Skip to main content
Top
Published in: Health Research Policy and Systems 1/2012

Open Access 01-12-2012 | Research

Leapfrog diagnostics: Demonstration of a broad spectrum pathogen identification platform in a resource-limited setting

Authors: Tomasz A Leski, Rashid Ansumana, Anthony P Malanoski, David H Jimmy, Umaru Bangura, Brian R Barrows, Morie Alpha, Bashiru M Koroma, Nina C Long, Abu J Sundufu, Alfred S Bockarie, Baochuan Lin, David A Stenger

Published in: Health Research Policy and Systems | Issue 1/2012

Login to get access

Abstract

Background

Resource-limited tropical countries are home to numerous infectious pathogens of both human and zoonotic origin. A capability for early detection to allow rapid outbreak containment and prevent spread to non-endemic regions is severely impaired by inadequate diagnostic laboratory capacity, the absence of a “cold chain” and the lack of highly trained personnel. Building up detection capacity in these countries by direct replication of the systems existing in developed countries is not a feasible approach and instead requires “leapfrogging” to the deployment of the newest diagnostic systems that do not have the infrastructure requirements of systems used in developed countries.

Methods

A laboratory for molecular diagnostics of infectious agents was established in Bo, Sierra Leone with a hybrid solar/diesel/battery system to ensure stable power supply and a satellite modem to enable efficient communication. An array of room temperature stabilization and refrigeration technologies for reliable transport and storage of reagents and biological samples were also tested to ensure sustainable laboratory supplies for diagnostic assays.

Results

The laboratory demonstrated its operational proficiency by conducting an investigation of a suspected avian influenza outbreak at a commercial poultry farm at Bo using broad range resequencing microarrays and real time RT-PCR. The results of the investigation excluded influenza viruses as a possible cause of the outbreak and indicated a link between the outbreak and the presence of Klebsiella pneumoniae.

