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Rakotondrasoa SR, Raherinandrasana AH, Ramanarivo N, Ramontalambo TJ, Randriananahirana ZA, Ravaoarisoa L, Rakotonirina J. Predictors of tuberculosis treatment outcomes in Antananarivo: a retrospective cohort study. Pan Afr Med J 2023; 46:104. [PMID: 38435404 PMCID: PMC10908297 DOI: 10.11604/pamj.2023.46.104.41514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/17/2023] [Indexed: 03/05/2024] Open
Abstract
Introduction Tuberculosis (TB) is a global public health issue, affecting Africa and Madagascar. Adverse outcomes following ineffective treatment are common. Previous studies conducted in similar settings have not adequately accounted for confounding factors. The objective of this study is to identify predictive factors that are associated with tuberculosis treatment outcomes in Madagascar. Methods a retrospective cohort study was conducted using registries of 628 outpatients with tuberculosis at the Analakely Hospital (CHUSSPA) in 2019. Univariate and multivariate logistic regression analyses were performed. Results the study included 628 patients with a mean age of 37.19 ± 15.86 years and a sex ratio of 1.57. These patients were followed up for a total of 2886 person-months. Out of the 628, 517 achieved treatment success, while 31 patients died and 31 discontinued their treatment. The rates of treatment success, death, failure, and default were 82.3%, 4.9%, 0.2%, and 8.3% respectively. Female gender was found to be a predictor of treatment success area of responsibility adjusted odds ratio(AOR 1.67 [1.07-2.66]; p=0.026). Smear-negative pulmonary tuberculosis (SNPTB) was associated with a lower likelihood of treatment success (AOR 0.38 [0.23-0.65]; p<0.001) and was a common factor for default (AOR 3.17 [1.60-6.21]; p=0.001) and death (AOR=8.03 [3.01-23.72; p<0.001]). Extra-pulmonary TB was identified as a predictor of death (AOR 5.15 [1.99-14.95]; p=0.001). Conclusion the tuberculosis treatment indicators in this center have not yet met national and global targets. It is necessary to focus on early diagnosis, improving education, and implementing rigorous follow-up procedures for patients at high risk of adverse outcomes (SNPTB and extra-pulmonary tuberculosis(EPTB).
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Affiliation(s)
- Sedera Radoniaina Rakotondrasoa
- Faculty of Medicine of Antananarivo, Antananarivo, Madagascar
- National Institute of Public and Community Health (INSPC), Antananarivo, Madagascar
| | - Antso Hasina Raherinandrasana
- Faculty of Medicine of Antananarivo, Antananarivo, Madagascar
- Hospital for Care and Public Health of Analakely (CHUSSPA), Antananarivo, Madagascar
| | - Norotiana Ramanarivo
- Faculty of Medicine of Antananarivo, Antananarivo, Madagascar
- Hospital for Care and Public Health of Analakely (CHUSSPA), Antananarivo, Madagascar
| | - Tantely Jenny Ramontalambo
- Faculty of Medicine of Antananarivo, Antananarivo, Madagascar
- National Institute of Public and Community Health (INSPC), Antananarivo, Madagascar
| | - Zina Antonio Randriananahirana
- Faculty of Medicine of Antananarivo, Antananarivo, Madagascar
- National Institute of Public and Community Health (INSPC), Antananarivo, Madagascar
| | | | - Julio Rakotonirina
- Faculty of Medicine of Antananarivo, Antananarivo, Madagascar
- National Institute of Public and Community Health (INSPC), Antananarivo, Madagascar
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Coronel Teixeira R, IJdema D, Gómez C, Arce D, Roman M, Quintana Y, González F, Jiménez de Romero N, Pérez Bejarano D, Aguirre S, Magis-Escurra C. The electronic nose as a rule-out test for tuberculosis in an indigenous population. J Intern Med 2021; 290:386-391. [PMID: 33720468 PMCID: PMC8361912 DOI: 10.1111/joim.13281] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 02/17/2021] [Indexed: 12/27/2022]
Abstract
INTRODUCTION To end the tuberculosis (TB) epidemic, efficient diagnostic tools are needed. In a previous calibration study, a portable 'point of care' electronic nose device (AeonoseTM ) proved to be a promising tool in a hospital setting. We evaluated this technology to detect TB in an indigenous population in Paraguay. METHODS A total of 131 participants were enrolled. eNose results were compared with anamnesis, physical examinations, chest radiography and mycobacterial cultures in individuals with signs and symptoms compatible with TB. The eNose analysis was performed in two stages: first, the training with a combination of a previous study population plus 47 participants from the new cohort (total n = 153), and second, the 'blind prediction' of 84 