1
|
Sciaudone M, Carpena R, Calderón M, Sheen P, Zimic M, Coronel J, Gilman RH, Bowman NM. Rapid detection of Mycobacterium tuberculosis using recombinase polymerase amplification: A pilot study. PLoS One 2023; 18:e0295610. [PMID: 38064441 PMCID: PMC10707601 DOI: 10.1371/journal.pone.0295610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 11/25/2023] [Indexed: 12/18/2023] Open
Abstract
Tuberculosis remains one of the leading causes of death worldwide, especially in low- and middle-income countries. Tuberculosis treatment and control efforts are hindered by the difficulty in making the diagnosis, as currently available diagnostic tests are too slow, too expensive, or not sufficiently sensitive. Recombinase polymerase amplification (RPA) is a novel technique that allows for the amplification of DNA rapidly, at constant temperature, and with minimal expense. We calculated and compared the limit of detection, sensitivity, and specificity of two RPA-based assays for the diagnosis of pulmonary tuberculosis, using two sets of published primers. We also calculated and compared the assays' limits of detection and compared their performance using two different DNA extraction methods prior to amplification (a commercially available DNA extraction kit vs. the chelex method). The RPA-lateral flow assay had a limit of detection of 5 fg/μL of DNA, a sensitivity of 53.2%, and a specificity of 93.3%, while the real time-RPA assay had a limit of detection of 25 fg/μL of DNA, a sensitivity of 85.1%, and a specificity of 93.3%. There was no difference in assay performance when DNA extraction was carried out using the commercial kit vs. the chelex method. The real-time RPA assay has adequate sensitivity and specificity for the diagnosis of pulmonary tuberculosis and could be a viable diagnostic tool in resource-limited settings, but the lateral flow assay did not perform as well, perhaps due to the fact we used stored sputum specimens from a biorepository. More work is needed to optimize the RPA-lateral flow assay, to get a more accurate estimate of its specificity and sensitivity using prospectively collected specimens, and to develop both assays into point-of-care tests that can be easily deployed in the field.
Collapse
Affiliation(s)
- Michael Sciaudone
- Department of Medicine, Section of Infectious Diseases, Tulane University School of Medicine, New Orleans, Louisiana, United States of America
- Center for Intelligent Molecular Diagnostics, Tulane University School of Medicine, New Orleans, Louisiana, United States of America
| | - Renzo Carpena
- Laboratorios de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Maritza Calderón
- Laboratorios de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Patricia Sheen
- Laboratorios de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Mirko Zimic
- Laboratorios de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Jorge Coronel
- Laboratorios de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Robert H. Gilman
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Natalie M. Bowman
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States of America
| |
Collapse
|
2
|
Cao WF, Leng EL, Liu SM, Zhou YL, Luo CQ, Xiang ZB, Cai W, Rao W, Hu F, Zhang P, Wen A. Recent advances in microbiological and molecular biological detection techniques of tuberculous meningitis. Front Microbiol 2023; 14:1202752. [PMID: 37700862 PMCID: PMC10494440 DOI: 10.3389/fmicb.2023.1202752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/21/2023] [Indexed: 09/14/2023] Open
Abstract
Tuberculous meningitis (TBM) is the most common type of central nervous system tuberculosis (TB) and has the highest mortality and disability rate. Early diagnosis is key to improving the prognosis and survival rate of patients. However, laboratory diagnosis of TBM is often difficult due to its paucibacillary nature and sub optimal sensitivity of conventional microbiology and molecular tools which often fails to detect the pathogen. The gold standard for TBM diagnosis is the presence of MTB in the CSF. The recognised methods for the identification of MTB are acid-fast bacilli (AFB) detected under CSF smear microscopy, MTB cultured in CSF, and MTB detected by polymerase chain reaction (PCR). Currently, many studies consider that all diagnostic techniques for TBM are not perfect, and no single technique is considered simple, fast, cheap, and efficient. A definite diagnosis of TBM is still difficult in current clinical practice. In this review, we summarise the current state of microbiological and molecular biological diagnostics for TBM, the latest advances in research, and discuss the advantages of these techniques, as well as the issues and challenges faced in terms of diagnostic effectiveness, laboratory infrastructure, testing costs, and clinical expertise, for clinicians to select appropriate testing methods.
Collapse
Affiliation(s)
- Wen-Feng Cao
- Department of Neurology, Jiangxi Provincial People’s Hospital (The First Affiliated Hospital of Nanchang Medical College), Nanchang, Jiangxi, China
- Department of neurology, Xiangya Hospital, Central South University, Jiangxi Hospital, National Regional Center for Neurological Diseases, Nanchang, Jiangxi, China
| | - Er-Ling Leng
- Department of Pediatrics, Jiangxi Provincial People’s Hospital (The First Affiliated Hospital of Nanchang Medical College), Nanchang, Jiangxi, China
| | - Shi-Min Liu
- Department of Neurology, Jiangxi Provincial People’s Hospital (The First Affiliated Hospital of Nanchang Medical College), Nanchang, Jiangxi, China
- Department of neurology, Xiangya Hospital, Central South University, Jiangxi Hospital, National Regional Center for Neurological Diseases, Nanchang, Jiangxi, China
| | - Yong-Liang Zhou
- Department of Neurology, Jiangxi Provincial People’s Hospital (The First Affiliated Hospital of Nanchang Medical College), Nanchang, Jiangxi, China
- Department of neurology, Xiangya Hospital, Central South University, Jiangxi Hospital, National Regional Center for Neurological Diseases, Nanchang, Jiangxi, China
| | - Chao-Qun Luo
- Department of Neurology, Jiangxi Provincial People’s Hospital (The First Affiliated Hospital of Nanchang Medical College), Nanchang, Jiangxi, China
- Department of neurology, Xiangya Hospital, Central South University, Jiangxi Hospital, National Regional Center for Neurological Diseases, Nanchang, Jiangxi, China
| | - Zheng-Bing Xiang
- Department of Neurology, Jiangxi Provincial People’s Hospital (The First Affiliated Hospital of Nanchang Medical College), Nanchang, Jiangxi, China
- Department of neurology, Xiangya Hospital, Central South University, Jiangxi Hospital, National Regional Center for Neurological Diseases, Nanchang, Jiangxi, China
| | - Wen Cai
- Department of Neurology, Jiangxi Provincial People’s Hospital (The First Affiliated Hospital of Nanchang Medical College), Nanchang, Jiangxi, China
- Department of neurology, Xiangya Hospital, Central South University, Jiangxi Hospital, National Regional Center for Neurological Diseases, Nanchang, Jiangxi, China
| | - Wei Rao
- Department of Neurology, Jiangxi Provincial People’s Hospital (The First Affiliated Hospital of Nanchang Medical College), Nanchang, Jiangxi, China
- Department of neurology, Xiangya Hospital, Central South University, Jiangxi Hospital, National Regional Center for Neurological Diseases, Nanchang, Jiangxi, China
| | - Fan Hu
- Department of Neurology, Jiangxi Provincial People’s Hospital (The First Affiliated Hospital of Nanchang Medical College), Nanchang, Jiangxi, China
- Department of neurology, Xiangya Hospital, Central South University, Jiangxi Hospital, National Regional Center for Neurological Diseases, Nanchang, Jiangxi, China
| | - Ping Zhang
- Department of Neurology, Jiangxi Provincial People’s Hospital (The First Affiliated Hospital of Nanchang Medical College), Nanchang, Jiangxi, China
- Department of neurology, Xiangya Hospital, Central South University, Jiangxi Hospital, National Regional Center for Neurological Diseases, Nanchang, Jiangxi, China
| | - An Wen
- Department of Neurology, Jiangxi Provincial People’s Hospital (The First Affiliated Hospital of Nanchang Medical College), Nanchang, Jiangxi, China
- Department of neurology, Xiangya Hospital, Central South University, Jiangxi Hospital, National Regional Center for Neurological Diseases, Nanchang, Jiangxi, China
| |
Collapse
|
3
|
Wang J, Ma X, Cao L, Leng Y, Li Z, Cheng Z, Cao Y, Huang X, Zheng J. DB-DCAFN: dual-branch deformable cross-attention fusion network for bacterial segmentation. Vis Comput Ind Biomed Art 2023; 6:13. [PMID: 37402101 DOI: 10.1186/s42492-023-00141-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/18/2023] [Indexed: 07/05/2023] Open
Abstract
Sputum smear tests are critical for the diagnosis of respiratory diseases. Automatic segmentation of bacteria from sputum smear images is important for improving diagnostic efficiency. However, this remains a challenging task owing to the high interclass similarity among different categories of bacteria and the low contrast of the bacterial edges. To explore more levels of global pattern features to promote the distinguishing ability of bacterial categories and maintain sufficient local fine-grained features to ensure accurate localization of ambiguous bacteria simultaneously, we propose a novel dual-branch deformable cross-attention fusion network (DB-DCAFN) for accurate bacterial segmentation. Specifically, we first designed a dual-branch encoder consisting of multiple convolution and transformer blocks in parallel to simultaneously extract multilevel local and global features. We then designed a sparse and deformable cross-attention module to capture the semantic dependencies between local and global features, which can bridge the semantic gap and fuse features effectively. Furthermore, we designed a feature assignment fusion module to enhance meaningful features using an adaptive feature weighting strategy to obtain more accurate segmentation. We conducted extensive experiments to evaluate the effectiveness of DB-DCAFN on a clinical dataset comprising three bacterial categories: Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa. The experimental results demonstrate that the proposed DB-DCAFN outperforms other state-of-the-art methods and is effective at segmenting bacteria from sputum smear images.
Collapse
Affiliation(s)
- Jingkun Wang
- School of Biomedical Engineering (Suzhou), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230026, China
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, 215163, China
| | - Xinyu Ma
- School of Biomedical Engineering (Suzhou), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230026, China
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, 215163, China
| | - Long Cao
- Department of Infectious Diseases, the First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Yilin Leng
- Institute of Biomedical Engineering, School of Communication and Information Engineering, Shanghai University, Shanghai, 200444, China
| | - Zeyi Li
- College of Computer and Information, Hohai University, Nanjing, 210098, China
| | - Zihan Cheng
- School of Electronic and Information Engineering, Changchun University of Science and Technology, Changchun, 130022, China
| | - Yuzhu Cao
- School of Biomedical Engineering (Suzhou), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230026, China
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, 215163, China
- Jinan Guoke Medical Technology Development Co., Ltd, Jinan, 250101, China
| | - Xiaoping Huang
- Department of Infectious Diseases, the First Affiliated Hospital of Soochow University, Suzhou, 215006, China.
| | - Jian Zheng
- School of Biomedical Engineering (Suzhou), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230026, China.
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, 215163, China.
- Jinan Guoke Medical Technology Development Co., Ltd, Jinan, 250101, China.
| |
Collapse
|
4
|
Mishra S, Saito K. Clinically encountered growth phenotypes of tuberculosis-causing bacilli and their in vitro study: A review. Front Cell Infect Microbiol 2022; 12:1029111. [PMID: 36439231 PMCID: PMC9684195 DOI: 10.3389/fcimb.2022.1029111] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/20/2022] [Indexed: 07/11/2024] Open
Abstract
The clinical manifestations of tuberculosis (TB) vary widely in severity, site of infection, and outcomes of treatment-leading to simultaneous efforts to individualize therapy safely and to search for shorter regimens that can be successfully used across the clinical spectrum. In these endeavors, clinicians and researchers alike employ mycobacterial culture in rich media. However, even within the same patient, individual bacilli among the population can exhibit substantial variability in their culturability. Bacilli in vitro also demonstrate substantial heterogeneity in replication rate and cultivation requirements, as well as susceptibility to killing by antimicrobials. Understanding parallels in clinical, ex vivo and in vitro growth phenotype diversity may be key to identifying those phenotypes responsible for treatment failure, relapse, and the reactivation of bacilli that progresses TB infection to disease. This review briefly summarizes the current role of mycobacterial culture in the care of patients with TB and the ex vivo evidence of variability in TB culturability. We then discuss current advances in in vitro models that study heterogenous subpopulations within a genetically identical bulk culture, with an emphasis on the effect of oxidative stress on bacillary cultivation requirements. The review highlights the complexity that heterogeneity in mycobacterial growth brings to the interpretation of culture in clinical settings and research. It also underscores the intricacies present in the interplay between growth phenotypes and antimicrobial susceptibility. Better understanding of population dynamics and growth requirements over time and space promises to aid both the attempts to individualize TB treatment and to find uniformly effective therapies.
Collapse
Affiliation(s)
- Saurabh Mishra
- Department of Microbiology and Immunology, Weill Cornell Medicine, New York, NY, United States
| | - Kohta Saito
- Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| |
Collapse
|
5
|
Sheen P, Rodriguez J, Alcántara R, Vargas J, Grandjean L, Moore DAJ, Gilman RH, Zimic M. Alternative cost-effective media to facilitate MODS culture for diagnostics of tuberculosis. Tuberculosis (Edinb) 2022; 135:102225. [PMID: 35728429 DOI: 10.1016/j.tube.2022.102225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 06/08/2022] [Accepted: 06/12/2022] [Indexed: 12/30/2022]
Abstract
Most culture-based methods for tuberculosis diagnosis remain low-cost options for low- and mid-income countries. The MODS culture is a rapid and low-cost assay to diagnose tuberculosis and determine drug susceptibility. However, its implementation is limited due to the low accessibility to supplies required for the enriched medium. In this study, we evaluate two alternative culture media: A powder-based mixed (PM) and a lyophilized media (LM). Catalase, PANTA, and gamma irradiation were evaluated as additions to PM and LM. The culture performance of the alternative media was compared with the standard MODS medium (MM) using Mycobacterium tuberculosis isolates and positive acid-fast smear sputum samples. Overall, no significant difference was observed in the bacterial growth between PM and LM with MM. However, PANTA and gamma irradiation combined reduced bacterial growth significantly in all media variants. A median positivity day of 6 ± 5 days was observed for sputum samples, regardless of the culture medium. The preliminary results show that the two variants culture media have a similar performance to the standard MODS medium. The powder-based media with PANTA (PM_P) showed a time-to-positivity and sensitivity similar to the standard MODS medium. It is the simplest to prepare and does not require any sterilization process.
Collapse
Affiliation(s)
- Patricia Sheen
- Laboratorio de Bioinformática, Biología Molecular y Desarrollos Tecnológicos. Laboratorios de Investigación y Desarrollo. Facultad de Ciencias y Filosofía. Universidad Peruana Cayetano Heredia, Lima, 15102, Peru.
| | - Joseline Rodriguez
- Laboratorio de Bioinformática, Biología Molecular y Desarrollos Tecnológicos. Laboratorios de Investigación y Desarrollo. Facultad de Ciencias y Filosofía. Universidad Peruana Cayetano Heredia, Lima, 15102, Peru
| | - Roberto Alcántara
- Biomolecules Laboratory, Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas (UPC), Lima, 15023, Peru
| | - Johnny Vargas
- Instituto Peruano de Energía Nuclear (IPEN), Lima, 15076, Peru
| | - Louis Grandjean
- Department of Infection, Immunity, and Inflammation, Institute of Child Health, WC1N 1EH, London, UK
| | - David A J Moore
- TB Centre, London School of Hygiene and Tropical Medicine, WC1E 7HT, London, UK
| | - Robert H Gilman
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, United States
| | - Mirko Zimic
- Laboratorio de Bioinformática, Biología Molecular y Desarrollos Tecnológicos. Laboratorios de Investigación y Desarrollo. Facultad de Ciencias y Filosofía. Universidad Peruana Cayetano Heredia, Lima, 15102, Peru
| |
Collapse
|
6
|
Mohanty M, Mishra B, Jain M, Karaniveed Puthiyapura L. Diagnostic role of Xpert-MTB RIF assay in osteoarticular tuberculosis: A retrospective study. World J Orthop 2022; 13:289-296. [PMID: 35317258 PMCID: PMC8935335 DOI: 10.5312/wjo.v13.i3.289] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/11/2021] [Accepted: 01/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Osteoarticular tuberculosis (OATB) is a severe form of extrapulmonary tuberculosis (TB), which causes notable morbidity and warrants a high index of suspicion for prompt management. The diagnosis of OATB poses a challenge, because of the difficulty of collecting the samples and, secondarily, the paucibacillary nature of lesion, which gives poor sensitivity and reproducibility, with long turnaround time of routine/conventional laboratory tests and the requirement for invasive procedures and expertise. The Xpert MTB/RIF assay has been approved by the World Health Organization as a rapid diagnostic tool for diagnosing pulmonary and extrapulmonary TB.
AIM To emphasize the diagnostic efficiency of gene Xpert for OATB in suspected patients in a tertiary care hospital of Eastern India.
METHODS This retrospective study was conducted in the Department of Microbiology and Orthopaedics by analyzing the data of the gene Xpert assay over a 3-year duration from January 2018 to February 2021. Demographic and clinical data were recorded. The diagnostic efficiency of gene Xpert was evaluated against the composite reference standard (CRS).
RESULTS A total of 37 cases fell into positive, probable, and possible categories of osteoarticular TB out of 112 patients included in the study by CRS; gene Xpert result was positive in 35 out of the 37 different CRS categorized cases. Of the 112 cases, culture was put in 40 cases, and, of these cultures, 5 cases showed the growth of MTB. Of these, 4 cases were included in the 35 cases diagnosed by gene Xpert. Smear microscopy was positive in 6 out of 37 CRS categorized cases. When compared with CRS, the sensitivity of gene Xpert assay, culture, and smear was found to be 94.6%, 13.5%, and 16.2%, respectively, while specificity in all the three types of tests was 100%. When kappa statistics were applied, the percentage of agreement gene Xpert, culture, and microscopy with CRS was found to be 95%, 20%, and 22.6%, respectively. Follow-up of the gene Xpert positive patients after getting anti-tubercular treatment revealed improved conditions.
