Evaluation of the performance of two liquid-phase culture media for the diagnosis of pulmonary tuberculosis in a national hospital in Lima, Peru

Soto, Alonso; Agapito, Juan; Acuña-Villaorduña, Carlos; Solari, Lely; Samalvides, Frine; Gotuzzo, Eduardo

doi:10.1016/j.ijid.2008.03.023

Cited by 11 publications

(16 citation statements)

References 18 publications

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“…Moreover, conventional culture methods such as Lowenstein-Jensen (LJ) are slow and have limited impact on therapeutic decision. Modern culture methods on liquid media such as Mycobacteria Growth Indicator Tube (MGIT), are more sensitive and faster [8]–[10], but have more risk of contamination compared to LJ [11], [12]. Alternative non-commercial rapid culture methods, such as Microscopic Observation Drug Susceptibility (MODS) or Thin Layer Agar (TLA), have recovery rates comparable to other techniques [13]–[18], and might be more suitable to resource-limited settings.…”

Section: Introductionmentioning

confidence: 99%

Performance of the 2007 WHO Algorithm to Diagnose Smear-Negative Pulmonary Tuberculosis in a HIV Prevalent Setting

Huerga¹,

Varaine

Okwaro

et al. 2012

PLoS ONE

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BackgroundThe 2007 WHO algorithm for diagnosis of smear-negative pulmonary tuberculosis (PTB) including Mycobacterium tuberculosis (MTB) culture was evaluated in a HIV prevalent area of Kenya.MethodsPTB smear-negative adult suspects were included in a prospective diagnostic study (2009–2011). In addition, program data (2008–2009) were retrospectively analysed. At the first consultation, clinical examination, chest X-ray, and sputum culture (Thin-Layer-Agar and Lowenstein-Jensen) were performed. Patients not started on TB treatment were clinically re-assessed after antibiotic course. The algorithm performance was calculated using culture as reference standard.Results380 patients were included prospectively and 406 analyzed retrospectively. Culture was positive for MTB in 17.5% (61/348) and 21.8% (72/330) of cases. Sensitivity of the clinical-radiological algorithm was 55.0% and 31.9% in the prospective study and the program data analysis, respectively. Specificity, positive and negative predictive values were 72.9%, 29.7% and 88.6% in the prospective study and 79.8%, 30.7% and 80.8% in the program data analysis. Performing culture increased the number of confirmed TB patients started on treatment by 43.3% in the prospective study and by 44.4% in the program data analysis. Median time to treatment of confirmed TB patients was 6 days in the prospective study and 27 days in the retrospective study. Inter-reader agreement for X-ray interpretation between the study clinician and a radiologist was low (Kappa coefficient = 0.11, 95%CI: 0.09–0.12). In a multivariate logistic analysis, past TB history, number of symptoms and signs at the clinical exam were independently associated with risk of overtreatment.ConclusionThe clinical-radiological algorithm is suboptimal to diagnose smear-negative PTB. Culture increases significantly the proportion of confirmed TB cases started on treatment. Better access to rapid MTB culture and development of new diagnostic tests is necessary.

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Section: Introductionmentioning

confidence: 99%

Performance of the 2007 WHO Algorithm to Diagnose Smear-Negative Pulmonary Tuberculosis in a HIV Prevalent Setting

Huerga¹,

Varaine

Okwaro

et al. 2012

PLoS ONE

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“…From the seminal isolation of M. tuberculosis by Robert Koch (10) until today, Ͼ15 different culture media have been developed in order to continuously improve the sensitivity and speed of M. tuberculosis culture, yet only a few media are routinely used today (11). This led to the development of several automated systems employing early growth indicators to accelerate growth detection (12).…”

