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Performances of single tube nested polymerase chain reaction and GeneXpert ultra on Formalin fixed paraffin embedded tissues in the diagnosis of tuberculous spondylodiscitis. Clin Rheumatol 2021; 40:4317-4323. [PMID: 34097177 DOI: 10.1007/s10067-021-05782-9] [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: 01/04/2021] [Revised: 05/12/2021] [Accepted: 05/19/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Tuberculous Spondylodiscitis is the most common form of musculoskeletal tuberculosis. Molecular techniques on fresh tissues are proved to improve the diagnosis of tuberculous spondylodiscitis and to allow a rapid diagnosis to initiate the treatment and prevent neurological complications. OBJECTIVES The objective of the present study was to assess the diagnostic performances of single tube nested PCR and GeneXpert ultra in the diagnosis of tuberculous spondylodiscitis on formalin fixed paraffin embedded tissues. METHODS This study included 63 tuberculous spondylodiscitis cases collected from June 2014 to January 2020 and corresponding to 27 definite tuberculous spondylodiscitis with positive microbiology, and 36 probable tuberculous spondylodiscitis, with histopathological, clinical and radiological findings consistent with tuberculous spondylodiscitis but with negative microbiology. The sensitivity, specificity, positive predictive value and negative predictive value of nested PCR and GeneXpert ultra were determined with reference to microbiology. RESULTS Nested PCR was positive in 47 (75%) cases: 26/27 definite tuberculous spondylodiscitis and 21/36 probable tuberculous spondylodiscitis. GeneXpert ultra was positive in only 6 (10%) cases corresponding to definite tuberculous spondylodiscitis. The sensitivity, specificity, positive predictive value and negative predictive value of nested PCR on formalin fixed paraffin embedded tissues were 96%, 100%, 100%, 83% respectively. For GeneXpert ultra, these rates were 22%, 100%, 100% and 25% respectively. CONCLUSION Nested PCR and GeneXpert ultra on formalin fixed paraffin embedded tissues are useful tools for the diagnosis of tuberculous spondylodiscitis, especially for cases where microbiological investigations were not carried out. Both techniques have excellent specificity but single tube nested PCR is more sensitive. Key Points • Molecular techniques are routinely performed on fresh tissues • GeneXpert and nested PCR on formalin fixed paraffin embedded tissues are reliable for the diagnosis of tuberculous spondylodiscitis • Nested PCR is more sensitive than Genexpert for diagnosing tuberculous spondylodiscitis.
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Comparative performance of the laboratory assays used by a Diagnostic Laboratory Hub for opportunistic infections in people living with HIV. AIDS 2020; 34:1625-1632. [PMID: 32694415 DOI: 10.1097/qad.0000000000002631] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We evaluated the comparative performance of different assays used in a Diagnostic Laboratory Hub that linked 13 HIV healthcare facilities for the diagnosis of tuberculosis (TB), histoplasmosis, and cryptococcosis, and describing its functions in Guatemala compared with other National Reference Laboratories. METHODS The following diagnostic techniques were analyzed in 24 months (2017-2018) in a cohort of patients with HIV: smear microscopy, mycobacterial and fungal cultures, isolator blood culture, PCR assays, and antigen detection tests. RESULTS A total of 4245 patients were included, 716 (16.2%) had an opportunistic infection: 249 (34.7%) TB, 40 (5.6%) nontuberculous mycobacteria, 227 (31.7%) histoplasmosis, 138 (19.3%) cryptococcosis, and 62 (8.6%) had multiple opportunistic infections. Two hundred sixty-three [92.6%; 95% confidence interval (CI), 89-95.1] of TB cases were diagnosed by PCR. Urine antigen assay detected 94% (95% CI, 89-96) of the disseminated histoplasmosis cases. A lateral flow assay to detect cryptococcal antigen diagnosed 97% (95% CI, 93.3-98.7%) of the cryptococcal cases. In 85 patients (51.5%) with a cerobrospinal fluid sample, cryptococcal meningitis was diagnosed in 55 (64.7%), of which 18 (32.7%) were only detected by cryptococcal antigen. CONCLUSION Validated commercial antigen tests, as used in this program, should be the new gold standard for histoplasmosis and cryptococcosis diagnosis. In their absence, 35% of disseminated histoplasmosis and 32.7% of cryptococcal meningitis cases would have been missed. Patients with multiple opportunistic infections were frequently diagnosed and strategies should be designed to screen patients irrespective of their clinical presentation. In low resource settings, Diagnostic Laboratory Hubs can deliver quality diagnostics services in record time at affordable prices.
