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Jose RA, Raja Inbaraj L, Catherine Vincent R, Baskar A, Mathew R. Diagnostic accuracy of truenat MTB plus for the detection of pulmonary and extrapulmonary tuberculosis. Indian J Med Microbiol 2024; 51:100709. [PMID: 39178990 DOI: 10.1016/j.ijmmb.2024.100709] [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: 02/08/2024] [Revised: 07/29/2024] [Accepted: 08/21/2024] [Indexed: 08/26/2024]
Abstract
BACKGROUND The diagnosis of Tuberculosis (TB) has been a challenge till the advent of rapid molecular diagnostic tests. The traditional diagnostic tests have its own limitations with regard to its performance or the turnaround time. Truenat MTB Plus assay, a battery-operated molecular assay developed in India has been introduced for its use in pulmonary TB (PTB). However, the diagnostic accuracy of the assay is not well studied in comparison with Mycobacterial culture, especially for extrapulmonary TB (EPTB). AIM We aimed at evaluating the diagnostic accuracy of Truenat MTB Plus assay for both PTB and EPTB comparing with culture for adult population. METHODS The specimens from presumptive PTB and EPTB patients were processed for Truenat MTB Plus assay, solid or liquid culture and AFB staining. The electronic data of all the specimen reports collected retrospectively were analysed for the sensitivity and specificity. RESULTS Out of the 736 samples which had valid culture reports, 364 (49.4 %) were respiratory and 372 (50.6 %) were extrapulmonary specimens. The test positivity rate for smear microscopy, Truenat MTB Plus assay and culture was 3.7 % (27), 8.2 % (60), 7.1 % (52) respectively. Of the 60 Truenat MTB Plus positive patients with TB, 33 (55 %) were PTB and 27 (45 %) were EPTB. We estimated overall sensitivity and specificity of Truenat MTB Plus as 90 % (95 % CI: 73.4-97.8) and 98. 2 (95 % CI:96-99.3) respectively for the detection of PTB. The overall sensitivity and specificity for EPTB was 81.8 % (95 % CI: 59.7-94.8) and 97.4 % (95 % CI: 95.1-98.8) respectively. CONCLUSIONS Truenat MTB Plus assay has comparable diagnostic accuracy with other molecular assays. The Truenat MTB Plus assay can be used for the diagnosis of PTB and EPTB, especially in resource limited settings.
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Affiliation(s)
- Reena Anie Jose
- Department of Microbiology, Believers Church Medical College Hospital, Thiruvalla, Kerala, India.
| | - Leeberk Raja Inbaraj
- Department of Clnical Research, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - Ria Catherine Vincent
- Department of Microbiology, Believers Church Medical College Hospital, Thiruvalla, Kerala, India
| | - Adhin Baskar
- Department of Statistics, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - Renu Mathew
- Department of Microbiology, Believers Church Medical College Hospital, Thiruvalla, Kerala, India
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2
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Mahmoudi S, Sadegh Moghaddasi AH. Evaluation of truenat assays for the diagnosis of pulmonary and extrapulmonary tuberculosis: a systematic review and meta-analysis. Expert Rev Anti Infect Ther 2024:1-10. [PMID: 39115877 DOI: 10.1080/14787210.2024.2389876] [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] [Accepted: 08/05/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND Tuberculosis (TB) remains a significant global health concern, necessitating accurate and timely diagnostic methods. This study aimed to conduct a systematic review and meta-analysis to assess the diagnostic accuracy of Truenat assays for both pulmonary TB (PTB) and extrapulmonary TB (EPTB). METHOD PubMed, Scopus, and Web of Science were systematically searched for studies comparing Truenat assays to Mycobacterium tuberculosis confirmation methods. RESULTS Comparing Truenat MTB assay with the Lowenstein-Jensen (LJ) culture, the pooled sensitivity and specificity were 86% (95% CI: 79-91%) and 86% (95% CI: 82-90%), respectively. For Mycobacterial Growth Indicator Tube (MGIT) culture comparison, pooled sensitivity was 88% (95% CI: 82-92%) with a specificity of 79% (95% CI: 57-92%). Compared to smear microscopy, Truenat assays displayed pooled sensitivity and specificity of 92% (95% CI: 78-98%) and 86% (95% CI: 64-95%). In comparison to Xpert MTB/RIF, Truenat assays exhibited a pooled sensitivity of 92% (95% CI: 80-97%) and a pooled specificity of 92% (95% CI: 56-99%) for PTB detection, and a pooled sensitivity of 94% (95% CI: 81-98%) and a specificity of 77% (95% CI: 32-96%) for the diagnosis of EPTB. CONCLUSION This study underscores the potential of Truenat assays as valuable tools for diagnosing both PTB and EPTB. PROSPERO ID CRD42024526686.
