Abstract
BACKGROUND: Non-conversion on auramine smear microscopy indicates a lack of treatment response, possibly associated with initial rifampicin-resistant tuberculosis (RR-TB). However, dead bacteria still stain positive and may be detected. Fluorescein diacetate smear microscopy (FDA) shows live mycobacteria only. Therefore, we studied the potential of 2-month (2M) FDA for the identification of initial RRTB. METHODS: Between 2015 and 2018, we enrolled new smear-positive pulmonary TB patients from five local centres in Bamako, Mali. After baseline screening, sputum samples were collected at 1M, 2M, 5M and 18M. We used rpoB sequencing to identify initial RRTB. RESULTS: Of 1359 patients enrolled, 1019 (75%) had rpoB sequencing results. Twenty-six (2.6%, 95%CI: 1.7a-3.7) had mutations conferring rifampicin resistance. Most frequent rpoB mutations were located at the codons Asp435Val (42.4%) and Ser450Leu (34.7%). Among patients with initial RR-TB, 72.2% were FDAnegative at 2M (P Â 0.2). The positive and negative predictive value of 5M FDA for culture-based failure was respectively 20.0% and 94.7%. CONCLUSION: FDA did not identify the majority of patients with initial RR-TB or culture-based failure. As the full spectrum of mutations identified on sequencing was identified using Xpert, our data support its rapid universal implementation in Mali.
Original language | English (US) |
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Pages (from-to) | 763-769 |
Number of pages | 7 |
Journal | International Journal of Tuberculosis and Lung Disease |
Volume | 24 |
Issue number | 8 |
DOIs | |
State | Published - Aug 1 2020 |
Funding
This work was done at the University Clinical Research Center of the University of Sciences, Techniques and Technologies of Bamako (USTTB), Mali, and was partially funded by the USTTB through NIH/R01 grant R01AI110386 and NIH/FIC D71 TWO10428-01A1, the Northwestern University (Chicago, IL, USA) through NIH/FIC D43 TW10350. The content of this publication does not necessarily reflect the views or policies of the US Department of Health and Human Services, nor does mention of trade names, commercial products, or organisations imply endorsement by the US Government. BD was supported by a TDR fellowship, TIMS ID B40072, the special programme for research and training in tropical diseases, co-sponsored by UNICEF, UNDP, World Bank and the WHO. Conflicts of interest: none declared.
Keywords
- FDA
- Mali
- rpoB
- sequencing
ASJC Scopus subject areas
- General Medicine