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Prakash Shrestha, Hemanta Khanal, Prasanna Dahal, Pranita Dongol
Background: In Nepal, introduction of GeneXpert MTB/RIF assay (Xpert assay) as an initial confirmation test for tuberculosis (TB) has been considered to have impact as a significant decrease in number of clinically diagnosed pulmonary tuberculosis (PTB) cases than previous years. This study aims to find out the distribution profile of suspected tuberculosis cases according to patients age, gender, treatment history and HIV status as well as to evaluate the utility of the Xpert assay over conventional acid-fast bacilli (AFB) staining method for the proper diagnosis of M...
2018: Open Microbiology Journal
Alan M McGovern, Grace O Androga, Peter Moono, Deirdre A Collins, Niki F Foster, Barbara J Chang, Thomas V Riley
Strains of Clostridium difficile producing only binary toxin (CDT) are found commonly in animals but not humans. However, human diagnostic tests rarely look for CDT. The Cepheid Xpert C. difficile BT assay detects CDT with equal sensitivity (≥92%) in human and animal faecal samples.
March 10, 2018: Anaerobe
Francois M J Lamoury, Sahar Bajis, Behzad Hajarizadeh, Alison D Marshall, Marianne Martinello, Elena Ivanova, Beth Catlett, Yasmin Mowat, Philippa Marks, Janaki Amin, Julie Smith, Nadine Ezard, Victoria Cock, Jeremy Hayllar, David Persing, Marika Kleman, Philip Cunningham, Gregory J Dore, Tanya L Applegate, Jason Grebely
Point-of-care hepatitis C virus (HCV) RNA testing is advantageous enabling diagnosis of active infection in a single visit. This study evaluated the sensitivity and specificity of the Xpert® HCV Viral Load Fingerstick assay (Xpert HCV VL FS) for HCV RNA detection (finger-stick) and the Xpert® HCV Viral Load assay (plasma) compared with the Abbott RealTime HCV Viral Load assay by venepuncture. Plasma and finger-stick capillary whole-blood samples were collected from participants in an observational cohort in Australia...
March 9, 2018: Journal of Infectious Diseases
Ray Y Chen, Laura E Via, Lori E Dodd, Gerhard Walzl, Stephanus T Malherbe, André G Loxton, Rodney Dawson, Robert J Wilkinson, Friedrich Thienemann, Michele Tameris, Mark Hatherill, Andreas H Diacon, Xin Liu, Jin Xing, Xiaowei Jin, Zhenya Ma, Shouguo Pan, Guolong Zhang, Qian Gao, Qi Jiang, Hong Zhu, Lili Liang, Hongfei Duan, Taeksun Song, David Alland, Michael Tartakovsky, Alex Rosenthal, Christopher Whalen, Michael Duvenhage, Ying Cai, Lisa C Goldfeder, Kriti Arora, Bronwyn Smith, Jill Winter, Clifton E Barry Iii
Background : By the early 1980s, tuberculosis treatment was shortened from 24 to 6 months, maintaining relapse rates of 1-2%. Subsequent trials attempting shorter durations have failed, with 4-month arms consistently having relapse rates of 15-20%. One trial shortened treatment only among those without baseline cavity on chest x-ray and whose month 2 sputum culture converted to negative. The 4-month arm relapse rate decreased to 7% but was still significantly worse than the 6-month arm (1.6%, P<0.01).  We hypothesize that PET/CT characteristics at baseline, PET/CT changes at one month, and markers of residual bacterial load will identify patients with tuberculosis who can be cured with 4 months (16 weeks) of standard treatment...
November 6, 2017: Gates Open Res
Giovana Rodrigues Pereira, Márcia Silva Barbosa, Natan José Dutra Dias, Carlos Podalirio Borges de Almeida, Denise Rossato Silva
BACKGROUND: Xpert MTB/RIF is increasingly used in many countries as the initial diagnostic test for tuberculosis (TB). Few studies have evaluated the effect of Xpert on TB diagnosis under programmatic conditions in Brazil. The aim of the present study was to evaluate the impact of introduction of Xpert MTB/RIF on TB diagnosis in a city with high TB incidence in Brazil. METHODS: We included patients evaluated with conventional diagnostic tests during one year before Xpert introduction (pre-Xpert group) and patients evaluated using Xpert during one year after the test introduction (post-Xpert group)...
