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Please use this identifier to cite or link to this item:
http://hdl.handle.net/123456789/1831
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| Title: | Direct nitrate reductase assay versus microscopic observation drug susceptibility test for rapid detection of MDR-TB in Uganda |
| Authors: | Bwanga, Freddie
Haile, Melle
Joloba, Moses L.
Ochom, Emmanuel
Hoffner, Sven |
| Keywords: | Resource-limited settings (RLSs)
Drug resistant diseases
Tuberculosis
Uganda
Multidrug-Resistant Tuberculosis
Mycobacterium tuberculosis
TB
Sub-Saharan African |
| Issue Date: | 9-May-2011 |
| Publisher: | Public Library of Science |
| Citation: | Bwanga, F., Haile, M., Joloba, M.L., Ochom, E., Hoffner, S. (2011) Direct nitrate reductase assay versus microscopic observation drug susceptibility test for rapid detection of MDR-TB in Uganda. PLoS ONE, 6(5). |
| Abstract: | The most common method for detection of drug resistant (DR) TB in resource-limited settings (RLSs) is indirect
susceptibility testing on Lowenstein-Jensen medium (LJ) which is very time consuming with results available only after 2–
3 months. Effective therapy of DR TB is therefore markedly delayed and patients can transmit resistant strains. Rapid and
accurate tests suitable for RLSs in the diagnosis of DR TB are thus highly needed. In this study we compared two direct
techniques - Nitrate Reductase Assay (NRA) and Microscopic Observation Drug Susceptibility (MODS) for rapid detection
of MDR-TB in a high burden RLS. The sensitivity, specificity, and proportion of interpretable results were studied. Smear
positive sputum was collected from 245 consecutive re-treatment TB patients attending a TB clinic in Kampala, Uganda.
Samples were processed at the national reference laboratory and tested for susceptibility to rifampicin and isoniazid with
direct NRA, direct MODS and the indirect LJ proportion method as reference. A total of 229 specimens were confirmed as
M. tuberculosis, of these interpretable results were obtained in 217 (95%) with either the NRA or MODS. Sensitivity,
specificity and kappa agreement for MDR-TB diagnosis was 97%, 98% and 0.93 with the NRA; and 87%, 95% and 0.78 with
the MODS, respectively. The median time to results was 10, 7 and 64 days with NRA, MODS and the reference technique,
respectively. The cost of laboratory supplies per sample was low, around 5 USD, for the rapid tests. The direct NRA and
MODS offered rapid detection of resistance almost eight weeks earlier than with the reference method. In the study
settings, the direct NRA was highly sensitive and specific. We consider it to have a strong potential for timely detection of MDR-TB in RLS. |
| URI: | doi:10.1371/journal.pone.0019565
http://hdl.handle.net/123456789/1831 |
| ISSN: | 1932-6203 |
| Appears in Collections: | Research Articles (Bio-Medical)
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| bwanga-joloba-chs-res.pdf | | 404Kb | Adobe PDF | View/Open |
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