Detecção do DNA de Mycobacterium tuberculosis através de hibridização em microplacas

Para auxiliar no controle da tuberculose são necessários novos métodos de detecção de Mycobacterium tuberculosis que sejam rápidos, específicos e de aplicabilidade em laboratórios de saúde pública, principalmente em países em desenvolvimento. Vários métodos moleculares de detecção e identificação de micobactérias em amostras clínicas têm sido desenvolvidos. Com o objetivo de padronizar e aplicar essas metodologias em laboratório foi desenvolvido um protocolo baseado na amplificação de DNA por reação em cadeia da polimerase (PCR) e na detecção colorimétrica em microplacas. Uma região interna do elemento de inserção IS6110, específico do complexo M. tuberculosis, foi selecionada como alvo para amplificação por PCR com primers biotinilados. Uma sonda complementar a uma região interna do fragmento foi fixada em microplacas onde, posteriormente, foi hibridizado o produto amplificado. A detecção através de hibridização foi feita utilizando um conjugado estreptavidina peroxidase. A eficácia da técnica foi testada em amostras clínicas pulmonares de pacientes com suspeita de infecção e sem tratamento prévio para tuberculose. O padrão ouro no diagnóstico de infecção por M. tuberculosis foi a associação da baciloscopia com a cultura a partir da amostra clínica dos pacientes selecionados. Foram testadas 303 amostras de escarro induzido de 303 pacientes com suspeita de TB pulmonar, dos quais 69 apresentaram resultado positivo e 234 negativo para TB. A sensibilidade e especificidade obtidas foram 88% e 98% e os Valores Preditivos Positivo (VPP) e Negativo (VPN) foram 92% e 97%, respectivamente. Os resultados obtidos demonstraram que a técnica desenvolvida no presente estudo pode ser uma importante ferramenta no diagnóstico de tuberculose e poderia ser utilizada como um teste complementar no diagnóstico da doença.New methods to detect Mycobacterium tuberculosis rapidly, accurately and that are feasible to apply in laboratories of developing countries are necessaries. Several methods for direct detection and identification of mycobacteria in clinical samples have been developed. With the aim to standardize the application of such methods in laboratory, we developed a molecular method for DNA extraction and PCR detection using a microwell plate hybridization assay. An internal region of the repetitive element, specific of M. tuberculosis complex, called IS6110 was selected as a target for amplification using specific biotinylated primers. The detection of amplified fragments was performed using microwell plates. An aminated DNA fragment complementary to an internal region of the amplified fragment was used as a probe. The biotinylated amplified products were added to the plate and identified with the use of streptavidin conjugated to horseradish peroxidase. The efficacy of the method was tested to detect pulmonary tuberculosis in patients suspected of TB infection with no previous treatment. As gold standard, the bacteriological criteria was used. Three hundred and three induced sputum samples from 303 pulmonary TB suspects were evaluated, of which 69 showed positive result and 224 negative for TB. The sensitivity and specificity obtained were 88% and 98% and Positive and Negative Predictive Values were 92% and 98%, respectively. The obtained results demonstrated that the PCR detection using a microwell plate hybridization assay may be an important tool for the diagnosis of tuberculosis and suggest that it could be used as a complementary diagnostic method

Detecção do DNA de Mycobacterium tuberculosis através de hibridização em microplacas

