Rifampicin-resistant TB: discordance between Xpert® MTB/RIF and MTBDRplus results

2021 ◽  
Vol 25 (10) ◽  
pp. 832-838
Author(s):  
M. Black ◽  
P. Da Silva ◽  
L. Scott
Keyword(s):  
South Africa ◽  
Mixed Infection ◽  
Screening Test ◽  
Diagnostic Algorithm ◽  
Initial Screening ◽  
Treatment Regimens ◽  
Good Management

BACKGROUND: South Africa´s diagnostic algorithm for TB diagnosis from 2011 to 2017 employed the Xpert® MTB/RIF assay as the initial screening test for TB diagnosis and rifampicin (RIF) susceptibility, followed by submission of a specimen for GenoType® MTBDRplus. This study aimed to determine the concordance between the two assays in terms of RIF susceptibility and explore reasons for discordance.METHODS: This was a retrospective laboratory-based study that included all MTBDRplus results of tests performed at the Braamfontein Mycobacteriology Referral Laboratory between 1 September 2014 and 31 August 2015. The patient´s Xpert RIF result was linked with the MTBDRplus result.RESULTS: The overall concordance between RIF susceptibility results was 96.4%. There were 68 discordant RIF results. The most common reasons for discordance identified were possible false Xpert RIF-resistant results (22%), mixed infection/heteroresistance (16%), transcription errors (7%) and erroneous manual interpretation of the MTBDRplus strip (7%). Xpert RIF resistance detected using delayed hybridisation was associated with discordance.CONCLUSIONS: The overall concordance between the MTBDRplus and Xpert RIF results were very good. Management of discordance should include repeat specimens for Xpert and MTBDRplus and rpoB sequencing. All variables should then be considered before treatment regimens are altered.

scholarly journals Survey of canine babesiosis in South Africa

2000 ◽  
Vol 71 (3) ◽  
Author(s):  
M.G. Collett
Keyword(s):  
South Africa ◽  
Trypan Blue ◽  
Western Cape ◽  
Supportive Treatment ◽  
Canine Babesiosis ◽  
Liver Support ◽  
Treatment Regimens ◽  
Research Priority ◽  
High Parasitaemia ◽  
Shock Lung

A questionnaire, designed to obtain qualitative information on a number of variables concerning canine babesiosis (biliary fever) in South Africa, was sent to 510 veterinary practices in late 1993. Of the 157 practices that responded, all were presented with cases of babesiosis and most were situated in Gauteng, the Western Cape and KwaZulu-Natal. Apart from the Western Cape, a winter-rainfall region, the prevalence of babesiosis cases in dogs was highest in summer. Most of the respondent practices treated between 1000 and 5000 sick dogs that included 100 to 500 babesiosis cases each year. Respondents identified cerebral babesiosis, enterorrhagia, 'red' or haemoconcentrated babesiosis, acute renal failure and pulmonary babesiosis or 'shock lung', amongst others, as the most prevalent forms of complicated ('atypical') babesiosis. Diminazene, imidocarb and trypan blue were the most popular antibabesials. Trypan blue was most often used in shocked patients, whereas diminazene and imidocarb were preferred when there was a high parasitaemia in the absence of shock. At least 19 antibabesial treatment regimens were used in practices. These comprised the use of single doses of antibabesial drugs; split doses with repeat injections, and combined drug variations, some of which are undesirable due to possible sterilisation of Babesia infection or potential toxicity. Side-effects were most commonly associated with imidocarb use. Ninety-six percent of respondents used supportive treatment (e.g. corticosteroids, vitamins and 'liver support') in all cases of babesiosis. The use of blood transfusion as supportive treatment varied according to practice and severity of the case. Most practices never cross-matched blood to be transfused, and transfusion reactions were rare. Diminazene was most frequently incriminated in cases where drug 'resistance' or relapses occurred. Cerebral and 'red' cases resulted in high mortality. Treatment of babesiosis costs the dog-owning public in South Africa more than R20 million each year. Information on the distribution and possible complicating role of Ehrlichia canis was obtained. Development of a vaccine was the first research priority identified.

Narrating Experiences of Breast Cancer: Reflections of Women Attending a Private Hospital in Bloemfontein, South Africa

2017 ◽  
Vol 13 (1) ◽  
pp. 136-157
Author(s):  
Alessandra K. Heggenstaller ◽  
Katinka De Wet ◽  
Jan K. Coetzee ◽  
Florian Elliker
Keyword(s):  
Breast Cancer ◽  
South Africa ◽  
Developing Countries ◽  
Private Hospital ◽  
Ethic Of Care ◽  
Medical System ◽  
Death Sentence ◽  
Self Perception ◽  
Medical Encounter ◽  
Treatment Regimens

It is commonly thought that breast cancer, like many other cancers, is an illness equivalent to a death sentence. Though this may be true in some cases, the majority of women diagnosed with breast cancer do survive this illness. Breast cancer is a growing illness and is continuing to affect women worldwide, including developing countries like South Africa. Furthermore, this country’s medical system operates in terms of a duality. Here, hospitals and healthcare are mainly situated in either state operated institutions or in privately run practices. This duality emphasizes the inequality within the socio-economic classes, treatment regimens, and ethic-of-care. This article deals with how women from the higher socio-economic stratum of the deeply polarized South Africa deal with breast cancer. The aim is to understand how each participant renegotiates and transforms her self-perception, her identity, and issues around femininity. In addition, the authors also seek to understand if this medical encounter influences the participants’ sense of embodiment, as well as how the medical encounter impacts on their everyday lifeworld.

