MODS Culture for Primary Diagnosis of Tuberculous Meningitis and HIV-Associated Pulmonary Tuberculosis in Indonesia.

Aims: To compare the microscopic observation drug susceptibility (MODS) culture with microscopy and solid culture for diagnosis of TB meningitis and HIV-associated pulmonary tuberculosis (TB). Study Design: Comparative study. Place and Duration of Study: Department of Clinical Pathology, Hasan Sadikin Hospital, Bandung, Indonesia, between 2010 and 2012. Methodology: Two groups of patients were included. The first group consisted of 167 consecutive HIV-infected patients presenting with suspected pulmonary TB. The second group consisted of 88 patients with clinical suspicion of TB meningitis. Sputum samples from HIV-associated pulmonary TB patients and cerebrospinal fluid (CSF) from patients with TB meningitis were analyzed using microscopy of Ziehl-Neelsen (ZN) stained smears, culture on solid medium (Ogawa), and MODS culture. Results: MODS showed the highest detection rate in both patient groups. Among HIV-associated pulmonary TB patients, positivity of MODS was 31.2% compared with 26.9% for Ogawa and 20.6% for ZN. Among TB meningitis patients, positivity of MODS was 41.2% compared with 38.8% for Ogawa and 8.3% for ZN. The median time to culture positivity was significantly shorter for MODS compared to Ogawa, both for sputum (median 11 vs 21 days) and CSF (14 vs 33 days). In 14 days, MODS detected significantly more cases compared with Ogawa in both patients group (79.2% vs 2.4% and 68.6% vs 0%, respectively). Laboratory staff readily used MODS after two weeks of training. Conclusion: We were able to implement MODS culture as a robust, sensitive, and rapid method for diagnosis of HIV-assoicated pulmonary TB and TB meningitis in a hospital setting in Indonesia. Further studies may be needed to assess the feasibility of MODS culture in other settings and assess its impact on case detection and timely treatment of both forms of TB.

Implementation of 25-well culture plates for M. tuberculosis drug susceptibility testing in Indonesia.

At present, there is no standardized method for Mycobacterium tuberculosis drug susceptibility testing (DST) among laboratories in Indonesia. Since January 2001 to January 2004 we have tried to establish the method of 25-well culture plates with middlebrook’s media (Drug Susceptibility Culture Plate (DSCP) method) used by the Dutch Supranational Reference Laboratory at the Institute of Public Health and the Environment (RIVM), Bilthoven, Netherlands. Our experience showed that this method potentially gives better result as it can be very well standardized, faster and provides detailed MIC (Minimal Inhibitory Concentration) values. Data from 364 isolates that have been tested by DSCP method showed that resistance to INH, rifampicin, ethambutol, and streptomycin were 21.4%, 19.8%, 15.7%, and 16.5% respectively. Multidrug resistance were found in 13.2% isolates.