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Casela M, Cerqueira SMA, Casela TDO, Pereira MA, Santos SQD, Pozo FAD, Freire SM, Matos ED. Rapid molecular test for tuberculosis: impact of its routine use at a referral hospital. ACTA ACUST UNITED AC 2019; 44:112-117. [PMID: 29791546 PMCID: PMC6044659 DOI: 10.1590/s1806-37562017000000201] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 12/07/2017] [Indexed: 01/02/2023]
Abstract
Objective: To evaluate the impact of the use of the molecular test for Mycobacterium tuberculosis and its resistance to rifampin (Xpert MTB/RIF), under routine conditions, at a referral hospital in the Brazilian state of Bahia. Methods: This was a descriptive study using the database of the Mycobacteriology Laboratory of the Octávio Mangabeira Specialized Hospital, in the city of Salvador, and georeferencing software. We evaluated 3,877 sputum samples collected from symptomatic respiratory patients, under routine conditions, between June of 2014 and March of 2015. All of the samples were submitted to sputum smear microscopy and the Xpert MTB/RIF test. Patients were stratified by gender, age, and geolocation. Results: Among the 3,877 sputum samples evaluated, the Xpert MTB/RIF test detected M. tuberculosis in 678 (17.5%), of which 60 (8.8%) showed resistance to rifampin. The Xpert MTB/RIF test detected M. tuberculosis in 254 patients who tested negative for sputum smear microscopy, thus increasing the diagnostic power by 59.9%. Conclusions: The use of the Xpert MTB/RIF test, under routine conditions, significantly increased the detection of cases of tuberculosis among sputum smear-negative patients.
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Affiliation(s)
- Marilda Casela
- Hospital Especializado Octávio Mangabeira, Secretaria de Saúde do Estado da Bahia, Salvador, BA, Brasil
| | | | | | - Mariana Araújo Pereira
- Laboratório de Imunologia e Biologia Molecular, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, BA, Brazil
| | - Samanta Queiroz Dos Santos
- Laboratório de Imunologia e Biologia Molecular, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, BA, Brazil
| | | | - Songeli Menezes Freire
- Laboratório de Imunologia e Biologia Molecular, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, BA, Brazil
| | - Eliana Dias Matos
- Departamento de Medicina, Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil
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Ma RQ, Gan L, Bi YW, Yuan YF, Ren H, Qian J. Clinical and laboratory features of PCR-confirmed periocular tuberculosis in China. Int J Ophthalmol 2018; 11:1865-1869. [PMID: 30450320 DOI: 10.18240/ijo.2018.11.20] [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: 01/03/2018] [Accepted: 09/04/2018] [Indexed: 11/23/2022] Open
Abstract
Experts lack knowledge of periocular tuberculosis (TB) in China. Nested polymerase chain reaction (PCR) shows advantages in diagnosis of extrapulmonary TB. Our study aims to explore the clinical and laboratory features of PCR-confirmed periocular TB. We retrospectively reviewed medical records of presumptive periocular TB and performed nested PCR test to confirm diagnosis. Nine cases were recruited. Clinical symptoms were chronic and insidious. Eight cases achieved favorable visual acuity, while one underwent enucleation due to fungal-TB panophthalmitis. Sensitivity of caseous necrosis, acid-fast bacilli (AFB) staining and interferon γ release assay (T-SPOT) test are 33.3%, 44.4% and 85.7% respectively. Low lymphocyte percentage (P=0.019) and high monocyte-lymphocyte ratio (P=0.042) positively correlate with AFB staining. Male gender (P=0.048) and Langhans giant cell (P=0.048) positively correlate with caseous necrosis. To conclude, traditional TB ancillary tests are not as sensitive as nested PCR technique. Several factors facilitate diagnosis including male gender, decreased lymphocytes, and typical Langhans giant cells.
