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Zhang M, Zhang H, Yan B, Ren M, Wang W, Zhang T. Diagnostic performance of matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) in bronchoalveolar lavage fluid for pulmonary tuberculosis in HIV-infected patients. J Clin Tuberc Other Mycobact Dis 2024; 36:100459. [PMID: 38983443 PMCID: PMC11231557 DOI: 10.1016/j.jctube.2024.100459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2024] Open
Abstract
Introduction Pulmonary tuberculosis (PTB) remains a significant health concern, particularly in individuals infected with human immunodeficiency virus (HIV) who are more susceptible to developing active TB disease. Early and accurate diagnosis of TB is crucial for effective treatment and prevention of transmission. This study aims to evaluate the potential of matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOFMS) analysis of bronchoalveolar lavage fluid (BALF) for diagnosis of suspected PTB in HIV-infected patients. Methods This retrospective study recruited 60 HIV-infected patients with suspected PTB presenting with respiratory symptoms and abnormal chest radiographs between January 2022 and June 2023. BALF samples were collected and subjected to analysis using MALDI-TOF MS, GeneXpert, acid-fast bacilli (AFB) smear and culture. And their diagnostic performance was compared. Results The sensitivity of MALDI⁃TOFMS for diagnosing PTB was 83.3 %, which was better than that of smear 11.9 %, culture 40.5 % or Xpert38.1 % (all p < 0.01). The area under the curve (AUC) value of MALDI⁃TOFMS was 0.889, which was better than that of smear 0.532, culture 0.675 or Xpert 0.690 (all p < 0.01). The katG315 and rpoB-RRDR 511 mutations were detected by the MALDI⁃TOFMS in two patients. Conclusion Nucleotide MALDI-TOFMS has a good clinical performance for rapid diagnosis of PTB from BALF samples in HIV infected patients, and detects mutations of TB simultaneously.
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Affiliation(s)
- Mei Zhang
- Department of Infectious Diseases and Medical Immunology, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
| | - Hongwei Zhang
- Clinic of Center for Infection, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
| | - Benyong Yan
- Department of Infectious Diseases and Medical Immunology, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
| | - Meixin Ren
- Department of Infectious Diseases and Medical Immunology, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
| | - Wen Wang
- Department of Infectious Diseases and Medical Immunology, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
| | - Tong Zhang
- Department of Infectious Diseases and Medical Immunology, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
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Xu L, Wang L, Song Y, Tong L. Metagenomic next-generation sequencing assistance in identifying Mycobacterium iranicum pulmonary infection: A case report. Diagn Microbiol Infect Dis 2024; 110:116445. [PMID: 39024931 DOI: 10.1016/j.diagmicrobio.2024.116445] [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: 04/15/2024] [Revised: 07/10/2024] [Accepted: 07/12/2024] [Indexed: 07/20/2024]
Abstract
Nontuberculous mycobacteria (NTM) are important opportunistic pathogens in humans, mostly affecting the lungs, and potentially causing progressive disease in individuals with underlying diseases. The prevalence of NTM infections is increasing worldwide. However, Mycobacterium iranicum (M. iranicum) infections are less common. Here we report a 65-year-old female who developed pneumonia caused by Mycobacterium iranicum, which was detected in bronchoalveolar lavage fluid (BALF) through metagenomic next-generation sequencing (mNGS). The patient was treated with moxifloxacin, doxycycline, and sulfamethoxazole/trimethoprim. Symptoms were relieved and lung abnormalities were shown to be partially absorbed on the follow-up chest computed tomography (CT) scans. As we know, this is the first case of Mycobacterium iranicum pulmonary infection identified by mNGS in BALF.
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Affiliation(s)
- Li Xu
- Department of Respiratory and Critical Care Medicine, People's Hospital of Chongqing Liangjiang New Area, Chongqing 401120, PR China
| | - Linlin Wang
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, PR China
| | - Yuanlin Song
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, PR China
| | - Lin Tong
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, PR China.
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3
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Keter AK, Vanobberghen F, Lynen L, Van Heerden A, Fehr J, Olivier S, Wong EB, Glass TR, Reither K, Goetghebeur E, Jacobs BKM. Simultaneous alleviation of verification and reference standard biases in a community-based tuberculosis screening study using Bayesian latent class analysis. PLoS One 2024; 19:e0305126. [PMID: 38857227 PMCID: PMC11164341 DOI: 10.1371/journal.pone.0305126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 05/24/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Estimation of prevalence and diagnostic test accuracy in tuberculosis (TB) prevalence surveys suffer from reference standard and verification biases. The former is attributed to the imperfect reference test used to bacteriologically confirm TB disease. The latter occurs when only the participants screening positive for any TB-compatible symptom or chest X-ray abnormality are selected for bacteriological testing (verification). Bayesian latent class analysis (LCA) alleviates the reference standard bias but suffers verification bias in TB prevalence surveys. This work aims to identify best-practice approaches to simultaneously alleviate the reference standard and verification biases in the estimates of pulmonary TB prevalence and diagnostic test performance in TB prevalence surveys. METHODS We performed a secondary analysis of 9869 participants aged ≥15 years from a community-based multimorbidity screening study in a rural district of KwaZulu-Natal, South Africa (Vukuzazi study). Participants were eligible for bacteriological testing using Xpert Ultra and culture if they reported any cardinal TB symptom or had an abnormal chest X-ray finding. We conducted Bayesian LCA in five ways to handle the unverified individuals: (i) complete-case analysis, (ii) analysis assuming the unverified individuals would be negative if bacteriologically tested, (iii) analysis of multiply-imputed datasets with imputation of the missing bacteriological test results for the unverified individuals using multivariate imputation via chained equations (MICE), and simultaneous imputation of the missing bacteriological test results in the analysis model assuming the missing bacteriological test results were (iv) missing at random (MAR), and (v) missing not at random (MNAR). We compared the results of (i)-(iii) to the analysis based on a composite reference standard (CRS) of Xpert Ultra and culture. Through simulation with an overall true prevalence of 2.0%, we evaluated the ability of the models to alleviate both biases simultaneously. RESULTS Based on simulation, Bayesian LCA with simultaneous imputation of the missing bacteriological test results under the assumption that the missing data are MAR and MNAR alleviate the reference standard and verification biases. CRS-based analysis and Bayesian LCA assuming the unverified are negative for TB alleviate the biases only when the true overall prevalence is <3.0%. Complete-case analysis produced biased estimates. In the Vukuzazi study, Bayesian LCA with simultaneous imputation of the missing bacteriological test results under the MAR and MNAR assumptions produced overall PTB prevalence of 0.9% (95% Credible Interval (CrI): 0.6-1.9) and 0.7% (95% CrI: 0.5-1.1) respectively alongside realistic estimates of overall diagnostic test sensitivity and specificity with substantially overlapping 95% CrI. The CRS-based analysis and Bayesian LCA assuming the unverified were negative for TB produced 0.7% (95% CrI: 0.5-0.9) and 0.7% (95% CrI: 0.5-1.2) overall PTB prevalence respectively with realistic estimates of overall diagnostic test sensitivity and specificity. Unlike CRS-based analysis, Bayesian LCA of multiply-imputed data using MICE mitigates both biases. CONCLUSION The findings demonstrate the efficacy of these advanced techniques in alleviating the reference standard and verification biases, enhancing the robustness of community-based screening programs. Imputing missing values as negative for bacteriological tests is plausible under realistic assumptions.
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Affiliation(s)
- Alfred Kipyegon Keter
- Institute of Tropical Medicine, Antwerp, Belgium
- Center for Community Based Research, Human Sciences Research Council, Pietermaritzburg, South Africa
- Ghent University, Ghent, Belgium
| | - Fiona Vanobberghen
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | - Alastair Van Heerden
- Center for Community Based Research, Human Sciences Research Council, Pietermaritzburg, South Africa
- Faculty of Health Sciences, Department of Paediatrics, SAMRC/WITS Developmental Pathways for Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Jana Fehr
- Africa Health Research Institute, Durban, South Africa
- Hasso-Plattner-Institute for Digital Engineering, Potsdam, Germany
| | | | - Emily B. Wong
- Africa Health Research Institute, Durban, South Africa
- University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Tracy R. Glass
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Klaus Reither
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Tan DTM, See KC. Diagnosis and management of severe pulmonary and extrapulmonary tuberculosis in critically ill patients: A mini review for clinicians. World J Crit Care Med 2024; 13:91435. [PMID: 38855275 PMCID: PMC11155508 DOI: 10.5492/wjccm.v13.i2.91435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/04/2024] [Accepted: 03/25/2024] [Indexed: 06/03/2024] Open
Abstract
Among critically ill patients, severe pulmonary and extrapulmonary tuberculosis has high morbidity and mortality. Yet, it is a diagnostic challenge given its nonspecific clinical symptoms and signs in early stages of the disease. In addition, management of severe pulmonary and extrapulmonary tuberculosis is complicated given the high risk of drug-drug interactions, drug-disease interactions, and adverse drug reactions. To help clinicians acquire an up-to-date approach to severe tuberculosis, this paper will provide a narrative review of contemporary diagnosis and management of severe pulmonary and extrapulmonary tuberculosis in critically ill patients.
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Affiliation(s)
- Dominic Ti Ming Tan
- Department of Medicine, National University Hospital, Singapore 119228, Singapore
| | - Kay Choong See
- Department of Medicine, National University Hospital, Singapore 119228, Singapore
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Kobe H, Ito A, Nakanishi Y, Miyazaki Y, Takahashi H, Toyota Y, Amano A, Matsui K, Ishida T. Diagnostic Usefulness of Liquid Culture Medium for Mycobacterium avium-intracellulare Complex Lung Disease: A Single-Centre, Retrospective Study. Cureus 2024; 16:e61542. [PMID: 38957255 PMCID: PMC11218519 DOI: 10.7759/cureus.61542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2024] [Indexed: 07/04/2024] Open
Abstract
Background The diagnosis of Mycobacterium avium-intracellulare complex lung disease (MAC-LD) requires two or more positive sputum cultures. Few reports have examined the usefulness of adding liquid culture to conventional solid culture for diagnosing MAC-LD. Methods A retrospective, cohort study of patients examined at Kurashiki Central Hospital in Japan with a confirmed diagnosis of MAC-LD between January 1, 2002, and June 20, 2021, was conducted. The primary endpoint was the culture positivity rate, which was compared between the liquid and Ogawa culture media in patients who underwent sputum culture using both methods. Secondary endpoints were the culture positivity rate in smear-positive specimens and the positivity rate by radiological type. Results The study, which involved 351 patients and 702 specimens, showed a higher positivity rate for liquid culture (n=690, 98.3%) than Ogawa culture (n=315, 44.9%). Overall, 265 patients (75.5%) would have had delayed MAC-LD diagnosis without liquid medium being used. Of the 95 smear-positive specimens, 71 (74.7%) were positive on both cultures, whereas 24 (25.3%) were positive only on liquid culture. The positivity rate of Ogawa culture varied by radiological type. Conclusions Liquid culture is more valuable for the early diagnosis of MAC-LD than Ogawa culture.
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Affiliation(s)
- Hiroshi Kobe
- Respiratory Medicine, Kurashiki Central Hospital, Kurashiki, JPN
| | - Akihiro Ito
- Respiratory Medicine, Kurashiki Central Hospital, Kurashiki, JPN
| | - Yosuke Nakanishi
- Respiratory Medicine, Kurashiki Central Hospital, Kurashiki, JPN
| | - Yui Miyazaki
- Respiratory Medicine, Kurashiki Central Hospital, Kurashiki, JPN
| | | | - Yushi Toyota
- Respiratory Medicine, Kurashiki Central Hospital, Kurashiki, JPN
| | - Akihiko Amano
- Respiratory Medicine, Kurashiki Central Hospital, Kurashiki, JPN
| | - Kyoko Matsui
- Respiratory Medicine, Kurashiki Central Hospital, Kurashiki, JPN
| | - Tadashi Ishida
- Respiratory Medicine, Kurashiki Central Hospital, Kurashiki, JPN
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Ferrari S, Zanoni M, Mangeli A, Pigoli C, D'Incau M, Alborali GL, Pacciarini ML, Boniotti MB. Bacteriological culture and direct PCR for detecting the Mycobacterium tuberculosis complex in the Italian eradication campaign: a decade of experience at the National Reference Laboratory. J Appl Microbiol 2024; 135:lxae064. [PMID: 38520154 DOI: 10.1093/jambio/lxae064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 03/05/2024] [Accepted: 03/21/2024] [Indexed: 03/25/2024]
Abstract
AIMS Our study evaluates the capacity of direct real-time PCR for detecting Mycobacterium tuberculosis complex (MTBC), with a focus on diagnostic performances and the feasibility of implementing this protocol in an eradication campaign. Specifically, we compare the effectiveness of the direct PCR method to various culture systems used by the Italian National Reference Laboratory over the last decade to detect MTBC. METHODS AND RESULTS Bovine tissue samples were routinely tested and analyzed for bovine tuberculosis (bTB) confirmation using microbiological culture (solid and liquid media), histopathological analysis, and a direct PCR assay targeting IS6110, an insertion sequence specific to the MTBC that is widely used for tuberculosis diagnosis. The direct real-time PCR demonstrated a high concordance (K = 0.871) with microbiological culture, as well as good sensitivity (91.84%) and specificity (95.24%). In contrast, histopathology demonstrated lower concordance (K = 0.746) and performance levels (sensitivity 91.41%, specificity 82.88%). Liquid media promoted faster and more efficient growth of MTBC than solid media. M. bovis and M. caprae had the comparable ability to respond to the direct real-time PCR test and grow on the microbiological medium. CONCLUSIONS This study confirms that direct real-time PCR can detect MTBC with high diagnostic accuracy within a few days. This study found no significant differences in performance between culture media and direct PCR for M. bovis and M. caprae.
