scholarly journals The simple direct slide method is comparable to indirect Lowenstein Jensen proportion culture for detecting rifampicin resistant tuberculosis

2021 ◽  
Author(s):  
Beatrice Achan ◽  
Benon B. Asiimwe ◽  
Moses L. Joloba ◽  
Mourad Gumusboga ◽  
Willy Ssengooba ◽  
...  
Keyword(s):  
Low Income ◽  
Gold Standard ◽  
Rifampicin Resistance ◽  
Middle Income ◽  
Predictive Values ◽  
Technical Performance ◽  
Resistant Tuberculosis ◽  
Treatment Centre ◽  
Lowenstein Jensen ◽  
Proportion Method

Introduction. Drug resistant tuberculosis remains a worldwide problem that requires prompt diagnosis. Hypothesis/Gap statement. The WHO recommended direct, rapid Xpert MTB/RIF is prohibitively costly, therefore, there is a need to validate a rapid, affordable DST for use in low- and middle-income settings. Aim. The technical performance and time to results of a simple, direct microscopy-based slide DST (SDST) assay for diagnosis of rifampicin-resistant TB was evaluated in Uganda. Methodology. Sputum samples from 122 smear-positive re-treatment TB patients presenting to the TB treatment centre at Uganda’s National Referral Hospital, Mulago, Kampala, Uganda were examined. The sputum samples were tested by the direct SDST which was compared to the indirect Lowenstein Jensen Proportion Method (LJDST) method as the gold standard. The time to results was defined as the time from DST setting to results interpretation. The results were further analysed for sensitivity and specificity as well as agreement between LJDST and SDST for rifampicin resistance determination. Results. A total of 117 smear positive sputum samples with valid results for both tests were compared. The median time to results for SDST was 14 days with an interquartile range (IQR) of 10–14 days compared to 60 days with IQR of 60–75 days for LJDST. The number for rifampicin resistance by the gold standard LJDST was 26. The SDST had a sensitivity of 96 % (95 %; CI 81–99 %) and a specificity of 97.8 % (95 %; CI 93–100 %). The Positive Predictive and Negative Predictive values for SDST were 92.3 % (95 %; CI 76.8–99 %) and 98.9 % (95 %; CI 94–100 %), respectively. The kappa agreement between SDST and LJDST was 92.3 %. Conclusion. The SDST was found to be a rapid and accurate direct test for the detection of rifampicin resistance among retreatment TB cases in low-income settings.

scholarly journals Multicentric study of cervical cancer screening with human papillomavirus testing and assessment of triage methods in Latin America: the ESTAMPA screening study protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (5) ◽  
pp. e035796
Author(s):  
Maribel Almonte ◽  
Raúl Murillo ◽  
Gloria Inés Sánchez ◽  
Paula González ◽  
Annabelle Ferrera ◽  
...  
Keyword(s):  
Latin America ◽  
Human Papillomavirus ◽  
Study Protocol ◽  
Low Income ◽  
International Agency ◽  
Hpv Testing ◽  
Middle Income ◽  
Multicentric Study ◽  
Predictive Values ◽  
Hpv Test

IntroductionHuman papillomavirus (HPV) testing is replacing cytology in primary screening. Its limited specificity demands using a second (triage) test to better identify women at high-risk of cervical disease. Cytology represents the immediate triage but its low sensitivity might hamper HPV testing sensitivity, particularly in low-income and middle-income countries (LMICs), where cytology performance has been suboptimal. The ESTAMPA (EStudio multicéntrico de TAMizaje y triaje de cáncer de cuello uterino con pruebas del virus del PApiloma humano; Spanish acronym) study will: (1) evaluate the performance of different triage techniques to detect cervical precancer and (2) inform on how to implement HPV-based screening programmes in LMIC.Methods and analysisWomen aged 30–64 years are screened with HPV testing and Pap across 12 study centres in Latin America. Screened positives have colposcopy with biopsy and treatment of lesions. Women with no evident disease are recalled 18 months later for another HPV test; those HPV-positive undergo colposcopy with biopsy and treatment as needed. Biological specimens are collected in different visits for triage testing, which is not used for clinical management. The study outcome is histological high-grade squamous intraepithelial or worse lesions (HSIL+) under the lower anogenital squamous terminology. About 50 000 women will be screened and 500 HSIL+ cases detected (at initial and 18 months screening). Performance measures (sensitivity, specificity and predictive values) of triage techniques to detect HSIL+ will be estimated and compared with adjustment by age and study centre.Ethics and disseminationThe study protocol has been approved by the Ethics Committee of the International Agency for Research on Cancer (IARC), of the Pan American Health Organisation (PAHO) and by those in each participating centre. A Data and Safety Monitoring Board (DSMB) has been established to monitor progress of the study, assure participant safety, advice on scientific conduct and analysis and suggest protocol improvements. Study findings will be published in peer-reviewed journals and presented at scientific meetings.Trial registration numberNCT01881659