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Affiliation(s)
- Shima Mahmoudi
- Biotechnology Centre, Silesian University of Technology, Gliwice, Poland
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3
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Ssengooba W, Katamba A, Sserubiri J, Semugenze D, Nyombi A, Byaruhanga R, Turyahabwe S, Joloba ML. Performance evaluation of Truenat MTB and Truenat MTB-RIF DX assays in comparison to gene XPERT MTB/RIF ultra for the diagnosis of pulmonary tuberculosis in Uganda. BMC Infect Dis 2024; 24:190. [PMID: 38350885 PMCID: PMC10863216 DOI: 10.1186/s12879-024-09063-z] [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: 11/24/2023] [Accepted: 01/26/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND The World Health Organization endorsed Truenat MTB rapid molecular assay in 2020 and recommended additional in-country evaluation studies before uptake. We evaluated the accuracy and operational feasibility of Truenat MTB assay (Truenat) in comparison with GeneXpert Ultra and culture. METHODS In a cross-sectional study of 250 presumptive TB patients, participants were requested to provide a sputum sample on the day of their visit to the clinic. The sputum sample was homogenized and a portion was tested using GeneXpert Ultra as per the routine standard procedure and the other portion was tested using Truenat assay at the clinic laboratory. The second sample portion was processed for Concentrated Fluorescent smear Microscopy (CFM), LJ, and MGIT cultures. Truenat sensitivity and specificity were compared to GeneXpert Ultra and culture. Test performance characteristics and operational feasibility assessment data through interview of the study laboratory staff were also collected and summarized as proportions and percentages. RESULTS Of the 250 participants recruited in the study, the sensitivity and specificity of Truenat was n/N (%, 95%CI); 66/82 (80.5, 70.2-88.4) and 156/159 (98.1, 94.5-99.6) when compared with Ultra, 50/64 (89.3, 66.0-87.4) and 166/180 (92.2, 87.2-95.6) when compared with LJ, 58/71 (81.7,70.7-89.8) and 131/138 (94.9, 89.8-97.9) when compared to MGIT culture and 59/73 (80.8, 69.9-89.1) and 159/169 (94.1,89.3-97.1) when compared to LJ and/or MGIT culture. The sensitivity of Truenat was lower, 14/23 (60.9, 40.6-82.8) among smear-negative compared to 45/50 (90.0, 78.1-96.6) among smear-positive participants but not different by HIV status. There were no special training needs especially among laboratory personnel with previous GeneXpert /molecular test experience, 19/242 (7.8%) error/invalid, and 12 (17,4%) uninterpretable/indeterminate results mainly for rifampicin resistance determination. However, there were 3 (3.5%) of GeneXpert Ultra indeterminate results. CONCLUSION Among presumptive TB patients in Uganda, the Truenat assay has high sensitivity and specificity. The Truenat assay has acceptable operational feasibility attributes when compared with the GeneXpert Assay.
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Affiliation(s)
- Willy Ssengooba
- Department of Medical Microbiology, Makerere University, Kampala, Uganda.
- Makerere University Lung Institute, Kampala, Uganda.
- Biomedical Research Center, Makerere University, Kampala, Uganda.
