of antituberculosis treatment. However, traditional DST is time-consuming and has high requirements for laboratory conditions. The recently developed molecular diagnostic techniques, such as DNA microarray, offer new options. We thus investigated the diagnostic value of DNA microarray in detecting RFP + INH-resistant TB, with an attempt to identify simple, efficient, and accurate drug-resistant TB testing methods. Methods The clinical features and DST results of patients diagnosed with pulmonary tuberculosis by Bactec MGIT 960 liquid culture system (Becton, Dickinson and Company, Franklin Lakes, NJ, USA) who received DNA microarray analysis in our center from July 2019 to July 2020 were retrospectively analyzed. Level of agreement between liquid culture and DNA microarray technology was assessed by using the Cohen kappa coefficient. With the results of liquid culture as the gold standard, the sensitivity and specificity of the DNA microarray were calculated, and the receiver operating characteristic (ROC) curves were used to assess the diagnostic values of the DNA microarray in detecting RFP + INH-resistant TB. Results A total of 825 patients were enrolled. The sensitivity and specificity of DNA microarray were 0.84 and 0.94, respectively, in the detection of RFP resistance, with an area under the curve (AUC) of 0.89 [95% confidence interval (CI): 0.87–0.91)] and a Cohen kappa coefficient of 0.78 (95% CI: 0.72–0.83). For INH resistance, the sensitivity and specificity of the DNA microarray were 0.73 and 0.97, respectively, with an AUC of 0.85 (95% CI: 0.82–0.87) and a Cohen kappa coefficient of 0.75 (95% CI: 0.70–0.80). Conclusions The DNA microarray had high specificity and sensitivity in detecting RFP + INH-resistant TB. As a rapid, accurate, and practical technique, it can be routinely performed in clinical laboratories.
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Affiliation(s)
- Bingqi Sun
- Department of Laboratory Medicine, No. 10 People's Hospital of Shenyang, Shenyang, China
| | - Ying Sun
- Department of Oncology, No. 10 People's Hospital of Shenyang, Shenyang, China
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Su W, Ruan YZ, Li T, Du X, Jiang JW, Li RZ. Characteristics of rifampicin-resistant tuberculosis detection in China, 2015-2019. Infect Dis Poverty 2021; 10:99. [PMID: 34274020 PMCID: PMC8285846 DOI: 10.1186/s40249-021-00883-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/05/2021] [Indexed: 12/25/2022] Open
Abstract
Background The very high burden of rifampicin resistance tuberculosis (RR-TB) and the very low detection of RR-TB cases are a major challenge that China has been facing. This study analyzed the characteristics of RR-TB detection in China after the change of RR-TB detection strategy since 2015, aiming to provide reference and evidence for the development of more precise national drug resistance tuberculosis prevention and control policy. Methods We extracted data related to rifampicin resistance screening from the national Tuberculosis Information Management System (TBIMS) from 2015 to 2019, and used descriptive research methods to analyze the screening rate of presumptive RR-TB, the number and duration of RR-TB patients detected and drug resistance testing methods in each year. Chi-square test was used to compare the differences in component ratio or rate between years, and Kruskal Wallis test was used to compare the differences in median days for detection of RR-TB patients in each year. Results A total of 68,200 RR-TB cases were detected during 2015–2019, of which 48.1% were new cases. The number and detection rate of RR-TB cases increased year by year, from 10 019 and 14.3% in 2015 to 18 623 and 28.7% in 2019, respectively. Of the bacteriologically confirmed TB cases, 81.9% were tested for RR in 2019, a considerable increase from 29.5% in 2015. In 2019, only 41.0% of RR-TB cases had fluoroquinolones (FQs) susceptibility testing performed, and this proportion has been declining year by year since 2016. The proportion of application of rapid molecular tools increased from 24.0% in 2015 to 67.1% in 2019, and the median days to obtain RR results was significantly shortened. In 2019, 76.0% of RR-TB cases were diagnosed as presumptive RR-TB in county-level hospitals. Conclusions After China modified the RR-TB detection strategy, the screening rate of RR and the number of RR-TB cases increased significantly. The RR testing methods now predominantly utilize rapid molecular tools. However, comprehensive measures should be implemented to close the gap in the detection of RR-TB cases. It is imperative to take FQs susceptibility testing seriously and effectively strengthen the laboratory capacity of county-level hospitals. Graphical Abstract ![]()
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Affiliation(s)
- Wei Su
- National Center for Tuberculosis Control and Prevention, China CDC, No.155 Changbai Road, Changping District, Beijing, 102206, People's Republic of China
| | - Yun-Zhou Ruan
- National Center for Tuberculosis Control and Prevention, China CDC, No.155 Changbai Road, Changping District, Beijing, 102206, People's Republic of China
| | - Tao Li
- National Center for Tuberculosis Control and Prevention, China CDC, No.155 Changbai Road, Changping District, Beijing, 102206, People's Republic of China
| | - Xin Du
- National Center for Tuberculosis Control and Prevention, China CDC, No.155 Changbai Road, Changping District, Beijing, 102206, People's Republic of China
| | - Jia-Wen Jiang
- National Center for Tuberculosis Control and Prevention, China CDC, No.155 Changbai Road, Changping District, Beijing, 102206, People's Republic of China
| | - Ren-Zhong Li
- National Center for Tuberculosis Control and Prevention, China CDC, No.155 Changbai Road, Changping District, Beijing, 102206, People's Republic of China.
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Qin L, Huo F, Ren W, Shang Y, Yao C, Zhang X, Liu R, Ma L, Gao M, Pang Y. Dependence of Xpert MTB/RIF Accuracy for Detecting Rifampin Resistance in Bronchoalveolar Lavage Fluid on Bacterial Load: A Retrospective Study in Beijing, China. Infect Drug Resist 2021; 14:2429-2435. [PMID: 34234473 PMCID: PMC8254186 DOI: 10.2147/idr.s307488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/26/2021] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION We assessed the effect of Mycobacterium tuberculosis (MTB) bacterial load on Xpert MTB/RIF accuracy for detection of rifampicin (RIF)-resistant MTB in bronchoalveolar lavage fluid (BALF) specimens obtained at a national tuberculosis (TB) specialized hospital in Beijing, China. METHODS A retrospective study was conducted at Beijing Chest Hospital. Patients with symptoms suggestive of pulmonary TB who provided BALF specimens for routine MTB detection between June 2019 and July 2020 were enrolled in the study. Chi-square test and Student's t-test were used to compare results across groups stratified according to BALF bacterial load. RESULTS In total, 1125 patients with positive Xpert results who were enrolled in final analysis, 263 provided BALF specimens that tested positive for RIF-resistant MTB via Xpert MTB/RIF. The RIF-resistance rate of specimens with very low MTB bacterial load was 30.9%, a resistance rate significantly greater than rates obtained for groups with high (25.0%), medium (17.3%) and low (19.2%) MTB loads (P<0.01). Notably, false-positive results obtained for the very low bacterial load group led to markedly reduced positive predictive value of Xpert MTB/RIF to provide correct RIF-resistance predictions for that group (67.1%, 95% CI: 56.1%-78.1%5) relative to the predictive value obtained for all other groups combined (about 90%, P<0.05). Sanger sequencing data obtained for 20 (32.8%) MTB isolates deemed RIF-resistant via Xpert (Probe E) lacked rpoB RRDR mutations. Meanwhile, of another group of 23 isolates deemed RIF-susceptible via DST but RIF-resistant via Xpert MTB/RIF, 20 isolate sequences (87.0%) lacked rpoB RRDR mutations, while sequences of the remaining 3 isolates harbored single rpoB RRDR mutations predicted to cause amino acid substitutions. CONCLUSION Xpert MTB/RIF assay performed alarmingly poorly when used to detect RIF-resistant MTB in BALF specimens with very low bacterial loads. A high rate of Xpert probe E hybridization failure was the main driver of false-positive RIF-resistant results.
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Affiliation(s)
- Lin Qin
- Department of Endoscopic Diagnosis & Treatment, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis & Thoracic Tumor Research Institute, Beijing, 101149, People’s Republic of China
| | - Fengmin Huo
- Department of Bacteriology and Immunology, Beijing Key Laboratory on Drug-Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis & Thoracic Tumor Research Institute, Beijing, 101149, People’s Republic of China
| | - Weicong Ren
- Department of Bacteriology and Immunology, Beijing Key Laboratory on Drug-Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis & Thoracic Tumor Research Institute, Beijing, 101149, People’s Republic of China
| | - Yuanyuan Shang
- Department of Bacteriology and Immunology, Beijing Key Laboratory on Drug-Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis & Thoracic Tumor Research Institute, Beijing, 101149, People’s Republic of China
| | - Cong Yao
- Department of Bacteriology and Immunology, Beijing Key Laboratory on Drug-Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis & Thoracic Tumor Research Institute, Beijing, 101149, People’s Republic of China
| | - Xuxia Zhang
- Department of Bacteriology and Immunology, Beijing Key Laboratory on Drug-Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis & Thoracic Tumor Research Institute, Beijing, 101149, People’s Republic of China
| | - Rongmei Liu
- Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis & Thoracic Tumor Research Institute, Beijing, 101149, People’s Republic of China
| | - Liping Ma
- Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis & Thoracic Tumor Research Institute, Beijing, 101149, People’s Republic of China
| | - Mengqiu Gao
- Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis & Thoracic Tumor Research Institute, Beijing, 101149, People’s Republic of China
| | - Yu Pang
- Department of Bacteriology and Immunology, Beijing Key Laboratory on Drug-Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis & Thoracic Tumor Research Institute, Beijing, 101149, People’s Republic of China
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Jiang WX, Li ZP, Zhao Q, Gao MQ, Long Q, Wang WB, Huang F, Wang N, Tang SL. Impacts of a comprehensive tuberculosis control model on the quality of clinical services and the financial burden of treatment for patients with drug-resistant tuberculosis in China: a mixed-methods evaluation. Infect Dis Poverty 2021; 10:54. [PMID: 33883030 PMCID: PMC8059277 DOI: 10.1186/s40249-021-00832-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/23/2021] [Indexed: 11/22/2022] Open
Abstract
Background The China National Health Commission-Gates TB Project Phase III implemented a comprehensive TB control model including multiple interventions to address the burden of drug-resistant TB (DRTB). This study aims to evaluate the quality of DRTB clinical services and assess the financial burden of DRTB patients during the intervention period. Methods A mixed-methods approach was used to evaluate the effectiveness of interventions in the three project provinces: Zhejiang, Jilin and Ningxia Hui Autonomous Region. The quantitative data included de-identified DRTB registry data during 2015–2018 in project provinces from China CDC, medical records of DRTB patients registered in 2018 (n = 106) from designated hospitals, and a structured DRTB patient survey in six sample prefectures in 2019. The quality of clinical services was evaluated using seven indicators across patient screening, diagnosis and treatment. Logistic regression was conducted to explore factors associated with the extremely high financial burden. Semi-structured in-depth interviews with policymakers and focus group discussions with physicians and DRTB patients were conducted to understand the interventions implemented and their impacts. Results The percentage of bacterially confirmed patients taking a drug susceptibility test (DST) increased significantly between 2015 and 2018: from 57.4 to 93.6% in Zhejiang, 12.5 to 86.5% in Jilin, and 29.7 to 91.4% in Ningxia. The treatment enrollment rate among diagnosed DRTB patients also increased significantly and varied from 73 to 82% in the three provinces in 2018. Over 90% of patients in Zhejiang and Jilin and 75% in Ningxia remained in treatment by the end of the first six months’ treatment. Among all survey respondents 77.5% incurred extremely high financial burden of treatment. Qualitative results showed that interventions on promoting rapid DST technologies and patient referral were successfully implemented, but the new financing policies for reducing patients’ financial burden were not implemented as planned. Conclusions The quality of DRTB related clinical services has been significantly improved following the comprehensive interventions, while the financial burden of DRTB patients remains high due to the delay in implementing financing policies. Stronger political commitment and leadership are required for multi-channel financing to provide additional financial support to DRTB patients. ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s40249-021-00832-5.