Conclusions

This study demonstrated that by application of a carefully selected set of technologies and sufficient personnel training, it is feasible to deploy and effectively use a broad-range infectious pathogen detection technology in a severely resource-limited setting.
Appendix
Available only for authorised users
Literature
1.
go back to reference Kebede S, Duales S, Yokouide A, Alemu W: Trends of major disease outbreaks in the African region, 2003–2007. East Afr J Public Health. 2010, 7 (1): 20-29.PubMed Kebede S, Duales S, Yokouide A, Alemu W: Trends of major disease outbreaks in the African region, 2003–2007. East Afr J Public Health. 2010, 7 (1): 20-29.PubMed
2.
go back to reference Bausch DG, Demby AH, Coulibaly M, Kanu J, Goba A, Bah A, Conde N, Wurtzel HL, Cavallaro KF, Lloyd E: Lassa fever in Guinea:I. Epidemiology of human disease and clinical observations. Vector Borne Zoonotic Dis. 2001, 1 (4): 269-281. 10.1089/15303660160025903.CrossRefPubMed Bausch DG, Demby AH, Coulibaly M, Kanu J, Goba A, Bah A, Conde N, Wurtzel HL, Cavallaro KF, Lloyd E: Lassa fever in Guinea:I. Epidemiology of human disease and clinical observations. Vector Borne Zoonotic Dis. 2001, 1 (4): 269-281. 10.1089/15303660160025903.CrossRefPubMed
3.
go back to reference Williams BG, Gouws E, Boschi-Pinto C, Bryce J, Dye C: Estimates of world-wide distribution of child deaths from acute respiratory infections. Lancet Infect Dis. 2002, 2 (1): 25-32. 10.1016/S1473-3099(01)00170-0.CrossRefPubMed Williams BG, Gouws E, Boschi-Pinto C, Bryce J, Dye C: Estimates of world-wide distribution of child deaths from acute respiratory infections. Lancet Infect Dis. 2002, 2 (1): 25-32. 10.1016/S1473-3099(01)00170-0.CrossRefPubMed
4.
go back to reference Merianos A: Surveillance and Response to Disease Emergence. Wildlife and Emerging Zoonotic Diseases: The Biology, Circumstances and Consequences of Cross-Species Transmission. Volume 315, edn. Edited by: Childs JE, Mackenzie JS, Richt JA. 2007, Springer, Berlin Heidelberg, 477-509.CrossRef Merianos A: Surveillance and Response to Disease Emergence. Wildlife and Emerging Zoonotic Diseases: The Biology, Circumstances and Consequences of Cross-Species Transmission. Volume 315, edn. Edited by: Childs JE, Mackenzie JS, Richt JA. 2007, Springer, Berlin Heidelberg, 477-509.CrossRef
5.
go back to reference Ozer N: Emerging vector-borne diseases in a changing environment. Turk J Biol. 2005, 29: 125-135. Ozer N: Emerging vector-borne diseases in a changing environment. Turk J Biol. 2005, 29: 125-135.
6.
go back to reference Meng XJ: Hepatitis E virus: animal reservoirs and zoonotic risk. Vet Microbiol. 2010, 140 (3–4): 256-265.CrossRefPubMed Meng XJ: Hepatitis E virus: animal reservoirs and zoonotic risk. Vet Microbiol. 2010, 140 (3–4): 256-265.CrossRefPubMed
7.
go back to reference Fichet-Calvet E, Lecompte E, Koivogui L, Soropogui B, Dore A, Kourouma F, Sylla O, Daffis S, Koulemou K, Ter Meulen J: Fluctuation of abundance and Lassa virus prevalence in Mastomys natalensis in Guinea, West Africa. Vector Borne Zoonotic Dis. 2007, 7 (2): 119-128. 10.1089/vbz.2006.0520.CrossRefPubMed Fichet-Calvet E, Lecompte E, Koivogui L, Soropogui B, Dore A, Kourouma F, Sylla O, Daffis S, Koulemou K, Ter Meulen J: Fluctuation of abundance and Lassa virus prevalence in Mastomys natalensis in Guinea, West Africa. Vector Borne Zoonotic Dis. 2007, 7 (2): 119-128. 10.1089/vbz.2006.0520.CrossRefPubMed
9.
go back to reference Maudlin I, Eisler MC, Welburn SC: Neglected and endemic zoonoses. Philos Trans R Soc Lond B Biol Sci. 2009, 364 (1530): 2777-2787. 10.1098/rstb.2009.0067.CrossRefPubMedPubMedCentral Maudlin I, Eisler MC, Welburn SC: Neglected and endemic zoonoses. Philos Trans R Soc Lond B Biol Sci. 2009, 364 (1530): 2777-2787. 10.1098/rstb.2009.0067.CrossRefPubMedPubMedCentral
