HIV Infections Clinical Trial
Official title:
EVALUATION OF THE PERFORMANCE OF THE NITRATE REDUCTASE AND RESAZURIN TITRE ASSAY FOR THE DETECTION OF MYCOBACTERIUM TUBERCULOSIS COMPLEX FROM SPUTUM IN A HIGH TB AND HIV SETTING
The Principle objective of this study is To evaluate the performance of NRA, NRA-p and
REMA-p for the detection of M. tuberculosis complex from sputum samples from adult pulmonary
TB suspects in a high TB and HIV prevalence setting, using LJ and MGIT culture as gold
standard.
The Secondary objectives are:
- To measure the performance of each assay (NRA, NRA-p, REMA-p) in sputum smear-negative
patients
- To describe the results of the colorimetric methods in HIV-positive and HIV-negative
patients
- To assess the time to detection of both NRA/NRA-p, REMA-p methods.
- To evaluate the feasibility of the NRA, NRA-p, REMA-p methods.
- To determine the rate of contamination of the NRA, NRA-p and REMA-p assays.
- To evaluate the proportion and the clinical relevance of NTM among TB suspects in a
high TB and HIV prevalence setting.
- To provide capacity building for TB diagnosis in Mbarara.
Tuberculosis (TB) remains a leading cause of death in developing countries and its burden
has been exacerbated by the concurrent HIV epidemic. Despite the advances in medicine, TB
diagnosis still remains a challenge, especially in developing countries where diagnosis
relies mostly on the detection of Mycobacterium tuberculosis complex (MTBC) by smear
microscopy and/or culture. Smear microscopy is rapid, simple and not expensive but it lacks
sensitivity. Culture on solid medium, which is performed in some well equipped laboratories,
is more sensitive than microscopy but takes up to 8 weeks to obtain the result.
Colorimetric methods have been used for the rapid detection of drug sensitivity in M.
tuberculosis either from isolates or directly from sputum. These methods rely on the
detection of live bacteria through either enzymatic activity (nitrate reduction) or their
ability to reduce an oxidation-reduction indicator, either in solid or liquid medium. They
are fast, simple, and offer a good potential that should be evaluated for the diagnosis of
TB.
The objective of this study is to evaluate the performance of colorimetric assays for the
detection of M. tuberculosis complex from sputum samples from adult pulmonary TB suspects in
a high TB and HIV prevalence setting, using Löwenstein Jensen (LJ) and Mycobacterium growth
indicator tube (MGIT) culture as gold standard. The colorimetric methods evaluated here will
be the solid medium-based nitrate reductase assay as described (NRA) or with an additional
step using para Nitrobenzoic (PNB) acid for differentiation of MTBC and NTM (NRA-p), and the
modified resazurin microplate assay, also using PNB for differentiation of MTBC and NTM
(REMA-p).
. If any of the colorimetric assays is found to be accurate, significantly faster than
conventional culture methods, and easy to perform, then it could be implemented in a
tuberculosis culture laboratory. By reducing the time to detection compared to conventional
culture and the costs compared to recent commercial methods, these assays offer a good
alternative to conventional methods and might help to improve TB diagnosis in developing
countries.
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Observational Model: Cohort, Time Perspective: Prospective
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