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Rajendran P, Jayabal L, Venkatesan M, Kumar MP, Ramalingam R, Sivaraman P, Fredrick A, Shanmugam S. Assessing the utility of Truenat in extrapulmonary tuberculosis diagnosis - A NRL's experience. J Clin Tuberc Other Mycobact Dis 2024; 35:100420. [PMID: 38440213 PMCID: PMC10909875 DOI: 10.1016/j.jctube.2024.100420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Abstract
Background Diagnosis of extra pulmonary TB (EPTB) remains a big challenge. While data on utility of Xpert testing in EPTB diagnosis is enormous, there is limited data on Truenat MTB testing. Aim In this study we aimed to evaluate the usefulness of Truenat in EPTB diagnosis. Materials and methods The study included patients suspected and/or treated for EPTB located from Chennai district during the year 2021-2022. All processed EPTB samples were subjected to smear microscopy, culture and Truenat MTB testing. Results Of the 195 samples tested, 38 (19.4%) samples were positive for EPTB by any one of the diagnostic methods (smear, culture, microscopy). Out of these 38, 16 (42.1 %) were positive for MTB by Truenat and negative by Culture, 12 (31.5%) were positive by culture but negative by Truenat and 8 (21%) were positive by both Truenat and/or smear and culture. The sensitivity and specificity of the test was calculated with the composite reference standard (Culture (exclusion of colonies as positives), clinical conditions, and smear) and was found to be 60% and 100% respectively. Conclusion Truenat MTB test is a cost-effective rapid molecular test that can be used only for the diagnosis of presumptive EPTB and not on follow-up samples.
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Affiliation(s)
- Priya Rajendran
- ICMR -National Institute for Research in Tuberculosis, Chennai, India
| | - Lavanya Jayabal
- District Tuberculosis Office, National Tuberculosis Elimination Programme, Chennai, India
| | | | - Michel Prem Kumar
- ICMR -National Institute for Research in Tuberculosis, Chennai, India
| | | | - P Sivaraman
- ICMR -National Institute for Research in Tuberculosis, Chennai, India
| | - Asha Fredrick
- State Tuberculosis Office, National Tuberculosis Elimination Programme, Chennai, India
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Leukes VN, Hella J, Sabi I, Cossa M, Khosa C, Erkosar B, Mangu C, Siyame E, Mtafya B, Lwilla A, Viegas S, Madeira C, Machiana A, Ribeiro J, Garcia-Basteiro AL, Riess F, Elísio D, Sasamalo M, Mhalu G, Denkinger CM, Castro MDM, Bashir S, Schumacher SG, Tagliani E, Malhotra A, Dowdy D, Schacht C, Buech J, Nguenha D, Ntinginya N, Ruhwald M, Penn-Nicholson A, Kranzer K. Study protocol: a pragmatic, cluster-randomized controlled trial to evaluate the effect of implementation of the Truenat platform/MTB assays at primary health care clinics in Mozambique and Tanzania (TB-CAPT CORE). BMC Infect Dis 2024; 24:107. [PMID: 38243223 PMCID: PMC10797907 DOI: 10.1186/s12879-023-08876-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/05/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND In 2020, the WHO-approved Molbio Truenat platform and MTB assays to detect Mycobacterium tuberculosis complex (MTB) and resistance to rifampicin directly on sputum specimens. This primary health care center-based trial in Mozambique and Tanzania investigates the effect of Truenat platform/MTB assays (intervention arm) combined with rapid communication of results compared to standard of care on TB diagnosis and treatment initiation for microbiologically confirmed TB at 7 days from enrolment. METHODS The Tuberculosis Close the Gap, Increase Access, and Provide Adequate Therapy (TB-CAPT) CORE trial employs a pragmatic cluster randomized controlled design to evaluate the impact of a streamlined strategy for delivery of Truenat platform/MTB assays testing at primary health centers. Twenty-nine centers equipped with TB microscopy units were selected to participate in the trial. Among them, fifteen health centers were randomized to the intervention arm (which involves onsite molecular testing using Truenat platform/MTB assays, process process optimization to enable same-day TB diagnosis and treatment initiation, and feedback on Molbio platform performance) or the control arm (which follows routine care, including on-site sputum smear microscopy and the referral of sputum samples to off-site Xpert testing sites). The primary outcome of the study is the absolute number and proportion of participants with TB microbiological confirmation starting TB treatment within 7 days of their first visit. Secondary outcomes include time to bacteriological confirmation, health outcomes up to 60 days from first visit, as well as user preferences, direct cost, and productivity analyses. ETHICS AND DISSEMINATION TB-CAPT CORE trial has been approved by regulatory and ethical committees in Mozambique and Tanzania, as well as by each partner organization. Consent is informed and voluntary, and confidentiality of participants is maintained throughout. Study findings will be presented at scientific conferences and published in peer-reviewed international journals. TRIAL REGISTRATION US National Institutes of Health's ClinicalTrials.gov, NCT04568954. Registered 23 September 2020.
