Evaluation of Microscopic Observation Drug Susceptibility (MODS) and the string test for rapid diagnosis of pulmonary tuberculosis in HIV/AIDS patients in Bolivia.
Evaluation of Microscopic Observation Drug Susceptibility (MODS) and the string test for rapid diagnosis of pulmonary tuberculosis in HIV/AIDS patients in Bolivia.
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DOI：
10.1186/s12879-015-0966-0
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发表时间：
2015-06-06
影响因子：
3.7
通讯作者：
Torrico F
中科院分区：
文献类型：
--
作者：
Lora MH;Reimer-McAtee MJ;Gilman RH;Lozano D;Saravia R;Pajuelo M;Bern C;Castro R;Espinoza M;Vallejo M;Solano M;Challapa R;Torrico F
结核病是最常见的机会性感染，也是全世界艾滋病毒阳性者的主要死因。诊断TB是困难的，并且在资源稀缺的环境中更具挑战性，其中基于培养的诊断方法依赖于通过Ziehl-Neelsen染色（ZN）进行的低灵敏度涂片显微镜检查。我们进行了一项横断面研究，比较了显微镜观察药物敏感性液体培养（MODS）与传统的Ziehl-Neelsen染色（ZN）和Lowenstein詹森培养（LJ）对玻利维亚HIV感染患者肺结核（TB）和耐多药结核（MDRTB）的诊断效用。对于痰液稀少的个体，我们评估了绳试验和诱导痰对结核病诊断的价值。采用ZN、LJ和MODS法对107例HIV阳性患者痰液中结核分枝杆菌（Mtb）的检出情况进行了评价。对102例患者的胃分泌物进行了MODS评价。有呼吸道症状的HIV感染者中，痰标本检测TB与HIV混合感染率为45%（48/107），其中MODS阳性46/48（96%），LJ阳性38/48（79%），ZN阳性30/48（63%）。耐多药结核病发生率为9%（4/48）。MODS组培养阳性的中位时间为10天，而LJ组为34天（p < 0.0001）。在涂片阴性患者中，MODS在17/18例患者中检测到TB，而LJ为11/18（94.4% vs 61.0%，p = 0.03%）。在未经诱导不能产生痰样品的患者中，通过MODS培养的绳状试验产生9/11（82%）的TB阳性患者中的Mtb，相比之下，诱导痰产生11/11（100%）的Mtb。在10名无法产生痰液样本的患者中，4名患者通过绳试验呈TB阳性。与LJ相比，MODS更快，Mtb检出率更高，在涂片阴性患者中两者之间的检出率差异更大。对于HIV阴性或无痰的患者，绳条试验是一种有价值的诊断技术，在资源有限的情况下，应考虑作为诱导痰的替代试验，以获得Mtb样本。我们的结核病+患者中有9%患有耐多药结核病，这加强了对玻利维亚艾滋病毒患者进行直接药物敏感性测试的快速检测的必要性。
Tuberculosis (TB) is the most common opportunistic infection and the leading cause of death in HIV-positive people worldwide. Diagnosing TB is difficult, and is more challenging in resource-scarce settings where culture-based diagnostic methods rely on poorly sensitive smear microscopy by Ziehl-Neelsen stain (ZN). We performed a cross-sectional study examining the diagnostic utility of Microscopic Observation Drug Susceptibility liquid culture (MODS) versus traditional Ziehl-Neelsen staining (ZN) and Lowenstein Jensen culture (LJ) of pulmonary tuberculosis (TB) and multidrug-resistant tuberculosis (MDRTB) in HIV-infected patients in Bolivia. For sputum scarce individuals we assessed the value of the string test and induced sputum for TB diagnosis. The presence of Mycobacterium tuberculosis (Mtb) in the sputum of 107 HIV-positive patients was evaluated by ZN, LJ, and MODS. Gastric secretion samples obtained by the string test were evaluated by MODS in 102 patients. The TB-HIV co-infection rate of HIV patients with respiratory symptoms by sputum sample was 45 % (48/107); 46/48 (96 %) were positive by MODS, 38/48 (79 %) by LJ, and 30/48 (63 %) by ZN. The rate of MDRTB was 9 % (4/48). Median time to positive culture was 10 days by MODS versus 34 days by LJ (p < 0.0001). In smear-negative patients, MODS detected TB in 17/18 patients, compared to 11/18 by LJ (94.4 % vs 61.0 %, p = 0.03 %). In patients unable to produce a sputum sample without induction, the string test cultured by MODS yielded Mtb in of 9/11 (82 %) TB positive patients compared to 11/11 (100 %) with induced sputum. Of the 10 patients unable to produce a sputum sample, 4 were TB-positive by string test. MODS was faster and had a higher Mtb detection yield compared to LJ, with a greater difference in yield between the two in smear-negative patients. The string test is a valuable diagnostic technique for HIV sputum-scarce or sputum-absent patients, and should be considered as an alternative test to induced sputum to obtain sample for Mtb in resource-limited settings. Nine percent of our TB+ patients had MDRTB, which reinforces the need for rapid detection with direct drug susceptibility testing in HIV patients in Bolivia.
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DOI：
10.1016/s2213-2600(13)70120-6
发表时间：
2013-08
期刊：
The Lancet. Respiratory medicine
影响因子：
--
作者：
Peter JG;Theron G;Pooran A;Thomas J;Pascoe M;Dheda K
通讯作者：
Dheda K
DOI：
10.1046/j.1440-1843.2000.00287.x
发表时间：
2000-12-01
期刊：
Respirology (Carlton, Vic.)
影响因子：
--
作者：
Lee, M P;Chan, J W;Li, P C
通讯作者：
Li, P C
DOI：
10.4269/ajtmh.1970.19.349
发表时间：
1970-01-01
影响因子：
3.3
作者：
BEAL, CB;UNIV, MONTRE;HUGHES, JM
通讯作者：
HUGHES, JM
影响因子：
4.6
作者：
Toossi, Z;Mayanja-Kizza, H;Whalen, CW
通讯作者：
Whalen, CW
影响因子：
168.9
作者：
DECOCK, KM;WILKINSON, D
通讯作者：
WILKINSON, D