scholarly journals Drug-Resistant Tuberculosis Among Children: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 9 ◽  
Author(s):  
Wan-mei Song ◽  
Yi-fan Li ◽  
Yun-xia Liu ◽  
Yao Liu ◽  
Chun-bao Yu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Low Income ◽  
Meta Analysis ◽  
Low Income Countries ◽  
Drug Resistant ◽  
Drug Resistant Tuberculosis ◽  
Middle Income ◽  
Middle Income Countries ◽  
Resistant Tuberculosis ◽  
Mdr Tb

Background: Drug-resistant tuberculosis (DR-TB), especially multidrug-resistant tuberculosis (MDR-TB) is a public health threat. Little is known about estimates of different profiles and rates of DR-TB among children globally.Methods: We did a systematic review and meta-analysis of observational studies reporting DR-TB among children by searching Embase, PubMed, and Scopus databases from January 1, 2000 to October 1, 2020. Publications reporting more than 60 children with bacteriological confirmed tuberculosis and phenotypical drug susceptibility testing (DST) results were included. Pooled proportions of MDR-TB and sub-analysis by age subgroups, regions, economical levels were performed.Results: We identified 4,063 studies, of which 37 were included. Of 23,652 pediatric TB patients, the proportions of DR-TB, MDR-TB, mono-resistant TB, polydrug resistant TB, extensively drug-resistant TB were 13.59% (1,964/14,453), 3.72% (881/23,652), 6.07% (529/8,719), 1.61% (119/7,361), 0.44% (30/6,763), respectively. The pooled proportion of MDR-TB among 23,652 children of 37 studies was 3.7% (95% CI, 3.5–4.0%). Rate of MDR-TB was much lower in high-income countries (1.8%) than that in lower-middle-income countries (6.3%) and upper-middle-income countries (7.3%). More specifically, the rates of MDR-TB were 1.7% in USA, 1.7% in UK, 2.9% in India, 6.0% in South Africa, 9.8% in China, respectively.Conclusions: The burden of DR-TB remains high in children, and there are potential associations between rates of pediatric MDR-TB and national economical levels. More interventions on child TB cases in low-income countries may be urgently needed in future.

The potential for financing small-scale wastewater treatment through resource recovery: experience from Bocas del Toro, Panama

2014 ◽  
Vol 4 (3) ◽  
pp. 449-459 ◽  
Author(s):  
Sebastien Tilmans ◽  
Ana Diaz-Hernandez ◽  
Eric Nyman ◽  
Jennifer Davis
Keyword(s):  
Wastewater Treatment ◽  
Low Income ◽  
Net Present Value ◽  
Waste Treatment ◽  
Resource Recovery ◽  
Small Scale ◽  
Anaerobic Sludge ◽  
Middle Income ◽  
Technical Performance ◽  
Cost Of Energy

The excreta of more than half of the world's population is discharged into the environment without treatment of any kind. Particularly in low- and middle-income countries with limited public finance for treatment infrastructure, resource recovery from wastewater has the potential to finance part of the costs of sanitation systems. Most assessments of resource-recovering treatment systems in low-income settings have focused on their technical performance. In this study, using data collected from 14 upward-flow anaerobic sludge blanket septic tanks in rural Panama, we estimate the proportion of waste treatment system costs that could be offset by biogas sales. We find that biogas revenues would cover between 26% and 49% of system operation and maintenance expenses, and would improve the net present value of the wastewater system investment by 8% to 15%. Aggregate stated demand for in-home biogas delivery among sample households is more than twice the volume of gas that could be generated by a system treating waste from the entire community. In Panama and other countries where public resources are devoted to subsidizing liquid propane gas, investment in wastewater treatment systems with biogas recovery could reduce the cost of energy provision to households while improving public and environmental health.