Para auxiliar no controle da tuberculose são necessários novos métodos de detecção de Mycobacterium tuberculosis que sejam rápidos, específicos e de aplicabilidade em laboratórios de saúde pública, principalmente em países em desenvolvimento. Vários métodos moleculares de detecção e identificação de micobactérias em amostras clínicas têm sido desenvolvidos. Com o objetivo de padronizar e aplicar essas metodologias em laboratório foi desenvolvido um protocolo baseado na amplificação de DNA por reação em cadeia da polimerase (PCR) e na detecção colorimétrica em microplacas. Uma região interna do elemento de inserção IS6110, específico do complexo M. tuberculosis, foi selecionada como alvo para amplificação por PCR com primers biotinilados. Uma sonda complementar a uma região interna do fragmento foi fixada em microplacas onde, posteriormente, foi hibridizado o produto amplificado. A detecção através de hibridização foi feita utilizando um conjugado estreptavidina peroxidase. A eficácia da técnica foi testada em amostras clínicas pulmonares de pacientes com suspeita de infecção e sem tratamento prévio para tuberculose. O padrão ouro no diagnóstico de infecção por M. tuberculosis foi a associação da baciloscopia com a cultura a partir da amostra clínica dos pacientes selecionados. Foram testadas 303 amostras de escarro induzido de 303 pacientes com suspeita de TB pulmonar, dos quais 69 apresentaram resultado positivo e 234 negativo para TB. A sensibilidade e especificidade obtidas foram 88% e 98% e os Valores Preditivos Positivo (VPP) e Negativo (VPN) foram 92% e 97%, respectivamente. Os resultados obtidos demonstraram que a técnica desenvolvida no presente estudo pode ser uma importante ferramenta no diagnóstico de tuberculose e poderia ser utilizada como um teste complementar no diagnóstico da doença.New methods to detect Mycobacterium tuberculosis rapidly, accurately and that are feasible to apply in laboratories of developing countries are necessaries. Several methods for direct detection and identification of mycobacteria in clinical samples have been developed. With the aim to standardize the application of such methods in laboratory, we developed a molecular method for DNA extraction and PCR detection using a microwell plate hybridization assay. An internal region of the repetitive element, specific of M. tuberculosis complex, called IS6110 was selected as a target for amplification using specific biotinylated primers. The detection of amplified fragments was performed using microwell plates. An aminated DNA fragment complementary to an internal region of the amplified fragment was used as a probe. The biotinylated amplified products were added to the plate and identified with the use of streptavidin conjugated to horseradish peroxidase. The efficacy of the method was tested to detect pulmonary tuberculosis in patients suspected of TB infection with no previous treatment. As gold standard, the bacteriological criteria was used. Three hundred and three induced sputum samples from 303 pulmonary TB suspects were evaluated, of which 69 showed positive result and 224 negative for TB. The sensitivity and specificity obtained were 88% and 98% and Positive and Negative Predictive Values were 92% and 98%, respectively. The obtained results demonstrated that the PCR detection using a microwell plate hybridization assay may be an important tool for the diagnosis of tuberculosis and suggest that it could be used as a complementary diagnostic method

Comparison of two laboratory-developed PCR methods for the diagnosis of pulmonary tuberculosis in Brazilian patients with and without HIV infection

Background: Direct smear examination with Ziehl-Neelsen (ZN) staining for the diagnosis of pulmonary tuberculosis (PTB) is cheap and easy to use, but its low sensitivity is a major drawback, particularly in HIV seropositive patients. As such, new tools for laboratory diagnosis are urgently needed to improve the case detection rate, especially in regions with a high prevalence of TB and HIV. Objective: To evaluate the performance of two in house PCR (Polymerase Chain Reaction): PCR dot-blot methodology (PCR dot-blot) and PCR agarose gel electrophoresis (PCR-AG) for the diagnosis of Pulmonary Tuberculosis (PTB) in HIV seropositive and HIV seronegative patients. Methods: A prospective study was conducted (from May 2003 to May 2004) in a TB/HIV reference hospital. Sputum specimens from 277 PTB suspects were tested by Acid Fast Bacilli (AFB) smear, Culture and in house PCR assays (PCR dot-blot and PCR-AG) and their performances evaluated. Positive cultures combined with the definition of clinical pulmonary TB were employed as the gold standard. Results: The overall prevalence of PTB was 46% (128/277); in HIV+, prevalence was 54.0% (40/74). The sensitivity and specificity of PCR dot-blot were 74% (CI 95%; 66.1%-81.2%) and 85% (CI 95%; 78.8%-90.3%); and of PCR-AG were 43% (CI 95%; 34.5%-51.6%) and 76% (CI 95%; 69.2%-82.8%), respectively. For HIV seropositive and HIV seronegative samples, sensitivities of PCR dot-blot (72% vs 75%; p = 0.46) and PCR-AG (42% vs 43%; p = 0.54) were similar. Among HIV seronegative patients and PTB suspects, ROC analysis presented the following values for the AFB smear (0.837), Culture (0.926), PCR dot-blot (0.801) and PCR-AG (0.599). In HIV seropositive patients, these area values were (0.713), (0.900), (0.789) and (0.595), respectively. Conclusion: Results of this study demonstrate that the in house PCR dot blot may be an improvement for ruling out PTB diagnosis in PTB suspects assisted at hospitals with a high prevalence of TB/HIV

Comparison of two laboratory-developed PCR methods for the diagnosis of pulmonary tuberculosis in Brazilian patients with and without HIV infection