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Affiliation(s)
| | - J Hella
- Ifakara Health Institute, Dar Es Salaam, Tanzania
| | - I Sabi
- Mbeya Medical Research Centre, National Institute for Medical Research (NIMR), Mbeya, Tanzania
| | - M Cossa
- Centro de Investigação Em Saúde de Manhiça (CISM), Manhica, Mozambique
| | - C Khosa
- Instituto Nacional de Saúde (INS), Marracuene, Mozambique
| | | | - C Mangu
- Mbeya Medical Research Centre, National Institute for Medical Research (NIMR), Mbeya, Tanzania
| | - E Siyame
- Mbeya Medical Research Centre, National Institute for Medical Research (NIMR), Mbeya, Tanzania
| | - B Mtafya
- Mbeya Medical Research Centre, National Institute for Medical Research (NIMR), Mbeya, Tanzania
| | - A Lwilla
- Mbeya Medical Research Centre, National Institute for Medical Research (NIMR), Mbeya, Tanzania
| | - S Viegas
- Instituto Nacional de Saúde (INS), Marracuene, Mozambique
| | - C Madeira
- Instituto Nacional de Saúde (INS), Marracuene, Mozambique
| | - A Machiana
- Instituto Nacional de Saúde (INS), Marracuene, Mozambique
| | - J Ribeiro
- Instituto Nacional de Saúde (INS), Marracuene, Mozambique
| | - A L Garcia-Basteiro
- Centro de Investigação Em Saúde de Manhiça (CISM), Manhica, Mozambique
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - F Riess
- Division of Infectious Diseases and Tropical Medicine, Ludwig Maximilian University Hospital, Munich, Germany
| | - D Elísio
- Centro de Investigação Em Saúde de Manhiça (CISM), Manhica, Mozambique
| | - M Sasamalo
- Ifakara Health Institute, Dar Es Salaam, Tanzania
| | - G Mhalu
- Ifakara Health Institute, Dar Es Salaam, Tanzania
| | - C M Denkinger
- Division of Infectious Disease and Tropical Medicine and German Centre for Infection Research, Heidelberg University Hospital, Heidelberg, Germany
| | - M D M Castro
- Division of Infectious Disease and Tropical Medicine and German Centre for Infection Research, Heidelberg University Hospital, Heidelberg, Germany
| | - S Bashir
- Division of Infectious Disease and Tropical Medicine and German Centre for Infection Research, Heidelberg University Hospital, Heidelberg, Germany
| | | | - E Tagliani
- Emerging Bacterial Pathogens Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - A Malhotra
- Johns Hopkins University (JHU), Baltimore, MD, USA
| | - D Dowdy
- Johns Hopkins University (JHU), Baltimore, MD, USA
| | | | - J Buech
- LINQ Management, Berlin, Germany
| | - D Nguenha
- Centro de Investigação Em Saúde de Manhiça (CISM), Manhica, Mozambique
| | - N Ntinginya
- Mbeya Medical Research Centre, National Institute for Medical Research (NIMR), Mbeya, Tanzania
| | | | | | - K Kranzer
- Division of Infectious Diseases and Tropical Medicine, Ludwig Maximilian University Hospital, Munich, Germany.