participants. RESULTS 21% of all participants (n = 131) showed symptoms and/or chest radiography abnormalities suspicious of TB. No sputum samples resulted culture positive for Mycobacterium tuberculosis complex. Only one patient had a positive smell print analysis. In the training model, the specificity was 92% (95% confidence interval (CI): 85%-96%) and the negative predictive value (NPV) was 95%. In the blind prediction model, the specificity and the NPV were 99% (95% CI: 93%-99%) and 100%, respectively. Although the sensitivity and positive predictive value of the eNose could not be assessed in this cohort due to the small sample size, no active TB cases were found during a one year of follow-up period. CONCLUSION The eNose showed promising specificity and negative predictive value and might therefore be developed as a rule-out test for TB in vulnerable populations.
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Affiliation(s)
- R Coronel Teixeira
- From the, National Institute of Respiratory Diseases and the Environment (INERAM), Asunción, Paraguay.,Department of Respiratory Diseases, Radboud University Medical Centre - TB Expert Centre Dekkerswald, Nijmegen - Groesbeek, The Netherlands
| | - D IJdema
- Department of Respiratory Diseases, Radboud University Medical Centre - TB Expert Centre Dekkerswald, Nijmegen - Groesbeek, The Netherlands
| | - C Gómez
- Medical Health Center, Puerto Casado, Chaco, Paraguay
| | - D Arce
- Medical Health Center, Puerto Casado, Chaco, Paraguay
| | - M Roman
- National Tuberculosis Control Program (PCNT), Asunción, Paraguay
| | - Y Quintana
- From the, National Institute of Respiratory Diseases and the Environment (INERAM), Asunción, Paraguay
| | - F González
- From the, National Institute of Respiratory Diseases and the Environment (INERAM), Asunción, Paraguay
| | - N Jiménez de Romero
- From the, National Institute of Respiratory Diseases and the Environment (INERAM), Asunción, Paraguay.,Central Public Health Laboratory (LCSP), Paraguay
| | - D Pérez Bejarano
- From the, National Institute of Respiratory Diseases and the Environment (INERAM), Asunción, Paraguay
| | - S Aguirre
- National Tuberculosis Control Program (PCNT), Asunción, Paraguay
| | - C Magis-Escurra
- Department of Respiratory Diseases, Radboud University Medical Centre - TB Expert Centre Dekkerswald, Nijmegen - Groesbeek, The Netherlands
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Diagnostic challenges and Gene-Xpert utility in detecting Mycobacterium tuberculosis among suspected cases of Pulmonary tuberculosis. PLoS One 2021; 16:e0251858. [PMID: 34015016 PMCID: PMC8136641 DOI: 10.1371/journal.pone.0251858] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 05/04/2021] [Indexed: 11/19/2022] Open
Abstract
The incidence of pulmonary tuberculosis (PTB) can be reduced by preventing transmission with rapid and precise case detection and early treatment. The Gene-Xpert MTB/RIF assay is a useful tool for detecting Mycobacterium tuberculosis (MTB) with rifampicin resistance within approximately two hours by using a nucleic acid amplification technique. This study was designed to reduce the underdiagnosis of smear-negative pulmonary TB and to assess the clinical and radiological characteristics of PTB patients. This cross-sectional study included 235 participants who went to the Luyang primary health care clinic from September 2016 to June 2017. The demographic data were analyzed to investigate the association of patient gender, age group, and ethnicity by chi-square test. To assess the efficacy of the diagnostic test, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated. The area under the curve for sputum for both AFB and gene-Xpert was analyzed to compare their accuracy in diagnosing TB. In this study, TB was more common in males than in females. The majority (50.71%) of the cases belonged to the 25-44-year-old age group and the Bajau ethnicity (57.74%). Out of 50 pulmonary TB cases (smear-positive with AFB staining), 49 samples were positive according to the Gene-Xpert MTB/RIF assay and was confirmed by MTB culture. However, out of 185 smear-negative presumptive cases, 21 cases were positive by Gene-Xpert MTB/RIF assay in that a sample showed drug resistance, and these results were confirmed by MTB culture, showing resistance to isoniazid. In comparison to sputum for AFB, Gene-Xpert showed more sensitivity and specificity with almost complete accuracy. The additional 21 PTB cases detection from the presumptive cases by GeneXpert had significant impact compared to initial observation by the routine tests which overcame the diagnostic challenges and ambiguities.
