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Dsouza A, Jangam S, Soni S, Agarwal P, Naik V, Manjula J, Nair CB, Toley BJ. A large-volume sputum dry storage and transportation device for molecular and culture-based diagnosis of tuberculosis. LAB ON A CHIP 2022; 22:1736-1747. [PMID: 35388829 DOI: 10.1039/d1lc00900a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Technologies for preservation of specimens in the absence of cold chains are essential for optimum utilization of existing laboratory services in the developing world. We present a prototype called specimen transportation tube (SPECTRA-tube) for the collection, exposure-free drying, ambient transportation, and liquid state recovery of large-volume (>1 mL) specimens. Specimens introduced into the SPECTRA-tube are dried in glass fiber membranes, which are critical for efficient liquid-state sample recovery by rehydration and centrifugation. SPECTRA-tube is demonstrated for the dry storage of sputum for tuberculosis detection. Mycobacterium smegmatis (Msm)-spiked mock sputum dried in a native Standard 17 glass fiber was stable for molecular testing after 10 day storage at 45 °C and for culture testing after 10- and 5-day storage at 37 °C and 45 °C, respectively. Compatibility with human sputum storage was demonstrated by dry storing 1.2 mL Mycobacterium bovis-spiked human sputum in a SPECTRA-tube for 5 days at room temperature. We have thus demonstrated the first workflow for dry storage of sputum followed by molecular and culture testing. Compared to existing specimen dry storage technologies, SPECTRA-tube significantly increases the volume of liquid specimens that can be transported in the dry state and enables the recovery of the entire sample in the liquid state, rendering it compatible with conventional downstream analysis methods.
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Affiliation(s)
- Andrea Dsouza
- Department of Chemical Engineering, Indian Institute of Science, 560012, Bangalore, India.
| | - Saylee Jangam
- Department of Chemical Engineering, Indian Institute of Science, 560012, Bangalore, India.
| | - Shruti Soni
- Department of Chemical Engineering, Indian Institute of Science, 560012, Bangalore, India.
| | - Priyanka Agarwal
- Department of Chemical Engineering, Indian Institute of Science, 560012, Bangalore, India.
| | - Vishwanath Naik
- Bigtec Labs, 2nd Floor, Golden Heights, 59th 'C' Cross, 4th M Block, Rajajinagar, Bengaluru, 560010, India
| | - J Manjula
- Bigtec Labs, 2nd Floor, Golden Heights, 59th 'C' Cross, 4th M Block, Rajajinagar, Bengaluru, 560010, India
| | - Chandrasekhar B Nair
- Bigtec Labs, 2nd Floor, Golden Heights, 59th 'C' Cross, 4th M Block, Rajajinagar, Bengaluru, 560010, India
| | - Bhushan J Toley
- Department of Chemical Engineering, Indian Institute of Science, 560012, Bangalore, India.
- Centre for Biosystems Science and Engineering, Indian Institute of Science, Bangalore, 560012, India
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Anthwal D, Jamwal S, Gupta RK, Singhal R, Verma AK, Bhalla M, Myneedu VP, Sarin R, Choudhary S, Tyagi JS, Haldar S. Direct Molecular Detection of Drug-Resistant Tuberculosis from Transported Bio-Safe Dried Sputum on Filter-Paper. Curr Microbiol 2022; 79:110. [PMID: 35175411 DOI: 10.1007/s00284-022-02780-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/20/2022] [Indexed: 11/27/2022]
Abstract
In 2019, amongst half a million new rifampicin-resistant tuberculosis (TB) cases, 78% were multi drug-resistant TB (MDR-TB). Access to rapid and Universal-Drug susceptibility testing (DST) to patients in remote areas is a major challenge to combat drug-resistant TB. To overcome this challenge, we had recently reported the development of 'TB Concentration & Transport kit' for bio-safe ambient temperature transport of dried sputum on filter-paper (Trans-Filter). The present study was conducted to evaluate the utility of DNA extracted from sputum on Trans-Filter in a Multiplex PCR-based sequencing assay (Mol-DSTseq) for diagnosing drug-resistant TB. The developed Mol-DSTseq assays were standardized on Mycobacterium tuberculosis clinical isolates (n = 98) and further validated on DNA extracted from sputum on Trans-Filter (n = 100). Using phenotypic DST as gold standard, the Mol-DSTseq assay showed 100% (95% Confidence Interval [CI] 79.4-100%) and 73.3% (95% CI 54.1-87.7%) sensitivity for detecting rifampicin and isoniazid resistance with a specificity of 85.1% (95% CI 66.2-95.8%) and 100% (95% CI:82.3-100%), respectively. For fluoroquinolones and aminoglycosides, the Mol-DSTseq assay showed a sensitivity of 78.5% (95% CI 49.2-95.3%) and 66.6% (95% CI 9.4-99.1%) with a specificity of 88.2% (95% CI 72.5-96.7%) and 100% (95% CI 93.1-100%), respectively. The Mol-DSTseq assays exhibited a high concordance of ~ 83-96% (κ value: 0.65-0.81) with phenotypic DST for all drugs. In conclusion, the 'TB Concentration and Transport kit' was compatible with Mol-DSTseq assays and has the potential to provide 'Universal-DST' to patients residing in distant areas in high burden countries, like India for early initiation of anti-tubercular treatment.