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK.
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Sharma K, Sharma M, Sharma V, Sharma M, Samanta J, Sharma A, Kochhar R, Sinha SK. Evaluating diagnostic performance of Truenat MTB Plus for gastrointestinal tuberculosis. J Gastroenterol Hepatol 2022; 37:1571-1578. [PMID: 35501293 DOI: 10.1111/jgh.15878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/24/2022] [Accepted: 04/28/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM Prompt and accurate diagnosis of gastrointestinal tuberculosis (GITB) along with simultaneous detection of drug resistance is inevitable for tuberculosis elimination. Truenat MTB Plus (TruPlus), a chip-based real-time polymerase chain reaction assay, was evaluated for the first time for diagnosing GITB and detecting rifampicin resistance. METHODS Fifty ileocecal biopsy specimens (5 microbiologically confirmed GITB [culture-positive], 25 clinically confirmed GITB [culture-negative], and 20 control patients) processed in the Department of Microbiology between 2011 and 2021 were subjected to TruPlus assay, Xpert MTB RIF assay multiplex polymerase chain reaction. Their performance was evaluated against both culture and composite reference standard. RESULTS The overall sensitivity and specificity of TruPlus in diagnosing GITB was 70% (21/30) and 100%, respectively. The sensitivity was 60% (3/5) for microbiologically confirmed cases and 72% (18/25) for clinically confirmed cases. Performance of TruPlus was superior to Xpert (sensitivity = 30%; P = 0.001) and comparable with MPCR (sensitivity = 83.33%; P = 0.13). Both TruPlus and MPCR had moderate agreement with reference standards, and MPCR detected additional three cases. Both TruPlus and Xpert correctly reported Rifampicin resistance in three cases. CONCLUSIONS TruPlus, with its greater portability and higher sensitivity than Xpert, could serve as an important tool for diagnosing GITB and rifampicin resistance at outreach endemic areas.
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Affiliation(s)
- Kusum Sharma
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Megha Sharma
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.,Department of Microbiology, All India Institute of Medical Sciences, Bilaspur, India
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Megha Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jayanta Samanta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aman Sharma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Kochhar
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Saroj Kant Sinha
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Gomathi NS, Singh M, Singh UB, Myneedu VP, Chauhan DS, Sarin R, Mohan A, Bhatnagar A, Khangembam JS, Kannan T, Rao MVV, Logani J, Dey B, Gangakhedkar RR, Swaminathan S, Tripathy S. Multicentric validation of indigenous molecular test Truenat™ MTB for detection of Mycobacterium tuberculosis in sputum samples from presumptive pulmonary tuberculosis patients in comparison with reference standards. Indian J Med Res 2021; 152:378-385. [PMID: 33380702 PMCID: PMC8061602 DOI: 10.4103/ijmr.ijmr_2539_19] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background & objectives: Early case detection is essential to interrupt transmission and to prevent further spread of tuberculosis (TB) in high endemic settings. Nucleic acid amplification tests (NAATs) with visual read-outs are ideal as point-of-care tests. Truenat™ MTB is an indigenous chip-based NAAT for detection of Mycobacterium tuberculosis, which involves extraction of DNA and real-time polymerase chain reaction (PCR) using portable, automated, battery-operated instruments. The current multicentric study was aimed to evaluate Truenat for detection of MTB in sputum samples obtained from patients with presumptive pulmonary TB with reference to culture as gold standard and Xpert as a comparator. Methods: The study was conducted at four sites, namely ICMR-National Institute for Research in Tuberculosis, Chennai; All India Institute of Medical Sciences, New Delhi; ICMR-National JALMA Institute for Leprosy and Other Mycobacterial Diseases, Agra; and National Institute of TB and Respiratory Diseases, New