CONCLUSION Gene Xpert could detect 31 extra cases with a low and very low mycobacterial load that were missed by the routine culture methods. Hence, more samples should be processed for molecular diagnostic methods like gene Xpert along with other conventional methods for the validation of the molecular test prospectively for the timely diagnosis of osteoarticular TB.
Collapse
Affiliation(s)
- Monalisa Mohanty
- Department of Microbiology, AIIMS Bhubaneswar, Bhubaneswar 751019, Odisha, India
| | | | - Mantu Jain
- Department of Orthopaedics, AIIMS Bhubaneswar, Bhubaneswar 751019, Odisha, India
| | | |
Collapse
|
7
|
Carrillo-Larco RM, Guzman-Vilca WC, Leon-Velarde F, Bernabe-Ortiz A, Jimenez MM, Penny ME, Gianella C, Leguía M, Tsukayama P, Hartinger SM, Lescano AG, Cuba-Fuentes MS, Cutipé Y, Diez-Canseco F, Mendoza W, Ugarte-Gil C, Valdivia-Gago A, Zavaleta-Cortijo C, Miranda JJ. Peru - Progress in health and sciences in 200 years of independence. LANCET REGIONAL HEALTH. AMERICAS 2022; 7:100148. [PMID: 36777656 PMCID: PMC9904031 DOI: 10.1016/j.lana.2021.100148] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Peru celebrates 200 years of independence in 2021. Over this period of independent life, and despite the turbulent socio-political scenarios, from internal armed conflict to economic crisis to political instability over the last 40 years, Peru has experienced major changes on its epidemiological and population health profile. Major advancements in maternal and child health as well as in communicable diseases have been achieved in recent decades, and today Peru faces an increasing burden of non-communicable diseases including mental health conditions. In terms of the configuration of the public health system, Peru has also strived to secure country-wide optimal health care, struggling in particular to improve primary health care and intercultural services. The science and technology infrastructure has also evolved, although the need for substantial investments remains if advancing science is to be a national priority. Climate change will also bring significant challenges to population health given Peru's geographical and microclimates diversity. Looking back over the 200-years of independence, we present a summary of key advances in selected health-related fields, thus serving as the basis for reflections on pending agendas and future challenges, in order to look forward to ensuring the future health and wellbeing of the Peruvian population. Resumen translated abstract El Perú cumple 200 años de independencia en 2021. Durante estos dos siglos de vida independiente, junto con periodos sociales y políticos turbulentos, incluyendo un conflicto armado interno, hiperinflación y la inestabilidad política de los últimos 40 años, el Perú ha experimentado importantes cambios en su perfil epidemiológico con repercusiones directas en la salud de la población. En las últimas décadas, los indicadores de salud materno-infantil y de las enfermedades transmisibles muestran mejoría importante, pero el país se enfrenta de manera simultánea a una carga cada vez mayor de enfermedades no transmisibles y de salud mental. En cuanto a los sistemas de salud pública, se han realizado esfuerzos por aumentar la cobertura y calidad de la atención de salud en todo el país, apostándose en particular por mejorar la atención primaria. La ciencia y tecnología relacionadas con la salud también han mejorado, aunque si se quiere que la ciencia sea una prioridad nacional, son necesarias inversiones sustanciales. El cambio climático traerá importantes desafíos para la salud de la población, dada la diversidad geográfica y de microclimas del país. Para conmemorar los 200 años de vida independiente del Perú, presentamos un resumen de avances clave en diversas áreas y temas relacionados con la salud. Este repaso sirve como base para reflexionar sobre agendas y desafíos pendientes y futuros, con el fin de asegurar la salud y el bienestar de la población peruana en las próximas décadas.
Collapse
Affiliation(s)
- Rodrigo M. Carrillo-Larco
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Campus, London, United Kingdom
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Fabiola Leon-Velarde
- Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofia, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Antonio Bernabe-Ortiz
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | | | - Camila Gianella
- Departmento de Psicología, Facultad de Psicología, Pontificia Universidad Católica del Perú, Lima, Peru
- Chr. Michelsen Institute, Bergen, Norway
| | - Mariana Leguía
- Laboratorio de Genómica, Pontificia Universidad Católica del Perú, Lima, Peru
| | - Pablo Tsukayama
- Laboratorio de Genómica Microbiana, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
- Parasites and Microbes Programme, Wellcome Sanger Institute, Hinxton, United Kingdom
| | - Stella M. Hartinger
- Clima, Latin American Center of Excellence for Climate Change and Health, Universidad Peruana Cayetano Heredia, Lima, Peru
- University of Basel, Basel, Switzerland
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Andres G. Lescano
- Clima, Latin American Center of Excellence for Climate Change and Health, Universidad Peruana Cayetano Heredia, Lima, Peru
- Emerge, Emerging Diseases and Climate Change Research Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | | | - Francisco Diez-Canseco
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Walter Mendoza
- Fondo de Población de las Naciones Unidas (UNFPA), Lima, Peru
| | - Cesar Ugarte-Gil
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- Instituto de Medicina Tropical “Alexander von Humboldt”, Universidad Peruana Cayetano Heredia, Lima, Peru
- TB Center, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States
| | - Andrea Valdivia-Gago
- Faculty of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
- Intercultural Citizenship and Indigenous Health Unit (UCISI), Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Carol Zavaleta-Cortijo
- Faculty of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
- Intercultural Citizenship and Indigenous Health Unit (UCISI), Universidad Peruana Cayetano Heredia, Lima, Peru
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, United Kingdom
| | - J. Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| |
Collapse
|
8
|
Salguedo M, Zarate G, Coronel J, Comina G, Gilman RH, Sheen P, Oberhelman R, Zimic M. Low-cost 3D-printed inverted microscope to detect Mycobacterium tuberculosis in a MODS culture. Tuberculosis (Edinb) 2022; 132:102158. [PMID: 34864388 PMCID: PMC8818028 DOI: 10.1016/j.tube.2021.102158] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/26/2021] [Accepted: 11/27/2021] [Indexed: 01/03/2023]
Abstract
MODS, an assay for diagnosis of tuberculosis and drug-susceptibility, is based in the microscopic observation of the characteristic cords of Mycobacterium tuberculosis colonies grown in liquid media. An inverted optical microscope (100× magnification) is required to observe and interpret MODS cultures. Unfortunately, the cost of commercial inverted microscopes is not affordable in low resource settings. To perform a diagnosis of tuberculosis using the MODS assay, images with modest quality are enough for proper interpretation. Therefore, the use of a high cost commercial inverted optical microscope is not indispensable. In this study, we designed a prototype of an optical inverted microscope created by 3D-printing and based on a smartphone. The system was evaluated with 226 MODS TB positive and 207 MODS TB negative digital images. These images were obtained from 10 sputum samples MODS positive and 10 sputum samples MODS negative. The quality of all images was assessed by a qualified technician, in terms of adequacy to interpret and classify them as positive or negative for tuberculosis. The quality of the images was considered appropriate for MODS interpretation. All the 20 samples were correctly classified (as TB positive/negative) by reading with the prototype 3D-printed inverted microscope.
Collapse
Affiliation(s)
- Mario Salguedo
- Laboratorio de Bioinformática, Biología Molecular y Desarrollos Tecnológicos. Laboratorios de Investigación y Desarrollo. Facultad de Ciencias y Filosofía. Universidad Peruana Cayetano Heredia. Lima, Peru
| | - Guillermo Zarate
- Laboratorio de Bioinformática, Biología Molecular y Desarrollos Tecnológicos. Laboratorios de Investigación y Desarrollo. Facultad de Ciencias y Filosofía. Universidad Peruana Cayetano Heredia. Lima, Peru
| | - Jorge Coronel
- Laboratorio de Bioinformática, Biología Molecular y Desarrollos Tecnológicos. Laboratorios de Investigación y Desarrollo. Facultad de Ciencias y Filosofía. Universidad Peruana Cayetano Heredia. Lima, Peru
| | - Germán Comina
- Laboratorio de Ingeniería Física.Facultad de Ciencias. Universidad Nacional de Ingeniería. Av. Tupac Amaru 210, Rimac. Lima 25, Peru
| | - Robert H Gilman
- Department of International Health, School of Public Health, Johns Hopkins University. Baltimore, USA
| | - Patricia Sheen
- Laboratorio de Bioinformática, Biología Molecular y Desarrollos Tecnológicos. Laboratorios de Investigación y Desarrollo. Facultad de Ciencias y Filosofía. Universidad Peruana Cayetano Heredia. Lima, Peru
| | - Richard Oberhelman
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Mirko Zimic
- Laboratorio de Bioinformática, Biología Molecular y Desarrollos Tecnológicos. Laboratorios de Investigación y Desarrollo. Facultad de Ciencias y Filosofía. Universidad Peruana Cayetano Heredia. Lima, Peru.
| |
Collapse
|
9
|
Torres Ortiz A, Coronel J, Vidal JR, Bonilla C, Moore DAJ, Gilman RH, Balloux F, Kon OM, Didelot X, Grandjean L. Genomic signatures of pre-resistance in Mycobacterium tuberculosis. Nat Commun 2021; 12:7312. [PMID: 34911948 PMCID: PMC8674244 DOI: 10.1038/s41467-021-27616-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 11/29/2021] [Indexed: 11/29/2022] Open
Abstract
Recent advances in bacterial whole-genome sequencing have resulted in a comprehensive catalog of antibiotic resistance genomic signatures in Mycobacterium tuberculosis. With a view to pre-empt the emergence of resistance, we hypothesized that pre-existing polymorphisms in susceptible genotypes (pre-resistance mutations) could increase the risk of becoming resistant in the future. We sequenced whole genomes from 3135 isolates sampled over a 17-year period. After reconstructing ancestral genomes on time-calibrated phylogenetic trees, we developed and applied a genome-wide survival analysis to determine the hazard of resistance acquisition. We demonstrate that M. tuberculosis lineage 2 has a higher risk of acquiring resistance than lineage 4, and estimate a higher hazard of rifampicin resistance evolution following isoniazid mono-resistance. Furthermore, we describe loci and genomic polymorphisms associated with a higher risk of resistance acquisition. Identifying markers of future antibiotic resistance could enable targeted therapy to prevent resistance emergence in M. tuberculosis and other pathogens.
Collapse
Affiliation(s)
- Arturo Torres Ortiz
- grid.7445.20000 0001 2113 8111Imperial College London, Department of Infectious Diseases, London, UK
| | - Jorge Coronel
- grid.11100.310000 0001 0673 9488Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Julia Rios Vidal
- grid.419858.90000 0004 0371 3700Unidad Técnica de Tuberculosis MDR, Ministerio de Salud, Lima, Perú
| | - Cesar Bonilla
- grid.419858.90000 0004 0371 3700Unidad Técnica de Tuberculosis MDR, Ministerio de Salud, Lima, Perú ,grid.441740.20000 0004 0542 2122Universidad Privada San Juan Bautista, Lima, Perú
| | - David A. J. Moore
- grid.8991.90000 0004 0425 469XLondon School of Hygiene and Tropical Medicine, London, UK
| | - Robert H. Gilman
- grid.21107.350000 0001 2171 9311Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | | | - Onn Min Kon
- grid.7445.20000 0001 2113 8111Respiratory Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - Xavier Didelot
- grid.7372.10000 0000 8809 1613University of Warwick, School of Life Sciences and Department of Statistics, Warwick, UK
| | - Louis Grandjean
- Imperial College London, Department of Infectious Diseases, London, UK. .,UCL Department of Infection, Institute of Child Health, London, UK.
| |
Collapse
|
10
|
Prevalence and Antimicrobial Susceptibility of Non-tuberculous Mycobacteria Isolated from Sputum Samples of Patients with Pulmonary Infections in China. Jundishapur J Microbiol 2021. [DOI: 10.5812/jjm.109676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Non-tuberculous mycobacteria (NTM) are widely associated with pulmonary diseases. Evidence is lacking on the transmission of NTM from one person to another. Hence, it has gained lower public health priority than tuberculosis. Objectives: We determined the prevalence and antibiotic resistance rate of NTM isolated from sputum samples of patients with pulmonary infections. Methods: A total of 375 duplicate sputum samples were collected from 375 patients on consecutive days. The NTM growth was assessed using BACTEC 960 mycobacterial growth indicator tubes. The GenoType Mycobacterium CM/AS line probe assay was used for the species-level identification of mycobacteria. Antibiotic susceptibility tests were performed using the auto-MODS assay. Results: The overall NTM prevalence rate was 34.4%. Mycobacterium avium complex (24.8%) was the predominant species identified, followed by M. kansasii (24%) and M. abscessus complex (20.2%). Of the 129 NTM isolates tested for antibiotic susceptibility, 62.8% were resistant to rifampicin, 60.5% to levofloxacin, 58.1% to ofloxacin, 55.8% to ethambutol, 49.6% to isoniazid, 48.1% to streptomycin, and 41.9% to amikacin. Seventy-three (56.6%) isolates were identified as multidrug-resistant (MDR) isolates. Conclusions: Mycobacterium avium complex was the predominant species identified, and the majority of the organisms were resistant to commonly used anti-tuberculosis drugs. The high prevalence of NTM and drug resistance towards the tested antibiotics suggests that NTM can no more be ignored as a contaminant, reiterating the need for periodic surveillance and species-specific treatment for effective management of diseases caused by NTM.
Collapse
|
11
|
Verrall AJ, Alisjahbana B, Apriani L, Novianty N, Nurani AC, van Laarhoven A, Ussher JE, Indrati A, Ruslami R, Netea MG, Sharples K, van Crevel R, Hill PC. Early Clearance of Mycobacterium tuberculosis: The INFECT Case Contact Cohort Study in Indonesia. J Infect Dis 2021; 221:1351-1360. [PMID: 31298280 DOI: 10.1093/infdis/jiz168] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 04/10/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Early clearance of Mycobacterium tuberculosis is the eradication of infection before an adaptive immune response develops. We aimed to identify host factors associated with early clearance. METHODS Indonesian household contacts patients with smear-positive tuberculosis (TB) had an interferon-γ release assay (IGRA) at baseline and 14 weeks later. Early clearance was defined as a persistently negative IGRA. Contact characteristics, exposure, and disease phenotype were assessed for association with a positive IGRA at each time point. RESULTS Of 1347 contacts of 462 TB cases, 780 (57.9%) were IGRA positive and 490 (36.3%) were IGRA negative. After 14 weeks, 116 of 445 (26.1%) initially negative contacts were IGRA converters; 317 (71.2%) remained persistently negative. BCG vaccination reduced the risk of a positive baseline IGRA (relative risk [RR], 0.89 [95% confidence interval {CI} .83-.97]; P = .01), and strongly reduced the risk of IGRA conversion (RR, 0.56 [95% CI, .40-.77]; P < .001). BCG protection decreased with increasing exposure (P = .05) and increasing age (P = .004). Risk of IGRA conversion was positively associated with hemoglobin concentration (P = .04). CONCLUSIONS A quarter of household TB case contacts were early clearers. Protection against M. tuberculosis infection was strongly associated with BCG vaccination. Lower protection from BCG with increasing M. tuberculosis exposure and age can inform vaccine development.
Collapse
Affiliation(s)
- Ayesha J Verrall
- Department of Pathology and Molecular Medicine, University of Otago, Wellington, New Zealand
| | - Bachti Alisjahbana
- TB-HIV Research Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
- Department of Internal Medicine, Faculty of Medicine, Universitas Padajdaran, Hasan Sadikin Hospital, Bandung, Indonesia
| | - Lika Apriani
- TB-HIV Research Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Novianty Novianty
- TB-HIV Research Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Andini C Nurani
- TB-HIV Research Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Arjan van Laarhoven
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - James E Ussher
- Department of Microbiology and Immunology, University of Otago, Dunedin, New Zealand
| | - Agnes Indrati
- Department of Clinical Pathology, Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Rovina Ruslami
- TB-HIV Research Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
- Division of Pharmacology and Therapy, Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Mihai G Netea
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
- Human Genomics Laboratory, Craiova University of Medicine and Pharmacy, Romania
| | - Katrina Sharples
- Department of Mathematics and Statistics, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Reinout van Crevel
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Philip C Hill
- Centre for International Health, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| |
Collapse
|
12
|
Verrall AJ, Schneider M, Alisjahbana B, Apriani L, van Laarhoven A, Koeken VACM, van Dorp S, Diadani E, Utama F, Hannaway RF, Indrati A, Netea MG, Sharples K, Hill PC, Ussher JE, van Crevel R. Early Clearance of Mycobacterium tuberculosis Is Associated With Increased Innate Immune Responses. J Infect Dis 2021; 221:1342-1350. [PMID: 30958547 DOI: 10.1093/infdis/jiz147] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 04/02/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND A proportion of tuberculosis (TB) case contacts do not become infected, even when heavily exposed. We studied the innate immune responses of TB case contacts to understand their role in protection against infection with Mycobacterium tuberculosis, termed "early clearance." METHODS Indonesian household contacts of TB cases were tested for interferon-γ release assay (IGRA) conversion between baseline and 14 weeks post recruitment. Blood cell populations and ex vivo innate whole blood cytokine responses were measured at baseline and, in a subgroup, flow cytometry was performed at weeks 2 and 14. Immunological characteristics were measured for early clearers, defined as a persistently negative IGRA at 3 months, and converters, whose IGRA converted from negative to positive. RESULTS Among 1347 case contacts, 317 were early clearers and 116 were converters. Flow cytometry showed a resolving innate cellular response from 2 to 14 weeks in persistently IGRA-negative contacts but not converters. There were no differences in cytokine responses to mycobacterial stimuli, but compared to converters, persistently IGRA-negative contacts produced more proinflammatory cytokines following heterologous stimulation with Escherichia coli and Streptococcus pneumoniae. CONCLUSIONS Early clearance of M. tuberculosis is associated with enhanced heterologous innate immune responses similar to those activated during induction of trained immunity.