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Affiliation(s)
- Wei-Xi Jiang
- Global Health Research Center, Duke Kunshan University, No. 8 Duke Avenue, Kunshan, 215316, Jiangsu, China
| | - Zhi-Peng Li
- School of Public Health, Fudan University, 130 Dongan Road, Shanghai, 200032, China
| | - Qi Zhao
- School of Public Health, Fudan University, 130 Dongan Road, Shanghai, 200032, China
| | - Meng-Qiu Gao
- Beijing Chest Hospital, Capital Medical University, No. 9 Beiguan Road, Beijing, 101149, China
| | - Qian Long
- Global Health Research Center, Duke Kunshan University, No. 8 Duke Avenue, Kunshan, 215316, Jiangsu, China
| | - Wei-Bing Wang
- School of Public Health, Fudan University, 130 Dongan Road, Shanghai, 200032, China
| | - Fei Huang
- National Center for Tuberculosis Control and Prevention, China CDC, No.155 Changbai Road, Changping District, Beijing, 102206, China
| | - Ni Wang
- National Center for Tuberculosis Control and Prevention, China CDC, No.27 Nanwei Road, Xicheng District, Beijing, 100050, China.
| | - Sheng-Lan Tang
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC, 27710, USA.
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Jiang W, Peng Y, Wang X, Elbers C, Tang S, Huang F, Chen B, Cobelens F. Policy changes and the screening, diagnosis and treatment of drug-resistant tuberculosis patients from 2015 to 2018 in Zhejiang Province, China: a retrospective cohort study. BMJ Open 2021; 11:e047023. [PMID: 33846156 PMCID: PMC8047997 DOI: 10.1136/bmjopen-2020-047023] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To examine changes in the screening, diagnosis, treatment and management of drug-resistant tuberculosis (DRTB) patients, and investigate the impacts of DRTB-related policies on patients of different demographic and socioeconomic characteristics. DESIGN A retrospective cohort study using registry data, plus a survey on DRTB-related policies. SETTING All prefecture-level Centres for Disease Control in Zhejiang Province, China. MAIN OUTCOME MEASURES Alongside the care cascade, we examined: (1) reported number of presumptive DRTB patients; (2) percentage of presumptive patients with drug susceptibility testing (DST) records; (3) percentage of DRTB/rifampicin-resistant (RR) patients registered; (4) percentage of RR/multidrug-resistant TB (MDRTB) patients that received anti-DRTB treatment; and (5) percentage of RR/MDRTB patients cured/completed treatment among those treated. Multivariate logistic regressions were conducted to explore the impacts of DRTB policies after adjusting for other factors. RESULTS The number of reported presumptive DRTB patients and the percentage with DST records largely increased during 2015-2018, and the percentage of registered patients who received anti-DRTB treatment also increased from 59.0% to 86.5%. Patients under the policies of equipping GeneXpert plus expanded criteria for DST had a higher likelihood of being registered compared with no GeneXpert (adjusted OR (aOR)=2.57, 95% CI: 1.20 to 5.51), while for treatment initiation the association was only significant when further expanding the registration criteria (aOR=2.38, 95% CI: 1.19 to 4.79). Patients with registered residence inside Zhejiang were more likely to be registered (aOR=1.96, 95% CI: 1.52 to 2.52), treated (aOR=3.83, 95% CI: 2.78 to 5.28) and complete treatment (aOR=1.92, 95% CI: 1.03 to 3.59) compared with those outside. CONCLUSION The policy changes on DST and registration have effectively improved DRTB case finding and care. Nevertheless, challenges remain in servicing vulnerable groups such as migrants and improving equity in the access to TB care. Future policies should provide comprehensive support for migrants to complete treatment at their current place of residence.
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Affiliation(s)
- Weixi Jiang
- Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Ying Peng
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Xiaomeng Wang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Chris Elbers
- School of Business and Economics, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Shenglan Tang
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Fei Huang
- National Center for Tuberculosis Control and Prevention, Centers for Disease Control and Prevention, Beijing, China
| | - Bin Chen
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Frank Cobelens
- Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam University Medical Centres, Duivendrecht, The Netherlands
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Shi J, Tao B, Li Z, Song H, Wu J, Qiu B, Wang J. Diagnostic Performance of GeneChip for the Rapid Detection of Drug-Resistant Tuberculosis in Different Subgroups of Patients. Infect Drug Resist 2021; 14:597-608. [PMID: 33633456 PMCID: PMC7900445 DOI: 10.2147/idr.s297725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 01/27/2021] [Indexed: 11/25/2022] Open
Abstract
Objective Drug-resistant tuberculosis (DR-TB) is a growing problem worldwide. The rapid drug susceptibility test (DST) of DR-TB enables the timely administration of a chemotherapy regimen that effectively treats DR-TB. GeneChip has been reported as a novel molecular diagnostic tool for rapid diagnosis but has limited data on the performance of subgroup patients with DR-TB. This study aims to assess the diagnostic value of GeneChip in patients with different sexes, ages, treatment histories, treatment outcomes, and places of residence. Methods We recruited newly registered sputum smear-positive pulmonary TB patients from January 2011 to September 2020 in Lianyungang City, Jiangsu Province, China. We applied both GeneChip and DST to measure drug resistance to rifampin (RIF) and isoniazid (INH). The kappa value, sensitivity, specificity, and agreement rate (AR) were calculated. We also applied a Classification and Regression Tree to explore factors related to the performance of GeneChip. Results We observed that sex, age, treatment history, treatment outcomes, and drug resistance type were significantly associated with the performance of GeneChip. For RIF resistance, there was significant accordance in young patients (kappa: 0.79) and cases with the treatment failure outcome (kappa: 0.92). For multidrug resistance (MDR), there was significant accordance in young cases (kappa: 0.77). Compared with previously treated patients, the newly treated patients had a significantly higher AR in detecting RIF resistance (0.97 vs 0.92), INH resistance (0.95 vs 0.89), and MDR (0.98 vs 0.92). The overall sensitivity, specificity, AR and kappa value for the diagnosis of MDR-TB were 0.70 (95% CI: 0.63–0.70), 0.99 (95% CI: 0.98–0.99), 0.98 (95% CI: 0.97–0.98), and 0.72 (95% CI: 0.67–0.78), respectively. Conclusion We observed a high concordance between GeneChip and DST among TB patients with different characteristics, indicating that GeneChip can be a potential alternative tool for rapid MDR-TB detection.
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Affiliation(s)
- Jinyan Shi
- Department of Clinical Laboratory, The Fourth People's Hospital of Lianyungang, Lianyungang, Jiangsu, People's Republic of China
| | - Bilin Tao
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, People's Republic of China
| | - Zhongqi Li
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, People's Republic of China
| | - Huan Song
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, People's Republic of China
| | - Jizhou Wu
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, People's Republic of China
| | - Beibei Qiu
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, People's Republic of China
| | - Jianming Wang
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, People's Republic of China
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Zhang J, Ren Y, Pan L, Yi J, Guan T, Yang X, Zhang Z. Analysis of drug resistance and mutation profiles in Mycobacterium tuberculosis isolates in a surveillance site in Beijing, China. J Int Med Res 2021; 49:300060520984932. [PMID: 33461383 PMCID: PMC7818002 DOI: 10.1177/0300060520984932] [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] [Indexed: 11/26/2022] Open
Abstract
Objective This study analyzed drug resistance and mutations profiles in
Mycobacterium tuberculosis isolates in a surveillance
site in Huairou District, Beijing, China. Methods The proportion method was used to assess drug resistance profiles for four
first-line and seven second-line anti-tuberculosis (TB) drugs. Molecular
line probe assays were used for the rapid detection of resistance to
rifampicin (RIF) and isoniazid (INH). Results Among 235 strains of M. tuberculosis, 79 (33.6%) isolates
were resistant to one or more drugs. The isolates included 18 monoresistant
(7.7%), 19 polyresistant (8.1%), 28 RIF-resistant (11.9%), 24
multidrug-resistant (MDR) (10.2%), 7 pre-extensively drug-resistant (XDR,
3.0%), and 2 XDR strains (0.9%). A higher rate of MDR-TB was detected among
previously treated patients than among patients with newly diagnosed TB
(34.5% vs. 6.8%). The majority (62.5%) of RIF-resistant isolates exhibited a
mutation at S531L in the DNA-dependent RNA polymerase gene. Meanwhile, 62.9%
of INH-resistant isolates carried a mutation at S315T1 in the katG gene. Conclusion Our results confirmed the high rate of drug-resistant TB, especially MDR-TB,
in Huairou District, Beijing, China. Therefore, detailed drug testing is
crucial in the evaluation of MDR-TB treatment.
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Affiliation(s)
- Jie Zhang
- Beijing Key Laboratory for Drug Resistance Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China.,Central Laboratory, Beijing Research Institute for Tuberculosis Control, Beijing, China
| | - Yixuan Ren
- Central Laboratory, Beijing Research Institute for Tuberculosis Control, Beijing, China
| | - Liping Pan
- Beijing Key Laboratory for Drug Resistance Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Junli Yi
- Central Laboratory, Beijing Research Institute for Tuberculosis Control, Beijing, China
| | - Tong Guan
- Department of Tuberculosis, Huairou District Center for Diseases Control and Prevention, Beijing, China
| | - Xinyu Yang
- Central Laboratory, Beijing Research Institute for Tuberculosis Control, Beijing, China
| | - Zongde Zhang
- Beijing Key Laboratory for Drug Resistance Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
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Wang J, Zhao W, Liu R, Huo F, Dong L, Xue Y, Wang Y, Xue Z, Ma L, Pang Y. Rapid Detection of Ethambutol-Resistant Mycobacterium tuberculosis from Sputum by High-Resolution Melting Analysis in Beijing, China. Infect Drug Resist 2020; 13:3707-3713. [PMID: 33116691 PMCID: PMC7586015 DOI: 10.2147/idr.s270542] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 08/29/2020] [Indexed: 11/23/2022] Open
Abstract
Objective We conducted a retrospective study to evaluate the performance of MeltPro assay for detecting ethambutol (EMB) susceptibility of Mycobacterium tuberculosis (MTB) isolates in sputum specimens in Beijing, China. Methods Smear-positive TB patients undergoing MeltPro assay in the Beijing Chest Hospital between January 2019 and December 2019 were included. Phenotypic drug susceptibility testing (DST) was used as the reference standard to calculate the diagnostic accuracy of MeltPro assay for EMB resistance. Sanger sequencing of embB gene was conducted to resolve the discrepancies between MeltPro assay and phenotypic DST. Results A total of 222 smear-positive patients were included in our analysis. The overall agreement rate between the two assays was 91.4%, with a kappa value of 0.78. Among 59 EMB-resistant TB cases diagnosed by DST, 49 were identified by MeltPro assay, demonstrating a sensitivity of 83.1%. In addition, 154 out of 163 EMB-susceptible patients diagnosed by DST were correctly detected with MeltPro assay, yielding a specificity of 93.9%. The probe frequency associated with the observed EMB-resistance was as follows: A (45/58), B (7/58), and D (6/58), and no EMB-resistance was associated with probe C. The presence of amino acid substitution was observed among all 9 cases with potentially “false-negative” results, including 7 with Met306Ile, 1 with Met306Val, 1 with Gly406Asp, respectively. Conclusion MeltPro assay is a promising diagnostic tool for the detection of EMB resistance in China. The specific amino acid substitution in embB gene is the major reason for discrepancies between MeltPro assay and phenotypic DST.