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Affiliation(s)
- Stefania Ferrari
- Centro Nazionale di Referenza per la Tubercolosi Bovina (CNR-bTB), Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia Romagna (IZSLER), via Bianchi 9, 25124 Brescia, Italy
| | - Mariagrazia Zanoni
- Centro Nazionale di Referenza per la Tubercolosi Bovina (CNR-bTB), Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia Romagna (IZSLER), via Bianchi 9, 25124 Brescia, Italy
| | - Anna Mangeli
- Centro Nazionale di Referenza per la Tubercolosi Bovina (CNR-bTB), Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia Romagna (IZSLER), via Bianchi 9, 25124 Brescia, Italy
| | - Claudio Pigoli
- Sede Territoriale di Milano, Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia Romagna (IZSLER), Via Celoria 12, 20133 Milano, Italy
| | - Mario D'Incau
- Centro Nazionale di Referenza per la Tubercolosi Bovina (CNR-bTB), Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia Romagna (IZSLER), via Bianchi 9, 25124 Brescia, Italy
| | - Giovanni Loris Alborali
- Centro Nazionale di Referenza per la Tubercolosi Bovina (CNR-bTB), Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia Romagna (IZSLER), via Bianchi 9, 25124 Brescia, Italy
| | - Maria Lodovica Pacciarini
- Centro Nazionale di Referenza per la Tubercolosi Bovina (CNR-bTB), Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia Romagna (IZSLER), via Bianchi 9, 25124 Brescia, Italy
| | - Maria Beatrice Boniotti
- Centro Nazionale di Referenza per la Tubercolosi Bovina (CNR-bTB), Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia Romagna (IZSLER), via Bianchi 9, 25124 Brescia, Italy
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Shanmuganathan R, Ramachandran K, Shetty AP, Kanna RM. Active tuberculosis of spine: Current updates. NORTH AMERICAN SPINE SOCIETY JOURNAL 2023; 16:100267. [PMID: 37736557 PMCID: PMC10510092 DOI: 10.1016/j.xnsj.2023.100267] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/13/2023] [Accepted: 08/15/2023] [Indexed: 09/23/2023]
Abstract
Background Spinal tuberculosis (TB) is the most common extrapulmonary form of tuberculosis. In both developing and developed countries, TB has been on the rising trend due to factors such as increasing HIV coinfection, multidrug resistance of the organism, and global migration. Spinal TB, which most often affects the lower thoracic and thoracolumbar area, accounts for 50% of all musculoskeletal tuberculosis. Methods Using the Cochrane Database of Systematic Reviews, EMBASE, and PubMed, a systematic computerized literature search was performed. Analyses of studies published within the past 10 years were conducted. The searches were performed using Medical Subject Headings terms, with "spinal tuberculosis," "diagnosis," "epidemiology," and "etiology","management," "surgery," and "therapy" as subheadings. Results Progressive collapse, kyphosis, and neurological deficiency are hallmarks of the disease because of its destructive effect on the intervertebral disc and adjacent vertebral bodies. The condition may be identified using laboratory testing and distinctive imaging features, but the gold standard for diagnosis is tissue diagnosis using cultures, histology, and polymerase chain reaction. Uncomplicated spinal TB is today a medical condition that can be adequately treated by multidrug ambulatory chemotherapy. Surgery is reserved for individuals who have instability, neurological impairment, and deformity correction. Debridement, deformity correction, and stable fusion are the cornerstones of surgical treatment. Conclusions Clinical results for the treatment of spinal TB are generally satisfactory when the disease is identified and treated early. However, the major health issue and the biggest obstacle in achieving the goals of the "End TB strategy" is the recent rise in the emergence of drug resistance. Hence strict vigilance and patient perseverance in the completion of the treatment is the main need of the hour.
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Affiliation(s)
- Rajasekaran Shanmuganathan
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Mettupalayam Rd, Coimbatore, 641043 India
| | - Karthik Ramachandran
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Mettupalayam Rd, Coimbatore, 641043 India
| | - Ajoy Prasad Shetty
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Mettupalayam Rd, Coimbatore, 641043 India
| | - Rishi Mugesh Kanna
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Mettupalayam Rd, Coimbatore, 641043 India
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Warren JL, Chitwood MH, Sobkowiak B, Colijn C, Cohen T. Spatial modeling of Mycobacterium tuberculosis transmission with dyadic genetic relatedness data. Biometrics 2023; 79:3650-3663. [PMID: 36745619 PMCID: PMC10404301 DOI: 10.1111/biom.13836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 01/31/2023] [Indexed: 02/07/2023]
Abstract
Understanding factors that contribute to the increased likelihood of pathogen transmission between two individuals is important for infection control. However, analyzing measures of pathogen relatedness to estimate these associations is complicated due to correlation arising from the presence of the same individual across multiple dyadic outcomes, potential spatial correlation caused by unmeasured transmission dynamics, and the distinctive distributional characteristics of some of the outcomes. We develop two novel hierarchical Bayesian spatial methods for analyzing dyadic pathogen genetic relatedness data, in the form of patristic distances and transmission probabilities, that simultaneously address each of these complications. Using individual-level spatially correlated random effect parameters, we account for multiple sources of correlation between the outcomes as well as other important features of their distribution. Through simulation, we show the limitations of existing approaches in terms of estimating key associations of interest, and the ability of the new methodology to correct for these issues across datasets with different levels of correlation. All methods are applied to Mycobacterium tuberculosis data from the Republic of Moldova, where we identify previously unknown factors associated with disease transmission and, through analysis of the random effect parameters, key individuals, and areas with increased transmission activity. Model comparisons show the importance of the new methodology in this setting. The methods are implemented in the R package GenePair.
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Affiliation(s)
| | - Melanie H. Chitwood
- Department of Epidemiology of Microbial Diseases, Yale University, Connecticut, USA
| | | | - Caroline Colijn
- Department of Mathematics, Simon Fraser University, Burnaby, Canada
| | - Ted Cohen
- Department of Epidemiology of Microbial Diseases, Yale University, Connecticut, USA
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Ayoun Alsoud R, Svensson RJ, Svensson EM, Gillespie SH, Boeree MJ, Diacon AH, Dawson R, Aarnoutse RE, Simonsson USH. Combined quantitative tuberculosis biomarker model for time-to-positivity and colony forming unit to support tuberculosis drug development. Front Pharmacol 2023; 14:1067295. [PMID: 36998606 PMCID: PMC10043246 DOI: 10.3389/fphar.2023.1067295] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 02/27/2023] [Indexed: 03/15/2023] Open
Abstract
Biomarkers are quantifiable characteristics of biological processes. In Mycobacterium tuberculosis, common biomarkers used in clinical drug development are colony forming unit (CFU) and time-to-positivity (TTP) from sputum samples. This analysis aimed to develop a combined quantitative tuberculosis biomarker model for CFU and TTP biomarkers for assessing drug efficacy in early bactericidal activity studies. Daily CFU and TTP observations in 83 previously patients with uncomplicated pulmonary tuberculosis after 7 days of different rifampicin monotherapy treatments (10–40 mg/kg) from the HIGHRIF1 study were included in this analysis. The combined quantitative tuberculosis biomarker model employed the Multistate Tuberculosis Pharmacometric model linked to a rifampicin pharmacokinetic model in order to determine drug exposure-response relationships on three bacterial sub-states using both the CFU and TTP data simultaneously. CFU was predicted from the MTP model and TTP was predicted through a time-to-event approach from the TTP model, which was linked to the MTP model through the transfer of all bacterial sub-states in the MTP model to a one bacterial TTP model. The non-linear CFU-TTP relationship over time was well predicted by the final model. The combined quantitative tuberculosis biomarker model provides an efficient approach for assessing drug efficacy informed by both CFU and TTP data in early bactericidal activity studies and to describe the relationship between CFU and TTP over time.
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Affiliation(s)
- Rami Ayoun Alsoud
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | - Robin J. Svensson
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | - Elin M. Svensson
- Department of Pharmacy, Uppsala University, Uppsala, Sweden
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Stephen H. Gillespie
- Division of Infection and Global Health, School of Medicine, University of St Andrews, St Andrews, United Kingdom
| | - Martin J. Boeree
- Department of Lung Diseases, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Rodney Dawson
- Division of Pulmonology, Department of Medicine, University of Cape Town, Cape Town, South Africa
- University of Cape Town Lung Institute, Cape Town, South Africa
| | - Rob E. Aarnoutse
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Ulrika S. H. Simonsson
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
- *Correspondence: Ulrika S. H. Simonsson,
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Keter AK, Lynen L, Van Heerden A, Wong E, Reither K, Goetghebeur E, Jacobs BKM. Evaluation of tuberculosis diagnostic test accuracy using Bayesian latent class analysis in the presence of conditional dependence between the diagnostic tests used in a community-based tuberculosis screening study. PLoS One 2023; 18:e0282417. [PMID: 36862729 PMCID: PMC9980779 DOI: 10.1371/journal.pone.0282417] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 01/15/2023] [Indexed: 03/03/2023] Open
Abstract
Diagnostic accuracy studies in pulmonary tuberculosis (PTB) are complicated by the lack of a perfect reference standard. This limitation can be handled using latent class analysis (LCA), assuming independence between diagnostic test results conditional on the true unobserved PTB status. Test results could remain dependent, however, e.g. with diagnostic tests based on a similar biological basis. If ignored, this gives misleading inferences. Our secondary analysis of data collected during the first year (May 2018 -May 2019) of a community-based multi-morbidity screening program conducted in the rural uMkhanyakude district of KwaZulu Natal, South Africa, used Bayesian LCA. Residents of the catchment area, aged ≥15 years and eligible for microbiological testing, were analyzed. Probit regression methods for dependent binary data sequentially regressed each binary test outcome on other observed test results, measured covariates and the true unobserved PTB status. Unknown model parameters were assigned Gaussian priors to evaluate overall PTB prevalence and diagnostic accuracy of 6 tests used to screen for PTB: any TB symptom, radiologist conclusion, Computer Aided Detection for TB version 5 (CAD4TBv5≥53), CAD4TBv6≥53, Xpert Ultra (excluding trace) and culture. Before the application of our proposed model, we evaluated its performance using a previously published childhood pulmonary TB (CPTB) dataset. Standard LCA assuming conditional independence yielded an unrealistic prevalence estimate of 18.6% which was not resolved by accounting for conditional dependence among the true PTB cases only. Allowing, also, for conditional dependence among the true non-PTB cases produced a 1.1% plausible prevalence. After incorporating age, sex, and HIV status in the analysis, we obtained 0.9% (95% CrI: 0.6, 1.3) overall prevalence. Males had higher PTB prevalence compared to females (1.2% vs. 0.8%). Similarly, HIV+ had a higher PTB prevalence compared to HIV- (1.3% vs. 0.8%). The overall sensitivity for Xpert Ultra (excluding trace) and culture were 62.2% (95% CrI: 48.7, 74.4) and 75.9% (95% CrI: 61.9, 89.2), respectively. Any chest X-ray abnormality, CAD4TBv5≥53 and CAD4TBv6≥53 had similar overall sensitivity. Up to 73.3% (95% CrI: 61.4, 83.4) of all true PTB cases did not report TB symptoms. Our flexible modelling approach yields plausible, easy-to-interpret estimates of sensitivity, specificity and PTB prevalence under more realistic assumptions. Failure to fully account for diagnostic test dependence can yield misleading inferences.
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Affiliation(s)
- Alfred Kipyegon Keter
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
- Centre for Community Based Research, Human Sciences Research Council, Pietermaritzburg, South Africa
- Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Ghent, Belgium
- * E-mail:
| | - Lutgarde Lynen
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | - Alastair Van Heerden
- Centre for Community Based Research, Human Sciences Research Council, Pietermaritzburg, South Africa
- MRC/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Emily Wong
- Africa Health Research Institute, Durban, South Africa
- Division of Infectious Diseases, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Klaus Reither
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Els Goetghebeur
- Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Ghent, Belgium
| | - Bart K. M. Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
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Luo J, Yu X, Dong L, Huo F, Ma Y, Liang Q, Shang Y, Huang H. Biological interpretation of the sporadic sputum smear-positive-culture-negative outcome for patients with tuberculosis undertaking treatments. Front Public Health 2023; 11:1064512. [PMID: 36844845 PMCID: PMC9950553 DOI: 10.3389/fpubh.2023.1064512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 01/16/2023] [Indexed: 02/12/2023] Open
Abstract
Introduction The objective of the study was to identify the causes of smear-positive-culture-negative (S+/C-) outcomes of patients with tuberculosis during the treatment course. Methods A laboratory-based retrospective study was performed at the Beijing Chest Hospital in China. Within the study period, all patients with pulmonary tuberculosis (PTB) who undertook anti-TB treatments and yielded smear positive outcomes with simultaneous culture outcomes on sputa were considered. Patients were classified into three groups: (I) performed LJ medium culture only; (II) performed BACTEC MGIT960 liquid culture only; and (III) performed both LJ culture and MGIT960 culture. The S+/C- rates of each group were analyzed. The clinical medical records regarding patient category, follow-up bacteriologic examination data, and treatment response were investigated. Results In total, 1,200 eligible patients were enrolled, and the overall S+/C- rate was 17.5% (210/1,200). Group I had obviously higher S+/C- rate (37%) than group II (18.5%) and group III (9.5%). When solid and liquid cultures were considered independently, the S+/C- outcome was observed more frequently in the solid culture group than in the liquid culture group (30.4%, 345/1,135 vs. 11.5%, 100/873; p < 0.001, χ2 = 102.64). Among the 102 S+/C- patients who had follow-up cultures performed, 35 (34.3%) had positive culture outcomes. Whereas among the 67 patients with follow-up information for more than 3 months but without supportive bacteriological evidence, 45 (67.2%, 45/67) had unfavorable prognosis (including relapse and unimproved conditions), and only 22 (32.8%, 22/67) patients had improved conditions. Compared with new cases, retreated cases produced S+/C- outcomes more frequently and had more chances to be cultivated bacilli successfully afterward. Conclusions Among our patients, the sporadic smear positive and culture negative outcomes for sputa are more likely associated with the technical failures of culture than with dead bacilli, and this is especially noteworthy for LJ medium culture.
