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Hassan-Moosa R, Motsomi KW, Narasimmulu R, Sivro A, Naidu KK, Kharsany ABM, Samsunder N, Perumal R, Naidoo K. Drug-Resistant TB, HIV and COVID-19 Co-Infection: Case Reviews from Kwa-Zulu Natal, South Africa. Infect Drug Resist 2023; 16:7663-7670. [PMID: 38126006 PMCID: PMC10731725 DOI: 10.2147/idr.s433695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023] Open
Abstract
Background Coronavirus disease (COVID-19) potentially exacerbates drug-resistant tuberculosis (DR-TB). We describe the clinical presentation and outcomes of three patients with human immunodeficiency virus (HIV), DR-TB and COVID-19. Case One A virologically suppressed 31-year-old man on antiretroviral therapy (ART) and multidrug-resistant (MDR)-TB treatment presented with mild COVID-19 and was hospitalised for 10 days of clinical monitoring, despite being clinically stable with normal baseline inflammatory markers. Severe acute respiratory syndrome coronavirus polymerase chain reaction (SARS-CoV-2 PCR) positivity persisted at Day 28. Case Two A virologically suppressed 37-year-old woman on ART and MDR-TB treatment presented with moderate COVID-19. Baseline inflammatory markers were raised, and dexamethasone and azithromycin were initiated with good clinical improvement. SARS-CoV-2 PCR positivity persisted at Day 28. Case Three A viraemic 24-year-old woman on second-line ART and MDR-TB treatment, presented with mild COVID-19 disease, normal oxygenation and normal inflammatory markers, and remained clinically stable with negative SARS-CoV-2 PCR at Days 14 and 28. Conclusion Screening for SARS-CoV-2 infection is advised for DR-TB patients with new or worsening respiratory symptoms.
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Affiliation(s)
- Razia Hassan-Moosa
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
- MRC-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | | | - Radhamoney Narasimmulu
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Aida Sivro
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
- Department of Medical Microbiology, University of KwaZulu-Natal, Durban, South Africa
- JC Wilt Infectious Disease Research Centre, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada
| | - Kevindra K Naidu
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Ayesha B M Kharsany
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
- Department of Medical Microbiology, University of KwaZulu-Natal, Durban, South Africa
| | - Natasha Samsunder
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Rubeshan Perumal
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
- MRC-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | - Kogieleum Naidoo
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
- MRC-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
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Kubheka SE, Archary M, Naidu KK. HIV viral load testing coverage and timeliness after implementation of the wellness anniversary in a paediatric and adolescent HIV clinic in KwaZulu-Natal, South Africa. South Afr J HIV Med 2020; 21:1016. [PMID: 32158554 PMCID: PMC7059249 DOI: 10.4102/sajhivmed.v21i1.1016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 08/24/2019] [Indexed: 11/03/2022] Open
Abstract
Background The UNAIDS 2020 Global strategy to reduce the transmission of HIV includes ensuring HIV viral load (VL) testing coverage of at least 90% on all patients on antiretroviral therapy (ART). Routine VL monitoring has been shown to result in earlier detection of treatment failure, timely regimen switches, promotion of adherence to treatment and improved survival. We wanted to assess the introduction of the wellness anniversary in improving routine viral load monitoring. Objectives We retrospectively assessed effects of the wellness anniversary on routine VL coverage, timeliness and suppression rates. Method The month when the patient initiated ART was designated as the wellness anniversary. On the anniversary month a package of care, which included a routine VL, was delivered. We conducted a retrospective chart audit to assess VL coverage and timeliness between two time periods, from January 2016 to December 2016 (pre-implementation) and from January 2017 to December 2017 (post-implementation). Results Timeliness of VL testing improved from 27.5% in the pre-implementation cohort to 49.7% in the post-implementation cohort. Our study showed high VL testing coverage before the implementation of the wellness anniversary with an average of 98.3% VL. There was a significant correlation between timeliness and VL suppression (VLS) in the post-implementation group. Conclusion Implementation of the wellness anniversary may improve timeliness of routine VL testing in settings with high VL coverage. Studies looking at the effect of timeliness on VLS and clinical outcomes are needed.
