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An Automated Culture System for Use in Preclinical Testing of Host-Directed Therapies for Tuberculosis
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Optimizing Mycobacterial Culture in Smear-Negative, Human Immunodeficiency Virus-Infected Tuberculosis Cases
N A Ismail1,2, H M Said2,3, Z Pinini4
1Department of Medical Microbiology, Faculty of Health Science, University of Pretoria, Pretoria, South Africa.
Plos One
|November 7, 2015
Summary
Optimizing mycobacterial culture for tuberculosis (TB) diagnosis in HIV-infected adults by adding nutrient supplements to culture media significantly reduced the time to detection. This improvement in diagnosing TB can help reduce treatment delays.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Public Health
Background:
- Tuberculosis (TB) diagnosis in HIV-infected individuals presents significant challenges.
- Mycobacterial culture is a crucial diagnostic tool, and its optimization is vital.
- Smear-negative pulmonary TB in HIV-positive adults requires improved diagnostic strategies.
Purpose of the Study:
- To evaluate the impact of increased sputum specimen numbers on diagnostic yield.
- To assess the effect of nutritional supplementation in culture media on TB detection.
- To determine how sputum appearance and volume influence diagnostic yield and time to detection in smear-negative, HIV-infected adults.
Main Methods:
- Prospective study involving 236 presumptive TB cases at an antiretroviral treatment site in South Africa.
- Collection of three sputum specimens per patient, processed using standard and nutrient-supplemented media.
- Recording of sputum appearance and volume, with analysis of culture yield and time to detection.
Main Results:
- A single specimen identified 79% of pulmonary TB cases; subsequent specimens added incrementally to yield.
- Nutritional supplementation significantly reduced the mean time to detection from 19.8 to 11.8 days (p = 0.002).
- Increased sputum volume correlated with decreased time to detection (p = 0.011), while appearance and volume did not affect yield or contamination.
Conclusions:
- Inexpensive culture supplementation substantially shortens the time to detect TB.
- Reduced time to detection can contribute to minimizing treatment delays in HIV-infected TB patients.
- Optimizing culture media offers a practical approach to enhance TB diagnostics in vulnerable populations.
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