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Snobre J, Villellas MC, Coeck N, Mulders W, Tzfadia O, de Jong BC, Andries K, Rigouts L. Bedaquiline- and clofazimine- selected Mycobacterium tuberculosis mutants: further insights on resistance driven largely by Rv0678. Sci Rep 2023; 13:10444. [PMID: 37369740 DOI: 10.1038/s41598-023-36955-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
Drug-resistant tuberculosis is a serious global health threat. Bedaquiline (BDQ) is a relatively new core drug, targeting the respiratory chain in Mycobacterium tuberculosis (Mtb). While mutations in the BDQ target gene, atpE, are rare in clinical isolates, mutations in the Rv0678 gene, a transcriptional repressor regulating the efflux pump MmpS5-MmpL5, are increasingly observed, and have been linked to worse treatment outcomes. Nevertheless, underlying mechanisms of (cross)-resistance remain incompletely resolved. Our study aims to distinguish resistance associated variants from other polymorphisms, by assessing the in vitro onset of mutations under drug pressure, combined with their impact on minimum inhibitory concentrations (MICs) and on protein stability. For this purpose, isolates were exposed in vitro to sub-lethal concentrations of BDQ or clofazimine (CFZ). Selected colonies had BDQ- and CFZ-MICs determined on 7H10 and 7H11 agar. Sanger sequencing and additional Deeplex Myc-TB and whole genome sequencing (WGS) for a subset of isolates were used to search for mutations in Rv0678, atpE and pepQ. In silico characterization of relevant mutations was performed using computational tools. We found that colonies that grew on BDQ medium had mutations in Rv0678, atpE or pepQ, while CFZ-exposed isolates presented mutations in Rv0678 and pepQ, but none in atpE. Twenty-eight Rv0678 mutations had previously been described among in vitro selected mutants or in patients' isolates, while 85 were new. Mutations were scattered across the Rv0678 gene without apparent hotspot. While most Rv0678 mutations led to an increased BDQ- and/or CFZ-MIC, only a part of them surpassed the critical concentration (69.1% for BDQ and 87.9% for CFZ). Among the mutations leading to elevated MICs for BDQ and CFZ, we report a synonymous Val1Val mutation in the Rv0678 start codon. Finally, in silico characterization of Rv0678 mutations suggests that especially the C46R mutant may render Rv0678 less stable.
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Affiliation(s)
- J Snobre
- Mycobacteriology Unit, Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Internal Medicine Department, UZ Brussel, Brussels, Belgium
- Doctoral School of Life Sciences & Medicine, Vrije Universiteit Brussel, Brussels, Belgium
| | - M C Villellas
- Department of Infectious Diseases, Janssen Pharmaceutica, Beerse, Belgium
| | - N Coeck
- Mycobacteriology Unit, Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - W Mulders
- Mycobacteriology Unit, Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - O Tzfadia
- Mycobacteriology Unit, Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - B C de Jong
- Mycobacteriology Unit, Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - K Andries
- Department of Infectious Diseases, Janssen Pharmaceutica, Beerse, Belgium
| | - L Rigouts
- Mycobacteriology Unit, Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
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Akkerman OW, Duarte R, Tiberi S, Schaaf HS, Lange C, Alffenaar JWC, Denholm J, Carvalho ACC, Bolhuis MS, Borisov S, Bruchfeld J, Cabibbe AM, Caminero JA, Carvalho I, Chakaya J, Centis R, Dalcomo MP, D Ambrosio L, Dedicoat M, Dheda K, Dooley KE, Furin J, García-García JM, van Hest NAH, de Jong BC, Kurhasani X, Märtson AG, Mpagama S, Torrico MM, Nunes E, Ong CWM, Palmero DJ, Ruslami R, Saktiawati AMI, Semuto C, Silva DR, Singla R, Solovic I, Srivastava S, de Steenwinkel JEM, Story A, Sturkenboom MGG, Tadolini M, Udwadia ZF, Verhage AR, Zellweger JP, Migliori GB. Clinical standards for drug-susceptible pulmonary TB. Int J Tuberc Lung Dis 2022; 26:592-604. [PMID: 35768923 PMCID: PMC9272737 DOI: 10.5588/ijtld.22.0228] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 04/20/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND: The aim of these clinical standards is to provide guidance on 'best practice´ for diagnosis, treatment and management of drug-susceptible pulmonary TB (PTB).METHODS: A panel of 54 global experts in the field of TB care, public health, microbiology, and pharmacology were identified; 46 participated in a Delphi process. A 5-point Likert scale was used to score draft standards. The final document represents the broad consensus and was approved by all 46 participants.RESULTS: Seven clinical standards were defined: Standard 1, all patients (adult or child) who have symptoms and signs compatible with PTB should undergo investigations to reach a diagnosis; Standard 2, adequate bacteriological tests should be conducted to exclude drug-resistant TB; Standard 3, an appropriate regimen recommended by WHO and national guidelines for the treatment of PTB should be identified; Standard 4, health education and counselling should be provided for each patient starting treatment; Standard 5, treatment monitoring should be conducted to assess adherence, follow patient progress, identify and manage adverse events, and detect development of resistance; Standard 6, a recommended series of patient examinations should be performed at the end of treatment; Standard 7, necessary public health actions should be conducted for each patient. We also identified priorities for future research into PTB.CONCLUSION: These consensus-based clinical standards will help to improve patient care by guiding clinicians and programme managers in planning and implementation of locally appropriate measures for optimal person-centred treatment for PTB.
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Affiliation(s)
- O W Akkerman
- TB Center Beatrixoord, University Medical Center Groningen, University of Groningen, Haren, the Netherlands, Department of Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - R Duarte
- Centro Hospitalar de Vila Nova de Gaia/Espinho; Instituto de Ciencias Biomédicas de Abel Saalazar, Universidade do Porto, Instituto de Saúde Publica da Universidade do Porto, Unidade de Investigação Clínica, ARS Norte, Porto, Portugal
| | - S Tiberi
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Division of Infection, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - H S Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - C Lange
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany, German Center for Infection Research (DZIF) Clinical Tuberculosis Unit, Borstel, Germany, Respiratory Medicine & International Health, University of Lübeck, Lübeck, Germany, The Global Tuberculosis Program, Texas Children´s Hospital, Immigrant and Global Health, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - J W C Alffenaar
- Sydney Institute for Infectious Diseases, The University of Sydney, Sydney, NSW, Australia, School of Pharmacy, The University of Sydney Faculty of Medicine and Health, Sydney, NSW, Australia, Westmead Hospital, Sydney, NSW, Australia
| | - J Denholm
- Victorian Tuberculosis Program, Melbourne Health, Department of Infectious diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - A C C Carvalho
- Laboratório de Inovações em Terapias, Ensino e Bioprodutos, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, RJ, Brazil
| | - M S Bolhuis
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - S Borisov
- Moscow Research and Clinical Center for Tuberculosis Control, Moscow, Russia
| | - J Bruchfeld
- Division of Infectious Diseases, Department of Medicine, Karolinska Institutet, Solna, Stockholm, Sweden, Department of Infectious Disease, Karolinska University Hospital, Stockholm, Sweden
| | - A M Cabibbe
- Emerging Bacterial Pathogens Unit, Division of Immunology, Transplantation and Infectious Diseases, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy
| | - J A Caminero
- Department of Pneumology, University General Hospital of Gran Canaria "Dr Negrin", Las Palmas, Spain, ALOSA (Active Learning over Sanitary Aspects) TB Academy, Spain
| | - I Carvalho
- Pediatric Department, Vila Nova de Gaia Outpatient Tuberculosis Centre, Vila Nova de Gaia Hospital Centre, Vila Nova de Gaia, Portugal
| | - J Chakaya
- Department of Medicine, Therapeutics and Dermatology, Kenyatta University, Nairobi, Kenya, Department of Clinical Sciences. Liverpool School of Tropical Medicine, Liverpool, UK
| | - R Centis
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
| | - M P Dalcomo
- Reference Center Helio Fraga, FIOCRUZ, Brazil
| | - L D Ambrosio
- Public Health Consulting Group, Lugano, Switzerland
| | - M Dedicoat
- Department of Infectious Diseases, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - K Dheda
- Centre for Lung Infection and Immunity Unit, Department of Medicine, Division of Pulmonology and UCT Lung Institute, University of Cape Town, Cape Town, South Africa, South African Medical Research Council Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - K E Dooley
- Center for Tuberculosis Research, Johns Hopkins, Baltimore, MD
| | - J Furin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | | | - N A H van Hest
- Department of Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands, Municipal Public Health Service Groningen, Groningen, The Netherlands
| | - B C de Jong
- Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - X Kurhasani
- UBT-Higher Education Institution Prishtina, Kosovo
| | - A G Märtson
- Antimicrobial Pharmacodynamics and Therapeutics, Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - S Mpagama
- Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzani, Kibong´oto Infectious Diseases Hospital, Sanya Juu, Siha, Kilimanjaro, United Republic of Tanzania
| | - M Munoz Torrico
