Comparison of Mycobacterium tuberculosis drug susceptibility using solid and liquid culture in Nigeria.

BACKGROUND: This study compares Mycobacterium tuberculosis culture isolation and drug sensitivity testing (DST) using solid (LJ) and liquid (BACTEC-MGIT-960) media in Nigeria. METHODS: This was a cross sectional survey of adults attending reference centres in Abuja, Ibadan and Nnewi with a new diagnosis of pulmonary tuberculosis (TB) or having failed the first-line TB treatment. Patients were requested to provide three sputum specimens for smear-microscopy and culture on LJ and BACTEC-MGIT-960. Positive cultures underwent DST for streptomycin, isoniazid, rifampicin and ethambutol. RESULTS: 527 specimens were cultured. 428 (81%) were positive with BACTEC-MGIT-960, 59 (11%) negative, 36 (7%) contaminated and 4 (1%) had non-tuberculosis mycobacteria (NTM). 411 (78%) LJ cultures were positive, 89 (17%) negative, 22 (4%) contaminated and 5 (1%) had NTM. The mean (SD) detection time was 11 (6) and 30 (11) days for BACTEC-MGIT-960 and LJ. DST patterns were compared in the 389 concordant positive BACTEC-MGIT-960 and LJ cultures. Rifampicin and isoniazid DST patterns were similar. Streptomycin resistance was detected more frequently with LJ than BACTEC-MGIT-960 and ethambutol resistance was detected more frequently with BACTEC-MGIT-960 than LJ, but differences were not statistically significant. MDR-TB was detected in 27 cases by LJ and 25 by BACTEC-MGIT-960 and using both methods detected 29 cases. CONCLUSIONS: There was a substantial degree of agreement between the two methods. However using the two in tandem increased the number of culture-positive patients and those with MDR-TB. The choice of culture method should depend on local availability, cost and test performance characteristics

The hidden costs of installing xpert machines in a tuberculosis high-burden country: experiences from Nigeria

Introduction Since the endorsement of GeneXpert MTB/RIF by the WHO, many countries have embarked on implementing this technology. Objective: We outline the cost of installing GeneXpert in district hospitals in Abuja, Nigeria. Methods We prospectively documented costs related to the installation of GeneXpert at five sites. Costs were collected from receipts received from suppliers and normalized to USD 2012 values. Results Costs were often identified after initiating installation for many reasons. Installation varied widely between sites with sufficient space and power supply; sites with insufficient space or power supply and costs not directly associated with site installation. The basic cost for installation was USD 2,621.98 per machine. Sites that required additional space cost close to USD 7,000.00. Conclusion Space and power requirements have a significant effect on installation costs. Countries need to carefully consider the placement of Xpert machines based on the quality and size of the available infrastructure

The hidden costs of installing xpert machines in a tuberculosis high-burden country: experiences from Nigeria

Introduction: Since the endorsement of GeneXpert MTB/RIF by the WHO, many countries have embarked on implementing this technology.Objective: We outline the cost of installing GeneXpert in district hospitals in Abuja, Nigeria.Methods: We prospectively documented costs related to the installation of GeneXpert at five sites. Costs were collected from receipts received from suppliers and normalized to USD 2012 values.Results: Costs were often identified after initiating installation for many reasons. Installation varied  widely between sites with sufficient space and power supply; sites with insufficient space or power supply and costs not directly associated with site installation. The basic cost for installation was USD 2,621.98 per machine. Sites that required additional space cost close to USD 7,000.00.Conclusion: Space and power requirements have a significant effect on installation costs. Countries need to carefully consider the placement of Xpert machines based on the quality and size of the available infrastructure.Key words: Tuberculosis, Xpert-Installation, low resource –settings, hidden cost, operational researc

Risk for Tuberculosis among Children

Risk among children is underestimated in countries with a high incidence of this disease

Yield of Smear Microscopy and Radiological Findings of Male and Female Patients with Tuberculosis in Abuja, Nigeria

Objective. To describe the yield of smear-microscopy and radiological findings by male and female patients with symptoms of tuberculosis in Abuja, Nigeria. Methods. Patients ≥15 years old with cough for >3 weeks submitted 3 sputum samples for smear microscopy. One specimen was cultured using MGIT-960. All patients had lung X-rays and screened for HIV. Results. were more likely to be smear-positive than females (262/774 [34%] and 137/547 [25%], P < .01), but similar proportions of males and females were culture-positive (437/691 [63%] and 294/495 [59%], P = .09). 317/626 (50.6%) males and 249/419 (59.4%) females were HIV-positive (P < .005). Among culture-positives patients, HIV-infected males were less likely to have positive smears than HIV-negative males (49.2% versus 66%, P = .001). Among females, smear positivity did not vary with HIV (46.4% for HIV-positive and 52.9% for HIV-negative, P = .38). Of 274 culture-confirmed TB cases, 226 (82.5%) had cavities, and 271 (99%) had ≥1 lung areas affected. HIV-positive males were more likely to have lung cavities than HIV-positive females (85% versus 69%, P < .04) and to have ≥3 lung areas affected (P = .03). Conclusion. Differences in the yield of smear-microscopy, culture and X-rays on presentation are due to several factors including HIV coinfection and gender