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Affiliation(s)
- Jingjing Luo
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China,National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug-Resistant Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Xia Yu
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug-Resistant Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Lingling Dong
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug-Resistant Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Fengmin Huo
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug-Resistant Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Yifeng Ma
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug-Resistant Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Qian Liang
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug-Resistant Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Yuanyuan Shang
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug-Resistant Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Hairong Huang
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug-Resistant Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China,*Correspondence: Hairong Huang ✉
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Barbier E, Fouchet T, Hartmann A, Cambau E, Mougari F, Dubois C, Lubetzki M, Rochelet M. Rapid electrochemical detection of Mycobacterium tuberculosis in sputum by measuring Ag85 activity with disposable carbon sensors. Talanta 2023; 253:123927. [PMID: 36174382 DOI: 10.1016/j.talanta.2022.123927] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/31/2022] [Accepted: 09/06/2022] [Indexed: 12/13/2022]
Abstract
An electrochemical assay for the detection of the enzymatic activity of the antigen 85 (Ag85) tuberculosis (TB) biomarker was developed and evaluated for the qualitative detection of Mycobacterium tuberculosis in decontaminated sputum. For this purpose, the electroactive properties of both synthetic p-aminophenyl-6-O-octanoyl-3-d-glucopyranoside (p-APOG) substrate and p-aminophenyl-6-3-d-glucopyranoside (p-APG) product released after the removal of the octanoyl fatty acid by the Ag85 were investigated with disposable carbon screen-printed electrodes by cyclic voltammetry. Since specific anodic responses were obtained for the p-APOG substrate and the p-APG product, the intensity of the oxidation peak of the p-APG (E = + 0.35 V vs. Ag/AgCl) was selected as the analytical response for the detection of the Ag85 acyltransferase activity. Once the proof of concept of the Ag85 electrochemical assay was validated with a commercially-available Ag85B protein, its specificity was further assessed by analyzing pure cultures of various bacteria including tuberculous and non-tuberculous mycobacteria as well as different species found in patients' sputum. Finally, with a specificity of 78% and a sensitivity of 89%, the method was successfully compared to microscopy and culture routine tests for TB testing in 36 frozen fluidized and decontaminated sputum. This suggests that owing to its convenience, rapidity, low-cost and portability, the reported Ag85 electrochemical assay is a promising tool to screen patients for TB.
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Affiliation(s)
- Elodie Barbier
- UMR AgroEcologie 1347, INRAe, Université Bourgogne Franche-Comté, BP 87999, Cedex, 21079, Dijon, France
| | - Théo Fouchet
- UMR AgroEcologie 1347, INRAe, Université Bourgogne Franche-Comté, BP 87999, Cedex, 21079, Dijon, France; Inserm UMR 1137 IAME, Université de Paris, 75018, Paris, France; Service de Mycobactériologie Spécialisée et de Référence, Laboratoire Associé du Centre National de Référence des Mycobactéries et Résistance des Mycobactéries aux Antituberculeux (CNR-MyRMA), APHP-Bichat GHU Nord, 75018, Paris, France; EpiLAB, 4 Rue Anatole France, 78350, Jouy-en-Josas, France
| | - Alain Hartmann
- UMR AgroEcologie 1347, INRAe, Université Bourgogne Franche-Comté, BP 87999, Cedex, 21079, Dijon, France
| | - Emmanuelle Cambau
- Inserm UMR 1137 IAME, Université de Paris, 75018, Paris, France; Service de Mycobactériologie Spécialisée et de Référence, Laboratoire Associé du Centre National de Référence des Mycobactéries et Résistance des Mycobactéries aux Antituberculeux (CNR-MyRMA), APHP-Bichat GHU Nord, 75018, Paris, France
| | - Faiza Mougari
- Inserm UMR 1137 IAME, Université de Paris, 75018, Paris, France; Service de Mycobactériologie Spécialisée et de Référence, Laboratoire Associé du Centre National de Référence des Mycobactéries et Résistance des Mycobactéries aux Antituberculeux (CNR-MyRMA), APHP-Bichat GHU Nord, 75018, Paris, France
| | - Clément Dubois
- EpiLAB, 4 Rue Anatole France, 78350, Jouy-en-Josas, France
| | | | - Murielle Rochelet
- UMR AgroEcologie 1347, INRAe, Université Bourgogne Franche-Comté, BP 87999, Cedex, 21079, Dijon, France.
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Calligaro GL, Singh N, Pennel TC, Steyn R, Brink A, Esmail A, Mottay L, Oelofse S, Mastrapa BL, Basera W, Manning K, Ofoegbu C, Linegar A, Dheda K. Outcomes of patients undergoing lung resection for drug-resistant TB and the prognostic significance of pre-operative positron emission tomography/computed tomography (PET/CT) in predicting treatment failure. EClinicalMedicine 2023; 55:101728. [PMID: 36386040 PMCID: PMC9646880 DOI: 10.1016/j.eclinm.2022.101728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/11/2022] [Accepted: 10/14/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Surgery remains an adjunctive treatment for drug-resistant tuberculosis (DR-TB) treatment failure despite the use of bedaquiline. However, there are few data about the role of surgery when combined with newer drugs. There are no outcome data from TB endemic countries, and the prognostic significance of pre-operative PET-CT remains unknown. METHODS We performed a prospective observational study of 57 DR-TB patients referred for surgery at Groote Schuur Hospital between 2010 and 2016. PET-CT was performed if there was nodal disease or disease outside the area of planned resection but did not influence treatment decisions. 24-month treatment success post-surgery (cure or treatment completion), including all-cause mortality, was determined. FINDINGS 35/57 (61.4%) patients (median age 40 years; 26% HIV-infected) underwent surgery and 22/57 (38.6%) did not (11 patients were deemed unsuitable due to bilateral cavitary disease and 11 patients declined surgery). Treatment failure was significantly lower in those who underwent surgery compared to those eligible but declined surgery [15/35 (43%) versus 11/11 (100%); relative risk 0.57 (0.42-0.76); p < 0.01). In patients treated with surgery, a post-operative regimen containing bedaquiline was associated with a lower odds of treatment failure [OR (95%CI) 0.06 (0.00-0.48); p = 0.007]. Pre-operative PET-CT (n = 25) did not predict treatment outcome. INTERPRETATION Resectional surgery for DR-TB combined with chemotherapy was associated with significantly better outcomes than chemotherapy alone. A post-operative bedaquiline-containing regimen was associated with improved outcome; however, this finding may have been confounded by higher use of bedaquiline and less loss to follow-up in the surgical group. However, PET-CT had no prognostic value. These data inform clinical practice in TB-endemic settings. FUNDING This work was supported by the South African MRC (RFA-EMU-02-2017) and the EDCTP (TMA-2015SF-1043 & TMA- 1051-TESAII).
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Affiliation(s)
- Gregory L. Calligaro
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute and South African MRC/UCT Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa
| | - Nevadna Singh
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute and South African MRC/UCT Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa
| | - Timothy C. Pennel
- Chris Barnard Division of Cardiothoracic Surgery, Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Rachelle Steyn
- Division of Nuclear Medicine, Department of Radiology, University of Cape Town, Cape Town, South Africa
| | - Anita Brink
- Division of Nuclear Medicine, Department of Radiology, University of Cape Town, Cape Town, South Africa
| | - Aliasgar Esmail
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute and South African MRC/UCT Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa
| | - Lynelle Mottay
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute and South African MRC/UCT Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa
| | - Suzette Oelofse
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute and South African MRC/UCT Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa
| | - Barbara L. Mastrapa
- District Clinical Specialist Team, Namakwa District, Springbok, South Africa
| | - Wisdom Basera
- Department of Medicine, University of Cape Town, Cape Town, South Africa
- Burden of Disease Research Unit, South African Medical Research Council, South Africa
| | - Kathryn Manning
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Chima Ofoegbu
- Chris Barnard Division of Cardiothoracic Surgery, Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Anthony Linegar
- Chris Barnard Division of Cardiothoracic Surgery, Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Keertan Dheda
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute and South African MRC/UCT Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa
- Faculty of Infectious and Tropical Diseases, Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Corresponding author. Centre for Lung Infection and Immunity , H46.41 Old Main Building, Groote Schuur Hospital, Observatory, Cape Town 7925, South Africa.
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Keter AK, Lynen L, Van Heerden A, Goetghebeur E, Jacobs BK. Implications of covariate induced test dependence on the diagnostic accuracy of latent class analysis in pulmonary tuberculosis. J Clin Tuberc Other Mycobact Dis 2022; 29:100331. [PMID: 36111071 PMCID: PMC9468460 DOI: 10.1016/j.jctube.2022.100331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Alfred Kipyegon Keter
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Nationalestraat 155, 2000 Antwerp, Belgium
- Centre for Community Based Research, Human Sciences Research Council, Sweetwaters, Bus Depot, Pietermaritzburg 3201, South Africa
- Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Krijgslaan 281, Building S9, 9000 Ghent, Belgium
- Corresponding author.
| | - Lutgarde Lynen
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Nationalestraat 155, 2000 Antwerp, Belgium
| | - Alastair Van Heerden
- Centre for Community Based Research, Human Sciences Research Council, Sweetwaters, Bus Depot, Pietermaritzburg 3201, South Africa
- MRC/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Science, University of the Witwatersrand, 7 York Rd, Parktown, Johannesburg 2193, South Africa
| | - Els Goetghebeur
- Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Krijgslaan 281, Building S9, 9000 Ghent, Belgium
| | - Bart K.M. Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Nationalestraat 155, 2000 Antwerp, Belgium
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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.
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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
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16
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Singhal R, Sah GC, Sethi P, Singh A, Kumar G, Myneedu VP. Detection of multidrug and extensively drug-resistance and mutation pattern in geriatric patients from North Indian referral institute. Indian J Tuberc 2022; 69 Suppl 2:S287-S294. [PMID: 36400525 DOI: 10.1016/j.ijtb.2022.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 10/25/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Geriatric population are predisposed to reactivation to tuberculosis (TB) and multi-drug resistance (MDR) due to deteriorated immune system. Limited data is available in this population hence present study is undertaken to study drug resistance and associated mutations among geriatric presumptive DR-TB patients by genotypic methods METHODS: From October 2011 to December 2018, demographic characteristics of enrolled patients was collected. Smear-positive processed sputum samples were subjected directly while cultures positive for Mycobacterium Tuberculosis (MTB) from smear-negative pulmonary and all extra-pulmonary samples were subjected to LPA. The LPA used were Genotype MTBDR plus (1st line LPA) for detection of susceptibility to rifampicin (RIF) and isoniazid (INH) and Genotype MTBDR sl (2nd line LPA), for susceptibility to fluoroquinolones (FQ) and aminoglycosides (AG). RESULTS Total of 2041 samples were received from presumptive MDR-TB patients above 60 years of age during study period, of which 1406; 68.9% were within 60-70 year followed by 495; 24.3% within 71-80 year and 140; 6.9% more than 80 years. Total of 1055 MTB were detected, of which those diagnosed as RIF resistant were 117/1055; 11.2% including 89/1055; 8.5% MDR-TB and resistance to INH was in 84/1055; 8%. Total 67, 2nd line LPA gave valid results, of which 19/67 (28.4%) isolates were resistant to only FQ, and one isolate was resistant to AG. CONCLUSION Study finding highlights need for dedicated efforts for diagnosis, and treatment of geriatric tuberculosis. Suitable intervention at programmatic country level at country will help in strengthening tuberculosis control strategies in this population.
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Affiliation(s)
- Ritu Singhal
- Department of Microbiology, National Institute of Tuberculosis and Respiratory Diseases, Sri Aurobindo Marg, New Delhi, India.
| | - Grish C Sah
- Department of Microbiology, National Institute of Tuberculosis and Respiratory Diseases, Sri Aurobindo Marg, New Delhi, India
| | - Prabhpreet Sethi
- Department of TB and Chest, National Institute of Tuberculosis and Respiratory Diseases, Sri Aurobindo Marg, New Delhi, India
| | - Anjali Singh
- Department of Microbiology, National Institute of Tuberculosis and Respiratory Diseases, Sri Aurobindo Marg, New Delhi, India
| | - Gavish Kumar
- Department of Microbiology, National Institute of Tuberculosis and Respiratory Diseases, Sri Aurobindo Marg, New Delhi, India
| | - Vithal Prasad Myneedu
- Department of Microbiology, National Institute of Tuberculosis and Respiratory Diseases, Sri Aurobindo Marg, New Delhi, India
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Nandlal L, Perumal R, Naidoo K. Rapid Molecular Assays for the Diagnosis of Drug-Resistant Tuberculosis. Infect Drug Resist 2022; 15:4971-4984. [PMID: 36060232 PMCID: PMC9438776 DOI: 10.2147/idr.s381643] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/20/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Louansha Nandlal
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), South African Medical Research Council (SAMRC)-CAPRISA-TB-HIV Pathogenesis and Treatment Research Unit, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Durban, South Africa
| | - Rubeshan Perumal
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), South African Medical Research Council (SAMRC)-CAPRISA-TB-HIV Pathogenesis and Treatment Research Unit, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Durban, South Africa
- Correspondence: Rubeshan Perumal, Centre for the AIDS Programme of Research in South Africa (CAPRISA), South African Medical Research Council (SAMRC)-CAPRISA-TB-HIV Pathogenesis and Treatment Research Unit, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Durban, South Africa, Email
| | - Kogieleum Naidoo
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), South African Medical Research Council (SAMRC)-CAPRISA-TB-HIV Pathogenesis and Treatment Research Unit, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Durban, South Africa
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Use of Whole-Genome Sequencing to Predict Mycobacterium tuberculosis Complex Drug Resistance from Early Positive Liquid Cultures. Microbiol Spectr 2022; 10:e0251621. [PMID: 35311541 PMCID: PMC9045259 DOI: 10.1128/spectrum.02516-21] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Our objective was to evaluate the performance of whole-genome sequencing (WGS) from early positive liquid cultures for predicting Mycobacterium tuberculosis complex (MTBC) drug resistance. Clinical isolates were obtained from tuberculosis patients at Shanghai Pulmonary Hospital (SPH). Antimicrobial susceptibility testing (AST) was performed, and WGS from early Bactec mycobacterial growth indicator tube (MGIT) 960-positive liquid cultures was performed to predict the drug resistance using the TB-Profiler informatics platform. A total of 182 clinical isolates were enrolled in this study. Using phenotypic AST as the gold standard, the overall sensitivity and specificity for WGS were, respectively, 97.1% (89.8 to 99.6%) and 90.4% (83.4 to 95.1%) for rifampin, 91.0% (82.4 to 96.3%) and 95.2% (89.1 to 98.4%) for isoniazid, 100.0% (89.4 to 100.0%) and 87.3% (80.8 to 92.1%) for ethambutol, 96.6% (88.3 to 99.6%) and 61.8% (52.6 to 70.4%) for streptomycin, 86.8% (71.9 to 95.6%) and 95.8% (91.2 to 98.5%) for moxifloxacin, 86.5% (71.2 to 91.5%) and 95.2% (90.3 to 98.0%) for ofloxacin, 100.0% (54.1 to 100.0%) and 67.6% (60.2 to 74.5%) for amikacin, 100.0% (63.1 to 100.0%) and 67.2% (59.7 to 74.2%) for kanamycin, 62.5% (24.5 to 91.5%) and 88.5% (82.8 to 92.8%) for ethionamide, 33.3% (4.3 to 77.7%) and 98.3% (95.1 to 99.7%) for para-aminosalicylic acid, and 0.0% (0.0 to 12.3%) and 100.0% (97.6 to 100.0%) for cycloserine. The concordances of WGS-based AST and phenotypic AST were as follows: rifampin (92.9%), isoniazid (93.4%), ethambutol (89.6%), streptomycin (73.1%), moxifloxacin (94.0%), ofloxacin (93.4%), amikacin (68.7%), kanamycin (68.7%), ethionamide (87.4%), para-aminosalicylic acid (96.2%) and cycloserine (84.6%). We conclude that WGS could be a promising approach to predict MTBC resistance from early positive liquid cultures. IMPORTANCE In this study, we used whole-genome sequencing (WGS) from early positive liquid (MGIT) cultures instead of solid cultures to predict drug resistance of 182 Mycobacterium tuberculosis complex (MTBC) clinical isolates to predict drug resistance using the TB-Profiler informatics platform. Our study indicates that WGS may be a promising method for predicting MTBC resistance using early positive liquid cultures.
