Performance of loop-mediated isothermal amplification assay in the diagnosis of pulmonary tuberculosis in a high prevalence TB/HIV rural setting in Uganda

Autor: Yukari C. Manabe, Frank Mubiru, Prossy Nakanwagi, Mark Mugenyi, Willy Ssengooba, Tifu Agaba, Jessica Briggs, Moses Joloba, Lydia Nakiyingi
Jazyk: angličtina
Rok vydání: 2018
Předmět:
0301 basic medicine
Adult
Male
Rural Population
medicine.medical_specialty
Tuberculosis
030106 microbiology
030231 tropical medicine
Loop-mediated isothermal amplification
HIV Infections
Sensitivity and Specificity
lcsh:Infectious and parasitic diseases
Mycobacterium tuberculosis
03 medical and health sciences
0302 clinical medicine
Medical microbiology
LAMP
Internal medicine
parasitic diseases
medicine
Prevalence
Humans
lcsh:RC109-216
Rural
Uganda
Diagnostic
Tuberculosis
Pulmonary
Microscopy
Bacteriological Techniques
biology
business.industry
Technician
Sputum
Nucleic acid amplification technique
Middle Aged
medicine.disease
biology.organism_classification
3. Good health
Infectious Diseases
Tropical medicine
Female
medicine.symptom
business
Nucleic Acid Amplification Techniques
Research Article
Zdroj: BMC Infectious Diseases
BMC Infectious Diseases, Vol 18, Iss 1, Pp 1-10 (2018)
ISSN: 1471-2334
Popis: Background Smear microscopy lacks sensitivity especially in HIV co-infection, resulting in undiagnosed tuberculosis (TB) and high mortality. The loop-mediated isothermal amplification (TB-LAMP) assay can be staged with minimal infrastructure, is rapid, low cost and detection can be with the naked eye. We assessed feasibility and performance of Eiken TB-LAMP test at point-of-need in TB diagnosis in a high prevalence TB/HIV rural setting in Uganda. Methods From October 2013-February 2014, TB-LAMP testing was performed on sputum specimens from outpatient presumptive TB adults at a district hospital and two low-level health centers in Kiboga District where smear microscopy is the available routine diagnostic option. TB-LAMP was performed by a technician after a week of training in the district hospital. The technician had no prior experience in the technology. Samples from the low-level health centers were transported to the district hospital for TB-LAMP. Results Of the 233 presumptive TB (126 at hospital); 113 (48.5%) were HIV-infected; 129 (55%) male; median age 40 (IQR 30-53). Compared to MTB culture, overall sensitivity and specificity of TB-LAMP were 55.4% (95 CI 44.1-66.3) and 98.0% (95 CI 94.3-99.6) respectively. Among HIV-infected participants, TB-LAMP sensitivity and specificity were 52.3% (95 CI 36.7-67.5%) and 97.1% (95 CI 89.9-99.6) respectively; and 24.4% (95% CI 12.9-39.5) and 98.6% (95% CI 95.1-99.8) respectively among smear-negatives. TB-LAMP sensitivity and specificity were 62.2% (95% CI 44.8-77.5) and 97.8% (95% CI 92.1-99.7) in the hospital setting where central testing occurred compared to 50.0% (95% CI 34.9-65.1) and 98.4% (95% CI 91.2-100) respectively in low-level health centers where specimens were transported centrally. Conclusions In this high prevalence TB/HIV rural setting, TB-LAMP performs better than conventional smear microscopy in diagnosis of MTB among presumptive TB patients although the sensitivity is lower than that reported by the World Health Organization. TB-LAMP can easily be performed following a short training period and in absence of sophisticated infrastructure and expertise.
Databáze: OpenAIRE
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