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Balisan OPR, Galamay JRT, Cale-Subia LN, De Luna AM. Utility of nucleic acid amplification test in the detection of tuberculosis in biological fluids from suspected TB patients in a cardiovascular center in the Philippines. Acta Trop 2024; 249:107078. [PMID: 38036022 DOI: 10.1016/j.actatropica.2023.107078] [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: 06/14/2023] [Revised: 08/30/2023] [Accepted: 11/17/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND TB NAAT is highly sensitive and can therefore be a helpful tool used in confirming M. tuberculosis. In a prospective study, we evaluated the utility of TB NAAT in the detection of tuberculosis in biological fluids from suspected TB patients. METHODS We compared tuberculosis nucleic acid amplification test and acid-fast bacilli smears with Lowenstein-Jensen culture, from patients with a clinical suspicion of tuberculosis disease. We calculated the sensitivity, specificity, PPV and NPV. RESULTS Using the Lowenstein-Jensen culture as the gold standard for detection of Mycobacterium tuberculosis, the TB-NAAT showed sensitivity of 66.67 %, specificity of 93.67 %, and gave a positive predictive value of 44.44 %. CONCLUSION We conclude that the TB-NAAT is a quick and consistent diagnostic test for TB detection. However, due to a comparably lower sensitivity than other previous studies, the utility of TB-NAAT alone may not be sufficient in the screening of TB patients. Likewise, the TB-NAAT cannot detect non-tuberculous mycobacteria, for which additional analysis may be needed.
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Affiliation(s)
- Othaniel Philip R Balisan
- Division of Laboratory Medicine, Philippine Heart Center, East Avenue, Diliman, Quezon City 0850, Philippines.
| | - John Ray T Galamay
- Division of Pulmonary and Critical Care Medicine, Philippine Heart Center, East Avenue, Diliman, Quezon City 0850, Philippines
| | - Laarnie N Cale-Subia
- Division of Laboratory Medicine, Philippine Heart Center, East Avenue, Diliman, Quezon City 0850, Philippines
| | - Arlene M De Luna
- Division of Laboratory Medicine, Philippine Heart Center, East Avenue, Diliman, Quezon City 0850, Philippines
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Leung KSS, Siu GKH, Tam KKG, Ho PL, Wong SSY, Leung EKC, Yu SH, Ma OCK, Yam WC. Diagnostic evaluation of an in-house developed single-tube, duplex, nested IS6110 real-time PCR assay for rapid pulmonary tuberculosis diagnosis. Tuberculosis (Edinb) 2018; 112:120-125. [PMID: 30205964 DOI: 10.1016/j.tube.2018.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 08/17/2018] [Accepted: 08/20/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To perform a prospective evaluation on the diagnostic performance of an in-house developed, duplex nested IS6110 real-time Polymerase-Chain-Reaction (PCR) assay (IS6110-qPCR assay) for rapid pulmonary TB diagnosis. METHODS A total of 503 sputum specimens were prospectively collected from July 2016 to November 2016. Diagnostic accuracy and optimal cut-off Cycle-threshold (Ct) value for IS6110-qPCR assay was determined by Receiver Operating Characteristic (ROC) curve. Using the optimal cut-off Ct, diagnostic performance of IS6110-qPCR assay was assessed with reference to both bacteriological and clinical information. Meanwhile, limit of detection (LOD) was calculated using Mycobacterium tuberculosis H37Rv as reference strain. RESULT ROC curve analysis of IS6110-qPCR assay showed a high Area Under the Curve (AUC) value (0.948) with optimal Ct value at 24.140. Prospective analysis of IS6110-qPCR assay with cut-off Ct = 24.140 showed a high overall sensitivity and specificity of 97.2% and 99.7%, respectively. No cross reactivity was observed among all non-tuberculous mycobacteria specimens in this study. LOD analysis on MTB-spiked sputum showed an average detection limit of 5.0 CFU/mL at Ct = 23.18 (±SD, 0.57). CONCLUSION IS6110-qPCR assay is a highly accurate and cost-effective assay developed for primary screening of suspected TB cases, which is particularly suitable for regions with limited resources but high TB burden.
