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Fagnant CS, Sánchez-Gonzalez LM, Zhou NA, Falman JC, Eisenstein M, Guelig D, Ockerman B, Guan Y, Kossik AL, Linden YS, Beck NK, Wilmouth R, Komen E, Mwangi B, Nyangao J, Shirai JH, Novosselov I, Borus P, Boyle DS, Meschke JS. Improvement of the Bag-Mediated Filtration System for Sampling Wastewater and Wastewater-Impacted Waters. Food Environ Virol 2018; 10:72-82. [PMID: 28674934 PMCID: PMC5823955 DOI: 10.1007/s12560-017-9311-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 06/23/2017] [Indexed: 05/22/2023]
Abstract
Environmental surveillance of poliovirus (PV) plays an important role in the global program for eradication of wild PV. The bag-mediated filtration system (BMFS) was first developed in 2014 and enhances PV surveillance when compared to the two-phase grab method currently recommended by the World Health Organization (WHO). In this study, the BMFS design was improved and tested for its usability in wastewater and wastewater-impacted surface waters in Nairobi, Kenya. Modifications made to the BMFS included the size, color, and shape of the collection bags, the filter housing used, and the device used to elute the samples from the filters. The modified BMFS concentrated 3-10 L down to 10 mL, which resulted in an effective volume assayed (900-3000 mL) that was 6-20 times greater than the effective volume assayed for samples processed by the WHO algorithm (150 mL). The system developed allows for sampling and in-field virus concentration, followed by transportation of the filter for further analysis with simpler logistics than the current methods. This may ultimately reduce the likelihood of false-negative samples by increasing the effective volume assayed compared to samples processed by the WHO algorithm, making the BMFS a valuable sampling system for wastewater and wastewater-impacted surface waters.
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Affiliation(s)
- Christine Susan Fagnant
- Department of Environmental and Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, Suite 100, Seattle, WA, 98195, USA
| | - Liliana Margarita Sánchez-Gonzalez
- Department of Environmental and Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, Suite 100, Seattle, WA, 98195, USA
| | - Nicolette A Zhou
- Department of Environmental and Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, Suite 100, Seattle, WA, 98195, USA
| | - Jill Christin Falman
- Department of Environmental and Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, Suite 100, Seattle, WA, 98195, USA
| | | | - Dylan Guelig
- PATH, 2201 Westlake Ave., Suite 200, Seattle, WA, 98121, USA
| | - Byron Ockerman
- Department of Mechanical Engineering, University of Washington, Stevens Way, Box 352600, Seattle, WA, 98195, USA
| | - Yifei Guan
- Department of Mechanical Engineering, University of Washington, Stevens Way, Box 352600, Seattle, WA, 98195, USA
| | - Alexandra Lynn Kossik
- Department of Environmental and Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, Suite 100, Seattle, WA, 98195, USA
| | - Yarrow S Linden
- Department of Environmental and Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, Suite 100, Seattle, WA, 98195, USA
| | - Nicola Koren Beck
- Department of Environmental and Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, Suite 100, Seattle, WA, 98195, USA
| | - Robyn Wilmouth
- PATH, 2201 Westlake Ave., Suite 200, Seattle, WA, 98121, USA
| | - Evans Komen
- Kenya Medical Research Institute, Center for Virus Research, Mbagathi Road, P.O. Box 54628, Nairobi, 00200, Kenya
| | - Benlick Mwangi
- Kenya Medical Research Institute, Center for Virus Research, Mbagathi Road, P.O. Box 54628, Nairobi, 00200, Kenya
| | - James Nyangao
- Kenya Medical Research Institute, Center for Virus Research, Mbagathi Road, P.O. Box 54628, Nairobi, 00200, Kenya
| | - Jeffry H Shirai
- Department of Environmental and Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, Suite 100, Seattle, WA, 98195, USA
| | - Igor Novosselov
- Department of Mechanical Engineering, University of Washington, Stevens Way, Box 352600, Seattle, WA, 98195, USA
| | - Peter Borus
- Kenya Medical Research Institute, Center for Virus Research, Mbagathi Road, P.O. Box 54628, Nairobi, 00200, Kenya
| | - David S Boyle
- PATH, 2201 Westlake Ave., Suite 200, Seattle, WA, 98121, USA
| | - John Scott Meschke
- Department of Environmental and Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, Suite 100, Seattle, WA, 98195, USA.
