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Agizew TB, Soka J, Fast CD, Mwimanzi S, Mwesiga G, Edward N, Stephen M, Kondo R, Burny R, Cox C, Beyene N. Increased tuberculosis case detection in Tanzanian children and adults using African giant pouched rats. BMC Infect Dis 2024; 24:401. [PMID: 38622527 PMCID: PMC11017552 DOI: 10.1186/s12879-024-09313-0] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 04/10/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND African giant pouched rats, trained by Anti-Persoonsmijnen Ontmijnende Product Ontwikkeling (APOPO), have demonstrated their ability to detect tuberculosis (TB) from sputum. We assessed rat-based case detection and compared the mycobacterium bacillary load (MTB-load) in children versus adults. METHODS From January-December 2022, samples were collected prospectively from 69 Directly Observed Therapy (DOT) facilities' presumed TB patients. Using an average of five rats, APOPO re-evaluated patients with bacteriologically negative (sputum-smear microscopy or Xpert MTB/RIF) results. Rat-positive samples were tested using concentrated smear light-emitting diode microscopy to confirm TB detection before treatment initiation. The rats' identification of pulmonary TB is based on smelling TB-specific volatile organic compounds (VOCs) in sputum. Using STATA, Chi-square for odds ratio and confidence interval was calculated and evaluated: (1) the yield of rat-based TB detection compared to that of the health facilities; (2) rat-based TB detection in children versus adults; and (3) rats' ability to detect TB across MTB-loads and between children and adults. RESULTS From 35,766 patients, 5.3% (1900/35,766) were smear-positive and 94.7% (33,866/35,766) were smear or Xpert-negatives at DOTS facility. Of those with negative results, 2029 TB cases were detected using rats, contributing to 52% (2029/3929 of total TB identified), which otherwise would have been missed. Compared to DOT facilities, rats were six-fold more likely to detect TB among Acid Fast Bacilli (AFB) 1+/scanty [90% (1829/2029) versus 60% (1139/1900), odds ratio, OR = 6.11, 95% confidence interval, CI: 5.14-7.26]; twice more likely to identify TB cases among children [71% (91/129) versus 51% (1795/3542), OR = 2.3, 95% CI: 1.59-3.42]; and twice more likely to identify TB cases among children with AFB 1+/scanty than adults with the same MTB-load [5% (86/1703) versus 3% (28/1067), OR = 2.0, 95% CI: 1.28-3.03]. CONCLUSIONS Rats contributed over half of the TB cases identified in program settings, and children, especially those with a lower MTB-load, were more likely to be diagnosed with TB by rats. The chemical signatures, VOCs, were only available for adults, and further research describing the characteristics of VOCs in children versus adults may pave the way to enhance TB diagnosis in children.
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Affiliation(s)
- Tefera B Agizew
- Anti-Persoonsmijnen Ontmijnende Product Ontwikkeling (APOPO) Tuberculosis Department, Sokoine University of Agriculture, Morogoro, Tanzania.
- Department of Biology, University of Antwerp, Antwerp, Belgium.
| | - Joseph Soka
- Anti-Persoonsmijnen Ontmijnende Product Ontwikkeling (APOPO) Tuberculosis Department, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Cynthia D Fast
- Anti-Persoonsmijnen Ontmijnende Product Ontwikkeling (APOPO) Tuberculosis Department, Sokoine University of Agriculture, Morogoro, Tanzania
- Department of Biology, University of Antwerp, Antwerp, Belgium
| | - Stephen Mwimanzi
- Anti-Persoonsmijnen Ontmijnende Product Ontwikkeling (APOPO) Tuberculosis Department, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Gilbert Mwesiga
- Anti-Persoonsmijnen Ontmijnende Product Ontwikkeling (APOPO) Tuberculosis Department, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Nashon Edward
- Anti-Persoonsmijnen Ontmijnende Product Ontwikkeling (APOPO) Tuberculosis Department, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Marygiven Stephen
- Anti-Persoonsmijnen Ontmijnende Product Ontwikkeling (APOPO) Tuberculosis Department, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Reheme Kondo
- Anti-Persoonsmijnen Ontmijnende Product Ontwikkeling (APOPO) Tuberculosis Department, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Robert Burny
- APOPO, TB Detection Program, Eduardo Mondlane University, Maputo, Mozambique
| | - Christophe Cox
- Anti-Persoonsmijnen Ontmijnende Product Ontwikkeling (APOPO) Tuberculosis Department, Sokoine University of Agriculture, Morogoro, Tanzania