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Affiliation(s)
- Sibusiso E Kubheka
- Department of Paediatrics and Child Health, College of Health Sciences, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Moherndran Archary
- Department of Paediatrics and Child Health, College of Health Sciences, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Kevindra K Naidu
- Maternal, Child and Adolescent Health, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Sunpath H, Hatlen TJ, Naidu KK, Msimango P, Adams RN, Moosa MYS, Marconi VC, Murphy RA, Gandhi RT, Pillay S, Siedner M, Naidoo K. Targeting the third '90': introducing the viral load champion. Public Health Action 2018; 8:225-231. [PMID: 30775284 DOI: 10.5588/pha.18.0063] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 11/05/2018] [Indexed: 11/10/2022] Open
Abstract
Objective: To move closer to achieving the third target of the UNAIDS 90-90-90 goals, we prospectively implemented a viral load (VL) champion (VLC) program aimed at enhancing VL monitoring and recognition of treatment failure. Design: Three clinics in eThekwini, Kwa-Zulu Natal (low-, medium- and high-volume, encompassing 9184 patients overall) were each assigned a VLC. We employed a descriptive analysis (chart audit) to compare the pre-intervention period to a 1-year post-intervention period. The number of patients with a VL test performed 6 and 12 months after the intervention was calculated as a proportion of VL tests due at those time points (VL completion rate). Results: The pre-implementation VL completion rate at the three sites was respectively 68% (140/205 patients), 54% (84/155 patients) and 64% (323/504 patients), and the 6-month post-implementation completion rate increased to 83% (995/1194 patients), 90% (793/878 patients) and 99% (3101/3124 patients) (P < 0.0001 for each site). VL completion rates remained significantly higher at 12 months post-implementation, with an average cumulative VL completion rate of >90% across all facilities. Conclusion: We demonstrate a successful, multifaceted, quality-improvement intervention centered on a clinic-level VLC which, taken to scale, has important implications for attaining the third UNAIDS 90-90-90 target.
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Affiliation(s)
- H Sunpath
- Centre for Aids Program of Research, University of Kwa Zulu-Natal, Durban, South Africa.,Infectious Diseases Unit, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - T J Hatlen
- Division of Infectious Diseases, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California, USA
| | - K K Naidu
- MatCH (Maternal Adolescent and Child Health), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - P Msimango
- Ethekwini Health District Office, Department of Health, Kwa-Zulu Natal, Durban, South Africa
| | - R N Adams
- Medical Research Council-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | - M-Y S Moosa
- Infectious Diseases Unit, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - V C Marconi
- Emory University School of Medicine and Rollins School of Public Health, Atlanta, Georgia, USA
| | - R A Murphy
- Division of Infectious Diseases, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California, USA
| | - R T Gandhi
- Harvard Medical School, Boston, Massachusetts, USA
| | - S Pillay
- Division of Medical Microbiology and Immunology, National Health Laboratory Services Tygerberg Hospital, Stellenbosch University, Tygerberg, South Africa
| | - M Siedner
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - K Naidoo
- Centre for Aids Program of Research, University of Kwa Zulu-Natal, Durban, South Africa.,Medical Research Council-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
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Chetty T, Yapa HMN, Herbst C, Geldsetzer P, Naidu KK, De Neve JW, Herbst K, Matthews P, Pillay D, Wyke S, Bärnighausen T. The MONARCH intervention to enhance the quality of antenatal and postnatal primary health services in rural South Africa: protocol for a stepped-wedge cluster-randomised controlled trial. BMC Health Serv Res 2018; 18:625. [PMID: 30089485 PMCID: PMC6083494 DOI: 10.1186/s12913-018-3404-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 07/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gaps in maternal and child health services can slow progress towards achieving the Sustainable Development Goals. The Management and Optimization of