| | - Achilles Katamba
- Department of Medicine, School of Medicine, Clinical Epidemiology and Biostatistics Unit, Makerere University, Kampala, Uganda
- Uganda TB Implementation Research Consortium, Kampala, Uganda
| | - James Sserubiri
- Department of Medical Microbiology, Makerere University, Kampala, Uganda
- Makerere University Lung Institute, Kampala, Uganda
| | - Derrick Semugenze
- Department of Medical Microbiology, Makerere University, Kampala, Uganda
- Makerere University Lung Institute, Kampala, Uganda
| | - Abdunoor Nyombi
- Ministry of Health, National Tuberculosis, and Leprosy Programme, Kampala, Uganda
| | - Raymond Byaruhanga
- Ministry of Health, National Tuberculosis, and Leprosy Programme, Kampala, Uganda
| | - Stavia Turyahabwe
- Ministry of Health, National Tuberculosis, and Leprosy Programme, Kampala, Uganda
| | - Moses L Joloba
- Department of Medical Microbiology, Makerere University, Kampala, Uganda
- Biomedical Research Center, Makerere University, Kampala, Uganda
- Ministry of Health, National Tuberculosis, and Leprosy Programme, Kampala, Uganda
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4
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Jayaprakasam M, Pandey RM, Choudhary H, Shanmugam S, Sivaramakrishnan GN, Gupta N. Evaluation of molecular diagnostic test for detection of adult pulmonary tuberculosis: A generic protocol. Indian J Med Res 2024; 159:246-253. [PMID: 38511943 PMCID: PMC11050747 DOI: 10.4103/ijmr.ijmr_2316_23] [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: 12/08/2023] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND OBJECTIVES Tuberculosis (TB) continues to be the second most-leading cause of death due to a single infectious agent as of 2022 after COVID-19. Many affordable new molecular diagnostic tools are being developed for early and more accurate diagnosis, especially for low-resource settings in low- and middle-income countries. In this context, there is a need to develop a standardized protocol for validation of new diagnostic tools. Here, we describe a generic protocol for multi-centric clinical evaluation of molecular diagnostic tests for adult pulmonary TB. METHODS This protocol describes a cross-sectional study in TB reference laboratories in India. Adults (>18 yr) visitng the chest clinics or outpatient departments with symptoms of TB need to be enrolled consecutively till the required sample size of 150 culture positives and 470 culture negatives are met. Mycobacterium tuberculosis (Mtb) culture (mycobacteria growth indicator tube liquid culture) to be used under this protocol as the gold standard and Xpert MTB/RIF molecular test will be used as the comparator. The sputum samples will be tested by smear microscopy, Mtb culture, Xpert MTB/RIF and index molecular test as per the proposed algorithm. The specificity sensitivity, and positive/ negative predictive values are to be calculated for the index test with reference to the gold standard. DISCUSSION TB diagnosis poses many challenges as it differs with type of disease, age group, clinical settings and type of diagnostic tests/kits used. Globally, different protocols are used by several investigators. This protocol provides standard methods for the validation of molecular tests for diagnosis of adult pulmonary TB, which can be adopted by investigators.
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Affiliation(s)
| | | | | | - Sivakumar Shanmugam
- Department of Bacteriology, ICMR-National Institute for Research in Tuberculosis, Chennai, India
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Ramasubban G, Michael JS, Gupta R, Venkatesan M, Beauton AP, Hoffner S, Asalapuram P. Rapid Detection of M. tuberculosis and Its Resistance to Rifampicin and Isoniazid with the mfloDx™ MDR-TB test. Int J Mycobacteriol 2024; 13:91-95. [PMID: 38771285 DOI: 10.4103/ijmy.ijmy_21_24] [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: 01/06/2024] [Accepted: 03/02/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Rapid detection of tuberculosis (TB) and its resistance are essential for the prompt initiation of correct drug therapy and for stopping the spread of drug-resistant TB. There is an urgent need for increased use of rapid diagnostic tests to control the threat of increased TB and multidrug-resistant TB (MDR-TB). METHODS EMPE Diagnostics has developed a multiplex molecular diagnostic platform called mfloDx™ by combining nucleotide-specific padlock probe-dependent rolling circle amplification with sensitive lateral flow biosensors, providing visual signals, similar to a COVID-19 test. The first test kit of this platform, mfloDx™ MDR-TB can identify Mycobacterium tuberculosis (MTB) complex and its clinically significant mutations in the rpoB and katG genes and in the inhA promotor contributing resistance to rifampicin (RIF) and isoniazid (INH), causing MDR-TB. RESULTS We have evaluated the performance of the mfloDx™ MDR-TB test on 210 sputum samples (110 from suspected TB cases and 100 from TB-negative controls) received from a tertiary care center in India. The clinical sensitivity for detecting MTB compared to acid-fast microscopy and mycobacteria growth indicator tube (MGIT) cultures was 86.4% and 84.9%, respectively. All the 100 control samples were negative indicating excellent specificity. In smear-positive sputum samples, the mfloDx™ MDR-TB test showed a sensitivity of 92.5% and 86.4% against MGIT culture and Xpert MTB/RIF, respectively. The clinical sensitivity for the detection of RIF and INH resistance in comparison with MGIT drug susceptibility testing was 100% and 84.6%, respectively, while the clinical specificity was 100%. CONCLUSION From the above evaluation, we find mfloDx™ MDR-TB to be a rapid and efficient test to detect TB and its multidrug resistance in 3 h at a low cost making it suitable for resource-limited laboratories.
