SETTING: Lusaka, Zambia. OBJECTIVES: To investigate the utility of nucleic amplification tests for the diagnosis of pulmonary tuberculosis in a resource-poor setting with a high incidence of human immunodeficiency virus (HIV). DESIGN: Sputum specimens from suspects attending a referral chest clinic were examined by low-cost 'in-house' one-tube nested polymerase chain reaction (PCR), the enhanced Gen-Probe Amplified Mycobacterium Direct Test (AMTD), auramine smear and Lowenstein-Jensen culture. RESULTS: PCR and AMTD detected respectively 80% and 92% of smear-positive specimens and 40% and 60% of smear-negative, culture-positive specimens. AMTD was positive for 18 culture-negative suspects; subsequent investigation indicated these to be six confirmed tuberculosis patients, nine judged from radiological data and clinical follow-up studies to have pulmonary tuberculosis, and three non-tuberculosis patients. Sensitivity for smear, culture, PCR and AMTD, when compared to a gold standard incorporating both microbiological and clinical data, was respectively 29%, 69%, 55% and 81%. CONCLUSION: In this setting, the sensitivity of the low-cost PCR proved insufficient for its effective use as a tool for diagnosing pulmonary tuberculosis, while AMTD performed considerably better than the current laboratory methods for diagnosis of pulmonary tuberculosis. However, the high cost of this technology may limit its application in the public sector of low-income countries.
SETTING: Lusaka, Zambia. OBJECTIVES: To investigate the utility of nucleic amplification tests for the diagnosis of pulmonary tuberculosis in a resource-poor setting with a high incidence of human immunodeficiency virus (HIV). DESIGN: Sputum specimens from suspects attending a referral chest clinic were examined by low-cost 'in-house' one-tube nested polymerase chain reaction (PCR), the enhanced Gen-Probe Amplified Mycobacterium Direct Test (AMTD), auramine smear and Lowenstein-Jensen culture. RESULTS: PCR and AMTD detected respectively 80% and 92% of smear-positive specimens and 40% and 60% of smear-negative, culture-positive specimens. AMTD was positive for 18 culture-negative suspects; subsequent investigation indicated these to be six confirmed tuberculosispatients, nine judged from radiological data and clinical follow-up studies to have pulmonary tuberculosis, and three non-tuberculosispatients. Sensitivity for smear, culture, PCR and AMTD, when compared to a gold standard incorporating both microbiological and clinical data, was respectively 29%, 69%, 55% and 81%. CONCLUSION: In this setting, the sensitivity of the low-cost PCR proved insufficient for its effective use as a tool for diagnosing pulmonary tuberculosis, while AMTD performed considerably better than the current laboratory methods for diagnosis of pulmonary tuberculosis. However, the high cost of this technology may limit its application in the public sector of low-income countries.
Authors: Renata L Guerra; Nancy M Hooper; James F Baker; Roya Alborz; Derek T Armstrong; Julia A Kiehlbauch; Marcus B Conde; Susan E Dorman Journal: J Clin Microbiol Date: 2008-09-17 Impact factor: 5.948
Authors: Philip Ifesinachi Anochie; Edwina C Onyeneke; Angelina C Ogu; Anthony C Onyeozirila; Srikanth Aluru; Nneka Onyejepu; Jian Zhang; Lauretta Efere; Mariam A Adetunji; Juan Gabriel Bueno Sánchez Journal: Germs Date: 2012-09-01
Authors: Conrad E Chan; Bryan Z Zhao; Amaury Cazenave-Gassiot; Shyue-Wei Pang; Anne K Bendt; Markus R Wenk; Paul A MacAry; Brendon J Hanson Journal: J Lipid Res Date: 2013-06-24 Impact factor: 5.922
Authors: Lydia Kivihya-Ndugga; Maarten van Cleeff; Ernest Juma; Joseph Kimwomi; Willie Githui; Linda Oskam; Anja Schuitema; Dick van Soolingen; Lucy Nganga; Daniel Kibuga; Joseph Odhiambo; Paul Klatser Journal: J Clin Microbiol Date: 2004-03 Impact factor: 5.948