Nutrition, Antenatal, Reproductive, Child Health & HIV Care (MONARCH) study will evaluate a Continuous Quality Improvement (CQI) intervention targeted at improving antenatal and postnatal health service outcomes in rural South Africa where HIV prevalence among pregnant women is extremely high. Specifically, it will establish the effectiveness of CQI on viral load (VL) testing in pregnant women who are HIV-positive and repeat HIV testing in pregnant women who are HIV-negative. METHODS This is a stepped-wedge cluster-randomised controlled trial (RCT) of 7 nurse-led primary healthcare clinics to establish the effect of CQI on selected routine antenatal and postnatal services. Each clinic was a cluster, with the exception of the two smallest clinics, which jointly formed one cluster. The intervention was applied at the cluster level, where staff received training on CQI methodology and additional mentoring as required. In the control exposure state, the clusters received the South African Department of Health standard of care. After a baseline data collection period of 2 months, the first cluster crossed over from control to intervention exposure state; subsequently, one additional cluster crossed over every 2 months. The six clusters were divided into 3 groups by patient volume (low, medium and high). We randomised the six clusters to the sequences of crossing over, such that both the first three and the last three sequences included one cluster with low, one with medium, and one with high patient volume. The primary outcome measures were (i) viral load testing among pregnant women who were HIV-positive, and (ii) repeat HIV testing among pregnant women who were HIV-negative. Consenting women ≥18 years attending antenatal and postnatal care during the data collection period completed outcome measures at delivery, and postpartum at three to 6 days, and 6 weeks. Data collection started on 15 July 2015. The total study duration, including pre- and post-exposure phases, was 19 months. Data will be analyzed by intention-to-treat based on first booked clinic of study participants. DISCUSSION The results of the MONARCH trial will establish the effectiveness of CQI in improving antenatal and postnatal clinic processes in primary care in sub-Saharan Africa. More generally, the results will contribute to our knowledge on quality improvement interventions in resource-poor settings. TRIAL REGISTRATION This trial was registered on 10 December 2015: www.clinicaltrials.gov, identifier NCT02626351 .
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Affiliation(s)
- Terusha Chetty
- Africa Health Research Institute, Somkhele, P.O. Box 198, Mtubatuba, KwaZulu-Natal 3935 South Africa
| | - H. Manisha N. Yapa
- Africa Health Research Institute, Somkhele, P.O. Box 198, Mtubatuba, KwaZulu-Natal 3935 South Africa
| | - Carina Herbst
- Africa Health Research Institute, Somkhele, P.O. Box 198, Mtubatuba, KwaZulu-Natal 3935 South Africa
| | - Pascal Geldsetzer
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115 USA
| | - Kevindra K. Naidu
- Africa Health Research Institute, Somkhele, P.O. Box 198, Mtubatuba, KwaZulu-Natal 3935 South Africa
- Maternal Adolescent and Child Health Systems (MatCH), School of Public Health, University of Witswatersrand, Braamfontein, South Africa
| | - Jan-Walter De Neve
- Institute of Public Health, Heidelberg University, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany
| | - Kobus Herbst
- Africa Health Research Institute, Somkhele, P.O. Box 198, Mtubatuba, KwaZulu-Natal 3935 South Africa
| | - Philippa Matthews
- Africa Health Research Institute, Somkhele, P.O. Box 198, Mtubatuba, KwaZulu-Natal 3935 South Africa
| | - Deenan Pillay
- Africa Health Research Institute, Somkhele, P.O. Box 198, Mtubatuba, KwaZulu-Natal 3935 South Africa
- Division of Infection & Immunity, University College London, Gower Street, Bloomsbury, London, WC1E 6BT UK
| | - Sally Wyke
- Africa Health Research Institute, Somkhele, P.O. Box 198, Mtubatuba, KwaZulu-Natal 3935 South Africa
- Institute for Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ Scotland, UK
| | - Till Bärnighausen
- Africa Health Research Institute, Somkhele, P.O. Box 198, Mtubatuba, KwaZulu-Natal 3935 South Africa
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115 USA
- Institute of Public Health, Heidelberg University, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany