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Guelig D, Bauer J, Wollen A, Schiller C, Sherman-Konkle J, Roche A, Weyrauch K, Eisenstein M. Design of a Novel, Adjustable Flow Rate, Reusable, Electricity-Free, Low-Cost Syringe Infusion Pump. J Med Device 2017. [DOI: 10.1115/1.4037935] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
We present a proof-of-concept design and preliminary data to demonstrate a novel syringe infusion pump that is low cost, nonelectric, reusable, and adjustable. This device addresses the need for infusion therapy in low- and middle-income countries (LMIC), where intermittent electrical power precludes the use of conventional electronic infusion pumps and limited financial resources make high costs of disposable infusion pumps impractical. Our design uses a pneumatically pressurized, hydraulic (air over oil) drive piston coupled to a closed-circuit flow restriction to drive a syringe plunger at a constant velocity, thus providing a constant volumetric flow rate to the patient. The device requires no proprietary or precision consumables, significantly reducing treatment costs compared with other methods. The highly adjustable device provides constant flow rates across the range of 0.5–8 mL/h when used with a 30-mL syringe. The user interface is simple and intuitive; the hardware is robust and portable. This novel technology platform has broad applications in addressing priority health needs in LMIC.
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Affiliation(s)
- Dylan Guelig
- PATH, 2201 Westlake Avenue #200, Seattle, WA 98121 e-mail:
| | - James Bauer
- PATH, 2201 Westlake Avenue #200, Seattle, WA 98121 e-mail:
| | - Alec Wollen
- PATH, 2201 Westlake Avenue #200, Seattle, WA 98121 e-mail:
| | | | | | - Anthony Roche
- Harborview Medical Center, PO Box 356540, Seattle, WA 98104 e-mail:
| | - Karl Weyrauch
- Pygmy Survival Alliance, 4545 49th Avenue NE, Seattle, WA 98105 e-mail:
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Poole CB, Li Z, Alhassan A, Guelig D, Diesburg S, Tanner NA, Zhang Y, Evans TC, LaBarre P, Wanji S, Burton RA, Carlow CKS. Colorimetric tests for diagnosis of filarial infection and vector surveillance using non-instrumented nucleic acid loop-mediated isothermal amplification (NINA-LAMP). PLoS One 2017; 12:e0169011. [PMID: 28199317 PMCID: PMC5310896 DOI: 10.1371/journal.pone.0169011] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 11/19/2016] [Indexed: 11/26/2022] Open
Abstract
Accurate detection of filarial parasites in humans is essential for the implementation and evaluation of mass drug administration programs to control onchocerciasis and lymphatic filariasis. Determining the infection levels in vector populations is also important for assessing transmission, deciding when drug treatments may be terminated and for monitoring recrudescence. Immunological methods to detect infection in humans are available, however, cross-reactivity issues have been reported. Nucleic acid-based molecular assays offer high levels of specificity and sensitivity, and can be used to detect infection in both humans and vectors. In this study we developed loop-mediated isothermal amplification (LAMP) tests to detect three different filarial DNAs in human and insect samples using pH sensitive dyes for enhanced visual detection of amplification. Furthermore, reactions were performed in a portable, non-instrumented nucleic acid amplification (NINA) device that provides a stable heat source for LAMP. The efficacy of several strand displacing DNA polymerases were evaluated in combination with neutral red or phenol red dyes. Colorimetric NINA-LAMP assays targeting Brugia Hha I repeat, Onchocerca volvulus GST1a and Wuchereria bancrofti LDR each exhibit species-specificity and are also highly sensitive, detecting DNA equivalent to 1/10-1/5000th of one microfilaria. Reaction times varied depending on whether a single copy gene (70 minutes, O. volvulus) or repetitive DNA (40 min, B. malayi and W. bancrofti) was employed as a biomarker. The NINA heater can be used to detect multiple infections simultaneously. The accuracy, simplicity and versatility of the technology suggests that colorimetric NINA-LAMP assays are ideally suited for monitoring the success of filariasis control programs.
