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Current tuberculosis diagnostic tools & role of urease breath test.

Maiga M, Abaza A, Bishai WR - Indian J. Med. Res. (2012)

Bottom Line: Metabolic pathway detection may provide rapid and effective new tools for TB that can improve TB diagnostics for children and HIV infected patients.The urea tracer was metabolized to 13 C-CO 2 and detected in exhaled breaths using portable infrared spectrometers.The signal correlated with bacterial load both for primary diagnostics and treatment monitoring.

View Article: PubMed Central - PubMed

Affiliation: Center for Tuberculosis Research, Department of Medicine, Johns Hopkins University, MD, USA.

ABSTRACT
Tuberculosis (TB) remains a significant public health issue worldwide especially in developing countries, where the disease is endemic, and effective TB diagnostic as well as treatment-monitoring tools are serious barriers to defeating the disease. Detection of pathogen-specific metabolic pathways offers a potential alternative to current methods, which focus on bacterial growth, bacterial nucleic acid amplification, or detection of host immune response to the pathogen. Metabolic pathway detection may provide rapid and effective new tools for TB that can improve TB diagnostics for children and HIV infected patients. Metabolic breath tests are attractive because these are safe, and provide an opportunity for rapid point of care diagnostics and tool for drug efficacy evaluation during clinical trials. Our group has developed a rabbit urease breath test model to evaluate the sensitivity and the specificity of urease based detection of Mycobacterium tuberculosis. TB infected rabbits were given stable isotopically labelled urea as the substrate. The urea tracer was metabolized to 13 C-CO 2 and detected in exhaled breaths using portable infrared spectrometers. The signal correlated with bacterial load both for primary diagnostics and treatment monitoring. Clinical trials are currently ongoing to evaluate the value of the test in clinical management settings. Urea breath testing may provide a useful diagnostic and biomarker assay for tuberculosis and treatment response.

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Related in: MedlinePlus

The 22 high burden TB countries in the word (Source: Kaiser Family Foundation, www.GlobalHealthFacts.org, based on WHO, Global tuberculosis control 2010, Slide Date: March 04, 2011; reprinted with permission from the Henry J. Kaiser Family Foundation, California, USA).
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Figure 1: The 22 high burden TB countries in the word (Source: Kaiser Family Foundation, www.GlobalHealthFacts.org, based on WHO, Global tuberculosis control 2010, Slide Date: March 04, 2011; reprinted with permission from the Henry J. Kaiser Family Foundation, California, USA).

Mentions: About two billion people (one-third of the world's population) carry latent tuberculosis (TB) infection and more than nine million of them become sick each year with active TB, which can be spread to others. It disproportionately affects people in resource-poor settings, particularly those in Asia and Africa12. More than 90 per cent of new TB cases and deaths occur in those parts of the world, posing significant challenges to the livelihood of individuals and developing economies, as TB primarily affects people during their most productive years12. Poor health systems, limited laboratory capacity for case detection, treatment barriers and complications (unreliable drug supply, patients not completing treatment, or prescribing errors), TB and HIV co-infection, and the emergence of drug-resistance34 make TB a major challenge facing public health programmes, particularly in the 22 countries with the highest TB burden (Fig. 1). In addition, TB is difficult to diagnose and its diagnosis is more difficult in individuals with TB/HIV co-infection. The current diagnostic techniques are either inadequate to detect TB cases with precision, or are time consuming, expensive, and require highly equipped laboratories which are not available in developing countries, where the disease is endemic. In this paper, we reviewed the current available diagnostic tools for TB and the potential role of urease breath test (UBT) to both diagnose TB and monitor treatment response.


Current tuberculosis diagnostic tools & role of urease breath test.

Maiga M, Abaza A, Bishai WR - Indian J. Med. Res. (2012)

The 22 high burden TB countries in the word (Source: Kaiser Family Foundation, www.GlobalHealthFacts.org, based on WHO, Global tuberculosis control 2010, Slide Date: March 04, 2011; reprinted with permission from the Henry J. Kaiser Family Foundation, California, USA).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3401707&req=5

Figure 1: The 22 high burden TB countries in the word (Source: Kaiser Family Foundation, www.GlobalHealthFacts.org, based on WHO, Global tuberculosis control 2010, Slide Date: March 04, 2011; reprinted with permission from the Henry J. Kaiser Family Foundation, California, USA).
Mentions: About two billion people (one-third of the world's population) carry latent tuberculosis (TB) infection and more than nine million of them become sick each year with active TB, which can be spread to others. It disproportionately affects people in resource-poor settings, particularly those in Asia and Africa12. More than 90 per cent of new TB cases and deaths occur in those parts of the world, posing significant challenges to the livelihood of individuals and developing economies, as TB primarily affects people during their most productive years12. Poor health systems, limited laboratory capacity for case detection, treatment barriers and complications (unreliable drug supply, patients not completing treatment, or prescribing errors), TB and HIV co-infection, and the emergence of drug-resistance34 make TB a major challenge facing public health programmes, particularly in the 22 countries with the highest TB burden (Fig. 1). In addition, TB is difficult to diagnose and its diagnosis is more difficult in individuals with TB/HIV co-infection. The current diagnostic techniques are either inadequate to detect TB cases with precision, or are time consuming, expensive, and require highly equipped laboratories which are not available in developing countries, where the disease is endemic. In this paper, we reviewed the current available diagnostic tools for TB and the potential role of urease breath test (UBT) to both diagnose TB and monitor treatment response.

Bottom Line: Metabolic pathway detection may provide rapid and effective new tools for TB that can improve TB diagnostics for children and HIV infected patients.The urea tracer was metabolized to 13 C-CO 2 and detected in exhaled breaths using portable infrared spectrometers.The signal correlated with bacterial load both for primary diagnostics and treatment monitoring.

View Article: PubMed Central - PubMed

Affiliation: Center for Tuberculosis Research, Department of Medicine, Johns Hopkins University, MD, USA.

ABSTRACT
Tuberculosis (TB) remains a significant public health issue worldwide especially in developing countries, where the disease is endemic, and effective TB diagnostic as well as treatment-monitoring tools are serious barriers to defeating the disease. Detection of pathogen-specific metabolic pathways offers a potential alternative to current methods, which focus on bacterial growth, bacterial nucleic acid amplification, or detection of host immune response to the pathogen. Metabolic pathway detection may provide rapid and effective new tools for TB that can improve TB diagnostics for children and HIV infected patients. Metabolic breath tests are attractive because these are safe, and provide an opportunity for rapid point of care diagnostics and tool for drug efficacy evaluation during clinical trials. Our group has developed a rabbit urease breath test model to evaluate the sensitivity and the specificity of urease based detection of Mycobacterium tuberculosis. TB infected rabbits were given stable isotopically labelled urea as the substrate. The urea tracer was metabolized to 13 C-CO 2 and detected in exhaled breaths using portable infrared spectrometers. The signal correlated with bacterial load both for primary diagnostics and treatment monitoring. Clinical trials are currently ongoing to evaluate the value of the test in clinical management settings. Urea breath testing may provide a useful diagnostic and biomarker assay for tuberculosis and treatment response.

Show MeSH
Related in: MedlinePlus