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Affiliation(s)
- Kenneth Siu-Sing Leung
- Department of Microbiology, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Gilman Kit-Hang Siu
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region
| | - Kingsley King-Gee Tam
- Department of Microbiology, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Pak-Leung Ho
- Department of Microbiology, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Samson Sai-Yin Wong
- Department of Microbiology, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Eunice Ka-Chun Leung
- Department of Microbiology, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Shi Hui Yu
- KingMed Diagnostics, Science Park, Hong Kong Special Administrative Region
| | - Oliver Chiu-Kit Ma
- KingMed Diagnostics, Science Park, Hong Kong Special Administrative Region
| | - Wing-Cheong Yam
- Department of Microbiology, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region.
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Nakiyingi L, Nonyane BAS, Ssengooba W, Kirenga BJ, Nakanjako D, Lubega G, Byakika-Kibwika P, Joloba ML, Ellner JJ, Dorman SE, Mayanja-Kizza H, Manabe YC. Predictors for MTB Culture-Positivity among HIV-Infected Smear-Negative Presumptive Tuberculosis Patients in Uganda: Application of New Tuberculosis Diagnostic Technology. PLoS One 2015. [PMID: 26222142 PMCID: PMC4519276 DOI: 10.1371/journal.pone.0133756] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background The existing World Health Organization diagnostic algorithms for smear-negative TB perform poorly in HIV-infected individuals. New TB diagnostics such as urine TB lipoarabinomannan (LAM) could improve the accuracy and reduce delays in TB diagnosis in HIV-infected smear-negative presumptive TB. We sought to determine predictors for MTB culture-positivity among these patients. Methods This study was nested into a prospective evaluation of HIV-infected outpatients and inpatients clinically suspected to have TB who were screened by smear-microscopy on two spot sputum samples. Data on socio-demographics, clinical symptoms, antiretroviral therapy, CXR, CD4 count, mycobacterial sputum and blood cultures and TB-LAM were collected. Logistic regression and conditional inference tree analysis were used to determine the most predictive indicators for MTB culture-positivity. Results Of the 418 smear-negative participants [female, 64%; median age (IQR) 32 (28-39) years, median CD4 106 (IQR 22 - 298) cells/mm3], 96/418 (23%) were sputum and/ or blood culture-positive for Mycobacterium tuberculosis (MTB) complex. Abnormal CXR (aOR 3.68, 95% CI 1.76- 7.71, p=0.001) and positive urine TB-LAM (aOR 6.21, 95% CI 3.14-12.27, p< 0.001) were significantly associated with MTB culture-positivity. Previous TB treatment (aOR 0.41, 95% CI 0.17-0.99, p=0.049) reduced the likelihood of a positive MTB culture. A conditional inference tree analysis showed that positive urine TB-LAM and abnormal CXR were the most predictive indicators of MTB culture-positivity. A combination of urine TB-LAM test and CXR had sensitivity and specificity of 50% and 86.1% respectively overall, and 70.8% and 84.1% respectively among those with CD4<100 cells/mm3. Conclusions A positive urine TB-LAM test and an abnormal CXR significantly predict MTB culture-positivity among smear-negative HIV-infected presumptive TB patients while previous TB treatment reduces the likelihood of a positive MTB culture. Validation studies to assess the performance of diagnostic algorithms that include urine TB-LAM in the diagnosis of smear-negative TB in HIV-infected individuals are warranted.
