title: Stool microbiome reveals diverse bacterial ureases as confounders of oral urea breath testing for Helicobacter pylori and Mycobacterium tuberculosis in Bamako, Mali.
abstract: Detection of bacterial urease activity has been utilized successfully to diagnose Helicobacter pylori (H. pylori). While Mycobacterium tuberculosis (M. tuberculosis) also possesses an active urease, it is unknown whether detection of mycobacterial urease activity by oral urease breath test (UBT) can be exploited as a rapid point of care biomarker for tuberculosis (TB) in humans. We enrolled 34 individuals newly diagnosed with pulmonary TB and 46 healthy subjects in Bamako, Mali and performed oral UBT, mycobacterial sputum culture and H. pylori testing. Oral UBT had a sensitivity and specificity (95% CI) of 70% (46-88%) and 11% (3-26%), respectively, to diagnose culture-confirmed M. tuberculosis disease among patients without H. pylori, and 100% sensitivity (69-100%) and 11% specificity (3-26%) to diagnose H. pylori among patients without pulmonary TB. Stool microbiome analysis of controls without TB or H. pylori but with positive oral UBT detected high levels of non-H. pylori urease producing organisms, which likely explains the low specificity of oral UBT in this setting and in other reports of oral UBT studies in Africa.
authors.affiliation: SEREFO HIV/TB, Université des Sciences, des Techniques et des Technologies de Bamako (USTTB), Bamako, Mali. Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA.
authors.forename: Mamoudou
authors.initials: M
authors.lastname: Maiga
authors.forename: Keira
authors.initials: K
authors.lastname: Cohen
authors.forename: Bocar
authors.initials: B
authors.lastname: Baya
authors.forename: Geetha
authors.initials: G
authors.lastname: Srikrishna
authors.forename: Sophia
authors.initials: S
authors.lastname: Siddiqui
authors.forename: Moumine
authors.initials: M
authors.lastname: Sanogo
authors.forename: Anou M
authors.initials: AM
authors.lastname: Somboro
authors.forename: Bassirou
authors.initials: B
authors.lastname: Diarra
authors.forename: Mariam H
authors.initials: MH
authors.lastname: Diallo
authors.forename: Varun
authors.initials: V
authors.lastname: Mazumdar
authors.forename: Christian
authors.initials: C
authors.lastname: Yoder
authors.forename: Susan
authors.initials: S
authors.lastname: Orsega
authors.forename: Michael
authors.initials: M
authors.lastname: Belson
authors.forename: Hamadoun
authors.initials: H
authors.lastname: Kassambara
authors.forename: Drissa
authors.initials: D
authors.lastname: Goita
authors.forename: Robert L
authors.initials: RL
authors.lastname: Murphy
authors.forename: Sounkalo
authors.initials: S
authors.lastname: Dao
authors.forename: Michael
authors.initials: M
authors.lastname: Polis
authors.forename: Souleymane
authors.initials: S
authors.lastname: Diallo
authors.forename: Graham S
authors.initials: GS
authors.lastname: Timmins
authors.forename: Lori
authors.initials: L
authors.lastname: Dodd
authors.forename: Ashlee M
authors.initials: AM
authors.lastname: Earl
authors.forename: William R
authors.initials: WR
authors.lastname: Bishai
mesh_terms: D000328:Adult; D001944:Breath Tests / Q000379:methods*; D003710:Demography; D005243:Feces / Q000382:microbiology*; D005260:Female; D016481:Helicobacter Infections / Q000175:diagnosis; D016480:Helicobacter pylori / Q000201:enzymology*; D006801:Humans; D008297:Male; D008302:Mali; D064307:Microbiota; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000201:enzymology*; D012680:Sensitivity and Specificity; D014376:Tuberculosis / Q000175:diagnosis; D014508:