scholarly journals Molecular Analysis of Rifampicin Resistance Conferring Mutations in Mycobacterium tuberculosis

2020 ◽  
Vol 17 (2) ◽  
pp. 0444
Author(s):  
Fairuz Tawgozy et al.
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Rpob Gene ◽  
Drug Susceptibility ◽  
Drug Susceptibility Testing ◽  
Rifampicin Resistance ◽  
New Finding ◽  
Lowenstein Jensen ◽  
Proportion Method ◽  
Rpoa Gene ◽  
First Time

Mycobacterium tuberculosis resistance to rifampicin is mainly mediated through mutations in the rpoB gene. The effects of rpoB mutations are relieved by secondary mutations in rpoA or rpoC genes. This study aims to identify mutations in rpoB, rpoA, and rpoC genes of Mycobacterium tuberculosis isolates and clarify their contribution to rifampicin resistance. Seventy isolates were identified by acid-fast bacilli smear, Genexpert assay, and growth on Lowenstein Jensen medium. Drug susceptibility, testing was performed by the proportional method.  DNA extraction, PCR, and sequencing were accomplished for the entire rpoA, rpoB, and rpoC genes. Twenty-three isolates (32.85%) showed resistance to rifampicin by either proportion method or Genexpert assay. Sequence analysis of the rpoB gene revealed fourteen different mutation patterns. Inside the rifampicin resistance determining region (RRDR), codons: S531L, D516V were highly mutated with frequencies of (21.73%, 17.39%) respectively. Outside the RRDR, there were nine different types of mutations, and M479L was the most prevalent one. Out of 23 RIF resistant isolates, seven isolates (30.43%) carried mutations in the rpoA gene, and twelve isolates (52.17%) harbored a mutation in rpoC. Most of the mutations were identified for the first time in this study. The current study demonstrated that mutations in rpoB, rpoA, and rpoC contributed to RIF resistance in Mycobacterium tuberculosis and this new finding may be relevant to realize how compensatory mutations in the rpoA and rpoC genes restore the fitness cost caused by rifampin resistance-conferring mutations in rpoB.

scholarly journals Tuberculosis: an overview of current literature on types, diagnosis and drug therapy

2019 ◽  
Vol 7 (7) ◽  
pp. 2875
Author(s):  
Victor Prabhakar D. ◽  
Lakshmi Keerthana R. ◽  
Shaik Salma ◽  
Amreen Siddiqua A. ◽  
Meghana Suryadevara ◽  
...  
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Low Income ◽  
Multiple Drug ◽  
Drug Resistant ◽  
Tuberculosis Complex ◽  
Middle Income ◽  
Middle Income Countries ◽  
Resistant Tuberculosis ◽  
Multiple Drug Resistant ◽  
Industrialized Nations

Tuberculosis (TB) is an airborne infectious disease caused by organisms of the Mycobacterium tuberculosis complex. It is a global problem and increases in case rates are occurring not only in the developing countries of the world but also in several industrialized nations. There has also been an alarming increase in the number and proportion of cases caused by strains of Mycobacterium tuberculosis that are resistant to multiple first-line drugs. The increase in multiple-drug resistant tuberculosis has re-taught physicians about the importance of pursuing and ensuring treatment until cure. In many low-income and middle-income countries, TB continues to be a major cause of morbidity and mortality, and drug-resistant TB is a major concern in many settings. This article offers an overview of types, diagnosis and management of TB.

scholarly journals Impacts of social support on the treatment outcomes of drug-resistant tuberculosis: a systematic review and meta-analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e036985
Author(s):  
Shuqin Wen ◽  
Jia Yin ◽  
Qiang Sun
Keyword(s):  
Social Support ◽  
Treatment Outcomes ◽  
Low Income ◽  
Meta Analysis ◽  
Treatment Success ◽  
Drug Resistant ◽  
Drug Resistant Tuberculosis ◽  
Middle Income ◽  
Material Support ◽  
Resistant Tuberculosis