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Affiliation(s)
- Lydia Nakiyingi
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
- Department of Medicine, School of Medicine, Makerere University College of Heath Sciences, Kampala, Uganda
- * E-mail:
| | - Bareng A. S. Nonyane
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Willy Ssengooba
- Department of Medical Microbiology, Makerere University College of Heath Sciences, Kampala, Uganda
| | - Bruce J. Kirenga
- Department of Medicine, School of Medicine, Makerere University College of Heath Sciences, Kampala, Uganda
| | - Damalie Nakanjako
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
- Department of Medicine, School of Medicine, Makerere University College of Heath Sciences, Kampala, Uganda
| | - Gloria Lubega
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Pauline Byakika-Kibwika
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
- Department of Medicine, School of Medicine, Makerere University College of Heath Sciences, Kampala, Uganda
| | - Moses L. Joloba
- Department of Medical Microbiology, Makerere University College of Heath Sciences, Kampala, Uganda
| | - Jerry J. Ellner
- Boston Medical Center, Boston University School of Medicine, Boston, MA, United States of America
| | - Susan E. Dorman
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Harriet Mayanja-Kizza
- Department of Medicine, School of Medicine, Makerere University College of Heath Sciences, Kampala, Uganda
| | - Yukari C. Manabe
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
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Pang Y, Lu J, Yang J, Wang Y, Cohen C, Ni X, Zhao Y. A novel method for diagnosis of smear-negative tuberculosis patients by combining a random unbiased Phi29 amplification with a specific real-time PCR. Tuberculosis (Edinb) 2015; 95:411-4. [PMID: 25957821 DOI: 10.1016/j.tube.2015.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 03/27/2015] [Accepted: 03/29/2015] [Indexed: 11/18/2022]
Abstract
In this study, we develop a novel method for diagnosis of smear-negative tuberculosis patients by performing a random unbiased Phi29 amplification prior to the use of a specific real-time PCR. The limit of detection (LOD) of the conventional real-time PCR was 100 colony-forming units (CFU) of MTB genome/reaction, while the REPLI real-time PCR assay could detect 0.4 CFU/reaction. In comparison with the conventional real-time PCR, REPLI real-time PCR shows better sensitivity for the detection of smear-negative tuberculosis (P = 0.015).
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Affiliation(s)
- Yu Pang
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jie Lu
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Jian Yang
- Shaanxi Tuberculosis Dispensary, Shaanxi, China
| | - Yufeng Wang
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Chad Cohen
- McGill International TB Centre, Montreal, Quebec, Canada
| | - Xin Ni
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, China.
| | - Yanlin Zhao
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
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Sekandi JN, Dobbin K, Oloya J, Okwera A, Whalen CC, Corso PS. Cost-effectiveness analysis of community active case finding and household contact investigation for tuberculosis case detection in urban Africa. PLoS One 2015; 10:e0117009. [PMID: 25658592 PMCID: PMC4319733 DOI: 10.1371/journal.pone.0117009] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 12/17/2014] [Indexed: 11/21/2022] Open
Abstract
Introduction Case detection by passive case finding (PCF) strategy alone is inadequate for detecting all tuberculosis (TB) cases in high burden settings especially Sub-Saharan Africa. Alternative case detection strategies such as community Active Case Finding (ACF) and Household Contact Investigations (HCI) are effective but empirical evidence of their cost-effectiveness is sparse. The objective of this study was to determine whether adding ACF or HCI compared with standard PCF alone represent cost-effective alternative TB case detection strategies in urban Africa. Methods A static decision modeling framework was used to examine the costs and effectiveness of three TB case detection strategies: PCF alone, PCF+ACF, and PCF+HCI. Probability and cost estimates were obtained from National TB program data, primary studies conducted in Uganda, published literature and expert opinions. The analysis was performed from the societal and provider perspectives over a 1.5 year time-frame. The main effectiveness measure was the number of true TB cases detected and the outcome was incremental cost-effectiveness ratios (ICERs) expressed as cost in 2013 US$ per additional true TB case detected. Results Compared to PCF alone, the PCF+HCI strategy was cost-effective at US$443.62 per additional TB case detected. However, PCF+ACF was not cost-effective at US$1492.95 per additional TB case detected. Sensitivity analyses showed that PCF+ACF would be cost-effective if the prevalence of chronic cough in the population screened by ACF increased 10-fold from 4% to 40% and if the program costs for ACF were reduced by 50%. Conclusions Under our baseline assumptions, the addition of HCI to an existing PCF program presented a more cost-effective strategy than the addition of ACF in the context of an African city. Therefore, implementation of household contact investigations as a part of the recommended TB control strategy should be prioritized.