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Affiliation(s)
| | - Zhiru Li
- New England Biolabs, Ipswich, MA United States of America
| | - Andy Alhassan
- New England Biolabs, Ipswich, MA United States of America
| | - Dylan Guelig
- PATH, Seattle, Washington, United States of America
| | | | | | - Yinhua Zhang
- New England Biolabs, Ipswich, MA United States of America
| | | | - Paul LaBarre
- PATH, Seattle, Washington, United States of America
| | - Samuel Wanji
- Research Foundation in Tropical Diseases and Environment, Buea, Cameroon
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Kemleu S, Guelig D, Eboumbou Moukoko C, Essangui E, Diesburg S, Mouliom A, Melingui B, Manga J, Donkeu C, Epote A, Texier G, LaBarre P, Burton R, Ayong L. A Field-Tailored Reverse Transcription Loop-Mediated Isothermal Assay for High Sensitivity Detection of Plasmodium falciparum Infections. PLoS One 2016; 11:e0165506. [PMID: 27824866 PMCID: PMC5100904 DOI: 10.1371/journal.pone.0165506] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 10/13/2016] [Indexed: 11/19/2022] Open
Abstract
Highly sensitive and field deployable molecular diagnostic tools are critically needed for detecting submicroscopic, yet transmissible levels of malaria parasites prevalent in malaria endemic countries worldwide. A reverse transcription loop-mediated isothermal amplification (RT-LAMP) assay was developed and evaluated in comparison with thick blood smear microscopy, an antigen-based rapid diagnostic test (RDT), and an in-house RT-PCR targeting the same RT-LAMP transcript. The optimized assay detected Plasmodium falciparum infections in as little as 0.25ng of total parasite RNA, and exhibited a detection limit of 0.08 parasites/ μL when tested directly on infected whole blood lysates, or ~0.0008 parasites/ μL when using RNA extracts. Assay positivity was observed as early as eight minutes from initiation of the RT-LAMP and in most cases the reaction was complete before twenty minutes. Clinical evaluation of the assay on 132 suspected malaria cases resulted in a positivity rate of 90% for RT-LAMP using extracted RNA, and 85% when using whole blood lysates. The positivity rates were 70% for P. falciparum-specific RDT, 83% for RT-PCR, and 74% for thick blood smear microscopy (Mean parasite density = 36,986 parasites/ μL). Concordance rates between the developed RT-LAMP and comparator tests were greater than 75%, the lowest being with light microscopy (78%, McNemar's test: P = 0.0002), and the highest was with RT-PCR (87%, McNemar's test: P = 0.0523). Compared to reference RT-PCR, assay sensitivity was 90% for RT-LAMP on whole blood, and 96% for RT-LAMP using corresponding RNA extracts. Electricity-free heaters were further developed and evaluated in comparison with a battery-operated isothermal amplification machine for use with the developed test in resource-limited settings. Taken together, the data highlight the benefits of targeting high abundant RNA transcripts in molecular diagnosis, as well as the potential usefulness of the developed RT-LAMP-assay in malaria diagnosis in low to high parasite density settings.