The Efficiency of the Revised Denver Developmental Screening Test as a Language Screening Tool

1996 ◽  
Vol 27 (4) ◽  
pp. 330-332 ◽  
Author(s):  
Jennifer Feeney ◽  
John Bernthal
Keyword(s):  
Screening Test ◽  
Screening Tool ◽  
False Positives ◽  
Developmental Screening ◽  
Initial Screening ◽  
False Negatives ◽  
Preschool Screening ◽  
Hit Rate ◽  
The Status ◽  
Language Screening

The purpose of this study was to determine the number of false positives and false negatives derived from the language domain of the Revised Denver Developmental Screening Test (RDDST) in a community preschool screening. Six months after the initial screening, 199 RDDST protocols were reviewed and the status of each child was documented. The study identified nine false positives and three false negatives, which resulted in a positive hit rate of 93.5 %. The results of the study indicate that the RDDST is an effective tool in predicting the need for formal assessment.

scholarly journals Diagnosis of Duchenne Muscular Dystrophy using Raman Hyperspectroscopy

2020 ◽  
Author(s):  
Nicole M. Ralbovsky ◽  
Paromita Dey ◽  
Andrew Galfano ◽  
Bijan K. Dey ◽  
Igor K. Lednev
Keyword(s):  
Duchenne Muscular Dystrophy ◽  
Muscular Dystrophy ◽  
Blood Serum ◽  
External Validation ◽  
Diagnostic Algorithm ◽  
Severe Form ◽  
Specific Method ◽  
Muscle Degeneration ◽  
Treatment Regimens ◽  
Progressive Muscle Weakness

AbstractDuchenne muscular dystrophy (DMD) is the most common and severe form of muscular dystrophy and affects boys in infancy or early childhood. DMD is known to trigger progressive muscle weakness due to skeletal muscle degeneration and ultimately causes death. There are limited treatment regimens available that can either slow or stop the progression of DMD. An accurate and specific method for diagnosing DMD in its earliest stages is needed to prevent progressive muscle degeneration and death. Current methods for diagnosing DMD are often laborious, expensive, invasive, and typically diagnose the disease later on it is progression. In an effort to improve the accuracy and ease of diagnosis, this study focused on developing a novel method for diagnosing DMD which combines Raman hyperspectroscopic analysis of blood serum with advanced statistical analysis. Partial Least Squares Discriminant Analysis (PLS-DA), was applied to the spectral dataset acquired from control and mdx blood serum of 3- and 12-month old mice to build a diagnostic algorithm. Internal cross-validation showed 95.2% sensitivity and 94.6% specificity for identifying diseased spectra. These results were verified using external validation, which achieved 100% successful classification efficiency at the level of individual donor. This proof-of-concept study presents Raman hyperspectroscopic analysis of blood serum as a fast, non-expensive, minimally invasive and early detection method for the diagnosis of Duchenne muscular dystrophy.

scholarly journals Findings from a novel and scalable community-based HIV testing approach to reduce the time required to complete point-of-care HIV testing in South Africa

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tonderai Mabuto ◽  
Geoffrey Setswe ◽  
Nolundi Mshweshwe-Pakela ◽  
Dave Clark ◽  
Sarah Day ◽  
...  
Keyword(s):  
South Africa ◽  
Hiv Testing ◽  
Screening Test ◽  
Point Of Care ◽  
Standard Of Care ◽  
Median Number ◽  
Hiv Positive ◽  
Hiv Screening ◽  
Rapid Tests ◽  
Intervention Team

Abstract Background Mobile HIV testing approaches are a key to reaching the global targets of halting the HIV epidemic by 2030. Importantly, the number of clients reached through mobile HIV testing approaches, need to remain high to maintain the cost-effectiveness of these approaches. Advances in rapid in-vitro tests such as INSTI® HIV-1/HIV-2 (INSTI) which uses flow-through technologies, offer opportunities to reduce the HIV testing time to about one minute. Using data from a routine mobile HTS programme which piloted the use of the INSTI point-of-care (POC) test, we sought to estimate the effect of using a faster test on client testing volumes and the number of people identified to be living with HIV, in comparison with standard of care HIV rapid tests. Methods In November 2019, one out of four mobile HTS teams operating in Ekurhuleni District (South Africa) was randomly selected to pilot the field use of INSTI-POC test as an HIV screening test (i.e., the intervention team). We compared the median number of clients tested for HIV and the number of HIV-positive clients by the intervention team with another mobile HTS team (matched on performance and area of operation) which used the standard of care (SOC) HIV screening test (i.e., SOC team). Results From 19 to 20 December 2019, the intervention team tested 7,403 clients, and the SOC team tested 2,426 clients. The intervention team tested a median of 442 (IQR: 288–522) clients/day; SOC team tested a median of 97 (IQR: 40–187) clients/day (p<0.0001). The intervention team tested about 180 more males/day compared to the SOC team, and the median number of adolescents and young adults tested/day by the intervention team were almost four times the number tested by the SOC team. The intervention team identified a higher number of HIV-positive clients compared to the SOC team (142 vs. 88), although the proportion of HIV-positive clients was lower in the intervention team due to the higher number of clients tested. Conclusions This pilot programme provides evidence of high performance and high reach, for men and young people through the use of faster HIV rapid tests, by trained lay counsellors in mobile HTS units.

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