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Affiliation(s)
- Juliet N. Sekandi
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia, United States of America
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
- * E-mail:
| | - Kevin Dobbin
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia, United States of America
| | - James Oloya
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia, United States of America
| | - Alphonse Okwera
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Christopher C. Whalen
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia, United States of America
| | - Phaedra S. Corso
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia, United States of America
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Cao D, Hu L, Lin M, Li M, Ye Z, Sun H, Huang J, Yang H, Tian J. Real-time fluorescence Loop-Mediated Isothermal Amplification (LAMP) for rapid and reliable diagnosis of pulmonary tuberculosis. J Microbiol Methods 2015; 109:74-8. [DOI: 10.1016/j.mimet.2014.12.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 12/18/2014] [Accepted: 12/18/2014] [Indexed: 11/27/2022]
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Nakiyingi L, Bwanika JM, Kirenga B, Nakanjako D, Katabira C, Lubega G, Sempa J, Nyesiga B, Albert H, Manabe YC. Clinical predictors and accuracy of empiric tuberculosis treatment among sputum smear-negative HIV-infected adult TB suspects in Uganda. PLoS One 2013; 8:e74023. [PMID: 24040151 PMCID: PMC3765314 DOI: 10.1371/journal.pone.0074023] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 07/26/2013] [Indexed: 11/18/2022] Open
Abstract
Introduction The existing diagnostic algorithms for sputum smear-negative tuberculosis (TB) are complicated, time-consuming, and often difficult to implement. The decision to initiate TB treatment in resource-limited countries is often largely based on clinical predictors. We sought to determine the clinical predictors and accuracy of empiric TB treatment initiation in HIV-infected sputum smear-negative TB suspects using sputum culture as a reference standard. Setting Out-patient HIV-TB integrated urban clinic in Kampala, Uganda. Methods HIV-infected TB suspects were screened using sputum smear microscopy, and mycobacterial sputum liquid and solid cultures were performed. Smear results were made available to the clinician who made a clinical decision on empiric TB treatment initiation for sputum smear-negative patients. Clinic records were reviewed for patients whose sputum smears were negative to collect data on socio-demographics, TB symptomatology, chest X-ray findings, CD4 cell counts and TB treatment initiation. Results Of 253 smear-negative TB suspects, 56% (142/253) were females, median age 38 IQR (31–44) years, with a median CD4 cell count of 291 IQR (150–482) cells/mm3. Of the 85 (33.6%) smear-negative patients empirically initiated on TB treatment, 35.3% (n = 30) were sputum culture positive compared to only 18 (10.7%) of the 168 untreated patients (p<0.001). Abnormal chest X-ray [aOR 10.18, 95% CI (3.14–33.00), p<0.001] and advanced HIV clinical stage [aOR 3.92, 95% CI (1.20–12.85), p = 0.024] were significantly associated with empiric TB treatment initiation. The sensitivity and specificity of empiric TB treatment initiation in the diagnosis of TB in HIV-infected patients after negative smear microscopy was 62.5% and 73.7% respectively. Conclusion In resource-limited settings, clinically advanced HIV and abnormal chest X-ray significantly predict a clinical decision to empirically initiate TB treatment in smear-negative HIV-infected patients. Empiric TB treatment initiation correlates poorly with TB cultures. Affordable, accurate and rapid point-of-care diagnostics are needed in resource-limited settings to more accurately determine which HIV-infected TB suspects have smear-negative TB.
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Affiliation(s)
- Lydia Nakiyingi
- Infectious Diseases Institute, Makerere College of Health Sciences, Kampala, Uganda
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- * E-mail:
| | - John Mark Bwanika
- Infectious Diseases Institute, Makerere College of Health Sciences, Kampala, Uganda
| | - Bruce Kirenga
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Damalie Nakanjako
- Infectious Diseases Institute, Makerere College of Health Sciences, Kampala, Uganda
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Catherine Katabira
- Infectious Diseases Institute, Makerere College of Health Sciences, Kampala, Uganda
| | - Gloria Lubega
- Infectious Diseases Institute, Makerere College of Health Sciences, Kampala, Uganda
| | - Joseph Sempa
- Infectious Diseases Institute, Makerere College of Health Sciences, Kampala, Uganda
| | - Barnabas Nyesiga
- Foundation for Innovative New Diagnostics (FIND), Kampala, Uganda
| | - Heidi Albert
- Foundation for Innovative New Diagnostics (FIND), Kampala, Uganda
| | - Yukari C. Manabe
- Infectious Diseases Institute, Makerere College of Health Sciences, Kampala, Uganda
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
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