Collapse
Affiliation(s)
- Ayesha J Verrall
- Department of Pathology and Molecular Medicine, University of Otago, Wellington, New Zealand
| | - Marion Schneider
- Department of Microbiology and Immunology, University of Otago, Dunedin, New Zealand
| | - Bachti Alisjahbana
- TB-HIV Research Center, Faculty of Medicine, Universitas Padjadjaran, Nijmegen, The Netherlands.,Department of Internal Medicine, Faculty of Medicine, Universitas Padajdaran, Hasan Sadikin Hospital, Nijmegen, The Netherlands
| | - Lika Apriani
- TB-HIV Research Center, Faculty of Medicine, Universitas Padjadjaran, Nijmegen, The Netherlands.,Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Arjan van Laarhoven
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Nijmegen, The Netherlands
| | - Valerie A C M Koeken
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Nijmegen, The Netherlands
| | - Suszanne van Dorp
- Department of Haematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Emira Diadani
- TB-HIV Research Center, Faculty of Medicine, Universitas Padjadjaran, Nijmegen, The Netherlands
| | - Fitri Utama
- TB-HIV Research Center, Faculty of Medicine, Universitas Padjadjaran, Nijmegen, The Netherlands
| | - Rachel F Hannaway
- Department of Microbiology and Immunology, University of Otago, Dunedin, New Zealand
| | - Agnes Indrati
- Department of Clinical Pathology, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin Hospital, Bandung, Indonesia
| | - Mihai G Netea
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Nijmegen, The Netherlands.,Human Genomics Laboratory, Craiova University of Medicine and Pharmacy, Romania
| | - Katrina Sharples
- Department of Mathematics and Statistics, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Philip C Hill
- Centre for International Health, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - James E Ussher
- Department of Microbiology and Immunology, University of Otago, Dunedin, New Zealand
| | - Reinout van Crevel
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Nijmegen, The Netherlands
| |
Collapse
|
13
|
Nanoluciferase Reporter Mycobacteriophage for Sensitive and Rapid Detection of Mycobacterium tuberculosis Drug Susceptibility. J Bacteriol 2020; 202:JB.00411-20. [PMID: 32900827 PMCID: PMC7585058 DOI: 10.1128/jb.00411-20] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/01/2020] [Indexed: 01/02/2023] Open
Abstract
Mycobacterium tuberculosis, the causative agent of tuberculosis disease, remains a public health crisis on a global scale, and development of new interventions and identification of drug resistance are pillars in the World Health Organization End TB Strategy. Leveraging the tractability of the TM4 mycobacteriophage and the sensitivity of the nanoluciferase reporter enzyme, the present work describes an evolution of phage-mediated detection and drug susceptibility testing of M. tuberculosis, adding a valuable tool in drug discovery and basic biology research. With additional validation, this system may play a role as a quantitative phenotypic reference method and complement to genotypic methods for diagnosis and antibiotic susceptibility testing. Phenotypic testing for drug susceptibility of Mycobacterium tuberculosis is critical to basic research and managing the evolving problem of antimicrobial resistance in tuberculosis management, but it remains a specialized technique to which access is severely limited. Here, we report on the development and validation of an improved phage-mediated detection system for M. tuberculosis. We incorporated a nanoluciferase (Nluc) reporter gene cassette into the TM4 mycobacteriophage genome to create phage TM4-nluc. We assessed the performance of this reporter phage in the context of cellular limit of detection and drug susceptibility testing using multiple biosafety level 2 drug-sensitive and -resistant auxotrophs as well as virulent M. tuberculosis strains. For both limit of detection and drug susceptibility testing, we developed a standardized method consisting of a 96-hour cell preculture followed by a 72-hour experimental window for M. tuberculosis detection with or without antibiotic exposure. The cellular limit of detection of M. tuberculosis in a 96-well plate batch culture was ≤102 CFU. Consistent with other phenotypic methods for drug susceptibility testing, we found TM4-nluc to be compatible with antibiotics representing multiple classes and mechanisms of action, including inhibition of core central dogma functions, cell wall homeostasis, metabolic inhibitors, compounds currently in clinical trials (SQ109 and Q203), and susceptibility testing for bedaquiline, pretomanid, and linezolid (components of the BPaL regimen for the treatment of multi- and extensively drug-resistant tuberculosis). Using the same method, we accurately identified rifampin-resistant and multidrug-resistant M. tuberculosis strains. IMPORTANCEMycobacterium tuberculosis, the causative agent of tuberculosis disease, remains a public health crisis on a global scale, and development of new interventions and identification of drug resistance are pillars in the World Health Organization End TB Strategy. Leveraging the tractability of the TM4 mycobacteriophage and the sensitivity of the nanoluciferase reporter enzyme, the present work describes an evolution of phage-mediated detection and drug susceptibility testing of M. tuberculosis, adding a valuable tool in drug discovery and basic biology research. With additional validation, this system may play a role as a quantitative phenotypic reference method and complement to genotypic methods for diagnosis and antibiotic susceptibility testing.
Collapse
|
14
|
Huang CC, Becerra MC, Calderon R, Contreras C, Galea J, Grandjean L, Lecca L, Yataco R, Zhang Z, Murray M. Isoniazid Preventive Therapy in Contacts of Multidrug-Resistant Tuberculosis. Am J Respir Crit Care Med 2020; 202:1159-1168. [PMID: 32551948 DOI: 10.1164/rccm.201908-1576oc] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rationale: The World Health Organization recommends the use of isoniazid (INH) alone or in combination with rifapentine to treat latent tuberculosis infections. The recent rise of drug-resistant tuberculosis has complicated the choice of treatment regimen for latent tuberculosis infection.Objectives: To evaluate the effects of INH preventive therapy on the contacts of patients with multidrug-resistant tuberculosis.Methods: In a prospective cohort study conducted between September 2009 and August 2012, we identified 4,500 index patients with tuberculosis and 14,044 tuberculosis-exposed household contacts who we followed for 1 year for the occurrence of incident tuberculosis disease. Although Peruvian national guidelines specify that INH preventive therapy should be provided to contacts aged 19 years old or younger, only half this group received INH preventive therapy.Measurements and Main Results: Among 4,216 contacts under 19 years of age, 2,106 contacts (50%) initiated INH preventive therapy at enrollment. The protective effect of INH was more extreme in contacts exposed to drug-sensitive tuberculosis (adjusted hazard ratio, 0.30; 95% confidence interval, 0.18-0.48) and to multidrug-resistant tuberculosis (adjusted hazard ratio, 0.19; 95% confidence interval, 0.05-0.66) compared with those exposed to mono-INH-resistant tuberculosis (adjusted hazard ratio, 0.80; 95% confidence interval, 0.23-2.80). In the second independent study, tuberculosis occurred in none of the 76 household contacts who received INH preventive therapy compared with 3% (8 of 273) of those who did not.Conclusions: Household contacts who received INH preventive therapy had a lower incidence of tuberculosis disease even when they had been exposed to an index patient with multidrug-resistant tuberculosis. INH may have a role in the management of latent multidrug-resistant tuberculosis infection.
Collapse
Affiliation(s)
- Chuan-Chin Huang
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Mercedes C Becerra
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | | | | | - Jerome Galea
- School of Social Work, University of South Florida, Tampa, Florida
| | - Louis Grandjean
- Wellcome Centre for Clinical Tropical Medicine, Imperial College London, London, United Kingdom.,Universidad Peruana Cayetano Heredia, Lima, Peru; and.,TB Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Leonid Lecca
- Partners in Health-Socios En Salud Sucursal, Lima, Peru
| | - Rosa Yataco
- Partners in Health-Socios En Salud Sucursal, Lima, Peru
| | - Zibiao Zhang
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Megan Murray
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
15
|
M D, Bandaru R, Janakiraman V, Sai VVR. A plasmonic fiberoptic absorbance biosensor for mannose-capped lipoarabinomannan based tuberculosis diagnosis. Biosens Bioelectron 2020; 167:112488. [PMID: 32805509 DOI: 10.1016/j.bios.2020.112488] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/16/2020] [Accepted: 07/30/2020] [Indexed: 02/06/2023]
Abstract
Tuberculosis (TB) is a resurgent infectious disease affecting a large number of people in the developing countries. An on-site, affordable diagnostic screening at an early-stage for an immediate anti-TB treatment is known to tremendously minimize the high mortality rates. Lipoarabinomannan (LAM), a surface glycolipid, has been identified as a potential TB biomarker present in urine at ultra-low concentrations of a few fg/mL. Here, we report a plasmonic fiber optic absorbance biosensor (P-FAB) strategy for mannosylated LAM (Man-LAM or Mtb LAM) detection down to attomolar concentrations. It involves a plasmonic sandwich immunoassay on a U-bent fiber optic probe with gold plasmonic (AuNP) labels functionalized with anti-Mtb LAM immunoglobulin M (IgM) and anti-Mtb LAM IgG respectively. The Mtb LAM is quantified in terms of absorption of light passing through the fiber probe using a green LED and a photodetector. The choice of fiber optic probes (fused silica versus polymer), the optimum size (20, 40, 60 and 80 nm) and concentration (2 × , 10 × , and 20 × ) of AuNP labels were investigated to obtain high sensitivity and lower limits of analyte detection (LoD). P-FAB with a simple LED-photodetector pair, 200 μm fused silica U-bent fiber probe and 60 nm (20 × ) AuNP labels gave LoDs down to 1 fg/mL and 10 fg/mL in the buffer and synthetic urine respectively. Moreover, the anti-Mtb LAM IgM bound sensor probes and the AuNP reagent stored at 4 °C were stable up to 45 days. P-FAB based Mtb LAM sensor demonstrates its potential for an on-site TB diagnosis.
Collapse
Affiliation(s)
- Divagar M
- Department of Biotechnology, Indian Institute of Technology Madras, Chennai, 600036, India; Biomedical Engineering Division, Department of Applied Mechanics, Indian Institute of Technology Madras, Chennai, 600036, India
| | - Ramakrishna Bandaru
- Biomedical Engineering Division, Department of Applied Mechanics, Indian Institute of Technology Madras, Chennai, 600036, India; Current Affiliation: SRM Institute of Science and Technology, Tankular, Chennai, 603203, India
| | - Vani Janakiraman
- Department of Biotechnology, Indian Institute of Technology Madras, Chennai, 600036, India.
| | - V V R Sai
- Biomedical Engineering Division, Department of Applied Mechanics, Indian Institute of Technology Madras, Chennai, 600036, India.
| |
Collapse
|
16
|
Lee GO, Comina G, Hernandez-Cordova G, Naik N, Gayoso O, Ticona E, Coronel J, Evans CA, Zimic M, Paz-Soldan VA, Gilman RH, Oberhelman R. Cough dynamics in adults receiving tuberculosis treatment. PLoS One 2020; 15:e0231167. [PMID: 32511248 PMCID: PMC7279573 DOI: 10.1371/journal.pone.0231167] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 03/17/2020] [Indexed: 11/19/2022] Open
Abstract
Cough is a characteristic symptom of tuberculosis, is the main cause of transmission, and is used to assess treatment response. We aimed to identify the best measure of cough severity and characterize changes during initial tuberculosis therapy. We conducted a prospective cohort of recently diagnosed ambulatory adult patients with pulmonary tuberculosis in two tertiary hospitals in Lima, Peru. Pre-treatment and five times during the first two months of treatment, a vibrometer was used to capture 4-hour recordings of involuntary cough. A total of 358 recordings from 69 participants were analyzed using a computer algorithm. Total time spent coughing (seconds per hour) was a better predictor of microbiologic indicators of disease severity and treatment response than the frequency of cough episodes or cough power. Patients with prior tuberculosis tended to cough more than patients without prior tuberculosis, and patients with tuberculosis and diabetes coughed more than patients without diabetes co-morbidity. Cough characteristics were similar regardless of HIV co-infection and for drug-susceptible versus drug-resistant tuberculosis. Tuberculosis treatment response may be meaningfully assessed by objectively monitoring the time spent coughing. This measure demonstrated that cough was increased in patients with TB recurrence or co-morbid diabetes, but not because of drug resistance or HIV co-infection.
Collapse
Affiliation(s)
- Gwenyth O. Lee
- Department of Global Community Health and Behavioral Sciences, Tulane University, New Orleans, Louisiana, United States of America
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Germán Comina
- Department of Global Community Health and Behavioral Sciences, Tulane University, New Orleans, Louisiana, United States of America
| | - Gustavo Hernandez-Cordova
- Department of Global Community Health and Behavioral Sciences, Tulane University, New Orleans, Louisiana, United States of America
| | - Nehal Naik
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Oscar Gayoso
- Pulmonology Department, Hospital Nacional Cayetano Heredia, Lima, Peru
| | - Eduardo Ticona
- Facultad de Medicina, Universidad Nacional Mayor de San Marcos, San Marcos, Peru
- Servicio de Enfermedades Infecciosas y Tropicales, Hospital Nacional Dos de Mayo Lima, Mayo, Lima, Perú
| | - Jorge Coronel
- Laboratorio de Investigación en Enfermedades Infecciosas, Laboratorio de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Carlton A. Evans
- Asociación Benéfica PRISMA, Lima, Perú
- Laboratory of Research and Development, Innovation For Health And Development (IFHAD), Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Infectious Disease, Imperial College London, London, United Kingdom
| | - Mirko Zimic
- Laboratorio de Investigación en Enfermedades Infecciosas, Laboratorio de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
- Laboratorio de Bioinformática y Biología Molecular, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Valerie A. Paz-Soldan
- Department of Global Community Health and Behavioral Sciences, Tulane University, New Orleans, Louisiana, United States of America
- Asociación Benéfica PRISMA, Lima, Perú
| | - Robert H. Gilman
- Laboratorio de Investigación en Enfermedades Infecciosas, Laboratorio de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
- Asociación Benéfica PRISMA, Lima, Perú
- Department of International Health, Program in Global Disease Epidemiology and Control, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Richard Oberhelman
- Department of Global Community Health and Behavioral Sciences, Tulane University, New Orleans, Louisiana, United States of America
| |
Collapse
|
17
|
Wang S, Tu J. Nomogram to predict multidrug-resistant tuberculosis. Ann Clin Microbiol Antimicrob 2020; 19:27. [PMID: 32505203 PMCID: PMC7276074 DOI: 10.1186/s12941-020-00369-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 05/30/2020] [Indexed: 12/13/2022] Open
Abstract
Background Multidrug-resistant tuberculosis (MDR-TB) is burgeoning globally, and has been a serious challenge in TB management. Clinically, the ability to identify MDR-TB is still limited, especially in smear-negative TB. The aim of this study was to develop a nomogram for predicting MDR-TB. Methods Demographics and clinical characteristics of both MDR-TB and drug-susceptible TB patients were utilized to develop a nomogram for predicting MDR-TB. The LASSO regression method was applied to filter variables and select predictors, and multivariate logistic regression was used to construct a nomogram. The discriminatory ability of the model was determined by calculating the area under the curve (AUC). Moreover, calibration analysis and decision curve analysis (DCA) of the model were performed. This study involved a second analysis of a completed prospective cohort study conducted in a country with a high TB burden. Results Five variables of TB patients were selected through the LASSO regression method, and a nomogram was built based on these variables. The predictive model yielded an AUC of 0.759 (95% CI, 0.719–0.799), and in the internal validation, the AUC was 0.757 (95% CI, 0.715–0.793). The predictive model was well-calibrated, and DCA showed that if the threshold probability of MDR-TB was between 70 and 90%, using the proposed nomogram to predict MDR-TB would obtain a net benefit. Conclusions In this study, a nomogram was constructed that incorporated five demographic and clinical characteristics of TB patients. The nomogram may be of great value for the prediction of MDR-TB in patients with sputum-free or smear-negative TB.
Collapse
Affiliation(s)
- Saibin Wang
- Department of Respiratory Medicine, Jinhua Municipal Central Hospital, Jinhua Hospital of Zhejiang University, No. 365, East Renmin Road, Jinhua, 321000, Zhejiang Province, China.
| | - Junwei Tu
- Department of Respiratory Medicine, Jinhua Municipal Central Hospital, Jinhua Hospital of Zhejiang University, No. 365, East Renmin Road, Jinhua, 321000, Zhejiang Province, China
| |
Collapse
|
18
|
Nair G, Jain V. Separation of Mycobacterium smegmatis From a Mixed Culture Using the Cell Wall Binding Domain of D29 Mycobacteriophage Endolysin. Front Microbiol 2020; 11:1119. [PMID: 32582083 PMCID: PMC7289928 DOI: 10.3389/fmicb.2020.01119] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 05/05/2020] [Indexed: 01/22/2023] Open
Abstract
Pathological infection caused by Mycobacterium tuberculosis is still a major global health concern. Traditional diagnostic methods are time-consuming, less sensitive, and lack high specificity. Due to an increase in the pathogenic graph of mycobacterial infections especially in developing countries, there is an urgent requirement for a rapid, low cost, and highly sensitive diagnostic method. D29 mycobacteriophage, which is capable of infecting and killing M. tuberculosis, projects itself as a potential candidate for the development of novel diagnostic methods and phage therapy of mycobacterial infections. In our previous study, we showed that the cell wall binding domain [C-terminal domain (CTD)] located at the C-terminal end of the D29 mycobacteriophage LysA endolysin very selectively binds to the peptidoglycan (PG) of Mycobacterium smegmatis and M. tuberculosis. Here, by using M. smegmatis as model organism and by exploiting the PG binding ability of CTD, we have developed a method to isolate M. smegmatis cells from a mixed culture via magnetic separation. We show that green fluorescent protein (GFP)-tagged CTD (CTD-GFP) can bind to M. smegmatis cells in vitro after treatment with non-ionic detergent Triton X-100. Fluorescence-based assays show that CTD-GFP binding to M. smegmatis cells is highly specific and stable, and is not disrupted by an excess of either GFP or BSA. We further fused CTD with glutathione-S-transferase (GST) to generate CTD-GST protein and carried out an anti-GST antibody-mediated coating of CTD-GST on Dynabeads. This allowed us to perform successful magnetic separation of M. smegmatis from a mixed culture of bacteria having both Gram-negative and Gram-positive bacteria. Furthermore, the separated cells could be confirmed by a simple PCR. Thus our assay allows us to separate and identify M. smegmatis from a mixed culture.
