The thin-layer agar method for direct phenotypic detection of multi- and extensively drug-resistant tuberculosis.

BACKGROUND: Molecular techniques rapidly detect resistance to rifampicin (RMP) and isoniazid (INH), but do not eliminate the need for culture-based drug susceptibility testing (DST) against other drugs. The thin-layer agar (TLA) test, a non-commercial direct DST method, has demonstrated good performance for INH and RMP; however, evidence is still limited, and its applicability for DST of ofloxacin (OFX) and kanamycin (KM) is unknown. DESIGN: We compared 279 TLA DST results with those of MGIT for INH and RMP, and 280 results for OFX and KM with those of the 7H11 agar proportion method, obtained from 320 smear-positive samples from 165 Georgian TB patients. Discrepancies were solved by comparison with a composite reference standard. The prevalence of multidrug-resistant tuberculosis (TB) was 30 of 164 patients (18.3%), 2 (6.7%) of whom had extensively drug-resistant TB. RESULTS: TLA showed 94.7%, 98.2%, 100% and 78.9% sensitivity, respectively, for INH, RMP, OFX and KM, with 100% specificity. Average time to results was 7 days in TLA, 23 in MGIT and 49 for 7H11 agar. CONCLUSIONS: In low-resource settings, TLA can be applied for the rapid detection of resistance to INH, RMP and fluoroquinolones. Further studies are necessary to improve sensitivity to KM and further assess its performance for OFX and other drugs and its applicability in field conditions.

[The placental histo- and ultrastructure peculiarities during the cytomegalovirus infection in pregnant].

Object of the investigation - estimation of changes of the feto-placental complex and syncytiotrophoblaston based on the placental morphology and the activity of the antiviral antibodies in expectant mothers. The work is based on findings from 50 expectant mothers with cytomegalovirus (CMV) infection - 43 with reactivation of the latent infection according to the data of high avid IgG (86%) and 7 with primary active CMV infection according the level of the low avid IgG (14%). 20 healthy expectant mothers were included in the control group. It was shown that the active primary and reactivated CMV infection accompanied by the drawing in pathologic process the chorion structures in a productive inflammation - chorionamnionis and choriovillusitis manner, which testify to drawing the fetus immune system in reciprocal reaction with subsequent intrauterine growth retardation.