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Kumar K, Loebinger MR. Nontuberculous Mycobacterial Pulmonary Disease: Clinical Epidemiologic Features, Risk Factors, and Diagnosis: The Nontuberculous Mycobacterial Series. Chest 2022; 161:637-646. [PMID: 34627854 DOI: 10.1016/j.chest.2021.10.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/26/2021] [Accepted: 10/02/2021] [Indexed: 10/20/2022] Open
Abstract
Nontuberculous mycobacterial pulmonary disease (NTM-PD) continues to impose a significant clinical burden of disease on susceptible patients. The incidence of NTM-PD is rising globally, but it remains a condition that is challenging to diagnose and treat effectively. This review provides an update on the global epidemiologic features, risk factors, and diagnostic considerations associated with the management of NTM-PD.
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Affiliation(s)
- Kartik Kumar
- National Heart and Lung Institute, Imperial College London, London, England; Host Defence Unit, Department of Respiratory Medicine, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, England
| | - Michael R Loebinger
- National Heart and Lung Institute, Imperial College London, London, England; Host Defence Unit, Department of Respiratory Medicine, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, England.
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Corti P, Collado B, Salgado M, Moraga CA, Radic-Schilling S, Tejeda C, Ruiz-Aravena M. Dynamic of Mycobacterium avium subspecies paratuberculosis infection in a domestic-wildlife interface: Domestic sheep and guanaco as reservoir community. Transbound Emerg Dis 2021; 69:e161-e174. [PMID: 34347393 DOI: 10.1111/tbed.14277] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 08/02/2021] [Indexed: 12/20/2022]
Abstract
Natural herbivore populations have experienced uninterrupted pressures from direct and evident domestic-wildlife interactions and competition, to indirect or less obvious ones such as pathogen transmission. Thus, pathogen spillover between wild and domestic animals is a constant concern because the domestic-wildlife interface represents the ecological frontier in which pathogen transmission takes place in both directions. In Patagonian steppe communities, extensive sheep ranching and guanaco (Lama guanicoe) populations coexist, and guanaco have shown to be infected by pathogens such as Mycobacterium avium subspecies paratuberculosis (MAP) likely transmitted from livestock. MAP causes chronic enteritis and affects mostly domestic ruminants. We evaluated MAP prevalence and pathogen shedding in both species' faeces collected in non-shared and shared sites according to presence/absence of sheep and guanaco along a year, in four different seasons (autumn, winter, and spring 2018, and summer 2019). Our results indicate that MAP circulates in both sheep and guanaco populations with self-sustained transmission; however, both species differ in their levels of competence. We detected higher pathogen shedding in sites occupied by sheep, suggesting that sheep populations may be the main source of infection for susceptible animals due to their large numbers which drive MAP dynamics.
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Affiliation(s)
- Paulo Corti
- Laboratorio de Manejo y Conservación de Vida Silvestre, Instituto de Ciencia Animal y Programa de Investigación Aplicada en Fauna Silvestre, Facultad de Ciencias Veterinarias, Universidad Austral de Chile, Valdivia, Chile
| | - Bernardita Collado
- Instituto de Medicina Preventiva Veterinaria, Facultad de Ciencias Veterinarias, Universidad Austral de Chile, Valdivia, Chile.,Escuela de Graduados, Facultad de Ciencias Veterinarias, Universidad Austral de Chile, Valdivia, Chile
| | - Miguel Salgado
- Instituto de Medicina Preventiva Veterinaria, Facultad de Ciencias Veterinarias, Universidad Austral de Chile, Valdivia, Chile
| | - Claudio A Moraga
- School of Natural Resources and the Environment, University of Florida, Gainesville, Florida, USA.,Departamento de Ciencias Agropecuarias y Acuícolas, Facultad de Ciencias, Universidad de Magallanes, Punta Arenas, Chile
| | - Sergio Radic-Schilling
- Departamento de Ciencias Agropecuarias y Acuícolas, Facultad de Ciencias, Universidad de Magallanes, Punta Arenas, Chile
| | - Carlos Tejeda
- Instituto de Medicina Preventiva Veterinaria, Facultad de Ciencias Veterinarias, Universidad Austral de Chile, Valdivia, Chile.,Escuela de Graduados, Facultad de Ciencias Veterinarias, Universidad Austral de Chile, Valdivia, Chile
| | - Manuel Ruiz-Aravena
- Department of Microbiology and Immunology, Montana State University, Bozeman, Montana, USA
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21
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Abstract
Nontuberculous mycobacteria (NTM) are ubiquitous in the environment and 193 species of NTM have been discovered thus far. NTM species vary in virulence from benign environmental organisms to difficult-to-treat human pathogens. Pulmonary infections remain the most common manifestation of NTM disease in humans and bronchiectasis continues to be a major risk factor for NTM pulmonary disease (NTM PD). This article will provide a useful introduction and framework for clinicians involved in the management of bronchiectasis and NTM. It includes an overview of the epidemiology, pathogenesis, diagnosis, and management of NTM PD. We will address the challenges faced in the diagnosis of NTM PD and the importance of subspeciation in guiding treatment and follow-up, especially in Mycobacterium abscessus infections. The treatment of both Mycobacterium avium complex and M. abscessus, the two most common NTM species known to cause disease, will be discussed in detail. Elements of the recent ATS/ERS/ESCMID/IDSA NTM guidelines published in 2020 will also be reviewed.
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Affiliation(s)
- Shera Tan
- Tuberculosis Control Unit, Tan Tock Seng Hospital, Singapore, Singapore
| | - Shannon Kasperbauer
- Division of Mycobacterial and Respiratory Infections, National Jewish Health, Denver, Colorado
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22
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Sharma D, Rai R. Neoteric advancements in TB diagnostics and its future frame. Indian J Tuberc 2021; 68:313-320. [PMID: 34099195 DOI: 10.1016/j.ijtb.2020.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 09/25/2020] [Accepted: 10/09/2020] [Indexed: 06/12/2023]
Abstract
Tuberculosis (TB) is one of the major infectious disease that causes threat to human health and leads to death in most of the cases. Mycobacterium tuberculosis is the causative agent that can affect both pulmonary and extra pulmonary regions of the body. This infection can be presented either as an active or latent form in the patients. Although this disease has been declared curable and preventable by WHO, it still holds its position as a global emergency. Over the past decade many hurdles such as low immunity, co-infections like HIV, autoimmune disorders, poverty, malnutrition and emerging trends in drug resistance patterns are hindering the eradication of this infection. However, many programmes have been launched by WHO with involvement of governments at various level to put a full stop over the disease. Under the Revised National Tuberculosis Control Programme (RNTCP) which was recently renamed as National Tuberculosis Elimination Programme (NTEP), the major focus is on eliminating tuberculosis by the year 2025. The main aim of the programme is to identify feasible quality testing, evaluate through NIKSHYA poshak yozana, restrict through BCG vaccination and assemble with public awareness to eradicate MTB. Numerous novel diagnostic techniques and molecular tools have been developed to elucidate and differentiate report of various suspected and active tuberculosis patients. However, improvements are still required to cut short the duration of the overall process ranging from screening of patients to their successful treatment.
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Affiliation(s)
- Diksha Sharma
- Department of Biotechnology, DAV College, Jalandhar, 144008, Punjab, India
| | - Rohit Rai
- Department of Medical Laboratory Sciences, Lovely Professional University, Phagwara, 144411, Punjab, India.
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23
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Affiliation(s)
- Ruvandhi R Nathavitharana
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Dolores Freire Jijon
- Universidad de Guayaquil, Guayaquil, Ecuador
- Division of Pediatric Infectious Diseases, University of Alberta, Edmonton, Canada
| | - Pankaj Pal
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Saurabh Rane
- Wadhani Institute for Artificial Intelligence, Mumbai, India
- Survivors Against TB, India
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24
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Assessment of Various Laboratory Diagnostic Methods in Diagnosis of Cutaneous Tuberculosis. A Study from A Tertiary Care Hospital of North India. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2021. [DOI: 10.22207/jpam.15.2.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Cutaneous tuberculosis (CTB) is the rarest case of extrapulmonary TB comprising 2% of total cases. It’s often a challenge both clinically and diagnostically. 1) To determine prevalence, age & gender-wise distribution of CTB. 2) To assess various diagnostic, microbiological modalities for the diagnosis of CTB. 76 skin biopsy specimens from suspected CTB lesions were analysed using following methods – Acid-fast Bacilli (AFB) staining (Ziehl-Neelsen method), growth of mycobacteria in culture (Lowenstein-Jensen media), and Gene Xpert MTB/RIF, Histopathological (H&E staining). Of the 76 specimens, 44 were males and 32 were females. The most commonly affected age group was 40–59 years. Infections were least common in 0-19 years age group. AFB was not seen in any of the primary smears. 10 were confirmed as CTB by the recovery of Mycobacterium in solid culture. Of the 10 culture positives, 9 were confirmed as MTB, and 1 was found to be NTM. Staining of 10 culture positive specimens revealed acid fast, beaded rods. Detection of MTB by Gene Xpert gave positive result in 9 cases with all RIF sensitive. All 9 PCR confirmed cases were also culture positive, all 9 were slow growers with a minimum of 5 weeks required for growth on the LJ slant. PCR is the test of choice and should be performed on all specimens of suspected CTB. However when coupled with the “gold standard” culture method, the diagnostic accuracy improves. Also, further, culture helps in identification and isolation of NTM’s.
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25
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Yang J, Shen Y, Wang L, Ju L, Wu X, Wang P, Hao X, Sun Q, Yu F, Sha W. Efficacy of the Xpert Mycobacterium tuberculosis/rifampicin assay for diagnosing sputum-smear negative or sputum-scarce pulmonary tuberculosis in bronchoalveolar lavage fluid. Int J Infect Dis 2021; 107:121-126. [PMID: 33864923 DOI: 10.1016/j.ijid.2021.04.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/12/2021] [Accepted: 04/12/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To evaluate he diagnostic performance of the Xpert Mycobacterium tuberculosis/Rifampin (MTB/RIF) assay in bronchoalveolar lavage fluid (BALF). METHODS We retrospectively reviewed the clinical data from 671 sputum-smear negative or sputum-scarce adult patients with suspected pulmonary tuberculosis (PTB) who had an Xpert MTB/RIF assay performed on BALF. The diagnostic performance of the Xpert MTB/RIF assay, smear microscopy (SM) and MTB culture was evaluated using MTB culture or final clinical diagnosis as the reference standard. RESULTS Compared with MTB culture, the sensitivity and specificity were 87.8% and 72.7% for the Xpert MTB/RIF assay and 11.0% and 99.2% for SM, respectively. Compared with final diagnosis, diagnostic performance was 58.9% and 83.9% for the Xpert MTB/RIF assay, 5.0% and 98.3% for SM, and 43.3% and 100% for culture, for sensitivity and specificity respectively. The Xpert MTB/RIF assay had low specificity and high sensitivity. When very low results were re-evaluated and considered MTB-negative, the specificity increased significantly. The sensitivity remained higher than SM and was similar to that of culture. CONCLUSIONS The Xpert MTB/RIF assay adds microbiologic evidence to clinical decisions; however, close attention should be paid to very low semi-quantitative positive results.
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Affiliation(s)
- Juan Yang
- Department of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China; Shanghai Clinical Research Center for Infectious Disease (Tuberculosis), Shanghai, China
| | - Yanheng Shen
- Department of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China; Shanghai Clinical Research Center for Infectious Disease (Tuberculosis), Shanghai, China
| | - Lei Wang
- Department of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China; Shanghai Clinical Research Center for Infectious Disease (Tuberculosis), Shanghai, China
| | - LiXia Ju
- Department of Integrative Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaocui Wu
- Department of Clinical Laboratory, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Peng Wang
- Department of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China; Shanghai Clinical Research Center for Infectious Disease (Tuberculosis), Shanghai, China
| | - Xiaohui Hao
- Department of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China; Shanghai Clinical Research Center for Infectious Disease (Tuberculosis), Shanghai, China
| | - Qin Sun
- Department of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China; Shanghai Clinical Research Center for Infectious Disease (Tuberculosis), Shanghai, China
| | - Fangyou Yu
- Department of Clinical Laboratory, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
| | - Wei Sha
- Department of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China; Shanghai Clinical Research Center for Infectious Disease (Tuberculosis), Shanghai, China.