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Affiliation(s)
- Gayathri Ramasubban
- Clinical Affairs, EMPE Diagnostics Private LImited, Hyderabad, Telangana, India
| | - Joy Sarojini Michael
- Department of Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Richa Gupta
- Department of Respiratory Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Alpha Praisy Beauton
- Department of Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sven Hoffner
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Pavan Asalapuram
- Clinical Affairs, EMPE Diagnostics Private LImited, Hyderabad, Telangana, India
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- EMPE Diagnostics AB, Stockholm, Sweden
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6
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Gopalaswamy R, Kumar N, Vashistha H, Rajendran P, Kayesth J, Peravali CJ, Kashyap S, Ghosh S, Yumo H, Moore M, Anand S, Ramachandran R, Alavadi U, Saini S, Shanmugam S. Comprehensive assessment of invalid and indeterminate results in Truenat MTB-RIF testing across sites under the national TB elimination program of India. Front Public Health 2023; 11:1255756. [PMID: 37886056 PMCID: PMC10598606 DOI: 10.3389/fpubh.2023.1255756] [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: 07/09/2023] [Accepted: 09/11/2023] [Indexed: 10/28/2023] Open
Abstract
Introduction Truenat MTB-RIF assay (Truenat), a nucleic acid amplification test (NAAT), is a real-time polymerase chain reaction (RT-PCR) chip-based assay that can detect Mycobacterium tuberculosis (Mtb) and rifampicin (RIF) drug resistance using portable, battery-operated devices. The National TB Elimination Program (NTEP) in India introduced this novel tool at the district and subdistrict level in 2020. This study aimed to assess the level and causes of inconclusive results (invalid results, errors, and indeterminate results) in MTB and RIF testing at NTEP sites and the root causes of these in the programmatic setting. Methods Truenat testing data from 1,690 functional Truenat sites under the NTEP from April to June 2021 were analyzed to assess the rates of errors, invalid MTB results, and indeterminate RIF results. Following this analysis, 12 Truenat sites were selected based on site performance in Truenat testing, diversity of climatic conditions, and geographical terrain. These sites were visited to assess the root causes of their high and low rates of inconclusive results using a structured checklist. Results A total of 327,649 Truenat tests performed for MTB and RIF testing were analyzed. The rate of invalid MTB results was 5.2% [95% confidence interval (CI): 5.11-5.26; n = 16,998] and the rate of errors was 2.5% (95% CI: 2.46-2.57; n = 8,240) in Truenat MTB chip testing. For Mtb-positive samples tested using the Truenat RIF chip for detection of RIF resistance (n = 40,926), the rate of indeterminate results was 15.3% (95% CI: 14.97-15.67; n = 6,267) and the rate of errors was 1.6% (95% CI: 1.53-1.78; n = 675). There was a 40.1% retesting gap for Mtb testing and a 78.2% gap for inconclusive RR results. Among the inconclusive results retested, 27.9% (95% CI: 27.23-28.66; n = 4,222) were Mtb-positive, and 9.2% (95% CI: 7.84-10.76; n = 139) were detected as RR. Conclusion The main causes affecting Truenat testing performance include suboptimal adherence to standard operating procedures (SOPs), inadequate training, improper storage of testing kits, inadequate sputum quality, lack of quality control, and delays in the rectification of machine issues. Root cause analysis identified that strengthening of training, external quality control, and supervision could improve the rate of inconclusive results. Ensuring hands-on training of technicians for Truenat testing and retesting of samples with inconclusive results are major recommendations while planning for Truenat scale-up. The recommendations from the study were consolidated into technical guidance documents and videos and disseminated to laboratory staff working at the tiered network of TB laboratories under the NTEP in order to improve Truenat MTB-RIF testing performance.