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Affiliation(s)
- Jun Wang
- Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis & Thoracic Tumor Research Institute, Beijing 101149, People's Republic of China
| | - Weijie Zhao
- Clinical Trial Agency Office, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis & Thoracic Tumor Research Institute, Beijing 101149, People's Republic of China
| | - Rongmei Liu
- Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis & Thoracic Tumor Research Institute, Beijing 101149, People's Republic of China
| | - Fengmin Huo
- National Clinical Laboratory on Tuberculosis, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis & Thoracic Tumor Research Institute, Beijing 101149, People's Republic of China
| | - Lingling Dong
- National Clinical Laboratory on Tuberculosis, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis & Thoracic Tumor Research Institute, Beijing 101149, People's Republic of China
| | - Yi Xue
- National Clinical Laboratory on Tuberculosis, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis & Thoracic Tumor Research Institute, Beijing 101149, People's Republic of China
| | - Yufeng Wang
- Department of Laboratory Quality Control, Innovation Alliance on Tuberculosis Diagnosis and Treatment (Beijing), Beijing 101149, People's Republic of China
| | - Zhongtan Xue
- Department of Laboratory Quality Control, Innovation Alliance on Tuberculosis Diagnosis and Treatment (Beijing), Beijing 101149, People's Republic of China
| | - Liping Ma
- Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis & Thoracic Tumor Research Institute, Beijing 101149, People's Republic of China
| | - Yu Pang
- National Clinical Laboratory on Tuberculosis, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis & Thoracic Tumor Research Institute, Beijing 101149, People's Republic of China
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10
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Huo F, Ma Y, Li S, Xue Y, Shang Y, Dong L, Li Y, Pang Y. Specific gyrA Gene Mutations Correlate with High Prevalence of Discordant Levofloxacin Resistance in Mycobacterium tuberculosis Isolates from Beijing, China. J Mol Diagn 2020; 22:1199-1204. [DOI: 10.1016/j.jmoldx.2020.06.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 05/25/2020] [Accepted: 06/18/2020] [Indexed: 11/26/2022] Open
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11
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Ma Y, Fan J, Li S, Dong L, Li Y, Wang F, Huo F, Pang Y, Qin S. Comparison of Lowenstein-Jensen medium and MGIT culture system for recovery of Mycobacterium tuberculosis from abscess samples. Diagn Microbiol Infect Dis 2020; 96:114969. [PMID: 31973887 DOI: 10.1016/j.diagmicrobio.2019.114969] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 11/23/2019] [Accepted: 12/14/2019] [Indexed: 01/28/2023]
Abstract
PURPOSE In this study, our aim was to assess Lowenstein-Jensen (L-J) medium and MGIT culture system for recovery of Mycobacterium tuberculosis (MTB) from abscess samples in skeletal tuberculosis (TB) cases. METHODS Abscess samples were collected from patients suggestive of skeletal TB in Beijing Chest Hospital for laboratory examination, including smear microscopy, L-J culture and MGIT culture. RESULTS Of the 232 abscess samples, 72 (31.0%) were culture-positive for mycobacteria. Of 72 isolates recovered, 94.4% were detected in MGIT 960 and 75.0% on L-J medium. MGIT could recover significantly higher rate of MTB isolates from smear-positive specimens than L-J medium. The mean time to detection of MTB in MGIT 960 was significantly lower than that on L-J medium. CONCLUSION The BACTEC MGIT 960 outperforms the conventional L-J medium in recovering MTB from abscess samples. The combination of MGIT and L-J method also increases the overall recovery rate of MTB in culture.
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Affiliation(s)
- Yifeng Ma
- National Clinical Laboratory on Tuberculosis, Beijing Key laboratory for Drug Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China
| | - Jun Fan
- Department of Orthopedics, Beijing Bone and Joint Tuberculosis Diagnosis and Treatment Center, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China
| | - Shanshan Li
- National Clinical Laboratory on Tuberculosis, Beijing Key laboratory for Drug Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China
| | - Lingling Dong
- National Clinical Laboratory on Tuberculosis, Beijing Key laboratory for Drug Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China
| | - Yunxu Li
- National Clinical Laboratory on Tuberculosis, Beijing Key laboratory for Drug Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China
| | - Fen Wang
- National Clinical Laboratory on Tuberculosis, Beijing Key laboratory for Drug Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China
| | - Fengmin Huo
- National Clinical Laboratory on Tuberculosis, Beijing Key laboratory for Drug Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China
| | - Yu Pang
- National Clinical Laboratory on Tuberculosis, Beijing Key laboratory for Drug Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China.
| | - Shibing Qin
- Department of Orthopedics, Beijing Bone and Joint Tuberculosis Diagnosis and Treatment Center, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China.
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12
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Huang F, van den Hof S, Qu Y, Li Y, Zhang H, Wang L, Sun M, Lu W, Hou S, Zhang T, Huan S, Chin DP, Cobelens F. Added Value of Comprehensive Program to Provide Universal Access to Care for Sputum Smear-Negative Drug-Resistant Tuberculosis, China. Emerg Infect Dis 2019; 25:1289-1296. [PMID: 31211666 PMCID: PMC6590765 DOI: 10.3201/eid2507.181417] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The increase in drug-resistant tuberculosis in China calls for scaling up rapid diagnosis. We evaluated introduction of rapid resistance testing by line-probe assay for all patients with a diagnosis of pulmonary tuberculosis in 2 prefectures in middle and eastern China. We analyzed sputum samples for smear-positive patients and cultures for smear-negative patients. We used a before–after comparison of baseline and intervention periods (12 months each) and analyzed data for 5,222 baseline period patients and 4,364 intervention period patients. The number of patients with rifampin resistance increased from 30 in the baseline period to 97 in the intervention period for smear-positive patients and from 0 to 13 for smear-negative patients, reflecting a low proportion of positive cultures (410/2,844, 14.4%). Expanding rapid testing for drug resistance for smear-positive patients resulted in a 3-fold increase in patients with diagnoses of rifampin-resistant tuberculosis. However, testing smear-negative patients had limited added value because of a low culture-positive rate.
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13
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Lin S, Wei S, Zhao Y, Lin J, Pang Y. Epidemiology Of Human Pulmonary Infection With Nontuberculous Mycobacteria In Southeast China: A Prospective Surveillance Study. Infect Drug Resist 2019; 12:3515-3521. [PMID: 31814740 PMCID: PMC6858808 DOI: 10.2147/idr.s223828] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 10/30/2019] [Indexed: 01/15/2023] Open
Abstract
Background China is facing a great challenge of pulmonary nontuberculous mycobacteria (NTM) infections. This primary objective of this study was to assess the prevalence of NTM isolates among patients with presumptive TB in Fujian. Methods The mycobacterial isolates were collected from the tuberculosis survey from Fujian Province conducted between July 1, 2010 and June 30, 2011. Results From July 1, 2010 to June 30, 2011, 1425 isolates were included in the final analysis, of which 60 (4.2%) were identified as NTM species. M. intracellulare was the most frequently isolated NTM in Fujian, accounting for 68.3% of all NTM isolates. Compared with patients aged <45 years, patients aged 45-59 were more likely to have NTM infections. The education level of patients had an impact on the distribution of NTM infections. Illiterate patients had significantly higher odds of having NTM compared to literate patients. Patients with a previous TB episode had higher NTM risk as compared to those without previous TB episodes. Conclusion In conclusion, the predominant NTM is M. intracellulare among patients with presumptive TB in Fujian. In addition, elderly patients, those with a previous TB episode and illiterate patients have higher NTM risk.
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Affiliation(s)
- Shufang Lin
- Institute of Tuberculosis Control and Prevention, Fujian Center for Disease Control and Prevention, Fuzhou, People's Republic of China.,Fujian Provincial Key Laboratory of Zoonosis Research, Fujian Center for Disease Control and Prevention, Fuzhou, People's Republic of China
| | - Shuzhen Wei
- Institute of Tuberculosis Control and Prevention, Fujian Center for Disease Control and Prevention, Fuzhou, People's Republic of China.,Fujian Provincial Key Laboratory of Zoonosis Research, Fujian Center for Disease Control and Prevention, Fuzhou, People's Republic of China
| | - Yong Zhao
- Institute of Tuberculosis Control and Prevention, Fujian Center for Disease Control and Prevention, Fuzhou, People's Republic of China.,Fujian Provincial Key Laboratory of Zoonosis Research, Fujian Center for Disease Control and Prevention, Fuzhou, People's Republic of China
| | - Jian Lin
- Institute of Tuberculosis Control and Prevention, Fujian Center for Disease Control and Prevention, Fuzhou, People's Republic of China.,Fujian Provincial Key Laboratory of Zoonosis Research, Fujian Center for Disease Control and Prevention, Fuzhou, People's Republic of China
| | - Yu Pang
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug-Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, People's Republic of China
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14
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Li X, Deng Y, Wang J, Jing H, Shu W, Qin J, Pang Y, Ma X. Rapid Diagnosis Of Multidrug-Resistant Tuberculosis Impacts Expenditures Prior To Appropriate Treatment: A Performance And Diagnostic Cost Analysis. Infect Drug Resist 2019; 12:3549-3555. [PMID: 31814743 PMCID: PMC6861515 DOI: 10.2147/idr.s224518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 11/05/2019] [Indexed: 11/23/2022] Open
Abstract
Background In this study, we aimed to describe the impact of the Genotype® MTBDRplus line probe assay (LPA) for multidrug-resistant tuberculosis (MDR-TB) on total costs in a high-burden setting in China. The second objective was to evaluate the performance of HAIN on smear-positive sputum and clinical isolates. Methods All definitive TB inpatients at the Shandong Provincial Chest Hospital between May 2012 and May 2017 were included in the study. Two sputum specimens were collected from each patient to conduct smear microscopy, conventional drug susceptibility testing (DST), and the HAIN test. Laboratory and cost data were collected from the electronic medical record system. Results A total of 1670 definitive TB patients were included in this study. Of these patients, 1307 (78.3%) had smear-positive/culture-positive tuberculosis, and the remaining 363 (21.7%) had smear-negative/culture-positive tuberculosis. The sensitivity and specificity of the HAIN test for RIF resistance was 94.8% (95% confidence interval [CI]: 91.9-97.6%) and 98.8% (95% CI: 98.3-99.4%), respectively. For INH resistance, the sensitivity and specificity was 89.5% (95% CI: 85.7-93.2%) and 95.6% (95% CI: 94.5-96.7%), respectively. The mean time for detection of MDR-TB in smear-negative cases was determined to be 32 days by the HAIN test, which was significantly shorter than that by conventional DST (56 days). Similarly, the mean time for detection of MDR-TB by the HAIN test was significantly shorter than that by conventional DST in smear-positive cases (3 versus 53 days). In addition, by utilizing the HAIN test, the total health care cost decreased by 71.0% for smear-positive cases and 25.9% for smear-negative cases. Conclusion In conclusion, our data demonstrate that the HAIN test is an accurate rapid test for detecting both RIF and INH resistance in TB patients. The use of the HAIN test can decrease health care costs and reduce the detection time for MDR-TB patients in China, despite the increased costs for laboratory testing.
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Affiliation(s)
- Xuezheng Li
- School of Public Health, Shandong University, Jinan, People's Republic of China.,Katharine Hsu International Research Center of Human Infectious Diseases, Shandong Provincial Chest Hospital, Shandong University, Jinan, People's Republic of China
| | - Yunfeng Deng
- Katharine Hsu International Research Center of Human Infectious Diseases, Shandong Provincial Chest Hospital, Shandong University, Jinan, People's Republic of China
| | - Junling Wang
- Katharine Hsu International Research Center of Human Infectious Diseases, Shandong Provincial Chest Hospital, Shandong University, Jinan, People's Republic of China
| | - Hui Jing
- Katharine Hsu International Research Center of Human Infectious Diseases, Shandong Provincial Chest Hospital, Shandong University, Jinan, People's Republic of China
| | - Wei Shu
- Clinical Center on TB Control, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, People's Republic of China
| | - Jingmin Qin
- Katharine Hsu International Research Center of Human Infectious Diseases, Shandong Provincial Chest Hospital, Shandong University, Jinan, People's Republic of China
| | - Yu Pang
- National Clinical Laboratory on Tuberculosis, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, People's Republic of China
| | - Xin Ma
- School of Public Health, Shandong University, Jinan, People's Republic of China.,Katharine Hsu International Research Center of Human Infectious Diseases, Shandong Provincial Chest Hospital, Shandong University, Jinan, People's Republic of China
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15
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Liu Z, Dong H, Wu B, Zhang M, Zhu Y, Pang Y, Wang X. Is rifampin resistance a reliable predictive marker of multidrug-resistant tuberculosis in China: A meta-analysis of findings. J Infect 2019; 79:349-356. [PMID: 31400354 DOI: 10.1016/j.jinf.2019.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 07/16/2019] [Accepted: 08/04/2019] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Systematic review of multidrug-resistant tuberculosis (MDR-TB) prevalence among rifampicin (RIF)-resistant tuberculosis (RR-TB) patients in 34 provinces of China was conducted to correlate RIF resistance with concurrent isoniazid (INH) resistance. METHODS Database searches (PubMed, Embase, China National Knowledge Infrastructure, Chinese Scientific Journal, Wanfang), identified drug resistance surveillance studies conducted between January 1, 2000 and June 30, 2018. Of 1554 records, random-effects meta-analysis of 34 studies of adequate methodological quality yielded 108,366 TB cases for MDR-TB prevalence analysis of RR-TB cases. RESULTS MDR-TB prevalence among RR-TB cases varied from 57% (Xinjiang; 95% CI 47%, 67%) to 95% (Taiwan; 95% CI 92%, 98%), for a pooled national rate of 77% (95% CI 75%, 80%). Subgroup and meta-regression analyses revealed greater MDR-TB prevalence in previously treated versus new RR-TB cases (P < 0.001), with no significant differences of regional initial drug resistance rates or sampling methods. Regional MDR-TB prevalence among RR-TB cases was lowest (69%) in the Northeast Region (95% CI 65%, 73%) and highest (90%) in Hong Kong, Macao and Taiwan (95% CI 81%, 98%). CONCLUSIONS In China, ∼77% of RR-TB cases are MDR-TB. Thus, RIF resistance cannot effectively predict MDR-TB. Highly variable RR-TB prevalence across China warrants improved TB management.