Section: Discussionmentioning

confidence: 99%

A Novel Solid Medium for Culturing Mycobacterium tuberculosis Isolates from Clinical Specimens

et al. 2015

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The laboratory diagnosis of tuberculosis usually relies on culture-based isolation of the causative Mycobacterium tuberculosis bacteria. We developed and evaluated the performance of MOD9, a new blood-free derivative of the MOD4 solid medium on which we previously reported for the isolation and culture of mycobacteria. First, inoculation of Lowenstein-Jensen medium with 21 M. tuberculosis isolates at 10 5 , 10 3 , and 10 CFU yielded colonies in 5.7 ؎ 1.5 days, 7.6 ؎ 0.8 days, and 10.8 ؎ 1.7 days versus 1.5 ؎ 0.4 days, 3.5 ؎ 0.6 days, and 4.9 ؎ 1 days in MOD9 (P < 0.05, Student's t test). Further, the time to detectable growth of M. tuberculosis was measured on MOD9 and Lowenstein-Jensen media after duplicate inoculation of 250 clinical specimens decontaminated with 0.7% chlorhexidine. The contamination rate was 1.6% (4/250) on MOD9 versus 4.4% (11/250) on Lowenstein-Jensen medium (P ‫؍‬ 0.11, Fisher's exact test). Chlorhexidine-MOD9 yielded 38/250 (15.2%) isolates versus 32/250 (12.8%) isolates for the chlorhexidine-LJ (P ‫؍‬ 0.5195, Fisher's exact test). All together, eight M. tuberculosis isolates were cultured solely from chlorhexidine-MOD9, and two M. tuberculosis isolates were cultured solely from chlorhexidine-LJ. The time to detection was 9.8 ؎ 3.9 (range, 5 to 18) days for chlorhexidine-MOD9 versus 17.4 ؎ 5.9 (range, 10 to 35) days for chlorhexidine-LJ (P < 0.05, Student's t test). These data indicate the superiority of the MOD9 medium over the standard LJ medium following chlorhexidine decontamination for the recovery of M. tuberculosis. P ulmonary tuberculosis caused by Mycobacterium tuberculosis complex (MTC) mycobacteria remains a global public health problem, causing on average 170 deaths every hour worldwide (1). Despite significant advances in the molecular diagnosis of tuberculosis over the past 2 decades (2), culture is still the universal gold standard for the laboratory diagnosis of tuberculosis, enabling complete postculture antimicrobial susceptibility testing and genotyping (3).MTC mycobacteria are fastidious organisms whose growth is routinely detected only after 7 to 12 days using advanced commercially available automated systems (4). These robots use various formulations of the Middlebrook liquid culture medium and indeed reduce the delay in growth detection compared to that with inoculation of standard solid culture media, such as Lowenstein-Jensen (LJ) medium (4). The World Health Organization (WHO) still recommends inoculating specimens in parallel into a liquid medium for accelerated diagnosis of high-titer specimens and onto a solid culture medium to increase the sensitivity of laboratory diagnosis of pulmonary tuberculosis (5).In an effort to conciliate speed and sensitivity of the culturebased diagnosis of tuberculosis, we developed new formulations of solid culture medium and new protocols for incubating and detecting colonies of M. tuberculosis. Recently, we showed that the MOD4 culture medium incorporating blood and egg lecithin, combined with an improved laboratory workflow, s...

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“…The time to detection of a positive culture with MGIT was found to be shorter than with LJ or TLA, in accordance with the results of previous studies. [5][6][7][8][9][10][11][12][13][14] Furthermore, Balabanova et al reported that the concordance between drug susceptibility testing on LJ and MGIT was 96.8% for rifampicin and 95.6% for isoniazid. 28 There are new molecular techniques that perform well, allowing diagnosis on the same day, with the added advantage of providing information about resistance to isoniazid and/or rifampicin.…”

Section: Discussionmentioning

confidence: 99%

Sputum induction is a safe procedure to use in prisoners and MGIT is the best culture method to diagnose tuberculosis in prisons: a cohort study

Rueda

López

Marín

et al. 2015

International Journal of Infectious Diseases

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Evaluation of the performance of two liquid-phase culture media for the diagnosis of pulmonary tuberculosis in a national hospital in Lima, Peru

Cited by 11 publications

References 18 publications

Performance of the 2007 WHO Algorithm to Diagnose Smear-Negative Pulmonary Tuberculosis in a HIV Prevalent Setting

Performance of the 2007 WHO Algorithm to Diagnose Smear-Negative Pulmonary Tuberculosis in a HIV Prevalent Setting

A Novel Solid Medium for Culturing Mycobacterium tuberculosis Isolates from Clinical Specimens

Sputum induction is a safe procedure to use in prisoners and MGIT is the best culture method to diagnose tuberculosis in prisons: a cohort study

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