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首页> 美国卫生研究院文献>Journal of Clinical Microbiology >Evaluation of Two Line Probe Assays for Rapid Detection of Mycobacterium tuberculosis Tuberculosis (TB) Drug Resistance and Non-TB Mycobacteria in HIV-Infected Individuals with Suspected TB
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Evaluation of Two Line Probe Assays for Rapid Detection of Mycobacterium tuberculosis Tuberculosis (TB) Drug Resistance and Non-TB Mycobacteria in HIV-Infected Individuals with Suspected TB

机译：快速检测结核分枝杆菌结核病（TB）耐药性和非结核分枝杆菌在疑似HIV感染者中的两种线型探针检测方法的评估

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Limited performance data from line probe assays (LPAs), nucleic acid tests used for the rapid diagnosis of tuberculosis (TB), nontuberculosis mycobacteria (NTM), and Mycobacterium tuberculosis drug resistance are available for HIV-infected individuals, in whom paucibacillary TB is common. In this study, the strategy of testing sputum with GenoType MTBDRplus (MTBDR-Plus) and GenoType Direct LPA (Direct LPA) was compared to a gold standard of one mycobacterial growth indicator tube (MGIT) liquid culture. HIV-positive (HIV+) individuals with suspected TB from southern Africa and South America with <7 days of TB treatment had 1 sputum specimen tested with Direct LPA, MTBDR-Plus LPA, smear microscopy, MGIT, biochemical identification of mycobacterial species, and culture-based drug-susceptibility testing (DST). Of 639 participants, 59.3% were MGIT M. tuberculosis culture positive, of which 276 (72.8%) were acid-fast bacillus (AFB) smear positive. MTBDR-Plus had a sensitivity of 81.0% and a specificity of 100%, with sensitivities of 44.1% in AFB smear-negative versus 94.6% in AFB smear-positive specimens. For specimens that were positive for M. tuberculosis by MTBDR-Plus, the sensitivity and specificity for rifampin resistance were 91.7% and 96.6%, respectively, and for isoniazid (INH) they were 70.6% and 99.1%. The Direct LPA had a sensitivity of 88.4% and a specificity of 94.6% for M. tuberculosis detection, with a sensitivity of 72.5% in smear-negative specimens. Ten of 639 MGIT cultures grew Mycobacterium avium complex or Mycobacterium kansasii, half of which were detected by Direct LPA. Both LPA assays performed well in specimens from HIV-infected individuals, including in AFB smear-negative specimens, with 72.5% sensitivity for M. tuberculosis identification with the Direct LPA and 44.1% sensitivity with MTBDR-Plus. LPAs have a continued role for use in settings where rapid identification of INH resistance and clinically relevant NTM are priorities.
机译：对于那些感染了结核杆菌结核的HIV感染者，可以从线性探针测定（LPA），用于快速诊断结核（TB）的核酸检测，非结核分枝杆菌（NTM）和结核分枝杆菌耐药性获得有限的性能数据。在这项研究中，使用GenoType MTBDRplus（MTBDR-Plus）和GenoType Direct LPA（Direct LPA）测试痰液的策略与一种分枝杆菌生长指示管（MGIT）液体培养的金标准进行了比较。来自南部非洲和南美地区的<7天结核病治疗怀疑可疑结核病的HIV阳性（HIV + ）患者接受了直接LPA，MTBDR-Plus LPA，涂片显微镜检查，MGIT，分枝杆菌物种的生化鉴定，以及基于培养的药物敏感性测试（DST）。在639名参与者中，有59.3％是MGIT结核分枝杆菌培养阳性，其中276（72.8％）是抗酸杆菌（AFB）涂片阳性。 MTBDR-Plus的敏感性为81.0％，特异性为100％，在AFB涂片阴性样本中的敏感性为44.1％，而在AFB涂片阳性样本中的敏感性为94.6％。对于MTBDR-Plus对结核分枝杆菌呈阳性的标本，对利福平耐药的敏感性和特异性分别为91.7％和96.6％，对于异烟肼（INH）的敏感性和特异性分别为70.6％和99.1％。 Direct LPA对结核分枝杆菌的检测灵敏度为88.4％，特异性为94.6％，在涂片阴性样本中灵敏度为72.5％。 639种MGIT培养物中有10种生长了鸟分枝杆菌复合物或堪萨斯分枝杆菌，其中一半通过直接LPA检测。两种LPA分析在HIV感染者的标本中都表现良好，包括AFB涂片阴性标本，直接LPA鉴定结核分枝杆菌的灵敏度为72.5％，MTBDR-Plus鉴定灵敏度为44.1％。 LPA在优先识别INH耐药性和临床相关NTM的环境中继续发挥作用。

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