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Affiliation(s)
- Radha Gopalaswamy
- ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - Nishant Kumar
- Central Tuberculosis Division, Ministry of Health and Family Welfare, New Delhi, India
| | - Himanshu Vashistha
- USAID’s Infectious Diseases Detection and Surveillance (IDDS) Project Awarded to Inner City Fund (ICF), Virginia, VA, United States
| | - Priya Rajendran
- ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - Jyoti Kayesth
- USAID’s Infectious Diseases Detection and Surveillance (IDDS) Project Awarded to Inner City Fund (ICF), Virginia, VA, United States
| | - Carel Joseph Peravali
- USAID’s Infectious Diseases Detection and Surveillance (IDDS) Project Awarded to Inner City Fund (ICF), Virginia, VA, United States
| | - Satabdi Kashyap
- USAID’s Infectious Diseases Detection and Surveillance (IDDS) Project Awarded to Inner City Fund (ICF), Virginia, VA, United States
| | - Shreeparna Ghosh
- USAID’s Infectious Diseases Detection and Surveillance (IDDS) Project Awarded to Inner City Fund (ICF), Virginia, VA, United States
| | - Habakkuk Yumo
- USAID’s Infectious Diseases Detection and Surveillance (IDDS) Project Awarded to Inner City Fund (ICF), Virginia, VA, United States
| | - Moe Moore
- USAID’s Infectious Diseases Detection and Surveillance (IDDS) Project Awarded to Inner City Fund (ICF), Virginia, VA, United States
| | | | | | - Umesh Alavadi
- United States Agency for International Development, New Delhi, India
| | - Sanjeev Saini
- USAID’s Infectious Diseases Detection and Surveillance (IDDS) Project Awarded to Inner City Fund (ICF), Virginia, VA, United States
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Rajendran P, Saini S, Kumar N, Vashistha H, Thiruvengadam K, Ramamoorthy T, Gopalaswamy R, Kayesth J, Alavadi U, Moore M, Joshi RP, Ramachandran R, Anand S, Shanmugam S, Padmapriyadarsini C. Establishing proof of concept for utility of Trueprep ®-extracted DNA in line-probe assay testing. Int J Tuberc Lung Dis 2023; 27:742-747. [PMID: 37749831 PMCID: PMC10519390 DOI: 10.5588/ijtld.23.0003] [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: 01/01/2023] [Accepted: 04/01/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVES: With an increased demand for rapid, diagnostic tools for TB and drug resistance detection, Truenat® MTB-RIF assay has proven to be a rapid point of care molecular test. The present study aimed to establish a proof of concept of using Trueprep-extracted DNA for line-probe assay (LPA) testing.METHODS: A total of 150 sputum samples (MTB-positive at Truenat sites) were divided into two aliquots. One aliquot was used for DNA extraction using the Trueprep device and MTB testing. The second aliquot of the sample was subjected to GenoLyse® DNA extraction. DNA from both the Trueprep and GenoLyse methods was subjected to first-line (FL) and second-line (SL) LPA testing.RESULTS: Of 139 Trueprep-extracted DNA, respectively 135 (97%) and 105 (75%) had interpretable results by FL and SL-LPA testing. Of 128 GenoLyse-extracted DNA, all 128 (100%) had interpretable FL-LPA results and 114 (89%) had interpretable SL-LPA results.CONCLUSION: The results obtained in this study indicate that Trueprep-extracted DNA can be used in obtaining valid LPA results. However, the study needs to be conducted on a larger sample size before our recommendations can be used for policy-making decisions.
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Affiliation(s)
- P Rajendran
- National Institute for Research in Tuberculosis, Indian Council of Medical Research, New Delhi
| | - S Saini
- Infectious Disease Detection and Surveillance Project, United States Agency for International Development (USAID), ICF Incorporated, Reston, VA, USA
| | - N Kumar
- Central TB Division, Ministry of Health and Family Welfare, New Delhi
| | - H Vashistha
- Infectious Disease Detection and Surveillance Project, United States Agency for International Development (USAID), ICF Incorporated, Reston, VA, USA
| | - K Thiruvengadam
- National Institute for Research in Tuberculosis, Indian Council of Medical Research, New Delhi
| | - T Ramamoorthy
- National Institute for Research in Tuberculosis, Indian Council of Medical Research, New Delhi
| | - R Gopalaswamy
- National Institute for Research in Tuberculosis, Indian Council of Medical Research, New Delhi
| | - J Kayesth
- Infectious Disease Detection and Surveillance Project, United States Agency for International Development (USAID), ICF Incorporated, Reston, VA, USA
| | | | - M Moore
- Infectious Disease Detection and Surveillance Project, United States Agency for International Development (USAID), ICF Incorporated, Reston, VA, USA
| | - R P Joshi
- Central TB Division, Ministry of Health and Family Welfare, New Delhi
| | - R Ramachandran
- World Health Organization India Office, New Delhi, India
| | - S Anand
- World Health Organization India Office, New Delhi, India
| | - S Shanmugam
- National Institute for Research in Tuberculosis, Indian Council of Medical Research, New Delhi
| | - C Padmapriyadarsini
- National Institute for Research in Tuberculosis, Indian Council of Medical Research, New Delhi
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8
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Bloom BR. A half-century of research on tuberculosis: Successes and challenges. J Exp Med 2023; 220:e20230859. [PMID: 37552470 PMCID: PMC10407785 DOI: 10.1084/jem.20230859] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 08/09/2023] Open
Abstract
Great progress has been made over the past half-century, but TB remains a formidable global health problem, particularly in low- and middle-income countries. Understanding the mechanisms of pathogenesis and necessary and sufficient conditions for protection are critical. The need for inexpensive and sensitive point-of-care diagnostic tests for earlier detection of infection and disease, shorter and less-toxic drug regimens for drug-sensitive and -resistant TB, and a more effective vaccine than BCG is immense. New and better tools, greater support for international research, collaborations, and training will be required to dramatically reduce the burden of this devastating disease which still kills 1.6 million people annually.