10.
go back to reference Tatem AJ, Rogers DJ, Hay SI: Global Transport Networks and Infectious Disease Spread. Global Mapping of Infectious Diseases Methods, Examples and Emerging Applications. Edited by: Simon I, Hay AG, David JR. 2006, Academic, New York, 293-343. Rollinson D, Hay SI(Series Editors):: Advances in Parasitology, vol 62CrossRef Tatem AJ, Rogers DJ, Hay SI: Global Transport Networks and Infectious Disease Spread. Global Mapping of Infectious Diseases Methods, Examples and Emerging Applications. Edited by: Simon I, Hay AG, David JR. 2006, Academic, New York, 293-343. Rollinson D, Hay SI(Series Editors):: Advances in Parasitology, vol 62CrossRef
11.
go back to reference Reiter P: The standardised freight container: vector of vectors and vector-borne diseases. Rev Sci Tech. 2010, 29 (1): 57-64.PubMed Reiter P: The standardised freight container: vector of vectors and vector-borne diseases. Rev Sci Tech. 2010, 29 (1): 57-64.PubMed
12.
go back to reference Webster CH: Airline operating realities and the global spread of infectious diseases. Asia-Pacific journal of public health/Asia-Pacific Academic Consortium for Public Health. 2010, 22 (3 Suppl): 137S-143S. 10.1177/1010539510373130.CrossRefPubMed Webster CH: Airline operating realities and the global spread of infectious diseases. Asia-Pacific journal of public health/Asia-Pacific Academic Consortium for Public Health. 2010, 22 (3 Suppl): 137S-143S. 10.1177/1010539510373130.CrossRefPubMed
14.
16.
go back to reference Bates I, Maitland K: Are laboratory services coming of age in sub-Saharan Africa?. Clin Infect Dis. 2006, 42 (3): 383-384. 10.1086/499368.CrossRefPubMed Bates I, Maitland K: Are laboratory services coming of age in sub-Saharan Africa?. Clin Infect Dis. 2006, 42 (3): 383-384. 10.1086/499368.CrossRefPubMed
17.
go back to reference Nkengasong JN, Nsubuga P, Nwanyanwu O, Gershy-Damet GM, Roscigno G, Bulterys M, Schoub B, DeCock KM, Birx D: Laboratory systems and services are critical in global health: time to end the neglect?. Am J Clin Pathol. 2010, 134 (3): 368-373. 10.1309/AJCPMPSINQ9BRMU6.CrossRefPubMed Nkengasong JN, Nsubuga P, Nwanyanwu O, Gershy-Damet GM, Roscigno G, Bulterys M, Schoub B, DeCock KM, Birx D: Laboratory systems and services are critical in global health: time to end the neglect?. Am J Clin Pathol. 2010, 134 (3): 368-373. 10.1309/AJCPMPSINQ9BRMU6.CrossRefPubMed
20.
go back to reference Ansumana R, Malanoski AP, Bockarie AS, Sundufu AJ, Jimmy DH, Bangura U, Jacobsen KH, Lin B, Stenger DA: Enabling methods for community health mapping in developing countries. Int J Health Geogr. 2010, 9: 56-10.1186/1476-072X-9-56.CrossRefPubMedPubMedCentral Ansumana R, Malanoski AP, Bockarie AS, Sundufu AJ, Jimmy DH, Bangura U, Jacobsen KH, Lin B, Stenger DA: Enabling methods for community health mapping in developing countries. Int J Health Geogr. 2010, 9: 56-10.1186/1476-072X-9-56.CrossRefPubMedPubMedCentral
21.
go back to reference Anthony RM, Brown TJ, French GL: Rapid diagnosis of bacteremia by universal amplification of 23 S ribosomal DNA followed by hybridization to an oligonucleotide array. J Clin Microbiol. 2000, 38 (2): 781-788.PubMedPubMedCentral Anthony RM, Brown TJ, French GL: Rapid diagnosis of bacteremia by universal amplification of 23 S ribosomal DNA followed by hybridization to an oligonucleotide array. J Clin Microbiol. 2000, 38 (2): 781-788.PubMedPubMedCentral
22.
go back to reference Goldemberg J: Leapfrog energy technologies. Energy Policy. 1998, 26 (10): 729-741.CrossRef Goldemberg J: Leapfrog energy technologies. Energy Policy. 1998, 26 (10): 729-741.CrossRef
23.
