Abstract
This preliminary study evaluated the transport reagent OMNIgene SPUTUM (OMS) in a real-world, resource-limited setting: a zonal hospital and national tuberculosis (TB) reference laboratory, Nepal. The objectives were to: (1) assess the performance of OMS for transporting sputum from peripheral sites without cold chain stabilization; and (2) compare with Nepal’s standard of care (SOC) for Mycobacterium tuberculosis smear and culture diagnostics. Sixty sputa were manually split into a SOC sample (airline-couriered to the laboratory, conventional processing) and an OMS sample (OMS added at collection, no cold chain transport or processing). Smear microscopy and solid culture were performed. Transport was 0–8 days. Forty-one samples (68%) were smear-positive using both methods. Of the OMS cultures, 37 (62%) were positive, 22 (36%) were negative, and one (2%) was contaminated. Corresponding SOC results were 32 (53%), 21 (35%), and seven (12%). OMS “rescued” six (i.e., missed using SOC) compared with one rescue using SOC. Of smear-positives, six SOC samples produced contaminated cultures whereas only one OMS sample was contaminated. OMS reduced culture contamination from 12% to 2%, and improved TB detection by 9%. The results suggest that OMS could perform well as a no cold chain, long-term transport solution for smear and culture testing. The findings provide a basis for larger feasibility studies.
Article PDF
Avoid common mistakes on your manuscript.
References
World Health Organization Post—2015 Global TB Strategy. Global strategy and targets for tuberculosis prevention, care and control after 2015. Available at: http://www.who.int/tb/post2015_strategy/en/. [Accessed 22 Mar 2016].
The Guardian. Nepal has lessons to teach on TB. Available at: <http://www.theguardian.com/global-development/2010/sep/27/who-fighting-tuberculosis-medical-nepal-health>. [Accessed 22 Mar 2016]; 2010.
Pang Y, Du J, Zhang ZY, Ou XC, Li Q, Xia H, et al. The feasibility of sputum transportation system in China: effect of sputum storage on the mycobacterial detection. Biomed Environ Sci 2014;27:982–6.
DNA Genotek Product Data Sheet PD-BR-00195. Available at: www.dnagenotek.com. [Accessed 22 Mar 2016].
World Health Organization. Mycobacteriology Laboratory Manual. 1st ed. Global Laboratory Initiative; 2014. Available at: www.who.int/tb/laboratory/mycobacteriology-laboratory-manual.pdf. [Accessed 22 Mar 2016].
Parsons LM, Somoskovi A, Gutierrez C, Lee E, Parmasivan CN, Abimiku A, et al. Laboratory diagnosis of tuberculosis in resource-poor countries: challenges and opportunities. Clin Microbiol Rev 2011;24:314–50.
Dowdy DW, Lourenco MC, Cavalcante SC, Saraceni V, King B, Golub JE, et al. Impact and cost-effectiveness of culture for diagnosis of tuberculosis in HIV-infected Brazilian adults. PLoS ONE 2008;3:e4057.
Paramasivan CN, Narayana A, Prabhakar R, Rajagopal MS, Somasundaram PR, Tripathy SP. Effect of storage of sputum specimens at room temperature on smear and culture results. Tuber 1983;64:119–24.
Asmar S, Drancourt M. Chlorhexidine decontamination of sputum for culturing Mycobacterium tuberculosis. BMC Microbiol 2015;15, 6 pages.
Bobadilla-del-Valle M, Ponce-de-Leon A, Kato-Maeda M, Hernandez-Cruz A, Calva-Mercado JJ, Chavez-Mazari BA, et al. Comparison of sodium carbonate, cetyl-pyridinium chloride and sodium borate for preservation of sputa for culture of Mycobacterium tuberculosis. J Clin Microbiol 2003;41:4487–8.
Kelly-Cirino C, Niles J, Ray B, Stewart A. Maximizing centralized testing models and GeneXpert hubs with OMNIgene SPUTUM. DNA Genotek Whitepaper PD-WP-00044. Available at: www.dnagenotek.com. [Accessed 22 Mar 2016].
DNA Genotek Product Data Sheet PD-BR-00196. Available at: www.dnagenotek.com. [Accessed 22 Mar 2016].
Author information
Authors and Affiliations
Corresponding author
Additional information
Peer review under responsibility of Ministry of Health, Saudi Arabia.
Rights and permissions
This is an open access article under the CC BY-NC-ND license (https://doi.org/creativecommons.org/licenses/by-nc-nd/4.0/).
About this article
Cite this article
Maharjan, B., Shrestha, B., Weirich, A. et al. A novel sputum transport solution eliminates cold chain and supports routine tuberculosis testing in Nepal. J Epidemiol Glob Health 6, 257–265 (2016). https://doi.org/10.1016/j.jegh.2016.04.002
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1016/j.jegh.2016.04.002