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African Journal of Laboratory Medicine
Journal Prestige (SJR): 0.718

Citation Impact (citeScore): 1
Number of Followers: 2

This is an Open Access Journal

Open Access journal
ISSN (Print) 2225-2002 - ISSN (Online) 2225-2010
Published by AOSIS Publishing

[34 journals]

Brucellosis – laboratory workers’ nightmare come true: A case
study
- Authors: Lebogang Skosana, Farzana Ismail, Nontombi Mbelle, Mohamed Said
  First page: 4
  Abstract: Introduction: Brucella spp. are rarely encountered organisms in the medical microbiology laboratory and, when encountered, can cause concern in laboratory workers. Laboratory personnel may in fact develop serious disease as a result of this exposure. This case highlights shortcomings in recognition of Brucella spp. from a patient presenting atypically as well as the follow-up and management of an infected patient.Case presentation: The patient was an 8-year-old boy from a rural area of South Africa who presented to an academic hospital with a bladder mass and history of enuresis in September 2016. Brucella melitensis was isolated from a blood culture submitted to the laboratory. The child was subsequently treated for brucellosis in November 2016.Management and outcome: The source of infection in the patient was traced to consumption of unpasteurised milk from a local farmer. The patient was treated with doxycycline 100 mg twice daily and rifampicin 600 mg daily for 6 weeks and completed treatment, however he was not followed up at our hospital. The laboratory personnel, however, did not handle the specimen as a Biosafety Level 3 pathogen as this organism is not commonly encountered; they were provided with prophylaxis for brucellosis (rifampicin and doxycycline).Conclusion: Brucella spp. is a dangerous pathogen, easily capable of causing significant exposure in an unsuspecting and unprepared laboratory. The case discusses the management of brucellosis in the infected patient as well as the management of laboratory exposure to Brucella spp. Our case also describes the public health response to a case of brucellosis.
  PubDate: 2020-09-29
  DOI: 10.4102/ajlm.v9i1.1114
  Issue No: Vol. 9, No. 2 (2020)
COVID-19 pandemic and antimicrobial resistance: Another call to strengthen
laboratory diagnostic capacity in Africa
- Authors: Beverly Egyir, Noah Obeng-Nkrumah, George B. Kyei
  First page: 4
  Abstract: No abstract available.
  PubDate: 2020-09-23
  DOI: 10.4102/ajlm.v9i1.1302
  Issue No: Vol. 9, No. 2 (2020)
Serological detection of brucellosis among febrile, malaria-negative
children and domesticated dogs in an urban African setting
- Authors: John B. Kalule, Joseph Tomusange, Teddy Namatovu
  First page: 6
  Abstract: Background: Childhood brucellosis and malaria are co-endemic febrile illnesses in some sub-Saharan African countries. Malaria and brucellosis co-infection or brucellosis sole infections are often missed due to an over emphasis on malaria and the lack of appropriate diagnostic infrastructure. Brucellosis in dogs is usually overlooked and yet there is extensive contact between humans and their pets.Objective: This study investigated brucellosis in children and dogs using a confirmatory serological testing series that screens for three Brucella sp.Methods: Residual blood samples from malaria smear-negative febrile children were collected and tested for Brucella sp and malaria parasite. During the same period, residual blood samples presented to a veterinary microbiology laboratory in the same area were tested for brucellosis using the same approach.Results: A total of 105 human and 80 canine blood samples were tested for brucellosis antibodies. The seroprevalence of brucellosis was 22.86% (25/105) in children and 1.3% (1/80) in dogs using the Card, buffered acidified plate antigen, and standard plate agglutination tests but was 0% using the rivanol precipitation plate agglutination test.Conclusion: Given that brucellosis can be caused by both smooth and rough colony strains, there is a need to modify the current serological surveillance strategy (targeted at only Brucella abortus and other smooth colony Brucella strains) to figure out the relative contribution of rough colony Brucella strains (B. ovis and B. canis). Since Uganda is endemic for brucellosis there is a need to modify the brucellosis surveillance strategy.
