Performance of Cholera-SMART? and Pathogen-Detection-Kit? in the quick diagnosis of cholera - Desempe?o de los sistemas Cholera-SMART? y Pathogen-Dete

[LaMenchos]

[FONT=Verdana, Arial, Helvetica-Normal, sans-serif]Performance of Cholera-SMART^? and Pathogen-Detection-Kit^? in the quick diagnosis of cholera[/FONT]
Desempe?o de los sistemas Cholera-SMART^? y Pathogen-Detection-Kit^?[FONT=Verdana, Arial, Helvetica-Normal, sans-serif] en el diagn?stico r?pido del c?lera[/FONT]

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 [FONT=Verdana, Arial, Helvetica, sans-serif]

INVESTIGACI?N ORIGINAL ORIGINAL RESEARCH[/FONT] [FONT=Verdana, Arial, Helvetica-Normal, sans-serif]

http://www.scielosp.org/scielo.php?pid=S1020-49892004001000002&script=sci_arttext
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[FONT=Verdana, Arial, Helvetica-Normal, sans-serif]Hilda Mar?a Bola?os^I; Mar?a Teresa Acu?a^I; Ana Mar?a Serrano^II; Xinia Obando^III; Hazel Mairena^IV; Lorena Ch?ves^V; Flor Sand?^VI; Gina Rodr?guez^VII; Mark L. Tamplin^VIII; Enrique P?rez^IX; Elena Campos^I[/FONT]
[FONT=Verdana, Arial, Helvetica, sans-serif]^ICentro 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
^IILaboratorio Cl?nico, Hospital Dr. Carlos Luis Valverde Vega, San Ram?n, Costa Rica
^IIILaboratorio Cl?nico, Hospital Upala, Upala, Costa Rica
^IVLaboratorio Cl?nico, Hospital Los Chiles, Los Chiles, Costa Rica
^VLaboratorio Cl?nico, Hospital Dr. Enrique Baltodano, Liberia, Costa Rica
^VILaboratorio Cl?nico, Hospital San Rafael, Alajuela, Costa Rica
^VIILaboratorio, Cl?nica Marcial Fallas, Desamparados, Costa Rica
^VIIIDepartamento de Ciencias de la Familia y el Consumidor, Universidad de la Florida, Gainesville, Florida, EUA
^IXCooperaci?n T?cnica, Instituto Panamericano de Protecci?n de Alimentos y Zoonosis-INPPAZ/ OPS-OMS, Buenos Aires, Argentina[/FONT]


<hr noshade="noshade" size="1"> [FONT=Verdana, Arial, Helvetica-Normal, sans-serif]RESUMEN[/FONT]
[FONT=Verdana, Arial, Helvetica, sans-serif]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^? (PDK, Intelligent Monitoring Systems, Gainsville, Florida, EUA) y Cholera-SMART^? (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.

[/FONT][FONT=Verdana, Arial, Helvetica-Normal, sans-serif]ABSTRACT[/FONT]
[FONT=Verdana, Arial, Helvetica, sans-serif]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^? (PDK, Intelligent Monitoring Systems, Gainesville, Florida, USA) and Cholera-SMART^? (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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