2018: PloS One
Yetunde A Kuyinu, Babatunde A Odugbemi, Shukrat O Salisu-Olatunji, Funmilade O Adepoju, Olumuyiwa O Odusanya
BACKGROUND: Nigeria is one of the ten countries with the highest tuberculosis (TB) burden globally and is experiencing an increasing incidence of drug resistance. This study aimed to determine the prevalence of mycobacterium tuberculosis and rifampicin resistance (DR-TB) among patients screened at the TB clinic of a tertiary institution in Lagos, South-West, Nigeria. METHODS: A review of records of 840 patients with suspected drug-resistant TB was carried out from Gene Xpert test clinic register at a tertiary health facility from November 2013 to April 2015...
February 2018: Journal of the National Medical Association
Neeraj Raizada, Sunil D Khaparde, Soumya Swaminathan, Sanjay Sarin, Virender Singh Salhotra, Aakshi Kalra, Ashwani Khanna, K K Chopra, M Hanif, K R Umadevi, Syed Hissar, Sreenivas Achuthan Nair, C H Surya Prakash, B K Saha, Raghuram Rao, Claudia Denkinger, Catharina Boehme
BACKGROUND: Unlike in adults, diagnosis of TB can be challenging in children, as signs and symptoms of paediatric TB can be very non-specific and similar to other common childhood chest infections, which may lead to under or delayed diagnosis of TB disease. In spite of the increasing availability of rapid high-sensitivity diagnostics in public and private sectors, majority of paediatric TB cases are empirically diagnosed, without laboratory confirmation. To address these diagnostic challenges, World Health Organization (WHO) has recommended upfront Xpert MTB/RIF (Xpert) testing for the diagnosis of TB in paediatric presumptive pulmonary and extra-pulmonary TB (EPTB) cases...
2018: PloS One
S Tahseen, H Shahnawaz, U Riaz, F M Khanzada, A Hussain, W Aslam, M von Euler-Chelpin
SETTING: Pakistan is a high tuberculosis (TB) burden country, moving from low human immunodeficiency virus (HIV) prevalence to a concentrated epidemic driven primarily by people who inject drugs (PWID). The Antiretroviral Treatment Adherence Unit (AAU) in Islamabad, Pakistan, is a residential facility that offers combined treatment for opioid dependence and HIV. OBJECTIVE AND DESIGN: This retrospective study was conducted to assess TB prevalence among HIV-infected PWID referred to the AAU and to evaluate the diagnostic value of cough as a screening symptom...
February 1, 2018: International Journal of Tuberculosis and Lung Disease
Zibusiso Ndlovu, Emmanuel Fajardo, Elton Mbofana, Tatenda Maparo, Daniela Garone, Carol Metcalf, Helen Bygrave, Kekeletso Kao, Sekesai Zinyowera
BACKGROUND: HIV Viral Load and Early Infant Diagnosis technologies in many high burden settings are restricted to centralized laboratory testing, leading to long result turnaround times and patient attrition. GeneXpert (Cepheid, CA, USA) is a polyvalent near point-of-care platform and is widely implemented for Xpert MTB/RIF diagnosis. This study sought to evaluate the operational feasibility of integrated HIV VL, EID and MTB/RIF testing in new GeneXpert platforms. METHODS: Whole blood samples were collected from consenting patients due for routine HIV VL testing and DBS samples from infants due for EID testing, at three rural health facilities in Zimbabwe...
2018: PloS One
Robert F Potter, Meghan A Wallace, Allison R McMullen, Jerome Prusa, Christina L Stallings, Carey-Ann D Burnham, Gautam Dantas
OBJECTIVES: A carbapenem resistant Providencia rettgeri (PR1) isolate was recovered from a wound infection in Missouri, USA. This isolate possessed an EDTA inhibitable carbapenemase that was unidentified using the Xpert CARBA-R assay. Our objective was to elucidate the molecular determinant of carbapenem resistance in this isolate. We then sought to test the transmissibility of blaIMP-27 loci in clinical P. rettgeri and Proteus mirabilis isolates. METHODS: In October 2016 the novel ambler Class B carbapenemase blaIMP-27 , was reported in two different Proteus mirablis (PM185 and PM187) isolates...