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Saifullah A, Mallhi TH, Khan YH, Iqbal MS, Alotaibi NH, Alzarea AI, Rasheed M. Evaluation of risk factors associated with the development of MDR- and XDR-TB in a tertiary care hospital: a retrospective cohort study. PeerJ 2021; 9:e10826. [PMID: 33777510 PMCID: PMC7982078 DOI: 10.7717/peerj.10826] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 01/03/2021] [Indexed: 01/27/2023] Open
Abstract
Background Drug resistant tuberculosis (DR-TB) infringes substantial burden in terms of longer treatment duration, morbidity and mortality. Timely identification of patients at risks of DR-TB will aid individualized treatment. Current study was aimed to ascertain several factors associated with DR-TB among patients attending a tertiary care hospital. Methods This retrospective study was conducted among patients with confirmed diagnosis of DR-TB and drug susceptible TB (DS-TB) seeking medical care from a tertiary care hospital during 2014–2019. The types of DR-TB included were rifampicin resistant tuberculosis (RR-TB), Multidrug resistant tuberculosis (MDR-TB) and extensively drug resistant tuberculosis (XDR-TB). Appropriate statistical methods were implied to evaluate the factors associated with DR-TB. Results Out of 580 patients, DS-TB was diagnosed in 198 (34.1%) patients while DR-TB was present in 382 patients. Of resistance cases, RR-TB, MDR-TB and XDR-TB were diagnosed in 176 (30.3%), 195 (33.6%) and 11 (1.9%) patients, respectively. Significant differences (P < 0.05) in demographics and clinico-laboratory characteristics were observed between patients with DS-TB and DR-TB. Logistic regression analysis revealed age ≤38 years (OR: 2.5), single marital status (OR: 11.1), tobacco use (OR: 2.9), previous treatment (OR: 19.2), treatment failure (OR: 9.2) and cavity on chest X-ray (OR: 30.1) as independent risk factors for MDR-TB. However, XDR-TB was independently associated with age group of ≤38 years (OR: 13.6), students (OR: 13.0), previous treatment (OR: 12.5), cavity on chest X-ray (OR: 59.6). The independent risk factors associated with RR-TB are age ≤38 years (OR: 2.8), females (OR: 5.7), unemployed (OR: 41.5), treatment failure (OR: 4.9), previous treatment (OR: 38.2) and cavity on chest X-ray (OR: 4.3). ROC curve analysis accentuate the excellent predictive accuracy of all logistic regression models as shown by AUC (0.968, P < 0.001) for MDR-TB, AUC (0.941, P < 0.001) for XDR-TB and AUC (0.962, P < 0.001) for RR-TB. Conclusions Current study demonstrates a sizeable extent of resistant cases among pulmonary TB patients. This study presaged significant risk of DR-TB among females, young adults, unemployed, smokers, patients with previous treatment failure and cavitation on chest X-ray. Timely identification of high risk patients will give pronounced advantages regarding appropriate choices of prevention, treatment and disease control.
