RESUMO
BACKGROUND: The prevalence of non-tuberculous mycobacteria (NTM) has been increasing worldwide in both developed and developing countries. NTM infection is clinically indistinguishable from tuberculosis and therefore poses significant challenges in patient management, especially in patients chronically treated for pulmonary TB. In this study, we evaluated a new highly sensitive Multiplex MTB/NTM assay that can differentiate M. tuberculosis complex (MTBC) from all NTM, including the treatable and most common NTM, M. avium complex (MAC). METHODS: We developed and optimized a new open- Multiplex MTB/NTM assay with two gene-targets for MTBC (IS6110/senX3-regX3) and two targets for MAC (IS1311/DT1) with samples spiked with stored strains and testing 20 replicates. Patients with presumptive TB and NTM were enrolled at the Respiratory Disease Department of The University Teaching Hospital of Point G, in Mali. FINDINGS: In the development stage, the new assay showed a high analytic performance with 100% detections of MTBC and MAC at only 5 colony forming units (CFUs). Overall, without the treatment failure cases, the Multiplex assay and the Xpert showed a sensitivity, specificity, PPV and NPV of 83·3% [66·4-92·6], 96·6% [88·6-99·0], 92·5% [82·3-96·5] and 92·2% [82·7-96·5] and the Xpert had values of 96·7% [83·3-99·4], 80·0% [68·2-88·1], 70·7 [55·5-82·3] and 97·9% [89·3-99·6], respectively. The Multiplex assay successfully detected all (5/5) the MAC cases. INTERPRETATION: Our new Multiplex assay demonstrates better specificity than Xpert for all group studied, in addition to detecting potential NTM cases. The assay could therefore complement the widely used Xpert assay and enhance discrimination of TB and NTM infections. FUNDING: This work was supported by the National Institutes of Health (R03AI137674, U54EB027049, D43TW010350 and UM1AI069471) and Northwestern University's Institute for Global Health Catalyzer Fund.
Assuntos
Técnicas de Diagnóstico Molecular/métodos , Reação em Cadeia da Polimerase Multiplex/métodos , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Mycobacterium tuberculosis/genética , Tuberculose/diagnóstico , Adulto , Feminino , Humanos , Masculino , Técnicas de Diagnóstico Molecular/normas , Reação em Cadeia da Polimerase Multiplex/normas , Infecções por Mycobacterium não Tuberculosas/microbiologia , Mycobacterium tuberculosis/isolamento & purificação , Mycobacterium tuberculosis/patogenicidade , Sensibilidade e Especificidade , Tuberculose/microbiologiaRESUMO
The precariousness of the rural population in Africa is often symbolized by the lack of potable and safe drinking water. This study investigates the physico-chemical and bacteriological characteristics of 32 water samples with respect to WHO standards. The water samples were collected from wells, boreholes and small drinking water supply systems (DWS) in and around the township of Bonkoukou (Niger). The Water Quality Index (WQI) tool was used to assess the overall water quality with different physico-chemical parameters. Where the pH of the samples was acceptable, the samples showed higher levels of mineralization and deoxygenation. Overall, the samples were slightly hard, chlorinated and sulfated but much alkaline and contained nitrate and nitrite ions 2-16 times higher than the WHO standards. The use of WQI shows that samples in the DWS are safe for drinking. Samples coming from wells are the most polluted (58.50%) compared to those taken from boreholes (53.00%), while the percentage of samples from boreholes, unfit for drinking, is higher (41.00%) than that of the samples taken from wells (25.00%). Moreover, water in this area was characterized by the presence of total germs indicating bacteriological pollution. Hence, for the supply of safe drinking water to the larger number of people in such a rural area, the capacity of actual DWS must be improved and widespread.