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26
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He Y, Lyon CJ, Nguyen DT, Liu C, Sha W, Graviss EA, Hu TY. Serum-Based Diagnosis of Pediatric Tuberculosis by Assay of Mycobacterium tuberculosis Factors: a Retrospective Cohort Study. J Clin Microbiol 2021; 59:e01756-20. [PMID: 33239373 PMCID: PMC8111146 DOI: 10.1128/jcm.01756-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 11/18/2020] [Indexed: 11/20/2022] Open
Abstract
Diagnosis of pediatric tuberculosis (TB) is often complicated by its nonspecific symptoms, paucibacillary nature, and the need for invasive specimen collection techniques. However, a recently reported assay that detects Mycobacterium tuberculosis virulence factors in serum can diagnose various TB manifestations, including paucibacillary TB cases, in adults with good sensitivity and specificity. The current study examined the ability of this M. tuberculosis biomarker assay to diagnose pediatric TB using archived cryopreserved serum samples drawn from children ≤18 years of age who were screened for suspected TB as part of a prospective population-based active surveillance study. In this analysis, any detectable level of either of the M. tuberculosis virulence factors CFP-10 and ESAT-6 was considered direct evidence of TB. Serum samples from 105 children evaluated for TB (55 TB cases and 50 close contacts without TB) were analyzed. The results of this analysis yielded sensitivity of 85.5% (95% confidence interval [CI], 73.3 to 93.5). Similar diagnostic sensitivities were observed for culture-positive (87.5%; 95% CI, 67.6 to 97.3) and culture-negative (83.9%; 95% CI, 66.3 to 94.5) TB cases and for culture negative pulmonary (77.8%; 95% CI, 40.0 to 97.2) and extrapulmonary (86.4%; 95% CI, 65.1 to 97.1) TB cases. These results suggest that serum biomarker analysis holds significant promise for rapid and sensitive diagnosis of pediatric TB cases, including extrapulmonary or paucibacillary TB cases. The ability to use frozen samples for this analysis should also permit assays to be performed at central sites, without a requirement for strict timelines for sample analysis.
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Affiliation(s)
- Yifan He
- Department of Biochemistry and Molecular Biology Center for Cellular and Molecular Diagnosis, School of Medicine, Tulane University, New Orleans, Louisiana, USA
- Shanghai Clinical Research Center for Infectious Diseases (Tuberculosis), Shanghai, China
| | - Christopher J Lyon
- Department of Biochemistry and Molecular Biology Center for Cellular and Molecular Diagnosis, School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Duc T Nguyen
- Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Houston, Texas, USA
| | - Chang Liu
- Department of Chemical Engineering, Biomedical Engineering Program, College of Engineering and Computing, University of South Carolina, Columbia, South Carolina, USA
| | - Wei Sha
- Department of Biochemistry and Molecular Biology Center for Cellular and Molecular Diagnosis, School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Edward A Graviss
- Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Houston, Texas, USA
| | - Tony Y Hu
- Department of Biochemistry and Molecular Biology Center for Cellular and Molecular Diagnosis, School of Medicine, Tulane University, New Orleans, Louisiana, USA
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27
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Calligaro GL, de Wit Z, Cirota J, Orrell C, Myers B, Decker S, Stein DJ, Sorsdahl K, Dawson R. Brief psychotherapy administered by non-specialised health workers to address risky substance use in patients with multidrug-resistant tuberculosis: a feasibility and acceptability study. Pilot Feasibility Stud 2021; 7:28. [PMID: 33468251 PMCID: PMC7814702 DOI: 10.1186/s40814-020-00764-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 12/21/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Only 55% of multidrug-resistant tuberculosis (MDR-TB) cases worldwide complete treatment, with problem substance use a risk for default and treatment failure. Nevertheless, there is little research on psychotherapeutic interventions for reducing substance use amongst MDR-TB patients, in general, and on their delivery by non-specialist health workers in particular. OBJECTIVES To explore the feasibility and acceptability of a non-specialist health worker-delivered 4-session brief motivational interviewing and relapse prevention (MI-RP) intervention for problem substance use and to obtain preliminary data on the effects of this intervention on substance use severity, depressive symptoms, psychological distress and functional impairment at 3 months after hospital discharge. METHODS Between December 2015 and October 2016, consenting MDR-TB patients admitted to Brewelskloof Hospital who screened at moderate to severe risk for substance-related problems on the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) were enrolled, and a baseline questionnaire administered. In the 4 weeks prior to planned discharge, trained counsellors delivered the MI-RP intervention. The baseline questionnaire was re-administered 3 months post-discharge and qualitative interviews were conducted with a randomly selected sample of participants (n = 10). RESULTS Sixty patients were screened: 40 (66%) met inclusion criteria of which 39 (98%) were enrolled. Of the enrolled patients, 26 (67%) completed the counselling sessions and the final assessment. Qualitative interviews revealed participants' perceptions of the value of the intervention. From baseline to follow-up, patients reported reductions in substance use severity, symptoms of depression, distress and functional impairment. CONCLUSION In this feasibility study, participant retention in the study was moderate. We found preliminary evidence supporting the benefits of the intervention for reducing substance use and symptoms of psychological distress, supported by qualitative reports of patient experiences. Randomised studies are needed to demonstrate efficacy of this intervention before considering potential for wider implementation. TRIAL REGISTRATION South African National Clinical Trials Register ( DOH-27-0315-5007 ) on 01/04/2015 ( http://www.sanctr.gov.za ).
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Affiliation(s)
- Gregory L Calligaro
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute and South African MRC/UCT Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa
| | - Zani de Wit
- Centre for TB Research Innovation, University of Cape Town Lung Institute, George Road, Mowbray, Cape Town, 7925, South Africa
| | - Jacqui Cirota
- Centre for TB Research Innovation, University of Cape Town Lung Institute, George Road, Mowbray, Cape Town, 7925, South Africa
| | - Catherine Orrell
- The Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Cape Town, South Africa
| | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Tygerberg, South Africa
- Addiction Psychiatry Division, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | | | - Dan J Stein
- SA MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Katherine Sorsdahl
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Rodney Dawson
- Centre for TB Research Innovation, University of Cape Town Lung Institute, George Road, Mowbray, Cape Town, 7925, South Africa.
- Division of Pulmonology, Department of Medicine, University of Cape Town Lung Institute, Cape Town, South Africa.
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28
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Chopra KK, Singh S. Tuberculosis: Newer diagnostic tests: Applications and limitations. Indian J Tuberc 2020; 67:S86-S90. [PMID: 33308677 DOI: 10.1016/j.ijtb.2020.09.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 01/29/2023]
Abstract
A public health worry as is Tuberculosis (TB) has been making more than 10 million people globally suffer from its terror and causing more than 2 million people worldwide to lose their lives every year. Mankind is putting all its efforts, since the discovery of the causative bacilli, to come up with some dramatic improvements in providing high-quality TB diagnostic services. Nevertheless, it poses a challenge and many people with TB remain use only smear microscopy for diagnosis. In an environment where transmission is becoming easier by the day the challenge becomes burdensome once disease gets associated with drug resistance, HIV, other diseases, etc. It becomes of paramount importance to address this biggest public health challenge delivering timely diagnosis using advanced technologies. Initial microscopic examination forms the backbone of TB diagnosis since 100 years along with clinical confirmations. Newer advanced diagnostic tools coming into play are genotypic assays (LPA, CBNAAT, LAMP) that are rapid molecular tests, and culture methods (liquid culture media) with standard drug susceptibility testing assays. Program ideates to correlate these rapid molecular diagnostics with turn-around time (TAT) as low as around 2 hours, with conventional standard methods. These help in reinforcing the diagnostic capacities and also provide identification of drug resistance patterns for few most important first line and second line drugs. The present day developments have brought these tests to near-patient point of care. Culture tests (liquid culture media) are gold standard technique for the analysis of TB with its increased sensitivity and highest quality over all others. An on-going search under TB diagnostics is to find an efficient, reproducible, cost effective tool with minimal infrastructure requirements. This review conveys the advances made over the past decades in the diagnosis of the disease and drug resistance.
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Affiliation(s)
- K K Chopra
- New Delhi Tuberculosis Centre, Jawaharlal Nehru Marg, Delhi Gate, New Delhi, 110002, India.
| | - Shweta Singh
- Preventive and Social Medicine, Government Institute of Medical Sciences, Greater Noida, Gautam Buddha Nagar, 201013, India.
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29
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Advances in the diagnosis of tuberculosis- Journey from smear microscopy to whole genome sequencing. Indian J Tuberc 2020; 67:S61-S68. [PMID: 33308673 DOI: 10.1016/j.ijtb.2020.09.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 09/24/2020] [Indexed: 12/14/2022]
Abstract
The laboratory plays an important role in diagnosing tuberculosis (TB) and the identification and drug sensitivity testing (DST) of Mycobacterium tuberculosis. With a timely diagnosis and treatment with appropriate anti-TB drugs, most people who develop TB can be cured and onward transmission of infection curtailed. For a long time, laboratories used only microscopy and conventional culture-based diagnosis, however these procedures are slow and may require 3-4 weeks to yield results. Given the increasing rate of drug resistance, it has been necessary to look for new and rapid diagnostic methods. Various molecular based diagnostic technologies became available in the beginning of early 90s, providing rapid detection, identification and DST of M. tuberculosis. Molecular technologies offer the greatest potential for laboratories because they have the highest sensitivity and specificity. The present article will review some of the new methodology that has been introduced in the clinical laboratory.
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30
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Jin W, Pan J, Miao Q, Ma Y, Zhang Y, Huang Y, Yao Y, Su Y, Wang Q, Wang M, Li B, Bao R, Gao X, Wu H, Hu B. Diagnostic accuracy of metagenomic next-generation sequencing for active tuberculosis in clinical practice at a tertiary general hospital. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1065. [PMID: 33145284 PMCID: PMC7575944 DOI: 10.21037/atm-20-2274] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background To evaluate the diagnostic accuracy of metagenomic next-generation sequencing (mNGS) for active tuberculosis (TB). Methods We retrospectively collected 820 samples at Zhongshan Hospital, Fudan University in Shanghai, China, between 1 April 2017 and 31 March 2018. They were classified into TB cases (125, 15.2%) and NOT TB cases (695, 84.8%) according to the clinical diagnosis. Specimens were evaluated by a regular clinical microbiological assay and mNGS performed in parallel. Results Sixty-one confirmed TB cases and 64 clinical TB cases were included. The overall sensitivity of mNGS was 49.6% [95% confidence interval (95% CI), 40.6–58.6%], and the specificity was 98.3% (95% CI, 96.9–99.1%), with peak sensitivities of 88.9% (95% CI, 50.7–99.4%) for lung tissue, 55.0% (95% CI, 32.0–76.2%) for bronchoalveolar lavage fluid (BALF), and 50.0% (95% CI, 32.8–67.2%) for serous fluids. The overall sensitivity of mNGS was superior to that of the culture assay (35.2%, 95% CI, 27.0–44.3), but no superior sensitivity for sputum was observed in mNGS compared with the culture assay (mNGS: 52.3%, 95% CI, 31.1–72.6%; culture: 60.9%, 95% CI, 38.8–79.5%). In clinical TB cases, mNGS detected additional positive results (40.6%, 26/64). mNGS reduced the turnaround time from 2–6 weeks to 32–36 hours. Conclusions mNGS may be a promising technology for the early auxiliary diagnosis of active TB, especially sputum-negative pulmonary TB (PTB) and tuberculous serous effusion.
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Affiliation(s)
- Wenting Jin
- Department of Infectious Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jue Pan
- Department of Infectious Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qing Miao
- Department of Infectious Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuyan Ma
- Department of Infectious Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yao Zhang
- Department of Infectious Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yingnan Huang
- Department of Infectious Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yumeng Yao
- Department of Infectious Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yi Su
- Department of Infectious Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qingqing Wang
- Department of Infectious Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Mengran Wang
- Department of Infectious Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Bing Li
- Department of Infectious Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Rong Bao
- Department of Microbiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaodong Gao
- Department of Hospital Infection Management, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Honglong Wu
- Binhai Genomics Institute, Tianjin Translational Genomics Center, BGI-Tianjin, BGI-Shenzhen, Tianjin, China
| | - Bijie Hu
- Department of Infectious Diseases, Zhongshan Hospital, Fudan University, Shanghai, China.,Department of Hospital Infection Management, Zhongshan Hospital, Fudan University, Shanghai, China
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31
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Daley CL, Iaccarino JM, Lange C, Cambau E, Wallace RJ, Andrejak C, Böttger EC, Brozek J, Griffith DE, Guglielmetti L, Huitt GA, Knight SL, Leitman P, Marras TK, Olivier KN, Santin M, Stout JE, Tortoli E, van Ingen J, Wagner D, Winthrop KL. Treatment of Nontuberculous Mycobacterial Pulmonary Disease: An Official ATS/ERS/ESCMID/IDSA Clinical Practice Guideline. Clin Infect Dis 2020; 71:e1-e36. [PMID: 32628747 PMCID: PMC7768748 DOI: 10.1093/cid/ciaa241] [Citation(s) in RCA: 339] [Impact Index Per Article: 84.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 03/05/2020] [Indexed: 12/14/2022] Open
Abstract
Nontuberculous mycobacteria (NTM) represent over 190 species and subspecies, some of which can produce disease in humans of all ages and can affect both pulmonary and extrapulmonary sites. This guideline focuses on pulmonary disease in adults (without cystic fibrosis or human immunodeficiency virus infection) caused by the most common NTM pathogens such as Mycobacterium avium complex, Mycobacterium kansasii, and Mycobacterium xenopi among the slowly growing NTM and Mycobacterium abscessus among the rapidly growing NTM. A panel of experts was carefully selected by leading international respiratory medicine and infectious diseases societies (ATS, ERS, ESCMID, IDSA) and included specialists in pulmonary medicine, infectious diseases and clinical microbiology, laboratory medicine, and patient advocacy. Systematic reviews were conducted around each of 22 PICO (Population, Intervention, Comparator, Outcome) questions and the recommendations were formulated, written, and graded using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Thirty-one evidence-based recommendations about treatment of NTM pulmonary disease are provided. This guideline is intended for use by healthcare professionals who care for patients with NTM pulmonary disease, including specialists in infectious diseases and pulmonary diseases.
