ObjectiveTo analyse the feasibility, cost and performance of rapid tuberculosis (TB) molecular and culture systems, in a high multidrug-resistant TB (MDR TB) middle-income region (Samara, Russia) and provide evidence for WHO policy change.MethodsPerformance and cost evaluation was conducted to compare the BACTEC™ MGIT™ 960 system for culture and drug susceptibility testing (DST) and molecular systems for TB diagnosis, resistance to isoniazid and rifampin, and MDR TB identification compared to conventional Lowenstein-Jensen culture assays.Findings698 consecutive patients (2487 sputum samples) with risk factors for drug-resistant tuberculosis were recruited. Overall M. tuberculosis complex culture positivity rates were 31.6% (787/2487) in MGIT and 27.1% (675/2487) in LJ (90.5% and 83.2% for smear-positive specimens). In total, 809 cultures of M. tuberculosis complex were isolated by any method. Median time to detection was 14 days for MGIT and 36 days for LJ (10 and 33 days for smear positive specimens) and indirect DST in MGIT took 9 days compared to 21 days on LJ. There was good concordance between DST on LJ and MGIT (96.8% for rifampin and 95.6% for isoniazid). Both molecular hybridization assay results correlated well with MGIT DST results, although molecular assays generally yielded higher rates of resistance (by approximately 3% for both isoniazid and rifampin).ConclusionWith effective planning and logistics, the MGIT 960 and molecular based methodologies can be successfully introduced into a reference laboratory setting in a middle incidence country. High rates of MDR TB in the Russian Federation make the introduction of such assays particularly useful.
ВВЕДЕНИЕВыявление туберкулеза осуществляют специалисты различного профиля в условиях общей лечебной сети [1,2]. Туберкулез не имеет строго патогномоничных признаков. Наиболее убедительные диагностические критерии -выделение у пациента микобактерий тубер-кулеза или их фрагментов различными методами, либо гистологическое исследование патологического мате-риала [2]. Особенность туберкулеза в детском возрас-те -преимущественное поражение внутригрудных лим-фатических узлов. В связи с этим наличие микобактерий в мокроте у ребенка свидетельствует о распространен-ном, далеко зашедшем процессе и является критери-ем несвоевременной диагностики заболевания [3,4]. Выполнение гистологического исследования возможно лишь в ограниченном числе случаев. Таким образом, в настоящее время вопрос диагностики туберкулеза у детей по-прежнему остается сложной клинической проблемой, нередко требующей совместного приложе-ния усилий врачей различной специализации [2].
Aim. To evaluate the sensitivity to tuberculin in patients with infiltrative pulmonary tuberculosis in combination with an infection, caused by the human immunodeficiency virus (HIV), using various different tests. Methods. Examined were patients with infiltrative pulmonary tuberculosis with HIV infection (134 patients, the main group) and without HIV infection (100 patients, control group). Tuberculin diagnostics included an intradermal Mantoux test with 2 tuberculin units, the skin prick test with a 100% solution of PPD-L and the intradermal test «Diaskintest». Results. In the main group, a positive reaction to the Mantoux test with 2 tuberculin units was reported significantly less frequently (56.0%) than in the comparison group (89.0%), the diagnostic value of the test decreased with a decrease in the number of CD4+ lymphocytes. The prick test was characterized by a complete correlation with the results of the Mantoux test, although having a number of advantages. The sensitivity of the «Diaskintest» in the main group was 48.3%, and in the control group - 84.6%, at the same time the sensitivity of the «Diaskintest» decreased to 17% in cases of pronounced immunodeficiency. Conclusion. The skin prick test can be used as a screening method for early detection of tuberculosis in HIV-infected individuals with CD4+ lymphocyte count of 300 cells in 1 ml or more with the aim of forming risk groups, followed by screening for tuberculosis.
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