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Affiliation(s)
- Rui-Qi Ma
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai 200031, China.,NHC Key Laboratory of Myopia (Fudan University), Shanghai 200031, China.,Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai 200031, China
| | - Lu Gan
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai 200031, China.,NHC Key Laboratory of Myopia (Fudan University), Shanghai 200031, China.,Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai 200031, China
| | - Ying-Wen Bi
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai 200031, China
| | - Yi-Fei Yuan
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai 200031, China
| | - Hui Ren
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai 200031, China
| | - Jiang Qian
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai 200031, China
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Santos FCF, Lira LADS, Montenegro RDA, Lima JFDC, Lima AS, Schindler HC, Montenegro LML. Performance of the IS6110-TaqMan® assay in the diagnosis of extrapulmonary tuberculosis from different biological samples. Rev Soc Bras Med Trop 2018; 51:331-337. [DOI: 10.1590/0037-8682-0372-2017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 05/25/2018] [Indexed: 01/10/2023] Open
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Amicosante M, D’Ambrosio L, Munoz M, Mello FCDQ, Tebruegge M, Chegou NN, Seghrouchni F, Centis R, Goletti D, Bothamley G, Migliori GB. Current use and acceptability of novel diagnostic tests for active tuberculosis: a worldwide survey. J Bras Pneumol 2017; 43:380-392. [PMID: 29160384 PMCID: PMC5790656 DOI: 10.1590/s1806-37562017000000219] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 09/03/2017] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To determine the current use and potential acceptance (by tuberculosis experts worldwide) of novel rapid tests for the diagnosis of tuberculosis that are in line with World Health Organization target product profiles. METHODS A multilingual survey was disseminated online between July and November of 2016. RESULTS A total of 723 individuals from 114 countries responded to the survey. Smear microscopy was the most commonly used rapid tuberculosis test (available to 90.9% of the respondents), followed by molecular assays (available to 70.7%). Only a small proportion of the respondents in middle- and low-income countries had access to interferon-gamma-release assays. Serological and lateral flow immunoassays were used by more than a quarter (25.4%) of the respondents. Among the respondents who had access to molecular tests, 46.7% were using the Xpert assay overall, that proportion being higher in lower middle-income countries (55.6%) and low-income countries (76.6%). The data also suggest that there was some alignment of pricing for molecular assays. Respondents stated they would accept novel rapid tuberculosis tests if available, including molecular assays (acceptable to 86.0%) or biomarker-based serological assays (acceptable to 81.7%). Simple biomarker-based assays were more commonly deemed acceptable in middle- and low-income countries. CONCLUSIONS Second-generation molecular assays have become more widely available in high- and low-resource settings. However, the development of novel rapid tuberculosis tests continues to be considered important by tuberculosis experts. Our data also underscore the need for additional training and education of end users.