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Affiliation(s)
- Sylvie Kemleu
- Malaria Research Unit, Centre Pasteur du Cameroun, Yaoundé, Cameroon
| | - Dylan Guelig
- PATH, Seattle, Washington, United States of America
| | - Carole Eboumbou Moukoko
- Malaria Research Unit, Centre Pasteur du Cameroun, Yaoundé, Cameroon
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Estelle Essangui
- Malaria Research Unit, Centre Pasteur du Cameroun, Yaoundé, Cameroon
- Faculty of Sciences, University of Douala, Douala, Cameroon
| | | | - Abas Mouliom
- Hematology Unit, Centre Pasteur du Cameroun, Yaoundé, Cameroon
| | | | - Jeanne Manga
- Hematology Unit, Centre Pasteur du Cameroun, Yaoundé, Cameroon
| | - Christiane Donkeu
- Malaria Research Unit, Centre Pasteur du Cameroun, Yaoundé, Cameroon
| | - Annie Epote
- Hematology Unit, Centre Pasteur du Cameroun, Yaoundé, Cameroon
| | - Gaëtan Texier
- Public Health & Epidemiology Unit, Centre Pasteur du Cameroun, Yaoundé, Cameroon
| | - Paul LaBarre
- PATH, Seattle, Washington, United States of America
| | | | - Lawrence Ayong
- Malaria Research Unit, Centre Pasteur du Cameroun, Yaoundé, Cameroon
- * E-mail:
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Curtis KA, Rudolph DL, Morrison D, Guelig D, Diesburg S, McAdams D, Burton RA, LaBarre P, Owen M. Single-use, electricity-free amplification device for detection of HIV-1. J Virol Methods 2016; 237:132-137. [PMID: 27616198 DOI: 10.1016/j.jviromet.2016.09.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 09/07/2016] [Indexed: 11/19/2022]
Abstract
Early and accurate diagnosis of HIV is key for the reduction of transmission and initiation of patient care. The availability of a rapid nucleic acid test (NAT) for use at the point-of-care (POC) will fill a gap in HIV diagnostics, improving the diagnosis of acute infection and HIV in infants born to infected mothers. In this study, we evaluated the performance of non-instrumented nucleic acid amplification, single-use disposable (NINA-SUD) devices for the detection of HIV-1 in whole blood using reverse-transcription, loop-mediated isothermal amplification (RT-LAMP) with lyophilized reagents. The NINA-SUD heating device harnesses the heat from an exothermic chemical reaction initiated by the addition of saline to magnesium iron powder. Reproducibility was demonstrated between NINA-SUD units and comparable, if not superior, performance for detecting clinical specimens was observed as compared to the thermal cycler. The stability of the lyophilized HIV-1 RT-LAMP reagents was also demonstrated following storage at -20, 4, 25, and 30°C for up to one month. The single-use, disposable NAT minimizes hands-on time and has the potential to facilitate HIV-1 testing in resource-limited settings or at the POC.
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Affiliation(s)
- Kelly A Curtis
- Laboratory Branch, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30329, USA.
| | - Donna L Rudolph
- Laboratory Branch, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30329, USA
| | - Daphne Morrison
- Laboratory Branch, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30329, USA
| | - Dylan Guelig
- PATH, 2201 Westlake Avenue, Suite 200, Seattle, WA 98121, USA
| | - Steven Diesburg
- PATH, 2201 Westlake Avenue, Suite 200, Seattle, WA 98121, USA
| | - David McAdams
- PATH, 2201 Westlake Avenue, Suite 200, Seattle, WA 98121, USA
| | - Robert A Burton
- PATH, 2201 Westlake Avenue, Suite 200, Seattle, WA 98121, USA
| | - Paul LaBarre
- PATH, 2201 Westlake Avenue, Suite 200, Seattle, WA 98121, USA
| | - Michele Owen
- Laboratory Branch, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30329, USA
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6
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Mohon AN, Lee LDY, Bayih AG, Folefoc A, Guelig D, Burton RA, LaBarre P, Chan W, Meatherall B, Pillai DR. NINA-LAMP compared to microscopy, RDT, and nested PCR for the detection of imported malaria. Diagn Microbiol Infect Dis 2016; 85:149-53. [PMID: 27017271 PMCID: PMC4862928 DOI: 10.1016/j.diagmicrobio.2015.11.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 10/06/2015] [Accepted: 11/08/2015] [Indexed: 01/08/2023]
Abstract
Microscopy and field adaptable rapid diagnostic tests (RDTs) are not sensitive and specific in certain conditions such as poor training of microscopists, lack of electricity, or lower sensitivity in the detection of non-falciparum malaria. More sensitive point-of-care testing (POCT) would reduce delays in diagnosis and initiation of therapy. In the current study, we have evaluated the efficacy of noninstrumented nucleic acid amplification (NINA) coupled with loop-mediated isothermal amplification (LAMP) for detection of traveler's malaria (n=140) in comparison with microscopy, nested PCR, and the only Food and Drug Administration-approved rapid diagnostic test. NINA-LAMP was 100% sensitive and 98.6% specific when compared to nested PCR. For non-falciparum detection, NINA-LAMP sensitivity was 100% sensitive compared to nested PCR, whereas RDT sensitivity was 71%. LAMP is highly sensitive and specific for symptomatic malaria diagnosis regardless of species.