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Affiliation(s)
- Zhengwei Liu
- The Institute of TB Control, Zhejiang Provincial Center for Disease Control and Prevention, No. 3399, Binsheng road, Binjiang District, Hangzhou 310005, China
| | - Huali Dong
- Department of Clinical Laboratory, Zhejiang Xiao Shan Hospital, Hangzhou, China
| | - BeiBei Wu
- The Institute of TB Control, Zhejiang Provincial Center for Disease Control and Prevention, No. 3399, Binsheng road, Binjiang District, Hangzhou 310005, China
| | - Mingwu Zhang
- The Institute of TB Control, Zhejiang Provincial Center for Disease Control and Prevention, No. 3399, Binsheng road, Binjiang District, Hangzhou 310005, China
| | - Yelei Zhu
- The Institute of TB Control, Zhejiang Provincial Center for Disease Control and Prevention, No. 3399, Binsheng road, Binjiang District, Hangzhou 310005, China
| | - Yu Pang
- National Clinical Laboratory on Tuberculosis, Beijing Key laboratory on Drug-resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, No. 9, Beiguan Street, Tongzhou District, Beijing 101149, China.
| | - Xiaomeng Wang
- The Institute of TB Control, Zhejiang Provincial Center for Disease Control and Prevention, No. 3399, Binsheng road, Binjiang District, Hangzhou 310005, China.
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16
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Lin M, Zhong Y, Chen Z, Lin C, Pei H, Shu W, Pang Y. High incidence of drug-resistant Mycobacterium tuberculosis in Hainan Island, China. Trop Med Int Health 2019; 24:1098-1103. [PMID: 31278806 DOI: 10.1111/tmi.13285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To assess the proportion of drug-resistant tuberculosis (TB) cases and to identify independent risk factors associated with drug-resistant TB in Hainan. METHODS Descriptive analysis of demographic and clinical data of culture-positive TB patients to assess the trends in drug-resistant TB at the Provincial Clinical Center on Tuberculosis of Hainan between 2014 and 2017. RESULTS 994 patients were recruited into the study. Overall, the proportion of patients resistant to at least one TB drug tested was 36.1% (359/994). The most frequent resistance was to isoniazid (INH, 29.8%), followed by rifampin (RIF, 29.3%), streptomycin (19.3%), ofloxacin (OFX, 17.4%), ethambutol (9.5%) and kanamycin (KAN, 3.2%). Of 291 RIF-resistant isolates, 228 (78.4%) were also resistant to INH, while the remaining 63 (21.6%) were susceptible to INH. Among those with multidrug-resistant tuberculosis (MDR-TB), 41.2% had additional resistance to OFX and 3.9% to KAN. 8.8% of MDR-TB patients were affected by extensively drug-resistant (XDR-TB). Females were more likely to infected with MDR-TB than males, and young people (<20 years old) were more likely to have MDR-TB; patients exhibited decreasing MDR-TB risk with increasing age. CONCLUSIONS Our data provide the first primary understanding of the drug-resistant TB epidemic in Hainan. The high incidence of drug resistance, especially RIF and FQ resistance, highlight the importance of interventions for preventing epidemics of drug-resistant TB. Younger age is an independent predictor of MDR-TB, reflecting the potential transmission in this population.
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Affiliation(s)
- Mingguan Lin
- Department of Clinical Laboratory, The Second Affiliated Hospital, Hainan Medical University, Haikou, China
| | - Yeteng Zhong
- Department of Clinical Laboratory, The Second Affiliated Hospital, Hainan Medical University, Haikou, China
| | - Zhuolin Chen
- Department of Clinical Laboratory, The Second Affiliated Hospital, Hainan Medical University, Haikou, China
| | - Chong Lin
- Department of Clinical Laboratory, The Second Affiliated Hospital, Hainan Medical University, Haikou, China
| | - Hua Pei
- Department of Clinical Laboratory, The Second Affiliated Hospital, Hainan Medical University, Haikou, China
| | - Wei Shu
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory on Drug-resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China
| | - Yu Pang
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory on Drug-resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China.,Biobank of Tuberculosis, Beijing Chest Hospital, Beijing Tuberculosis and Thoracic Tumor Institute, Capital Medical University, Beijing, China
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17
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Wattal C, Raveendran R. Newer Diagnostic Tests and their Application in Pediatric TB. Indian J Pediatr 2019; 86:441-447. [PMID: 30628039 DOI: 10.1007/s12098-018-2811-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 10/05/2018] [Indexed: 11/25/2022]
Abstract
The diagnosis of childhood tuberculosis is a challenge due to the pauci-bacillary nature of infection and the difficulty in obtaining appropriate sample. In the past 2-3 decades, many new tests were introduced for the diagnosis of tuberculosis (TB) and some of them have been evaluated for their application in pediatric tuberculosis as well. There is an attempt to improve smear microscopy by introducing light-emitting diode (LED) fluorescence microscopy and there are also some automated digital microscopy platforms under evaluation. Introduction of automated liquid culture platform along with rapid molecular based identification methods have considerably reduced the time delay in mycobacterial culture. Recent addition of many nucleic acid amplification platforms like Amplicor PCR, Genprobe, Xpert MTB/Rif, line probe assays, loop mediated isothermal amplification etc are also been found to be useful. Latest techniques like microarray and gene sequencing are also being used in clinical laboratories with variable results. Indirect methods of TB diagnosis like T cell based assays including tuberculin skin test and interferon-gamma release assays have their role primarily in the diagnosis of latent TB. Biomarkers are the latest addition in the battery of TB diagnostic tests facilitating diagnosis using easily accessible samples like urine, blood and breath of patients. Many biomarkers are still under evaluation and some of them are found to have a potential role as promising diagnostic tests of future.
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Affiliation(s)
- Chand Wattal
- Department of Clinical Microbiology & Immunology, Sir Ganga Ram Hospital, New Delhi, India.
| | - Reena Raveendran
- Department of Clinical Microbiology & Immunology, Sir Ganga Ram Hospital, New Delhi, India
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18
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Feasibility and Performance of Loop-Mediated Isothermal Amplification Assay in the Diagnosis of Pulmonary Tuberculosis in Decentralized Settings in Eastern China. BIOMED RESEARCH INTERNATIONAL 2019; 2019:6845756. [PMID: 30805368 PMCID: PMC6362501 DOI: 10.1155/2019/6845756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 01/12/2019] [Indexed: 11/17/2022]
Abstract
Early diagnosis is essential for the control and prevention of tuberculosis (TB). The objective of this study was to investigate the feasibility and performance of loop-mediated isothermal amplification (LAMP) in the diagnosis of pulmonary TB in county-level microscopy centers in Qingdao, Eastern China. A total of 523 presumptive TB patients were consecutively recruited between July 2017 and April 2018, and 22 patients were excluded from the analysis. Of 102 culture-positive cases, TB-LAMP identified 91 cases, demonstrating a sensitivity of 89.2%. In comparison, the sensitivity of routine smear microscopy was 69.6% (71/102), which was significantly lower than that of TB-LAMP (P=0.001). In addition, TB-LAMP sensitivities in smear-positive and smear-negative samples were 98.6% and 67.7%, respectively. In conclusion, our data demonstrate that TB-LAMP outperforms conventional smear microscopy in TB diagnosis, which could be used as an alternative method for smear microscopy in resource-limited settings in China.
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19
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Lu J, Zheng H, Chu P, Han S, Yang H, Wang Z, Shi J, Yang Z. Direct detection from clinical sputum samples to differentiate live and dead Mycobacterium Tuberculosis. J Clin Lab Anal 2018; 33:e22716. [PMID: 30461054 DOI: 10.1002/jcla.22716] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 10/18/2018] [Accepted: 10/19/2018] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND In this study, we aimed to optimize the condition of propidium monoazide (PMA) treatment for direct detection of Mycobacterium tuberculosis (MTB) from clinical specimens. METHODS The light exposure time, dark incubation time, bacterial load, and PMA concentration were varied to determine the optimal condition of PMA treatment. RESULTS Overall, the maximum ΔCq value was observed in the group receiving a light exposure time of 20 minutes, which was significantly higher than the others (P < 0.05). The prolongation of dark incubation time seemed more likely to result in greater ΔCq value, and the ΔCq values were 2.0, 4.1, 6.5, 10.1, and 12.7 cycles under dark incubation time of 10, 20, 40, 60, and 120 minutes, respectively. Alternatively, the 4+ samples exhibited favorable detection results at the application of 104 -fold dilution by PMA assay with Cq values higher than 35 cycles. Further evaluation revealed that the PMA assay showed an accordance rate of 98.0% (98/100) among clinical sputa. CONCLUSIONS we develop an acceptable method to directly identify the live bacteria from sputum samples. Our data demonstrate that the dark incubation plays a crucial role in the efficacy of PMA treatment for MTB.
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Affiliation(s)
- Jie Lu
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, MOE Key Laboratory of Major Diseases in Children, Beijing Pediatric Research Institute, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Huiwen Zheng
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, MOE Key Laboratory of Major Diseases in Children, Beijing Pediatric Research Institute, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Ping Chu
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, MOE Key Laboratory of Major Diseases in Children, Beijing Pediatric Research Institute, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Shujing Han
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, MOE Key Laboratory of Major Diseases in Children, Beijing Pediatric Research Institute, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Hui Yang
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, MOE Key Laboratory of Major Diseases in Children, Beijing Pediatric Research Institute, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Zhongdong Wang
- Qingdao Center for Disease Control and Prevention, Qingdao, China
| | - Jin Shi
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, MOE Key Laboratory of Major Diseases in Children, Beijing Pediatric Research Institute, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Zuosen Yang
- Liaoning Provincial Center for Disease Control and Prevention, Shenyang, China
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20
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Shenoy VP, Kumar A, Chawla K. Rapid detection of multidrug resistant tuberculosis in respiratory specimens at a tertiary care centre in south coastal Karnataka using Genotype MTBDR plus assay. IRANIAN JOURNAL OF MICROBIOLOGY 2018; 10:275-280. [PMID: 30675322 PMCID: PMC6339998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES Despite high prevalence of MDR-TB in India very limited information about MDR-TB and mutation patterns in rpoB, inhA and katG genes among MDR-isolates of Mycobacterium tuberculosis in south coastal Karnataka region is available; thus present study is an attempt to explore the extent of MDR-TB and mutation patterns prevalent among clinical isolates in this region using GenoType MTBDR plus assay. MATERIALS AND METHODS A total of 256 sputum samples from Pulmonary TB patients suspected of MDR-TB were tested by GenoType MTBDR plus as per manufacturer's guidelines for detection of mutations conferring resistance to rifampicin and isoniazid. The results of GenoType MTBDR plus were recorded and analysed using SPSS version 22. For all analyses, a p value <0.05 was considered statistically significant. RESULTS Fifty (19.53%) isolates were found MDR, 32 (12.50%) isolates were found mono-resistant to isoniazid and 15 (5.86%) isolates were found mono-resistant to rifampicin. Eleven isolates (4.3%) were found NTM. Mutation in codon S531L, S315T1 and C15T were most common in rpoB, katG and inhA genes respectively. Unknown mutations were found in 50.77% (33/65), 3.66% (3/82) and 26.83% (22/82) isolates for rpoB, katG and inhA genes respectively. Hetero-resistance in MDR, rifampicin monoresistant and isoniazid monoresistant isolates was found to be 26% (13/50), 20% (3/15) and 34.37% (11/32) respectively. CONCLUSION Mutation in codon S531L, S315T1 and C15T were most common mutations associated with MDR-TB. Further high number of isolates showed mutations in unknown regions and hetero-resistance thus more elaborate studies based on sequencing are desirable in this region.