February 26, 2018: Clinical Microbiology and Infection
Neeraj Raizada, Sunil D Khaparde, Virender Singh Salhotra, Raghuram Rao, Aakshi Kalra, Soumya Swaminathan, Ashwani Khanna, Kamal Kishore Chopra, M Hanif, Varinder Singh, K R Umadevi, Sreenivas Achuthan Nair, Sophie Huddart, C H Surya Prakash, Shalini Mall, Pooja Singh, B K Saha, Claudia M Denkinger, Catharina Boehme, Sanjay Sarin
BACKGROUND: Diagnosis of TB in children is challenging, and is largely based on positive history of contact with a TB case, clinical and radiological findings, often without microbiological confirmation. Diagnostic efforts are also undermined by challenges in specimen collection and the limited availability of high sensitivity, rapid diagnostic tests that can be applied with a quick turnaround time. The current project was undertaken in four major cities of India to address TB diagnostic challenges in pediatric population, by offering free of cost Xpert testing to pediatric presumptive TB cases, thereby paving the way for better TB care...
2018: PloS One
M Meulbroek, F Pujol, F Pérez, A Dalmau-Bueno, H Taboada, G Marazzi, A Carrillo, A Cabas, A Gata, E Aldabó, B Roldán, P Coll, F Añez, J Pantaleón, M Mochales, V Gómez, O Marín, J F Mir, J Decoca, J Saz
BACKGROUND: The introduction in 2006 of the rapid HIV test by BCN Checkpoint in a non-clinical setting has been a successful step forwards in the uptake of testing. Nevertheless, HIV serostatus should be reported as HIV positive only when a reactive result has been tested again using a different assay (WHO guidelines 2015). The standard confirmation test has been the Western Blot (WB) test. However confirmation results take around 7 days to come back. AIMS: This study explores the possibility of Point of Care PCR testing for a same-day confirmation...
February 2018: HIV Medicine
Kanchan Ajbani, Mubin Kazi, Jeffrey Tornheim, Swapna Naik, Rajeev Soman, Anjali Shetty, Camilla Rodrigues
Delayed diagnosis of drug resistance has been a major obstacle to proper management and control of drug-resistant tuberculosis (TB). Expanded access to rapid molecular diagnostics such as Xpert MTB/RIF has been helpful, but has generated confusion about how to interpret genotype-phenotype discordance. Optimal management is not clearly defined for patients with rifampin resistance by Xpert MTB/RIF but rifampin susceptibility by phenotypic testing. To resolve this discrepancy, we performed pyrosequencing of discordant isolates identified at a reference laboratory over a 6-month period...
March 2018: Lung India: Official Organ of Indian Chest Society
Kamela Charmaine Ng, Conor Joseph Meehan, Gabriela Torrea, Léonie Goeminne, Maren Diels, Leen Rigouts, Bouke Catherine de Jong, Emmanuel André
BACKGROUND: Tuberculosis (TB) is the highest-mortality infectious disease in the world and the main cause of death related to antimicrobial resistance, yet its surveillance is still paper-based. Rifampicin-resistant TB (RR-TB) is an urgent public health crisis. The World Health Organization has, since 2010, endorsed a series of rapid diagnostic tests (RDTs) that enable rapid detection of drug-resistant strains and produce large volumes of data. In parallel, most high-burden countries have adopted connectivity solutions that allow linking of diagnostics, real-time capture, and shared repository of these test results...