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Affiliation(s)
- Abu Naser Mohon
- Department of Microbiology, Immunology and Infectious Disease, University of Calgary, AB, Canada; Department of Pathology and Laboratory Medicine, University of Calgary, AB, Canada
| | - Lydia Da-Yeong Lee
- Department of Microbiology, Immunology and Infectious Disease, University of Calgary, AB, Canada
| | - Abebe Genetu Bayih
- Department of Pathology and Laboratory Medicine, University of Calgary, AB, Canada
| | - Asongna Folefoc
- Department of Pathology and Laboratory Medicine, University of Calgary, AB, Canada
| | | | | | | | - Wilson Chan
- Department of Pathology and Laboratory Medicine, University of Calgary, AB, Canada
| | | | - Dylan R Pillai
- Department of Microbiology, Immunology and Infectious Disease, University of Calgary, AB, Canada; Department of Pathology and Laboratory Medicine, University of Calgary, AB, Canada; Department of Medicine, University of Calgary, Calgary, AB, Canada.
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Buser JR, Diesburg S, Singleton J, Guelig D, Bishop JD, Zentner C, Burton R, LaBarre P, Yager P, Weigl BH. Precision chemical heating for diagnostic devices. Lab Chip 2015; 15:4423-4432. [PMID: 26503640 DOI: 10.1039/c5lc01053e] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Decoupling nucleic acid amplification assays from infrastructure requirements such as grid electricity is critical for providing effective diagnosis and treatment at the point of care in low-resource settings. Here, we outline a complete strategy for the design of electricity-free precision heaters compatible with medical diagnostic applications requiring isothermal conditions, including nucleic acid amplification and lysis. Low-cost, highly energy dense components with better end-of-life disposal options than conventional batteries are proposed as an alternative to conventional heating methods to satisfy the unique needs of point of care use.
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Affiliation(s)
- J R Buser
- Department of Bioengineering, University of Washington, Box 355061, Seattle, WA, USA.
| | - S Diesburg
- PATH: The Program for Appropriate Technology in Healthcare, Seattle, WA, USA
| | - J Singleton
- PATH: The Program for Appropriate Technology in Healthcare, Seattle, WA, USA
| | - D Guelig
- PATH: The Program for Appropriate Technology in Healthcare, Seattle, WA, USA
| | - J D Bishop
- Department of Bioengineering, University of Washington, Box 355061, Seattle, WA, USA.
| | - C Zentner
- PATH: The Program for Appropriate Technology in Healthcare, Seattle, WA, USA
| | - R Burton
- PATH: The Program for Appropriate Technology in Healthcare, Seattle, WA, USA
| | - P LaBarre
- PATH: The Program for Appropriate Technology in Healthcare, Seattle, WA, USA
| | - P Yager
- Department of Bioengineering, University of Washington, Box 355061, Seattle, WA, USA.
| | - B H Weigl
- PATH: The Program for Appropriate Technology in Healthcare, Seattle, WA, USA
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Shah KG, Guelig D, Diesburg S, Buser J, Burton R, LaBarre P, Richards-Kortum R, Weigl B. Design of a New Type of Compact Chemical Heater for Isothermal Nucleic Acid Amplification. PLoS One 2015; 10:e0139449. [PMID: 26430883 PMCID: PMC4591995 DOI: 10.1371/journal.pone.0139449] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 08/13/2015] [Indexed: 11/18/2022] Open
Abstract
Previous chemical heater designs for isothermal nucleic acid amplification have been based on solid-liquid phase transition, but using this approach, developers have identified design challenges en route to developing a low-cost, disposable device. Here, we demonstrate the feasibility of a new heater configuration suitable for isothermal amplification in which one reactant of an exothermic reaction is a liquid-gas phase-change material, thereby eliminating the need for a separate phase-change compartment. This design offers potentially enhanced performance and energy density compared to other chemical and electric heaters.