go back to reference Watson J, Sauter R: Sustainable innovation through leapfrogging: a review of the evidence. International Journal of Technology and Globalisation. 2011, 5 (3–4): 170-189.CrossRef Watson J, Sauter R: Sustainable innovation through leapfrogging: a review of the evidence. International Journal of Technology and Globalisation. 2011, 5 (3–4): 170-189.CrossRef
24.
go back to reference Kwankam SY, Ningo NN: Information Technology in Africa: A Proactive Approach and the Prospects of Leapfrogging Decades in the Development Process. Inet97. 1997, Internet Society, Kuala Lumpur, Malaysia, - Kwankam SY, Ningo NN: Information Technology in Africa: A Proactive Approach and the Prospects of Leapfrogging Decades in the Development Process. Inet97. 1997, Internet Society, Kuala Lumpur, Malaysia, -
25.
go back to reference Jacobus HS, Lin B, Jimmy DH, Ansumana R, Malanoski AP, Stenger DA: Evaluating the impact of adding energy storage on the performance of a hybrid power system. Energy Conversion and Management. 2011, 52 (7): 2604-2610. 10.1016/j.enconman.2011.01.015.CrossRef Jacobus HS, Lin B, Jimmy DH, Ansumana R, Malanoski AP, Stenger DA: Evaluating the impact of adding energy storage on the performance of a hybrid power system. Energy Conversion and Management. 2011, 52 (7): 2604-2610. 10.1016/j.enconman.2011.01.015.CrossRef
26.
go back to reference Jacobus HS: Solar-Diesel Hybrid Power System Optimization and Experimental Validation. MS thesis. 2010, University of Maryland, Jacobus HS: Solar-Diesel Hybrid Power System Optimization and Experimental Validation. MS thesis. 2010, University of Maryland,
27.
go back to reference Burgoyne LA: Solid medium and method for DNA storage. Edited by USPTO, vol. 5496562. 1996, Flinders Technologies Pty Ltd, USA Burgoyne LA: Solid medium and method for DNA storage. Edited by USPTO, vol. 5496562. 1996, Flinders Technologies Pty Ltd, USA
28.
go back to reference Rogers CD, Burgoyne LA: Reverse transcription of an RNA genome from databasing paper (FTA(R)). Biotechnology and Applied Biochemistry. 2000, 31 (Pt 3): 219-224.CrossRefPubMed Rogers CD, Burgoyne LA: Reverse transcription of an RNA genome from databasing paper (FTA(R)). Biotechnology and Applied Biochemistry. 2000, 31 (Pt 3): 219-224.CrossRefPubMed
29.
go back to reference Lin B, Malanoski AP, Wang Z, Blaney KM, Long NC, Meador CE, Metzgar D, MC A, YS L, MM R: Universal detection and Identification of avian Influenza using resequencing microarrays. J Clin Microbiol. 2009, 47 (4): 988-993. 10.1128/JCM.01346-08.CrossRefPubMedPubMedCentral Lin B, Malanoski AP, Wang Z, Blaney KM, Long NC, Meador CE, Metzgar D, MC A, YS L, MM R: Universal detection and Identification of avian Influenza using resequencing microarrays. J Clin Microbiol. 2009, 47 (4): 988-993. 10.1128/JCM.01346-08.CrossRefPubMedPubMedCentral
30.
go back to reference Leski TA, Lin B, Malanoski AP, Wang Z, Long NC, Meador CE, Barrows B, Ibrahim S, Hardick JP, Aitichou M: Testing and validation of high density resequencing microarray for broad range biothreat agents detection. PLoS ONE. 2009, 4 (8): e6569-10.1371/journal.pone.0006569.CrossRefPubMedPubMedCentral Leski TA, Lin B, Malanoski AP, Wang Z, Long NC, Meador CE, Barrows B, Ibrahim S, Hardick JP, Aitichou M: Testing and validation of high density resequencing microarray for broad range biothreat agents detection. PLoS ONE. 2009, 4 (8): e6569-10.1371/journal.pone.0006569.CrossRefPubMedPubMedCentral
31.
go back to reference Lin B, Blaney KM, Malanoski AP, Ligler AG, Schnur JM, Metzgar D, Russell KL, Stenger DA: Using a resequencing microarray as a multiple respiratory pathogen detection assay. J Clin Microbiol. 2007, 45 (2): 443-452. 10.1128/JCM.01870-06.CrossRefPubMed Lin B, Blaney KM, Malanoski AP, Ligler AG, Schnur JM, Metzgar D, Russell KL, Stenger DA: Using a resequencing microarray as a multiple respiratory pathogen detection assay. J Clin Microbiol. 2007, 45 (2): 443-452. 10.1128/JCM.01870-06.CrossRefPubMed
