title: Reducing the string test intra-gastric downtime for detection of Mycobacterium tuberculosis.
abstract: OBJECTIVE
  To explore the potential for reducing the procedural duration of the string test for the diagnosis of tuberculosis (TB) using microscopic observation drug susceptibility (MODS) culture.
  
  
  METHODS
  Twelve patients already diagnosed with pulmonary TB, four each with sputum smear acid-fast bacilli grade 1+, 2+ and 3+, underwent four consecutive string tests of varying intra-gastric downtime (IGDT) of 30 min, 1, 2 and 4 h. Each retrieved string was cut into three-one oesophageal and two gastric sections. Eluates from one of the gastric sections and the oesophageal section were cultured in MODS after a decontamination procedure; eluate from the other gastric section was cultured in MODS with no decontamination.
  
  
  RESULTS
  No significant difference was observed in the retrieval efficacy of Mycobacterium tuberculosis (P = 0.29) or time to positive MODS culture (P = 0.80) among string tests of varying IGDTs. Every patient with a sample that was positive after a 4-h IGDT also had positive culture of a 1-h IGDT sample. A pre-inoculation sample decontamination step significantly reduced culture contamination (P < 0.001).
  
  
  CONCLUSIONS
  In smear-positive patients, reducing the IGDT to 1 h did not affect the M. tuberculosis retrieval efficacy of the string test. Future evaluations in non-expectorating human immunodeficiency virus and paediatric populations should include a 1-h IGDT.
authors.affiliation: Harvard College, Cambridge, Massachusetts, USA.
authors.forename: W H
authors.initials: WH
authors.lastname: Bae
authors.forename: A
authors.initials: A
authors.lastname: Salas
authors.forename: M F
authors.initials: MF
authors.lastname: Brady
authors.forename: J
authors.initials: J
authors.lastname: Coronel
authors.forename: C G L
authors.initials: CG
authors.lastname: Colombo
authors.forename: B
authors.initials: B
authors.lastname: Castro
authors.forename: R H
authors.initials: RH
authors.lastname: Gilman
authors.forename: D A J
authors.initials: DA
authors.lastname: Moore
mesh_terms: D000293:Adolescent; D000328:Adult; D003955:Diagnostic Tests, Routine / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D013997:Time Factors; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis