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The Global Crisis of Drug-Resistant Tuberculosis and Leadership of China and the BRICS Challenges and Opportunities: Summary of a Joint Workshop by the Institute of Medicine and the Institute of Microbiology, Chinese Academy of Sciences (2014) / Chapter Skim
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8 Rapid Diagnostic Technologies: Status and Limitations
Pages 79-90

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From page 79...
... • Susceptibility testing of some FLDs and most SLDs can be difficult to standardize, and results often vary across high-quality laboratories. • Decentralized testing can reduce turnaround time, lower initial default rates, improve communication, and require less reliance on logistics.
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From page 80...
... Thus, a test that works well in South Africa may not work at all or may perform poorly in Russia. 1  This section is based on the presentation by Mark Nicol, Wernher and Beit Professor and Head of the Department of Medical Microbiology, University of Cape Town and National Health Laboratory Service of South Africa.
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From page 81...
... The introduction of LPA testing in South Africa had positive although incremental effects on treatment delays, Nicol reported. Data gathered from a low-income housing area on the outskirts of Cape Town showed that its use reduced the median time to treatment initiation for smear-negative patients from 88 to 69 days and for smear-positive patients from 59 to 37 days.
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From page 82...
... In an unpublished study comparing GeneXpert with smear microscopy plus a culture if the smear was negative and a patient was HIV positive, 80 percent of patients with positive GeneXpert results were started on treatment within 1 week. In the routine arm on the study, only about 50 percent of patients were being treated by day 30.
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From page 83...
... There is pressure to decentralize testing, which can reduce turnaround time, lower initial default rates, improve communication, and require less reliance on logistics. On the other hand, centralized testing can use sophisticated technology; allow for a broader range of tests; and provide better quality assurance, which can make it more cost-effective.
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From page 84...
... 2  This subsection is based on the presentation by Jin Chen, Chair, Department of Clinical Laboratory Science; and Deputy Director, Shanghai Key Laboratory of Tuberculosis, Tongji University School of Medicine, Shanghai Pulmonary Disease Hospital. 3  This subsection is based on the presentation by Yao-Ju Tan, Director, Clinical Laboratory Department, Guangzhou Chest Hospital.
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From page 85...
... Also, mutations in the rpsA gene, which encodes a ribosomal protein, can confer increased pyrazinamide resistance. In 120 clinical isolates from the Guangzhou Chest Hospital, the mutations in pncA and rpsA were detected by DNA sequencing.
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From page 86...
... Use of the LPA in China4 Hairong Huang, Deputy Director, National Clinical Laboratory on Tuberculosis, Beijing Chest Hospital, described the use of LPA testing in China. There, two LPA techniques are commonly used: the Hain test from Germany and a domestically produced test called the CapitalBio M ­ icroarray.
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From page 87...
... Future work includes rechecking all isolates and specimens for which discordant results were obtained with GenoType MTBDRplus and conventional DST. Use of the GeneChip in China6 Pang Yu, Associate Professor, National Tuberculosis Reference Laboratory, National Center for Tuberculosis Control and Prevention, China CDC, described an evaluation of the use of GeneChip for detecting DR TB in China.
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From page 88...
... For isoniazid resistance, the concordance was 70.2 percent for the isolates and 78.1 percent for the sputum samples. Evaluation of GeneChip for samples from 2,247 smear-positive patients in four cities in different provinces found a sensitivity of 87.6 percent for rifampicin resistance and 80.3 percent for isoniazid resistance, using DST as the gold standard.
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From page 89...
... . Similarly, mutations known to cause isoniazid resistance occur in regions involved in the activation and binding of the drug, although mutations occur throughout the molecule involved in activating isoniazid, suggesting that anything that impairs the function of that protein could reduce activation.
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From page 90...
... . Genes associated with mutations conferring resistance or a growth or fitness advantage in the presence of a drug are likely to be under strong evolutionary positive selection.
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Key Terms

  • rifampicin resistance
  • isoniazid resistance
  • rapid diagnostic
  • drug resistance
  • lpa testing

  • chest hospital
  • sputum samples
  • susceptibility testing
  • clinical laboratory
  • positive predictive

  • predictive value
  • cape town
  • genotype mtbdrplus
  • sputum sample
  • guangzhou chest

  • hain test
  • initial default
  • resistance mutation
  • detecting rifampicin
  • south african

  • national clinical
  • genotypic resistance
  • traditional dst
  • shanghai key
  • gene mutations

  • provincial chest
  • diagnostic tests
  • median time
  • shanghai pulmonary
  • lower initial


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