  PubDate: 2020-09-30
  DOI: 10.4102/ajlm.v9i1.864
  Issue No: Vol. 9, No. 2 (2020)
An open-source molecular diagnostic platform approach for outbreak and
epidemic preparedness
- Authors: Devy M. Emperador, Laura T. Mazzola, Cassandra Kelly-Cirino
  First page: 6
  Abstract: Background: Diagnostic development for outbreak pathogens has typically followed a disease-specific reactive rather than proactive response. Given the diversity of outbreak pathogens, particularly those prioritised by the World Health Organization Research and Development Blueprint, a more flexible and proactive approach to epidemic preparedness is needed to expand access to critical molecular diagnostic tests in peripheral and resource-constrained deployment settings.Objective: New and more sustainable directives are needed to spur the development of high-quality products, particularly for epidemics more often found in low- and middle-income countries. To leverage and de-risk the development process, we present the benefits and challenges of an open-source business model for co-development of molecular diagnostic tests for decentralised settings.Methods: We identify key outbreak pathogens that are available only for testing in high infrastructure laboratories and compare in-country installed base platforms that could be leveraged for menu expansion. Key strengths and challenges for development are highlighted for both platform and assay developers, with discussion of how to leverage and de-risk the process through an open-source development model.Results: Depending on the specific partner strengths, options for partnership roles are presented. The proposed open-source business model addresses the particular challenges in the detection of outbreak- and epidemic-prone pathogens in low- and middle-income countries, reduces development and deployment risks to support outbreak response, strengthens diagnostic capacity and creates a viable market for product developers.Conclusion: We hope this model for a collaborative and open-source approach for molecular diagnostics serves to encourage stakeholders to consider co-development partnerships to improve outbreak preparedness and epidemic/pandemic response.
  PubDate: 2020-09-28
  DOI: 10.4102/ajlm.v9i2.1017
  Issue No: Vol. 9, No. 2 (2020)
Fluorescence microscopy for the diagnosis of smear-negative pulmonary
tuberculosis in Ethiopia
- Authors: Gemeda Abebe, Dossegnaw Aragaw, Mulualem Tadesse
  First page: 6
  Abstract: Background: Despite its low sensitivity, microscopy remains the main method for the diagnosis of pulmonary tuberculosis in most laboratories in Ethiopia. Few studies have evaluated the performance of light-emitting diode fluorescent microscopy (LED-FM) in bleach-concentrated smear-negative sputum specimens.Objective: This study aimed to evaluate the diagnostic performance of LED-FM for smear-negative pulmonary tuberculosis in Ethiopia.Methods: A total of 194 adult patients with a cough lasting for more than two weeks, and who had three direct smear-negative sputum tests for Mycobacterium tuberculosis by Ziehl-Neelsen light microscopy, were included. All direct Ziehl-Neelsen-stained smear-negative sputum samples were cultured and were also visualised by LED-FM. Smears for LED-FM were performed from bleach-concentrated sputum sediment. The diagnostic performance of the LED-FM was compared to the culture method (the reference standard).Results: Of the 194 smear-negative sputum specimens analysed, 28 (14.4%) were culture-positive and 21 (10.8%) were LED-FM-positive for M. tuberculosis. However, only 11 of the 21 (52.4%) LED-FM-positive patients had a confirmed tuberculosis diagnosis by culture. Light-emitting diode fluorescence microscopy (FM) had a sensitivity of 39.3% (95% confidence interval: 21.2–57.4) and specificity of 93.9% (95% confidence interval: 90.4–97.6). Ten LED-FM-positive specimens were culture-negative, and all of these specimens had scanty grading (1–19 bacilli per 40 fields on LED-FM).Conclusion: This study showed that implementation of LED-FM on bleach pre-treated and concentrated sputum can significantly improve the diagnosis of smear-negative pulmonary tuberculosis. However, all scanty grade, positive smears by LED-FM need to be confirmed by reference culture method.