Collapse
Affiliation(s)
- Gokul Nair
- Microbiology and Molecular Biology Laboratory, Department of Biological Sciences, Indian Institute of Science Education and Research, Bhopal, India
| | - Vikas Jain
- Microbiology and Molecular Biology Laboratory, Department of Biological Sciences, Indian Institute of Science Education and Research, Bhopal, India
| |
Collapse
|
19
|
Vargas AP, Rios AA, Grandjean L, Kirwan DE, Gilman RH, Sheen P, Zimic MJ. Determination of potentially novel compensatory mutations in rpoc associated with rifampin resistance and rpob mutations in Mycobacterium tuberculosis Clinical isolates from peru. Int J Mycobacteriol 2020; 9:121-137. [PMID: 32474533 PMCID: PMC10022416 DOI: 10.4103/ijmy.ijmy_27_20] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Rifampicin (RIF) resistance in Mycobacterium tuberculosis is frequently caused by mutations in the rpoB gene. These mutations are associated with a fitness cost, which can be overcome by compensatory mutations in other genes, among which rpoC may be the most important. We analyzed 469 Peruvian M. tuberculosis clinical isolates to identify compensatory mutations in rpoC/rpoA associated with RIF resistance. Methods The M. tuberculosis isolates were collected and tested for RIF susceptibility and spoligotyping. Samples were sequenced and aligned to the reference genome to identify mutations. By analyzing the sequences and the metadata, we identified a list of rpoC mutations exclusively associated with RIF resistance and mutations in rpoB. We then evaluated the distribution of these mutations along the protein sequence and tridimensional structure. Results One hundred and twenty-five strains were RIF susceptible and 346 were resistant. We identified 35 potential new compensatory mutations, some of which were distributed on the interface surface between rpoB and rpoC, arising in clusters and suggesting the presence of hotspots for compensatory mutations. Conclusion This study identifies 35 putative novel compensatory mutations in the β' subunit of M. tuberculosis RNApol. Six of these (S428T, L507V, A734V, I997V, and V1252LM) are considered most likely to have a compensatory role, as they fall in the interaction zone of the two subunits and the mutation did not lead to any change in the protein's physical-chemical properties.
Collapse
Affiliation(s)
- Ana Paula Vargas
- Department of Cellular and Molecular Sciences, Laboratory of Bioinformatics and Molecular Biology, Faculty of Science and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Angela A. Rios
- Department of Cellular and Molecular Sciences, Laboratory of Bioinformatics and Molecular Biology, Faculty of Science and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Louis Grandjean
- Department of Paediatric Infectious Diseases, Imperial College, University of London, London, England
| | - Daniela E. Kirwan
- Infection and Immunity Research Institute, St. George’s, University of London, London, England
| | - Robert H. Gilman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Patricia Sheen
- Department of Cellular and Molecular Sciences, Laboratory of Bioinformatics and Molecular Biology, Faculty of Science and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Mirko J. Zimic
- Department of Cellular and Molecular Sciences, Laboratory of Bioinformatics and Molecular Biology, Faculty of Science and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Peru
| |
Collapse
|
20
|
Owusu E, Newman MJ. Microscopic Observation Drug Susceptibility (MODS) Assay: A Convenient Method for Determining Antibiogram of Clinical Isolates of Mycobacterium tuberculosis in Ghana. Med Sci (Basel) 2020; 8:medsci8010005. [PMID: 31991795 PMCID: PMC7151611 DOI: 10.3390/medsci8010005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 12/23/2019] [Accepted: 01/13/2020] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Present methods for drug susceptibility tests (DST) rely on culture methods that are sophisticated and relatively faster, or a slow and cheaper option. These methods frustrate disease control; therefore, there is a need for methods that incorporate key functions of microscopy and culture, with reduced cost burden and sophistry. Thus, the purpose of this study was to identify which, among the most commonly used (in Ghana) methods, can conveniently be used at health centers located in rural areas for effective DST determination of Mycobacterium tuberculosis (MTB). (2) Methods: Mycobacterium tuberculosis isolates were tested for their susceptibility to streptomycin, isoniazid, rifampicin, ethambutol (SIRE), and pyrazinamide by microscopic observation drug susceptibility (MODS) and BACTEC MGIT 960 methods. Evaluations were based on shorter turnaround periods, rapidity, ease of use, cost, etc. A comparative analysis was statistically expressed as kappa values. (3) Results: Endpoints for drug susceptibilities by MODS averaged 13 days (7–32), whilst that for BACTEC MGIT 960 was 10 days with a further 12 days to detect resistance. Therefore, a turnaround period of 22 days was needed for DST by BACTEC MGIT 960, compared to 13 days for MODS. There were differences in correlation levels between the two methods, as determined by their kappa values. (4) Conclusion: The MODS assay was found to be less costly, more user-friendly, and still able to be conveniently used at health centers located in rural areas known to be endemic for TB, particularly in Ghana.
Collapse
Affiliation(s)
- Enid Owusu
- Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, University of Ghana, P.O. Box LG 25, Accra, Ghana
- Correspondence: or ; Tel.: +233-050-891-7569
| | - Mercy Jemima Newman
- Department of Medical Microbiology, University of Ghana Medical School, University of Ghana, P.O. Box LG 25, Accra, Ghana;
| |
Collapse
|
21
|
Molecular Specific and Sensitive Detection of Pyrazinamide and Its Metabolite Pyrazinoic Acid by Means of Surface Enhanced Raman Spectroscopy Employing In Situ Prepared Colloids. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9122511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The prodrug pyrazinamide (PZA) is metabolized by the mycobacteria to pyrazinoic acid (POA), which is expelled into the extracellular environment. PZA resistance is highly associated to a lack of POA efflux. Thus, by detecting a reduction of the concentration of POA in the extracellular environment, by means of lab-on-a-chip (LoC)-SERS (surface-enhanced Raman spectroscopy), an alternative approach for the discrimination of PZA resistant mycobacteria is introduced. A droplet-based microfluidic SERS device has been employed to illustrate the potential of the LoC-SERS method for the discrimination of PZA resistant mycobacteria. The two analytes were detected discretely in aqueous solution with a limit of detection of 27 µm for PZA and 21 µm for POA. The simultaneous detection of PZA and POA in aqueous mixtures could be realized within a concentration range from 20 μm to 50 μm for PZA and from 50 μm to 80 μm for POA.
Collapse
|
22
|
Datta S, Alvarado K, Gilman RH, Valencia T, Aparicio C, Ramos ES, Montoya R, Evans CA. Optimising fluorescein diacetate sputum smear microscopy for assessing patients with pulmonary tuberculosis. PLoS One 2019; 14:e0214131. [PMID: 31039160 PMCID: PMC6490897 DOI: 10.1371/journal.pone.0214131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 03/07/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Assessing Mycobacterium tuberculosis (TB) viability by fluorescein diacetate (FDA) microscopy can predict TB culture results, treatment response and infectiousness. However, diverse methods have been published. We aimed to optimise FDA microscopy, minimising sputum processing, biohazard and complexity for use in resource-constrained settings. METHODS AND RESULTS Optimization: Patients with smear-positive pulmonary TB before treatment and healthy control participants provided sputa. These were divided into equal aliquots that were tested directly or after NaOH centrifuge-decontamination. Each aliquot was cultured and used to prepare slides (n = 80). FDA microscopy used: 1 or 3 drops of sputum; with/out acid-alcohol wash; with/out phenol sterilization; with 0/30/60 seconds KMnO4 quenching. Control samples all had negative culture and microscopy results. FDA microscopy had higher sensitivity when performed directly (without centrifuge-decontamination) on 1 drop of sputum (P<0.001), because 3 drops obscured microscopy. Acid-alcohol wash and KMnO4 quenching made bacilli easier to identity (P = 0.005). Phenol sterilization did not impair microscopy (P>0.1). Validation: The 2 protocols that performed best in the optimization experiments were reassessed operationally by comparing duplicate slides (n = 412) stained with KMnO4 quenching for 30 versus 60 seconds. FDA microscopy results were similar (P = 0.4) and highly reproducible, with 97% of counts agreeing within +/-1 logarithm. Storage: Smear microscopy slides and aliquots of the sputum from which they were made were stored for 4 weeks. Twice-weekly, paired slides (n = 80) were stained with freshly prepared versus stored FDA and read quantitatively. Storing sputum, microscopy slides or FDA solution at 4°C or room temperature had no effect on FDA microscopy results (all P>0.2). Cost: Material costs for each slide tested by FDA microscopy using reagents purchased locally were USD $0.05 and required the same equipment, time and skills as auramine acid-fast microscopy. CONCLUSIONS We recommend a simple, bio-secure protocol for FDA microscopy that provides sensitive and repeatable results without requiring centrifugation.
Collapse
Affiliation(s)
- Sumona Datta
- Infectious Diseases & Immunity, Wellcome Trust Centre for Global Health Research, Imperial College London, United Kingdom
- IFHAD: Innovation For Health And Development, Laboratory of research and development, Universidad Peruana Cayetano Heredia, Lima, Peru
- Innovacion Por la Salud Y el Desarollo (IPSYD), Asociación Benéfica Prisma, Lima, Peru
| | - Keren Alvarado
- IFHAD: Innovation For Health And Development, Laboratory of research and development, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Robert H. Gilman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Teresa Valencia
- IFHAD: Innovation For Health And Development, Laboratory of research and development, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Christian Aparicio
- IFHAD: Innovation For Health And Development, Laboratory of research and development, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Eric S. Ramos
- IFHAD: Innovation For Health And Development, Laboratory of research and development, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Rosario Montoya
- IFHAD: Innovation For Health And Development, Laboratory of research and development, Universidad Peruana Cayetano Heredia, Lima, Peru
- Innovacion Por la Salud Y el Desarollo (IPSYD), Asociación Benéfica Prisma, Lima, Peru
| | - Carlton A. Evans
- Infectious Diseases & Immunity, Wellcome Trust Centre for Global Health Research, Imperial College London, United Kingdom
- IFHAD: Innovation For Health And Development, Laboratory of research and development, Universidad Peruana Cayetano Heredia, Lima, Peru
- Innovacion Por la Salud Y el Desarollo (IPSYD), Asociación Benéfica Prisma, Lima, Peru
| |
Collapse
|
23
|
Lopez-Garnier S, Sheen P, Zimic M. Automatic diagnostics of tuberculosis using convolutional neural networks analysis of MODS digital images. PLoS One 2019; 14:e0212094. [PMID: 30811445 PMCID: PMC6392246 DOI: 10.1371/journal.pone.0212094] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 01/26/2019] [Indexed: 11/23/2022] Open
Abstract
Tuberculosis is an infectious disease that causes ill health and death in millions of people each year worldwide. Timely diagnosis and treatment is key to full patient recovery. The Microscopic Observed Drug Susceptibility (MODS) is a test to diagnose TB infection and drug susceptibility directly from a sputum sample in 7-10 days with a low cost and high sensitivity and specificity, based on the visual recognition of specific growth cording patterns of M. Tuberculosis in a broth culture. Despite its advantages, MODS is still limited in remote, low resource settings, because it requires permanent and trained technical staff for the image-based diagnostics. Hence, it is important to develop alternative solutions, based on reliable automated analysis and interpretation of MODS cultures. In this study, we trained and evaluated a convolutional neural network (CNN) for automatic interpretation of MODS cultures digital images. The CNN was trained on a dataset of 12,510 MODS positive and negative images obtained from three different laboratories, where it achieved 96.63 +/- 0.35% accuracy, and a sensitivity and specificity ranging from 91% to 99%, when validated across held-out laboratory datasets. The model's learned features resemble visual cues used by expert diagnosticians to interpret MODS cultures, suggesting that our model may have the ability to generalize and scale. It performed robustly when validated across held-out laboratory datasets and can be improved upon with data from new laboratories. This CNN can assist laboratory personnel, in low resource settings, and is a step towards facilitating automated diagnostics access to critical areas in developing countries.
Collapse
Affiliation(s)
- Santiago Lopez-Garnier
- Unidad de Bioinformática / Laboratorio de Enfermedades Infecciosas, Laboratorio de Investigación y Desarrollo, Facultad de Ciencias y Filosofía—Universidad Peruana Cayetano Heredia, Lima, Peru
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, Massachusetts, United States of America
| | - Patricia Sheen
- Unidad de Bioinformática / Laboratorio de Enfermedades Infecciosas, Laboratorio de Investigación y Desarrollo, Facultad de Ciencias y Filosofía—Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Mirko Zimic
- Unidad de Bioinformática / Laboratorio de Enfermedades Infecciosas, Laboratorio de Investigación y Desarrollo, Facultad de Ciencias y Filosofía—Universidad Peruana Cayetano Heredia, Lima, Peru
| |
Collapse
|
24
|
Shibabaw A, Gelaw B, Kelley H, Balada-Llasat JM, Evans C, Wang SH, Torrelles JB, Tessema B. Accuracy of the color plate micro-colony detection for the diagnosis of Mycobacterium tuberculosis complex in Northwest Ethiopia. Tuberculosis (Edinb) 2019; 114:54-60. [PMID: 30711158 DOI: 10.1016/j.tube.2018.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 11/18/2018] [Accepted: 11/25/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Accurate and timely tuberculosis diagnosis is the primary step for initiating effective treatment. The color plate agar-based culture test (TB-CX test) is low cost, simple to use and detects Mycobacterium tuberculosis faster. Therefore, the main objective of this study was to compare the diagnostic accuracy and time to detection of positive cultures using color test and Lӧwenstein Jensen culture. METHODS A comparative cross-sectional study was conducted at University of Gondar Hospital. A total of 200 sputum samples were collected from TB patients and processed for direct smear microscopy and cultures. RESULTS Sixty-five percent were found positive on both methods and 4 (2%) were positive on LJ culture and negative on the color plate. The median time for detection of MTB growth was significantly shorter using color plate test (Median 12 days) than LJ culture (Median 21 days) (P < 0.0001). The overall sensitivity and specificity of the color test compared to LJ culture were 97% (95% CI: 93-99) and 100% (95% CI: 94-100), respectively. CONCLUSIONS The color plate test for micro-colonies allows early and accurate MTB diagnosis in a median time of 12 days. This rapid method could be an option for diagnosis of pulmonary TB in resource limited settings.
Collapse
Affiliation(s)
- Agumas Shibabaw
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Baye Gelaw
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Holden Kelley
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, OH, USA
| | | | - Carlton Evans
- The Wellcome Centre for Clinical Tropical Medicine, Imperial College of London, London, United Kingdom
| | - Shu-Hua Wang
- Department of Internal Medicine, Division of Infectious Diseases, College of Medicine, The Ohio State University, Columbus, OH, USA
| | | | - Belay Tessema
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
25
|
Jamil NIN, Wahab WNAWA, Ali IA, Yahaya ML. Direct Resazurin Microplate Assay in Drug Susceptibility Testing of Smear-Positive Sputum Samples against Mycobacterium tuberculosis. Malays J Med Sci 2018; 25:59-66. [PMID: 30914879 PMCID: PMC6422566 DOI: 10.21315/mjms2018.25.6.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 09/27/2018] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND A new direct microplate-based colorimetric drug susceptibility test that omits the initial isolation of Mycobacterium tuberculosis from sputum specimens was evaluated. METHODS A total of 51 M. tuberculosis acid fast bacilli (AFB) smear-positive sputum specimens were inoculated directly into drug-free and serial dilutions of drug-containing Middlebrook 7H9 broth media. With this direct resazurin micro plate assay (REMA) method, resazurin dye was used as a growth indicator in microplate wells. The minimum inhibitory concentrations (MIC) of isoniazid (INH) and rifampicin (RIF) were compared with those of the 'gold standard' absolute concentration method (ACM). The turnaround time (TAT) of the direct REMA and the ACM were also determined. RESULTS At the selected cut-off points (INH: 0.0625 μg/mL; RIF: 0.125 μg/mL), good drug susceptibility test results were obtained for INH and RIF with an average sensitivity, specificity and accuracy of 90%, 100% and 97%, respectively, with a TAT of 15 days. The REMA method also correctly classified the resistant isolates with positive predictive values of 95% and negative predictive values of 98% for the two drugs. CONCLUSIONS The direct REMA was reliable in routine diagnostic laboratories for the drug susceptibility testing of M. tuberculosis and the rapid detection of multi-drug-resistant tuberculosis.
