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https://www.readbyqxmd.com/read/28746344/treatment-initiation-among-persons-diagnosed-with-drug-resistant-tuberculosis-in-johannesburg-south-africa
#1
Denise Evans, Kathryn Schnippel, Caroline Govathson, Tembeka Sineke, Andrew Black, Lawrence Long, Rebecca Berhanu, Sydney Rosen
BACKGROUND: In South Africa, roughly half of the drug-resistant TB cases diagnosed are reported to have been started on treatment. We determined the proportion of persons diagnosed with rifampicin resistant (RR-) TB who initiated treatment in Johannesburg after the introduction of decentralized RR-TB care in 2011. METHODS: We retrospectively matched adult patients diagnosed with laboratory-confirmed RR-TB in Johannesburg from 07/2011-06/2012 with records of patients initiating RR-TB treatment at one of the city's four public sector treatment sites (one centralized, three decentralized)...
2017: PloS One
https://www.readbyqxmd.com/read/28745310/a-two-step-algorithm-for-rapid-diagnosis-of-active-pulmonary-tuberculosis-in-entry-applicants-using-the-t-spot-tb-and-xpert-mtb-rif-assays-in-shanghai-china
#2
Chengyan Meng, Yaojie Shen, Jian Wang, Sen Wang, Xinchang Chen, Shenglei Yu, Wei Ye, Jing Wu
No abstract text is available yet for this article.
July 26, 2017: Emerging Microbes & Infections
https://www.readbyqxmd.com/read/28739268/xpert%C3%A2-mtb-rif-usefulness-for-the-diagnosis-of-tuberculosis-and-resistance-to-rifampicin
#3
REVIEW
Andrea Vergara Gómez, Julià González-Martín, Alberto L García-Basteiro
The advent of the Xpert® MTB/RIF technique was a revolution in the diagnosis of tuberculosis, especially in areas with high incidence and low resources. It allows the detection of Mycobacterium tuberculosis complex and simultaneously the most common resistance mutations to rifampicin in less than 2h. For respiratory samples the sensitivity is very high, but it decreases for extrapulmonary samples and children. Although it is faster and simpler than conventional methods, it presents some limitations and new and better techniques are needed to reduce the number of cases and deaths caused by tuberculosis...
July 21, 2017: Medicina Clínica
https://www.readbyqxmd.com/read/28727491/impact-of-point-of-care-xpert-mtb-rif-on-tuberculosis-treatment-initiation-a-cluster-randomised-trial
#4
Richard J Lessells, Graham S Cooke, Nuala McGrath, Mark P Nicol, Marie-Louise Newell, Peter Godfrey-Faussett
RATIONALE: Point-of-care (POC) diagnostics have potential to reduce pre-treatment loss to follow-up and delays to initiation of appropriate TB treatment. OBJECTIVE: To evaluate the effect of a POC diagnostic strategy on initiation of appropriate TB treatment. METHODS: A cluster randomised trial of adults with cough who were HIV positive and/or at high risk of drug-resistant TB. Two-week time blocks were randomised to two strategies (i) Xpert performed at district hospital laboratory (ii) POC Xpert performed at primary health care clinic...
July 20, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28717600/implementation-of-the-xpert-mtb-rif-assay-for-tuberculosis-in-mongolia-a-qualitative-exploration-of-barriers-and-enablers
#5
Nicole L Rendell, Solongo Bekhbat, Gantungalag Ganbaatar, Munkhjargal Dorjravdan, Madhukar Pai, Claudia C Dobler
OBJECTIVE: The aim of our study was to identify barriers and enablers to implementation of the Xpert MTB/RIF test within Mongolia's National Tuberculosis Program. METHODS: Twenty-foursemi-structured interviews were conducted between June and September 2015 with laboratory staff and tuberculosis physicians in Mongolia's capital Ulaanbaatar and regional towns where Xpert MTB/RIF testing had been implemented. Interviews were recorded, transcribed, translated and analysed thematically using NVIVO qualitative analysis software...
2017: PeerJ
https://www.readbyqxmd.com/read/28716809/determining-clinical-decision-thresholds-for-hiv-positive-patients-suspected-of-having-tuberculosis
#6
Tom Boyles, Isabella Locatelli, Nicolas Senn, Mark Ebell
Clinical decision thresholds may aid the evaluation of diagnostic tests but have rarely been determined for tuberculosis (TB). We presented clinicians with six web-based clinical scenarios, describing patients with HIV and possible TB at various sites and with a range of clinical stability. The probability of disease was varied randomly and clinicians asked to make treatment decisions; threshold curves and therapeutic thresholds were calculated. Test and treatment thresholds were calculated using Bayes theorem and the diagnostic accuracy of Xpert MTB/RIF...