FluoroType MTB system for the detection of pulmonary tuberculosis

Altres ajuts: The authors would like to acknowledge Hain Lifescience (Germany) for their provision of a FluoroCycler and sufficient FluoroType MTB assays to carry out the study. Hain Lifescience had no influence on the study design, data analysis or preparation of the manuscript. Funding information for this article has been deposited with the Crossref Funder RegistryDiagnosis continues to be a major barrier for the control of tuberculosis (TB), especially in low- and middle-income countries (LMIC) [1]. The number of platforms for the molecular diagnosis of TB have increased in recent years and they can provide test results more rapidly than culture. Molecular assays are increasingly being used as alternative or adjunct methods to culture and smear microscopy, and modern systems seek to partially or fully automate the DNA extraction and amplification steps, increasing their suitability for resource-limited laboratories. One of these platforms, the GeneXpert MTB/RIF (Cepheid, USA), has a sensitivity of roughly 85% compared to culture [2] and has seen significant uptake in developing countries [3]. However, as a fully closed system, the DNA extracted during the process cannot be used for further downstream drug susceptibility testing (DST), which is crucial for patients with suspected drug-resistant TB. FluoroType MTB is a sensitive test for TB but specificity is low compared with fully integrated molecular system

Front-Loading Sputum Microscopy Services: An Opportunity to Optimise Smear-Based Case Detection of Tuberculosis in High Prevalence Countries

Setting. Ethiopia, Nepal, Nigeria, and Yemen. Objective. To reduce the time to complete sputum microscopy. Design. Cross-sectional surveys enrolling 923 patients with chronic cough in the 4 countries and using similar protocols. Spot-morning-spot sputum specimens were collected. An additional sputum specimen (Xspot) was collected one hour after the first, and the yields of the first two or the three specimens collected as spot-morning-spot or spot-Xspot-morning were compared. Results. 216 patients had ≥ one positive smear. 210 (97%) were identified by the spot-morning-spot, and 210 (97%) were identified by the spot-Xspot-morning specimens, with 203 and 200 identified by the first 2 specimens of each approach, respectively. Neither difference was significant. Conclusions. The time to complete smear microscopy could be reduced

Community Acquired Bacteremia in Young Children from Central Nigeria- A Pilot Study

<p>Abstract</p> <p>Background</p> <p>Reports of the etiology of bacteremia in children from Nigeria are sparse and have been confounded by wide spread non-prescription antibiotic use and suboptimal laboratory culture techniques. We aimed to determine causative agents and underlying predisposing conditions of bacteremia in Nigerian children using data arising during the introduction of an automated blood culture system accessed by 7 hospitals and clinics in the Abuja area.</p> <p>Methods</p> <p>Between September 2008 and November 2009, we enrolled children with clinically suspected bacteremia at rural and urban clinical facilities in Abuja or within the Federal Capital Territory of Nigeria. Blood was cultured using an automated system with antibiotic removing device. We documented clinical features in all children and tested for prior antibiotic use in a random sample of sera from children from each site.</p> <p>Results</p> <p>969 children aged 2 months-5 years were evaluated. Mean age was 21 ± 15.2 months. All children were not systematically screened but there were 59 (6%) children with established diagnosis of sickle cell disease and 42 (4.3%) with HIV infection. Overall, 212 (20.7%) had a positive blood culture but in only 105 (10.8%) were these considered to be clinically significant. Three agents, <it>Staphylococcus aureus </it>(20.9%), <it>Salmonella typhi </it>(20.9%) and Acinetobacter (12.3%) accounted for over half of the positive cultures. <it>Streptococcus pneumoniae and non-typhi Salmonellae </it>each accounted for 7.6%. Although not the leading cause of bacteremia, <it>Streptococcus pneumoniae </it>was the single leading cause of all deaths that occurred during hospitalization and after hospital discharge.</p> <p>Conclusion</p> <p><it>S. typhi </it>is a significant cause of vaccine-preventable morbidity while <it>S. pneumoniae </it>may be a leading cause of mortality in this setting. This observation contrasts with reports from most other African countries where non-typhi Salmonellae are predominant in young children. Expanded surveillance is required to confirm the preliminary observations from this pilot study to inform implementation of appropriate public health control measures.</p

Tuberculosis and diabetes in Nigerian patients with and without HIV

Type 2 Diabetes mellitus (DM) and the Human Immunodeficiency Virus (HIV) increase the risk of Tuberculosis (TB). The frequency of DM among patients with TB with and without HIV is poorly documented in many LMIC. This was a cross-sectional hospital-based study in Abuja, Nigeria. Adults with presumptive TB were screened consecutively using sputum culture for TB and blood for HIV screening, Fasting Plasma Glucose (FPG) and glycolisated haemoglobin (HbA1c) for diagnosis. HbA1c was measured using the D-10 Haemoglobin Testing System and a point-of-care test (A1C Now+ system) for comparison. Patients were classified as having DM or pre-diabetes using the D-10 reference test. 410 individuals had TB culture, FPG and HbA1c results. Participants had a mean (SD) age of 37.8 (12.6) years and 217 (54.8%) were male. 113 (27.6%) patients were culture-positive, 62 (15.1%) had DM and 46 (11.2%) pre-diabetes. 184 (53.3%) participants were HIV-positive and 95 (51.6%) were on ART. Patients with pre-diabetes and DM were more likely to have TB (OR=1.94, 95%CI=0.01-3.74 and OR=2.39, 95%CI=1.35-4.24, respectively). After adjustment for HIV, age and sex, only DM was statistically associated with TB (AOR=3.10, 95%CI=1.62-5.94). HIV-negative patients with DM had higher risk of TB (AOR=4.32, 95%CI 1.57-11.92) than HIV-positive patients with DM (AOR=3.31, 95%CI 1.29-8.54), but the difference was not statistically significant. A1C Now+ HbA1c measurements correlated poorly with the D-10 HbA1c reference test. A high proportion of patients in Abuja have markers of DM and pre-diabetes at the time of TB diagnosis