- Department of Biology, University of Antwerp, Antwerp, Belgium
| | - Negussie Beyene
- Anti-Persoonsmijnen Ontmijnende Product Ontwikkeling (APOPO) Tuberculosis Department, Sokoine University of Agriculture, Morogoro, Tanzania
- Department of Biology, University of Antwerp, Antwerp, Belgium
- APOPO TB Research Project, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
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Beyene N, Sitotaw AL, Telila EG, Gebre HA, Alemu NB, Burny R, Cox C, Soka J, Tegegn B, Wassie L, Bobosha K, Agizew T. The use of rats to detect drug-resistant TB. Public Health Action 2023; 13:1-3. [PMID: 37152211 PMCID: PMC10162364 DOI: 10.5588/pha.22.0059] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 12/18/2022] [Indexed: 05/09/2023] Open
Abstract
Although detection of drug-susceptible TB by Anti-Persoonsmijnen Ontmijnende Product Ontwikkeling-trained African giant pouched rats has been known for more than a decade, the detection of drug-resistant TB (DR-TB) using rats has never been explored before. We present what we believe to be the first report on rifampicin-resistant TB (RR-TB) detected using Xpert® MTB/RIF Ultra, comparably identified by rats sniffing sputum samples from presumptive TB patients: 88% of RR-TB detected using Ultra were identified by the rats. Further evaluation of the usefulness of rats for large-scale DR-TB contact triage testing is needed, especially in low- and middle-income countries, where resources are limited.
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Affiliation(s)
- N. Beyene
- Anti-Persoonsmijnen Ontmijnende Product Ontwikkeling (APOPO) TB Research Project, Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
- APOPO, Tuberculosis Department, Sokoine University of Agriculture, Morogoro, Tanzania
- Department of Biology, University of Antwerp, Belgium
| | - A. L. Sitotaw
- Anti-Persoonsmijnen Ontmijnende Product Ontwikkeling (APOPO) TB Research Project, Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | - E. G. Telila
- Anti-Persoonsmijnen Ontmijnende Product Ontwikkeling (APOPO) TB Research Project, Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | - H. A. Gebre
- Anti-Persoonsmijnen Ontmijnende Product Ontwikkeling (APOPO) TB Research Project, Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | - N. B. Alemu
- Anti-Persoonsmijnen Ontmijnende Product Ontwikkeling (APOPO) TB Research Project, Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | - R. Burny
- APOPO, Tuberculosis Department, Sokoine University of Agriculture, Morogoro, Tanzania
- APOPO, Research Project, Eduardo Mondlane University, Maputo, Mozambique
| | - C. Cox
- APOPO, Tuberculosis Department, Sokoine University of Agriculture, Morogoro, Tanzania
- Department of Biology, University of Antwerp, Belgium
| | - J. Soka
- APOPO, Tuberculosis Department, Sokoine University of Agriculture, Morogoro, Tanzania
- APOPO, Research Project, Tanzanian Veterinary Research Institute, Dar es Salaam, Tanzania
| | - B. Tegegn
- Addis Ababa City Administration Health Bureau, Tuberculosis/HIV, Addis Ababa, Ethiopia
| | - L. Wassie
- AHRI, Mycobacterium, Diseases Research Directorate, Addis Ababa, Ethiopia
| | - K. Bobosha
- AHRI, Mycobacterium, Diseases Research Directorate, Addis Ababa, Ethiopia
| | - T. Agizew
- Anti-Persoonsmijnen Ontmijnende Product Ontwikkeling (APOPO) TB Research Project, Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
- APOPO, Tuberculosis Department, Sokoine University of Agriculture, Morogoro, Tanzania
- Department of Biology, University of Antwerp, Belgium
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Fiebig L, Beyene N, Burny R, Fast CD, Cox C, Mgode GF. From pests to tests: training rats to diagnose tuberculosis. Eur Respir J 2020; 55:55/3/1902243. [DOI: 10.1183/13993003.02243-2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 01/07/2020] [Indexed: 11/05/2022]
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Mulder C, Mgode GF, Ellis H, Valverde E, Beyene N, Cox C, Reid SE, van't Hoog AH, Edwards TL. Accuracy of giant African pouched rats for diagnosing tuberculosis: comparison with culture and Xpert® MTB/RIF. Int J Tuberc Lung Dis 2017; 21:1127-1133. [DOI: 10.5588/ijtld.17.0139] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- C. Mulder
- Anti-Persoonsmijnen Ontmijnende Product Ontwikkeling, Sokoine University of Agriculture, Morogoro, Tanzania, Department of Global Health, Academic Medical Centre, Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam,