- Department of Global Health, University College London, Gower Street, Bloomsbury, London, WC1E 6BT UK
| | - for the MONARCH study team
- Africa Health Research Institute, Somkhele, P.O. Box 198, Mtubatuba, KwaZulu-Natal 3935 South Africa
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115 USA
- Maternal Adolescent and Child Health Systems (MatCH), School of Public Health, University of Witswatersrand, Braamfontein, South Africa
- Institute of Public Health, Heidelberg University, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany
- Division of Infection & Immunity, University College London, Gower Street, Bloomsbury, London, WC1E 6BT UK
- Institute for Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ Scotland, UK
- Department of Global Health, University College London, Gower Street, Bloomsbury, London, WC1E 6BT UK
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Hontelez JAC, Tanser FC, Naidu KK, Pillay D, Bärnighausen T. The Effect of Antiretroviral Treatment on Health Care Utilization in Rural South Africa: A Population-Based Cohort Study. PLoS One 2016; 11:e0158015. [PMID: 27384178 PMCID: PMC4934780 DOI: 10.1371/journal.pone.0158015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 06/08/2016] [Indexed: 12/30/2022] Open
Abstract
Background The effect of the rapid scale-up of vertical antiretroviral treatment (ART) programs for HIV in sub-Saharan Africa on the overall health system is under intense debate. Some have argued that these programs have reduced access for people suffering from diseases unrelated to HIV because ART programs have drained human and physical resources from other parts of the health system; others have claimed that the investments through ART programs have strengthened the general health system and the population health impacts of ART have freed up health care capacity for the treatment of diseases that are not related to HIV. To establish the population-level impact of ART programs on health care utilization in the public-sector health system, we compared trends in health care utilization among HIV-infected people receiving and not receiving ART with HIV-uninfected people during a period of rapid ART scale-up. Methods and Findings We used data from the Wellcome Trust Africa Centre for Population Health, which annually elicited information on health care utilization from all surveillance participants over the period 2009–2012 (N = 32,319). We determined trends in hospitalization, and public-sector and private-sector primary health care (PHC) clinic visits for HIV-infected and -uninfected people over a time period of rapid ART scale-up (2009–2012) in this community. We regressed health care utilization on HIV status and ART status in different calendar years, controlling for sex, age, and area of residence. The proportion of people who reported to have visited a public-sector primary health care (PHC) clinic in the last 6 months increased significantly over the period 2009–2012, for both HIV-infected people (from 59% to 67%; p<0.001), and HIV-uninfected people (from 41% to 47%; p<0.001). In contrast, the proportion of HIV-infected people visiting a private-sector PHC clinic declined from 22% to 12% (p<0.001) and hospitalization rates declined from 128 to 82 per 1000 PY (p<0.001). For HIV-uninfected people, the proportion visiting a private-sector PHC clinic declined from 16% to 9%, and hospitalization rates declined from 78 to 44 per 1000 PY (p<0.001). After controlling for potential confounding factors, all trends remained of similar magnitude and significance. Conclusions Our results indicate that the ART scale-up in this high HIV prevalence community has shifted health care utilization from hospitals and private-sector primary care to public-sector primary care. Remarkably, this shift is observed for both HIV-infected and -uninfected populations, supporting and extending hypotheses of ‘therapeutic citizenship’ whereby HIV-infected patients receiving ART facilitate primary care access for family and community members. One explanation of our findings is that ART has improved the capacity or quality of primary care in this community and, as a consequence, increasingly met overall health care needs at the primary care level rather than at the secondary level. Future research needs to confirm this causal interpretation of our findings using qualitative work to understand causal mechanisms or quasi-experimental quantitative studies to increase the strength of causal inference.