Collapse
Affiliation(s)
- Noor Izani Noor Jamil
- School of Health Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | | | - Ibyhaslin Alyani Ali
- School of Health Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Mohammad Lukman Yahaya
- School of Health Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| |
Collapse
|
26
|
Koul AN, Kassana BA, Rather AR. Utility of GeneXpert in the diagnosis, reliance on urine microscopy and clinical characteristics of genitourinary tuberculosis at a tertiary care hospital. Indian J Med Microbiol 2018; 36:93-96. [PMID: 29735834 DOI: 10.4103/ijmm.ijmm_18_114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background One-third of the world's population is infected with tuberculosis (TB) with new infection occurring every second. In humans, TB is primarily caused by Mycobacterium tuberculosis(MTB). Genitourinary TB (GUTB) is still a major health problem in many developing countries including India and had been declared by the World Health Organisation as 'public health emergency' in 1993. Materials and Methods This is a prospective study conducted at a tertiary care hospital involving 46 patients who presented with clinical feature suggestive of GUTB - urine specimens of these 46 patients were analysed for acid-fast bacilli (AFB), AFB culture, GeneXpert, and other relevant investigations were done to reach the diagnosis. Majority of patients were female (65.25%). This is especially relevant to rural and low socioeconomic areas in developing countries where women's health is worse than men's (in terms of nutrition); women's risk of disease may be increased. Most of our patients were above 30 years of age and exhibited nonspecific symptoms such as dysuria, haematuria and frequency. All patients were put on antitubercular drugs and followed as per the guidelines. Conclusion The sample size in the present study is small to arrive at a brisk inference, but it may safely be postulated that yield of detection for GeneXpert may be improved using multiple sampling, especially the early morning ones. It is also pertinent to mention here that GeneXpert may not be able to pick up mutant genomes.
Collapse
Affiliation(s)
- Ajaz Nabi Koul
- Department of Medicine and Infectious Diseases, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Basharat A Kassana
- Department of Medicine and Infectious Diseases, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Aadil Rafeeq Rather
- Department of Medicine and Infectious Diseases, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| |
Collapse
|
27
|
Proaño A, Bui DP, López JW, Vu NM, Bravard MA, Lee GO, Tracey BH, Xu Z, Comina G, Ticona E, Mollura DJ, Friedland JS, Moore DAJ, Evans CA, Caligiuri P, Gilman RH. Cough Frequency During Treatment Associated With Baseline Cavitary Volume and Proximity to the Airway in Pulmonary TB. Chest 2018; 153:1358-1367. [PMID: 29559307 PMCID: PMC6026292 DOI: 10.1016/j.chest.2018.03.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 02/14/2018] [Accepted: 03/01/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Cough frequency, and its duration, is a biomarker that can be used in low-resource settings without the need of laboratory culture and has been associated with transmission and treatment response. Radiologic characteristics associated with increased cough frequency may be important in understanding transmission. The relationship between cough frequency and cavitary lung disease has not been studied. METHODS We analyzed data in 41 adults who were HIV negative and had culture-confirmed, drug-susceptible pulmonary TB throughout treatment. Cough recordings were based on the Cayetano Cough Monitor, and sputum samples were evaluated using microscopic observation drug susceptibility broth culture; among culture-positive samples, bacillary burden was assessed by means of time to positivity. CT scans were analyzed by a US-board-certified radiologist and a computer-automated algorithm. The algorithm evaluated cavity volume and cavitary proximity to the airway. CT scans were obtained within 1 month of treatment initiation. We compared small cavities (≤ 7 mL) and large cavities (> 7 mL) and cavities located closer to (≤ 10 mm) and farther from (> 10 mm) the airway to cough frequency and cough cessation until treatment day 60. RESULTS Cough frequency during treatment was twofold higher in participants with large cavity volumes (rate ratio [RR], 1.98; P = .01) and cavities located closer to the airway (RR, 2.44; P = .001). Comparably, cough ceased three times faster in participants with smaller cavities (adjusted hazard ratio [HR], 2.89; P = .06) and those farther from the airway (adjusted HR, 3.61;, P = .02). Similar results were found for bacillary burden and culture conversion during treatment. CONCLUSIONS Cough frequency during treatment is greater and lasts longer in patients with larger cavities, especially those closer to the airway.
Collapse
Affiliation(s)
- Alvaro Proaño
- Laboratorio de Investigación en Enfermedades Infecciosas, Laboratorio de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru.
| | - David P Bui
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
| | - José W López
- Laboratorio de Bioinformática y Biología Molecular, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru; Instituto Nacional de Salud del Niño San Borja, Lima, Peru
| | - Nancy M Vu
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH
| | - Marjory A Bravard
- Innovation for Health and Development, Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru; Asociación Benéfica PRISMA, Lima, Peru; Department of General Internal Medicine, Massachusetts General Hospital, Boston, MA
| | - Gwenyth O Lee
- Department of Global Community Health and Behavioral Sciences, Tulane University, New Orleans, LA
| | - Brian H Tracey
- Department of Electrical and Computer Engineering, Tufts University, Medford, MA
| | - Ziyue Xu
- Center for Infectious Disease Imaging, Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD
| | - Germán Comina
- Escuela Profesional de Ingeniería Física, Facultad de Ciencias, Universidad Nacional de Ingeniería, Lima, Peru; Department of Global Community Health and Behavioral Sciences, Tulane University, New Orleans, LA
| | - Eduardo Ticona
- Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Peru; Servicio de Enfermedades Infecciosas y Tropicales, Hospital Nacional Dos de Mayo, Lima, Peru
| | - Daniel J Mollura
- Center for Infectious Disease Imaging, Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD
| | - Jon S Friedland
- Section of Infectious Diseases & Immunity and Wellcome Trust Imperial College Centre for Global Health Research, Imperial College London, London, England
| | - David A J Moore
- Laboratorio de Investigación en Enfermedades Infecciosas, Laboratorio de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru; Asociación Benéfica PRISMA, Lima, Peru; TB Centre, London School of Hygiene and Tropical Medicine, London, England
| | - Carlton A Evans
- Innovation for Health and Development, Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru; Asociación Benéfica PRISMA, Lima, Peru; Section of Infectious Diseases & Immunity and Wellcome Trust Imperial College Centre for Global Health Research, Imperial College London, London, England
| | - Philip Caligiuri
- Department of Radiology & Imaging Sciences, University of Utah School of Medicine, Salt Lake City, UT
| | - Robert H Gilman
- Laboratorio de Investigación en Enfermedades Infecciosas, Laboratorio de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru; Asociación Benéfica PRISMA, Lima, Peru; Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| |
Collapse
|
28
|
Agarwal A, Katoch CDS, Kumar M, Dhole TN, Sharma YK. Evaluation of Microscopic observation drug susceptibility (MODS) assay as a rapid, sensitive and inexpensive test for detection of tuberculosis and multidrug resistant tuberculosis. Med J Armed Forces India 2018; 75:58-64. [PMID: 30705479 DOI: 10.1016/j.mjafi.2018.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 03/22/2018] [Indexed: 11/16/2022] Open
Abstract
Background Microscopic observation drug susceptibility (MODS) assay has been suggested as a low cost method for rapid, accurate detection of tuberculosis (TB) and multidrug resistant tuberculosis (MDR-TB). Methods A total of 2424 samples collected from 1063 eligible patients of suspected pulmonary or extrapulmonary TB were subjected to MODS assay. Performance of MODS was compared with culture and drug susceptibility testing (DST) by conventional solid Lowenstein-Jensen (LJ) media or liquid Mycobacteria Growth Indicator Tube (MGIT) culture. Results When compared to reference gold standard of positivity in either solid or liquid reference culture, the MODS assay had sensitivity, specificity, positive predictive value and negative predictive value of 91.3%, 98.2%, 96.0% and 95.9% respectively. MODS took a median time of 10.3 days to culture positivity as compared to 13.8 days using MGIT and 30.5 days using LJ culture. Culture and DST being concurrent in MODS, the median turnaround time for DST was the same as that for culture i.e. 10.3 days. The overall median turn around time for culture positivity and DST using manual MGIT and LJ medium was 23.6 days and 61.2 days respectively. The concordance between MODS culture and the reference susceptibility method was 97.7% for rifampicin, 95.6% for isoniazid, 98.5% for rifampicin and isoniazid. The cost of performing a single MODS assay was INR 200. Conclusion MODS is a rapid and sensitive, yet simple and inexpensive test that may be helpful to enhance diagnostic accuracy, and case detection of TB and MDR-TB in resource constrained settings.
Collapse
Affiliation(s)
- A Agarwal
- Professor, Department of Microbiology, Armed Forces Medical College, Pune 411040, India
| | - C D S Katoch
- Senior Advisor (Medicine & Respiratory Med), Military Hospital (Cardio Thoracic Centre), Pune 411040, India
| | - M Kumar
- Classified Specialist (Pathology & Microbiology), Army Hospital (R&R), New Delhi, India
| | - T N Dhole
- Professor and Head (Microbiology), SGPGIMS, Lucknow, India
| | - Y K Sharma
- Professor and Head (Botany), University of Lucknow, Lucknow, India
| |
Collapse
|
29
|
Comparison of the validity of smear and culture conversion as a prognostic marker of treatment outcome in patients with multidrug-resistant tuberculosis. PLoS One 2018; 13:e0197880. [PMID: 29791488 PMCID: PMC5965863 DOI: 10.1371/journal.pone.0197880] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 05/10/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The World Health Organization (WHO) has conditionally recommended the use of sputum smear microscopy and culture examination for the monitoring of multidrug-resistant tuberculosis (MDR-TB) treatment. We aimed to assess and compare the validity of smear and culture conversion at different time points during treatment for MDR-TB, as a prognostic marker for end-of-treatment outcomes. METHODS We undertook a retrospective observational cohort study using data obtained from Hunan Chest Hospital, China and Gondar University Hospital, Ethiopia. The sensitivity and specificity of culture and sputum smear conversion for predicting treatment outcomes were analysed using a random-effects generalized linear mixed model. RESULTS A total of 429 bacteriologically confirmed MDR-TB patients with a culture and smear positive result were included. Overall, 345 (80%) patients had a successful treatment outcome, and 84 (20%) patients had poor treatment outcomes. The sensitivity of smear and culture conversion to predict a successful treatment outcome were: 77.9% and 68.9% at 2 months after starting treatment (difference between tests, p = 0.007); 95.9% and 92.7% at 4 months (p = 0.06); 97.4% and 96.2% at 6 months (p = 0.386); and 99.4% and 98.9% at 12 months (p = 0.412), respectively. The specificity of smear and culture non-conversion to predict a poor treatment outcome were: 41.6% and 60.7% at 2 months (p = 0.012); 23.8% and 48.8% at 4 months (p<0.001); and 20.2% and 42.8% at 6 months (p<0.001); and 15.4% and 32.1% (p<0.001) at 12 months, respectively. The sensitivity of culture and smear conversion increased as the month of conversion increased but at the cost of decreased specificity. The optimum time points after conversion to provide the best prognostic marker of a successful treatment outcome were between two and four months after treatment commencement for smear, and between four and six months for culture. The common optimum time point for smear and culture conversion was four months. At this time point, culture conversion (AUROC curve = 0.71) was significantly better than smear conversion (AUROC curve = 0.6) in predicting successful treatment outcomes (p < 0.001). However, the validity of smear conversion (AUROC curve = 0.7) was equivalent to culture conversion (AUROC curve = 0.71) in predicting treatment outcomes when demographic and clinical factors were included in the model. The positive and negative predictive values for smear conversion were: 57.3% and 65.7% at two months, 55.7% and 85.4% at four months, and 55.0% and 88.6% at six months; and for culture conversions it was: 63.7% and 66.2% at two months, 64.4% and 87.1% at four months, and 62.7% and 91.9% at six months, respectively. CONCLUSIONS The validity of smear conversion is significantly lower than culture conversion in predicting MDR-TB treatment outcomes. We support the WHO recommendation of using both smear and culture examination rather than smear alone for the monitoring of MDR-TB patients for a better prediction of successful treatment outcomes. The optimum time points to predict a future successful treatment outcome were between two and four months after treatment commencement for sputum smear conversion and between four and six months for culture conversion. The common optimum times for culture and smear conversion together was four months.
Collapse
|
30
|
Liu C, Lyon CJ, Bu Y, Deng Z, Walters E, Li Y, Zhang L, Hesseling AC, Graviss EA, Hu Y. Clinical Evaluation of a Blood Assay to Diagnose Paucibacillary Tuberculosis via Bacterial Antigens. Clin Chem 2018; 64:791-800. [PMID: 29348166 DOI: 10.1373/clinchem.2017.273698] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 12/08/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND The diagnosis of active tuberculosis (TB) cases primarily relies on methods that detect Mycobacterium tuberculosis (Mtb) bacilli or their DNA in patient samples (e.g., mycobacterial culture and Xpert MTB/RIF assays), but these tests have low clinical sensitivity for patients with paucibacillary TB disease. Our goal was to evaluate the clinical performance of a newly developed assay that can rapidly diagnose active TB cases by direct detection of Mtb-derived antigens in patients' blood samples. METHODS Nanoparticle (NanoDisk)-enriched peptides derived from the Mtb virulence factors CFP-10 (10-kDa culture factor protein) and ESAT-6 (6-kDa early secretory antigenic target) were analyzed by high-throughput mass spectrometry (MS). Serum from 294 prospectively enrolled Chinese adults were analyzed with this NanoDisk-MS method to evaluate the performance of direct serum Mtb antigen measurement as a means for rapid diagnosis of active TB cases. RESULTS NanoDisk-MS diagnosed 174 (88.3%) of the study's TB cases, with 95.8% clinical specificity, and with 91.6% and 85.3% clinical sensitivity for culture-positive and culture-negative TB cases, respectively. NanoDisk-MS also exhibited 88% clinical sensitivity for pulmonary and 90% for extrapulmonary TB, exceeding the diagnostic performance of mycobacterial culture for these cases. CONCLUSIONS Direct detection and quantification of serum Mtb antigens by NanoDisk-MS can rapidly and accurately diagnose active TB in adults, independent of disease site or culture status, and outperform Mycobacterium-based TB diagnostics.
Collapse
Affiliation(s)
- Chang Liu
- Virginia G. Piper Biodesign Center for Personalized Diagnostics, The Biodesign Institute, Arizona State University, Tempe, AZ.,School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ.,Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX
| | - Christopher J Lyon
- Virginia G. Piper Biodesign Center for Personalized Diagnostics, The Biodesign Institute, Arizona State University, Tempe, AZ.,Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX
| | - Yang Bu
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX.,College of Materials Sciences and Opto-Electronics, University of Chinese Academy of Sciences, Beijing, China
| | - Zaian Deng
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX.,School of Biomedical Engineering, School of Ophthalmology and Optometry, The Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Elisabetta Walters
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Yan Li
- Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
| | - Liqun Zhang
- Department of Tuberculosis, Beijing Tuberculosis & Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Anneke C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Edward A Graviss
- Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Houston, TX
| | - Ye Hu
- Virginia G. Piper Biodesign Center for Personalized Diagnostics, The Biodesign Institute, Arizona State University, Tempe, AZ; .,School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ.,Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX
| |
Collapse
|
31
|
Abstract
Central nervous system (CNS) disease caused by Mycobacterium tuberculosis (MTB) is highly devastating. Tuberculous meningitis (TBM) is the most common form of CNS tuberculosis (TB). Rapid, sensitive, and affordable diagnostic tests are not available. Ziehl-Neelsen (ZN) stain has a very low sensitivity in cases of TBM, the sensitivity rates is of about 10-20%.The detection rate can be improved by taking large volume CSF samples (>6 ml) and prolonged slide examination (30 min). Culture of MTB from the CSF is slow and insufficiently sensitive. The sensitivity is different, which varies from 36% to 81.8%. The microscopic observation drug susceptibility (MODS) assay was recommended by the World Health Organization in 2011. The sensitivity is 65%, which is more sensitive and faster than CSF smear. Commercial PCR assays were found to be insensitive at detecting MTB in CSF samples. Many research provided the value of ADA on the TBM diagnosis. Interferon-gamma release assays (IGRAs) are not recommended for diagnosis of active TB disease. Imaging is essential in diagnosis and showing complications of CNS TB. Thwaites criteria and the Lancet consensus scoring system (LCSS) were developed to improve the diagnosis of TBM. Clinicians will continue to make judgment based on clinical examination, inflammatory CSF examinations, imaging studies, and scoring systems.
Collapse
Affiliation(s)
- Yi-Yi Wang
- Department of Neurology, Tianjin Haihe Hospital, Tianjin, P.R. China.
| | - Bing-di Xie
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, P.R. China
| |
Collapse
|
32
|
Sertel Şelale D, Uzun M. The value of microscopic-observation drug susceptibility assay in the diagnosis of tuberculosis and detection of multidrug resistance. APMIS 2018; 126:38-44. [DOI: 10.1111/apm.12783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 09/18/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Denİz Sertel Şelale
- Department of Medical Microbiology; Istanbul Faculty of Medicine; Istanbul University; Istanbul Turkey
- Department of Medical Microbiology; International School of Medicine; Istanbul Medipol University; Istanbul Turkey
| | - Meltem Uzun
- Department of Medical Microbiology; Istanbul Faculty of Medicine; Istanbul University; Istanbul Turkey
| |
Collapse
|
33
|
Grandjean L, Gilman RH, Iwamoto T, Köser CU, Coronel J, Zimic M, Török ME, Ayabina D, Kendall M, Fraser C, Harris S, Parkhill J, Peacock SJ, Moore DAJ, Colijn C. Convergent evolution and topologically disruptive polymorphisms among multidrug-resistant tuberculosis in Peru. PLoS One 2017; 12:e0189838. [PMID: 29281674 PMCID: PMC5744980 DOI: 10.1371/journal.pone.0189838] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 12/01/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Multidrug-resistant tuberculosis poses a major threat to the success of tuberculosis control programs worldwide. Understanding how drug-resistant tuberculosis evolves can inform the development of new therapeutic and preventive strategies. METHODS Here, we use novel genome-wide analysis techniques to identify polymorphisms that are associated with drug resistance, adaptive evolution and the structure of the phylogenetic tree. A total of 471 samples from different patients collected between 2009 and 2013 in the Lima suburbs of Callao and Lima South were sequenced on the Illumina MiSeq platform with 150bp paired-end reads. After alignment to the reference H37Rv genome, variants were called using standardized methodology. Genome-wide analysis was undertaken using custom written scripts implemented in R software. RESULTS High quality homoplastic single nucleotide polymorphisms were observed in genes known to confer drug resistance as well as genes in the Mycobacterium tuberculosis ESX secreted protein pathway, pks12, and close to toxin/anti-toxin pairs. Correlation of homoplastic variant sites identified that many were significantly correlated, suggestive of epistasis. Variation in genes coding for ESX secreted proteins also significantly disrupted phylogenetic structure. Mutations in ESX genes in key antigenic epitope positions were also found to disrupt tree topology. CONCLUSION Variation in these genes have a biologically plausible effect on immunogenicity and virulence. This makes functional characterization warranted to determine the effects of these polymorphisms on bacterial fitness and transmission.
