Application of transdermal patches with new skin test reagents for detection of latent tuberculosis.

Introduction. Current intradermal tuberculin skin tests for latent tuberculosis infection (LTBI) based on purified protein derivative (PPD) have poor specificity.Aims. Developing a better skin test antigen as well as a simple skin patch test may improve and facilitate diagnostic performance.Methodology. Defined recombinant antigens that were unique to Mycobacterium tuberculosis (MTB), including two potential latency-associated antigens (ESAT-6 and Rv2653c) and five DosR-encoded latency proteins (Rv1996, Rv2031c, Rv2032, DevR and Rv3716c), were used as diagnostic skin test reagents in comparison with a standard PPD. The performance of the skin tests based on the detection of delayed-type hypersensitivity (DTH) reaction in guinea pigs sensitized to MTB and M. bovis bacille Calmette-Guérin (BCG) vaccine was evaluated.Results. The latency antigens Rv1996, Rv2031c, Rv2032 and Rv2653c and the ESAT-6 protein elicited less reactive DTH skin responses in MTB-sensitized guinea pigs than those resulting from PPD, but elicited no response in BCG-vaccinated guinea pigs. The remaining two latency antigens (DevR and Rv3716c) elicited DTH responses in both groups of animals, as did PPD. The reactivity of PPD in BCG-vaccinated guinea pigs was greater than that of any of the selected skin test reagents. Using stronger concentrations of selected skin test reagents in the patch test led to increased DTH responses that were comparable to those elicited by PPD in guinea pigs sensitized with MTB.Conclusion. Transdermal application of defined purified antigens might be a promising method for LTBI screening.

Comparative Proteomic Profiling of Mycobacterium tuberculosis and the Thai Vaccine Strain Mycobacterium bovis Bacille Calmette-Guerin Tokyo172: Diverse Biomarker Candidates for Species Differentiation.

BACKGROUND: Bacille Calmette-Guerin (BCG)-related complications can occur in vaccinated children. Comparison of the composition of cellular proteins of virulent Mycobacterium tuberculosis (MTB) H37Rv with of attenuated Mycobacterium bovis BCG Tokyo172 vaccine strain used in Thailand and identify protein candidates of value for differentiation between the two mycobacterial species may facilitate the diagnosis of etiologic agent of mycobacterial disease in vaccinated children, as most cases have been believed to have originated from BCG vaccine. MATERIALS AND METHODS: The two-dimensional electrophoresis (2DE) proteomic profiles of cellular proteins from the Thai vaccine strain M. bovis BCG Tokyo172 and MTB were compared and the matched spots in 2DE gels were submitted to mass spectrometry analysis. RESULTS: There were a number of similar protein contents with different intensity or position between MTB and M. bovis BCG Tokyo172. A higher expression of some immunogenic proteins was shown in BGG Tokyo172 when compared to MTB, while some were shown the opposite pattern. CONCLUSIONS: Proteomic approach reveals key proteins participating in different species of Mycobacteria, and may be useful for discrimination between MTB and the BCG Tokyo172 infection.

Improved Serodiagnostic Sensitivity of Strip Test for Latent Tuberculosis.

INTRODUCTION: Diagnosis of Latent Tuberculosis Infection (LTBI) is difficult due to no clinical manifestations. Cases of LTBI are mostly sputum negative. The World Health Organization recommends the Tuberculin Skin Test (TST) as the current diagnostic standard for LTBI. Our previously developed serologic strip test for LTBI detection had suboptimal sensitivity. Additional Mycobacteriumtuberculosis (MTB) latency-associated antigens may improve the detection rate of LTBI. AIM: The present study aimed to optimize sensitivity of existing strip test. MATERIALS AND METHODS: A combination of recombinant latency proteins Rv2029c, Rv2031c, Rv2032, Rv2627c, Rv3133c, and Rv3716c was used to prepare the strips and evaluate the performance with the sera of patients in four well-classified categories: LTBI, active pulmonary TB, healthy TB contacts and other non-TB diseases. RESULTS: A total of 91 serum samples from various clinical categories were screened with the strips. Among clinically diagnosed LTBI patients, strip test yielded a sensitivity of 75.0%. Among clinically diagnosed non-LTBI subjects, strip test yielded 88.1% specificity. The diagnostic positive and negative predictive values for strip test in reference to various clinical contexts were 77.4% and 86.7%, respectively. CONCLUSION: Addition of the six potential latency proteins could improve the diagnostic performance of existing strip test for LTBI. The use of suitable immunodominant antigens could maximize sensitivity in the diagnosis and differentiate MTB infection status.