  PubDate: 2020-09-28
  DOI: 10.4102/ajlm.v9i1.810
  Issue No: Vol. 9, No. 2 (2020)
Endometrial sampling at an academic hospital in South Africa: Histological
findings, lessons learnt and interesting surprises
- Authors: Reena D. Mohanlal
  First page: 7
  Abstract: Background: Outpatient sampling is used to investigate endometrial pathology. Little is known about practice habits and local failure rates at Chris Hani Baragwanath Academic Hospital in Johannesburg, South Africa.Objective: This study assessed the frequency of samples that showed no or limited histological representation of endometrium, and described demographic and pathological features.Methods: All endometrial sample histology reports from the National Health Laboratory Services at the hospital from 01 July 2013 to 31 May 2017 were retrieved by searching the laboratory’s information system. Clinical variables (age, menopausal state, indication for biopsy, endometrial thickness on ultrasound) and pathological findings (macroscopic amount of tissue, histological diagnosis, microscopic presence of endometrial tissue) were extracted and statistically analysed.Results: A total of 1926 samples were included, 91% of which were submitted for abnormal or postmenopausal bleeding. No endometrium was observed in 25% of samples and 13% showed limited endometrium. Benign diagnoses (86%) were most common, with proliferative or secretory changes, endometrial polyps and endometritis accounting for most of these. Associations between the amount of sample received and the presence of endometrial tissue (p ≤ 0.001) and benign versus malignant diagnoses (p ≤ 0.001) were noted. The greater the endometrial thickness, the greater the likelihood of obtaining more sample (bulky vs scant p < 0.001) and making a malignant versus benign diagnosis (p = 0.005).Conclusion: These findings are in keeping with literature outside Africa. Histology reports should be explicit when terms such as ‘inadequate’ or ‘insufficient’ are used, in order to facilitate clinical decision-making.
  PubDate: 2020-09-29
  DOI: 10.4102/ajlm.v9i1.1038
  Issue No: Vol. 9, No. 2 (2020)
COVID-19 rapid diagnostic test could contain transmission in low- and
middle-income countries
- Authors: Adesola Olalekan, Bamidele Iwalokun, Oluwabukola M. Akinloye, Olayiwola Popoola, Titilola A. Samuel, Oluyemi Akinloye
  First page: 8
  Abstract: Background: Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has impacted heavily on global health. Although real-time polymerase chain reaction (RT-PCR) is the current diagnostic method, challenges for low- and middle-income countries (LMICs) necessitate cheaper, higher-throughput, reliable rapid diagnostic tests (RDTs).Objective: We reviewed the documented performance characteristics of available COVID-19 RDTs to understand their public health utility in the ongoing pandemic, especially in resource-scarce LMIC settings.Methods: Using a scoping review methodology framework, common literature databases and documentary reports were searched up to 22 April 2020, irrespective of geographical location. The search terms included ‘SARS-CoV-2 AND serological testing’ and ‘COVID-19 AND serological testing’.Results: A total of 18 RDTs produced in eight countries, namely China (6; 33.33%), the United States (4; 22.22%), Germany (2; 11.11%), Singapore (2; 11.11%), Canada, Kenya, Korea and Belgium (1 each; 5.56%), were evaluated. Reported sensitivity ranged from 18.4% to 100% (average = 84.7%), whereas specificity ranged from 90.6% to 100% (average = 95.6%). The testing time ranged from 2 min to 30 min. Of the 12 validated RDTs, the IgM/IgG duo kit with non-colloidal gold labelling system was reported to elicit the highest sensitivity (98% – 100%) and specificity (98% – 99% for IgG and 96% – 99% for IgM).Conclusion: We found reports of high sensitivity and specificity among the developed RDTs that could complement RT-PCR for the detection of SARS-CoV-2 antibodies, especially for screening in LMICs. However, it is necessary to validate these kits locally.