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Affiliation(s)
- Amna Saifullah
- Institute of Pharmacy, Lahore College for Women University, Lahore, Punjab, Pakistan.,Current Affiliation: Department of Pharmacy, University of Lahore, Chenab Campus, Gujrat, Pakistan
| | - Tauqeer Hussain Mallhi
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Al-Jouf, Saudi Arabia
| | - Yusra Habib Khan
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Al-Jouf, Saudi Arabia
| | - Muhammad Shahid Iqbal
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam bin Abdulaziz University, Al-kharj, Saudi Arabia
| | - Nasser Hadal Alotaibi
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Al-Jouf, Saudi Arabia
| | - Abdulaziz Ibrahim Alzarea
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Al-Jouf, Saudi Arabia
| | - Maria Rasheed
- Institute of Pharmacy, Lahore College for Women University, Lahore, Punjab, Pakistan
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Evaluation and comparison of molecular and conventional diagnostic modalities for detecting pulmonary tuberculosis in bronchoalveolar lavage fluid. Indian J Med Microbiol 2020; 39:48-53. [PMID: 33610256 DOI: 10.1016/j.ijmmb.2020.10.003] [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] [Indexed: 11/24/2022]
Abstract
CONTEXT In cases of sputum smear-negative and sputum-scarce (SSN/SC) pulmonary tuberculosis (PTB), bronchoalveolar lavage (BAL) fluid may be helpful in establishing diagnosis. No specific recommendations for BAL samples have yet been formulated due to limited literature. AIMS 1. To find a sensitive and specific protocol for same-day diagnosis of PTB using BAL in SSN/SC clinically suspected patients. 2. To evaluate the need to routinely perform MGIT for all BAL samples. SETTINGS AND DESIGN Prospective observational study design in a tertiary care hospital in New Delhi. METHODS AND MATERIAL Fibreoptic bronchoscopy was performed and BAL collected from 175 clinically suspected SSN/SC PTB patients. BAL samples were subjected to: ZN Stain, Xpert MTB/RIF CBNAAT, BACTEC MGIT 960 liquid culture and M. tuberculosis complex DNA Real time PCR. The results of the various diagnostic tests were analysed using a) MGIT as gold standard and b) a composite reference standard (CRS) for a final diagnosis of PTB. STATISTICAL ANALYSIS USED Microsoft Excel 2016 and SPSS version 21.0 were used. Sensitivity, specificity and predictive values were calculated and compared using McNemar test. A p value of <0.05 was considered statistically significant. RESULTS 34 Cases had a final diagnosis of TB as per the CRS. Using CRS, MGIT had a sensitivity of 50.0% (32.4%-67.6%). There was no statistically significant difference between sensitivities of CBNAAT and PCR; both were more sensitive than ZN stain. Sensitivity and specificity of CBNAAT was 79.4% (62.1%-91.3%) and 100.0% (97.4%-100.0%) respectively. The preferred protocol for the hospital is CBNAAT and ZN stain. There was no statistically significant difference in sensitivity by adding PCR or MGIT to this protocol. CONCLUSIONS We found it a good strategy to perform CBNAAT and ZN stain on BAL fluid for accurate and same-day PTB diagnosis. CBNAAT is useful for ruling PTB in even when BAL cultures are negative. It is prudent to continue to routinely perform MGIT for all BAL samples.