Delhi. Patients suspected to have TB were screened for eligibility. Two sputum samples were collected from each patient. Tests included smear, Xpert and Truenat directly from the sputum sample and culture by Lowenstein-Jensen (L-J) medium and MGIT960 from decontaminated pellets. Sample used for Truenat assay was coded. Resolution of Truenat false positives was done using an in-house PCR with TRC4 primers. Results: The study enrolled 2419 presumptive TB patients after screening 2465 patients, and 3541 sputum samples were collected from the enrolled patients. Results of 2623 samples were available for analysis. Truenat showed a positivity rate of 48.5 per cent as compared to 37.0 per cent by Xpert. The sensitivities of Truenat and Xpert were was 88.3 and 79.7 per cent, respectively in comparison with culture. Interpretation & conclusions: Truenat MTB identified more positives among culture-confirmed samples than Xpert and had higher sensitivity. In addition, other advantageous operational features of Truenat MTB were identified which would be useful in field settings.
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Affiliation(s)
- N S Gomathi
- Department of Bacteriology, ICMR-National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - Manjula Singh
- Division of Epidemiology & Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Urvashi B Singh
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - V P Myneedu
- Department of Microbiology, National Institute of Tuberculosis & Other Respiratory Diseases, New Delhi, India
| | - D S Chauhan
- Department of Microbiology & Molecular Biology, ICMR-National JALMA Institute of Leprosy & Other Mycobacterial Diseases, Agra, Uttar Pradesh, India
| | - Rohit Sarin
- National Institute of Tuberculosis & Other Respiratory Diseases, New Delhi, India
| | - Anant Mohan
- Department of Pulmonary Medicine & Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Anuj Bhatnagar
- Department of Chest & TB, National Institute of Tuberculosis & Other Respiratory Diseases, New Delhi, India
| | - Jiten Singh Khangembam
- Department of Pulmonary Medicine & Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - T Kannan
- Statistics Section, Epidemiology Unit, ICMR-National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - M V V Rao
- ICMR-National Institute of Medical Statistics, New Delhi, India
| | - Jyoti Logani
- Department of Biotechnology, Ministry of Science & Technology, Government of India, New Delhi, India
| | - Bindu Dey
- Department of Biotechnology, Ministry of Science & Technology, Government of India, New Delhi, India
| | - Raman R Gangakhedkar
- Division of Epidemiology & Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | | | - Srikanth Tripathy
- ICMR-National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
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Chopra KK, Sidiq Z, Hanif M, Dwivedi KK. Advances in the diagnosis of tuberculosis- Journey from smear microscopy to whole genome sequencing. Indian J Tuberc 2020; 67:S61-8. [PMID: 33308673 DOI: 10.1016/j.ijtb.2020.09.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 09/24/2020] [Indexed: 12/14/2022]
Abstract
The laboratory plays an important role in diagnosing tuberculosis (TB) and the identification and drug sensitivity testing (DST) of Mycobacterium tuberculosis. With a timely diagnosis and treatment with appropriate anti-TB drugs, most people who develop TB can be cured and onward transmission of infection curtailed. For a long time, laboratories used only microscopy and conventional culture-based diagnosis, however these procedures are slow and may require 3-4 weeks to yield results. Given the increasing rate of drug resistance, it has been necessary to look for new and rapid diagnostic methods. Various molecular based diagnostic technologies became available in the beginning of early 90s, providing rapid detection, identification and DST of M. tuberculosis. Molecular technologies offer the greatest potential for laboratories because they have the highest sensitivity and specificity. The present article will review some of the new methodology that has been introduced in the clinical laboratory.
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