- Clínica de Tuberculosis, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, México City, Mexico
| | - E Nunes
- Department of Pulmonology of Central Hospital of Maputo, Maputo, Mozambique, Faculty of Medicine of Eduardo Mondlane University, Maputo, Mozambique
| | - C W M Ong
- Infectious Disease Translational Research Programme, Department of Medicine, National University of Singapore, Yong Loo Lin School of Medicine, Singapore, National University of Singapore Institute for Health Innovation & Technology (iHealthtech), Singapore, Division of Infectious Diseases, Department of Medicine, National University Hospital, Singapore
| | - D J Palmero
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - R Ruslami
- Department of Biomedical Science, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia, Research Center for Care and Control of Infectious Disease (RC3iD), Universitas Padjadjaran, Bandung, Indonesia
| | - A M I Saktiawati
- Department of Internal Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia, Center for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - C Semuto
- Research, Innovation and Data Science Division, Rwanda Biomedical Center, Kigali, Rwanda
| | - D R Silva
- Instituto Vaccarezza, Hospital Muñiz, Buenos Aires, Argentina
| | - R Singla
- National Institute of Tuberculosis & Respiratory Diseases, New Delhi, India
| | - I Solovic
- National Institute of Tuberculosis, Lung Diseases and Thoracic Surgery, Faculty of Health, Catholic University, Ružomberok, Vyšné Hágy, Slovakia
| | - S Srivastava
- Department of Pulmonary Immunology, University of Texas Health Science Centre at Tyler, Tyler, TX, USA
| | - J E M de Steenwinkel
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - A Story
- Institute of Epidemiology and Healthcare, University College London, London, UK, Find and Treat, University College Hospitals NHS Foundation Trust, London, UK
| | - M G G Sturkenboom
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - M Tadolini
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Z F Udwadia
- P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | - A R Verhage
- Department of Pediatrics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - J P Zellweger
- TB Competence Center, Swiss Lung Association, Berne, Switzerland
| | - G B Migliori
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
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Ejo M, Van Deun A, Nunn A, Meredith S, Ahmed S, Dalai D, Tumenbayar O, Tsogt B, Dat PT, Ha DTM, Hang PT, Kokebu D, Teferi M, Mebrahtu T, Ngubane N, Moodliar R, Duckworth L, Conradie F, Enduwamahoro E, Keysers J, De Rijk P, Mulders W, Diro E, Rigouts L, de Jong BC, Torrea G. Effectiveness of GenoType MTBDR sl in excluding TB drug resistance in a clinical trial. Int J Tuberc Lung Dis 2021; 25:839-845. [PMID: 34615581 DOI: 10.5588/ijtld.21.0212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES: To assess the performance of the GenoType MTBDRsl v1, a line-probe assay (LPA), to exclude baseline resistance to fluoroquinolones (FQs) and second-line injectables (SLIs) in the Standard Treatment Regimen of Anti-tuberculosis Drugs for Patients With MDR-TB 1 (STREAM 1) trial.METHODS: Direct sputum MTBDRsl results in the site laboratories were compared to indirect phenotypic drug susceptibility testing (pDST) results in the central laboratory, with DNA sequencing as a reference standard.RESULTS: Of 413 multidrug-resistant TB (MDR-TB) patients tested using MTBDRsl and pDST, 389 (94.2%) were FQ-susceptible and 7 (1.7%) FQ-resistant, while 17 (4.1%) had an inconclusive MTBDRsl result. For SLI, 372 (90.1%) were susceptible, 5 (1.2%) resistant and 36 (8.7%) inconclusive. There were 9 (2.3%) FQ discordant pDST/MTBDRsl results, of which 3 revealed a mutation and 5 (1.3%) SLI discordant pDST/MTBDRsl results, none of which were mutants on sequencing. Among the 17 FQ- and SLI MTBDRsl-inconclusive samples, sequencing showed 1 FQ- and zero SLI-resistant results, similar to frequencies among the conclusive MTBDRsl. The majority of inconclusive MTBDRsl results were associated with low bacillary load samples (acid-fast bacilli smear-negative or scantily positive) compared to conclusive results (P < 0.001).CONCLUSION: MTBDRsl can facilitate the rapid exclusion of FQ and SLI resistances for enrolment in clinical trials.
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Affiliation(s)
- M Ejo
- Institute of Tropical Medicine, Antwerp, Belgium, University of Gondar, Gondar, Ethiopia, Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - A Van Deun
- Institute of Tropical Medicine, Antwerp, Belgium, Independent Consultant, Leuven, Belgium
| | - A Nunn
- Medical Research Council Clinical Trials at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - S Meredith
- Medical Research Council Clinical Trials at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - S Ahmed
- Medical Research Council Clinical Trials at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - D Dalai
- National Centre of Infectious Diseases, National Tuberculosis Reference Laboratory, Ulaanbaatar, Mongolia
| | - O Tumenbayar
- National Centre of Infectious Diseases, National Tuberculosis Reference Laboratory, Ulaanbaatar, Mongolia
| | - B Tsogt
- Mongolian TB Coalition, Ulaanbaatar, Mongolia
| | - P T Dat
- Pham Ngoc Thach Hospital, Ho Chi Minh, Vietnam
| | - D T M Ha
- Pham Ngoc Thach Hospital, Ho Chi Minh, Vietnam
| | - P T Hang
- Pham Ngoc Thach Hospital, Ho Chi Minh, Vietnam
| | - D Kokebu
- Saint Peter´s TB Specialized Hospital, Addis Ababa, Ethiopia
| | - M Teferi
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - T Mebrahtu
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - N Ngubane
- Doris Goodwin Hospital, Pietermaritzburg, South Africa
| | - R Moodliar
- King Dinuzulu Hospital, Durban, South Africa
| | - L Duckworth
- King Dinuzulu Hospital, Durban, South Africa
| | - F Conradie
- Sizwe Tropical Disease, Johannesburg, South Africa
| | | | - J Keysers
- Institute of Tropical Medicine, Antwerp, Belgium
| | - P De Rijk
- Institute of Tropical Medicine, Antwerp, Belgium
| | - W Mulders
- Institute of Tropical Medicine, Antwerp, Belgium
| | - E Diro
- University of Gondar, Gondar, Ethiopia
| | - L Rigouts
- Institute of Tropical Medicine, Antwerp, Belgium, Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - B C de Jong
- Institute of Tropical Medicine, Antwerp, Belgium
| | - G Torrea
- Institute of Tropical Medicine, Antwerp, Belgium
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4
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Guglielmetti L, Ardizzoni E, Atger M, Baudin E, Berikova E, Bonnet M, Chang E, Cloez S, Coit JM, Cox V, de Jong BC, Delifer C, Do JM, Tozzi DDS, Ducher V, Ferlazzo G, Gouillou M, Khan A, Khan U, Lachenal N, LaHood AN, Lecca L, Mazmanian M, McIlleron H, Moschioni M, O’Brien K, Okunbor O, Oyewusi L, Panda S, Patil SB, Phillips PPJ, Pichon L, Rupasinghe P, Rich ML, Saluhuddin N, Seung KJ, Tamirat M, Trippa L, Cellamare M, Velásquez GE, Wasserman S, Zimetbaum PJ, Varaine F, Mitnick CD. Evaluating newly approved drugs for multidrug-resistant tuberculosis (endTB): study protocol for an adaptive, multi-country randomized controlled trial. Trials 2021; 22:651. [PMID: 34563240 PMCID: PMC8465691 DOI: 10.1186/s13063-021-05491-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 03/08/2021] [Accepted: 07/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Treatment of multidrug- and rifampin-resistant tuberculosis (MDR/RR-TB) is expensive, labour-intensive, and associated with substantial adverse events and poor outcomes. While most MDR/RR-TB patients do not receive treatment, many who do are treated for 18 months or more. A shorter all-oral regimen is currently recommended for only a sub-set of MDR/RR-TB. Its use is only conditionally recommended because of very low-quality evidence underpinning the recommendation. Novel combinations of newer and repurposed drugs bring hope in the fight against MDR/RR-TB, but their use has not been optimized in all-oral, shorter regimens. This has greatly limited their impact on the burden of disease. There is, therefore, dire need for high-quality evidence on the performance of new, shortened, injectable-sparing regimens for MDR-TB which can be adapted to individual patients and different settings. METHODS endTB is a phase III, pragmatic, multi-country, adaptive, randomized, controlled, parallel, open-label clinical trial evaluating the efficacy and safety of shorter treatment regimens containing new drugs for patients with fluoroquinolone-susceptible, rifampin-resistant tuberculosis. Study participants are randomized to either the control arm, based on the current standard of care for MDR/RR-TB, or to one of five 39-week multi-drug regimens containing newly approved and repurposed drugs. Study participation in all arms lasts at least 73 and up to 104 weeks post-randomization. Randomization is response-adapted using interim Bayesian analysis of efficacy endpoints. The primary objective is to assess whether the efficacy of experimental regimens at 73 weeks is non-inferior to that of the control. A sample size of 750 patients across 6 arms affords at least 80% power to detect the non-inferiority of at least 1 (and up to 3) experimental regimens, with a one-sided alpha of 0.025 and a non-inferiority margin of 12%, against the control in both modified intention-to-treat and per protocol populations. DISCUSSION The lack of a safe and effective regimen that can be used in all patients is a major obstacle to delivering appropriate treatment to all patients with active MDR/RR-TB. Identifying multiple shorter, safe, and effective regimens has the potential to greatly reduce the burden of this deadly disease worldwide. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT02754765. Registered on 28 April 2016; the record was last updated for study protocol version 3.3, on 27 August 2019.