Collapse
Affiliation(s)
- Louis Grandjean
- University College London, Institute of Child Health, London, United Kingdom
- Academic Health Sciences Centre, Imperial College, London, United Kingdom
- Universidad Peruana Cayetano Heredia, Avenida Honorio Delgado, San Martin de Porras, Lima, Peru
- Wellcome Trust Sanger Institute, Genome Campus, Hinxton, Cambridge, United Kingdom
| | - Robert H. Gilman
- Universidad Peruana Cayetano Heredia, Avenida Honorio Delgado, San Martin de Porras, Lima, Peru
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Tomatada Iwamoto
- Department of Infectious Diseases, Kobe Institute of Health, Chuo-ku, Kobe, Japan
| | - Claudio U. Köser
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Jorge Coronel
- Universidad Peruana Cayetano Heredia, Avenida Honorio Delgado, San Martin de Porras, Lima, Peru
| | - Mirko Zimic
- Universidad Peruana Cayetano Heredia, Avenida Honorio Delgado, San Martin de Porras, Lima, Peru
| | - M. Estee Török
- Wellcome Trust Sanger Institute, Genome Campus, Hinxton, Cambridge, United Kingdom
| | - Diepreye Ayabina
- Faculty of Natural Sciences, Department of Mathematics, Imperial College London, London, United Kingdom
| | - Michelle Kendall
- Faculty of Natural Sciences, Department of Mathematics, Imperial College London, London, United Kingdom
| | - Christophe Fraser
- Department of Infectious Diseases Epidemiology, Imperial College, London, United Kingdom
| | - Simon Harris
- Wellcome Trust Sanger Institute, Genome Campus, Hinxton, Cambridge, United Kingdom
| | - Julian Parkhill
- Wellcome Trust Sanger Institute, Genome Campus, Hinxton, Cambridge, United Kingdom
| | - Sharon J. Peacock
- Wellcome Trust Sanger Institute, Genome Campus, Hinxton, Cambridge, United Kingdom
- London School of Tropical Medicine and Hygiene, London, United Kingdom
| | - David A. J. Moore
- London School of Tropical Medicine and Hygiene, London, United Kingdom
| | - Caroline Colijn
- Faculty of Natural Sciences, Department of Mathematics, Imperial College London, London, United Kingdom
| |
Collapse
|
34
|
Zhang ZT, Wang DB, Li CY, Deng JY, Zhang JB, Bi LJ, Zhang XE. Microbial sensor for drug susceptibility testing of Mycobacterium tuberculosis. J Appl Microbiol 2017; 124:286-293. [PMID: 29055163 DOI: 10.1111/jam.13617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 10/11/2017] [Accepted: 10/15/2017] [Indexed: 11/29/2022]
Abstract
AIMS Drug susceptibility testing (DST) of clinical isolates of Mycobacterium tuberculosis is critical in treating tuberculosis. We demonstrate the possibility of using a microbial sensor to perform DST of M. tuberculosis and shorten the time required for DST. METHODS AND RESULTS The sensor is made of an oxygen electrode with M. tuberculosis cells attached to its surface. This sensor monitors the residual oxygen consumption of M. tuberculosis cells after treatment with anti-TB drugs with glycerine as a carbon source. In principle, after drug pretreatment for 4-5 days, the response differences between the sensors made of drug-sensitive isolates are distinguishable from the sensors made of drug-resistant isolates. The susceptibility of the M. tuberculosis H37Ra strain, its mutants and 35 clinical isolates to six common anti-TB drugs: rifampicin, isoniazid, streptomycin, ethambutol, levofloxacin and para-aminosalicylic acid were tested using the proposed method. The results agreed well with the gold standard method (LJ) and were determined in significantly less time. The whole procedure takes approximately 11 days and therefore has the potential to inform clinical decisions. CONCLUSIONS To our knowledge, this is the first study that demonstrates the possible application of a dissolved oxygen electrode-based microbial sensor in M. tuberculosis drug resistance testing. This study used the microbial sensor to perform DST of M. tuberculosis and shorten the time required for DST. SIGNIFICANCE AND IMPACT OF THE STUDY The overall detection result of the microbial sensor agreed well with that of the conventional LJ proportion method and takes less time than the existing phenotypic methods. In future studies, we will build an O2 electrode array microbial sensor reactor to enable a high-throughput drug resistance analysis.
Collapse
Affiliation(s)
- Z-T Zhang
- State Key Laboratory of Agromicrobiology, College of Life Science and Technology, Huazhong Agricultural University, Wuhan, China.,National Laboratory of Biomacromolecules, CAS Center for Excellence in Biomacromolecules, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
| | - D-B Wang
- National Laboratory of Biomacromolecules, CAS Center for Excellence in Biomacromolecules, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
| | - C-Y Li
- Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - J-Y Deng
- State Key Laboratory of Virology, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan, China
| | - J-B Zhang
- State Key Laboratory of Agromicrobiology, College of Life Science and Technology, Huazhong Agricultural University, Wuhan, China
| | - L-J Bi
- National Laboratory of Biomacromolecules, CAS Center for Excellence in Biomacromolecules, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
| | - X-E Zhang
- National Laboratory of Biomacromolecules, CAS Center for Excellence in Biomacromolecules, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
| |
Collapse
|
35
|
Datta S, Sherman JM, Tovar MA, Bravard MA, Valencia T, Montoya R, Quino W, D'Arcy N, Ramos ES, Gilman RH, Evans CA. Sputum Microscopy With Fluorescein Diacetate Predicts Tuberculosis Infectiousness. J Infect Dis 2017; 216:514-524. [PMID: 28510693 PMCID: PMC5853787 DOI: 10.1093/infdis/jix229] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 05/11/2017] [Indexed: 01/03/2023] Open
Abstract
Background Sputum from patients with tuberculosis contains subpopulations of metabolically active and inactive Mycobacterium tuberculosis with unknown implications for infectiousness. Methods We assessed sputum microscopy with fluorescein diacetate (FDA, evaluating M. tuberculosis metabolic activity) for predicting infectiousness. Mycobacterium tuberculosis was quantified in pretreatment sputum of patients with pulmonary tuberculosis using FDA microscopy, culture, and acid-fast microscopy. These 35 patients’ 209 household contacts were followed with prevalence surveys for tuberculosis disease for 6 years. Results FDA microscopy was positive for a median of 119 (interquartile range [IQR], 47–386) bacteria/µL sputum, which was 5.1% (IQR, 2.4%–11%) the concentration of acid-fast microscopy–positive bacteria (2069 [IQR, 1358–3734] bacteria/μL). Tuberculosis was diagnosed during follow-up in 6.4% (13/209) of contacts. For patients with lower than median concentration of FDA microscopy–positive M. tuberculosis, 10% of their contacts developed tuberculosis. This was significantly more than 2.7% of the contacts of patients with higher than median FDA microscopy results (crude hazard ratio [HR], 3.8; P = .03). This association maintained statistical significance after adjusting for disease severity, chemoprophylaxis, drug resistance, and social determinants (adjusted HR, 3.9; P = .02). Conclusions Mycobacterium tuberculosis that was FDA microscopy negative was paradoxically associated with greater infectiousness. FDA microscopy–negative bacteria in these pretreatment samples may be a nonstaining, slowly metabolizing phenotype better adapted to airborne transmission.
Collapse
Affiliation(s)
- Sumona Datta
- Innovation for Health and Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru.,Infectious Diseases and Immunity and Wellcome Trust Centre for Global Health Research, Imperial College London, United Kingdom.,Innovacion por la Salud y el Desarollo (IPSYD), Asociación Benéfica Prisma, Lima, Peru
| | - Jonathan M Sherman
- Innovation for Health and Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Marco A Tovar
- Innovation for Health and Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru.,Innovacion por la Salud y el Desarollo (IPSYD), Asociación Benéfica Prisma, Lima, Peru
| | - Marjory A Bravard
- Innovation for Health and Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Teresa Valencia
- Innovation for Health and Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Rosario Montoya
- Innovacion por la Salud y el Desarollo (IPSYD), Asociación Benéfica Prisma, Lima, Peru
| | - Willi Quino
- Innovation for Health and Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru.,Innovacion por la Salud y el Desarollo (IPSYD), Asociación Benéfica Prisma, Lima, Peru
| | - Nikki D'Arcy
- Innovation for Health and Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru.,Innovacion por la Salud y el Desarollo (IPSYD), Asociación Benéfica Prisma, Lima, Peru
| | - Eric S Ramos
- Innovation for Health and Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Robert H Gilman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Carlton A Evans
- Innovation for Health and Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru.,Infectious Diseases and Immunity and Wellcome Trust Centre for Global Health Research, Imperial College London, United Kingdom.,Innovacion por la Salud y el Desarollo (IPSYD), Asociación Benéfica Prisma, Lima, Peru
| |
Collapse
|
36
|
Pang Y, Shang Y, Lu J, Liang Q, Dong L, Li Y, Zhao L, Jiang G, Huang H. GeneXpert MTB/RIF assay in the diagnosis of urinary tuberculosis from urine specimens. Sci Rep 2017; 7:6181. [PMID: 28733605 PMCID: PMC5522429 DOI: 10.1038/s41598-017-06517-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 06/14/2017] [Indexed: 01/09/2023] Open
Abstract
Conventional bacteriological methods are not generally helpful in diagnosing urinary tuberculosis (UTB). GeneXpert is endorsed for the detection of pulmonary tuberculosis, whereas the data on its utility for urine specimens is limited. In this study, we aimed to evaluate its performance on urine specimens in a country with high TB incidence. A total of 163 suspected UTB patients were consecutively enrolled in the analysis, including 37 (22.7%) culture-positive and 44 (27.0%) clinically diagnosed UTB cases. Compared with conventional culture, the sensitivity of GeneXpert (94.6%) was significantly higher than that of smear microscopy (40.5%, P < 0.001). When setting clinical diagnosis as gold standard, 51 out of 81 clinically diagnosed UTB cases were detected by GeneXpert, demonstrating a sensitivity of 63.0%, which was significantly higher than that of smear microscopy (18.5%, P < 0.001) and culture (45.7%, P = 0.027), respectively. In addition, the proportion of UTB cases in the migrant population was significantly higher than that in the resident population (P = 0.019). To conclude, our data demonstrate that GeneXpert outperforms AFB smear and culture for the detection of MTB in urine samples, which provides an alternative for the diagnosis of UTB. The migrant population and previously diagnosed TB cases are high risk factors for developing UTB cases.
Collapse
Affiliation(s)
- 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
| | - Yuanyuan Shang
- 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
| | - Jie Lu
- Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Qian Liang
- 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
| | - Liping Zhao
- 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
| | - Guanglu Jiang
- 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
| | - Hairong Huang
- 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.
| |
Collapse
|
37
|
Kwak M, Lee WK, Lim YJ, Lee SH, Ryoo S. Systematic review and meta-analysis of the nitrate reductase assay for drug susceptibility testing of Mycobacterium tuberculosis and the detection limits in liquid medium. J Microbiol Methods 2017; 141:1-9. [PMID: 28694139 DOI: 10.1016/j.mimet.2017.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 07/06/2017] [Accepted: 07/06/2017] [Indexed: 10/19/2022]
Abstract
Recently, the need for rapid, reliable, and low-cost drug susceptibility testing (DST) methods has increased due to the emergence of multidrug-resistant Mycobacterium tuberculosis. Colorimetric methods of DST provide results more quickly than standard culture methods and are inexpensive than molecular methods. Thus, colorimetric methods, such as the nitrate reductase assay (NRA), are being recommended. We searched Medline PubMed for reports on the NRA for DST of M. tuberculosis written in English and published within the last five years. We selected 20 reports on six major anti-TB drugs and conducted a meta-analysis using Meta-Disc software. The pooled sensitivities for isoniazid, rifampicin, streptomycin, ethambutol, ofloxacin, and kanamycin were 95.4%, 96.4%, 91.5%, 93.1%, 99.3%, and 88.4%, and the pooled specificities were 98.5%, 99.2%, 92.9%, 97.8%, 97.4%, and 99.4%, respectively. The area under the summary receiver operator curve for all drugs was 0.9723-0.9952. The time to results (TTR) for the direct and indirect NRAs was 7-28days and 6-15days, respectively. Quality assessments were conducted using the quality of diagnostic accuracy studies tool (QUADAS-2) items, and most reports showed good performance. However, ethambutol, streptomycin, and kanamycin showed relatively low sensitivity. We performed a quantitative NRA in liquid media at various inoculum concentrations. The TTR at 4.94×106, 1.67×104, and 2.27×102CFU/mL was 4, 14, and 14days, respectively. The minimum absorbance and nitrite concentration for positive samples were 0.8 and 168μM, respectively. We propose a quantitative standard to determine sample positivity to address the problems with the current standard NRA which is much less expensive than the conventional assay conducted on solid medium.
Collapse
Affiliation(s)
- Miri Kwak
- Hana Pharmaceutical Pangyo R&D Center, Innovally E-dong, 255, Pangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 13550, Republic of Korea
| | - Won-Kyu Lee
- Osong Medical Innovation Foundation, 123 Osongsaengmyeong-ro, Osong-eup, Heungdeok-gu, Cheongju-si, Chungcheongbuk-do 28160, Republic of Korea
| | - Young Ju Lim
- CELLTRION, Academy-ro 51beon-gil, Yeonsu-gu, Incheon 22014, Republic of Korea
| | - Seung Heon Lee
- Division of Pulmonary, Sleep, and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan 15355, Republic of Korea
| | - Sungweon Ryoo
- Korean National Tuberculosis Association, 57 Baumoe 6-gil, Seocho-gu 06763, Republic of Korea.
| |
Collapse
|
38
|
Oommen S, Banaji N. Laboratory Diagnosis of Tuberculosis: Advances in Technology and Drug Susceptibility Testing. Indian J Med Microbiol 2017; 35:323-331. [DOI: 10.4103/ijmm.ijmm_16_204] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
39
|
Sanogo M, Kone B, Diarra B, Maiga M, Baya B, Somboro AM, Sarro YS, Togo ACG, Dembele BPP, Goita D, Kone A, M'Baye O, Coulibaly N, Diabate S, Traore B, Diallo MH, Coulibaly YI, Saleeb P, Belson M, Orsega S, Siddiqui S, Polis MA, Dao S, Murphy RL, Diallo S. Performance of microscopic observation drug susceptibility for the rapid diagnosis of tuberculosis and detection of drug resistance in Bamako, Mali. Clin Microbiol Infect 2017; 23:408.e1-408.e6. [PMID: 28110049 PMCID: PMC5441965 DOI: 10.1016/j.cmi.2017.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 11/08/2016] [Accepted: 01/04/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVES In Mali early detection and treatment of multidrug-resistant tuberculosis (MDR-TB) are still challenging due to the cost, time and/or complexity associated with regular tests. Microscopic Observation Drug Susceptibility (MODS) is a low-cost assay validated by WHO in 2010. It is a liquid-culture-based assay to detect the 'cording' characteristic of Mycobacterium tuberculosis complex and to assess susceptibility to both isoniazid and rifampicin defining multidrug-resistant tuberculosis (MDR-TB). In this study we aimed to evaluate the performance of MODS as diagnostic tool compared with a validated method-Mycobacteria Growth Indicator Tube/Antimicrobial Susceptibility Testing/Streptomycin, Isoniazid, Rifampicin and Ethambutol (MGIT/AST/SIRE). METHODS AND RESULTS Between January 2010 and October 2015 we included 98 patients with suspected TB in an observational cohort study. The sensitivity and specificity of MODS assay for detecting TB were respectively 94.12% and 85.71% compared with the reference MGIT/7H11 culture, with a Cohen κ coefficient of 0.78 (95% CI 0.517-1.043). The median time to culture positivity for MODS assay and MGIT (plus interquartile range, IQR) was respectively 8 days (IQR 5-11) and 6 days (IQR 5-6). In detecting patients with MDR-TB, the sensitivity and specificity of MODS assay were respectively 100% and 95.92%. The positive predictive value and negative predictive value were, respectively, 66.7% and 100%. The median turnaround times for obtaining MDR-TB results using MODS assay and MGIT/AST/SIRE was respectively 9 days and 35 days. Hence, the MODS assay rapidly identifies MDR-TB in Mali compared with the MGIT/AST/SIRE. CONCLUSION As an easy, simple, fast and affordable method, the MODS assay could significantly improve the management of TB.