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Use of GeneXpert and the role of an expert panel in improving clinical diagnosis of smear-negative tuberculosis cases. PLoS One 2019; 14:e0227093. [PMID: 31887127 PMCID: PMC6936841 DOI: 10.1371/journal.pone.0227093] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 12/12/2019] [Indexed: 11/19/2022] Open
Abstract
SETTING A high proportion of notified tuberculosis cases in the Philippines are clinically diagnosed (63%) as opposed to bacteriologically confirmed. Better understanding of this phenomenon is required to improve tuberculosis control. OBJECTIVES To determine the percentage of smear negative presumptive tuberculosis patients that would be diagnosed by GeneXpert; compare clinical characteristics of patients diagnosed as tuberculosis cases; and review the impact that the current single government physician and a reconstituted Tuberculosis Diagnostic committee (expert panel) may have on tuberculosis over-diagnosis. DESIGN This a cross-sectional study of 152 patients 15-85 years old with two negative Direct Sputum Smear Microscopy results, with abnormal chest X-ray who underwent GeneXpert testing and review by an expert panel. RESULTS Thirty-two percent (48/152) of the sample were Xpert positive and 93% (97/104) of GeneXpert negatives were clinically diagnosed by a single physician. Typical symptoms and X-ray findings were higher in bacteriologically confirmed tuberculosis. When compared to the GeneXpert results the Expert panel's sensitivity for active tuberculosis was high (97.5%, 39/40), specificity was low (40.2%, 35/87). CONCLUSION Using the GeneXpert would increase the level of bacteriologically confirmed tuberculosis substantially among presumptive tuberculosis. An expert panel will greatly reduce over-diagnosis usually seen when a decision is made by a single physician.
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Kim S, Kim Y, Chang Y, Hirgo WK, Chang CL, Shim TS, Uh Y, Lee H. Comparison of Quantamatrix Multiplexed Assay Platform and GenoType MTBDR Assay Using Smear-Positive Sputum Specimens From Patients With Multidrug- Resistant/Extensively Drug-Resistant Tuberculosis in South Korea. Front Microbiol 2019; 10:1075. [PMID: 31139175 PMCID: PMC6527879 DOI: 10.3389/fmicb.2019.01075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 04/29/2019] [Indexed: 11/17/2022] Open
Abstract
Rapid detection of drug-resistant tuberculosis (DR-TB) is crucial for timely treatment and management. The GenoType MTBDRplus and MTBDRsl (MTBDR) assays have been endorsed by the World Health Organization (WHO) for the detection of DR-TB. However, MTBDR assays cannot simultaneously detect multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB). Furthermore, interpretation of the MTBDR assay requires trained people, and the assay has low sample throughput, processing only up to 12 samples in parallel. We have developed the Quantamatrix Multiplexed Assay Platform (QMAP) to detect MDR-/XDR-TB simultaneously. The interpretation of QMAP results is automated, and the platform can process up to 96 samples in parallel. To compare the performance of QMAP with MTBDR assays, we performed QMAP and the MTBDR assay on 76 smear-positive, Mycobacterium tuberculosis culture-positive sputum specimens. Compared with phenotypic drug susceptibility testing (DST) results, the sensitivity and specificity of QMAP were 100 and 98% for rifampin resistance, 80 and 100% for isoniazid resistance, 44.4 and 100% for ethambutol resistance, 100 and 100% for fluoroquinolone resistance, and 100 and 100% for second-line injectable drug resistance, respectively. The sensitivity and specificity of MTBDR assays were 100 and 98% for rifampin resistance, 80 and 100% for isoniazid resistance, 44.4 and 98.1% for ethambutol resistance, 100 and 100% for fluoroquinolone resistance, and 100 and 100% for second-line injectable drug resistance, respectively. The sensitivity and specificity of QMAP were 85.0 and 100%, respectively, for the detection of MDR-TB and 100 and 100%, respectively, for XDR-TB. The sensitivity and specificity of MTBDR assays was consistent with those of QMAP. Our study showed that the QMAP assay has sensitivity and specificity equivalent to that of MTBDR assays in smear-positive sputum specimens. In combination with phenotypic DST, QMAP might be useful as a supplementary DST assay for rapid detection of MDR-/XDR-TB.