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Affiliation(s)
- L. Guglielmetti
- Médecins Sans Frontières, Paris, France
- Sorbonne Université, INSERM, U1135, Centre d’Immunologie Et Des Maladies Infectieuses, Paris, France
- Assistance Publique Hôpitaux de Paris, Groupe Hospitalier Universitaire Sorbonne Université, Hôpital Pitié-Salpêtrière, Centre National De Référence Des Mycobactéries Et De La Résistance Des Mycobactéries Aux Antituberculeux, Paris, France
| | - E. Ardizzoni
- Institute of Tropical Medicine, Antwerp, Belgium
| | - M. Atger
- Médecins Sans Frontières, Paris, France
| | | | - E. Berikova
- Partners In Health, Astana, Kazakhstan
- National Scientific Center of Phthisiopulmonology, Almaty, Kazakhstan
| | - M. Bonnet
- Médecins Sans Frontières, Paris, France
- Institut de Recherche pour le Développement/INSERM U1175/UMI233/ Université de Montpellier, Montpellier, France
| | - E. Chang
- Médecins Sans Frontières, Toronto, Ontario Canada
| | - S. Cloez
- Médecins Sans Frontières, Paris, France
| | - J. M. Coit
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA
| | - V. Cox
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | | | - J. M. Do
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA
| | | | - V. Ducher
- Médecins Sans Frontières, Paris, France
| | - G. Ferlazzo
- Southern Africa Medical Unit, Médecins Sans Frontières, Cape Town, South Africa
| | | | - A. Khan
- Interactive Research and Development, Karachi, Pakistan
| | - U. Khan
- Interactive Research and Development, Karachi, Pakistan
| | | | - A. N. LaHood
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA
| | - L. Lecca
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA
- Socios En Salud-Sucursal Peru, Lima, Peru
| | - M. Mazmanian
- Médecins Sans Frontières, Paris, France
- Assistance Publique Hôpitaux de Paris, Unité de Recherche Clinique, Hôpital Pitié-Salpêtrière, Paris, France
| | - H. McIlleron
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | | | | | - O. Okunbor
- Social & Scientific Systems-DLH, Silver Spring, MD USA
| | | | - S. Panda
- Epidemiology and Communicable Diseases Division, Indian Council of Medical Research, Pune, India
- Indian Council of Medical Research – National AIDS Research Institute, Pune, India
| | - S. B. Patil
- Indian Council of Medical Research – National AIDS Research Institute, Pune, India
| | - P. P. J. Phillips
- University of San Francisco Center for Tuberculosis, San Francisco, CA USA
| | - L. Pichon
- Médecins Sans Frontières, Paris, France
| | | | - M. L. Rich
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA
- Partners In Health, Boston, MA USA
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA USA
| | - N. Saluhuddin
- Department of Infectious Diseases, Indus Hospital, Karachi, Pakistan
| | - K. J. Seung
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA
- Partners In Health, Boston, MA USA
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA USA
| | | | - L. Trippa
- Dana-Farber Cancer Institute, Boston, MA USA
- Harvard T.H. Chan School of Public Health, Boston, MA USA
| | | | - G. E. Velásquez
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA USA
- Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, MA USA
| | - S. Wasserman
- Wellcome Centre for Infectious Diseases Research in Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - P. J. Zimetbaum
- Harvard Medical School, Boston, MA USA
- Beth Israel Deaconess Medical Center, Boston, MA USA
| | | | - C. D. Mitnick
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA
- Partners In Health, Boston, MA USA
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA USA
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5
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Diarra B, Decroo T, Somboro A, Coulibaly G, Tolofoudie M, Kone M, Degoga B, Diallo F, Togo ACG, Sanogo M, Sarro YS, Cisse AB, Kodio O, Baya B, Kone A, Maiga M, Dao S, Maiga II, Murphy RL, Siddiqui S, Toloba Y, Konate B, Diakite M, Doumbia S, Van Deun A, Rigouts L, Diallo S, de Jong BC. Fluorescein diacetate and rapid molecular testing for the early identification of rifampicin resistance in Mali. Int J Tuberc Lung Dis 2021; 24:763-769. [PMID: 32912379 DOI: 10.5588/ijtld.19.0698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Non-conversion on auramine smear microscopy indicates a lack of treatment response, possibly associated with initial rifampicin-resistant tuberculosis (RR-TB). However, dead bacteria still stain positive and may be detected. Fluorescein diacetate smear microscopy (FDA) shows live mycobacteria only. Therefore, we studied the potential of 2-month (2M) FDA for the identification of initial RR-TB.METHODS: Between 2015 and 2018, we enrolled new smear-positive pulmonary TB patients from five local centres in Bamako, Mali. After baseline screening, sputum samples were collected at 1M, 2M, 5M and 18M. We used rpoB sequencing to identify initial RR-TB.RESULTS: Of 1359 patients enrolled, 1019 (75%) had rpoB sequencing results. Twenty-six (2.6%, 95%CI: 1.7-3.7) had mutations conferring rifampicin resistance. Most frequent rpoB mutations were located at the codons Asp435Val (42.4%) and Ser450Leu (34.7%). Among patients with initial RR-TB, 72.2% were FDA-negative at 2M (P = 0.2). The positive and negative predictive value of 5M FDA for culture-based failure was respectively 20.0% and 94.7%.CONCLUSION: FDA did not identify the majority of patients with initial RR-TB or culture-based failure. As the full spectrum of mutations identified on sequencing was identified using Xpert, our data support its rapid universal implementation in Mali.
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Affiliation(s)
- B Diarra
- University Clinical Research Centre, SEREFO Laboratory, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali, Unit of Mycobacteriology, Institute of Tropical Medicine Antwerp, Antwerp
| | - T Decroo
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Antwerp, Research Foundation Flanders, Brussels, Belgium
| | - A Somboro
- University Clinical Research Centre, SEREFO Laboratory, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - G Coulibaly
- University Clinical Research Centre, SEREFO Laboratory, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - M Tolofoudie
- University Clinical Research Centre, SEREFO Laboratory, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - M Kone
- University Clinical Research Centre, SEREFO Laboratory, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - B Degoga
- University Clinical Research Centre, SEREFO Laboratory, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - F Diallo
- University Clinical Research Centre, SEREFO Laboratory, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - A C G Togo
- University Clinical Research Centre, SEREFO Laboratory, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - M Sanogo
- University Clinical Research Centre, SEREFO Laboratory, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Y S Sarro
- University Clinical Research Centre, SEREFO Laboratory, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - A B Cisse
- Laboratoire National de Référence des Mycobactéries, Institut National de Recherche en Santé publique, Bamako, Mali
| | - O Kodio
- University Clinical Research Centre, SEREFO Laboratory, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - B Baya
- University Clinical Research Centre, SEREFO Laboratory, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - A Kone
- University Clinical Research Centre, SEREFO Laboratory, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - M Maiga
- Global Health, Northwestern University, Chicago, IL, USA
| | - S Dao
- University Clinical Research Centre, SEREFO Laboratory, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - I I Maiga
- Laboratoire d´analyses Médicales et Hygiène Hospitalière du Centre Hospitalier Universitaire du Point-G, Bamako, Mali
| | - R L Murphy
- Laboratoire National de Référence des Mycobactéries, Institut National de Recherche en Santé publique, Bamako, Mali
| | - S Siddiqui
- Collaborative Clinical Research Branch, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
| | - Y Toloba
- Service de Pneumo-phtisiologie du Centre Hospitalier Universitaire du Point-G, Bamako
| | - B Konate
- Programme National de Lutte contre la Tuberculose (PNLT), Ministère de la santé et des Affaires Sociales, Bamako, Mali
| | - M Diakite
- University Clinical Research Centre, SEREFO Laboratory, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - S Doumbia
- University Clinical Research Centre, SEREFO Laboratory, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | | | - L Rigouts
- Unit of Mycobacteriology, Institute of Tropical Medicine Antwerp, Antwerp, Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - S Diallo
- University Clinical Research Centre, SEREFO Laboratory, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - B C de Jong
- Unit of Mycobacteriology, Institute of Tropical Medicine Antwerp, Antwerp
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6
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Ngabonziza JCS, Habimana YM, Decroo T, Migambi P, Dushime A, Mazarati JB, Rigouts L, Affolabi D, Ivan E, Meehan CJ, Van Deun A, Fissette K, Habiyambere I, Nyaruhirira AU, Turate I, Semahore JM, Ndjeka N, Muvunyi CM, Condo JU, Gasana M, Hasker E, Torrea G, de Jong BC. Reduction of diagnostic and treatment delays reduces rifampicin-resistant tuberculosis mortality in Rwanda. Int J Tuberc Lung Dis 2021; 24:329-339. [PMID: 32228764 DOI: 10.5588/ijtld.19.0298] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING: In 2005, in response to the increasing prevalence of rifampicin-resistant tuberculosis (RR-TB) and poor treatment outcomes, Rwanda initiated the programmatic management of RR-TB, including expanded access to systematic rifampicin drug susceptibility testing (DST) and standardised treatment.OBJECTIVE: To describe trends in diagnostic and treatment delays and estimate their effect on RR-TB mortality.DESIGN: Retrospective analysis of individual-level data including 748 (85.4%) of 876 patients diagnosed with RR-TB notified to the World Health Organization between 1 July 2005 and 31 December 2016 in Rwanda. Logistic regression was used to estimate the effect of diagnostic and therapeutic delays on RR-TB mortality.RESULTS: Between 2006 and 2016, the median diagnostic delay significantly decreased from 88 days to 1 day, and the therapeutic delay from 76 days to 3 days. Simultaneously, RR-TB mortality significantly decreased from 30.8% in 2006 to 6.9% in 2016. Total delay in starting multidrug-resistant TB (MDR-TB) treatment of more than 100 days was associated with more than two-fold higher odds for dying. When delays were long, empirical RR-TB treatment initiation was associated with a lower mortality.CONCLUSION: The reduction of diagnostic and treatment delays reduced RR-TB mortality. We anticipate that universal testing for RR-TB, short diagnostic and therapeutic delays and effective standardised MDR-TB treatment will further decrease RR-TB mortality in Rwanda.