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Affiliation(s)
- Charles L Daley
- Department of Medicine, National Jewish Health, Denver, Colorado, USA
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jonathan M Iaccarino
- Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Christoph Lange
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany
- German Center for Infection Research (DZIF), Clinical Tuberculosis Unit, Borstel, Germany
- Respiratory Medicine & International Health, University of Lübeck, Lübeck, Germany
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Emmanuelle Cambau
- National Reference Center for Mycobacteria and Antimycobacterial Resistance, APHP -Hôpital Lariboisière, Bacteriology; Inserm, University Paris Diderot, IAME UMR1137, Paris, France
| | - Richard J Wallace
- Mycobacteria/Nocardia Laboratory, Department of Microbiology, The University of Texas Health Science Center, Tyler, Texas, USA
| | - Claire Andrejak
- Respiratory and Intensive Care Unit, University Hospital Amiens, Amiens, France
- EA 4294, AGIR, Jules Verne Picardy University, Amiens, France
| | - Erik C Böttger
- Institute of Medical Microbiology, National Reference Center for Mycobacteria, University of Zurich, Zurich, Switzerland
| | - Jan Brozek
- Department of Clinical Epidemiology & Biostatistics, McMaster University Health Sciences Centre, Hamilton, Ontario, Canada
| | - David E Griffith
- Pulmonary Infectious Disease Section, University of Texas Health Science Center, Tyler, Texas, USA
| | - Lorenzo Guglielmetti
- National Reference Center for Mycobacteria and Antimycobacterial Resistance, APHP -Hôpital Lariboisière, Bacteriology; Inserm, University Paris Diderot, IAME UMR1137, Paris, France
- Team E13 (Bactériologie), Centre d’Immunologie et des Maladies Infectieuses, Sorbonne Université, Université Pierre et Marie Curie, Université Paris 06, Centre de Recherche 7, INSERM, IAME UMR1137, Paris, France
| | - Gwen A Huitt
- Department of Medicine, National Jewish Health, Denver, Colorado, USA
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Shandra L Knight
- Library and Knowledge Services, National Jewish Health, Denver, Colorado, USA
| | | | - Theodore K Marras
- Department of Medicine, University of Toronto and University Health Network, Toronto, Ontario, Canada
| | - Kenneth N Olivier
- Pulmonary Branch, National Heart, Lung and Blood Institute, Bethesda, Maryland, USA
| | - Miguel Santin
- Service of Infectious Diseases, Bellvitge University Hospital-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Jason E Stout
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina, USA
| | - Enrico Tortoli
- Emerging Bacterial Pathogens Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Jakko van Ingen
- Radboud Center for Infectious Diseases, Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dirk Wagner
- Division of Infectious Diseases, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kevin L Winthrop
- Divisions of Infectious Diseases, Schools of Public Health and Medicine, Oregon Health and Science University, Portland, Oregon, USA
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Daley CL, Iaccarino JM, Lange C, Cambau E, Wallace RJ, Andrejak C, Böttger EC, Brozek J, Griffith DE, Guglielmetti L, Huitt GA, Knight SL, Leitman P, Marras TK, Olivier KN, Santin M, Stout JE, Tortoli E, van Ingen J, Wagner D, Winthrop KL. Treatment of nontuberculous mycobacterial pulmonary disease: an official ATS/ERS/ESCMID/IDSA clinical practice guideline. Eur Respir J 2020; 56:2000535. [PMID: 32636299 PMCID: PMC8375621 DOI: 10.1183/13993003.00535-2020] [Citation(s) in RCA: 343] [Impact Index Per Article: 85.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 03/03/2020] [Indexed: 12/28/2022]
Abstract
Nontuberculous mycobacteria (NTM) represent over 190 species and subspecies, some of which can produce disease in humans of all ages and can affect both pulmonary and extrapulmonary sites. This guideline focuses on pulmonary disease in adults (without cystic fibrosis or human immunodeficiency virus infection) caused by the most common NTM pathogens such as Mycobacterium avium complex, Mycobacterium kansasii, and Mycobacterium xenopi among the slowly growing NTM and Mycobacterium abscessus among the rapidly growing NTM. A panel of experts was carefully selected by leading international respiratory medicine and infectious diseases societies (ATS, ERS, ESCMID, IDSA) and included specialists in pulmonary medicine, infectious diseases and clinical microbiology, laboratory medicine, and patient advocacy. Systematic reviews were conducted around each of 22 PICO (Population, Intervention, Comparator, Outcome) questions and the recommendations were formulated, written, and graded using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Thirty-one evidence-based recommendations about treatment of NTM pulmonary disease are provided. This guideline is intended for use by healthcare professionals who care for patients with NTM pulmonary disease, including specialists in infectious diseases and pulmonary diseases.
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Affiliation(s)
- Charles L. Daley
- National Jewish Health and University of Colorado Health
Sciences, Denver, Colorado, USA
| | | | - Christoph Lange
- Division of Clinical Infectious Diseases, Research Center
Borstel, Borstel, Germany, German Center for Infection Research (DZIF), Respiratory
Medicine & International Health, University of Lübeck, Lübeck,
Germany, and Dept of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Emmanuelle Cambau
- National Reference Center for Mycobacteria and
Antimycobacterial Resistance, APHP -Hôpital Lariboisière,
Bacteriology; Inserm University Paris Diderot, IAME UMR1137, Bacteriology, Paris,
France
| | - Richard J. Wallace
- Mycobacteria/Nocardia Laboratory, Dept of Microbiology, The
University of Texas Health Science Center, Tyler, TX, USA
| | - Claire Andrejak
- Respiratory and Intensive Care Unit, University Hospital
Amiens, Amiens, France and EA 4294, AGIR, Jules Verne Picardy University, Amiens,
France
| | - Erik C. Böttger
- Institute of Medical Microbiology, National Reference
Center for Mycobacteria, University of Zurich, Zurich, Switzerland
| | - Jan Brozek
- Department of Clinical Epidemiology & Biostatistics,
McMaster University Health Sciences Centre, 1200 Main Street West, Hamilton, ON L8N
3Z5 Canada
| | - David E. Griffith
- Pulmonary Infectious Disease Section, University of Texas
Health Science Center, Tyler, TX, USA
| | - Lorenzo Guglielmetti
- National Reference Center for Mycobacteria and
Antimycobacterial Resistance, APHP -Hôpital Lariboisière,
Bacteriology; Inserm University Paris Diderot, IAME UMR1137, Bacteriology, Paris,
France
- Team E13 (Bactériologie), Centre
d’Immunologie et des Maladies Infectieuses, Sorbonne Université,
Université Pierre et Marie Curie, Université Paris 06, Centre de
Recherche 7, INSERM, IAME UMR1137, Paris, Francis
| | - Gwen A. Huitt
- Library and Knowledge Services, National Jewish Health,
Denver, Colorado, USA
| | - Shandra L. Knight
- Library and Knowledge Services, National Jewish Health,
Denver, Colorado, USA
| | | | - Theodore K. Marras
- Dept of Medicine, University of Toronto and University
Health Network, Toronto, ON, Canada
| | - Kenneth N. Olivier
- Pulmonary Branch, National Heart, Lung and Blood
Institute, Bethesda, MD, USA
| | - Miguel Santin
- Service of Infectious Diseases, Bellvitge University
Hospital-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat,
Barcelona, Spain
| | - Jason E. Stout
- Division of Infectious Diseases and International Health,
Duke University Medical Center, Durham, NC, USA
| | - Enrico Tortoli
- Emerging Bacterial Pathogens Unit, IRCCS San Raffaele
Scientific Institute, Milan, Italy
| | - Jakko van Ingen
- Radboud Center for Infectious Diseases, Dept of Medical
Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dirk Wagner
- Division of Infectious Diseases, Dept of Medicine II,
Medical Center - University of Freiburg, Faculty of Medicine, University of
Freiburg, Freiburg, Germany
| | - Kevin L. Winthrop
- Divisions of Infectious Diseases, Schools of Public
Health and Medicine, Oregon Health and Science University, Portland, OR, USA
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Yu Z, Lu R, Gan M, Tu X, He Z. Mycobacterial identification on homogenised biopsy facilitates the early diagnosis and treatment of laryngeal tuberculosis. Open Med (Wars) 2020; 15:508-512. [PMID: 33336005 PMCID: PMC7712452 DOI: 10.1515/med-2020-0171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 02/26/2020] [Accepted: 05/07/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction The incidence of laryngeal tuberculosis has increased gradually in recent years. Laryngeal tuberculosis has strong infectivity and atypical clinical manifestations. Hence, establishing the early diagnosis of laryngeal tuberculosis is considered difficult, resulting in the high rate of misdiagnosis of laryngeal tuberculosis and increased rates of tuberculosis infection. Objective This study aimed to describe a case of laryngeal tuberculosis detected using the mycobacteria gene chips technology, facilitating the early diagnosis and the treatment of laryngeal tuberculosis. Case presentation A 27-year-old woman presented with a 7-day history of hoarseness, with a normal routine blood chemistry test and chest computed tomography results. Histological analysis of the vocal cord biopsy showed granulomatous inflammation and the negative acid-fast stain test. The mycobacteria gene chips method was used to directly examine the vocal cord tissue treated with homogenate, and the Mycobacterium tuberculosis was successfully identified. Thus, the early diagnosis of laryngeal tuberculosis and the drug sensitivity of rifampin and isoniazid were confirmed. The patient recovered after undergoing a 1-year standard anti-tuberculosis therapy. Conclusions Mycobacterial identification on homogenised biopsy using the mycobacteria gene chips method significantly facilitates the early diagnosis and the treatment of tuberculosis.
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Affiliation(s)
- Zhenjun Yu
- Department of Infectious Diseases, Taizhou Enze Medical Center (Group) Enze Hospital, No. 1, Tongyang Road, Taizhou 318000, Zhejiang, China
| | - Ruyue Lu
- Department of Clinical Laboratory, Taizhou Enze Medical Center (Group) Enze Hospital, No. 1, Tongyang Road, Taizhou 318000, Zhejiang, China
| | - Meifu Gan
- Department of Pathology, Taizhou Enze Medical Center (Group) Enze Hospital, No. 1, Tongyang Road, Taizhou 318000, Zhejiang, China
| | - Xi Tu
- Department of Clinical Laboratory, Taizhou Enze Medical Center (Group) Enze Hospital, No. 1, Tongyang Road, Taizhou 318000, Zhejiang, China
| | - Zebao He
- Department of Infectious Diseases, Taizhou Enze Medical Center (Group) Enze Hospital, No. 1, Tongyang Road, Taizhou 318000, Zhejiang, China
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Roy-Chowdhuri S, Dacic S, Ghofrani M, Illei PB, Layfield LJ, Lee C, Michael CW, Miller RA, Mitchell JW, Nikolic B, Nowak JA, Pastis NJ, Rauch CA, Sharma A, Souter L, Billman BL, Thomas NE, VanderLaan PA, Voss JS, Wahidi MM, Yarmus LB, Gilbert CR. Collection and Handling of Thoracic Small Biopsy and Cytology Specimens for Ancillary Studies: Guideline From the College of American Pathologists in Collaboration With the American College of Chest Physicians, Association for Molecular Pathology, American Society of Cytopathology, American Thoracic Society, Pulmonary Pathology Society, Papanicolaou Society of Cytopathology, Society of Interventional Radiology, and Society of Thoracic Radiology. Arch Pathol Lab Med 2020; 144:933-958. [PMID: 32401054 DOI: 10.5858/arpa.2020-0119-cp] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The need for appropriate specimen use for ancillary testing has become more commonplace in the practice of pathology. This, coupled with improvements in technology, often provides less invasive methods of testing, but presents new challenges to appropriate specimen collection and handling of these small specimens, including thoracic small biopsy and cytology samples. OBJECTIVE.— To develop a clinical practice guideline including recommendations on how to obtain, handle, and process thoracic small biopsy and cytology tissue specimens for diagnostic testing and ancillary studies. METHODS.— The College of American Pathologists convened an expert panel to perform a systematic review of the literature and develop recommendations. Core needle biopsy, touch preparation, fine-needle aspiration, and effusion specimens with thoracic diseases including malignancy, granulomatous process/sarcoidosis, and infection (eg, tuberculosis) were deemed within scope. Ancillary studies included immunohistochemistry and immunocytochemistry, fluorescence in situ hybridization, mutational analysis, flow cytometry, cytogenetics, and microbiologic studies routinely performed in the clinical pathology laboratory. The use of rapid on-site evaluation was also covered. RESULTS.— Sixteen guideline statements were developed to assist clinicians and pathologists in collecting and processing thoracic small biopsy and cytology tissue samples. CONCLUSIONS.— Based on the systematic review and expert panel consensus, thoracic small specimens can be handled and processed to perform downstream testing (eg, molecular markers, immunohistochemical biomarkers), core needle and fine-needle techniques can provide appropriate cytologic and histologic specimens for ancillary studies, and rapid on-site cytologic evaluation remains helpful in appropriate triage, handling, and processing of specimens.
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Affiliation(s)
- Sinchita Roy-Chowdhuri
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Sanja Dacic
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Mohiedean Ghofrani
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Peter B Illei
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Lester J Layfield
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Christopher Lee
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Claire W Michael
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Ross A Miller
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Jason W Mitchell
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Boris Nikolic
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Jan A Nowak
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Nicholas J Pastis
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Carol Ann Rauch
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Amita Sharma
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Lesley Souter
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Brooke L Billman
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Nicole E Thomas
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Paul A VanderLaan
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Jesse S Voss
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Momen M Wahidi
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Lonny B Yarmus
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Christopher R Gilbert
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
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Acharya B, Acharya A, Gautam S, Ghimire SP, Mishra G, Parajuli N, Sapkota B. Advances in diagnosis of Tuberculosis: an update into molecular diagnosis of Mycobacterium tuberculosis. Mol Biol Rep 2020; 47:4065-4075. [DOI: 10.1007/s11033-020-05413-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 03/28/2020] [Indexed: 01/02/2023]
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Santos NCDS, Scodro RBDL, Leal DC, do Prado SM, Micheletti DF, Sampiron EG, Costacurta GF, de Almeida AL, da Silva LA, Ieque AL, Ghiraldi Lopes LD, de Pádua RA, Siqueira VL, Caleffi-Ferracioli KR, Cardoso RF. Determination of minimum bactericidal concentration, in single or combination drugs, against Mycobacterium tuberculosis. Future Microbiol 2020; 15:107-114. [PMID: 32064924 DOI: 10.2217/fmb-2019-0050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To evaluate an assay to detect minimum bactericidal concentration (MBC) in Mycobacterium tuberculosis, using as single model rifampicin, isoniazid, levofloxacin (LVX) and linezolid (LNZ) and in combination. Material & methods: MBCs were carried out directly from resazurin microtiter assay plate and 3D checkerboard in M. tuberculosis H37Rv and five resistant clinical isolates. Results: The proposed MBC assay showed similar values to those determined by MGIT™, used as control. LVX and LNZ's MBC values were close to their MIC values. LNZ or LVX combined with isoniazid and rifampicin showed MBC value reduced in 63.7% of the assays. Conclusion: The proposed assay to determine MBCs of drugs can be applied to the study of new compounds with anti-M. tuberculosis activity to detect their bactericidal effect and also in laboratory routine for clinical dose adjustment of drugs according to the patient's profile.