February 27, 2018: JMIR Medical Informatics
Devasahayam J Christopher, Sridevi Dinakaran, Richa Gupta, Prince James, Barney Isaac, Balamugesh Thangakunam
BACKGROUND AND OBJECTIVE: Extrapulmonary tuberculosis (EPTB) accounts for ~15% of all TB patients, and TB pleural effusion is the second most common site of EPTB. The diagnosis of pleural TB is challenging due to the pauci-bacillary nature of the disease. Histopathology of thoracoscopically obtained pleural biopsy provides the highest diagnostic yield. The Xpert MTB/RIF assay (Xpert) is a PCR test that can identify both Mycobacterium tuberculosis (MTB) and rifampicin resistance. Currently, there is a lack of clarity regarding the value of Xpert on pleural tissue...
February 27, 2018: Respirology: Official Journal of the Asian Pacific Society of Respirology
Mark P Nicol, Lesley Workman, Margaretha Prins, Lindy Bateman, Yonas Ghebrekristos, Silindile Mbhele, Claudia M Denkinger, Heather J Zar
We determined the accuracy of the new Xpert MTB/RIF Ultra assay for diagnosis of pulmonary tuberculosis in children, using banked induced sputum. Sensitivity and specificity were 75.3% and 96.9% compared with a culture result from the same specimen. Of those children with microbiologically confirmed TB (positive culture, Xpert or Ultra), Xpert detected 63.2%, Ultra 73.7% and culture 82.9.
February 22, 2018: Pediatric Infectious Disease Journal
P F Kweza, C Van Schalkwyk, N Abraham, M Uys, M M Claassens, A Medina-Marino
SETTING: The present study was conducted at 20 randomly selected primary health clinics across Buffalo City Metropolitan Health District, a high TB burden district in South Africa. OBJECTIVE: To estimate the proportion of TB patients missed by primary health clinics. DESIGN: We enrolled 1255 TB-symptomatic individuals exiting primary health clinics between March and December 2015. Participants were interviewed and asked to provide sputum for Xpert® MTB/RIF testing...
March 1, 2018: International Journal of Tuberculosis and Lung Disease
Suman Sharma, Bhawna Dahiya, Vishnubhatla Sreenivas, Netrapal Singh, Ankush Raj, Abhishek Sheoran, Aparna Yadav, Krishna B Gupta, Promod K Mehta
AIM: Diagnosis of pleural TB poses serious challenges due to paucibacillary nature of specimens and there is an urgent need to devise a reliable diagnostic test. METHODS: We compared GeneXpert Mycobacterium tuberculosis/rifampin assay and the multiplex PCR (M-PCR) targeting mpb64 (Rv1980c) and IS6110 in pleural fluids (n = 78) of pleural TB patients and non-TB controls. RESULTS: The sensitivities of 89.6 and 33.3%, and specificities of 96...
February 21, 2018: Future Microbiology
Yang-Hui Jin, Shi-Yuan Shi, Qi Zheng, Jian Shen, Xiao-Zhang Ying, Yi-Fan Wang
OBJECTIVE: To investigate the application value of Xpert MTB/RIF in diagnosis of spinal tuberculosis and detection of rifampin resistance. METHODS: The 109 pus specimens were obtained from patients who were primaryly diagnosed as spinal tuberculosis. All of the pus specimens were detected by acid-fast stain, liquid fast culturing by BACTEC MGIT 960 and Xpert MTB/RIF assay to definite the differences in sensitivity and specificity of mycobacterium tuberculosis among detecting methods...
September 25, 2017: Zhongguo Gu Shang, China Journal of Orthopaedics and Traumatology
B Derendinger, M de Vos, R R Nathavitharana, T Dolby, J A Simpson, P D van Helden, R M Warren, G Theron
The scale-up of rapid drug resistance testing for TB is a global priority. MTBDRplus is a WHO-endorsed multidrug-resistant (MDR)-TB PCR assay with suboptimal sensitivities and high indeterminate rates on smear-negative specimens. We hypothesised that widespread use of incorrect thermocycler ramp rate (speed of temperature change between cycles) impacts performance. A global sample of 72 laboratories was surveyed. We tested 107 sputa from Xpert MTB/RIF-positive patients and, separately, dilution series of bacilli, both at the manufacturer-recommended ramp rate (2...
February 16, 2018: Scientific Reports
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