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Affiliation(s)
- J-C S Ngabonziza
- National Reference Laboratory Division, Department of Biomedical Services, Rwanda Biomedical Centre, Kigali, Rwanda, Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Y M Habimana
- Tuberculosis and Other Respiratory Diseases Division, Institute of HIV/AIDS Disease Prevention and Control, Rwanda Biomedical Centre, Kigali, Rwanda
| | - T Decroo
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium, Research Foundation Flanders, Brussels, Belgium
| | - P Migambi
- Tuberculosis and Other Respiratory Diseases Division, Institute of HIV/AIDS Disease Prevention and Control, Rwanda Biomedical Centre, Kigali, Rwanda
| | - A Dushime
- Tuberculosis and Other Respiratory Diseases Division, Institute of HIV/AIDS Disease Prevention and Control, Rwanda Biomedical Centre, Kigali, Rwanda
| | - J B Mazarati
- Department of Biomedical Services, Rwanda Biomedical Centre, Kigali, Rwanda
| | - L Rigouts
- Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - D Affolabi
- Laboratoire de Référence des Mycobactéries, Cotonou, Benin
| | - E Ivan
- National Reference Laboratory Division, Department of Biomedical Services, Rwanda Biomedical Centre, Kigali, Rwanda
| | - C J Meehan
- Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, School of Chemistry and Biosciences, University of Bradford, Bradford, UK
| | - A Van Deun
- Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, International Union Against Tuberculosis and Lung Disease, Paris, France
| | - K Fissette
- Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp
| | - I Habiyambere
- Tuberculosis and Other Respiratory Diseases Division, Institute of HIV/AIDS Disease Prevention and Control, Rwanda Biomedical Centre, Kigali, Rwanda
| | | | - I Turate
- Institute of HIV/AIDS Disease Prevention and Control, Rwanda Biomedical Centre, Kigali
| | - J M Semahore
- HIV, STIs, Hepatitis and Tuberculosis Programmes, World Health Organization Country Office, Kigali, Rwanda
| | - N Ndjeka
- National Tuberculosis Programme, National Department of Health, Pretoria, South Africa
| | - C M Muvunyi
- Department of Clinical Biology, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali
| | - J U Condo
- Rwanda Biomedical Centre, Kigali, Rwanda
| | - M Gasana
- Tuberculosis and Other Respiratory Diseases Division, Institute of HIV/AIDS Disease Prevention and Control, Rwanda Biomedical Centre, Kigali, Rwanda
| | - E Hasker
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - G Torrea
- Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp
| | - B C de Jong
- Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp
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7
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Van Deun A, Piubello A, Lynen L, de Jong BC, Decroo T. Human rights: finding the right balance for rifampicin-resistant TB treatment. Int J Tuberc Lung Dis 2021; 25:327-328. [PMID: 33762079 DOI: 10.5588/ijtld.20.0939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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)
| | | | - L Lynen
- Unit of HIV and TB, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - B C de Jong
- Unit of Mycobacteriology, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - T Decroo
- Unit of HIV and TB, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium, Research Foundation Flanders, Brussels, Belgium
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8
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Maug AKJ, Hossain MA, Gumusboga M, Decroo T, Mulders W, Braet S, Buyze J, Jiménez DA, Schurmans C, Herssens N, Demeulenaere T, Lynen L, de Jong BC, Van Deun A. Finding the right balance between efficacy and tolerability for TB treatment: the search continues. Int J Tuberc Lung Dis 2021; 25:84-86. [PMID: 33384054 DOI: 10.5588/ijtld.20.0575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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)
- A K J Maug
- Damien Foundation Bangladesh, Dhaka, Bangladesh
| | - M A Hossain
- Damien Foundation Bangladesh, Dhaka, Bangladesh
| | - M Gumusboga
- Institute of Tropical Medicine, Antwerp, Belgium
| | - T Decroo
- Institute of Tropical Medicine, Antwerp, Belgium, Research Foundation Flanders, Brussels, Belgium
| | - W Mulders
- Institute of Tropical Medicine, Antwerp, Belgium
| | - S Braet
- Institute of Tropical Medicine, Antwerp, Belgium
| | - J Buyze
- Institute of Tropical Medicine, Antwerp, Belgium
| | - D A Jiménez
- Institute of Tropical Medicine, Antwerp, Belgium
| | - C Schurmans
- Institute of Tropical Medicine, Antwerp, Belgium
| | - N Herssens
- Institute of Tropical Medicine, Antwerp, Belgium
| | | | - L Lynen
- Institute of Tropical Medicine, Antwerp, Belgium
| | - B C de Jong
- Institute of Tropical Medicine, Antwerp, Belgium
| | - A Van Deun
- Independent Consultant, Leuven, Belgium, ,
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9
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Maug AKJ, Hossain MA, Gumusboga M, Decroo T, Mulders W, Braet S, Buyze J, Arango D, Schurmans C, Herssens N, Demeulenaere T, Lynen L, de Jong BC, Van Deun A. First-line tuberculosis treatment with double-dose rifampicin is well tolerated. Int J Tuberc Lung Dis 2020; 24:499-505. [DOI: 10.5588/ijtld.19.0063] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE: To compare the occurrence of unfavourable treatment and safety outcomes of double-dose rifampicin (RMP; 20 mg/kg/d, intervention) with standard dose (10 mg/kg/d, control) in a first-line tuberculosis (TB) treatment regimen for smear-positive TB patients in Bangladesh.DESIGN:
This was a randomised clinical trial. The primary efficacy and safety endpoints were the occurrence of an unfavourable treatment outcome (death, failure, relapse or loss to follow-up) and the occurrence of any serious drug-related adverse event (SAE).RESULTS: In primary efficacy
analysis, among 343 control and 347 intervention patients, respectively 15.5% and 11.8% had an unfavourable outcome. In safety analysis, among 349 intervention and 352 control patients, respectively 4.3% and 2.6% experienced an SAE. These differences were not significant. There was a significantly
lower occurrence of SAEs, explained by a lower occurrence of hepatic toxicity, in a RMP double-dosed but erroneously HZE (isoniazid+pyrazinamide+ethambutol) under-dosed subgroup.CONCLUSIONS: Our findings show that there is no statistically significant difference in terms of efficacy
and safety between standard and double-dose RMP. An accidental finding (related to dosage levels of the standard regimen) suggests that high-dose RMP is potentially a lesser cause of hepatotoxicity. Larger trials with more power, or trials with at least a triple-dose might be needed to clearly
see the effect of high-dose RMP on unfavourable outcomes.
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Affiliation(s)
| | | | | | - T. Decroo
- Institute of Tropical Medicine, Antwerp, Research Foundation Flanders, Brussels
| | | | - S. Braet
- Institute of Tropical Medicine, Antwerp
| | - J. Buyze
- Institute of Tropical Medicine, Antwerp
| | - D. Arango
- Institute of Tropical Medicine, Antwerp
| | | | | | | | - L. Lynen
- Institute of Tropical Medicine, Antwerp
| | | | - A. Van Deun
- Institute of Tropical Medicine, Antwerp, The Union, Paris, France
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10
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Hasker E, Assoumani Y, Mzembaba A, Zakir AM, Ortuno-Gutierrez N, de Jong BC. Using a geographic information system as a management tool for tuberculosis control. Int J Tuberc Lung Dis 2020; 24:354-356. [PMID: 32228769 DOI: 10.5588/ijtld.19.0704] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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)
- E Hasker
- Institute of Tropical Medicine, Antwerp
| | | | - A Mzembaba
- National Tuberculosis and Leprosy Control Programme, Moroni, Comoros, ,
| | - A M Zakir
- National Tuberculosis and Leprosy Control Programme, Moroni, Comoros, ,
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11
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Diarra B, Tolofoudie M, Sarro YS, Togo ACG, Bane S, Nientao I, Cisse AB, Kone M, Somboro A, Degoga B, Diallo F, Coulibaly G, Kodio O, Sanogo M, Kone B, Diabate S, Baya B, Kone A, Dabitao D, Maiga M, Belson M, Dao S, Maiga II, Murphy RL, Siddiqui S, Toloba Y, Konate B, Doumbia S, de Jong BC, Diallo S. Diabetes Mellitus among new tuberculosis patients in Bamako, Mali. J Clin Tuberc Other Mycobact Dis 2019; 17:100128. [PMID: 31788570 PMCID: PMC6879999 DOI: 10.1016/j.jctube.2019.100128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Indexed: 12/02/2022] Open
Abstract
Introduction Diabetes Mellitus (DM) increases worldwide, mostly in low- and middle-income countries. In Mali, the prevalence in the adult population is estimated at 1.8%, but tuberculosis (TB) patients are not systematically screened. The goal of our study was to determine the prevalence of DM among newly diagnosed TB patients. Methods We conducted a cross sectional study and a pilot prospective cohort study in four health centers in Bamako. All patients underwent fasting capillary-blood glucose (FCBG) test at Day 0, and repeated after one-week of TB treatment. Venous FBG test was performed for discrepancies between the two FCBG results. Thereafter, FCBG was performed for pilot study at month-2 (M2) and M5 of TB treatment. Results Two hundred and one patients were enrolled in this study. Impaired fasting blood glucose was identified in 17 (8.5%), of whom 11 (5.5%) had DM (VFBG >7 mmol/L). Among patients with DM, seven (63.6%) had successful TB treatment outcome, versus 142 (74.7%) of those without DM (p = 0.64), and (OR: 1.69, 95%CI 0.47–6.02). Conclusion The prevalence of DM among TB patients in Bamako exceeds that of the general population and screening at TB diagnosis suffices to identify those with DM. Systematic screening of both diseases will allow better treatment.