August 2017: Evidence-based Medicine
https://www.readbyqxmd.com/read/28716462/rapid-identification-of-a-mycobacterium-tuberculosis-full-genetic-drug-resistance-profile-through-whole-genome-sequencing-directly-from-sputum
#7
Camus Nimmo, Ronan Doyle, Carrie Burgess, Rachel Williams, Rebecca Gorton, Timothy D McHugh, Mike Brown, Stephen Morris-Jones, Helen Booth, Judith Breuer
INTRODUCTION: Resistance to second line tuberculosis drugs is common, but slow to diagnose with phenotypic drug sensitivity testing. Rapid molecular tests speed up diagnosis, but can only detect limited mutations. Whole genome sequencing (WGS) of culture isolates can generate a complete genetic drug resistance profile, but is delayed by the initial culture step. We previously successfully achieved WGS directly from sputum using targeted enrichment. CASE REPORT: A 29-year-old Nigerian lady was diagnosed with tuberculosis...
July 14, 2017: International Journal of Infectious Diseases: IJID
https://www.readbyqxmd.com/read/28709488/endobronchial-ultrasound-experience-in-a-high-tuberculosis-prevalence-setting
#8
Balamugesh Thangakunam, Barney Thomas Jesudason Isaac, Devasahayam Jesudas Christopher
BACKGROUND: Most of the published endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) data are from the western countries, establishing the role of EBUS-TBNA in the diagnosis and staging of lung cancer. The etiology of mediastinal lymphadenopathy may be different in an ethnic group with a high prevalence of tuberculosis (TB). OBJECTIVE: To assess the etiology of mediastinal adenopathy in a high TB prevalence setting and to determine the performance of various tests in the diagnosis of tuberculous mediastinal lymphadenitis...
July 2017: Indian Journal of Tuberculosis
https://www.readbyqxmd.com/read/28708844/diagnostic-accuracy-of-xpert-mtb-rif-for-tuberculosis-detection-in-different-regions-with-different-endemic-burden-a-systematic-review-and-meta-analysis
#9
Shiying Li, Bin Liu, Mingli Peng, Min Chen, Wenwei Yin, Hui Tang, Yuxuan Luo, Peng Hu, Hong Ren
PURPOSE: To estimate the diagnostic accuracy of Xpert MTB/RIF, a systematic review and meta-analysis were carried out. METHODS: Up to June 20, 2015, multiple databases were screened for relevant studies. RESULTS: Accordingly, 106 studies included 52,410 samples were selected. Diagnostic accuracy of Xpert MTB/RIF for TB detection was validated against either culture or a composite reference standard (CRS). Additionally, selected studies were further subgrouped in four groups based on sample's type, subject's age, status of HIV co-infection and smear-positivity...
2017: PloS One
https://www.readbyqxmd.com/read/28708053/rapid-diagnosis-of-extrapulmonary-tuberculosis-with-xpert-mycobacterium-tuberculosis-rifampicin-assay
#10
Yan Li, Yu Pang, Tianhua Zhang, Xiaoping Xian, Xidi Wang, Jian Yang, Rui Wang, Meiling Chen, Wei Chen
PURPOSE: XpertMycobacterium tuberculosis/rifampicin (Xpert MTB/RIF) assay has been endorsed by the World Health Organization (WHO) for diagnosis of extrapulmonary tuberculosis (EPTB), while the sensitivity and specificity have not been fully evaluated. We aimed to evaluate the performance of Xpert MTB/RIF assay in the detection of different extrapulmonary specimens. METHODS: A total of 420 nonrespiratory specimens were detected with acid-fast bacilli (AFB) smear microscopy, solid culture, conventional drug susceptibility testing (DST) and Xpert MTB/RIF assay...
July 15, 2017: Journal of Medical Microbiology
https://www.readbyqxmd.com/read/28705388/the-good-the-bad-and-the-ugly-of-the-next-generation-xpert-mtb-rif-%C3%A2-ultra-test-for-tuberculosis-diagnosis
#11
Alberto L García-Basteiro, Belén Saavedra, Frank Cobelens
No abstract text is available yet for this article.