32.
go back to reference Wang Z, Malanoski AP, Lin B, Kidd C, Long NC, Blaney KM, Thach DC, Tibbetts C, Stenger DA: Resequencing microarray probe design for typing genetically diverse viruses: human rhinoviruses and enteroviruses. BMC genomics. 2008, 9 (1): 577-10.1186/1471-2164-9-577.CrossRefPubMedPubMedCentral Wang Z, Malanoski AP, Lin B, Kidd C, Long NC, Blaney KM, Thach DC, Tibbetts C, Stenger DA: Resequencing microarray probe design for typing genetically diverse viruses: human rhinoviruses and enteroviruses. BMC genomics. 2008, 9 (1): 577-10.1186/1471-2164-9-577.CrossRefPubMedPubMedCentral
33.
go back to reference Malanoski AP, Lin B, Wang Z, Schnur JM, Stenger DA: Automated identification of multiple micro-organisms from resequencing DNA microarrays. Nucleic Acids Res. 2006, 34 (18): 5300-5311. 10.1093/nar/gkl565.CrossRefPubMedPubMedCentral Malanoski AP, Lin B, Wang Z, Schnur JM, Stenger DA: Automated identification of multiple micro-organisms from resequencing DNA microarrays. Nucleic Acids Res. 2006, 34 (18): 5300-5311. 10.1093/nar/gkl565.CrossRefPubMedPubMedCentral
34.
go back to reference Carr MJ, Gunson R, Maclean A, Coughlan S, Fitzgerald M, Scully M, O'Herlihy B, Ryan J, O'Flanagan D, Connell J: Development of a real-time RT-PCR for the detection of swine-lineage influenza A (H1N1) virus infections. J Clin Virol. 2009, 45 (3): 196-199. 10.1016/j.jcv.2009.06.001.CrossRefPubMed Carr MJ, Gunson R, Maclean A, Coughlan S, Fitzgerald M, Scully M, O'Herlihy B, Ryan J, O'Flanagan D, Connell J: Development of a real-time RT-PCR for the detection of swine-lineage influenza A (H1N1) virus infections. J Clin Virol. 2009, 45 (3): 196-199. 10.1016/j.jcv.2009.06.001.CrossRefPubMed
35.
go back to reference Whatman: Whatman FTA for Total RNA. Whatman. 2004, 51643: 1-2. Whatman: Whatman FTA for Total RNA. Whatman. 2004, 51643: 1-2.
36.
go back to reference Whatman: Whatman FTA DNA protection. Whatman. 2006, 51677: 1-2. Whatman: Whatman FTA DNA protection. Whatman. 2006, 51677: 1-2.
37.
go back to reference Abdelwhab EM, Luschow D, Harder TC, Hafez HM: The use of FTA((R)) filter papers for diagnosis of avian influenza virus. J Virol Methods. 2011, 174 (1–2): 120-122.CrossRefPubMed Abdelwhab EM, Luschow D, Harder TC, Hafez HM: The use of FTA((R)) filter papers for diagnosis of avian influenza virus. J Virol Methods. 2011, 174 (1–2): 120-122.CrossRefPubMed
38.
go back to reference Smith LM, Burgoyne LA: Collecting, archiving and processing DNA from wildlife samples using FTA databasing paper. BMC ecology. 2004, 4: 4-10.1186/1472-6785-4-4.CrossRefPubMedPubMedCentral Smith LM, Burgoyne LA: Collecting, archiving and processing DNA from wildlife samples using FTA databasing paper. BMC ecology. 2004, 4: 4-10.1186/1472-6785-4-4.CrossRefPubMedPubMedCentral
40.
go back to reference Natarajan P, Trinh T, Mertz L, Goldsborough M, Fox DK: Paper-based archiving of mammalian and plant samples for RNA analysis. Biotechniques. 2000, 29 (6): 1328-1333.PubMed Natarajan P, Trinh T, Mertz L, Goldsborough M, Fox DK: Paper-based archiving of mammalian and plant samples for RNA analysis. Biotechniques. 2000, 29 (6): 1328-1333.PubMed
41.
go back to reference Chua AL, Elina HT, Lim BH, Yean CY, Ravichandran M, Lalitha P: Development of a dry reagent-based triplex PCR for the detection of toxigenic and non-toxigenic Vibrio cholerae. J Med Microbiol. 2011, 60 (Pt 4): 481-485.CrossRefPubMed Chua AL, Elina HT, Lim BH, Yean CY, Ravichandran M, Lalitha P: Development of a dry reagent-based triplex PCR for the detection of toxigenic and non-toxigenic Vibrio cholerae. J Med Microbiol. 2011, 60 (Pt 4): 481-485.CrossRefPubMed