Background: Direct smear examination with Ziehl-Neelsen (ZN) staining for the diagnosis of pulmonary tuberculosis (PTB) is cheap and easy to use, but its low sensitivity is a major drawback, particularly in HIV seropositive patients. As such, new tools for laboratory diagnosis are urgently needed to improve the case detection rate, especially in regions with a high prevalence of TB and HIV. Objective: To evaluate the performance of two in house PCR (Polymerase Chain Reaction): PCR dot-blot methodology (PCR dot-blot) and PCR agarose gel electrophoresis (PCR-AG) for the diagnosis of Pulmonary Tuberculosis (PTB) in HIV seropositive and HIV seronegative patients. Methods: A prospective study was conducted (from May 2003 to May 2004) in a TB/HIV reference hospital. Sputum specimens from 277 PTB suspects were tested by Acid Fast Bacilli (AFB) smear, Culture and in house PCR assays (PCR dot-blot and PCR-AG) and their performances evaluated. Positive cultures combined with the definition of clinical pulmonary TB were employed as the gold standard. Results: The overall prevalence of PTB was 46% (128/277); in HIV+, prevalence was 54.0% (40/74). The sensitivity and specificity of PCR dot-blot were 74% (CI 95%; 66.1%-81.2%) and 85% (CI 95%; 78.8%-90.3%); and of PCR-AG were 43% (CI 95%; 34.5%-51.6%) and 76% (CI 95%; 69.2%-82.8%), respectively. For HIV seropositive and HIV seronegative samples, sensitivities of PCR dot-blot (72% vs 75%; p = 0.46) and PCR-AG (42% vs 43%; p = 0.54) were similar. Among HIV seronegative patients and PTB suspects, ROC analysis presented the following values for the AFB smear (0.837), Culture (0.926), PCR dot-blot (0.801) and PCR-AG (0.599). In HIV seropositive patients, these area values were (0.713), (0.900), (0.789) and (0.595), respectively. Conclusion: Results of this study demonstrate that the in house PCR dot blot may be an improvement for ruling out PTB diagnosis in PTB suspects assisted at hospitals with a high prevalence of TB/HIV

Colorimetric microwell plate reverse-hybridization assay for Mycobacterium tuberculosis detection

Direct smear examination using Ziehl-Neelsen staining for pulmonary tuberculosis (PTB) diagnosis is inexpensive and easy to use, but has the major limitation of low sensitivity. Rapid molecular methods are becoming more widely available in centralized laboratories, but they depend on timely reporting of results and strict quality assurance obtainable only from costly commercial kits available in high burden nations. This study describes a pre-commercial colorimetric method, Detect-TB, for detecting Mycobacterium tuberculosis DNA in which an oligonucleotide probe is fixed onto wells of microwell plates and hybridized with biotinylated polymerase chain reaction amplification products derived from clinical samples. The probe is capable of hybridising with the IS6110 insertion element and was used to specifically recognise the M. tuberculosis complex. When combined with an improved silica-based DNA extraction method, the sensitivity of the test was 50 colony-forming units of the M. tuberculosis reference strain H37Rv. The results that were in agreement with reference detection methods were observed in 95.2% (453/476) of samples included in the analysis. Sensitivity and specificity for 301 induced sputum samples and 175 spontaneous sputum samples were 85% and 98%, and 94% and 100%, respectively. This colorimetric method showed similar specificity to that described for commercially available kits and may provide an important contribution for PTB diagnosis

Colorimetric microwell plate reverse-hybridization assay for Mycobacterium tuberculosis detection

Direct smear examination using Ziehl-Neelsen staining for pulmonary tuberculosis (PTB) diagnosis is inexpensive and easy to use, but has the major limitation of low sensitivity. Rapid molecular methods are becoming more widely available in centralized laboratories, but they depend on timely reporting of results and strict quality assurance obtainable only from costly commercial kits available in high burden nations. This study describes a pre-commercial colorimetric method, Detect-TB, for detecting Mycobacterium tuberculosis DNA in which an oligonucleotide probe is fixed onto wells of microwell plates and hybridized with biotinylated polymerase chain reaction amplification products derived from clinical samples. The probe is capable of hybridising with the IS6110 insertion element and was used to specifically recognise the M. tuberculosis complex. When combined with an improved silica-based DNA extraction method, the sensitivity of the test was 50 colony-forming units of the M. tuberculosis reference strain H37Rv. The results that were in agreement with reference detection methods were observed in 95.2% (453/476) of samples included in the analysis. Sensitivity and specificity for 301 induced sputum samples and 175 spontaneous sputum samples were 85% and 98%, and 94% and 100%, respectively. This colorimetric method showed similar specificity to that described for commercially available kits and may provide an important contribution for PTB diagnosis