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Affiliation(s)
- Kamal G. Shah
- Department of Bioengineering, Rice University, Houston, Texas, United States of America
- PATH, Seattle, Washington, United States of America
- * E-mail:
| | - Dylan Guelig
- PATH, Seattle, Washington, United States of America
| | | | - Joshua Buser
- Department of Bioengineering, University of Washington, Seattle, Washington, United States of America
| | | | - Paul LaBarre
- PATH, Seattle, Washington, United States of America
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Sema M, Alemu A, Bayih AG, Getie S, Getnet G, Guelig D, Burton R, LaBarre P, Pillai DR. Evaluation of non-instrumented nucleic acid amplification by loop-mediated isothermal amplification (NINA-LAMP) for the diagnosis of malaria in Northwest Ethiopia. Malar J 2015; 14:44. [PMID: 25626339 PMCID: PMC4323137 DOI: 10.1186/s12936-015-0559-9] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [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: 10/21/2014] [Accepted: 01/13/2015] [Indexed: 11/15/2022] Open
Abstract
Background Malaria is a major public health problem in sub-Saharan African countries including Ethiopia. Early and accurate diagnosis followed by prompt and effective treatment is among the various tools available for prevention, control and elimination of malaria. This study aimed to evaluate the performance of non-instrumented nucleic acid amplification loop-mediated isothermal amplification (NINA-LAMP) compared to standard thick and thin film microscopy and nested PCR as gold standard for the sensitive diagnosis of malaria in Northwest Ethiopia. Methods A cross-sectional study was conducted in North Gondar, Ethiopia from March to July 2014. Eighty-two blood samples were collected from malaria suspected patients visiting Kola Diba Health Centre and analysed for Plasmodium parasites by microscopy, NINA-LAMP and nested PCR. The NINA-LAMP method was performed using the Loopamp™ Malaria Pan/Pf detection kits for detecting DNA of the genus Plasmodium and more specifically Plasmodium falciparum using an electricity-free heater. Diagnostic accuracy outcome measures (analytical sensitivity, specificity, predictive values, and Kappa scores) of NINA-LAMP and microscopy were compared to nested PCR. Results A total of 82 samples were tested in the primary analysis. Using nested PCR as reference, the sensitivity and specificity of the primary NINA-LAMP assay were 96.8% (95% confidence interval (CI), 83.2% - 99.5%) and 84.3% (95% CI, 71.4% - 92.9%), respectively for detection of Plasmodium genus, and 100% (95% CI, 75.1% - 100%) and 81.2% (95% CI, 69.9% - 89.6%), respectively for detection of P. falciparum parasite. Microscopy demonstrated sensitivity and specificity of 93.6% (95% CI, 78.5% - 99.0%) and 98.0% (95% CI, 89.5% - 99.7%), respectively for the detection of Plasmodium parasites. Post-hoc repeat NINA-LAMP analysis showed improvement in diagnostic accuracy, which was comparable to nested PCR performance and superior to microscopy for detection at both the Plasmodium genus level and P. falciparum parasites. Conclusion NINA-LAMP is highly sensitive for the diagnosis of malaria and detection of Plasmodium parasite infection at both the genus and species level when compared to nested PCR. NINA-LAMP is more sensitive than microscopy for the detection of P. falciparum and differentiation from non-falciparum species and may be a critical diagnostic modality in efforts to eradicate malaria from areas of low endemicity.
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Affiliation(s)
- Meslo Sema
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
| | - Abebe Alemu
- School of Medicine, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita, Ethiopia.
| | - Abebe Genetu Bayih
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Canada.
| | - Sisay Getie
- Department of Medical Parasitology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Gebeyaw Getnet
- Department of Medical Parasitology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | | | | | | | - Dylan R Pillai
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Canada. .,Department of Medical Parasitology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
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