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Affiliation(s)
- B Diarra
- University Clinical Research Center (UCRC)-SEREFO-Laboratory, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali.,Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - M Tolofoudie
- University Clinical Research Center (UCRC)-SEREFO-Laboratory, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - Y S Sarro
- University Clinical Research Center (UCRC)-SEREFO-Laboratory, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - A C G Togo
- University Clinical Research Center (UCRC)-SEREFO-Laboratory, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - S Bane
- University Clinical Research Center (UCRC)-SEREFO-Laboratory, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - I Nientao
- Service de Médecine et d'Endocrinologie de l'hôpital du Mali, Bamako, Mali
| | - A B Cisse
- Laboratoire National de Référence des Mycobactéries (LNR), Institut National de Recherche en Santé publique (INRSP), Bamako, Mali
| | - M Kone
- University Clinical Research Center (UCRC)-SEREFO-Laboratory, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - A Somboro
- University Clinical Research Center (UCRC)-SEREFO-Laboratory, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - B Degoga
- University Clinical Research Center (UCRC)-SEREFO-Laboratory, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - F Diallo
- University Clinical Research Center (UCRC)-SEREFO-Laboratory, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - G Coulibaly
- University Clinical Research Center (UCRC)-SEREFO-Laboratory, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - O Kodio
- University Clinical Research Center (UCRC)-SEREFO-Laboratory, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - M Sanogo
- University Clinical Research Center (UCRC)-SEREFO-Laboratory, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - B Kone
- University Clinical Research Center (UCRC)-SEREFO-Laboratory, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - S Diabate
- University Clinical Research Center (UCRC)-SEREFO-Laboratory, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - B Baya
- University Clinical Research Center (UCRC)-SEREFO-Laboratory, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - A Kone
- University Clinical Research Center (UCRC)-SEREFO-Laboratory, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - D Dabitao
- University Clinical Research Center (UCRC)-SEREFO-Laboratory, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - M Maiga
- Global Health, Northwestern University, Chicago, IL, United States
| | - M Belson
- Collaborative Clinical Research Branch, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, United States
| | - S Dao
- University Clinical Research Center (UCRC)-SEREFO-Laboratory, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - I I Maiga
- Laboratoire d'analyses Médicales et Hygiène Hospitalière du Centre Hospitalier Universitaire du Point-G, Bamako, Mali
| | - R L Murphy
- Global Health, Northwestern University, Chicago, IL, United States
| | - S Siddiqui
- Collaborative Clinical Research Branch, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, United States
| | - Y Toloba
- Service de Pneumo-phtisiologie du Centre Hospitalier Universitaire du Point-G, Bamako, Mali
| | - B Konate
- Programme National de Lutte contre la Tuberculose (PNLT), Ministère de la santé et de l'hygiène publique, Bamako, Mali
| | - S Doumbia
- University Clinical Research Center (UCRC)-SEREFO-Laboratory, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - B C de Jong
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - S Diallo
- University Clinical Research Center (UCRC)-SEREFO-Laboratory, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
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12
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Rigouts L, Miotto P, Schats M, Lempens P, Cabibbe AM, Galbiati S, Lampasona V, de Rijk P, Cirillo DM, de Jong BC. Fluoroquinolone heteroresistance in Mycobacterium tuberculosis: detection by genotypic and phenotypic assays in experimentally mixed populations. Sci Rep 2019; 9:11760. [PMID: 31409849 PMCID: PMC6692311 DOI: 10.1038/s41598-019-48289-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [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: 11/21/2018] [Accepted: 08/01/2019] [Indexed: 12/19/2022] Open
Abstract
Heteroresistance - the simultaneous presence of drug-susceptible and -resistant organisms - is common in Mycobacterium tuberculosis. In this study, we aimed to determine the limit of detection (LOD) of genotypic assays to detect gatifloxacin-resistant mutants in experimentally mixed populations. A fluoroquinolone-susceptible M. tuberculosis mother strain (S) and its in vitro selected resistant daughter strain harbouring the D94G mutation in gyrA (R) were mixed at different ratio’s. Minimum inhibitory concentrations (MICs) against gatifloxacin were determined, while PCR-based techniques included: line probe assays (Genotype MTBDRsl and GenoScholar-FQ + KM TB II), Sanger sequencing and targeted deep sequencing. Droplet digital PCR was used as molecular reference method. A breakpoint concentration of 0.25 mg/L allows the phenotypic detection of ≥1% resistant bacilli, whereas at 0.5 mg/L ≥ 5% resistant bacilli are detected. Line probe assays detected ≥5% mutants. Sanger sequencing required the presence of around 15% mutant bacilli to be detected as (hetero) resistant, while targeted deep sequencing detected ≤1% mutants. Deep sequencing and phenotypic testing are the most sensitive methods for detection of fluoroquinolone-resistant minority populations, followed by line probe assays (provided that the mutation is confirmed by a mutation band), while Sanger sequencing proved to be the least sensitive method.
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Affiliation(s)
- L Rigouts
- Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium. .,Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium.
| | - P Miotto
- Emerging Bacterial Pathogens Unit, Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - M Schats
- Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - P Lempens
- Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - A M Cabibbe
- Emerging Bacterial Pathogens Unit, Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - S Galbiati
- Unit of Genomic for the Diagnosis of Human Pathologies, Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - V Lampasona
- Unit of Genomic for the Diagnosis of Human Pathologies, Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - P de Rijk
- Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - D M Cirillo
- Emerging Bacterial Pathogens Unit, Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - B C de Jong
- Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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13
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Van Deun A, Decroo T, Piubello A, de Jong BC, Lynen L, Rieder HL. Principles for constructing a tuberculosis treatment regimen: the role and definition of core and companion drugs. Int J Tuberc Lung Dis 2019; 22:239-245. [PMID: 29471899 DOI: 10.5588/ijtld.17.0660] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Current World Health Organization guidelines for the formulation of treatment regimens for multidrug-resistant tuberculosis (MDR-TB) pay too little attention to the microbiological activity of anti-tuberculosis drugs. Here, we draw lessons from the pioneering work done on shorter MDR-TB treatment regimens and the current knowledge of the bactericidal and sterilizing properties of the drugs to inform the composition of treatment regimens for MDR-TB. We propose to reserve the term 'core drug' for the one drug in a regimen that contributes most to relapse-free cure. The core drug has both moderate to high bactericidal and sterilizing activity, is given throughout treatment, is well tolerated, and has no cross-resistance with the core drug used in the previous regimen. Currently used core drugs include rifampicin in the first-line 6-month regimen, and fourth-generation fluoroquinolones and bedaquiline in regimens for drug-resistant TB. All other drugs are 'companion drugs', used to avert treatment failure due to acquired drug resistance against the core drug. Some also help further reduce the risk of relapse. Moreover, toxic drugs should be avoided if there is an alternative. A regimen must always include the core drug, plus at least one companion drug with high bactericidal activity, a second bactericidal companion drug, plus two sterilizing companion drugs.
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Affiliation(s)
- A Van Deun
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium, International Union Against Tuberculosis and Lung Disease, Paris, France
| | - T Decroo
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp
| | - A Piubello
- International Union Against Tuberculosis and Lung Disease, Paris, France, Damien Foundation, Brussels, Belgium
| | - B C de Jong
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - L Lynen
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp
| | - H L Rieder
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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Van Deun A, Tahseen S, Affolabi D, Hossain MA, Joloba ML, Angra PK, Ridderhof JC, de Jong BC, Rieder HL. Sputum smear microscopy in the Xpert ® MTB/RIF era. Int J Tuberc Lung Dis 2018; 23:12-18. [PMID: 30567624 DOI: 10.5588/ijtld.18.0553] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
A balanced perspective is advocated for the assessment and application of the most recent and the oldest diagnostic methods for pulmonary tuberculosis (TB)-the molecular Xpert® MTB/RIF assay and microscopy for acid-fast bacilli. We discuss their respective merits and shortcomings and identify threats that may hamper their use in TB control. Neither test on its own provides all the information needed for diagnosis and treatment monitoring. Considering all aspects important for both individual patient care and disease control, neither seems 'better' than the other. The required advancement of microscopy had already been hampered before the introduction of the GeneXpert technology by unsuccessful and probably misguided attempts to decentralise culture-based diagnosis and drug susceptibility testing. It seems evident that systematic replacement of microscopy by Xpert is not a viable option for the foreseeable future. Instead, the two methods should complement each other to arrive at a comprehensive, accessible and continuous service for a maximum number of patients. This will intrinsically prioritise targeting the most potent transmitters with the worst prognosis, simultaneously offering optimised prospects for efficient TB control. New microscopy and Xpert applications are expected to ultimately make control programmes independent of culture-based methods in diagnosis, treatment monitoring and outcome assessment.