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Affiliation(s)
- Vishnu Prasad Shenoy
- Corresponding author: Vishnu Prasad Shenoy, Ph.D, Department of Microbiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India. Tel: +919886616197,
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Xu K, Wang S, Wu J, Liu Z, Ji Z, Zheng L, Jin X, Ren J, Yang S, Li Z, Yuan J, Zhao Y, Li L. Performance of Biochip system in detecting drug resistant and multidrug-resistant tuberculosis using sputum collected from multiple clinical settings in Zhejiang, China. Sci Rep 2018; 8:10587. [PMID: 30002508 PMCID: PMC6043617 DOI: 10.1038/s41598-018-28955-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 06/25/2018] [Indexed: 11/24/2022] Open
Abstract
The objective of the present study was to conduct a multicentre, prospective evaluation of the diagnostic performance of the Biochip system for the detection of drug-resistant tuberculosis using smear-positive sputum specimens. This prospective study evaluated the diagnostic performance of this new platform for drug resistant and multidrug-resistant tuberculosis (MDR-TB) using 1491 smear-positive sputum specimens collected from multiple clinical settings. Using conventional culture-based culturing and drug-susceptibility testing as reference standards, the biochip system had a sensitivity of 86.08% and a specificity of 97.7% for rifampicin (RIF) detection, in detecting isoniazid (INH) resistance, it had a sensitivity of 79.36% and a specificity of 98.71%. With respect to MDR-TB detection, the sensitivity was 78.01% and the specificity was 98.86%. The performance only varies among different sites for RIF resistance, and there are no other statistically difference in diagnostic performance for other variables considered. The Biochip system shows favourable sensitivity and specificity for RIF and INH resistance, along with MDR-TB detection, directly using clinical smear-positive sputum samples. It is an alternative to conventional drug-susceptibility testing (DST) for detecting drug resistance or MDR-TB and is a method worth expanding to clinical settings in China.
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Affiliation(s)
- Kaijin Xu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Shuting Wang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Jie Wu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Zhengwei Liu
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, 310051, China
| | - Zhongkang Ji
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Lin Zheng
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Xiuyuan Jin
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Jingjing Ren
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Shigui Yang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Zhaoxia Li
- Department of infectious Diseases, Dongyang Municipal People'sHospital, Zhejiang, 322100, China
| | - Jing Yuan
- The Third People's Hospital of Shenzhen, Shenzhen, 518112, China
| | - Yanlin Zhao
- National Tuberculosis Reference Laboratory of China CDC, Beijing, 102206, China
| | - Lanjuan Li
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China.
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Zhang MJ, Ren WZ, Sun XJ, Liu Y, Liu KW, Ji ZH, Gao W, Yuan B. GeneChip analysis of resistant Mycobacterium tuberculosis with previously treated tuberculosis in Changchun. BMC Infect Dis 2018; 18:234. [PMID: 29788948 PMCID: PMC5964880 DOI: 10.1186/s12879-018-3131-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 05/04/2018] [Indexed: 11/29/2022] Open
Abstract
Background With the widespread use of rifampicin and isoniazid, bacterial resistance has become a growing problem. Additionally, the lack of relevant baseline information for the frequency of drug-resistant tuberculosis (TB) gene mutations is a critical issue, and the incidence of this infection in the city of Changchun has not investigated to date. However, compared with the slow traditional methods of drug susceptibility testing, recently developed detection methods, such as rifampicin and isoniazid resistance-related gene chip techniques, allow for rapid, easy detection and simultaneous testing for mutation frequency and drug resistance. Methods In this study, the rifampicin and isoniazid resistance-related gene mutation chip method was employed for an epidemiological investigation. To assess the gene mutation characteristics of drug-resistant TB and evaluate the chip method, we tested 2143 clinical specimens from patients from the infectious diseases hospital of Changchun city from January to December 2016. The drug sensitivity test method was used as the reference standard. Results The following mutation frequencies of sites in the rifampicin resistance gene rpoB were found: Ser531Leu (52.6%), His526Tyr (12.3%), and Leu511Pro (8.8%). The multidrug-resistance (MDR)-TB mutation frequency was 34.7% for rpoB Ser531Leu and katG Ser315Thr, 26.4% for rpoB Ser531Leu and inhA promoter − 15 (C → T), and 10.7% for rpoB His526Tyr and katG Ser315Thr. In addition, drug susceptibility testing served as a reference standard. In previously treated clinical cases, the sensitivity and specificity of GeneChip were 83.1 and 98.7% for rifampicin resistance, 79.9 and 99.6% for isoniazid resistance, and 74.1 and 99.8% for MDR-TB. Conclusions Our experimental results show that the chip method is accurate and reliable; it can be used to detect the type of drug-resistant gene mutation in clinical specimens. Moreover, this study can be used as a reference for future research on TB resistance baselines. Electronic supplementary material The online version of this article (10.1186/s12879-018-3131-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ming-Jin Zhang
- Department of Laboratory Animals, College of Animal Sciences, Jilin University, Changchun, 130062, Jilin, China.,Department of Infectious Diseases, Changchun Infectious Hospital, Changchun, 130123, Jilin, China
| | - Wen-Zhi Ren
- Department of Laboratory Animals, College of Animal Sciences, Jilin University, Changchun, 130062, Jilin, China
| | - Xue-Juan Sun
- Department of Infectious Diseases, Changchun Infectious Hospital, Changchun, 130123, Jilin, China
| | - Yang Liu
- Department of Infectious Diseases, Changchun Infectious Hospital, Changchun, 130123, Jilin, China
| | - Ke-Wei Liu
- Department of Infectious Diseases, Changchun Infectious Hospital, Changchun, 130123, Jilin, China
| | - Zhong-Hao Ji
- Department of Laboratory Animals, College of Animal Sciences, Jilin University, Changchun, 130062, Jilin, China
| | - Wei Gao
- Department of Laboratory Animals, College of Animal Sciences, Jilin University, Changchun, 130062, Jilin, China.
| | - Bao Yuan
- Department of Laboratory Animals, College of Animal Sciences, Jilin University, Changchun, 130062, Jilin, China.
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Wu X, Pang Y, Song Y, Dong W, Zhang T, Wen S, Huang H, Gao M. Implications of a school outbreak of multidrug-resistant tuberculosis in Northern China. Epidemiol Infect 2018; 146:584-588. [PMID: 29486815 PMCID: PMC9134526 DOI: 10.1017/s0950268817003120] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 12/11/2017] [Accepted: 12/16/2017] [Indexed: 11/06/2022] Open
Abstract
In this study, we identified a multidrug-resistant tuberculosis (MDR-TB) outbreak in a high school in northern China. The aim of this work was to describe TB transmission, drug resistance and treatment outcomes for this patient cluster. In January 2017, pulmonary TB was identified in a 17-year-old boy in northern China. Subsequently, a total of 11 TB cases were identified during 6-month follow-up of attendees of the same school. Of five students with latent TB infection (LTBI) receiving isoniazid preventive therapy (IPT), two pulmonary TB cases (40.0%) emerged in March and April, for an active case rate not significantly different from that of the non-IPT group (4/16, 25.0%, P = 0.598). All TB patients were first treated with a standardised first-line treatment regimen administered by the local TB hospital, with 11 of 12 active TB patients exhibiting poor treatment outcomes. Further data demonstrated that all nine patient isolates collected during this outbreak were MDR-TB and shared a common genotypic profile. In conclusion, our data demonstrate that diagnostic delay for the index MDR-TB case of this outbreak played a primary role in transmission of MDR-TB infection within a school setting. Importantly, IPT failed to prevent progression of MDR-TB from LTBI to active TB.
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Affiliation(s)
- Xiaoguang Wu
- Department of Tuberculosis, Beijing Chest Hospital affiliated to Capital Medical University, Beijing Tuberculosis & Thoracic Tumor Research Institute, Beijing, 101149, P. R. China
| | - Yu Pang
- National Clinical Laboratory on Tuberculosis, Beijing Chest Hospital affiliated to Capital Medical University, Beijing Tuberculosis & Thoracic Tumor Research Institute, Beijing, 101149, P. R. China
| | - Yanhua Song
- Department of Tuberculosis, Beijing Chest Hospital affiliated to Capital Medical University, Beijing Tuberculosis & Thoracic Tumor Research Institute, Beijing, 101149, P. R. China
| | - Wenzhu Dong
- National Clinical Laboratory on Tuberculosis, Beijing Chest Hospital affiliated to Capital Medical University, Beijing Tuberculosis & Thoracic Tumor Research Institute, Beijing, 101149, P. R. China
| | - Tingting Zhang
- National Clinical Laboratory on Tuberculosis, Beijing Chest Hospital affiliated to Capital Medical University, Beijing Tuberculosis & Thoracic Tumor Research Institute, Beijing, 101149, P. R. China
| | - Shuan Wen
- National Clinical Laboratory on Tuberculosis, Beijing Chest Hospital affiliated to Capital Medical University, Beijing Tuberculosis & Thoracic Tumor Research Institute, Beijing, 101149, P. R. China
| | - Hairong Huang
- National Clinical Laboratory on Tuberculosis, Beijing Chest Hospital affiliated to Capital Medical University, Beijing Tuberculosis & Thoracic Tumor Research Institute, Beijing, 101149, P. R. China
| | - Mengqiu Gao
- Department of Tuberculosis, Beijing Chest Hospital affiliated to Capital Medical University, Beijing Tuberculosis & Thoracic Tumor Research Institute, Beijing, 101149, P. R. China
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GeneXpert MTB/RIF Outperforms Mycobacterial Culture in Detecting Mycobacterium tuberculosis from Salivary Sputum. BIOMED RESEARCH INTERNATIONAL 2018; 2018:1514381. [PMID: 29805972 PMCID: PMC5899871 DOI: 10.1155/2018/1514381] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 02/28/2018] [Indexed: 01/22/2023]
Abstract
GeneXpert MTB/RIF (Xpert) assay has been endorsed for the diagnosis of pulmonary TB due to its high sensitivity and specificity for culture positive TB. There is no doubt that Xpert could not be more sensitive than mycobacterial culture, while the positive rate of Xpert among sputum samples was higher than that of mycobacterial culture in our laboratory. We therefore carried out a prospective study to determine a potential explanation for this unexpected result regarding the clinical use of Xpert. Overall, a total of 558 patients meeting inclusion criteria were enrolled in final analysis between August 2017 and September 2017 in Beijing Chest Hospital. The overall positive rate of Xpert among sputum samples was 45.9% (256/558), which was significantly higher than that of liquid culture (33.4%, 184/558; P < 0.01). The percentage of culture negative result in salivary sputum was significantly higher than that in mucoid sputum [odds ratio (OR): 5.04, 95% confidence interval (95% CI): 2.74–9.28; P < 0.01]. In addition, the TB cases having previous treatment history had a higher proportion of culture negative result than new cases (OR: 4.26, 95% CI: 1.61–11.28; P = 0.01). In conclusion, the results of this study demonstrate that Xpert outperforms mycobacterial culture in detecting MTB from salivary sputum. In addition, the previously treated patients are more likely to yield negative culture results. Our data will provide important hints to formulate an appropriate diagnostic algorithm for pulmonary tuberculosis based on the appearance of sputum samples.