Performance of a rapid strip test for the serologic diagnosis of latent tuberculosis in children.

BACKGROUND: The serodiagnostic tests for tuberculosis (TB) present a high variability in terms of sensitivity and specificity. Data on patients with latent TB infection (LTBI) and children in high prevalence settings are still limited. The present study aimed to evaluate an in-house strip test for detection of anti-M. tuberculosis antibodies in TB patients, mostly children aged under 15 y, grouped into four diagnostic categories: active TB, LTBI, healthy TB contacts, and other non-TB diseases. MATERIALS AND METHODS: The diagnostic performance of strip test was compared with the tuberculin skin test (TST) and interferon-gamma release assay (IGRA). Sensitivity and specificity were assessed for all three diagnostic tests. The detection accuracy among the tests was calculated by using a receiver operating characteristic analysis. RESULTS: TST and IGRA could diagnose the active TB cases correctly (100%). The sensitivity of strip test for active TB was 58.3% and 37.5% for LTBI, while the sensitivities of TST and IGRA for LTBI were 90.3% and 37.5%, respectively. The overall specificities of strip test and IGRA were 91.5% and 95.7%, respectively, which were superior to that of TST (68.1%). CONCLUSION: The strip test did not appear to be useful for diagnosis of active TB in comparison with the current diagnostic standard. The assay may be particularly significant in situations where TB is clinically difficult to diagnose like LTBI and could be a meaningful tool in terms of high specificity and simplicity for ruling in pediatric TB in countries with high TB infection rate. Further studies are needed to determine whether strip test can be improved in its sensitivity and should be implemented into routine clinical practice.

Alterations in brain cerebral cortex proteome of rabies-infected cat.

Comparative proteome analysis using brain cerebral cortex tissues from cats and dogs infected with/without rabies virus were conducted using both two-dimensional gel-electrophoresis (2-DE) and 2-D fluorescence difference gel- electrophoresis (2D-DIGE) methods. The 2-DE gel images of all samples revealed >1,000 protein spots in each gel. Quantitative intensity analysis revealed the same overall protein pattern in certain regions of the gel, but the rabies-infected brains exhibited more protein spots than the non-infected controls. From approximately 880 protein spots detected by 2D-DIGE, 65 protein spots were increased and 46 were decreased. Eight of these protein spots were randomly selected and annotated by reference to previous known proteome data of rabid dog brains. They were similarly altered in both of the rabies-infected cats and dogs. A more detailed comparison of changes in proteomic profiles of brains between rabid cats and dogs should shed some light on the pathophysiological mechanism of rabies in domestic animals, as most rabies cases have been traceable to or believed to have originated from rabid dogs.

Evaluation of a rapid immunochromatographic test strip for detection of Rabies virus in dog saliva samples.

An immunochromatographic test strip for Rabies virus was evaluated with dog saliva samples. The test was initially validated against 237 dogs of known infection status, and then evaluated in the field with 1,290 live dogs. By validation of paired saliva-brain specimens obtained from dogs at necropsy, the saliva strip test was 94.4% specific and 93.0% sensitive when compared to the gold standard fluorescent antibody test (FAT) on brain smears. The sensitivity and specificity of a nested polymerase chain reaction (nPCR) assay using saliva were 100% compared to the FAT results. The performance of strip test with field saliva samples from street dogs had a specificity of 98.7% in comparison to nPCR as the reference method. As the strip test kit can potentially be used outside the laboratory and be applicable as an on-site testing assay, it represents a powerful screening tool for epidemiological surveys and disease control. The test could be useful for the surveillance of rabies in dogs and, in particular, be used to monitor the success of rabies control programs.

Use of latex agglutination test to determine rabies antibodies in production of rabies antisera in horses.

A therapeutic anti-rabies immunoglobulin for human use has been produced mainly in horses. The presently available seroneutralization test, the rapid fluorescent focus inhibition test (RFFIT), is laborious and rather difficult to carry out in horse farms. This study was undertaken to develop a simple latex agglutination test (LAT) for determining rabies antibodies in horse sera. LAT was validated by testing a total of 468 horse serum samples characterized by RFFIT. Of these, 253 of 260 samples with antibody titers of less than 100 IU/ml had agglutination score of 1+, whereas 174 of 208 samples with antibody titers equal to or greater than 100 IU/ml had agglutination scores of 2-4+. Results of LAT correlated with those of RFFIT (r = 0.87, p < 0.0001). LAT has the advantages of being rapid, simple to perform, easy to interpret, and applicable as an on-site testing tool for the estimation of rabies antibodies in horses.

