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Free Content Comparison of two bacteriophage tests and nucleic acid amplification for the diagnosis of pulmonary tuberculosis in sub-Saharan Africa

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Abstract:

SETTING: National reference laboratory in Zambia, a high-incidence setting with a high prevalence of HIV infection.

OBJECTIVE: To compare the performance of a commercial bacteriophage kit with a nucleic acid amplification kit and an ‘in-house’ bacteriophage method for rapid diagnosis of pulmonary tuberculosis (TB).

METHODS: Sputum specimens from suspected pulmonary TB cases were examined by direct fluorescence microscopy and culture on Löwenstein Jensen (LJ). In a blinded study, remaining samples were tested by AMTD and FASTPlaqueTB™ or an in-house bacteriophage assay. Two specimen decontamination protocols were investigated.

RESULTS: Microbial contamination of 40.4% was observed when using the FASTPlaqueTB kit specimen preparation protocol. When compared to culture on LJ, the sensitivity of the FASTPlaqueTB test was 20.7%. Implementation of a modified Petroff's decontamination protocol reduced contamination to 5.8% and the FASTPlaqueTB test detected 8/25 (32%) of culture-positive specimens. The sensitivity of AMTD and smear microscopy for these specimens were 64% and 48%, respectively. In a separate experiment the sensitivity of an in-house bacteriophage assay was 45.3% compared to 64.2% for AMTD and 45.3% for direct smear microscopy.

CONCLUSIONS: Additional analysis of sputum specimens by bacteriophage assay provided no advantage in this setting. For the rapid diagnosis of TB, AMTD offered improved sensitivity over direct smear microscopy.

Keywords: bacteriophage; diagnosis; tuberculosis

Document Type: Regular Paper

Affiliations: 1: ZAMBART Project and Department of Microbiology and Pathology, University Teaching Hospital, Lusaka, Zambia 2: Chest Diseases Laboratory, Ministry of Health, Lusaka, Zambia 3: Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom

Publication date: November 1, 2004

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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