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Affiliation(s)
- Barry R. Bloom
- Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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9
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Singh UB, Singh M, Sharma S, Mahajan N, Bala K, Srivastav A, Singh KJ, Rao MVV, Lodha R, Kabra SK. Expedited diagnosis of pediatric tuberculosis using Truenat MTB-Rif Dx and GeneXpert MTB/RIF. Sci Rep 2023; 13:6976. [PMID: 37117209 PMCID: PMC10147673 DOI: 10.1038/s41598-023-32810-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 04/03/2023] [Indexed: 04/30/2023] Open
Abstract
Rapid, cost-effective, and sensitive diagnostic assays are essential for global tuberculosis (TB) control, especially in high TB burden, resource-limited settings. The current study was designed to evaluate diagnostic accuracy of Truenat MTB-Rif Dx (MolBio) in children less than 18 years of age, with symptoms suggestive of TB. Gastric aspirate, induced sputum, and broncho-alveolar lavage samples were subjected simultaneously to AFB-smear, GeneXpert MTB/RIF, liquid culture (MGIT-960) and Truenat MTB-Rif Dx. The index-test results were evaluated against microbiological reference standards (MRS). Truenat MTB-Rif Dx had a sensitivity of 57.1%, specificity of 92% against MRS. The sensitivity and specificity of the Truenat MTB-RIF Dx compared with liquid culture was 58.7% and 87.5% while GeneXpert MTB/RIF was 56% and 91.4%. The performance of both GeneXpert MTB/RIF and Truenat MTB-Rif Dx are comparable. Result of our study demonstrates that Truenat MTB-Rif can aid in early and efficient diagnosis of TB in children.
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Affiliation(s)
- Urvashi B Singh
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India.
| | - Manjula Singh
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Sangeeta Sharma
- Department of Pediatrics, National Institute of TB and Respiratory Diseases, New Delhi, India
| | - Neeraj Mahajan
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Kiran Bala
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Abhinav Srivastav
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | | | - M V V Rao
- National Institute of Medical Statistics, ICMR, New Delhi, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Sushil K Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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10
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Inbaraj LR, Daniel J, Rajendran P, Bhaskar A, Srinivasalu VA, Narayanan MKS, Shewade HD, Kirubakaran R, Scandrett K, Malaisamy M, Takwoingi Y, Padmapriyadarsini C. Truenat MTB assays for pulmonary tuberculosis and rifampicin resistance in adults. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2023; 2023:CD015543. [PMCID: PMC9837843 DOI: 10.1002/14651858.cd015543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
This is a protocol for a Cochrane Review (diagnostic). The objectives are as follows: To determine the diagnostic accuracy of Truenat assays (MTB, MTB Plus, and MTB RIF Dx) for detecting pulmonary tuberculosis and rifampicin resistance in adults with presumptive pulmonary tuberculosis.