July 10, 2017: Archivos de Bronconeumología
https://www.readbyqxmd.com/read/28705265/comparison-of-histological-microbiological-and-molecular-methods-in-diagnosis-of-patients-with-tbln-having-different-anti-tb-treatment-background
#12
Nan Ying Che, Shao Jun Huang, Yan Ma, Yi Han, Zi Chen Liu, Chen Zhang, Jing Mu, Dan Zhao, Yang Qu, Hai Qing Zhang, Zhi Dong Liu, Shao Fa Xu
OBJECTIVE: The influence of anti-tuberculosis (TB) treatment history on tuberculous lymphadenitis (TBLN) diagnosis is unclear. Therefore, this study aims to evaluate the diagnostic methods, including histology, microbiology, and molecular tests, used for TBLN. METHODS: In this study, suspected patients with TBLN and having different anti-TB treatment background were enrolled. All the samples were tested simultaneously by histology, Ziehl-Neelsen (ZN) staining, mycobacterial culture (culture), Xpert MTB/RIF (xpert), real-time PCR, and high-resolution melting curve PCR (HRM)...
June 2017: Biomedical and Environmental Sciences: BES
https://www.readbyqxmd.com/read/28697621/undiagnosed-tuberculosis-in-patients-with-hiv-infection-who-present-with-severe-anaemia-at-a-district-hospital
#13
Mbulelo Mntonintshi, Don O'Mahony, Sikhumbuzo Mabunda, Kakia A F Namugenyi
BACKGROUND: Tuberculosis (TB) is a major cause of severe anaemia in patients with human immunodeficiency virus (HIV) infection in South Africa. However, TB can be difficult to diagnose as it may be extra pulmonary and paucibacillary. AIM: The aim of this study was to investigate undiagnosed TB in patients with HIV infection and severe anaemia and to identify the optimal investigations for diagnosing TB. SETTING: Mthatha General Hospital, a district hospital...
June 30, 2017: African Journal of Primary Health Care & Family Medicine
https://www.readbyqxmd.com/read/28686705/sputum-quality-and-diagnostic-performance-of-genexpert-mtb-rif-among-smear-negative-adults-with-presumed-tuberculosis-in-uganda
#14
Amanda J Meyer, Collins Atuheire, William Worodria, Samuel Kizito, Achilles Katamba, Ingvar Sanyu, Alfred Andama, Irene Ayakaka, Adithya Cattamanchi, Freddie Bwanga, Laurence Huang, J Lucian Davis
BACKGROUND: Introduction of GeneXpert MTB/RIF (Xpert) assay has constituted a major breakthrough for tuberculosis (TB) diagnostics. Several patient factors may influence diagnostic performance of Xpert including sputum quality. OBJECTIVE: We carried out a prospective, observational, cross-sectional study to determine the effect of sputum quality on diagnostic performance of Xpert among presumed TB patients in Uganda. METHODS: We collected clinical and demographic information and two sputum samples from participants...
2017: PloS One
https://www.readbyqxmd.com/read/28681972/pneumonia-in-the-developing-world-characteristic-features-and-approach-to-management
#15
REVIEW
Stephen J Aston
Community-acquired pneumonia (CAP) is a common cause of morbidity and mortality in adults worldwide, but its epidemiology varies markedly by region. Whilst in high-income countries, the predominant burden of CAP is in the elderly and those with chronic cardiovascular and pulmonary co-morbidity, CAP patients in low-income settings are often of working age and, in sub-Saharan Africa, frequently HIV-positive. Although region-specific aetiological data are limited, they are sufficient to highlight major trends: in high-burden settings, tuberculosis (TB) is a common cause of acute CAP; Gram-negative pathogens such as Klebsiella pneumoniae are regionally important; and HIV-associated opportunistic infections are common but difficult to diagnose...
July 6, 2017: Respirology: Official Journal of the Asian Pacific Society of Respirology
https://www.readbyqxmd.com/read/28633698/feasibility-of-a-streamlined-tuberculosis-diagnosis-and-treatment-initiation-strategy
#16
P B Shete, T Nalugwa, K Farr, C Ojok, M Nantale, P Howlett, P Haguma, E Ochom, F Mugabe, M Joloba, L H Chaisson, D W Dowdy, D Moore, J L Davis, A Katamba, A Cattamanchi
OBJECTIVE: To assess the feasibility of a streamlined strategy for improving tuberculosis (TB) diagnostic evaluation and treatment initiation among patients with presumed TB. DESIGN: Single-arm interventional pilot study at five primary care health centers of a streamlined, SIngle-saMPLE (SIMPLE) TB diagnostic evaluation strategy: 1) examination of two smear results from a single spot sputum specimen using light-emitting diode fluorescence microscopy, and 2) daily transportation of smear-negative sputum samples to Xpert® MTB/RIF testing sites...