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Affiliation(s)
- Massimo Amicosante
- . Dipartimento di Biomedicina e Prevenzione, Università degli Studi di Roma “Tor Vergata”, Roma, Italia.Università degli Studi di Roma Tor VergataDipartimento di Biomedicina e PrevenzioneUniversità degli Studi di Roma “Tor Vergata”RomaItaly
- . ProxAgen OOD, Sofia, Bulgaria.ProxAgen OODSofiaBulgaria
| | - Lia D’Ambrosio
- . WHO Collaborating Centre for TB and Lung Diseases, Maugeri Care and Research Institute, Tradate, Italia.World Health OrganizationWHO Collaborating Centre for TB and Lung DiseasesTradateItalia
- . Public Health Consulting Group SAGL, Lugano, Switzerland.Public Health Consulting Group SAGLLuganoSwitzerland
| | - Marcela Munoz
- . Clínica en Tuberculosis y Enfermedades Pleurales, Instituto Nacional de Enfermedades Respiratorias - INER - Ciudad de México, México.Clínica en Tuberculosis y Enfermedades PleuralesInstituto Nacional de Enfermedades RespiratoriasCiudad de MéxicoMéxico
| | - Fernanda Carvalho de Queiroz Mello
- . Instituto de Doenças do Tórax, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro (RJ) Brasil.Instituto de Doenças do TóraxHospital Universitário Clementino Fraga FilhoRio de JaneiroRJBrasil
| | - Marc Tebruegge
- . Faculty of Medicine, University of Southampton, Southampton, United Kingdom.University of SouthamptonFaculty of MedicineUniversity of SouthamptonSouthamptonUnited Kingdom
- . Department of Paediatric Infectious Diseases and Immunology, Evelina London Children’s Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.Department of Paediatric Infectious Diseases and ImmunologyEvelina London Children’s HospitalGuy’s and St. Thomas’ NHS Foundation TrustLondonUnited Kingdom
- . Great Ormond Street Hospital Institute of Child Health, University College London, London, United Kingdom.University College LondonGreat Ormond Street Hospital Institute of Child HealthUniversity College LondonLondonUnited Kingdom
| | - Novel Njweipi Chegou
- . SA MRC Centre for TB Research, DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.Division of Molecular Biology and Human GeneticsFaculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
| | - Fouad Seghrouchni
- . National Institute of Hygiene, Rabat, Morocco.National Institute of HygieneRabatMorocco
| | - Rosella Centis
- . WHO Collaborating Centre for TB and Lung Diseases, Maugeri Care and Research Institute, Tradate, Italia.World Health OrganizationWHO Collaborating Centre for TB and Lung DiseasesTradateItalia
| | - Delia Goletti
- . Unità di Ricerca Translazionale, Dipartimento di Epidemiologia e Ricerca Preclinica, Istituto Nazionale per le Mallatie Infettive - INMI - Lazzaro Spallanzani, Roma, Italia.Unità di Ricerca TranslazionaleDipartimento di Epidemiologia e Ricerca PreclinicaIstituto Nazionale per le Mallatie InfettiveLazzaro SpallanzaniRomaItalia
| | - Graham Bothamley
- . Homerthon University Hospital, London, United Kingdom.Homerthon University HospitalLondonUnited Kingdom
| | - Giovanni Battista Migliori
- . WHO Collaborating Centre for TB and Lung Diseases, Maugeri Care and Research Institute, Tradate, Italia.World Health OrganizationWHO Collaborating Centre for TB and Lung DiseasesTradateItalia
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Khosravi AD, Alami A, Meghdadi H, Hosseini AA. Identification of Mycobacterium tuberculosis in Clinical Specimens of Patients Suspected of Having Extrapulmonary Tuberculosis by Application of Nested PCR on Five Different Genes. Front Cell Infect Microbiol 2017; 7:3. [PMID: 28144587 PMCID: PMC5239771 DOI: 10.3389/fcimb.2017.00003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 01/03/2017] [Indexed: 01/05/2023] Open
Abstract
Definitive and rapid diagnosis of extrapulmonary tuberculosis (EPTB) is challenging since conventional techniques have limitations due to the paucibacillary nature of the disease. To increase the sensitivity of detection of Mycobacterium tuberculosis (MTB) in EPTB specimens, we performed a nested PCR assay targeting several genes of MTB on EPTB specimens. A total of 100 clinical specimens from suspected cases of EPTB were processed. Standard staining for acid fast bacilli (AFB) was performed as the preliminary screening test. Extracted DNAs from specimens were subjected to Nested PCR technique for the detection of five different MTB target genes of IS6110, IS1081, hsp65kd, mbp64, and mtp40. On performing AFB staining, only 13% of specimens were positive, of which ascites fluid (33.3%), followed by pleural effusion (30.8%) showed the greatest AFB positivity rate. We demonstrated slight improvement in yields in lymph node which comprised the majority of specimens in this study, by employing PCR targeted to IS6110- and hsp65-genes in comparison to AFB staining. However, the yields in ascites fluid and pleural effusion were not substantially improved by PCR, but those from bone and wound were, as in nested PCR employing either gene, the same positivity rate were obtained for ascites fluid (33.3%), while for pleural effusion specimens only IS1081 based PCR showed identical positivity rate with AFB stain (30.8%). The results for bone and wound specimens, however, demonstrated an improved yield mainly by employing IS1081 gene. Here, we report higher detection rate of EPTB in clinical specimens using five different targeted MTB genes. This nested PCR approach facilitates the comparison and the selection of the most frequently detected genes. Of course this study demonstrated the priority of IS1081 followed by mtp40 and IS6110, among the five tested genes and indicates the effectiveness of any of the three genes in the design of an efficient nested-PCR test that facilitates an early diagnosis of paucibacillary EPTB cases, which are difficult to diagnose with the available standard.