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Affiliation(s)
| | - Leeberk Raja Inbaraj
- Department of Clinical ResearchICMR – National Institute for Research in TuberculosisChennaiIndia
| | - Jefferson Daniel
- Department of Pulmonary MedicineChristian Medical CollegeVelloreIndia
| | - Priya Rajendran
- Department of BacteriologyICMR – National Institute for Research in TuberculosisChennaiIndia
| | - Adhin Bhaskar
- Department of BiostatisticsICMR – National Institute for Research in TuberculosisChennaiIndia
| | - Vignes Anand Srinivasalu
- Department of Clinical ResearchICMR - National Institute for Research in TuberculosisChennaiIndia
| | - Mukesh KS Narayanan
- Department of EpidemiologyICMR – National Institute for Research in TuberculosisChennaiIndia
| | - Hemant D Shewade
- Division of Health System ResearchICMR – National Institute of EpidemiologyChennaiIndia
| | - Richard Kirubakaran
- Prof. BV Moses Center for Evidence-Informed Health Care and Health PolicyChristian Medical CollegeVelloreIndia
| | - Katie Scandrett
- Test Evaluation Research Group, Institute of Applied Health ResearchUniversity of BirminghamBirminghamUK
| | - Muniyandi Malaisamy
- Department of Health EconomicsICMR – National Institute for Research in TuberculosisChennaiIndia
| | - Yemisi Takwoingi
- Test Evaluation Research Group, Institute of Applied Health ResearchUniversity of BirminghamBirminghamUK
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Vaezipour N, Fritschi N, Brasier N, Bélard S, Domínguez J, Tebruegge M, Portevin D, Ritz N. Towards Accurate Point-of-Care Tests for Tuberculosis in Children. Pathogens 2022; 11:pathogens11030327. [PMID: 35335651 PMCID: PMC8949489 DOI: 10.3390/pathogens11030327] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 12/20/2022] Open
Abstract
In childhood tuberculosis (TB), with an estimated 69% of missed cases in children under 5 years of age, the case detection gap is larger than in other age groups, mainly due to its paucibacillary nature and children’s difficulties in delivering sputum specimens. Accurate and accessible point-of-care tests (POCTs) are needed to detect TB disease in children and, in turn, reduce TB-related morbidity and mortality in this vulnerable population. In recent years, several POCTs for TB have been developed. These include new tools to improve the detection of TB in respiratory and gastric samples, such as molecular detection of Mycobacterium tuberculosis using loop-mediated isothermal amplification (LAMP) and portable polymerase chain reaction (PCR)-based GeneXpert. In addition, the urine-based detection of lipoarabinomannan (LAM), as well as imaging modalities through point-of-care ultrasonography (POCUS), are currently the POCTs in use. Further to this, artificial intelligence-based interpretation of ultrasound imaging and radiography is now integrated into computer-aided detection products. In the future, portable radiography may become more widely available, and robotics-supported ultrasound imaging is currently being trialed. Finally, novel blood-based tests evaluating the immune response using “omic-“techniques are underway. This approach, including transcriptomics, metabolomic, proteomics, lipidomics and genomics, is still distant from being translated into POCT formats, but the digital development may rapidly enhance innovation in this field. Despite these significant advances, TB-POCT development and implementation remains challenged by the lack of standard ways to access non-sputum-based samples, the need to differentiate TB infection from disease and to gain acceptance for novel testing strategies specific to the conditions and settings of use.
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Affiliation(s)
- Nina Vaezipour
- Mycobacterial and Migrant Health Research Group, University Children’s Hospital Basel, Department for Clinical Research, University of Basel, 4056 Basel, Switzerland; (N.V.); (N.F.)
- Infectious Disease and Vaccinology Unit, University Children’s Hospital Basel, University of Basel, 4056 Basel, Switzerland
| | - Nora Fritschi
- Mycobacterial and Migrant Health Research Group, University Children’s Hospital Basel, Department for Clinical Research, University of Basel, 4056 Basel, Switzerland; (N.V.); (N.F.)
| | - Noé Brasier
- Department of Health Sciences and Technology, Institute for Translational Medicine, ETH Zurich, 8093 Zurich, Switzerland;
- Department of Digitalization & ICT, University Hospital Basel, 4031 Basel, Switzerland
| | - Sabine Bélard
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité–Universitätsmedizin Berlin, 13353 Berlin, Germany;
- Institute of Tropical Medicine and International Health, Charité–Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - José Domínguez
- Institute for Health Science Research Germans Trias i Pujol. CIBER Enfermedades Respiratorias, Universitat Autònoma de Barcelona, 08916 Barcelona, Spain;
| | - Marc Tebruegge
- Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London WCN1 1EH, UK;
- Department of Pediatrics, The Royal Children’s Hospital Melbourne, The University of Melbourne, Parkville, VIC 3052, Australia
| | - Damien Portevin
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, 4123 Allschwil, Switzerland;
- University of Basel, 4001 Basel, Switzerland
| | - Nicole Ritz
- Mycobacterial and Migrant Health Research Group, University Children’s Hospital Basel, Department for Clinical Research, University of Basel, 4056 Basel, Switzerland; (N.V.); (N.F.)