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Affiliation(s)
- A Van Deun
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium, International Union Against Tuberculosis and Lung Disease, Paris, France
| | - S Tahseen
- National Tuberculosis Control Programme and National Tuberculosis Reference Laboratory, Islamabad, Pakistan
| | - D Affolabi
- Laboratoire de Référence des Mycobactéries, Cotonou, Benin
| | | | - M L Joloba
- National Tuberculosis Control Programme and National Tuberculosis Reference Laboratory, Kampala, College of Health Sciences, School of Biomedical Sciences, Kampala, Uganda
| | - P K Angra
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - J C Ridderhof
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - B C de Jong
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - H L Rieder
- Tuberculosis Consultant Services, Kirchlindach, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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15
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Van Deun A, Aung KJM, Hossain MA, Salim MAH, Gumusboga M, de Jong BC, Decroo T. Twenty years of rifampicin resistance surveillance in Bangladesh: periodic vs. continuous monitoring. Int J Tuberc Lung Dis 2018; 22:1450-1461. [PMID: 30606317 DOI: 10.5588/ijtld.18.0158] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To analyse 20 years of tuberculosis (TB) drug resistance surveillance, comparing conventional periodic random drug resistance surveys with continuous monitoring, in Damien Foundation-supported districts of Bangladesh. DESIGN Retrospective study of data on TB drug resistance from five periodic surveys among newly registered patients vs. continuous monitoring of retreatment patients from 1996 to 2016. RESULTS Periodic surveys and continuous monitoring showed similar trends in rifampicin (RMP) resistance; with all smear-positives registered as denominator, prevalence in new cases was found to be at approximately the same level as incidence in retreatment cases. Changes in trends observed using continuous monitoring preceded those detected in periodic surveys by a few years. The accurate interpretation of trend changes requires detailed knowledge of changes in treatment regimens, referral criteria, testing methods and operational factors. CONCLUSION Low rates of resistance to RMP, isoniazid and the fluoroquinolones were maintained over the two decades, indicating excellent TB programme performance, including highly active standard first- and second-line treatment regimens. Continuous monitoring is feasible, but requires rigorous application of referral guidelines and data maintenance. Contrary to random surveys, continuous monitoring provides early indications of programme performance, essential for individual patient management, and is more efficient and cost-effective.
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Affiliation(s)
- A Van Deun
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium, International Union Against Tuberculosis and Lung Disease, Paris, France
| | | | | | - M A H Salim
- National Tuberculosis Programme, Dhaka, Bangladesh
| | - M Gumusboga
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - B C de Jong
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - T Decroo
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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16
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Ssengooba W, Lukoye D, Meehan CJ, Kateete DP, Joloba ML, de Jong BC, Cobelens FG, van Leth F. Tuberculosis resistance-conferring mutations with fitness cost among HIV-positive individuals in Uganda. Int J Tuberc Lung Dis 2018; 21:531-536. [PMID: 28399968 DOI: 10.5588/ijtld.16.0544] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multidrug-resistant tuberculosis (MDR-TB) is considered to be less transmissible due to the fitness cost associated with drug resistance-conferring mutations in essential genes. OBJECTIVE To test the hypothesis that TB drug resistance-conferring mutations with fitness cost are more frequent among human immunodeficiency virus (HIV) positive than among HIV-negative patients. DESIGN We analysed all strains from the two TB drug resistance surveys conducted in Uganda between 2008 and 2011. Strains phenotypically susceptible to rifampicin and/or isoniazid were assumed to be wild-type; in all other cases, we performed whole-genome sequencing. Mutations at the rpoB531 and katG315 codons were considered without fitness loss, whereas other rpoB codons and non-katG were considered with fitness loss. RESULTS Of the 897 TB patients, 286 (32.1%) were HIV-positive. Mutations with fitness loss in HIV-positive and HIV-negative patients were respectively as follows: non-531 rpoB: 1.03% (n = 3), 0.71% (n = 4) (OR 1.46, 95%CI 0.58-3.68); non-katG: 0.40% (n = 1), 1.0% (n = 6) (OR 0.40, 95%CI 0.07-2.20); rpoB531: 1.49% (n = 4), 0.69% (n = 4) (OR 2.29, 95%CI 0.83-5.77); katG315: 3.86% (n = 11), 2.55% (n = 15) (OR 1.54, 95%CI 0.81-2.90). The odds of mutations with and without fitness cost were higher for patients with a history of previous anti-tuberculosis treatment. CONCLUSIONS Our data do not support the hypothesis that resistance-conferring mutations with fitness cost are likely to be often present in HIV-positive individuals.
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Affiliation(s)
- W Ssengooba
- Department of Global Health and Amsterdam Institute of Global Health and Development, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands, Mycobacteriology Unit, Institute of Tropical Medicine, Antwerp, Belgium, Department of Medical Microbiology, College of Health Sciences, Makerere University, Kampala
| | - D Lukoye
- National Tuberculosis Reference Laboratory, Ministry of Health, Kampala, Uganda
| | - C J Meehan
- Mycobacteriology Unit, Institute of Tropical Medicine, Antwerp, Belgium
| | - D P Kateete
- Department of Medical Microbiology, College of Health Sciences, Makerere University, Kampala
| | - M L Joloba
- Department of Medical Microbiology, College of Health Sciences, Makerere University, Kampala, National Tuberculosis Reference Laboratory, Ministry of Health, Kampala, Uganda
| | - B C de Jong
- Mycobacteriology Unit, Institute of Tropical Medicine, Antwerp, Belgium, Division of Infectious Diseases, New York University, New York, NY, USA
| | - F G Cobelens
- Department of Global Health and Amsterdam Institute of Global Health and Development, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands, KNCV Tuberculosis Foundation, The Hague, The Netherlands
| | - F van Leth
- Department of Global Health and Amsterdam Institute of Global Health and Development, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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17
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Andre E, Isaacs C, Affolabi D, Alagna R, Brockmann D, de Jong BC, Cambau E, Churchyard G, Cohen T, Delmee M, Delvenne JC, Farhat M, Habib A, Holme P, Keshavjee S, Khan A, Lightfoot P, Moore D, Moreno Y, Mundade Y, Pai M, Patel S, Nyaruhirira AU, Rocha LEC, Takle J, Trébucq A, Creswell J, Boehme C. Connectivity of diagnostic technologies: improving surveillance and accelerating tuberculosis elimination. Int J Tuberc Lung Dis 2018; 20:999-1003. [PMID: 27393530 DOI: 10.5588/ijtld.16.0015] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
In regard to tuberculosis (TB) and other major global epidemics, the use of new diagnostic tests is increasing dramatically, including in resource-limited countries. Although there has never been as much digital information generated, this data source has not been exploited to its full potential. In this opinion paper, we discuss lessons learned from the global scale-up of these laboratory devices and the pathway to tapping the potential of laboratory-generated information in the field of TB by using connectivity. Responding to the demand for connectivity, innovative third-party players have proposed solutions that have been widely adopted by field users of the Xpert(®) MTB/RIF assay. The experience associated with the utilisation of these systems, which facilitate the monitoring of wide laboratory networks, stressed the need for a more global and comprehensive approach to diagnostic connectivity. In addition to facilitating the reporting of test results, the mobility of digital information allows the sharing of information generated in programme settings. When they become easily accessible, these data can be used to improve patient care, disease surveillance and drug discovery. They should therefore be considered as a public health good. We list several examples of concrete initiatives that should allow data sources to be combined to improve the understanding of the epidemic, support the operational response and, finally, accelerate TB elimination. With the many opportunities that the pooling of data associated with the TB epidemic can provide, pooling of this information at an international level has become an absolute priority.