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Affiliation(s)
- Seoyong Kim
- Department of Biomedical Laboratory Science, College of Health Sciences, Yonsei University, Wonju, South Korea
| | - Yeun Kim
- Department of Biomedical Laboratory Science, College of Health Sciences, Yonsei University, Wonju, South Korea
| | - Yunhee Chang
- Department of Biomedical Laboratory Science, College of Health Sciences, Yonsei University, Wonju, South Korea
| | - Workneh Korma Hirgo
- Department of Biomedical Laboratory Science, College of Health Sciences, Yonsei University, Wonju, South Korea
| | - Chulhun L Chang
- Department of Laboratory Medicine, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Tae-Sun Shim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Young Uh
- Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Hyeyoung Lee
- Department of Biomedical Laboratory Science, College of Health Sciences, Yonsei University, Wonju, South Korea
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Luo L, Zhu L, Yue J, Liu J, Liu G, Zhang X, Wang H, Xu Y. Antigens Rv0310c and Rv1255c are promising novel biomarkers for the diagnosis of Mycobacterium tuberculosis infection. Emerg Microbes Infect 2017; 6:e64. [PMID: 28698665 PMCID: PMC5567170 DOI: 10.1038/emi.2017.54] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 05/21/2017] [Accepted: 05/22/2017] [Indexed: 12/19/2022]
Abstract
This study aimed to identify novel immunogenic epitopes from Mycobacterium tuberculosis (MTB) that could be used in tuberculosis (TB) diagnostics. To determine the diagnostic potential of mycobacterial antigens in serodiagnosis of TB, 256 patients were enrolled in a study and divided into two groups: 126 smear-positive pulmonary TB patients (SPPT) and 130 smear-negative pulmonary TB patients (SNPT); 152 bacillus Calmette-Guerin (BCG)-vaccinated healthy people were used as a control. Murine results showed that antigens Rv0310c-E from RD 8 and Rv1255c-E from RD 10 were strongly immunogenic to Th1 cells and induced a great humoral response. Receiver operating characteristic analysis indicated that Rv0310c-E (area under the curve (AUC): 0.800) and Rv1255c-E (AUC: 0.808) performed better than ESAT-6 (AUC: 0.665) and CFP-10 (AUC: 0.623) proteins but were comparable with Rv3425 (AUC: 0.788) protein in a human serum IgG analysis. Rv0310c-E demonstrated the highest diagnostic ability for the SPPT group (Youden index: 0.5602, sensitivity: 69.84%, specificity: 86.18%), while Rv1255c-E demonstrated the highest diagnostic ability for the SNPT group (Youden index: 0.5674, sensitivity: 73.84%, specificity: 82.89%). In addition, combination analysis found that antigen Rv0310c-E, coupled with the Rv3425 protein (Youden index: 0.6098, sensitivity: 87.30%, specificity: 73.68%) had the strongest performance for TB diagnostics of the SPPT group, and the single antigen Rv1255c-E was strongest for the SNPT group. These results suggest that antigens Rv0310c-E and Rv1255c-E are potential antigens for TB serodiagnostic tests, which may facilitate detection of MTB in smear-negative and smear-positive patients.
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Affiliation(s)
- Liulin Luo
- State Key Laboratory of Genetic Engineering, Institute of Genetics, Fudan University, Shanghai 200433, China.,Department of Clinical Laboratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Lin Zhu
- State Key Laboratory of Genetic Engineering, Institute of Genetics, Fudan University, Shanghai 200433, China
| | - Jun Yue
- Department of Clinical Laboratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Jianping Liu
- State Key Laboratory of Genetic Engineering, Institute of Genetics, Fudan University, Shanghai 200433, China
| | - Guoyuan Liu
- State Key Laboratory of Genetic Engineering, Institute of Genetics, Fudan University, Shanghai 200433, China
| | - Xuelian Zhang
- State Key Laboratory of Genetic Engineering, Institute of Genetics, Fudan University, Shanghai 200433, China
| | - Honghai Wang
- State Key Laboratory of Genetic Engineering, Institute of Genetics, Fudan University, Shanghai 200433, China
| | - Ying Xu
- State Key Laboratory of Genetic Engineering, Institute of Genetics, Fudan University, Shanghai 200433, China
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