Moving towards the elimination of rabies in Thailand.

Human rabies is regarded as a fatal disease; however, its occurrence is preventable. Prevention consists of post-exposure prophylaxis (PEP) for humans and controlling the main cause through dog vaccination. In Thailand, health care budgets are increasingly allocated to human PEP rather than eradication of rabies in dogs. This is the case, even if controlling rabies in the dog population is a more cost-effective, longterm approach to prevent human rabies than PEP. While the principal cause of rabies is the roaming stray dogs, the impetus for control and removal is hampered by a lack of awareness of its true impact. The declaration of an annual World Rabies Day, September 8, is an initial effort to raise global awareness of the ongoing and unnecessary tragedy of rabies.

Real-time PCR analysis of dog cerebrospinal fluid and saliva samples for ante-mortem diagnosis of rabies.

The use of a 10-day observation to determine whether a dog is rabid is standard practice. This study was conducted in order to look for evidence of rabies vius in saliva and cerebrospinal fluid (CSF) of suspected live rabid dogs at the time of quarantine by using a SYBR Green real-time RT-PCR based assay for the detection of rabies virus RNA. Saliva and CSF of dogs were collected once on the day of admission for the 10-day quarantine. All test dogs were or became ill and died of rabies within the observation period. Thirteen of 15 dogs (87%) had saliva samples that were positive for rabies RNA. Two dogs with furious rabies had negative saliva samples. Positive CSF samples were found in 4 of 15 dogs (27%) whose saliva samples were positive. The time from sample collection to result was less than 5 hours. Because virus may be absent or present at very low level in both clinical fluids, samples taken for ante-mortem diagnosis cannot definitively rule out rabies.

Reduced-dose intradermal vaccination against hepatitis A with an aluminum-free vaccine is immunogenic and can lower costs.

A reduced dose (0.1 mL) of intradermal hepatitis A virus (HAV) vaccine could facilitate the control of hepatitis A in countries of endemicity. All study subjects receiving an aluminum-free HAV vaccine intradermally were seroprotected 28 days after vaccination (anti-HAV titer, > or =10 mIU/mL). Seroprotection rates decreased to 80.8% at 12 months but returned to 100%, with titers increasing 28-fold, after receipt of a booster vaccination.

Genetic typing of feline rabies virus isolated in greater Bangkok, Thailand.

To study the molecular epidemiology of rabies virus that is prevalent among cats in greater Bangkok, Thailand, a total of 17 rabies virus isolates from cats were characterized and compared with 120 rabies virus isolates from dogs. Analyses were performed on the genetic polymorphism in the rabies virus nucleoprotein (N) gene. Rabies virus N gene of isolates was amplified by reverse transcriptionpolymerase chain reaction. The diversity of N gene was revealed by the restriction fragment length polymorphism (RFLP) method. The rabies virus isolates from cats could be classified into 5 types, designated as Dd I-Hf I, Dd II-Hf II, Dd III-Hf I, Dd IV-Hf I, and Dd IV-Hf III. Type Dd I-Hf I was encountered more frequently than the others. It was apparent that no less than five rabies virus types presented in the areas of Bangkok. Moreover, all five RFLP patterns were typical of those which had been observed in dogs. Our findings suggest that there had been viral transmission between the dogs and the cats.

Oral bacterial flora of dogs with and without rabies: a preliminary study in Thailand.

The authors studied the bacterial flora of the dog oral cavity and of bite wounds, Aerobic bacteria were isolated from mouth swabs of 16 normal and 5 rabid dogs as well as from infected dog-bite wounds from 18 patients. A total of 20 different microbial species were recovered from mouth swab cultures. The most frequently isolated organisms were Klebsiella pneumoniae ssp pneumoniae, Escherichia coli, Staphylococcus aureus, Citrobacter freundii, Enterobacter cloacae, Acinetobacter calcoaceticus, and Pasteurella species. There were no differences in the aerobic bacterial flora between rabid and nonrabid dogs. From the cultures of the bite wound swabs, the authors found that almost all of the organisms identified were part of the normal oral flora of the dog. One or more aerobic bacteria were isolated from the infected dog-bite wounds. Two patients had four, 3 had three, 4 had two, and 6 had one of the nine organisms in their wounds. The predominant species of bacteria involved in infection of bite wounds were, as follows: Staphylococcus aureus, Pasteurella multocida, E. coli, Moraxella species, Pasteurella canis, and Enterobacter cloacae. However, three wound cultures had no aerobic bacterial growth. The results of this study show that the infected bite wounds may contain a mixed bacterial flora that colonize human skin and the oral cavity of dogs.