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Affiliation(s)
- Nathally C de S Santos
- Postgraduate Program in Bioscience and Physiopathology, State University of Maringá, Paraná, Brazil
| | - Regiane B de L Scodro
- Laboratory of Medical Bacteriology, Department of Clinical Analysis and Biomedicine, State University of Maringá, Paraná, Brazil.,Postgraduate Program in Health Sciences, State University of Maringá, Paraná, Brazil
| | - Dayane Cb Leal
- Laboratory of Medical Bacteriology, Department of Clinical Analysis and Biomedicine, State University of Maringá, Paraná, Brazil.,Postgraduate Program in Health Sciences, State University of Maringá, Paraná, Brazil
| | - Silvia Mt do Prado
- Laboratory of Medical Bacteriology, Department of Clinical Analysis and Biomedicine, State University of Maringá, Paraná, Brazil
| | - Daniela F Micheletti
- Laboratory of Medical Bacteriology, Department of Clinical Analysis and Biomedicine, State University of Maringá, Paraná, Brazil
| | - Eloísa G Sampiron
- Postgraduate Program in Health Sciences, State University of Maringá, Paraná, Brazil
| | - Giovana F Costacurta
- Postgraduate Program in Health Sciences, State University of Maringá, Paraná, Brazil
| | - Aryadne L de Almeida
- Postgraduate Program in Bioscience and Physiopathology, State University of Maringá, Paraná, Brazil
| | - Liliani Af da Silva
- Laboratory of Medical Bacteriology, Department of Clinical Analysis and Biomedicine, State University of Maringá, Paraná, Brazil
| | - Andressa L Ieque
- Postgraduate Program in Health Sciences, State University of Maringá, Paraná, Brazil
| | - Luciana D Ghiraldi Lopes
- Laboratory of Medical Bacteriology, Department of Clinical Analysis and Biomedicine, State University of Maringá, Paraná, Brazil
| | - Rubia Af de Pádua
- Laboratory of Medical Bacteriology, Department of Clinical Analysis and Biomedicine, State University of Maringá, Paraná, Brazil
| | - Vera Ld Siqueira
- Postgraduate Program in Bioscience and Physiopathology, State University of Maringá, Paraná, Brazil.,Laboratory of Medical Bacteriology, Department of Clinical Analysis and Biomedicine, State University of Maringá, Paraná, Brazil
| | - Katiany R Caleffi-Ferracioli
- Postgraduate Program in Bioscience and Physiopathology, State University of Maringá, Paraná, Brazil.,Laboratory of Medical Bacteriology, Department of Clinical Analysis and Biomedicine, State University of Maringá, Paraná, Brazil
| | - Rosilene F Cardoso
- Postgraduate Program in Bioscience and Physiopathology, State University of Maringá, Paraná, Brazil.,Laboratory of Medical Bacteriology, Department of Clinical Analysis and Biomedicine, State University of Maringá, Paraná, Brazil.,Postgraduate Program in Health Sciences, State University of Maringá, Paraná, Brazil
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Advanced integrative sensing technologies for detection of drug-resistant tuberculosis in point-of-care settings. SENSORS INTERNATIONAL 2020. [DOI: 10.1016/j.sintl.2020.100036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Kim YW, Kwon BS, Lim SY, Lee YJ, Cho YJ, Yoon HI, Lee JH, Lee CT, Park JS. Diagnostic value of bronchoalveolar lavage and bronchial washing in sputum-scarce or smear-negative cases with suspected pulmonary tuberculosis: a randomized study. Clin Microbiol Infect 2019; 26:911-916. [PMID: 31759097 DOI: 10.1016/j.cmi.2019.11.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/06/2019] [Accepted: 11/09/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Bronchoalveolar lavage (BAL) and bronchial washing (BW) are two major methods used to obtain high-quality respiratory specimens from patients with suspected pulmonary tuberculosis (TB) but a sputum-scarce or smear-negative status. We aimed to compare the value of BAL and BW in the diagnosis of TB in such patients. METHODS We enrolled patients with suspected pulmonary TB but with a sputum-scarce or smear-negative status who were referred for bronchoscopy between October 2013 and January 2016. Participants were randomized into the BAL and BW groups for evaluation. The primary outcome was the diagnostic yield for TB detection. Secondary outcomes included culture positivity, positivity of nucleic acid amplification tests (NAATs) for Mycobacterium tuberculosis and procedure-related complications. RESULTS A total of 94 patients were assessed and 91 (43 in the BAL group, 48 in the BW group) were analysed. Twenty-one patients (48.8%) in the BAL group and 30 (62.5%) in the BW group had a final diagnosis of pulmonary TB. The detection rate of M. tuberculosis by culture or NAAT was significantly higher in BAL specimens than in BW specimens (85.7% vs 50.0%, p 0.009). The procedure-related complications were hypoxic events, 2/43 (4.7%) in the BAL group and 5/48 (10.4%) in the BW group; and post-bronchoscopic fever, 3/43 (7.0%) in the BAL group and 4/48 (8.3%) in the BW group. DISCUSSION As long as it is tolerable, BAL rather than BW, should be used to obtain specimens for the diagnosis of pulmonary TB in sputum-scarce or smear-negative cases.
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Affiliation(s)
- Y W Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - B S Kwon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - S Y Lim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Y J Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Y-J Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - H I Yoon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - J H Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - C-T Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - J S Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
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Sharma S, Singhal R, Sarin R, Myneedu VP. Emerging trends in microbiological diagnostics in children. Indian J Tuberc 2019; 66:549-554. [PMID: 31813447 DOI: 10.1016/j.ijtb.2019.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The targets of the WHO's End TB Strategy and the United Nations' (UN) Sustainable Development Goals (SDGs) have been expanded to"Find. Treat. All #EndTB" with universal access to TB diagnosis, treatment and care by 2022 in an effort to end the global TB epidemic. Trends to achieve the above targets in children have led to greater emphasis on the newer diagnostics paving way to microbiological confirmation and universal drug sensitivity in children.
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Affiliation(s)
| | | | - Rohit Sarin
- National Institute of Tuberculosis and Respiratory Diseases, India
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Tu Phan LM, Tufa LT, Kim HJ, Lee J, Park TJ. Trends in Diagnosis for Active Tuberculosis Using Nanomaterials. Curr Med Chem 2019; 26:1946-1959. [DOI: 10.2174/0929867325666180912105617] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 07/19/2018] [Accepted: 07/19/2018] [Indexed: 12/18/2022]
Abstract
Background:Tuberculosis (TB), one of the leading causes of death worldwide, is difficult to diagnose based only on signs and symptoms. Methods for TB detection are continuously being researched to design novel effective clinical tools for the diagnosis of TB.Objective:This article reviews the methods to diagnose TB at the latent and active stages and to recognize prospective TB diagnostic methods based on nanomaterials.Methods:The current methods for TB diagnosis were reviewed by evaluating their advantages and disadvantages. Furthermore, the trends in TB detection using nanomaterials were discussed regarding their performance capacity for clinical diagnostic applications.Results:Current methods such as microscopy, culture, and tuberculin skin test are still being employed to diagnose TB, however, a highly sensitive point of care tool without false results is still needed. The utilization of nanomaterials to detect the specific TB biomarkers with high sensitivity and specificity can provide a possible strategy to rapidly diagnose TB. Although it is challenging for nanodiagnostic platforms to be assessed in clinical trials, active TB diagnosis using nanomaterials is highly expected to achieve clinical significance for regular application. In addition, aspects and future directions in developing the high-efficiency tools to diagnose active TB using advanced nanomaterials are expounded.Conclusion:This review suggests that nanomaterials have high potential as rapid, costeffective tools to enhance the diagnostic sensitivity and specificity for the accurate diagnosis, treatment, and prevention of TB. Hence, portable nanobiosensors can be alternative effective tests to be exploited globally after clinical trial execution.
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Affiliation(s)
- Le Minh Tu Phan
- Department of Chemistry, Institute of Interdisciplinary Convergence Research, Research Institute of Halal Industrialization Technology, Chung-Ang University, 84 Heukseok-ro, Dongjak-gu, Seoul 06974, Korea
| | - Lemma Teshome Tufa
- Department of Nano Fusion and Cogno-Mechatronics Engineering, Pusan National University, 2 Busandaehak-ro 63beon-gil, Geumjeong-gu, Busan 46241, Korea
| | - Hwa-Jung Kim
- Department of Microbiology and Research Institute for Medical Science, College of Medicine, Chungnam National University, 266 Munhwa- ro, Jung-gu, Daejeon 35015, Korea
| | - Jaebeom Lee
- Department of Chemistry, Chungnam National University, 99 Daehak-ro, Yuseong-gu, Daejeon 34134, Korea
| | - Tae Jung Park
- Department of Chemistry, Institute of Interdisciplinary Convergence Research, Research Institute of Halal Industrialization Technology, Chung-Ang University, 84 Heukseok-ro, Dongjak-gu, Seoul 06974, Korea
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Genetic diversity and drug susceptibility patterns of the Mycobacterium tuberculosis complex in Yunnan, China. Biosci Rep 2019; 39:BSR20181746. [PMID: 30988070 PMCID: PMC6542976 DOI: 10.1042/bsr20181746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 04/12/2019] [Accepted: 04/14/2019] [Indexed: 11/20/2022] Open
Abstract
Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis (Mtb) which has been threatening global public health for many years. High genetic diversity is dominant feature of Mtb. Increasing cases of multidrug-resistant (MDR) tuberculosis (MDR-TB) is a serious public health problem to TB control in China. Spontaneous mutations in the Mtb genome can alter proteins which are the target of drugs, making the bacteria drug resistant. The purpose of the present study was to analyze the genotype of Mtb isolates from some areas in Yunnan, China and explore the association between genotypes and MDR-TB. Using spoligotyping, we identified Beijing genotypes, six non-Beijing genotypes and a number of orphan genotypes from 270 Mtb isolates from patients in Yunnan Province during 2014–2016. Of 270 Mtb isolates, 102 clinical Mtb strains were identified as drug-resistant (DR) by drug susceptibility testing (DST), among them, 52 MDR strains. Beijing genotypes occupied the highest MDR proportion (78.85%) followed by the orphan genotypes (15.38%). The characteristics of MDR strains showed high genetic diversity. The results will help to efficiently improve diagnosis and treatment and provide valuable information for Mtb molecular epidemiology.
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Zhang J, Huang J, He F. The construction of Mycobacterium tuberculosis 16S rDNA MSPQC sensor based on Exonuclease III-assisted cyclic signal amplification. Biosens Bioelectron 2019; 138:111322. [PMID: 31112916 DOI: 10.1016/j.bios.2019.111322] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 05/05/2019] [Accepted: 05/12/2019] [Indexed: 12/27/2022]
Abstract
Tuberculosis caused by Mycobacterium tuberculosis (M. tuberculosis) remains one of the most serious infectious diseases all over the world. The key to reduce the spread and mortality rate of tuberculosis is to develop faster and more sensitive approaches for detection of M. tuberculosis. However, current detection methods can not meet the requirements of rapid clinical M. tuberculosis detection in terms of detection time. Herein, a new 16S rDNA multichannel series piezoelectric quartz crystal (MSPQC) sensor based on Exonuclease III (Exo III)-aided target recycling has been developed for rapid detection of M. tuberculosis. The specific 16S rDNA fragment of M. tuberculosis was used as biomarker, DNA capture probes complementary to the biomarker were designed and modified on the surface of AuNPs. The Exo III which could recognise hybrid duplexes and selectively digest DNA capture probe was used to assist digestion cycle by digesting DNA capture probe and releasing the intact target fragment. After all DNA probes loading on the surface of AuNPs were removed, the surface of AuNPs was exposed and conductive connection was formed between the nanogap network electrode by self-catalytic growth of exposed AuNPs in the glucose and HAuCl4 solution. This resulted in sensitive response of M. tuberculosis sensor and M. tuberculosis was detected by recording this response. The limit of detection (LOD) of the method was 20 CFU/mL and the detection time was less than 3 h. It was expected to be widely used in detection methods of M. tuberculosis.
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Affiliation(s)
- Jialin Zhang
- State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha, 410082, PR China
| | - Ji Huang
- State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha, 410082, PR China
| | - Fengjiao He
- State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha, 410082, PR China.
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Zhang X, Feng Y, Duan S, Su L, Zhang J, He F. Mycobacterium tuberculosis strain H37Rv Electrochemical Sensor Mediated by Aptamer and AuNPs-DNA. ACS Sens 2019; 4:849-855. [PMID: 30900450 DOI: 10.1021/acssensors.8b01230] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The accurate and rapid detection of Mycobacterium tuberculosis ( M. tuberculosis) is essential for the effective treatment of tuberculosis. In this article, we propose an electrochemical sensor to detect M. tuberculosis reference strain H37Rv. The sensor contains an H37Rv aptamer and oligonucleotides modified with gold nanoparticles (AuNPs-DNA). An H37Rv aptamer screened by our laboratory was used as the recognition probe. The change in frequency shift mediated by AuNPs-DNA in the presence of H37Rv was detected using a multichannel series piezoelectric quartz crystal (MSPQC) system. Three oligonucleotides modified with gold nanoparticles were designed. These oligonucleotides contained 12, 12, and 13 bases that hybridized with the 37-nt H37Rv aptamer. H37Rv aptamer was immobilized on the gold electrode surface by Au-S bonds. A conductive-layer was then formed by sequential hybridization of the aptamer with the three designed AuNPs-DNAs. When H37Rv was present, it specifically bound to the aptamer, resulting in the detachment of AuNPs-DNA from the electrode. The conductive layer was thereby replaced by a nonconductive complex of aptamer and bacteria. These changes were monitored by the MSPQC system. The proposed sensor is rapid, specific and sensitive, the detection time was 2 h. The detection limit was 100 cfu/mL. This sensor would be of great benefit for the early clinical diagnosis of tuberculosis.
