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1 March 2007

Volume 44, Number 5
Clinical Infectious Diseases 2007;44:674–680
© 2007 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2007/4405-0008$15.00
DOI: 10.1086/511639
MAJOR ARTICLE

Clinical Evaluation of the Microscopic‐Observation Drug‐Susceptibility Assay for Detection of Tuberculosis

Mayra Arias,1,a

Fernanda C. Q. Mello,4,a

Ada Pavón,5

Anna Grazia Marsico,4

Carlos Alvarado‐Gálvez,5

Senia Rosales,6

Carlos Leonardo Carvalho Pessôa,4

Melly Pérez,6

Monica K. Andrade,4

Afranio L. Kritski,4

Leila S. Fonseca,4

Richard E. Chaisson,2,3

Michael E. Kimerling,1 and

Susan E. Dorman2,3

1University of Alabama at Birmingham, Birmingham; 2Johns Hopkins University School of Medicine and 3Bloomberg School of Public Health, Baltimore, Maryland; 4Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; 5National Thorax Institute and 6Gorgas Tuberculosis Initiative‐Honduras, Tegucigalpa, Honduras

Background.There is an urgent need for low‐cost methods for rapid, accurate detection of Mycobacterium tuberculosis in clinical specimens. The microscopic‐observation drug‐susceptibility (MODS) assay is a relatively low‐cost and simple liquid culture method that has been proposed for use in resource‐limited environments.

Methods.This prospective study evaluated the performance of the MODS assay for detection of M. tuberculosis in persons undergoing evaluation for pulmonary tuberculosis in Brazil and Honduras. Respiratory specimens were evaluated using smear microscopy, culture on Löwenstein‐Jensen medium, and culture using the MODS assay. A subset of specimens was also cultured using the Mycobacterial Growth Indicator Tube (MGIT) 960 automated system (Becton Dickinson). A study subject was considered to have tuberculosis if at least 1 culture on Löwenstein‐Jensen medium was positive for M. tuberculosis.

Findings.A total of 1639 respiratory specimens obtained from 854 study subjects were analyzed. On a per‐subject basis, MODS sensitivity was 97.5% (95% confidence interval [CI], 95.7–98.6), and specificity was 94.4% (95% CI, 93.1–95.2). Median times to detection were 21 days (interquartile range [IQR], 17–25 days) and 7 days (IQR, 5–10) for culture on Löwenstein‐Jensen medium and for the MODS assay, respectively ( ). For 64 specimens cultured using the MGIT 960 automated system, median time to growth was similar for the MODS assay (7 days; IQR, 7–10 days) and the MGIT 960 automated system (8 days; IQR, 6–11.5 days; ). The percentage of contaminated cultures was lower for the MODS assay than for culture on Löwenstein‐Jensen medium (3.8% vs. 5.8%; ).

Conclusions.The MODS assay is a relatively simple test whose good performance characteristics for detection of pulmonary tuberculosis may make it suitable for resource‐limited environments.

Received 8 September 2006; accepted 13 November 2006; electronically published 22 January 2007.

Reprints or correspondence: Dr. Susan E. Dorman, Johns Hopkins University School of Medicine, 1550 Orleans St., Rm. 1M‐06, Baltimore, MD 21231 ().

Cited by

Melissa R Nyendak, Deborah A Lewinsohn, David M Lewinsohn. (2009) New diagnostic methods for tuberculosis. Current Opinion in Infectious Diseases 22:2, 174-182
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Sheela Shenoi, Scott Heysell, Anthony Moll, Gerald Friedland. (2009) Multidrug-resistant and extensively drug-resistant tuberculosis: consequences for the global HIV community. Current Opinion in Infectious Diseases 22:1, 11-17
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Edward D Chan, Michael D Iseman. (2009) Multidrug-resistant and extensively drug-resistant tuberculosis: a review. Current Opinion in Infectious Diseases 21:6, 587-595
Online publication date: 1-Jan-2009.
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Louis Grandjean, David AJ Moore. (2008) Tuberculosis in the developing world: recent advances in diagnosis with special consideration of extensively drug-resistant tuberculosis. Current Opinion in Infectious Diseases 21:5, 454-461
Online publication date: 1-Nov-2008.
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Ritu Banerjee, Gisela F Schecter, Jennifer Flood, Travis C Porco. (2008) Extensively drug-resistant tuberculosis: new strains, new challenges. Expert Review of Anti-infective Therapy 6:5, 713-724
Online publication date: 1-Nov-2008.
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Neil W. SCHLUGER. (2008) Advances in the diagnosis of tuberculosis. Respirology 13, S73-S80
Online publication date: 1-Oct-2008.
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David AJ Moore. (2007) Future prospects for the MODS assay in multidrug-resistant tuberculosis diagnosis. Future Microbiology 2:2, 97-101
Online publication date: 1-May-2007.
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  • M.A. and F.C.Q.M. contributed equally to this article.

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