Collapse
Affiliation(s)
- M Sanogo
- SEREFO Laboratories of the University Clinical Research Centre, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - B Kone
- SEREFO Laboratories of the University Clinical Research Centre, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - B Diarra
- SEREFO Laboratories of the University Clinical Research Centre, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali; Institute of Tropical Medicine (ITM), Biomedical Department, Antwerp, Belgium.
| | - M Maiga
- SEREFO Laboratories of the University Clinical Research Centre, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali; Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc., NCI Campus at Frederick, Frederick, MD, USA
| | - B Baya
- SEREFO Laboratories of the University Clinical Research Centre, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - A M Somboro
- SEREFO Laboratories of the University Clinical Research Centre, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - Y S Sarro
- SEREFO Laboratories of the University Clinical Research Centre, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - A C G Togo
- SEREFO Laboratories of the University Clinical Research Centre, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - B P P Dembele
- SEREFO Laboratories of the University Clinical Research Centre, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - D Goita
- SEREFO Laboratories of the University Clinical Research Centre, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - A Kone
- SEREFO Laboratories of the University Clinical Research Centre, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - O M'Baye
- SEREFO Laboratories of the University Clinical Research Centre, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - N Coulibaly
- SEREFO Laboratories of the University Clinical Research Centre, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - S Diabate
- SEREFO Laboratories of the University Clinical Research Centre, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - B Traore
- SEREFO Laboratories of the University Clinical Research Centre, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - M H Diallo
- SEREFO Laboratories of the University Clinical Research Centre, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - Y I Coulibaly
- Filariasis Unit of the Malaria Research and Training Centre (MRTC), USTTB, Bamako, Mali
| | - P Saleeb
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - M Belson
- Division of Clinical Research, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
| | - S Orsega
- Division of Clinical Research, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
| | - S Siddiqui
- Division of Clinical Research, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
| | - M A Polis
- Division of Clinical Research, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
| | - S Dao
- SEREFO Laboratories of the University Clinical Research Centre, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - R L Murphy
- Division of Infectious Diseases, Northwestern University, Chicago, IL, USA
| | - S Diallo
- SEREFO Laboratories of the University Clinical Research Centre, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| |
Collapse
|
40
|
Wikman-Jorgensen PE, Llenas-García J, Pérez-Porcuna TM, Hobbins M, Ehmer J, Mussa MA, Ascaso C. Microscopic observation drug-susceptibility assay vs. Xpert ® MTB/RIF for the diagnosis of tuberculosis in a rural African setting: a cost-utility analysis. Trop Med Int Health 2017; 22:734-743. [PMID: 28380276 DOI: 10.1111/tmi.12879] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare the cost-utility of microscopic observation drug-susceptibility assay (MODS) and Xpert® MTB/RIF implementation for tuberculosis (TB) diagnosis in rural northern Mozambique. METHODS Stochastic transmission compartmental TB model from the healthcare provider perspective with parameter input from direct measurements, systematic literature reviews and expert opinion. MODS and Xpert® MTB/RIF were evaluated as replacement test of smear microscopy (SM) or as an add-on test after a negative SM. Costs were calculated in 2013 USD, effects in disability-adjusted life years (DALY). Willingness to pay threshold (WPT) was established at once the per capita Gross National Income of Mozambique. RESULTS MODS as an add-on test to negative SM produced an incremental cost-effectiveness ratio (ICER) of 5647.89USD/DALY averted. MODS as a substitute for SM yielded an ICER of 5374.58USD/DALY averted. Xpert® MTB/RIF as an add-on test to negative SM yielded ICER of 345.71USD/DALY averted. Xpert® MTB/RIF as a substitute for SM obtained an ICER of 122.13USD/DALY averted. TB prevalence and risk of infection were the main factors impacting MODS and Xpert® MTB/RIF ICER in the one-way sensitivity analysis. In the probabilistic sensitivity analysis, Xpert® MTB/RIF was most likely to have an ICER below the WPT, whereas MODS was not. CONCLUSION Our cost-utility analysis favours the implementation of Xpert® MTB/RIF as a replacement of SM for all TB suspects in this rural high TB/HIV prevalence African setting.
Collapse
Affiliation(s)
- Philip E Wikman-Jorgensen
- Department of Public Health, University of Barcelona, Barcelona, Spain.,SolidarMed Mozambique, Ancuabe, Mozambique
| | - Jara Llenas-García
- SolidarMed Mozambique, Ancuabe, Mozambique.,Infectious Diseases Unit, Hospital General Universitario de Elche, Alicante, Spain
| | - Tomàs M Pérez-Porcuna
- Department of Public Health, University of Barcelona, Barcelona, Spain.,Research Unit, Paediatrics Department, CAP Valldoreix, Mutua Terrassa Foundation, Mutua Terrassa University Hospital, Terrassa, Catalunya, Spain
| | | | | | - Manuel A Mussa
- Provincial Health Directorate, Operational Research Nucleus of Pemba, Pemba, Mozambique
| | - Carlos Ascaso
- Department of Public Health, University of Barcelona, Barcelona, Spain
| |
Collapse
|
41
|
Proaño A, Bravard MA, López JW, Lee GO, Bui D, Datta S, Comina G, Zimic M, Coronel J, Caviedes L, Cabrera JL, Salas A, Ticona E, Vu NM, Kirwan DE, Loader MCI, Friedland JS, Moore DAJ, Evans CA, Tracey BH, Gilman RH. Dynamics of Cough Frequency in Adults Undergoing Treatment for Pulmonary Tuberculosis. Clin Infect Dis 2017; 64:1174-1181. [PMID: 28329268 PMCID: PMC5399950 DOI: 10.1093/cid/cix039] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 01/13/2017] [Indexed: 01/01/2023] Open
Abstract
Background Cough is the major determinant of tuberculosis transmission. Despite this, there is a paucity of information regarding characteristics of cough frequency throughout the day and in response to tuberculosis therapy. Here we evaluate the circadian cycle of cough, cough frequency risk factors, and the impact of appropriate treatment on cough and bacillary load. Methods We prospectively evaluated human immunodeficiency virus-negative adults (n = 64) with a new diagnosis of culture-proven, drug-susceptible pulmonary tuberculosis immediately prior to treatment and repeatedly until treatment day 62. At each time point, participant cough was recorded (n = 670) and analyzed using the Cayetano Cough Monitor. Consecutive coughs at least 2 seconds apart were counted as separate cough episodes. Sputum samples (n = 426) were tested with microscopic-observation drug susceptibility broth culture, and in culture-positive samples (n = 252), the time to culture positivity was used to estimate bacillary load. Results The highest cough frequency occurred from 1 pm to 2 pm, and the lowest from 1 am to 2 am (2.4 vs 1.1 cough episodes/hour, respectively). Cough frequency was higher among participants who had higher sputum bacillary load (P < .01). Pretreatment median cough episodes/hour was 2.3 (interquartile range [IQR], 1.2-4.1), which at 14 treatment days decreased to 0.48 (IQR, 0.0-1.4) and at the end of the study decreased to 0.18 (IQR, 0.0-0.59) (both reductions P < .001). By 14 treatment days, the probability of culture conversion was 29% (95% confidence interval, 19%-41%). Conclusions Coughs were most frequent during daytime. Two weeks of appropriate treatment significantly reduced cough frequency and resulted in one-third of participants achieving culture conversion. Thus, treatment by 2 weeks considerably diminishes, but does not eliminate, the potential for airborne tuberculosis transmission.
Collapse
Affiliation(s)
- Alvaro Proaño
- Escuela Profesional de Medicina, Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Perú
- Laboratorio de Investigación en Enfermedades Infecciosas, Laboratorio de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia
| | - Marjory A Bravard
- Asociación Benéfica PRISMA, Lima, Perú
- Department of General Internal Medicine, Massachusetts General Hospital, Boston, USA
- Innovation For Health And Development, Laboratory of Research and Development,Universidad Peruana Cayetano Heredia, Lima, Peru
| | - José W López
- Laboratorio de Bioinformática y Biología Molecular, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
- Instituto Nacional de Salud del Niño San Borja, Lima, Perú
| | - Gwenyth O Lee
- Department of Global Community Health and Behavioral Sciences, Tulane University, New Orleans, Louisiana
| | - David Bui
- Division of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson
| | - Sumona Datta
- Innovation For Health And Development, Laboratory of Research and Development,Universidad Peruana Cayetano Heredia, Lima, Peru
- Infectious Diseases and Immunity and Wellcome Trust Imperial College Centre for Global Health Research, Imperial College London, United Kingdom
| | - Germán Comina
- Department of Global Community Health and Behavioral Sciences, Tulane University, New Orleans, Louisiana
- Escuela Profesional de Ingeniería Física, Facultad de Ciencias, Universidad Nacional de Ingeniería
| | - Mirko Zimic
- Laboratorio de Investigación en Enfermedades Infecciosas, Laboratorio de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia
- Laboratorio de Bioinformática y Biología Molecular, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Jorge Coronel
- Laboratorio de Investigación en Enfermedades Infecciosas, Laboratorio de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia
| | - Luz Caviedes
- Laboratorio de Investigación en Enfermedades Infecciosas, Laboratorio de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia
| | - José L Cabrera
- Servicio de Neumología, Hospital Nacional Alcides Carrión,Bellavista , Peru
| | - Antonio Salas
- Servicio de Neumología, Hospital Nacional Dos de Mayo, Lima, Peru
| | - Eduardo Ticona
- Facultad de Medicina, Univ Nacional Mayor de San Marcosersidad, Lima, Peru
- Servicio de Enfermedades Infecciosas y Tropicales, Hospital Nacional Dos de Mayo, Lima, Perú
| | - Nancy M Vu
- Department of Internal Medicine, Cleveland Clinic, Ohio, USA
| | - Daniela E Kirwan
- Infectious Diseases and Immunity and Wellcome Trust Imperial College Centre for Global Health Research, Imperial College London, United Kingdom
| | - Maria-Cristina I Loader
- Infectious Diseases and Immunity and Wellcome Trust Imperial College Centre for Global Health Research, Imperial College London, United Kingdom
| | - Jon S Friedland
- Infectious Diseases and Immunity and Wellcome Trust Imperial College Centre for Global Health Research, Imperial College London, United Kingdom
| | - David A J Moore
- Laboratorio de Investigación en Enfermedades Infecciosas, Laboratorio de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia
- Asociación Benéfica PRISMA, Lima, Perú
- Tuberculosis Centre, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Carlton A Evans
- Asociación Benéfica PRISMA, Lima, Perú
- Innovation For Health And Development, Laboratory of Research and Development,Universidad Peruana Cayetano Heredia, Lima, Peru
- Infectious Diseases and Immunity and Wellcome Trust Imperial College Centre for Global Health Research, Imperial College London, United Kingdom
| | - Brian H Tracey
- Department of Electrical and Computer Engineering, Tufts University, Medford, Massachusetts, USA
| | - Robert H Gilman
- Laboratorio de Investigación en Enfermedades Infecciosas, Laboratorio de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia
- Asociación Benéfica PRISMA, Lima, Perú
- Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| |
Collapse
|
42
|
Catanzaro DG, Trollip AP, Seifert M, Georghiou SB, Garfein RS, Rodwell TC, Catanzaro A, Eisenach KD. Evaluation of the microscopic observation drug susceptibility assay for the detection of first- and second-line drug susceptibility for Mycobacterium tuberculosis. Eur Respir J 2017; 49:49/4/1602215. [PMID: 28381434 DOI: 10.1183/13993003.02215-2016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 12/16/2016] [Indexed: 12/31/2022]
Affiliation(s)
- Donald G Catanzaro
- Dept of Biological Sciences, University of Arkansas, Fayetteville, AR, USA
| | - Andre P Trollip
- Foundation for Innovative New Diagnostics, Cape Town, South Africa
| | - Marva Seifert
- University of California San Diego School of Medicine, La Jolla, CA, USA
| | | | - Richard S Garfein
- University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Timothy C Rodwell
- University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Antonino Catanzaro
- University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Kathleen D Eisenach
- University of Arkansas for Medical Sciences, Dept of Pathology, Little Rock, AR, USA
| |
Collapse
|
43
|
Proaño A, Xu Z, Caligiuri P, Mollura DJ, Gilman RH. Computer automated algorithm to evaluate cavitary lesions in adults with pulmonary tuberculosis. J Thorac Dis 2017; 9:E93-E96. [PMID: 28203447 PMCID: PMC5303076 DOI: 10.21037/jtd.2017.01.35] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 12/26/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Alvaro Proaño
- School of Medicine, Faculty of Medicine Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Perú
- Laboratory of Tuberculosis - Infectious Diseases, Laboratories of Research and Development, Faculty of Science, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Ziyue Xu
- Center for Infectious Disease Imaging (CIDI), Radiology and Imaging Sciences, National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Philip Caligiuri
- Department of Radiology & Imaging Sciences, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Daniel J. Mollura
- Center for Infectious Disease Imaging (CIDI), Radiology and Imaging Sciences, National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Robert H. Gilman
- Laboratory of Tuberculosis - Infectious Diseases, Laboratories of Research and Development, Faculty of Science, Universidad Peruana Cayetano Heredia, Lima, Perú
- Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Tuberculosis Working Group in Peru
- School of Medicine, Faculty of Medicine Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Perú
- Laboratory of Tuberculosis - Infectious Diseases, Laboratories of Research and Development, Faculty of Science, Universidad Peruana Cayetano Heredia, Lima, Perú
- Center for Infectious Disease Imaging (CIDI), Radiology and Imaging Sciences, National Institutes of Health (NIH), Bethesda, Maryland, USA
- Department of Radiology & Imaging Sciences, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| |
Collapse
|
44
|
Ticona E, Huaroto L, Kirwan DE, Chumpitaz M, Munayco CV, Maguiña M, Tovar MA, Evans CA, Escombe R, Gilman RH. Impact of Infection Control Measures to Control an Outbreak of Multidrug-Resistant Tuberculosis in a Human Immunodeficiency Virus Ward, Peru. Am J Trop Med Hyg 2016; 95:1247-1256. [PMID: 27621303 PMCID: PMC5154435 DOI: 10.4269/ajtmh.15-0712] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 07/31/2016] [Indexed: 11/07/2022] Open
Abstract
Multidrug-resistant tuberculosis (MDRTB) rates in a human immunodeficiency virus (HIV) care facility increased by the year 2000-56% of TB cases, eight times the national MDRTB rate. We reported the effect of tuberculosis infection control measures that were introduced in 2001 and that consisted of 1) building a respiratory isolation ward with mechanical ventilation, 2) triage segregation of patients, 3) relocation of waiting room to outdoors, 4) rapid sputum smear microscopy, and 5) culture/drug-susceptibility testing with the microscopic-observation drug-susceptibility assay. Records pertaining to patients attending the study site between 1997 and 2004 were reviewed. Six hundred and fifty five HIV/TB-coinfected patients (mean age 33 years, 79% male) who attended the service during the study period were included. After the intervention, MDRTB rates declined to 20% of TB cases by the year 2004 (P = 0.01). Extremely limited access to antiretroviral therapy and specific MDRTB therapy did not change during this period, and concurrently, national MDRTB prevalence increased, implying that the infection control measures caused the fall in MDRTB rates. The infection control measures were estimated to have cost US$91,031 while preventing 97 MDRTB cases, potentially saving US$1,430,026. Thus, this intervention significantly reduced MDRTB within an HIV care facility in this resource-constrained setting and should be cost-effective.
Collapse
Affiliation(s)
- Eduardo Ticona
- Department of Infectious Diseases, Hospital Nacional Dos de Mayo, Lima, Peru
- Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Luz Huaroto
- Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Peru
- Department of Microbiology, Hospital Nacional Dos De Mayo, Lima, Peru
| | - Daniela E. Kirwan
- Department of Medical Microbiology, St George's Hospital, London, United Kingdom
- Department of Infectious Diseases and Immunity, Imperial College London, London, United Kingdom
| | - Milagros Chumpitaz
- Department of Infectious Diseases, Hospital Nacional Dos de Mayo, Lima, Peru
| | - César V. Munayco
- Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Mónica Maguiña
- Asociacion Benéfica Proyectos en Informatica, Salud, Medicina, y Agricultura (PRISMA), Lima, Peru
| | - Marco A. Tovar
- Innovation for Health and Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Carlton A. Evans
- Department of Infectious Diseases and Immunity, Imperial College London, London, United Kingdom
- Innovation for Health and Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru
- Wellcome Trust Centre for Global Health Research, Imperial College London, London, United Kingdom
| | - Roderick Escombe
- Department of Infectious Diseases and Immunity, Imperial College London, London, United Kingdom
- Wellcome Trust Centre for Global Health Research, Imperial College London, London, United Kingdom
| | - Robert H. Gilman
- Asociacion Benéfica Proyectos en Informatica, Salud, Medicina, y Agricultura (PRISMA), Lima, Peru
- Laboratorio de Investigación en Enfermedades Infecciosas, Laboratorios de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| |
Collapse
|
45
|
Dudley MZ, Sheen P, Gilman RH, Ticona E, Friedland JS, Kirwan DE, Caviedes L, Rodriguez R, Cabrera LZ, Coronel J, Grandjean L, Moore DAJ, Evans CA, Huaroto L, Chávez-Pérez V, Zimic M. Detecting Mutations in the Mycobacterium tuberculosis Pyrazinamidase Gene pncA to Improve Infection Control and Decrease Drug Resistance Rates in Human Immunodeficiency Virus Coinfection. Am J Trop Med Hyg 2016; 95:1239-1246. [PMID: 27928075 PMCID: PMC5154434 DOI: 10.4269/ajtmh.15-0711] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 08/24/2016] [Indexed: 11/07/2022] Open
Abstract
Hospital infection control measures are crucial to tuberculosis (TB) control strategies within settings caring for human immunodeficiency virus (HIV)-positive patients, as these patients are at heightened risk of developing TB. Pyrazinamide (PZA) is a potent drug that effectively sterilizes persistent Mycobacterium tuberculosis bacilli. However, PZA resistance associated with mutations in the nicotinamidase/pyrazinamidase coding gene, pncA, is increasing. A total of 794 patient isolates obtained from four sites in Lima, Peru, underwent spoligotyping and drug resistance testing. In one of these sites, the HIV unit of Hospital Dos de Mayo (HDM), an isolation ward for HIV/TB coinfected patients opened during the study as an infection control intervention: circulating genotypes and drug resistance pre- and postintervention were compared. All other sites cared for HIV-negative outpatients: genotypes and drug resistance rates from these sites were compared with those from HDM. HDM patients showed high concordance between multidrug resistance, PZA resistance according to the Wayne method, the two most common genotypes (spoligotype international type [SIT] 42 of the Latino American-Mediterranean (LAM)-9 clade and SIT 53 of the T1 clade), and the two most common pncA mutations (G145A and A403C). These associations were absent among community isolates. The infection control intervention was associated with 58-92% reductions in TB caused by SIT 42 or SIT 53 genotypes (odds ratio [OR] = 0.420, P = 0.003); multidrug-resistant TB (OR = 0.349, P < 0.001); and PZA-resistant TB (OR = 0.076, P < 0.001). In conclusion, pncA mutation typing, with resistance testing and spoligotyping, was useful in identifying a nosocomial TB outbreak and demonstrating its resolution after implementation of infection control measures.