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Affiliation(s)
- Jan A. C. Hontelez
- Wellcome Trust Africa Centre for Population Health, University of KwaZulu-Natal, Mtubatuba, South Africa
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, United States of America
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- * E-mail:
| | - Frank C. Tanser
- Wellcome Trust Africa Centre for Population Health, University of KwaZulu-Natal, Mtubatuba, South Africa
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Kevindra K. Naidu
- Wellcome Trust Africa Centre for Population Health, University of KwaZulu-Natal, Mtubatuba, South Africa
| | - Deenan Pillay
- Wellcome Trust Africa Centre for Population Health, University of KwaZulu-Natal, Mtubatuba, South Africa
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Till Bärnighausen
- Wellcome Trust Africa Centre for Population Health, University of KwaZulu-Natal, Mtubatuba, South Africa
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, United States of America
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Lessells RJ, Stott KE, Manasa J, Naidu KK, Skingsley A, Rossouw T, de Oliveira T. Implementing antiretroviral resistance testing in a primary health care HIV treatment programme in rural KwaZulu-Natal, South Africa: early experiences, achievements and challenges. BMC Health Serv Res 2014; 14:116. [PMID: 24606875 PMCID: PMC3973961 DOI: 10.1186/1472-6963-14-116] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 02/28/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Antiretroviral drug resistance is becoming increasingly common with the expansion of human immunodeficiency virus (HIV) treatment programmes in high prevalence settings. Genotypic resistance testing could have benefit in guiding individual-level treatment decisions but successful models for delivering resistance testing in low- and middle-income countries have not been reported. METHODS An HIV Treatment Failure Clinic model was implemented within a large primary health care HIV treatment programme in northern KwaZulu-Natal, South Africa. Genotypic resistance testing was offered to adults (≥16 years) with virological failure on first-line antiretroviral therapy (one viral load >1000 copies/ml after at least 12 months on a standard first-line regimen). A genotypic resistance test report was generated with treatment recommendations from a specialist HIV clinician and sent to medical officers at the clinics who were responsible for patient management. A quantitative process evaluation was conducted to determine how the model was implemented and to provide feedback regarding barriers and challenges to delivery. RESULTS A total of 508 specimens were submitted for genotyping between 8 April 2011 and 31 January 2013; in 438 cases (86.2%) a complete genotype report with recommendations from the specialist clinician was sent to the medical officer. The median turnaround time from specimen collection to receipt of final report was 18 days (interquartile range (IQR) 13-29). In 114 (26.0%) cases the recommended treatment differed from what would be given in the absence of drug resistance testing. In the majority of cases (n = 315, 71.9%), the subsequent treatment prescribed was in line with the recommendations of the report. CONCLUSIONS Genotypic resistance testing was successfully implemented in this large primary health care HIV programme and the system functioned well enough for the results to influence clinical management decisions in real time. Further research will explore the impact and cost-effectiveness of different implementation models in different settings.
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Affiliation(s)
- Richard J Lessells
- Africa Centre for Health and Population Studies, University of KwaZulu-Natal, PO Box 198, Mtubatuba, KwaZulu-Natal 3935, South Africa.
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Coovadia YM, Naidu KK. Evaluation of Bactigen latex agglutination and Phadebact coagglutination for detection of bacterial antigens in cerebrospinal fluid. J Clin Pathol 1985; 38:561-4. [PMID: 3923058 PMCID: PMC499209 DOI: 10.1136/jcp.38.5.561] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The Bactigen latex agglutination and Phadebact coagglutination tests were evaluated for their ability to detect bacterial antigens of Haemophilus influenzae type b, Streptococcus pneumoniae (83 serotypes) and Neisseria meningitidis groups A, B, C, and Y in 214 samples of cerebrospinal fluid (CSF). Bactigen latex agglutination was more sensitive than Phadebact coagglutination: it detected 87% (59/68) of culture positive CSF specimens, whereas Phadebact detected 72% (52/72). Bactigen detected all cases of meningitis caused by S pneumoniae and H influenzae. Of the 19 specimens that were positive for N meningitidis, 74% were detected by Phadebact and only 53% by Bactigen. Gram stain results were positive for 85% of all specimens positive on culture. Bactigen was slightly more specific (97%) than Phadebact (96%). Bactigen, however, showed less specificity (81%) than Phadebact (94%) on 31 CSF specimens that were culture positive for organisms other than the test organisms. These included two CSF specimens from patients with tuberculous meningitis which gave false positive results for S pneumoniae with the Bactigen reagents. No false positive results were obtained on 104 culture negative CSF samples. Bactigen latex agglutination was superior to Phadebact coagglutination and Gram stain for the detection of S pneumoniae and H influenzae in CSF specimens from patients with bacteriologically proved meningitis.
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