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Affiliation(s)
- E Andre
- Pôle de Microbiologie Médicale, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium; Service de Microbiologie, Département de Biologie Clinique, Cliniques Universitaires Saint-Luc, Brussels, Belgium; European Society for Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Mycobacterial Infections (ESGMYC), ESCMID, Basel, Switzerland
| | - C Isaacs
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - D Affolabi
- Faculty of Health Sciences, Abomey-Calavi University, Cotonou, National Tuberculosis Programme, Cotonou, Benin
| | - R Alagna
- TB Supranational Reference Laboratory, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Milan, Italy
| | - D Brockmann
- Institute for Theoretical Biology, Department of Biology, Humboldt University of Berlin, Berlin, Germany; Epidemiological Modelling of Infectious Diseases, Robert Koch Institute, Berlin, Germany
| | - B C de Jong
- Unit of Mycobacteriology, Department of Biomedical Sciences, Institute of Tropical Medicine, Belgium
| | - E Cambau
- European Society for Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Mycobacterial Infections (ESGMYC), ESCMID, Basel, Switzerland; Université Paris Diderot, Institut National de la Santé et de la Recherche Médicale, Unité mixte de recherche 1137, Infection, Antimicrobiens, Modélisation, Evolution, Paris, Bactériologie, Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisière, Paris, France
| | | | - T Cohen
- Yale School of Public Health, Yale University, New Haven, Connecticut, USA
| | - M Delmee
- Pôle de Microbiologie Médicale, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium; Service de Microbiologie, Département de Biologie Clinique, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - J-C Delvenne
- Institute of Information and Communication Technologies, Electronics and Applied Mathematics, Centre for Operations Research and Econometrics, Université Catholique de Louvain, Belgium
| | - M Farhat
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - A Habib
- Interactive Health Solutions, Karachi, Pakistan
| | - P Holme
- Sungkyunkwan University, Seoul, South Korea
| | - S Keshavjee
- Harvard Medical School Center for Global Health Delivery, Dubai, United Arab Emirates
| | - A Khan
- Interactive Research and Development, Karachi, Pakistan
| | - P Lightfoot
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - D Moore
- TB Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Y Moreno
- Institute for Biocomputation and Physics of Complex Systems (BIFI), Department of Theoretical Physics, Faculty of Sciences, University of Zaragoza, Zaragoza, Spain
| | | | - M Pai
- McGill International TB Centre & McGill Global Health Programs, McGill University, Montreal, Quebec, Canada
| | - S Patel
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - L E C Rocha
- Karolinska Institutet, Stockholm, Sweden, Université de Namur, Namur, Belgium
| | - J Takle
- Global Connectivity LLC, Somerville, Massachusetts, USA
| | - A Trébucq
- International Union Against Tuberculosis and Lung Disease, France
| | - J Creswell
- Stop TB Partnership, Geneva, Switzerland
| | - C Boehme
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
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18
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Driesen M, Kondo Y, de Jong BC, Torrea G, Asnong S, Desmaretz C, Mostofa KSM, Tahseen S, Whitfield MG, Cirillo DM, Miotto P, Cabibbe AM, Rigouts L. Evaluation of a novel line probe assay to detect resistance to pyrazinamide, a key drug used for tuberculosis treatment. Clin Microbiol Infect 2017; 24:60-64. [PMID: 28587904 PMCID: PMC5756542 DOI: 10.1016/j.cmi.2017.05.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 05/24/2017] [Accepted: 05/25/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The development of rapid molecular diagnostic assays for pyrazinamide (PZA) resistance is considered technically challenging as mutations are highly diverse, scattered along the full length of the pncA gene and not all are associated with PZA resistance. We evaluated the performance of the novel Genoscholar PZA-TB II line probe assay (PZA-LPA2; NIPRO Corporation, Japan). METHODS To evaluate the applicability of the PZA-LPA2 in clinical settings, we compared the performance of the PZA-LPA2 to a composite reference standard pncA Sanger and Illumina sequencing plus phenotypic susceptibility testing on a panel of 87 Mycobacterium tuberculosis isolates from World Health Organization (WHO) drug resistance surveys, harbouring mutations previously classified as associated or not associated with resistance according to data from peer-reviewed literature. In addition, the PZA-LPA2 was challenged against a selection of isolates with lineage-specific and non-resistance-associated mutations, for which the frequency among clinical isolates is unknown, and tested directly on 59 sputum extracts. RESULTS For the survey isolates, the PZA-LPA2 reached an overall agreement with the composite reference of 97.6% (80/82) or 94.3% (82/87) excluding or including heteroresistance, respectively. The PZA-LPA2 failed on 8.5% (5/59) of clinical samples; among valid results, 100% (14/14) sensitivity and 100% (7/7) specificity was reached relative to pncA Sanger sequencing. CONCLUSIONS The PZA-LPA2 represents a valid and rapid alternative for indirect PZA susceptibility testing. Preliminary findings on clinical samples show promise for direct testing. Further studies are needed to assess the clinical risk of missing heteroresistance and falsely detecting lineage-specific, silent and nonassociated mutations.
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Affiliation(s)
- M Driesen
- Mycobacteriology Unit, Institute of Tropical Medicine, Antwerp, Belgium.
| | - Y Kondo
- R&D Laboratory, NIPRO Corporation, Shiga, Japan
| | - B C de Jong
- Mycobacteriology Unit, Institute of Tropical Medicine, Antwerp, Belgium; New York University, New York, USA; Medical Research Council Unit, Fajara, Gambia
| | - G Torrea
- Mycobacteriology Unit, Institute of Tropical Medicine, Antwerp, Belgium
| | - S Asnong
- Mycobacteriology Unit, Institute of Tropical Medicine, Antwerp, Belgium
| | - C Desmaretz
- Mycobacteriology Unit, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - S Tahseen
- National TB Reference Laboratory, Islamabad, Pakistan
| | - M G Whitfield
- SA MRC Centre for Tuberculosis Research, DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, Division of Molecular Biology and Human Genetics, Stellenbosch University, South Africa
| | - D M Cirillo
- Emerging Bacterial Pathogens Unit, Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - P Miotto
- Emerging Bacterial Pathogens Unit, Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - A M Cabibbe
- Emerging Bacterial Pathogens Unit, Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - L Rigouts
- Mycobacteriology Unit, Institute of Tropical Medicine, Antwerp, Belgium; Biomedical Sciences Department, Antwerp University, Antwerp, Belgium
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19
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Diarra B, Goita D, Tounkara S, Sanogo M, Baya B, Togo ACG, Maiga M, Sarro YS, Kone A, Kone B, M'Baye O, Coulibaly N, Kassambara H, Cisse A, Belson M, Polis MA, Otu J, Gehre F, Antonio M, Dao S, Siddiqui S, Murphy RL, de Jong BC, Diallo S. Tuberculosis drug resistance in Bamako, Mali, from 2006 to 2014. BMC Infect Dis 2016; 16:714. [PMID: 27894266 PMCID: PMC5126865 DOI: 10.1186/s12879-016-2060-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 02/06/2016] [Accepted: 11/22/2016] [Indexed: 12/02/2022] Open
Abstract
Background Although Drug resistance tuberculosis is not a new phenomenon, Mali remains one of the “blank” countries without systematic data. Methods Between 2006 and 2014, we enrolled pulmonary TB patients from local TB diagnostics centers and a university referral hospital in several observational cohort studies. These consecutive patients had first line drug susceptibility testing (DST) performed on their isolates. A subset of MDR was subsequently tested for second line drug resistance. Results A total of 1186 mycobacterial cultures were performed on samples from 522 patients, including 1105 sputa and 81 blood samples, yielding one or more Mycobacterium tuberculosis complex (Mtbc) positive cultures for 343 patients. Phenotypic DST was performed on 337 (98.3%) unique Mtbc isolates, of which 127 (37.7%) were resistant to at least one drug, including 75 (22.3%) with multidrug resistance (MDR). The overall prevalence of MDR-TB was 3.4% among new patients and 66.3% among retreatment patients. Second line DST was available for 38 (50.7%) of MDR patients and seven (18.4%) had resistance to either fluoroquinolones or second-line injectable drugs. Conclusion The drug resistance levels, including MDR, found in this study are relatively high, likely related to the selected referral population. While worrisome, the numbers remained stable over the study period. These findings prompt a nationwide drug resistance survey, as well as continuous surveillance of all retreatment patients, which will provide more accurate results on countrywide drug resistance rates and ensure that MDR patients access appropriate second line treatment. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-2060-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- B Diarra
- SEREFO Program, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali. .,Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
| | - D Goita
- SEREFO Program, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - S Tounkara
- SEREFO Program, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - M Sanogo
- SEREFO Program, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - B Baya
- SEREFO Program, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - A C G Togo
- SEREFO Program, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - M Maiga
- SEREFO Program, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - Y S Sarro
- SEREFO Program, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - A Kone
- SEREFO Program, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - B Kone
- SEREFO Program, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - O M'Baye
- SEREFO Program, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - N Coulibaly
- SEREFO Program, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - H Kassambara
- SEREFO Program, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - A Cisse
- Laboratoire National de Référence des Mycobactéries (LNR), Institut National de Recherche en Santé publique (INRSP), Bamako, Mali
| | - M Belson
- CCRB, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
| | - M A Polis
- CCRB, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
| | - J Otu
- Vaccines and Immunity Theme, Atlantic Boulevard, Medical Research Council (MRC), Fajara, Banjul, The Gambia
| | - F Gehre
- Vaccines and Immunity Theme, Atlantic Boulevard, Medical Research Council (MRC), Fajara, Banjul, The Gambia.,Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - M Antonio
- Vaccines and Immunity Theme, Atlantic Boulevard, Medical Research Council (MRC), Fajara, Banjul, The Gambia.,Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.,Microbiology and Infection Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - S Dao
- SEREFO Program, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - S Siddiqui
- CCRB, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
| | - R L Murphy
- Global Health, Northwestern University, Chicago, IL, USA
| | - B C de Jong
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - S Diallo
- SEREFO Program, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
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20
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Ardizzoni E, Mulders W, Kotrikadze T, Aspindzelashvili R, Goginashvili L, Pangtey H, Varaine F, Bastard M, Rigouts L, de Jong BC. The thin-layer agar method for direct phenotypic detection of multi- and extensively drug-resistant tuberculosis. Int J Tuberc Lung Dis 2016; 19:1547-52. [PMID: 26614200 DOI: 10.5588/ijtld.15.0136] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Molecular techniques rapidly detect resistance to rifampicin (RMP) and isoniazid (INH), but do not eliminate the need for culture-based drug susceptibility testing (DST) against other drugs. The thin-layer agar (TLA) test, a non-commercial direct DST method, has demonstrated good performance for INH and RMP; however, evidence is still limited, and its applicability for DST of ofloxacin (OFX) and kanamycin (KM) is unknown. DESIGN We compared 279 TLA DST results with those of MGIT for INH and RMP, and 280 results for OFX and KM with those of the 7H11 agar proportion method, obtained from 320 smear-positive samples from 165 Georgian TB patients. Discrepancies were solved by comparison with a composite reference standard. The prevalence of multidrug-resistant tuberculosis (TB) was 30 of 164 patients (18.3%), 2 (6.7%) of whom had extensively drug-resistant TB. RESULTS TLA showed 94.7%, 98.2%, 100% and 78.9% sensitivity, respectively, for INH, RMP, OFX and KM, with 100% specificity. Average time to results was 7 days in TLA, 23 in MGIT and 49 for 7H11 agar. CONCLUSIONS In low-resource settings, TLA can be applied for the rapid detection of resistance to INH, RMP and fluoroquinolones. Further studies are necessary to improve sensitivity to KM and further assess its performance for OFX and other drugs and its applicability in field conditions.