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Affiliation(s)
- Azar D Khosravi
- Department of Microbiology, School of Medicine, Ahvaz Jundishapur University of Medical SciencesAhvaz, Iran; Health Research Institute, Infectious and Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical SciencesAhvaz, Iran
| | - Ameneh Alami
- Department of Microbiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences Ahvaz, Iran
| | - Hossein Meghdadi
- Department of Microbiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences Ahvaz, Iran
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Galisteu KJ, Cardoso LV, Furini AADC, Schiesari Júnior A, Cesarino CB, Franco C, Baptista ARDS, Machado RLD. Opportunistic infections among individuals with HIV-1/AIDS in the highly active antiretroviral therapy era at a Quaternary Level Care Teaching Hospital. Rev Soc Bras Med Trop 2016; 48:149-56. [PMID: 25992928 DOI: 10.1590/0037-8682-0299-2014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 03/26/2015] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION In this study, clinical-laboratory and epidemiological characteristics are described for a group of 700 individuals with HIV (human immunodeficiency virus)/AIDS (acquired immunodeficiency syndrome) in the ART (antiretroviral therapy) era at a teaching hospital that provides a quaternary level of care, with an emphasis on opportunistic infections (OIs), co-infections and immune profile. METHODS A retrospective cross-sectional study of AIDS cases was conducted from 1998 to 2008 by reviewing medical records from the Base Hospital/FUNFARME (Fundação Faculdade Regional de Medicina), São José do Rio Preto, São Paulo, Brazil. RESULTS The individuals were 14 to 75 years of age, and 458 were males. Heterosexuals accounted for 31.1% of all patients. Eighty-three percent were on ART, and 33.8% of those presented difficulties with treatment adherence. OIs were analyzed from medical records, and Pneumocystis jiroveci pneumonia was the most prevalent, regardless of the LTCD4+ (TCD4+ Lymphocytes) levels. Individuals whose viral loads were ≥10,000 showed a 90% greater chance of neurotoxoplasmosis. For P. jiroveci pneumonia, neurotoxoplasmosis, esophageal candidiasis, pulmonary tuberculosis and neurocryptococcosis, the chances of infection were higher among patients with LTCD4+ levels below 200 cells/mm3. HIV/hepatitis C virus (HCV) and HIV/hepatitis B virus (HBV) co-infections were significantly associated with death. CONCLUSIONS OIs remain frequent in the ART era even in populations where the access to medical care is considered satisfactory.
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Affiliation(s)
- Katia Jaira Galisteu
- Centro de Investigação de Microrganismos, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
| | - Luciana Ventura Cardoso
- Centro de Investigação de Microrganismos, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
| | - Adriana Antônia da Cruz Furini
- Centro de Investigação de Microrganismos, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
| | | | - Claudia Bernardi Cesarino
- Centro de Investigação de Microrganismos, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
| | - Célia Franco
- Hospital de Base, São José do Rio Preto, São Paulo, Brazil
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