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Affiliation(s)
- Divya Anthwal
- Department of Experimental Medicine and Biotechnology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
- Department of Bioscience and Biotechnology, Banasthali Vidyapith, P.O. Banasthali Vidyapith, Tonk, Rajasthan, India
| | - Shaina Jamwal
- Department of Experimental Medicine and Biotechnology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Kumar Gupta
- Department of Experimental Medicine and Biotechnology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
- Department of Bioscience and Biotechnology, Banasthali Vidyapith, P.O. Banasthali Vidyapith, Tonk, Rajasthan, India
| | - Ritu Singhal
- Department of Microbiology, National Institute of Tuberculosis and Respiratory Diseases, Mehrauli, New Delhi, India
| | - Ajoy Kumar Verma
- Department of Microbiology, National Institute of Tuberculosis and Respiratory Diseases, Mehrauli, New Delhi, India
| | - Manpreet Bhalla
- Department of Microbiology, National Institute of Tuberculosis and Respiratory Diseases, Mehrauli, New Delhi, India
| | - Vithal Prasad Myneedu
- Department of Microbiology, National Institute of Tuberculosis and Respiratory Diseases, Mehrauli, New Delhi, India
| | - Rohit Sarin
- Department of Microbiology, National Institute of Tuberculosis and Respiratory Diseases, Mehrauli, New Delhi, India
| | - Sangeeta Choudhary
- Department of Bioscience and Biotechnology, Banasthali Vidyapith, P.O. Banasthali Vidyapith, Tonk, Rajasthan, India
| | - Jaya Sivaswami Tyagi
- Department of Biotechnology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Sagarika Haldar
- Department of Experimental Medicine and Biotechnology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
- Translational Health Science and Technology Institute, NCR Biotech Science Cluster, 3rd Milestone, Faridabad - Gurgaon Expressway, PO box #04, Faridabad, India.
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Anthwal D, Gupta RK, Singhal R, Bhalla M, Verma AK, Khayyam KU, Myneedu VP, Sarin R, Gupta A, Gupta NK, Singh M, Sivaswami Tyagi J, Haldar S. Compatibility of a novel filter paper-based bio-safe sputum transport kit with line probe assay for diagnosing drug-resistant tuberculosis: a single-site evaluation study. ERJ Open Res 2021; 7:00137-2021. [PMID: 34350282 PMCID: PMC8326685 DOI: 10.1183/23120541.00137-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/08/2021] [Indexed: 01/29/2023] Open
Abstract
Background Near-patient access to appropriate tests is a major obstacle for the efficient diagnosis of tuberculosis (TB) and associated drug resistance. Methods We recently developed the “TB Concentration & Transport” kit for bio-safe, ambient-temperature transportation of dried sputum on Trans-Filter, and the “TB DNA Extraction” kit for DNA extraction from Trans-Filter for determining drug resistance by DNA sequencing. In the present study, we evaluated the compatibility of Kit-extracted DNA with Hain's line probe assays (LPAs), which are endorsed by National TB programmes for the detection of drug resistance in sputum collected from presumptive multidrug-resistant TB patients (n=207). Results Trans-Filter-extracted DNA was seamlessly integrated with the LPA protocol (Kit-LPA). The sensitivity of Kit-LPA for determining drug resistance was 83.3% for rifampicin (95% CI 52–98%), 77.7% for isoniazid (95% CI 52–94%), 85.7% for fluoroquinolones (95% CI 42–100%) and 66.6% for aminoglycosides (95% CI 9–99%), with a specificity range of 93.7% (95% CI 87–97) to 99.1% (95% CI 95–100) using phenotypic drug susceptibility testing (DST) as a reference standard. A high degree of concordance was noted between results obtained from Kit-LPA and LPA (99% to 100% (κ value: 0.83–1.0)). Conclusions This study demonstrates successful integration of our developed kits with LPA. The adoption of these kits across Designated Microscopy Centres in India can potentially overcome the existing challenge of transporting infectious sputum at controlled temperature to centralised testing laboratories and can provide rapid near-patient cost-effective “Universal DST” services to TB subjects residing in remote areas. The adoption of bio-safe “TB Concentration & Transport” kit by Microscopy Centres can potentially overcome the challenge of transporting infectious sputum to central laboratories and provide universal DST services to TB subjects residing in remote areas.https://bit.ly/2QrQ5qL
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Affiliation(s)
- Divya Anthwal
- Dept of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.,Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, India
| | - Rakesh Kumar Gupta
- Dept of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.,Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, India
| | - Ritu Singhal
- Dept of Microbiology, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - Manpreet Bhalla
- Dept of Microbiology, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - Ajoy Kumar Verma
- Dept of Microbiology, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - Khalid Umar Khayyam
- Dept of Microbiology, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - Vithal Prasad Myneedu
- Dept of Microbiology, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - Rohit Sarin
- Dept of Microbiology, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | | | | | - Manjula Singh
