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Performance of Cholera-SMART? and Pathogen-Detection-Kit? in the quick diagnosis of cholera - Desempe?o de los sistemas Cholera-SMART? y Pathogen-Detection-Kit? en el diagn?stico r?pido del c?lera

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  • Performance of Cholera-SMART? and Pathogen-Detection-Kit? in the quick diagnosis of cholera - Desempe?o de los sistemas Cholera-SMART? y Pathogen-Detection-Kit? en el diagn?stico r?pido del c?lera

    Performance of Cholera-SMART<sup>?</sup> and Pathogen-Detection-Kit<sup>?</sup> in the quick diagnosis of cholera
    Desempe?o de los sistemas Cholera-SMART<sup>?</sup> y Pathogen-Detection-Kit<sup>?</sup> en el diagn?stico r?pido del c?lera

    Revista Panamericana de Salud P?blica

    Print version ISSN 1020-4989

    Rev Panam Salud Publica vol.16 no.4 Washington Oct. 2004

    doi: 10.1590/S1020-49892004001000002

    INVESTIGACI?N ORIGINAL
    ORIGINAL RESEARCH




    Hilda Mar?a Bola?os<sup>I</sup>; Mar?a Teresa Acu?a<sup>I</sup>; Ana Mar?a Serrano<sup>II</sup>; Xinia Obando<sup>III</sup>; Hazel Mairena<sup>IV</sup>; Lorena Ch?ves<sup>V</sup>; Flor Sand?<sup>VI</sup>; Gina Rodr?guez<sup>VII</sup>; Mark L. Tamplin<sup>VIII</sup>; Enrique P?rez<sup>IX</sup>; Elena Campos<sup>I</sup>
    <sup>I</sup>Centro Nacional de Referencia en Bacteriolog?a, Instituto Costarricense de Investigaci?n y Ense?anza en Nutrici?n y Salud (INCIENSA), Apdo. 4-2250 Tres R?os, Costa Rica. Correo electr?nico: hbolanos@inciensa.sa.cr
    <sup>II</sup>Laboratorio Cl?nico, Hospital Dr. Carlos Luis Valverde Vega, San Ram?n, Costa Rica
    <sup>III</sup>Laboratorio Cl?nico, Hospital Upala, Upala, Costa Rica
    <sup>IV</sup>Laboratorio Cl?nico, Hospital Los Chiles, Los Chiles, Costa Rica
    <sup>V</sup>Laboratorio Cl?nico, Hospital Dr. Enrique Baltodano, Liberia, Costa Rica
    <sup>VI</sup>Laboratorio Cl?nico, Hospital San Rafael, Alajuela, Costa Rica
    <sup>VII</sup>Laboratorio, Cl?nica Marcial Fallas, Desamparados, Costa Rica
    <sup>VIII</sup>Departamento de Ciencias de la Familia y el Consumidor, Universidad de la Florida, Gainesville, Florida, EUA
    <sup>IX</sup>Cooperaci?n T?cnica, Instituto Panamericano de Protecci?n de Alimentos y Zoonosis-INPPAZ/ OPS-OMS, Buenos Aires, Argentina



    <hr noshade="noshade" size="1"> RESUMEN
    OBJETIVOS: Comparar el desempe?o de dos sistemas r?pidos de diagn?stico de c?lera con el m?todo de cultivo y proponer una estrategia que permita mejorar la especificidad y la sensibilidad de estos sistemas y disminuir los costos del diagn?stico.
    M?TODOS: En el estudio participaron el Centro Nacional de Referencia en Bacteriolog?a (CNRB) del Instituto Costarricense de Investigaci?n y Ense?anza en Nutrici?n y Salud (INCIENSA) y hospitales de las provincias de Alajuela, Guanacaste y San Jos?, en Costa Rica. Se emplearon 237 muestras de heces para evaluar el desempe?o de dos pruebas r?pidas para el diagn?stico de Vibrio cholerae O1: Pathogen Detection Kit<sup>?</sup> (PDK, Intelligent Monitoring Systems, Gainsville, Florida, EUA) y Cholera-SMART<sup>?</sup> (New Horizons Diagnostics Corp., Columbia, Maryland, EUA), tanto en forma directa (SMART directo y PDK directo) como a partir de cultivos de enriquecimiento de 6 horas (SMART-6 y PDK-6) y de 18 horas (SMART-18 y PDK-18) a 37 ?C en agua de peptona alcalina. Las muestras diarreicas y semiformadas se cultivaron y se evaluaron con las pruebas r?pidas directas; cuando el resultado inicial era negativo se repitieron a las 6 y 18 horas de cultivo. Los hisopados rectales y fecales se evaluaron a partir de cultivos de enriquecimiento de 6 y de 18 horas. Adicionalmente se estudi? la sensibilidad anal?tica de los sistemas r?pidos con cultivos puros de 18 a 24 horas de incubaci?n de V. cholerae O1 (cepa SOS-833, CNRB, Costa Rica) y se evalu? la utilidad del an?lisis microsc?pico de la motilidad para racionalizar el uso de las t?cnicas r?pidas.

    ABSTRACT
    OBJECTIVES: To compare the performance of two rapid systems for the diagnosis of cholera with the culture method, and to propose a strategy for improving the specificity and sensitivity of these systems and reducing the costs involved in making a diagnosis.
    METHODS: The following institutions participated in the study: the National Bacteriology Referral Center (Centro Nacional de Referencia en Bacteriolog?a, CNRB) of the Costa Rican Institute for Research and Teaching in Nutrition and Health (Instituto Costarricense de Investigaci?n y Ense?anza en Nutrici?n y Salud, INCIENSA) and various hospitals in the provinces of Alajuela, Guanacaste and San Jos?, in Costa Rica. A total of 237 feces samples were used to asses the performance of two tests for the rapid detection of Vibrio cholerae 01: the Pathogen Detection Kit<sup>?</sup> (PDK, Intelligent Monitoring Systems, Gainesville, Florida, USA) and Cholera-SMART<sup>?</sup> (New Horizons Diagnostics Corp., Columbia, Maryland, USA), both when applied directly (direct SMART and direct PDK) and when applied to specimens cultured in broth-enriched medium for 6 hours (SMART-6 and CPK-6) and for 18 hours (SMART-18 and PDK-18) at 37 ?C in alkaline peptone water. Liquid and partially formed stools were cultured and examined by means of the rapid direct test; when the initial result was negative, the tests were repeated after culture for periods of 6 and 18 hours. Rectal and fecal swabs were obtained from feces cultured in enriched-broth medium for 6 and 18 hours. In addition, we studied the sensitivity of the rapid testing systems by using pure cultures of V. cholerae 01 (strain SOS-833, CNRB, Costa Rica) that were incubated for 18 to 24 hours, and we assessed the usefulness of observing motility under the microscope in order to rationalize the use of rapid methods.
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