42.
go back to reference Klatser PR, Kuijper S, van Ingen CW, Kolk AH: Stabilized, freeze-dried PCR mix for detection of mycobacteria. J Clin Microbiol. 1998, 36 (6): 1798-1800.PubMedPubMedCentral Klatser PR, Kuijper S, van Ingen CW, Kolk AH: Stabilized, freeze-dried PCR mix for detection of mycobacteria. J Clin Microbiol. 1998, 36 (6): 1798-1800.PubMedPubMedCentral
43.
go back to reference Aziah I, Ravichandran M, Ismail A: Amplification of ST50 gene using dry-reagent-based polymerase chain reaction for the detection of Salmonella typhi. Diagn Microbiol Infect Dis. 2007, 59 (4): 373-377. 10.1016/j.diagmicrobio.2007.05.014.CrossRefPubMed Aziah I, Ravichandran M, Ismail A: Amplification of ST50 gene using dry-reagent-based polymerase chain reaction for the detection of Salmonella typhi. Diagn Microbiol Infect Dis. 2007, 59 (4): 373-377. 10.1016/j.diagmicrobio.2007.05.014.CrossRefPubMed
44.
go back to reference Barnes HJ: Miscellaneous and sporadic bacterial infections. Diseases of poultry. Edited by: Saif YM. 2003, Blackwell Publishing Company, Ames, 845-862. 11 Barnes HJ: Miscellaneous and sporadic bacterial infections. Diseases of poultry. Edited by: Saif YM. 2003, Blackwell Publishing Company, Ames, 845-862. 11
45.
go back to reference Berger-Bachi B: Genetic basis of methicillin resistance in Staphylococcus aureus. Cellular and Molecular Life Sciences. 1999, 56 (9–10): 764-770.CrossRefPubMed Berger-Bachi B: Genetic basis of methicillin resistance in Staphylococcus aureus. Cellular and Molecular Life Sciences. 1999, 56 (9–10): 764-770.CrossRefPubMed
46.
go back to reference Kawano J, Shimizu A, Saitoh Y, Yagi M, Saito T, Okamoto R: Isolation of methicillin-resistant coagulase-negative staphylococci from chickens. J Clin Microbiol. 1996, 34 (9): 2072-2077.PubMedPubMedCentral Kawano J, Shimizu A, Saitoh Y, Yagi M, Saito T, Okamoto R: Isolation of methicillin-resistant coagulase-negative staphylococci from chickens. J Clin Microbiol. 1996, 34 (9): 2072-2077.PubMedPubMedCentral
47.
go back to reference Alexander DJ: Avian Paramyxoviruses 2–9. Diseases of poultry. Edited by: Saif YM. 2003, Blackwell Publishing Company, Ames, 88-92. 11 Alexander DJ: Avian Paramyxoviruses 2–9. Diseases of poultry. Edited by: Saif YM. 2003, Blackwell Publishing Company, Ames, 88-92. 11
48.
go back to reference Gough RE: Avian Pneumoviruses. Diseases of poultry. Edited by: Saif YM. 2003, Blackwell Publishing Company, Ames, 92-100. 11 Gough RE: Avian Pneumoviruses. Diseases of poultry. Edited by: Saif YM. 2003, Blackwell Publishing Company, Ames, 92-100. 11
49.
go back to reference Colaco C: Extraordinary stability of enzymes dried in trehalose: simplified molecular biology. Biotechnology (N Y). 1992, 10 (9): 1007-1011. 10.1038/nbt0992-1007.CrossRef Colaco C: Extraordinary stability of enzymes dried in trehalose: simplified molecular biology. Biotechnology (N Y). 1992, 10 (9): 1007-1011. 10.1038/nbt0992-1007.CrossRef
Metadata
Title
Leapfrog diagnostics: Demonstration of a broad spectrum pathogen identification platform in a resource-limited setting
Authors
Tomasz A Leski
Rashid Ansumana
Anthony P Malanoski
David H Jimmy
Umaru Bangura
Brian R Barrows
Morie Alpha
Bashiru M Koroma
Nina C Long
Abu J Sundufu
Alfred S Bockarie
Baochuan Lin
David A Stenger
Publication date
01-12-2012
Publisher
BioMed Central
Published in
Health Research Policy and Systems / Issue 1/2012
Electronic ISSN: 1478-4505
DOI
https://doi.org/10.1186/1478-4505-10-22

Other articles of this Issue 1/2012

Health Research Policy and Systems 1/2012 Go to the issue