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Affiliation(s)
- Xiaoqing Zhang
- State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha, China, 410082
- School of Pharmacy, Hunan University of Chinese Medicine, Changsha, China, 410208
| | - Ye Feng
- State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha, China, 410082
| | - Shaoyun Duan
- State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha, China, 410082
| | - Lingling Su
- State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha, China, 410082
| | - Jialin Zhang
- State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha, China, 410082
| | - Fengjiao He
- State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha, China, 410082
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Santin M, Barrabeig I, Malchair P, Gonzalez-Luquero L, Benitez MA, Sabria J, Palau-Benavent M, Cañete C, Lloret-Queraltó JA, Grijota-Camino MD, Dorca J, Alcaide F. Pulmonary Infections with Nontuberculous Mycobacteria, Catalonia, Spain, 1994-2014. Emerg Infect Dis 2019; 24:1091-1094. [PMID: 29774836 PMCID: PMC6004863 DOI: 10.3201/eid2406.172095] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
In Spain, systematic reporting of pulmonary infections with nontuberculous mycobacteria is not mandatory. Therefore, to determine trends, we retrospectively identified cases for January 1994–December 2014 in Catalonia. Over the 21 years, prevalence increased and was associated with being male. Mycobacterium avium complex and M. abscessus prevalence increased; M. kansasii prevalence decreased.
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Li QH, Zhang Y, Zhao MM, Gu Y, Hu Y, Su YL, Zhang F, Shen L, Zhou Y, Li HP. Simultaneous amplification and testing method forMycobacterium tuberculosisrRNA to differentiate sputum-negative tuberculosis from sarcoidosis. Am J Physiol Lung Cell Mol Physiol 2019; 316:L519-L524. [PMID: 30652492 DOI: 10.1152/ajplung.00172.2018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We use the simultaneous application and testing method to detect Mycobacterium tuberculosis rRNA (SAT-TB) with the endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) biopsy specimens to differentiate sputum-negative tuberculosis from sarcoidosis. In the first part, we validated the SAT-TB on the bronchial or EBUS-TBNA biopsy specimens from sputum smear-positive pulmonary tuberculosis. In the second part, all EBUS-TBNA specimens for sputum smear-negative intrathoracic tuberculous lymphadenopathies or sarcoidosis were tested with the SAT-TB, acid-fast bacilli smear, and culture. In the 16 sputum-positive tuberculosis cases, 5 showed negative SAT (2 nontuberculous mycobacteria and 3 had anti-tuberculosis therapies previously); the remaining 11 were positive. Of the 41 sputum-negative tuberculosis cases in the second part, five other diseases were negative. In the remaining 36 cases, 27 sarcoidosis cases were negative; 7 in 9 with sputum-negative tuberculosis were positive (77.78%). In these 36 patients, the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of the SAT method were 77.78, 100, 100, 93.10, and 94.44%, respectively. The SAT distinguished sputum-negative tuberculosis from sarcoidosis significantly ( P < 0.0001) and identified cases with active M. tuberculosis as accurately as the conventional methods (κ = 0.912, P < 0.0001). We conclude that the SAT-TB may be an effective method for using biopsy specimens to differentiate sputum-negative tuberculosis from sarcoidosis.
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Affiliation(s)
- Qiu-Hong Li
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Yuan Zhang
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Meng-Meng Zhao
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Ye Gu
- Department of Endoscope, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Yang Hu
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Yi-Liang Su
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Fen Zhang
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Li Shen
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Ying Zhou
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Hui-Ping Li
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
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Karinauske E, Abramavicius S, Musteikiene G, Stankevicius E, Zaveckiene J, Pilvinis V, Kadusevicius E. A case report and literature review: previously excluded tuberculosis masked by amiodarone induced lung injury. BMC Pharmacol Toxicol 2018; 19:88. [PMID: 30594249 PMCID: PMC6311077 DOI: 10.1186/s40360-018-0279-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 12/12/2018] [Indexed: 11/10/2022] Open
Abstract
Background Amiodarone is an antiarrhythmic drug which is used to treat and prevent several dysrhythmias. This includes ventricular tachycardia and fibrillation, wide complex tachycardia, as well as atrial fibrillation (AF) and paroxysmal supraventricular tachycardia. Amiodarone may prove to be the agent of choice where the patient is hemodynamically unstable and unsuitable for direct current (DC) cardioversion. Although, it is not recommended for long-term use. The physician might encounter issues when differentiating amiodarone-induced lung toxicity with suspicion of interstitial lung disease, cancer or vasculitis. Adverse drug reactions are difficult to confirm and it leads to serious problems of pharmacotherapy. Case presentation A 78-year-old Caucasian male pensioner complaining of fever, dyspnea, malaise, non-productive cough, fatigue, weight loss, diagnosed with acute respiratory failure with a 16-year long history of amiodarone use and histologically confirmed temporal arteritis with long-term glucocorticosteroid (GCC) therapy. Patient was treated for temporal arteritis with GCC for ~ 1 year, then fever and dyspnea occurred, and the patient was hospitalized for treatment of bilateral pneumonia. Chest X-ray and chest high resolution computed tomography (HRCT) indicated several possible diagnoses: drug-induced interstitial lung disease, autoimmune interstitial lung disease, previously excluded pulmonary TB. Amiodarone was discontinued. Antibiotic therapy for bilateral pneumonia was started. Fiberoptic bronchoscopy with bronchial washings and brushings was performed. Acid fast bacilli (AFB) were found on Ziehl-Nielsen microscopy and tuberculosis (TB) was confirmed (later confirmed to be Mycobacterium tuberculosis in culture), initial treatment for TB was started. After a few months of treating for TB, patient was diagnosed with pneumonia and sepsis, empiric antibiotic therapy was prescribed. After reevaluation and M. Tuberculosis identification, the patient was referred to the Tuberculosis hospital for further treatment. After 6 months of TB treatment, pneumonia occurred which was complicated by sepsis. Despite the treatment, multiple organ dysfunction syndrome evolved and patient died. Probable cause of death: pneumonia and sepsis. Conclusions The current clinical case emphasizes issues that a physician may encounter in the differential diagnostics of amiodarone-induced lung toxicity with other lung diseases.
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Affiliation(s)
- Egle Karinauske
- Institute of Physiology and Pharmacology, Lithuanian University of Health Sciences, A. Mickeviciaus str. 9, 44307, Kaunas, LT, Lithuania.
| | - Silvijus Abramavicius
- Institute of Physiology and Pharmacology, Lithuanian University of Health Sciences, A. Mickeviciaus str. 9, 44307, Kaunas, LT, Lithuania.,Intensive care unit, Republican Vilnius University Hospital, Vilnius, Lithuania
| | - Greta Musteikiene
- Department of Pulmonology, Medical Academy, Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania
| | - Edgaras Stankevicius
- Institute of Physiology and Pharmacology, Lithuanian University of Health Sciences, A. Mickeviciaus str. 9, 44307, Kaunas, LT, Lithuania
| | - Jurgita Zaveckiene
- Department of Radiology, Medical Academy, Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania
| | - Vidas Pilvinis
- Department of Intensive Care, Medical Academy, Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania
| | - Edmundas Kadusevicius
- Institute of Physiology and Pharmacology, Lithuanian University of Health Sciences, A. Mickeviciaus str. 9, 44307, Kaunas, LT, Lithuania
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Abstract
STUDY DESIGN Review article. OBJECTIVES A review of literature on the epidemiology, diagnosis, and management of spinal tuberculosis (TB). METHODS A systematic computerized literature search was performed using Cochrane Database of Systematic Reviews, EMBASE, and PubMed. Studies published over the past 10 years were analyzed. The searches were performed using Medical Subject Headings terms, and the subheadings used were "spinal tuberculosis," "diagnosis," "epidemiology," "etiology," "management," "surgery," and "therapy." RESULTS Tissue diagnosis remains the only foolproof investigation to confirm diagnosis. Magnetic resonance imaging and Gene Xpert help in early detection and treatment of spinal TB. Uncomplicated spinal TB has good response to appropriately dosed multimodal ambulant chemotherapy. Surgery is warranted only in cases of neurological complications, incapacitating deformity, and instability. CONCLUSIONS The incidence of atypical clinicoradiological presentations of spinal TB is on the rise. Improper dosing, inadequate duration of treatment, and inappropriate selection of candidates for chemotherapy has not only resulted in the resurgence of TB but also led to the most dreadful consequence of multidrug resistant strains. In addition, global migration phenomenon has resulted in worldwide spread of spinal TB. The current consensus is to diagnose and treat spinal TB early, prevent complications, promote early mobilization, and restore the patient to his or her earlier functional status.
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Affiliation(s)
- S. Rajasekaran
- Ganga Hospital, Coimbatore, India,S. Rajasekaran, Department of Spine Surgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore 641043, India.
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MacPherson P, Webb EL, Lalloo DG, Nliwasa M, Maheswaran H, Joekes E, Phiri D, Squire B, Pai M, Corbett EL. Design and protocol for a pragmatic randomised study to optimise screening, prevention and care for tuberculosis and HIV in Malawi (PROSPECT Study). Wellcome Open Res 2018; 3:61. [PMID: 30542662 PMCID: PMC6259593 DOI: 10.12688/wellcomeopenres.14598.3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2018] [Indexed: 01/20/2023] Open
Abstract
Background: Adults seeking diagnosis and treatment for tuberculosis (TB) and HIV in low-resource settings face considerable barriers and have high pre-treatment mortality. Efforts to improve access to prompt TB treatment have been hampered by limitations in TB diagnostics, with considerable uncertainty about how available and new tests can best be implemented. Design and methods: The PROSPECT Study is an open, three-arm pragmatic randomised study that will investigate the effectiveness and cost-effectiveness of optimised HIV and TB diagnosis and linkage to care interventions in reducing time to TB diagnosis and prevalence of undiagnosed TB and HIV in primary care in Blantyre, Malawi. Participants (≥ 18 years) attending a primary care clinic with TB symptoms (cough of any duration) will be randomly allocated to one of three groups: (i) standard of care; (ii) optimised HIV diagnosis and linkage; or (iii) optimised HIV and TB diagnosis and linkage. We will test two hypotheses: firstly, whether prompt linkage to HIV care should be prioritised for adults with TB symptoms; and secondly, whether an optimised TB triage testing algorithm comprised of digital chest x-ray evaluated by computer-aided diagnosis software and sputum GeneXpert MTB/Rif can outperform clinician-directed TB screening. The primary trial outcome will be time to TB treatment initiation by day 56, and secondary outcomes will include prevalence of undiagnosed TB and HIV, mortality, quality of life, and cost-effectiveness. Conclusions: The PROSPECT Study will provide urgently-needed evidence under "real-life" conditions to inform clinicians and policy makers on how best to improve TB/HIV diagnosis and treatment in Africa. Clinical trial registration: NCT03519425 (08/05/2018).
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Affiliation(s)
- Peter MacPherson
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre , Malawi
| | - Emily L Webb
- London School of Hygiene & Tropical Medicine, London, UK
| | - David G. Lalloo
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Marriott Nliwasa
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre , Malawi
- Helse Nord TB Programme, Department of Microbiology, College of Medicine, University of Malawi, Blantyre, Malawi
| | | | - Elizabeth Joekes
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Dama Phiri
- Radiology Department, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Bertie Squire
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre , Malawi
| | - Madhukar Pai
- McGill International TB Centre, McGill University, Montreal , Canada
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MacPherson P, Webb EL, Lalloo DG, Nliwasa M, Maheswaran H, Joekes E, Phiri D, Squire B, Pai M, Corbett EL. Design and protocol for a pragmatic randomised study to optimise screening, prevention and care for tuberculosis and HIV in Malawi (PROSPECT Study). Wellcome Open Res 2018; 3:61. [PMID: 30542662 PMCID: PMC6259593 DOI: 10.12688/wellcomeopenres.14598.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2018] [Indexed: 11/20/2022] Open
Abstract
Background: Adults seeking diagnosis and treatment for tuberculosis (TB) and HIV in low-resource settings face considerable barriers and have high pre-treatment mortality. Efforts to improve access to prompt TB treatment have been hampered by limitations in TB diagnostics, with considerable uncertainty about how available and new tests can best be implemented. Design and methods: The PROSPECT Study is an open, three-arm pragmatic randomised study that will investigate the effectiveness and cost-effectiveness of optimised HIV and TB diagnosis and linkage to care interventions in reducing time to TB diagnosis and prevalence of undiagnosed TB and HIV in primary care in Blantyre, Malawi. Participants (≥ 18 years) attending a primary care clinic with TB symptoms (cough of any duration) will be randomly allocated to one of three groups: (i) standard of care; (ii) optimised HIV diagnosis and linkage; or (iii) optimised HIV and TB diagnosis and linkage. We will test two hypotheses: firstly, whether prompt linkage to HIV care should be prioritised for adults with TB symptoms; and secondly, whether an optimised TB triage testing algorithm comprised of digital chest x-ray evaluated by computer-aided diagnosis software and sputum GeneXpert MTB/Rif can outperform clinician-directed TB screening. The primary trial outcome will be time to TB treatment initiation by day 56, and secondary outcomes will include prevalence of undiagnosed TB and HIV, mortality, quality of life, and cost-effectiveness. Conclusions: The PROSPECT Study will provide urgently-needed evidence under "real-life" conditions to inform clinicians and policy makers on how best to improve TB/HIV diagnosis and treatment in Africa. Clinical trial registration: NCT03519425 (08/05/2018).
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Affiliation(s)
- Peter MacPherson
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre , Malawi
| | - Emily L Webb
- London School of Hygiene & Tropical Medicine, London, UK
| | - David G. Lalloo
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Marriott Nliwasa
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre , Malawi
- Helse Nord TB Programme, Department of Microbiology, College of Medicine, University of Malawi, Blantyre, Malawi
| | | | - Elizabeth Joekes
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Dama Phiri
- Radiology Department, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Bertie Squire
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre , Malawi
| | - Madhukar Pai
- McGill International TB Centre, McGill University, Montreal , Canada
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