  PubDate: 2020-09-30
  DOI: 10.4102/ajlm.v9i1.1255
  Issue No: Vol. 9, No. 2 (2020)
Development of dried tube specimens for Xpert MTB/RIF proficiency testing
- Authors: Kyle DeGruy, Katherine Klein, Zilma Rey, Patricia Hall, Andrea Kim, Heather Alexander
  First page: 8
  Abstract: Background: Proficiency testing (PT) is part of a comprehensive quality assurance programme, which is critical to ensuring patients receive accurate and reliable diagnostic testing. Implementation of the Cepheid Xpert® MTB/RIF assay to aid in the diagnosis of tuberculosis has expanded rapidly in recent years; however, PT material for Xpert MTB/RIF is not readily available in many resource-limited settings.Objective: To develop an accurate and precise PT material based on the dried tube specimen (DTS) method, using supplies and reagents available in most tuberculosis culture laboratories.Methods: Dried tube specimens were produced at the United States Centers for Disease Control and Prevention from 2013 to 2015 by inactivating liquid cultures of well-characterised mycobacterial strains. Ten percent of DTS produced were tested with Xpert MTB/RIF and evaluated for accuracy and precision.Results: Validation testing across eight rounds of PT demonstrated that DTS are highly accurate, achieving an average of 96.8% concordance with the Xpert MTB/RIF results from the original mycobacterial strains. Dried tube specimen testing was also precise, with cycle threshold standard deviations below two cycles when inherent test cartridge variability was low.Conclusion: Dried tube specimens can be produced using equipment already present in tuberculosis culture laboratories, making Xpert MTB/RIF PT scale-up more feasible in resource-limited settings. Use of DTS may fill the gap in tuberculosis laboratory access to external quality assessment, which is an essential component of a comprehensive continuous quality improvement programme.
  PubDate: 2020-09-29
  DOI: 10.4102/ajlm.v9i1.1166
  Issue No: Vol. 9, No. 2 (2020)
Using Systematized Nomenclature of Medicine clinical term codes to assign
histological findings for prostate biopsies in the Gauteng province, South
Africa: Lessons learnt
- Authors: Naseem Cassim, Ahsan Ahmad, Reubina Wadee, Jaya A. George, Deborah K. Glencross
  First page: 9
  Abstract: Background: Prostate cancer (PCa) is a leading male neoplasm in South Africa.Objective: The aim of our study was to describe PCa using Systemized Nomenclature of Medicine (SNOMED) clinical terms codes, which have the potential to generate more timely data.Methods: The retrospective study design was used to analyse prostate biopsy data from our laboratories using SNOMED morphology (M) and topography (T) codes where the term ’prostate’ was captured in the narrative report. Using M code descriptions, the diagnosis, sub-diagnosis, sub-result and International Classification of Diseases for Oncology (ICD-O-3) codes were assigned using a lookup table. Topography code descriptions identified biopsies of prostatic origin. Lookup tables were prepared using Microsoft Excel and combined with the data extracts using Access. Contingency tables reported M and T codes, diagnosis and sub-diagnosis frequencies.Results: An M and T code was reported for 88% (n = 22 009) of biopsies. Of these, 20 551 (93.37%) were of prostatic origin. A benign diagnosis (ICD-O-3:8000/0) was reported for 10 441 biopsies (50.81%) and 45.26% had a malignant diagnosis (n = 9302). An adenocarcinoma (8140/3) sub-diagnosis was reported for 88.16% of malignant biopsies (n = 8201). An atypia diagnosis was reported for 760 biopsies (3.7%). Inflammation (39.03%) and hyperplasia (20.82%) were the predominant benign sub-diagnoses.Conclusion: Our study demonstrated the feasibility of generating PCa data using SNOMED codes from national laboratory data. This highlights the need for extending the results of our study to a national level to deliver timeous monitoring of PCa trends.
  PubDate: 2020-09-28
  DOI: 10.4102/ajlm.v9i1.909
  Issue No: Vol. 9, No. 2 (2020)
Preparing national tiered laboratory systems and networks to advance
diagnostics in Africa and meet the continent’s health agenda: Insights
into priority areas for improvement
- Authors: Pascale Ondoa, Nqobile Ndlovu, Mah-Sere Keita, Marguerite Massinga-Loembe, Yenew Kebede, Collins Odhiambo, Teferi Mekonen, Aytenew Ashenafi, Amha Kebede, John Nkengasong
  First page: 10
  Abstract: No abstract available.
  PubDate: 2020-09-21
  DOI: 10.4102/ajlm.v9i2.1103
  Issue No: Vol. 9, No. 2 (2020)