July 1, 2017: International Journal of Tuberculosis and Lung Disease
https://www.readbyqxmd.com/read/28628437/nontuberculous-mycobacteria-infections-at-a-provincial-reference-hospital-cambodia
#17
Maryline Bonnet, Kim Chamroeun San, Yati Pho, Chandara Sok, Jean-Philippe Dousset, William Brant, Northan Hurtado, Khun Kim Eam, Elisa Ardizzoni, Seiha Heng, Sylvain Godreuil, Wing-Wai Yew, Cathy Hewison
Prevalence of nontuberculous mycobacteria (NTM) disease is poorly documented in countries with high prevalence of tuberculosis (TB). We describe prevalence, risk factors, and TB program implications for NTM isolates and disease in Cambodia. A prospective cohort of 1,183 patients with presumptive TB underwent epidemiologic, clinical, radiologic, and microbiologic evaluation, including >12-months of follow-up for patients with NTM isolates. Prevalence of NTM isolates was 10.8% and of disease was 0.9%; 217 (18...
July 2017: Emerging Infectious Diseases
https://www.readbyqxmd.com/read/28622763/treatment-decisions-and-mortality-in-hiv-positive-presumptive-smear-negative-tb-in-the-xpert%C3%A2-mtb-rif-era-a-cohort-study
#18
Sabine M Hermans, Juliet A Babirye, Olive Mbabazi, Francis Kakooza, Robert Colebunders, Barbara Castelnuovo, Christine Sekaggya-Wiltshire, Rosalind Parkes-Ratanshi, Yukari C Manabe
BACKGROUND: The Xpert™ MTB/RIF (XP) has a higher sensitivity than sputum smear microscopy (70% versus 35%) for TB diagnosis and has been endorsed by the WHO for TB high burden countries to increase case finding among HIV co-infected presumptive TB patients. Its impact on the diagnosis of smear-negative TB in a routine care setting is unclear. We determined the change in diagnosis, treatment and mortality of smear-negative presumptive TB with routine use of Xpert MTB/RIF (XP). METHODS: Prospective cohort study of HIV-positive smear-negative presumptive TB patients during a 12-month period after XP implementation in a well-staffed and trained integrated TB/HIV clinic in Kampala, Uganda...
June 16, 2017: BMC Infectious Diseases
https://www.readbyqxmd.com/read/28619229/cost-effectiveness-of-xpert-mtb-rif-for-tuberculosis-diagnosis-in-south-africa-a-real-world-cost-analysis-and-economic-evaluation
#19
Anna Vassall, Mariana Siapka, Nicola Foster, Lucy Cunnama, Lebogang Ramma, Katherine Fielding, Kerrigan McCarthy, Gavin Churchyard, Alison Grant, Edina Sinanovic
BACKGROUND: In 2010 a new diagnostic test for tuberculosis, Xpert MTB/RIF, received a conditional programmatic recommendation from WHO. Several model-based economic evaluations predicted that Xpert would be cost-effective across sub-Saharan Africa. We investigated the cost-effectiveness of Xpert in the real world during national roll-out in South Africa. METHODS: For this real-world cost analysis and economic evaluation, we applied extensive primary cost and patient event data from the XTEND study, a pragmatic trial examining Xpert introduction for people investigated for tuberculosis in 40 primary health facilities (20 clusters) in South Africa enrolled between June 8, and Nov 16, 2012, to estimate the costs and cost per disability-adjusted life-year averted of introducing Xpert as the initial diagnostic test for tuberculosis, compared with sputum smear microscopy (the standard of care)...
July 2017: Lancet Global Health
https://www.readbyqxmd.com/read/28611407/evaluation-of-the-mtbdrplus-2-0-assay-for-the-detection-of-multidrug-resistance-among-persons-with-presumptive-pulmonary-tb-in-china
#20
Yaoju Tan, Qiang Li, Qing Wang, Huiping Sun, Jin Chen, Xingshan Cai, Yinchai Yao, Xundi Bao, Chao Wang, Yuan Liu, Xia Wu, Yu Pang, Yanlin Zhao
We have conducted a multicenter study of the diagnostic accuracy of the MTBDRplus 2.0 assay in compared with conventional and molecular reference standard in four tuberculosis (TB)-specialized hospitals of China. A total of 5038 patients were enrolled in this study. The overall sensitivity of the assay for the diagnosis of TB was 92.7% [1723/1858, 95% confidence interval (95% CI): 91.5-93.9]. In smear-positive/culture-positive cases the sensitivity was 97.7% (995/1018, 95% CI: 96.6-98.6), whereas in smear-negative/culture-positive cases it was 86...
June 13, 2017: Scientific Reports
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