- Department of Pediatrics, The Royal Children’s Hospital Melbourne, The University of Melbourne, Parkville, VIC 3052, Australia
- Department of Paediatrics and Paediatric Infectious Diseases, Children’s Hospital, Lucerne Cantonal Hospital, 6000 Lucerne, Switzerland
- Correspondence: ; Tel.: +41-61-704-1212
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Gomathi NS, Singh M, Myneedu VP, Chauhan DS, Tripathy S, Sarin R, Mohan A, Bhatnagar A, Khangembam JS, Kannan T, V Rao MV, Logani J, Dey B, Gangakhedkar RR, Swaminathan S, Singh UB. Validation of an indigenous assay for rapid molecular detection of rifampicin resistance in presumptive multidrug-resistant pulmonary tuberculosis patients. Indian J Med Res 2021; 152:482-489. [PMID: 33707390 PMCID: PMC8157890 DOI: 10.4103/ijmr.ijmr_2557_19] [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: 11/23/2022] Open
Abstract
Background & objectives: There is a need for an affordable, easy, high-sensitivity test usable at the peripheral health facility for diagnosis of drug-resistant (DR) tuberculosis (TB) to interrupt disease transmission. Nucleic acid amplification tests (NAATs) for early detection of DR-TB are ideal to bring testing near to the patient. Truenat™ MTB (Mycobacterium tuberculosis) and Truenat™ MTB-RIF (rifampicin) is an indigenous chip-based real-time polymerase chain reaction (PCR) based test for detection of multidrug-resistant (MDR) TB. The test involves extraction of DNA using automated, battery operated Trueprep instrument and real-time PCR performed on the Truelab analyzer. We report here multicentric validation of Truenat MTB-RIF for detection of DR-TB in suspected DR-TB patients. Methods: Consecutive patients aged 18-65 yr, with symptoms suggestive of TB and with a history of previous treatment, reporting to the National TB Elimination Programme (NTEP) clinics under four national institutes, namely AIIMS (All India Institute of Medical Sciences, New Delhi), NITRD (National Institute of Tuberculosis and Respiratory Diseases, New Delhi), NIRT (National Institute for Research in Tuberculosis, Chennai) and ICMR-National JALMA Institute for Leprosy and other Mycobacterial Diseases, Agra, were included in the study. Two sputum samples (one spot and one morning) were collected from each patient, after obtaining informed written consent. The samples were subjected to smear, GeneXpert and MGIT 960 culture (and drug susceptibility testing to RIF) (surrogate for MDR-TB) to serve as reference tests. The samples were coded to ensure blinding and subjected to Truenat MTB-RIF. Truenat MTB-RIF Version 1.5 was used for testing 1084 samples for RIF resistance, while Version 2.0 was used to test another 1201 samples. Results: Truenat MTB-RIF Version 1.5 in comparison with comprehensive laboratory reference standards yielded sensitivity and specificity of 76.2 and 94.7 per cent, respectively for the detection of RIF resistance in 1084 samples, collected across four sites. Based on the analysis of discordant samples, Version 2.0 of Truenat was developed by the manufacturer and this was further tested on additional 1201 samples, yielding a sensitivity of 87.5 per cent and specificity of 99.5 per cent. Interpretation & conclusions: Multicentric trial of Truenat™ MTB-RIF demonstrated a great potential of this point of care NAAT for detection of MDR-TB. The test would be useful in limited resource settings and inaccessible areas without need for any additional infrastructure.
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Affiliation(s)
- N S Gomathi
- Department of Bacteriology, Epidemiology Unit, Chennai, Tamil Nadu, India
| | - Manjula Singh
- Division of Epidemiology & Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - V P Myneedu
- Department of Microbiology, National Institute of Tuberculosis & Other Respiratory Diseases, New Delhi, India
| | - D S Chauhan
- Department of Microbiology & Molecular Biology, ICMR-National JALMA Institute for Leprosy & Other Mycobacterial Diseases, Agra, Uttar Pradesh, India
| | - Srikanth Tripathy
- ICMR-National Institute of Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - Rohit Sarin
- National Institute of Tuberculosis & Other Respiratory Diseases, New Delhi, India
| | - Anant Mohan
- Department of Pulmonary Medicine & Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Anuj Bhatnagar
- Department of Chest & TB, Rajan Babu Institute of Pulmonary Medicine and Tuberculosis, New Delhi, India
| | | | - T Kannan
- Statistics Section, Epidemiology Unit, ICMR-National Institute of Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - M V V Rao
- ICMR-National Institute of Medical Statistics, New Delhi, India
| | - Jyoti Logani
- Department of Biotechnology, Ministry of Science & Technology, New Delhi, India
| | - Bindu Dey
- Department of Biotechnology, Ministry of Science & Technology, New Delhi, India
| | - R R Gangakhedkar
- Division of Epidemiology & Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | | | - Urvashi B Singh
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
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