The Netherlands
| | - G. F. Mgode
- Anti-Persoonsmijnen Ontmijnende Product Ontwikkeling, Sokoine University of Agriculture, Morogoro, Tanzania
| | - H. Ellis
- Anti-Persoonsmijnen Ontmijnende Product Ontwikkeling, Sokoine University of Agriculture, Morogoro, Tanzania, Waikato University, Hamilton, New Zealand
| | - E. Valverde
- Anti-Persoonsmijnen Ontmijnende Product Ontwikkeling, Sokoine University of Agriculture, Morogoro, Tanzania, Vanderbilt University Medical School, Nashville, Tennessee
| | - N. Beyene
- Anti-Persoonsmijnen Ontmijnende Product Ontwikkeling, Sokoine University of Agriculture, Morogoro, Tanzania
| | - C. Cox
- Anti-Persoonsmijnen Ontmijnende Product Ontwikkeling, Sokoine University of Agriculture, Morogoro, Tanzania
| | - S. E. Reid
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA, Tuberculosis Department, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - A. H. van't Hoog
- Department of Global Health, Academic Medical Centre, Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, The Netherlands
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Poling A, Valverde E, Beyene N, Mulder C, Cox C, Mgode G, Edwards TL. Active tuberculosis detection by pouched rats in 2014: More than 2,000 new patients found in two countries. J Appl Behav Anal 2016; 50:165-169. [PMID: 27718224 DOI: 10.1002/jaba.356] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 01/04/2016] [Accepted: 07/05/2016] [Indexed: 11/11/2022]
Abstract
Tuberculosis (TB) is a major problem in poor countries because sensitive diagnostic tools are unavailable. In 2014, our pouched rats evaluated sputum from 21,600 Tanzanians and 9,048 Mozambicans whose sputum had previously been evaluated by microscopy, the standard diagnostic for TB. Evaluation by the rats revealed 1,412 new patients with active TB in Tanzania and 645 new patients in Mozambique, increases of 39% and 53%, respectively, when compared to detections by microscopy alone. These results provide further support for the applied use of scent-detecting rats.
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Affiliation(s)
- Alan Poling
- Western Michigan University, Anti-Persoonsmijen Ontmijnende Product Ontwikkeling (APOPO)
| | | | | | - Christiaan Mulder
- Anti-Persoonsmijen Ontmijnende Product Ontwikkeling (APOPO), Amsterdam Institute for Global Health and Development
| | - Christophe Cox
- Anti-Persoonsmijen Ontmijnende Product Ontwikkeling (APOPO)
| | - Georgies Mgode
- Anti-Persoonsmijen Ontmijnende Product Ontwikkeling (APOPO), Sokoine University of Agriculture
| | - Timothy L Edwards
- Anti-Persoonsmijen Ontmijnende Product Ontwikkeling (APOPO), University of Waikato
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Beyene N, Mahoney A, Cox C, Weetjens B, Makingi G, Mgode G, Durgin A, Kuipers D, Jubitana M, Egwaga S, Kamara D, Lwilla F, Mfinanga SG, Kahwa A, Machang'u R, Kazwala R, Reither K, Kaufmann SHE, Poling A. APOPO's tuberculosis research agenda: achievements, challenges and prospects. ACTA ACUST UNITED AC 2015; 14:121-30. [PMID: 26591733 DOI: 10.4314/thrb.v14i2.5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article describes Anti-Persoonsmijnen Ontmijnende Product Ontwikkeling (APOPO) recent use of specially trained African giant pouched rats as detectors of pulmonary tuberculosis in people living in Tanzania. It summarizes the achievements and challenges encountered over the years and outlines future prospects. Since 2008, second-line screening by the rats has identified more than 2000 tuberculosis-positive patients who were missed by microscopy at Direct Observation of Treatment--Short Course centres in Tanzania. Moreover, data that are reviewed herein have been collected with respect to the rats' sensitivity and specificity in detecting tuberculosis. Findings strongly suggest that scent-detecting rats offer a quick and practical tool for detecting pulmonary tuberculosis and within the year APOPO's tuberculosis-detection project will be extended to Mozambique. As part of its local capacity building effort, APOPO hires and trains Tanzanians to play many important roles in its TB detection project and provides research and training opportunities for Tanzanian students.
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Affiliation(s)
- Negussie Beyene
- Anti-Persoonsmijnen Ontmijnende Product Ontwikkeling, Sokoine University of Agriculture, Morogoro, Tanzania.