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Xu C, Pang Y, Li R, Ruan Y, Wang L, Chen M, Zhang H. Clinical outcome of multidrug-resistant tuberculosis patients receiving standardized second-line treatment regimen in China. J Infect 2018; 76:348-353. [PMID: 29374587 DOI: 10.1016/j.jinf.2017.12.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 10/18/2017] [Accepted: 12/14/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of this study was to retrospectively analyze the clinical outcome and the risk factors associated with poor outcome of MDR-TB patients receiving standardized second-line treatment regimen in China. METHODS Between January 2008 and December 2010, a total of 12,100 clinical diagnosed TB cases at high risk of drug-resistant TB (DR-TB) were enrolled in this study. Routine follow-up tests were conducted every month during the 6-month intensive phase, and every two months during the 18-month continuation phase. RESULTS On the basis of phenotypical drug susceptibility test (DST) results, 2322 MDR-TB patients were confirmed, of which 1542 further received standardized second-line anti-TB regimen. The treatment success rate was 47.6% (734/1542): 688 patients (44.6%) were cured and 46 (3.0%) completed treatment. The percentage of cases with favorable outcome in previously untreated patients (57.6%) was significantly higher than that in treatment-experienced patients (46.1%, OR: 1.58, 95% CI: 1.17-2.14). In addition, a significant lower percentage of male MDR-TB cases with favorable outcome (45.8%) was observed using female MDR-TB cases as a reference (52.0%, OR: 1.31, 95% CI: 1.03-1.60). The proportion of MDR-TB cases with favorable outcome was significantly decreased in older age groups. CONCLUSIONS In conclusion, our data demonstrate that less than half of these patients receiving standardized second-line treatment regimen meet the definition of successful treatment during a 3-year period in China. More attention should be paid to the MDR-TB population at high-risk of poor clinical outcome, including male, elderly age, and those who have received prior treatment.
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Affiliation(s)
- Caihong Xu
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yu Pang
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory on Drug-resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China
| | - Renzhong Li
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yunzhou Ruan
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lixia Wang
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Mingting Chen
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hui Zhang
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
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The Feasibility of Xpert MTB/RIF Testing to Detect Rifampicin Resistance among Childhood Tuberculosis for Prevalence Surveys in Northern China. BIOMED RESEARCH INTERNATIONAL 2017; 2017:5857369. [PMID: 29359155 PMCID: PMC5735616 DOI: 10.1155/2017/5857369] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 10/17/2017] [Accepted: 11/09/2017] [Indexed: 12/22/2022]
Abstract
Drug resistance surveillance is crucial for control of drug-resistant tuberculosis (TB). However, limited data exists on the burden of drug-resistant TB in children. The goal of this work was to generate prevalence data regarding rifampicin- (RIF-) resistant childhood TB in northern China and to test the feasibility of Xpert for surveying pediatric TB drug resistance prevalence. We enrolled 362 clinically diagnosed childhood TB patients and collected sputum, gastric lavage aspirate (GLA), bronchoalveolar lavage fluid (BALF), and cerebral spinal fluid (CSF) samples. Xpert and solid culture were utilized to detect RIF resistance. The detection rate of Xpert-positive TB among new clinically diagnosed TB cases was 38.4% (139/362), significantly higher than that of solid culture-positive TB (16.3%, 59/362, P < 0.01). Notably, Xpert-positive rates differed significantly by sample type, with the highest positive rate for GLA (51.2%). The unit testing costs per RIF-resistant TB patient were $828.41 for solid culture and $761.86 for Xpert. Our data demonstrate that the prevalence of RIF resistance among childhood TB cases in our study (6.9%) is comparable to the national RIF resistance prevalence level of new cases (6.7%). In addition, Xpert is superior to the solid culture for RIF resistance survey in the childhood TB patients.
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Liu Z, Pan A, Wu B, Zhou L, He H, Meng Q, Chen S, Pang Y, Wang X. Feasibility of a new model for early detection of patients with multidrug-resistant tuberculosis in a developed setting of eastern China. Trop Med Int Health 2017; 22:1328-1333. [PMID: 28746979 DOI: 10.1111/tmi.12934] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The poor detection rate of multidrug-resistant tuberculosis (MDR-TB) highlights the urgent need to explore new case finding model to improve the detection of MDR-TB in China. The aim of this study was to evaluate the feasibility of a new model that combines molecular diagnostics and sputum transportation for early detection of patients with MDR-TB in Zhejiang. METHODS From May 2014 to January 2015, TB suspects were continuously enrolled at six county-level designated TB hospitals in Zhejiang. Each patient gave three sputum samples, which were submitted to laboratory for smear microscopy, solid culture and GeneXpert. The specimens from rifampin (RIF)-resistant cases detected by GeneXpert, and positive cultures were transported from county-level to prefecture-level laboratories for line probe analysis (LPA) and drug susceptibility testing (DST). The performance and interval of MDR-TB detection of the new model were compared with those of conventional model. RESULTS A total of 3151 sputum specimens were collected from TB suspects. The sensitivity of GeneXpert for detecting culture-positive cases was 92.7% (405/437), and its specificity was 91.3% (2428/2659). Of 16 RIF-resistant cases detected by DST, GeneXpert could correctly identify 15 cases, yielding a sensitivity of 93.8% (15/16). The specificity of GeneXpert for detecting RIF susceptibility was 100.0% (383/383). The average interval to diagnosis of the conventional DST model was 56.5 days, ranging from 43 to 71 days, which was significantly longer than that of GeneXpert plus LPA (22.2 days, P < 0.01). CONCLUSION Our data demonstrate that the combination of improved molecular TB tests and sputum transportation could significantly shorten the time required for detection of MDR-TB, which will bring benefits for preventing an epidemic of MDR-TB in this high-prevalence setting.
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Affiliation(s)
- Zhengwei Liu
- The Institute of TB Control, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Aizhen Pan
- The Institute of TB Control, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - BeiBei Wu
- The Institute of TB Control, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Lin Zhou
- The Institute of TB Control, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Haibo He
- The Institute of TB Control, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Qiong Meng
- The Institute of TB Control, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Songhua Chen
- The Institute of TB Control, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Yu Pang
- National Clinical Laboratory on Tuberculosis, Beijing Key laboratory for Drug-resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China
| | - Xiaomeng Wang
- The Institute of TB Control, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
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Jing W, Pang Y, Zong Z, Wang J, Guo R, Huo F, Jiang G, Ma Y, Huang H, Chu N. Rifabutin Resistance Associated with Double Mutations in rpoB Gene in Mycobacterium tuberculosis Isolates. Front Microbiol 2017; 8:1768. [PMID: 28959248 PMCID: PMC5603767 DOI: 10.3389/fmicb.2017.01768] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 08/31/2017] [Indexed: 11/14/2022] Open
Abstract
The objective of this study was to investigate the cross-resistance between rifampin (RIF) and rifabutin (RFB) among clinical Mycobacterium tuberculosis (MTB) isolates, and the correlations between specific rpoB mutations and the minimum inhibitory concentrations (MICs) of RIF and RFB. A total of 256 RIF-resistant isolates were included from the National Tuberculosis Clinical Laboratory in China. The MICs of MTB isolates against RIF and RFB were determined by using a microplate alamarBlue assay. In addition, all the MTB isolates were sequenced for mutations in rpoB gene. 204 out of 256 isolates (79.7%) were resistant to RFB, whereas 52 (20.3%) were susceptible to RFB. RIF-resistant/INH-susceptible (RR) group had a significant lower proportion of RFB-resistance than MDR- (P = 0.04) and XDR-TB group (P < 0.01). DNA sequencing revealed that there were 218 isolates (85.2%) with a single mutation, 26 (10.1%) with double mutations, and 12 (4.7%) without mutation in rpoB gene. Notably, although the single substitution of Leu511Pro, Asp516Gly, and His526Asn did not result in RFB resistance, 77.8% (7/9) of the MTB isolates with these double mutations became resistant to RFB. Compared with RR group (38.9%, 7/18), MDR-TB (63.5%, 106/167) had significantly higher proportion of isolates with mutations in codon 531 of rpoB gene (P = 0.04). Our data demonstrate that various rpoB mutations are associated with differential resistance to RIF and RFB. A single specific mutation in codons 511, 516, 526, and 533 was linked to the susceptibility to RFB for MTB, while the strains with these double mutations irrelevantly conferring RFB resistance produced RFB-resistant phenotype.
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Affiliation(s)
- Wei Jing
- Department of Tuberculosis, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital Affiliated to Capital Medical UniversityBeijing, China
| | - Yu Pang
- National Clinical Laboratory on Tuberculosis, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital Affiliated to Capital Medical UniversityBeijing, China
| | - Zhaojing Zong
- National Clinical Laboratory on Tuberculosis, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital Affiliated to Capital Medical UniversityBeijing, China
| | - Jing Wang
- Department of Tuberculosis, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital Affiliated to Capital Medical UniversityBeijing, China
| | - Ru Guo
- Department of Tuberculosis, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital Affiliated to Capital Medical UniversityBeijing, China
| | - Fengmin Huo
- National Clinical Laboratory on Tuberculosis, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital Affiliated to Capital Medical UniversityBeijing, China
| | - Guanglu Jiang
- National Clinical Laboratory on Tuberculosis, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital Affiliated to Capital Medical UniversityBeijing, China
| | - Yifeng Ma
- National Clinical Laboratory on Tuberculosis, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital Affiliated to Capital Medical UniversityBeijing, China
| | - Hairong Huang
- National Clinical Laboratory on Tuberculosis, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital Affiliated to Capital Medical UniversityBeijing, China
| | - Naihui Chu
- Department of Tuberculosis, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital Affiliated to Capital Medical UniversityBeijing, China
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Evaluation of the MTBDRplus 2.0 assay for the detection of multidrug resistance among persons with presumptive pulmonary TB in China. Sci Rep 2017; 7:3364. [PMID: 28611407 PMCID: PMC5469733 DOI: 10.1038/s41598-017-03473-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 04/28/2017] [Indexed: 11/08/2022] Open
Abstract
We have conducted a multicenter study of the diagnostic accuracy of the MTBDRplus 2.0 assay in compared with conventional and molecular reference standard in four tuberculosis (TB)-specialized hospitals of China. A total of 5038 patients were enrolled in this study. The overall sensitivity of the assay for the diagnosis of TB was 92.7% [1723/1858, 95% confidence interval (95% CI): 91.5-93.9]. In smear-positive/culture-positive cases the sensitivity was 97.7% (995/1018, 95% CI: 96.6-98.6), whereas in smear-negative/culture-positive cases it was 86.7% (728/840, 95% CI: 84.2-88.9). The agreement rate between MTBDRplus 2.0 and Xpert MTB/RIF was 97.7% (1015/1039, 95% CI: 96.6-98.5) for smear-positive cases and 97.0% (3682/3794, 95% CI: 96.5-97.6) for smear-negative cases. As compared with phenotypic drug susceptibility testing, the MTBDRplus 2.0 correctly identified 298 of 315 patients (94.6%, 95% CI: 91.5-96.8) with rifampicin-resistance. As noted previously, isoniazid resistance is associated with many different mutations and consequently the sensitivity compared to phenotypic testing was lower (81.0%, 95% CI: 76.8-84.7). In conclusion, this assay is a rapid, accurate test in terms of increased sensitivity for detecting smear-negative TB patients, as well as an alternative for detecting both RIF and INH resistance in persons with presumptive TB, whereas the absence of a mutation in the specimens must be interpreted cautiously.
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Li Q, Ou XC, Pang Y, Xia H, Huang HR, Zhao B, Wang SF, Zhao YL. A novel automatic molecular test for detection of multidrug resistance tuberculosis in sputum specimen: A case control study. Tuberculosis (Edinb) 2017; 105:9-12. [PMID: 28610793 DOI: 10.1016/j.tube.2017.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 03/16/2017] [Accepted: 03/28/2017] [Indexed: 01/26/2023]
Abstract
MiniLab tuberculosis (ML TB) assay is a new automatic diagnostic tool for diagnosis of multidrug resistance tuberculosis (MDR-TB). This study was conducted with aims to know the performance of this assay. Sputum sample from 224 TB suspects was collected from tuberculosis suspects seeking medical care at Beijing Chest hospital. The sputum samples were directly used for smear and ML TB test. The left sputum sample was used to conduct Xpert MTB/RIF, Bactec MGIT culture and drug susceptibility test (DST). All discrepancies between the results from DST, molecular and phenotypic methods were confirmed by DNA Sequencing. The sensitivity and specificity of ML TB test for detecting MTBC from TB suspects were 95.1% and 88.9%, respectively. The sensitivity for smear negative TB suspects was 64.3%. For detection of RIF resistance, the sensitivity and specificity of ML TB test were 89.2% and 95.7%, respectively. For detection of INH resistance, the sensitivity and specificity of ML TB test were 78.3% and 98.1%, respectively. ML TB test showed similar performance to Xpert MTB/RIF for detection of MTBC and RIF resistance. In addition, ML TB also had good performance for INH resistance detection.