ObjectiveTo assess the effectiveness of social support on treatment success promotion or lost to follow-up (LTFU) reduction for patients with drug-resistant tuberculosis (DR-TB).DesignWe searched Pubmed, Web of Science, Embase, Scopus and Medline databases until 18 June 2020 for interventional or mixed-method studies which reported social support and treatment outcomes of DR-TB patients. Two independent reviewers extracted data and disagreements were resolved by consensus with a third reviewer. Random-effects meta-analysis was performed to calculate the OR and 95% CI for the effects of social support on the improvement of treatment outcomes and the heterogeneity and risk of bias were assessed.SettingLow-income and middle-income countries.ParticipantsDR-TB patients.OutcomesTreatment success is defined as the combination of the cured and treatment completion, and LTFU is measured as treatment being interrupted for two consecutive months or more.ResultsAmong 173 articles selected for full-text review, 162 were excluded through independent review (kappa=0.87) and 10 studies enrolling 1621 DR-TB patients in eight countries were included for qualitative analysis. In these studies, the most frequently introduced social support was material support (10 studies), followed by informational (eight studies), emotional (seven studies) and companionship support (four studies). Seven studies that reported treatment outcomes in both intervention arm and control arm are qualified for meta-analysis. An encouraging improvement on treatment success rate (OR: 2.58; 95% CI: 1.80 to 3.69) was found when material support was integrated into social support packages and no heterogeneity was observed (I1 of 0%, Q test p=0.72). Reduction on LTFU rate (OR: 0.17; 95% CI: 0.05 to 0.55) was also noted when material support was available but substantial heterogeneity was found (I2 of 80%, Q test p=0.002).ConclusionMaterial support appeared feasible and effective to improve treatment success for DR-TB patients combined with other social support interventions.PROSPERO registration numberCRD42019140824.

scholarly journals ANTITUBERCULOSIS ACTIVITY OF EXTRACT AND FRACTIONS OF TINOSPORA CRISPA AGAINST MYCOBACTERIUM TUBERCULOSIS H37RV USING MYCOBACTERIA GROWTH INDICATOR TUBE AND AGAR PROPORTION METHOD

2018 ◽  
Vol 11 (3) ◽  
pp. 132
Author(s):  
Retno Wahyuningrum ◽  
Ritmaleni Ritmaleni ◽  
Tatang Irianti ◽  
Subagus Wahyuono ◽  
Takushi Kaneko
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Ethanolic Extract ◽  
Multidrug Resistant ◽  
Drug Candidates ◽  
Mycobacterium Tuberculosis H37rv ◽  
Indicator Tube ◽  
Resistant Tuberculosis ◽  
Lowenstein Jensen ◽  
Proportion Method ◽  
Growth Indicator

 Objective: The increasing incidence of multidrug-resistant tuberculosis (TB) has created a need to discover a new anti-TB drug candidates. The aim of this study was to screen extract and fractions of Tinospora crispa for activity against Mycobacterium tuberculosis H37Rv.Methods: The dried and pulverized T. crispa stem was extracted by maceration method using ethanol (96%). The anti-TB activity was carried out using mycobacteria growth indicator tube (MGIT) system and agar proportion method with Lowenstein–Jensen (LJ) medium.Result: The result of this study showed that ethanolic extract and fractions of T. Crispa did not exhibit anti-TB activity in the range of 100–1000 μg/ml with MGIT method, while with agar proportion method, there were M. tuberculosis colonies growth on the LJ containing 1000 μg/ml extract slants.Conclusion: The tested extract and fractions of T. crispa have no anti-TB activity against M. tuberculosis until 1000 μg/ml.

scholarly journals Uji Diagnostik Genexpert Mtb/Rif Di Rumah Sakit Umum Pusat Haji Adam Malik Medan

2016 ◽  
Vol 1 (2) ◽  
pp. 19
Author(s):  
Elva Susanty ◽  
Zainuddin Amir ◽  
Parluhutan Siagian ◽  
Rina Yunita ◽  
Putri Chairani Eyanoer
Keyword(s):  
Drug Sensitivity ◽  
Surrogate Marker ◽  
Multidrug Resistant ◽  
Sensitivity Testing ◽  
Standard Drug ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Mdr Tb ◽  
Lowenstein Jensen ◽  
Proportion Method