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Poling A, Mahoney A, Beyene N, Mgode G, Weetjens B, Cox C, Durgin A. Using giant African pouched rats to detect human tuberculosis: a review. Pan Afr Med J 2015; 21:333. [PMID: 26587178 PMCID: PMC4634033 DOI: 10.11604/pamj.2015.21.333.2977] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 11/30/2013] [Indexed: 11/11/2022] Open
Abstract
Despite its characteristically low sensitivity, sputum smear microscopy remains the standard for diagnosing tuberculosis (TB) in resource-poor countries. In an attempt to develop an alternative or adjunct to microscopy, researchers have recently examined the ability of pouched rats to detect TB-positive human sputum samples and the microbiological variables that affect their detection. Ten published studies, reviewed herein, suggest that the rats are able to detect the specific odor of Mycobacterium tuberculosis, which causes TB, and can substantially increase new-case detections when used for second-line TB screening following microscopy. Further research is needed to ascertain the rats' ability to detect TB in children and in HIV-positive patients, to detect TB when used for first-line screening, and to be useful in broad-scale applications where cost-effectiveness is a major consideration.
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Affiliation(s)
- Alan Poling
- Department of Psychology, Western Michigan University, Kalamazoo, Michigan 49008, United States of America ; APOPO, Tanzania
| | | | | | - Georgies Mgode
- APOPO, Tanzania ; Sokoine University of Agriculture, Tanzania
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Mahoney A, Edwards TL, LaLonde K, Beyene N, Cox C, Weetjens BJ, Poling A. Pouched rats' (Cricetomys gambianus) detection of Salmonella in horse feces. J Vet Behav 2014. [DOI: 10.1016/j.jveb.2014.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Mahoney A, Edwards TL, Weetjens BJ, Cox C, Beyene N, Jubitana M, Durgin A, Poling A. Giant African Pouched Rats (Cricetomys Gambianus) as Detectors of Tuberculosis in Human Sputum: Two Operational Improvements. TPR 2013. [DOI: 10.11133/j.tpr.2013.63.3.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
In recent years, operant discrimination training procedures have been used to teach giant African pouched rats to detect tuberculosis (TB) in human sputum samples. This article summarizes how the rats are trained and used operationally, as well as their performance in studies published to date. Available data suggest that pouched rats, which can evaluate many samples quickly, are sufficiently accurate in detecting TB to merit further investigation as a diagnostic tool.
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Affiliation(s)
- Alan Poling
- Western Michigan University and Anti-Persoonsmijnen Ontmijnende Product Ontwikkeling
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Poling A, Weetjens BJ, Cox C, Beyene N, Bach H, Sully A. Teaching giant african pouched rats to find landmines: operant conditioning with real consequences. Behav Anal Pract 2012; 3:19-25. [PMID: 22532890 DOI: 10.1007/bf03391761] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Giant African pouched rats recently have been used as mine-detection animals in Mozambique. To provide an example of the wide range of problems to which operant conditioning procedures can be applied and to illustrate the common challenges often faced in applying those procedures, this manuscript briefly describes how the rats are trained and used operationally. To date, the rats have performed well and it appears they can play a valuable role in humanitarian demining.
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Affiliation(s)
- Alan Poling
- Department of Psychology, Western Michigan University
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Mahoney AM, Weetjens BJ, Cox C, Beyene N, Mgode G, Jubitana M, Kuipers D, Kazwala R, Mfinanga GS, Durgin A, Poling A. Using giant African pouched rats to detect tuberculosis in human sputum samples: 2010 findings. Pan Afr Med J 2011; 9:28. [PMID: 22145062 PMCID: PMC3215550 DOI: 10.4314/pamj.v9i1.71204] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [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: 06/06/2011] [Accepted: 07/06/2011] [Indexed: 11/17/2022] Open
Abstract
Giant African pouched rats previously have detected tuberculosis (TB) in human sputum samples in which the presence of TB was not initially detected by smear microscopy. Operant conditioning principles were used to train these rats to indicate TB-positive samples. In 2010, rats trained in this way evaluated 26,665 sputum samples from 12,329 patients. Microscopy performed at DOTS centers found 1,671 (13.6%) of these patients to be TB-positive. Detection rats identified 716 additional TB-positive patients, a 42.8% increase in new-case detection. These previously unreported data, which extend to over 20,000 the number of patients evaluated by pouched rats in simulated second-line screening, suggest that the rats can be highly valuable in that capacity.
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Affiliation(s)
- Amanda M Mahoney
- Anti-Persoonsmijnen Ontmijnende Product Ontwikkeling, Morogoro, Tanzania
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