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MESH Headings
- Antitubercular Agents/therapeutic use
- Automation, Laboratory
- Bacterial Proteins/genetics
- Bacteriological Techniques
- Case-Control Studies
- Catalase/genetics
- China
- DNA, Bacterial/genetics
- DNA, Bacterial/isolation & purification
- DNA-Directed RNA Polymerases/genetics
- Drug Resistance, Multiple, Bacterial/genetics
- Genotype
- Humans
- Mycobacterium tuberculosis/classification
- Mycobacterium tuberculosis/drug effects
- Mycobacterium tuberculosis/genetics
- Mycobacterium tuberculosis/isolation & purification
- Oxidoreductases/genetics
- Polymerase Chain Reaction
- Predictive Value of Tests
- RNA, Ribosomal, 16S/genetics
- Reproducibility of Results
- Ribotyping
- Sequence Analysis, DNA
- Sputum/microbiology
- Tuberculosis, Multidrug-Resistant/diagnosis
- Tuberculosis, Multidrug-Resistant/drug therapy
- Tuberculosis, Multidrug-Resistant/microbiology
- Tuberculosis, Pulmonary/diagnosis
- Tuberculosis, Pulmonary/drug therapy
- Tuberculosis, Pulmonary/microbiology
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Affiliation(s)
- Qiang Li
- National Tuberculosis Reference Laboratory, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xi C Ou
- National Tuberculosis Reference Laboratory, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yu Pang
- National Tuberculosis Reference Laboratory, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hui Xia
- National Tuberculosis Reference Laboratory, Chinese Center for Disease Control and Prevention, Beijing, China
| | | | - Bing Zhao
- National Tuberculosis Reference Laboratory, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Sheng F Wang
- National Tuberculosis Reference Laboratory, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yan L Zhao
- National Tuberculosis Reference Laboratory, Chinese Center for Disease Control and Prevention, Beijing, China.
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Wang L, Zhang Z, Yan Q, Lu J, Gao B, Zhao Y, Pang Y. Diagnostic dilemma of pulmonary tuberculosis among adults with severe mental illness in Beijing, China. BMC Infect Dis 2017; 17:83. [PMID: 28100191 PMCID: PMC5241947 DOI: 10.1186/s12879-017-2190-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 01/05/2017] [Indexed: 11/10/2022] Open
Abstract
Background Although the prevalence of tuberculosis has decreased significantly over the past decades, the certain populations with mental illness are at increased risk for tuberculosis infection and transmission. However, no studies have examined the performance of different laboratory examination methods among people with severe mental illness in China. Methods In this study, we firstly performed a retrospective study to evaluate the feasibility of three routine laboratory methods, including sputum microscopy, solid culture and GeneXpert, to diagnose tuberculosis patients with mental illness. Results During August 2010 and March 2013, a total of 251 TB patients based on clinical and radiographic criteria with severe mental illness were enrolled in this study. The majority of patients was homeless (97/251, 38.6%), and the other 62 (24.7%) and 92 (36.7%) were from urban and rural region, respectively. The most frequently diagnosed mental illness was schizophrenia, accounting for 84.1% (211/251) of patients available for analysis. In addition, the laboratory received 753 sputum samples collected from these 251 TB patients, of which 76.0% (572/753) of samples were classified as salivary sputum, which were unqualified for microscopy and culture. When the test results were analyzed by patients, the positive numbers of TB patients detected by sputum microscopy, solid culture and GeneXpert were 3 (1.2%), 5 (2.0%) and 5 (2.0%), respectively. Conclusions In conclusion, our findings reveal that the current laboratory examinations based on sputum samples seem not to be suitable for the diagnosis of active TB in the persons with severe mental illness. The products using a non-invasive specimen such as urine deserve further evaluation, which may generate benefit for the early diagnosis of TB in this special population.
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Affiliation(s)
- Li Wang
- Changping Tuberculosis Dispensary, Beijing, People's Republic of China
| | - Zhiguo Zhang
- Changping Tuberculosis Dispensary, Beijing, People's Republic of China
| | - Qiuli Yan
- Changping Hospital of Integrated Chinese and Western Medicine, Beijing, People's Republic of China
| | - Jie Lu
- Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Baoyin Gao
- Changping Hospital of Integrated Chinese and Western Medicine, Beijing, People's Republic of China
| | - Yanlin Zhao
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Yu Pang
- Beijing Chest Hospital, Capital Medical University, Beijing, People's Republic of China. .,National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China.
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Factors Associated with Missed Detection of Mycobacterium tuberculosis by Automated BACTEC MGIT 960 System. BIOMED RESEARCH INTERNATIONAL 2016; 2016:5972021. [PMID: 28078294 PMCID: PMC5204086 DOI: 10.1155/2016/5972021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 11/03/2016] [Indexed: 01/29/2023]
Abstract
Despite the demonstration of excellent performance, mycobacterial growth in BACTEC MGIT 960 can go undetected. The aim of this study was to investigate the prevalence of “false-negative” culture sample in Beijing and the potential factors associated with the detection failures by MGIT 960. Of the 577 sputum samples tested, 141 (24.4%) were culture-positive for mycobacteria, of which 133 (94.3%) were automatically determined by MGIT 960 system and 8 (5.7%) were positive for visual growth (false negative by MGIT). Statistical analysis showed that positive grade of specimen had no influence on the false-negative rate by MGIT 960 system (χ2 = 2.207, P = 0.820). In addition, the mean time to detection (TTD) was 241.4 (range: 224–261) hours for false-negative group and 186.8 (range: 173–199) hours for positive group. The difference in TTD between false-negative and positive groups was statistically significant (P < 0.01). In conclusion, our data demonstrate that the automatic MGIT missed a small portion of bacteriological mycobacterial patients. In addition, the poor growth rate rather than the low grade of AFB smear is associated with the detection failure by MGIT. Our findings highlight the notion that manual inspection for all instrument-negative MGIT tubes will bring about considerable benefit to patients and clinicians.
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Pang Y, Dong H, Tan Y, Deng Y, Cai X, Jing H, Xia H, Li Q, Ou X, Su B, Li X, Zhang Z, Li J, Zhang J, Huan S, Zhao Y. Rapid diagnosis of MDR and XDR tuberculosis with the MeltPro TB assay in China. Sci Rep 2016; 6:25330. [PMID: 27149911 PMCID: PMC4858717 DOI: 10.1038/srep25330] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 04/15/2016] [Indexed: 11/09/2022] Open
Abstract
New diagnostic methods have provided a promising solution for rapid and reliable detection of drug-resistant TB strains. The aim of this study was to evaluate the performance of the MeltPro TB assay in identifying multidrug-resistant (MDR-) and extensively drug-resistant tuberculosis (XDR-TB) patients from sputum samples. The MeltPro TB assay was evaluated using sputum samples from 2057 smear-positive TB patients. Phenotypic Mycobacterial Growth Indicator Tube (MGIT) 960 drug susceptibility testing served as a reference standard. The sensitivity of the MeltPro TB assay was 94.2% for detecting resistance to rifampicin and 84.9% for detecting resistance to isoniazid. For second-line drugs, the assay showed a sensitivity of 83.3% for ofloxacin resistance, 75.0% for amikacin resistance, and 63.5% for kanamycin resistance. However, there was a significant difference for detecting kanamycin resistance between the two pilot sites in sensitivity, which was 53.2% in Guangdong and 81.5% in Shandong (P = 0.015). Overall, the MeltPro TB assay demonstrated good performance for the detection of MDR- and XDR-TB, with a sensitivity of 86.7% and 71.4%, respectively. The MeltPro TB assay is an excellent alternative for the detection of MDR- and XDR-TB cases in China, with high accuracy, short testing turn-around time, and low unit price compared with other tests.
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Affiliation(s)
- Yu Pang
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | | | - Yaoju Tan
- Department of Clinical Laboratory, Guangzhou Chest Hospital, Guangdong Province, Guangzhou, China
| | - Yunfeng Deng
- Katharine Hsu International Research Center of Human Infectious Diseases, Shandong Provincial Chest Hospital, Jinan, China
| | - Xingshan Cai
- Department of Clinical Laboratory, Guangzhou Chest Hospital, Guangdong Province, Guangzhou, China
| | - Hui Jing
- Katharine Hsu International Research Center of Human Infectious Diseases, Shandong Provincial Chest Hospital, Jinan, China
| | - Hui Xia
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Qiang Li
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xichao Ou
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Biyi Su
- Department of Clinical Laboratory, Guangzhou Chest Hospital, Guangdong Province, Guangzhou, China
| | - Xuezheng Li
- Katharine Hsu International Research Center of Human Infectious Diseases, Shandong Provincial Chest Hospital, Jinan, China
| | | | | | | | - Shitong Huan
- Bill and Melinda Gates Foundation, China Office, Beijing, China
| | - Yanlin Zhao
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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Drobniewski F, Cooke M, Jordan J, Casali N, Mugwagwa T, Broda A, Townsend C, Sivaramakrishnan A, Green N, Jit M, Lipman M, Lord J, White PJ, Abubakar I. Systematic review, meta-analysis and economic modelling of molecular diagnostic tests for antibiotic resistance in tuberculosis. Health Technol Assess 2016; 19:1-188, vii-viii. [PMID: 25952553 DOI: 10.3310/hta19340] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Drug-resistant tuberculosis (TB), especially multidrug-resistant (MDR, resistance to rifampicin and isoniazid) disease, is associated with a worse patient outcome. Drug resistance diagnosed using microbiological culture takes days to weeks, as TB bacteria grow slowly. Rapid molecular tests for drug resistance detection (1 day) are commercially available and may promote faster initiation of appropriate treatment. OBJECTIVES To (1) conduct a systematic review of evidence regarding diagnostic accuracy of molecular genetic tests for drug resistance, (2) conduct a health-economic evaluation of screening and diagnostic strategies, including comparison of alternative models of service provision and assessment of the value of targeting rapid testing at high-risk subgroups, and (3) construct a transmission-dynamic mathematical model that translates the estimates of diagnostic accuracy into estimates of clinical impact. REVIEW METHODS AND DATA SOURCES A standardised search strategy identified relevant studies from EMBASE, PubMed, MEDLINE, Bioscience Information Service (BIOSIS), System for Information on Grey Literature in Europe Social Policy & Practice (SIGLE) and Web of Science, published between 1 January 2000 and 15 August 2013. Additional 'grey' sources were included. Quality was assessed using quality assessment of diagnostic accuracy studies version 2 (QUADAS-2). For each diagnostic strategy and population subgroup, a care pathway was constructed to specify which medical treatments and health services that individuals would receive from presentation to the point where they either did or did not complete TB treatment successfully. A total cost was estimated from a health service perspective for each care pathway, and the health impact was estimated in terms of the mean discounted quality-adjusted life-years (QALYs) lost as a result of disease and treatment. Costs and QALYs were both discounted at 3.5% per year. An integrated transmission-dynamic and economic model was used to evaluate the cost-effectiveness of introducing rapid molecular testing (in addition to culture and drug sensitivity testing). Probabilistic sensitivity analysis was performed to evaluate the impact on cost-effectiveness of diagnostic and treatment time delays, diagnosis and treatment costs, and associated QALYs. RESULTS A total of 8922 titles and abstracts were identified, with 557 papers being potentially eligible. Of these, 56 studies contained sufficient test information for analysis. All three commercial tests performed well when detecting drug resistance in clinical samples, although with evidence of heterogeneity between studies. Pooled sensitivity for GenoType® MTBDRplus (Hain Lifescience, Nehren, Germany) (isoniazid and rifampicin resistance), INNO-LiPA Rif.TB® (Fujirebio Europe, Ghent, Belgium) (rifampicin resistance) and Xpert® MTB/RIF (Cepheid Inc., Sunnyvale, CA, USA) (rifampicin resistance) was 83.4%, 94.6%, 95.4% and 96.8%, respectively; equivalent pooled specificity was 99.6%, 98.2%, 99.7% and 98.4%, respectively. Results of the transmission model suggest that all of the rapid assays considered here, if added to the current diagnostic pathway, would be cost-saving and achieve a reduction in expected QALY loss compared with current practice. GenoType MTBDRplus appeared to be the most cost-effective of the rapid tests in the South Asian population, although results were similar for GeneXpert. In all other scenarios GeneXpert appeared to be the most cost-effective strategy. CONCLUSIONS Rapid molecular tests for rifampicin and isoniazid resistance were sensitive and specific. They may also be cost-effective when added to culture drug susceptibility testing in the UK. There is global interest in point-of-care testing and further work is needed to review the performance of emerging tests and the wider health-economic impact of decentralised testing in clinics and primary care, as well as non-health-care settings, such as shelters and prisons. STUDY REGISTRATION This study is registered as PROSPERO CRD42011001537. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Francis Drobniewski
- Public Health England National Mycobacterium Reference Laboratory, London, UK
| | - Mary Cooke
- Centre for Infectious Disease Epidemiology, Research Department of Infection and Population Health, University College London, London, UK
| | - Jake Jordan
- Health Economics Research Group, Brunel University, Uxbridge, UK
| | - Nicola Casali
- Department of Infectious Diseases and Immunity, Imperial College London, London, UK
| | - Tendai Mugwagwa
- Modelling and Economics Unit, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Agnieszka Broda
- Department of Infectious Diseases and Immunity, Imperial College London, London, UK
| | | | | | - Nathan Green
- Modelling and Economics Unit, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Mark Jit
- Modelling and Economics Unit, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Marc Lipman
- Division of Medicine, University College London, London, UK
| | - Joanne Lord
- Health Economics Research Group, Brunel University, Uxbridge, UK
| | - Peter J White
- Modelling and Economics Unit, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Ibrahim Abubakar
- Centre for Infectious Disease Epidemiology, Research Department of Infection and Population Health, University College London, London, UK
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Pang Y, Lu J, Yang J, Wang Y, Cohen C, Ni X, Zhao Y. A novel method for diagnosis of smear-negative tuberculosis patients by combining a random unbiased Phi29 amplification with a specific real-time PCR. Tuberculosis (Edinb) 2015; 95:411-4. [PMID: 25957821 DOI: 10.1016/j.tube.2015.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 03/27/2015] [Accepted: 03/29/2015] [Indexed: 11/18/2022]
Abstract
In this study, we develop a novel method for diagnosis of smear-negative tuberculosis patients by performing a random unbiased Phi29 amplification prior to the use of a specific real-time PCR. The limit of detection (LOD) of the conventional real-time PCR was 100 colony-forming units (CFU) of MTB genome/reaction, while the REPLI real-time PCR assay could detect 0.4 CFU/reaction. In comparison with the conventional real-time PCR, REPLI real-time PCR shows better sensitivity for the detection of smear-negative tuberculosis (P = 0.015).