Background: Cases of multidrug resistant tuberculosis (MDR TB) is increasing in number in the world and requires early detection to prevent further transmission. GeneXpert MTB/RIF is a tool that can be used for detection of rifampicin resistance, as a surrogate marker for MDR TB. This study aims to assess the sensitivity and specificity of the GeneXpert MTB/RIF in diagnosis of MDR TB. Methods: diagnostic test study was conducted at a poly MDR TB General Hospital Haji Adam Malik Medan. The subjects were all suspected MDR TB who had results positive GeneXpert MTB/ RIF with sensitive rifampin or resistant  rifampin and had a drug sensitivity test results with the proportion method Lowenstein Jensen medium. Data retrieved from the medical records, between January until December 2013. Results: founded 64 samples that had results of GeneXpert MTB/RIF test positive and had the results of drug sensitivity, 87.5% of rifampin-resistant samples were also resistant to isoniazid. The GeneXpert MTB/RIF examination showed the sensitivity of 92.86% and the specificitu of 59.09%. Conclusion: GeneXpert MTB/ RIF has a high sensitivity for diagnosing MDR TB compared the gold standard drug sensitivity testing proportion method on Lowenstein Jensen medium. This study recommends the GeneXpert MTB/RIF be used for MDR TB screening tool. Keywords: GeneXpert MTB/RIF, multidrug resistant tuberculosis, drug susceptibility test, Lowenstein Jensen medium

scholarly journals Comparison of Gene Xpert MTB/RIF Assays with Conventional Standard Proportion Method for Determination of Drug Susceptibility In Multidrug Resistant TB Suspects

2018 ◽  
Vol 24 (1) ◽  
pp. 570-576 ◽  
Author(s):  
Muhammad Kashif Munir ◽  
Sana Rehman ◽  
Rizwan Iqbal ◽  
Muhammad Saqib Saeed ◽  
Muhammad Aasim
Keyword(s):  
Rapid Detection ◽  
Multidrug Resistant ◽  
World Health ◽  
Rifampicin Resistance ◽  
Research Centre ◽  
Isoniazid Resistance ◽  
Agreement Rate ◽  
Standard Drug ◽  
Resistant Tuberculosis ◽  
Proportion Method

Background: Tuberculosis (TB) is a contagious disease and multidrug resistant tuberculosis is an emerging global issue. Rapid detection of such type of tuberculosis is necessary for timely control of the disease. GeneXpert test has already been implemented by World Health Organization to diagnose the infection on urgent basis. Objectives: This study was designed to apply GeneXpert MTB/RIF assays for the detection of rifampicin resistant tuberculosis and validation of assays by comparing with conventional standard drug proportion method. Additionally, to explore whether the assay can be utilized in treatment of Multidrug Resistant TB Settings: This study was undertaken in Pakistan Health Research Council TB Research Centre in collaboration with Department of Pulmonology, King Edward Medical University, Mayo Hospital, Lahore. Methods: Sputum samples from 125 patients were collected from confirmed pulmonary TB patients who were not responding to standard regimen of first line anti-tubercular treatment. Smears were stained by Ziehl-Neelsen method. All specimens were processed for culture and drug sensitivity by drug proportion method using Lowenstein Jensen medium as well as GeneXpert MTB/RIF assay. Results: A total of 125 subjects were registered in present study including 64 (51.2%) males and 61 (48.8%) females of age 15 years and above with mean age of 36.9±14.99. Sensitivity and specificity of the assay was observed as 92.1% and 93.5%, respectively. Association of rifampicin resistant by MTB/RIF assay and isoniazid resistance was found to be 88.1% and an agreement rate of rifampicin resistance by GeneXpert MTB/ RIF assay with isoniazid resistance was 81.25%. A total of 56 (44.8%) cases were found to be multidrug resistant patients and an agreement rate of 92.9% (52/56) was demonstrated in multidrug resistant patients which was found to be rifampicin resistant by GeneXpert in present study. Conclusion: GeneXpert MTB/RIF assay shown high sensitivity (96.7%) and specificity (98.6%). This most modern and latest technique, particularly in smear negative patients, helps rapid detection of TB and rifampicin resistance, which facilitates prompt diagnosis of multidrug resistant TB. These results propose that effective treatment can be initiated at an early stage, which will greatly help in reducing multidrug resistant TB.

Sign in / Sign up

Export Citation Format

Share Document