Collapse
Affiliation(s)
- Matthew Z. Dudley
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Patricia Sheen
- Laboratorio de Bioinformática y Biología Molecular, Laboratorios de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
- Laboratorio de Investigación en Enfermedades Infecciosas, Laboratorios de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Robert H. Gilman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Laboratorio de Investigación en Enfermedades Infecciosas, Laboratorios de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
- Asociación Benéfica Proyectos en Informatica, Salud, Medicina, y Agricultura (PRISMA), Lima, Peru
| | - Eduardo Ticona
- Hospital Nacional Dos de Mayo, Lima, Peru
- Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Jon S. Friedland
- Infectious Diseases and Immunity, Wellcome Trust Centre for Global Health Research, Imperial College London, London, United Kingdom
| | - Daniela E. Kirwan
- Department of Medical Microbiology, St. George's Hospital, London, United Kingdom
- Infections Diseases and Immunity, Imperial College London, London, United Kingdom
| | - Luz Caviedes
- Laboratorio de Investigación en Enfermedades Infecciosas, Laboratorios de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Lilia Z. Cabrera
- Asociación Benéfica Proyectos en Informatica, Salud, Medicina, y Agricultura (PRISMA), Lima, Peru
| | - Jorge Coronel
- Laboratorio de Investigación en Enfermedades Infecciosas, Laboratorios de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Louis Grandjean
- Laboratorio de Investigación en Enfermedades Infecciosas, Laboratorios de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
- Infectious Diseases and Immunity, Wellcome Trust Centre for Global Health Research, Imperial College London, London, United Kingdom
| | - David A. J. Moore
- Laboratorio de Investigación en Enfermedades Infecciosas, Laboratorios de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
- Asociación Benéfica Proyectos en Informatica, Salud, Medicina, y Agricultura (PRISMA), Lima, Peru
- TB Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Carlton A. Evans
- Infectious Diseases and Immunity, Wellcome Trust Centre for Global Health Research, Imperial College London, London, United Kingdom
- Innovation For Health and Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Luz Huaroto
- Hospital Nacional Dos de Mayo, Lima, Peru
- Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Víctor Chávez-Pérez
- Hospital Nacional Dos de Mayo, Lima, Peru
- Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Mirko Zimic
- Laboratorio de Bioinformática y Biología Molecular, Laboratorios de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
- Laboratorio de Investigación en Enfermedades Infecciosas, Laboratorios de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| |
Collapse
|
46
|
Walusimbi S, Kwesiga B, Rodrigues R, Haile M, de Costa A, Bogg L, Katamba A. Cost-effectiveness analysis of microscopic observation drug susceptibility test versus Xpert MTB/Rif test for diagnosis of pulmonary tuberculosis in HIV patients in Uganda. BMC Health Serv Res 2016; 16:563. [PMID: 27724908 PMCID: PMC5057383 DOI: 10.1186/s12913-016-1804-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 09/28/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Microscopic Observation Drug Susceptibility (MODS) and Xpert MTB/Rif (Xpert) are highly sensitive tests for diagnosis of pulmonary tuberculosis (PTB). This study evaluated the cost effectiveness of utilizing MODS versus Xpert for diagnosis of active pulmonary TB in HIV infected patients in Uganda. METHODS A decision analysis model comparing MODS versus Xpert for TB diagnosis was used. Costs were estimated by measuring and valuing relevant resources required to perform the MODS and Xpert tests. Diagnostic accuracy data of the tests were obtained from systematic reviews involving HIV infected patients. We calculated base values for unit costs and varied several assumptions to obtain the range estimates. Cost effectiveness was expressed as costs per TB patient diagnosed for each of the two diagnostic strategies. Base case analysis was performed using the base estimates for unit cost and diagnostic accuracy of the tests. Sensitivity analysis was performed using a range of value estimates for resources, prevalence, number of tests and diagnostic accuracy. RESULTS The unit cost of MODS was US$ 6.53 versus US$ 12.41 of Xpert. Consumables accounted for 59 % (US$ 3.84 of 6.53) of the unit cost for MODS and 84 % (US$10.37 of 12.41) of the unit cost for Xpert. The cost effectiveness ratio of the algorithm using MODS was US$ 34 per TB patient diagnosed compared to US$ 71 of the algorithm using Xpert. The algorithm using MODS was more cost-effective compared to the algorithm using Xpert for a wide range of different values of accuracy, cost and TB prevalence. The cost (threshold value), where the algorithm using Xpert was optimal over the algorithm using MODS was US$ 5.92. CONCLUSIONS MODS versus Xpert was more cost-effective for the diagnosis of PTB among HIV patients in our setting. Efforts to scale-up MODS therefore need to be explored. However, since other non-economic factors may still favour the use of Xpert, the current cost of the Xpert cartridge still needs to be reduced further by more than half, in order to make it economically competitive with MODS.
Collapse
Affiliation(s)
- Simon Walusimbi
- Department of Microbiology, Makerere University College of Health Sciences, Kampala, Uganda.,Department of Public Health Sciences, Karolinska Institute, Solna, Sweden
| | | | - Rashmi Rodrigues
- Department of Public Health Sciences, Karolinska Institute, Solna, Sweden
| | - Melles Haile
- Department of Microbiology, Public Health Agency of Sweden, Solna, Sweden
| | - Ayesha de Costa
- Department of Public Health Sciences, Karolinska Institute, Solna, Sweden
| | - Lennart Bogg
- Department of Public Health Sciences, Karolinska Institute, Solna, Sweden.,School of Health, Care and social Welfare, Malardalen University, Vasteras, Sweden
| | - Achilles Katamba
- Department of Medicine, Clinical Epidemiology Unit, Makerere University, College of Health Sciences, Kampala, Uganda.
| |
Collapse
|
47
|
Shinu P, AshokKumar Singh V, Nair A, Farooq R, Ishaq S. Long-Term Storage at -80°C: Effect on Rate of Recovery of Mycobacterium tuberculosis From Direct Acid-Fast Bacilli Smear-Positive Sputum Samples. J Clin Lab Anal 2016; 30:567-76. [PMID: 27685316 DOI: 10.1002/jcla.21904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 08/13/2015] [Accepted: 10/11/2015] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the difference in the rate of recovery of Mycobacterium tuberculosis (MTB) from routinely cultured sputum and long-term stored sputum specimens (at -80°C) using Löwenstein-Jensen (LJ) media, Mycobacterium Growth Indicator Tube (BBL MGIT(TM) ), and Middlebrook 7H11 (MB 7H11) agar. METHODS Direct acid-fast bacilli smear-positive sputum specimens (both before and after storage [n = 136]) were studied (after culturing on LJ media, BBL MGIT(TM) , and MB 7H11 agar) and the performances were compared. RESULTS For the detection of MTB, BBL MGIT(TM) and MB 7H11 agar (before storage) demonstrated a sensitivity, specificity, positive predictive value (PPV) of 98.28%, 30.77%, 92.68%, 66.67%, and negative predictive value (NPV) of 97.41%, 30.77%, 92.62%, 57.14%, respectively, when compared to LJ media (before storage). Similarly, BBL MGIT(TM) and MB 7H11 agar (after storage) demonstrated a sensitivity, specificity, PPV, and NPV of 95.5%, 38.89%, 90.6%, 58.33%, and 95.5%, 66.67 %, 94.64%, 70.59%, respectively, when compared to LJ media (after storage) for the detection of MTB. CONCLUSION None of the culture techniques independently (both before and after storage) detected growth of MTB from all the sputum specimens studied. However, BBL MGIT(TM) system and LJ media combination (both before and after storage) effectively detected the growth of MTB from sputum specimens when compared to other culture technique combinations.
Collapse
Affiliation(s)
- Pottathil Shinu
- Department of Microbiology, MMIMSR, MM University, Mullana, Ambala, Haryana, India.
| | | | - Anroop Nair
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, Kingdom of Saudi Arabia
| | - Rumana Farooq
- Department of Microbiology, MMIMSR, MM University, Mullana, Ambala, Haryana, India
| | - Sheikh Ishaq
- Department of Biochemistry, MMIMSR, MM University, Mullana, Ambala, Haryana, India
| |
Collapse
|
48
|
Chen X, Wu B, Jayawardana KW, Hao N, Jayawardena HSN, Langer R, Jaklenec A, Yan M. Magnetic Multivalent Trehalose Glycopolymer Nanoparticles for the Detection of Mycobacteria. Adv Healthc Mater 2016; 5:2007-12. [PMID: 27283385 PMCID: PMC5242184 DOI: 10.1002/adhm.201600071] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 05/11/2016] [Indexed: 01/29/2023]
Abstract
A multivalent trehalose-grafted poly(lactic acid) is synthesized and encapsulated with iron oxide magnetic nanoparticles. The magnetic micelles interact with Mycobacterium smegmatis to form orange clusters. Very little particle interaction is found on Staphylococcus epidermidis 35984 or Escherichia coli ORN 208. The presented new approach to the detection of mycobacteria does not require molecular biology reagents or sophisticated instruments.
Collapse
Affiliation(s)
- Xuan Chen
- Department of Chemistry, University of Massachusetts, Lowell, MA, 01854, USA
| | - Bin Wu
- Department of Chemistry, University of Massachusetts, Lowell, MA, 01854, USA
| | | | - Nanjing Hao
- Department of Chemistry, University of Massachusetts, Lowell, MA, 01854, USA
| | - H Surangi N Jayawardena
- David H. Koch Institute of Integrative Cancer Research Centre, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Robert Langer
- David H. Koch Institute of Integrative Cancer Research Centre, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Ana Jaklenec
- David H. Koch Institute of Integrative Cancer Research Centre, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Mingdi Yan
- Department of Chemistry, University of Massachusetts, Lowell, MA, 01854, USA
| |
Collapse
|
49
|
Galarza M, Fasabi M, Levano KS, Castillo E, Barreda N, Rodriguez M, Guio H. High-resolution melting analysis for molecular detection of multidrug resistance tuberculosis in Peruvian isolates. BMC Infect Dis 2016; 16:260. [PMID: 27278526 PMCID: PMC4899911 DOI: 10.1186/s12879-016-1615-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 06/03/2016] [Indexed: 12/30/2022] Open
Abstract
Background The emergence of multidrug-resistant strains is a major health problem especially for countries with high TB incidence such as Peru. In this study, we evaluated High Resolution Melting (HRM) assay in Peruvian isolates for the detection of mutations within rpoB, katG genes and promoter region inhA to determine isoniazid and rifampicin resistance in Mycobacterium tuberculosis (Mtb). Methods DNA samples extracted from a total of 167 clinical isolates of Mtb, 89 drug-sensitive and 78 multidrug-resistant, were blindly analyzed by HRM analysis and verified by DNA sequencing. Results The HRM analysis generated patterns that were specific to distinguish between sensitive and resistance isolates. The sensitivity and specificity of the HRM assays in comparison with drug susceptibility testing (DST) for detection of rifampicin resistance were 98.7 % and 97.5 %, and for isoniazid resistance were 98.7 % and 100 %. Conclusion This study suggests that HRM Analysis could help with rapid diagnosis of MDR-TB cases in Peru.
Collapse
Affiliation(s)
- Marco Galarza
- Laboratorio de Biotecnología y Biología Molecular, Instituto Nacional de Salud, Lima, Peru
| | - Manuel Fasabi
- Laboratorio de Biotecnología y Biología Molecular, Instituto Nacional de Salud, Lima, Peru
| | - Kelly S Levano
- Laboratorio de Biotecnología y Biología Molecular, Instituto Nacional de Salud, Lima, Peru
| | - Edith Castillo
- Laboratorio de Referencia Regional de Tuberculosis y Microbiología, DIRESA Callao, Lima, Peru
| | - Nadia Barreda
- Laboratorio de Referencia Regional de Tuberculosis y Microbiología, DIRESA Callao, Lima, Peru
| | - Mitzi Rodriguez
- Laboratorio de Referencia Regional de Tuberculosis y Microbiología, DIRESA Callao, Lima, Peru
| | - Heinner Guio
- Laboratorio de Biotecnología y Biología Molecular, Instituto Nacional de Salud, Lima, Peru.
| |
Collapse
|
50
|
Proaño A, Bravard MA, Tracey BH, López JW, Comina G, Zimic M, Coronel J, O'Neill Lee G, Caviedes L, Luis Cabrera J, Salas A, Ticona E, Kirwan DE, Friedland JS, Evans CA, Moore DA, Gilman RH. Protocol for studying cough frequency in people with pulmonary tuberculosis. BMJ Open 2016; 6:e010365. [PMID: 27105713 PMCID: PMC4853990 DOI: 10.1136/bmjopen-2015-010365] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Cough is a key symptom of tuberculosis (TB) as well as the main cause of transmission. However, a recent literature review found that cough frequency (number of coughs per hour) in patients with TB has only been studied once, in 1969. The main aim of this study is to describe cough frequency patterns before and after the start of TB treatment and to determine baseline factors that affect cough frequency in these patients. Secondarily, we will evaluate the correlation between cough frequency and TB microbiological resolution. METHODS This study will select participants with culture confirmed TB from 2 tertiary hospitals in Lima, Peru. We estimated that a sample size of 107 patients was sufficient to detect clinically significant changes in cough frequency. Participants will initially be evaluated through questionnaires, radiology, microscopic observation drug susceptibility broth TB-culture, auramine smear microscopy and cough recordings. This cohort will be followed for the initial 60 days of anti-TB treatment, and throughout the study several microbiological samples as well as 24 h recordings will be collected. We will describe the variability of cough episodes and determine its association with baseline laboratory parameters of pulmonary TB. In addition, we will analyse the reduction of cough frequency in predicting TB cure, adjusted for potential confounders. ETHICS AND DISSEMINATION Ethical approval has been obtained from the ethics committees at each participating hospital in Lima, Peru, Asociación Benéfica PRISMA in Lima, Peru, the Universidad Peruana Cayetano Heredia in Lima, Peru and Johns Hopkins University in Baltimore, USA. We aim to publish and disseminate our findings in peer-reviewed journals. We also expect to create and maintain an online repository for TB cough sounds as well as the statistical analysis employed.
Collapse
Affiliation(s)
- Alvaro Proaño
- Facultad de Medicina ‘Alberto Hurtado’, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Marjory A Bravard
- Asociación Benéfica PRISMA, Lima, Perú
- Department of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Innovation For Health And Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Brian H Tracey
- Department of Electrical and Computer Engineering, Tufts University, Medford, Massachusetts, USA
| | - José W López
- Instituto Nacional de Salud del Niño San Borja, Lima, Perú
- Laboratorio de Bioinformática y Biología Molecular, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - German Comina
- Department of Global Community Health and Behavioral Sciences, Tulane University, New Orleans, Louisiana, USA
- Escuela Profesional de Ingeniería Física, Facultad de Ciencias, Universidad Nacional de Ingeniería, Lima, Perú
| | - Mirko Zimic
- Laboratorio de Bioinformática y Biología Molecular, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
- Laboratorio de Investigación en Enfermedades Infecciosas, Laboratorio de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Jorge Coronel
- Laboratorio de Investigación en Enfermedades Infecciosas, Laboratorio de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Gwenyth O'Neill Lee
- Department of Global Community Health and Behavioral Sciences, Tulane University, New Orleans, Louisiana, USA
| | - Luz Caviedes
- Laboratorio de Investigación en Enfermedades Infecciosas, Laboratorio de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Jose Luis Cabrera
- Servicio de Neumología, Hospital Nacional Alcides Carrión, Lima, Perú
| | - Antonio Salas
- Servicio de Neumología, Hospital Nacional Dos de Mayo, Lima, Perú
| | - Eduardo Ticona
- Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Perú
- Servicio de Enfermedades Infecciosas y Tropicales, Hospital Nacional Dos de Mayo, Lima, Perú
| | - Daniela E Kirwan
- Infectious Diseases & Immunity, Imperial College London, London, UK
| | - Jon S Friedland
- Infectious Diseases & Immunity, Imperial College London, London, UK
- Wellcome Trust Imperial College Centre for Global Health Research, London, UK
| | - Carlton A Evans
- Innovation For Health And Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru
- Infectious Diseases & Immunity, Imperial College London, London, UK
- Wellcome Trust Imperial College Centre for Global Health Research, London, UK
| | - David A Moore
- Asociación Benéfica PRISMA, Lima, Perú
- Laboratorio de Investigación en Enfermedades Infecciosas, Laboratorio de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
- TB Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Robert H Gilman
- Asociación Benéfica PRISMA, Lima, Perú
- Laboratorio de Investigación en Enfermedades Infecciosas, Laboratorio de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
- Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | | |
Collapse
|