- India TB Research Consortium, Indian Council of Medical Research, New Delhi, India
| | - Jaya Sivaswami Tyagi
- Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, India.,Dept of Biotechnology, All India Institute of Medical Sciences, New Delhi, India
| | - Sagarika Haldar
- Dept of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.,Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, India
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Anthwal D, Gupta RK, Gomathi NS, Tripathy SP, Das D, Pati S, Panwalkar N, Desikan P, Bala K, Singh UB, Bhalla M, Singhal R, Verma AK, Khayyam KU, Myneedu VP, Sarin R, Sharma S, Bansal AK, Gupta UD, Patil SA, Goyal A, Gupta A, Singh M, Gupta NK, Haldar S, Tyagi JS. Evaluation of 'TBDetect' sputum microscopy kit for improved detection of Mycobacterium tuberculosis: a multi-centric validation study. Clin Microbiol Infect 2020; 27:911.e1-911.e7. [PMID: 32835794 DOI: 10.1016/j.cmi.2020.08.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/14/2020] [Accepted: 08/15/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The present study aimed to evaluate the performance of the 'TBDetect' kit-based bio-safe fluorescent microscopy filter (BioFM-Filter) microscopy in comparison with direct smear microscopy and culture for the detection of pulmonary tuberculosis (TB) in a multi-centric setting in India. METHODS The TBDetect kit enables sputum concentration through filtration using the BioFM-Filter for improved and bio-safe smear microscopy. We evaluated the performance of the TBDetect kit in a six-site multi-centric validation study on sputum collected from 2086 presumptive TB patients. RESULTS The combined positivity of TBDetect microscopy performed on these sputum samples was 20% (n = 417/2086) vs 16.1% of light-emitting diode fluorescence microscopy (LED-FM, n = 337/2086) and 16% of Ziehl Neelsen (ZN) smear microscopy (n = 333/2086). The increment in positivity of TBDetect over both LED-FM and ZN smears was significant (p < 0.001). The overall sensitivity of TBDetect for six sites was ~55% (202/367, 95% confidence interval (CI): 50, 60%) vs 52% (191/367, 95% CI: 47, 57%) for LED-FM (p 0.14) and 50.9% (187/367, 95% CI: 46, 56%) for ZN smear (p < 0.05), using Mycobacterium Growth Indicator Tube culture (MGIT, n = 1949, culture positive, n = 367) as the reference standard. A bio-safety evaluation at six sites confirmed efficient sputum disinfection by TBDetect; 99.95% samples (1873/1874) were sterile after 42 days of incubation. Scientists and technicians at the study sites indicated the ease of use and convenience of TBDetect microscopy during feedback. CONCLUSIONS TBDetect added value to the smear microscopy test due to its improved performance, convenience and user safety. These findings indicate that equipment-free TBDetect technology has the potential to improve TB diagnosis in basic laboratory settings by leveraging on the existing nationwide network of designated microscopy centres and primary healthcare centres.
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Affiliation(s)
- Divya Anthwal
- Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, India; Department of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Kumar Gupta
- Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, India; Department of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | - Dasarathi Das
- Regional Medical Research Center, Bhubaneshwar, India
| | | | | | - Prabha Desikan
- Bhopal Memorial Hospital and Research Centre, Bhopal, India
| | - Kiran Bala
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Urvashi B Singh
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Manpreet Bhalla
- Department of Microbiology, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - Ritu Singhal
- Department of Microbiology, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - Ajoy Kumar Verma
- Department of Microbiology, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - Khalid Umar Khayyam
- Department of Microbiology, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - Vithal Prasad Myneedu
- Department of Microbiology, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - Rohit Sarin
- Department of Microbiology, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - Sandeep Sharma
- National JALMA Institute of Leprosy and Other Mycobacterial Diseases, Agra, India
| | - Avi Kumar Bansal
- National JALMA Institute of Leprosy and Other Mycobacterial Diseases, Agra, India
| | - Umesh D Gupta
- National JALMA Institute of Leprosy and Other Mycobacterial Diseases, Agra, India
| | - Sripad A Patil
- National JALMA Institute of Leprosy and Other Mycobacterial Diseases, Agra, India
| | - Abhinav Goyal
- Advanced Microdevices Pvt Ltd, Industrial Area, Ambala Cantt, India
| | - Ashawant Gupta
- Advanced Microdevices Pvt Ltd, Industrial Area, Ambala Cantt, India
| | - Manjula Singh
- India Tuberculosis Research Consortium (ITRC), Indian Council of Medical Research, V. Ramalingaswami Bhawan, Ansari Nagar, New Delhi, India
| | | | - Sagarika Haldar
- Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, India; Department of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Jaya Sivaswami Tyagi
- Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, India; Department of Biotechnology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
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