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Affiliation(s)
- Yu Pang
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jie Lu
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Jian Yang
- Shaanxi Tuberculosis Dispensary, Shaanxi, China
| | - Yufeng Wang
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Chad Cohen
- McGill International TB Centre, Montreal, Quebec, Canada
| | - Xin Ni
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, China.
| | - Yanlin Zhao
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
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Zhang Z, Lu J, Liu M, Wang Y, Qu G, Li H, Wang J, Pang Y, Liu C, Zhao Y. Genotyping and molecular characteristics of multidrug-resistant Mycobacterium tuberculosis isolates from China. J Infect 2015; 70:335-45. [DOI: 10.1016/j.jinf.2014.11.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 11/23/2014] [Accepted: 11/25/2014] [Indexed: 01/02/2023]
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Effect of a comprehensive programme to provide universal access to care for sputum-smear-positive multidrug-resistant tuberculosis in China: a before-and-after study. LANCET GLOBAL HEALTH 2015; 3:e217-28. [DOI: 10.1016/s2214-109x(15)70021-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Diagnostic value of GeneChip for detection of resistant Mycobacterium tuberculosis in patients with differing treatment histories. J Clin Microbiol 2014; 53:131-5. [PMID: 25355771 DOI: 10.1128/jcm.02283-14] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The increasing burden of drug-resistant tuberculosis (TB) poses an escalating threat to national TB control programs. To assist appropriate treatment for TB patients, accurate and rapid detection of drug resistance is critical. The GeneChip test is a novel molecular tool for the diagnosis of TB drug resistance. Performance-related data on GeneChip are limited, and evaluation in new and previously treated TB cases has never been performed. We evaluated the diagnostic performance of GeneChip in detecting resistance to rifampin (RMP) and isoniazid (INH) and in detecting multidrug-resistant tuberculosis (MDR-TB) in comparison with standard drug susceptibility testing (DST) and compared the results in a group of previously treated and newly detected TB patients in an urban area in southeastern China. One thousand one hundred seventy-three (83.8%) new cases and 227 (16.2%) previously treated cases were collected between January 2011 and September 2013. The GeneChip showed a specificity of 97.8% and a sensitivity of 94.8% for detection of RMP resistance and 97.3% and 70.9%, respectively, for INH resistance in new cases. For previously treated cases, the overall sensitivity, specificity, and agreement rate are 94.6%, 91.3%, and 92.1%, respectively, for detection of RMP resistance and 69.7%, 95.4%, and 86.8%, respectively, for INH resistance. The sensitivity and specificity of MDR-TB were 81.8% and 99.0% in new cases and 77.8% and 93.4% in previously treated cases, respectively. The GeneChip system provides a simple, rapid, reliable, and accurate clinical assay for the detection of TB drug resistance, and it is a potentially important diagnostic tool in a high-prevalence area.
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Zhang D, Liu B, Wang Y, Pang Y. Rapid molecular screening for multidrug-resistant tuberculosis in a resource-limited region of China. Trop Med Int Health 2014; 19:1259-66. [PMID: 25040060 DOI: 10.1111/tmi.12359] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the molecular characteristics of MDR and XDR strains circulating in Chongqing, China. METHODS The drug target genes conferring for rifampicin (RIF), isoniazid (INH), ethambutol (EMB), ofloxacin (OFLX) and kanamycin (KAN) resistance were screened by DNA sequencing to determine the mutation frequencies in this area. RESULTS Drug susceptibility of 208 MDR isolates revealed that 132 (63.46%) were resistant to streptomycin (SM), 96 (46.15%) to ethambutol (EMB), 51 (24.52%) to ofloxacin (OFLX), and 26 (12.50%) to kanamycin (KAN); six (2.88%) isolates had XDR profiles. In comparison with the drug susceptibility phenotype, the sensitivity of drug resistance by DNA sequencing was 91.83% for RIF, 87.50% for INH, 66.67% for EMB, 74.51% for OFLX and 53.85% for KAN resistance. 12.50% of EMB- and 1.27% of OFLX-susceptible isolates were harboured genetic mutations in embB and gyrA, respectively. CONCLUSION Our findings demonstrate that the hot-spot regions localised in rpoB, katG and inhA genes serve as excellent markers for the corresponding drug resistance, while EMB, OFLX or KAN drug-resistant TB cases may not be identifiable by scanning embB, gyrA, rrs and eis promoter in Chongqing, indicating that further studies on the drug resistance mechanisms of EMB, OFLX and KAN are urgently needed to elucidate the low sensitivity between genomic substitutions and drug-resistant phenotype.
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Affiliation(s)
- Dan Zhang
- Yongchuan Hospital, Chongqing Medical University, Chongqing, China
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40
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Hu S, Li G, Li H, Liu X, Niu J, Quan S, Wang F, Wen H, Xu Y, Li Q. Rapid detection of isoniazid resistance in Mycobacterium tuberculosis isolates by use of real-time-PCR-based melting curve analysis. J Clin Microbiol 2014; 52:1644-52. [PMID: 24599986 PMCID: PMC3993622 DOI: 10.1128/jcm.03395-13] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 03/01/2014] [Indexed: 11/20/2022] Open
Abstract
The MeltPro TB/INH assay, recently approved by the Chinese Food and Drug Administration, is a closed-tube, dual-color, melting curve analysis-based, real-time PCR test specially designed to detect 30 isoniazid (INH) resistance mutations in katG position 315 (katG 315), the inhA promoter (positions -17 to -8), inhA position 94, and the ahpC promoter (positions -44 to -30 and -15 to 3) of Mycobacterium tuberculosis. Here we evaluated both the analytical performance and clinical performance of this assay. Analytical studies with corresponding panels demonstrated that the accuracy for detection of different mutation types (10 wild-type samples and 12 mutant type samples), the limit of detection (2×10(3) to 2×10(4) bacilli/ml), reproducibility (standard deviation [SD], <0.4°C), and the lowest heteroresistance level (40%) all met the parameters preset by the kit. The assay could be run on five types of real-time PCR machines, with the shortest running time (105 min) obtained with the LightCycler 480 II. Clinical studies enrolled 1,096 clinical isolates collected from three geographically different tuberculosis centers, including 437 INH-resistant isolates and 659 INH-susceptible isolates characterized by traditional drug susceptibility testing on Löwenstein-Jensen solid medium. The clinical sensitivity and specificity of the MeltPro TB/INH assay were 90.8% and 96.4%, respectively. DNA sequencing analysis showed that, except for the 5 mutants outside the detection range of the MeltPro assay, a concordance rate between the two methods of 99.1% (457/461) was obtained. Among the 26 mutation types detected, katG S315T (AGC→ACC), inhA -15C→T, katG S315N (AGC→AAC), and ahpC promoter -10C→T accounted for more than 90%. Overall, the MeltPro TB/INH assay represents a reliable and rapid tool for the detection of INH resistance in clinical isolates.
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Affiliation(s)
- Siyu Hu
- Engineering Research Center of Molecular Diagnostics, Ministry of Education, The State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Life Sciences, Xiamen University, Xiamen, Fujian, China
| | - Guoli Li
- Institute for Tuberculosis Research, 309th Hospital of Chinese PLA, Beijing, China
| | - Hui Li
- Tuberculosis Reference Laboratory, Henan Center for Disease Control and Prevention, Zhengzhou, Henan, China
| | - Xiaoli Liu
- Department of Pathological Laboratory, Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Jianjun Niu
- Division of Tuberculosis Prevention, Xiamen Center for Disease Control and Prevention, Xiamen, Fujian, China
| | - Shengmao Quan
- Engineering Research Center of Molecular Diagnostics, Ministry of Education, The State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Life Sciences, Xiamen University, Xiamen, Fujian, China
| | - Feng Wang
- Department of Pathological Laboratory, Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Huixin Wen
- Division of Tuberculosis Prevention, Xiamen Center for Disease Control and Prevention, Xiamen, Fujian, China
| | - Ye Xu
- Engineering Research Center of Molecular Diagnostics, Ministry of Education, The State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Life Sciences, Xiamen University, Xiamen, Fujian, China
| | - Qingge Li
- Engineering Research Center of Molecular Diagnostics, Ministry of Education, The State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Life Sciences, Xiamen University, Xiamen, Fujian, China
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Cost-effectiveness comparison of Genechip and conventional drug susceptibility test for detecting multidrug-resistant tuberculosis in China. PLoS One 2013; 8:e69267. [PMID: 23935970 PMCID: PMC3720587 DOI: 10.1371/journal.pone.0069267] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 06/06/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Genechip (CapitalBio, Beijing, China) is a system for diagnosing resistance to rifampin and isoniazid, which shows high efficiency in detecting drug-resistant tuberculosis. Here, we firstly evaluated the costs of Genechip for detecting the drug susceptibility of Mycobacterium tuberculosis, compared to conventional drug susceptibility test (DST) in laboratories in China. METHODOLOGY/PRINCIPAL FINDINGS Data on the costs of the two tests were collected at four hospitals. Costs were calculated using the essential factor cost calculation method. The costs of diagnosing a single case of multidrug-resistant tuberculosis (MDR-TB) using Genechip and DST were US$22.38 and $53.03, respectively. Taking into account the effect on costs from failure of a certain number of tests to accurately diagnose MDR-TB, the costs of Genechip and DST increased by 17.65% and 5.22%, respectively. The cost of both tests decreased with the increasing prevalence of MDR-TB disease, and the cost of Genechip at a sensitivity of more than 50% was lower than that of DST. When price of Genechip was varied to 50%, 80%, 150%, and 200% of the original price, the cost of Genechip at sensitivities of more than 30%, 40%, 60%, and 70%, respectively, was also lower than that of DST. CONCLUSIONS/SIGNIFICANCE This study showed that Genechip was a more cost-effective method of diagnosing MDR-TB compared to conventional DST.
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