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Affiliation(s)
- E Ardizzoni
- Institute of Tropical Medicine, Antwerp, Belgium; Médecins Sans Frontières, Paris, France
| | - W Mulders
- Institute of Tropical Medicine, Antwerp, Belgium
| | - T Kotrikadze
- National Tuberculosis Programme, Tbilisi, Georgia
| | | | | | - H Pangtey
- Médecins Sans Frontières, Paris, France
| | - F Varaine
- Médecins Sans Frontières, Paris, France
| | | | - L Rigouts
- Institute of Tropical Medicine, Antwerp, Belgium
| | - B C de Jong
- Institute of Tropical Medicine, Antwerp, Belgium;New York University, New York, New York, USA
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Rigouts L, Coeck N, Gumusboga M, de Rijk WB, Aung KJM, Hossain MA, Fissette K, Rieder HL, Meehan CJ, de Jong BC, Van Deun A. Specific gyrA gene mutations predict poor treatment outcome in MDR-TB. J Antimicrob Chemother 2015; 71:314-23. [PMID: 26604243 PMCID: PMC4710215 DOI: 10.1093/jac/dkv360] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [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: 07/16/2015] [Accepted: 10/02/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Mutations in the gyrase genes cause fluoroquinolone resistance in Mycobacterium tuberculosis. However, the predictive value of these markers for clinical outcomes in patients with MDR-TB is unknown to date. The objective of this study was to determine molecular markers and breakpoints predicting second-line treatment outcomes in M. tuberculosis patients treated with fourth-generation fluoroquinolones. METHODS We analysed treatment outcome data in relation to the gyrA and gyrB sequences and MICs of ofloxacin, gatifloxacin and moxifloxacin for pretreatment M. tuberculosis isolates from 181 MDR-TB patients in Bangladesh whose isolates were susceptible to injectable drugs. RESULTS The gyrA 90Val, 94Gly and 94Ala mutations were most frequent, with the highest resistance levels for 94Gly mutants. Increased pretreatment resistance levels (>2 mg/L), related to specific mutations, were associated with lower cure percentages, with no cure in patients whose isolates were resistant to gatifloxacin at 4 mg/L. Any gyrA 94 mutation, except 94Ala, predicted a significantly lower proportion of cure compared with all other gyrA mutations taken together (all non-94 mutants + 94Ala) [OR = 4.3 (95% CI 1.4-13.0)]. The difference in treatment outcome was not explained by resistance to the other drugs. CONCLUSIONS Our study suggests that gyrA mutations at position 94, other than Ala, predict high-level resistance to gatifloxacin and moxifloxacin, as well as poor treatment outcome, in MDR-TB patients in whom an injectable agent is still effective.
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Affiliation(s)
- L Rigouts
- Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - N Coeck
- Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - M Gumusboga
- Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - W B de Rijk
- Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | | | | | - K Fissette
- Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - H L Rieder
- Epidemiology Department, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - C J Meehan
- Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - B C de Jong
- Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium Department of Medicine, Division of Infectious Diseases, New York University, New York, NY, USA Vaccinology Department, Medical Research Council Unit, Fajara, The Gambia
| | - A Van Deun
- Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium International Union Against Tuberculosis and Lung Disease, Paris, France
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Van Deun A, Aung KJM, Hossain A, de Rijk P, Gumusboga M, Rigouts L, de Jong BC. Disputed rpoB mutations can frequently cause important rifampicin resistance among new tuberculosis patients. Int J Tuberc Lung Dis 2015; 19:185-90. [DOI: 10.5588/ijtld.14.0651] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Ardizzoni E, Mulders W, Sanchez-Padilla E, Varaine F, de Jong BC, Rigouts L. Decontamination methods for samples preserved in cetylpyridinium chloride and cultured on thin-layer agar. Int J Tuberc Lung Dis 2014; 18:972-7. [PMID: 25199014 DOI: 10.5588/ijtld.13.0887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Long transportation times of samples to culture laboratories can lead to higher contamination rates and significant loss of viability, resulting in lower culture positivity rates. Thin-layer agar (TLA) is a sensitive culture method for the isolation of Mycobacterium tuberculosis that has been optimised with N-acetyl-L-cysteine-sodium hydroxide (NALC-NaOH) decontaminated samples. The combination of the TLA culture method and other decontamination procedures has not been extensively validated. DESIGN Among 390 smear-positive samples, we compared the culture positivity of samples decontaminated using the Petroff method vs. NALC-NaOH neutralised with phosphate buffer (PBS), applied to samples preserved with cetylpyridinium chloride (CPC) or CPC-free, and then of CPC-preserved samples decontaminated with NALC-NaOH neutralised using Difco neutralising buffer. The sediments were inoculated on TLA, and then on MGIT 960 or Löwenstein-Jensen (LJ) as gold standards. RESULTS Decontamination with NALC-NaOH yielded higher culture positivity in TLA than in the Petroff method, which was further enhanced by neutralising CPC with the Difco buffer. Surprisingly, culture positivity on LJ also increased after using Difco buffer, suggesting that CPC may not be completely neutralised in egg-based medium. CONCLUSIONS After transportation in CPC, decontamination using NALC-NaOH followed by neutralisation using Difco buffer resulted in the best recovery rates for samples inoculated on TLA and on LJ.
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Affiliation(s)
- E Ardizzoni
- Institute of Tropical Medicine, Antwerp, Belgium
| | - W Mulders
- Institute of Tropical Medicine, Antwerp, Belgium
| | | | - F Varaine
- Médecins Sans Frontières, Paris, France
| | - B C de Jong
- Institute of Tropical Medicine, Antwerp, Belgium
| | - L Rigouts
- Institute of Tropical Medicine, Antwerp, Belgium
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Van Deun A, Aung KJM, Khan MH, de Jong BC, Gumusboga M, Hossain MA. An operational study comparing microscopes and staining variations for tuberculosis LED FM. Int J Tuberc Lung Dis 2014; 18:964-71. [DOI: 10.5588/ijtld.14.0077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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)
- A. Van Deun
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | | | - M. H. Khan
- Damien Foundation Bangladesh, Dhaka, Bangladesh
| | - B. C. de Jong
- Mycobacteriology Unit, Institute of Tropical Medicine, Antwerp, Belgium
| | - M. Gumusboga
- Mycobacteriology Unit, Institute of Tropical Medicine, Antwerp, Belgium
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Van Deun A, Maug AKJ, Hossain A, Gumusboga M, de Jong BC. Fluorescein diacetate vital staining allows earlier diagnosis of rifampicin-resistant tuberculosis. Int J Tuberc Lung Dis 2012; 16:1174-9. [DOI: 10.5588/ijtld.11.0166] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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de Jong BC, Hill PC, Aiken A, Jeffries DJ, Onipede A, Small PM, Adegbola RA, Corrah TP. Clinical presentation and outcome of tuberculosis patients infected by M. africanum versus M. tuberculosis. Int J Tuberc Lung Dis 2007; 11:450-6. [PMID: 17394693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023] Open
Abstract
SETTING A tuberculosis (TB) case contact study in the Gambia. OBJECTIVE To test whether Mycobacterium africanum, which has lost around 68 kb compared with M. tuberculosis sensu stricto, causes less severe TB disease. DESIGN We genotyped mycobacterial isolates and compared clinical and radiological characteristics as well as outcome data of M. africanum-infected TB patients with those infected with M. tuberculosis. RESULTS Of 317 index cases, 301 had a mycobacterial isolate available, 290 of which had an interpretable spoligotype pattern. Of these, 110 isolates (38%) were M. africanum and 180 (62%) were M. tuberculosis. M. africanum cases had lower body mass indices (17 vs. 17.45 for M. tuberculosis-infected patients, P = 0.029) and their radiographic disease was more extensive (96% vs. 89% had at least moderately severe radiographic changes, P = 0.031). Outcome on treatment was similar (2.8% of human immunodeficiency virus [HIV] negative M. africanum patients died on treatment vs. 3.0% of M. tuberculosis patients, P = 0.95). CONCLUSION M. africanum causes sputum smear-positive tuberculosis disease that is at least as severe as that caused by M. tuberculosis sensu stricto. Further clinical comparisons may be helpful in smear-negative patients and HIV-TB co-infected patients, and to identify whether there is any difference in time to develop disease.
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Affiliation(s)
- B C de Jong
- Bacterial Diseases Programme, Medical Research Council Laboratories, Banjul, The Gambia.
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Adetifa IMO, Brookes R, Lugos MD, de Jong BC, Antonio M, Adegbola RA, Hill PC. Rising ELISPOT count prior to the onset of symptoms of full-blown tuberculosis disease. Int J Tuberc Lung Dis 2007; 11:350-2. [PMID: 17352104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023] Open
Abstract
The relationship between the T-cell response to mycobacterial antigens and the likelihood of progression to disease has not been defined. We report a rapidly rising ELISPOT count in a 55-year-old man with evidence of Mycobacterium tuberculosis infection prior to the onset of symptoms of disease. This case illustrates the possible utility of quantitative changes in the ELISPOT count in predicting progression from M. tuberculosis infection to disease.
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Affiliation(s)
- I M O Adetifa
- Bacterial Diseases Programme, Medical Research Council Laboratories, Banjul, The Gambia.
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de Jong BC, Overbeke AJ. [Peer review: is one-eye king?]. Ned Tijdschr Geneeskd 1993; 137:17-21. [PMID: 8419837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- B C de Jong
- Nederlands Tijdschrft voor Geneeskunde, Amsterdam
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