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PLoS One. 2019 May 28;14(5):e0215679. doi: 10.1371/journal.pone.0215679. eCollection 2019.

Evaluation of the tuberculosis culture color plate test for rapid detection of drug susceptible and drug-resistant Mycobacterium tuberculosis in a resource-limited setting, Addis Ababa, Ethiopia.

Author information

1
Department of Microbiology, Immunology and Parasitology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
2
Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia.
3
Ethiopia Public Health Institute (EPHI), Addis Ababa, Ethiopia.
4
Department of Microbial Infection and Immunity, College of Medicine, The Ohio State University, Columbus, Ohio, United States of America.
5
Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, United States of America.
6
Center for Biostatistics, College of Medicine, The Ohio State University, Columbus, Ohio, United States of America.
7
Department of Pathology, College of Medicine, The Ohio State University, Columbus, Ohio, United States of America.
8
Global One Health Initiative (GOHi), The Ohio State University, Columbus, Ohio, United States of America.
9
Infectious Diseases & Immunity, Imperial College London, and Wellcome Trust Imperial College Centre for Global Health Research, London, United Kingdom.
10
Innovation for Health and Development (IFHAD), Laboratory of Research and Development, Universidad PeruanaCayetano Heredia University, Lima, Peru.
11
InnovaciónPor la Salud Y Desarrollo (IPSYD), Asociación Benéfica PRISMA, Lima, Perú.
12
Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, United States of America.

Abstract

Timely diagnosis of tuberculosis (TB) is limited in Ethiopia. We evaluated the performance of a low technology, thin layer agar, Mycobacterium tuberculosis (M.tb) culture color plate (TB-CX) test with concurrent drug susceptibility testing (DST) to isoniazid (INH), rifampin (RIF), and pyrazinamide (PZA) directly from sputum specimens. Patients undergoing examination for TB and multidrug-resistant (MDR)-TB were enrolled in Addis Ababa, Ethiopia from March 2016 to February 2017. All subjects received a GeneXpert MTB/RIF PCR test. TB-CX test results were compared to reference Löwenstein-Jensen (LJ) culture for M.tb detection and DST for susceptibility to INH and RIF. Kappa statistic was applied to test agreement between results for TB-CX test and the reference methods, a cut-off Kappa value of 0.75 was considered as high level of agreements. A total of 137 participants were analyzed: 88 (64%) were new TB cases, 49 (36%) were re-treatment cases. The TB-CX test detected M.tb and DST in an average of 13 days compared to 50 days for the conventional DST result. The sensitivity and specificity of the TB-CX test for detecting M.tb were 94% and 98%, respectively (concordance, 96%; kappa 0.91). The sensitivity of the TB-CX test to detect drug resistance to INH, RIF, and MDR-TB was 91%, 100%, and 90% respectively. The specificity of the TB-CX test for detecting INH, RIF, and MDR-TB was 94%, 40%, and 94% respectively. Overall agreement between TB-CX test and LJ DST for detection of MDR-TB was 93%. The TB-CX test showed strong agreement with the GeneXpert test for detecting M.tb (89%, kappa 0.76) but low agreement for the detection of RIF resistance (57%, kappa 0.28). The TB-CX test was found to be a good alternative method for screening of TB and selective drug resistant-TB in a timely and cost-efficient manner.

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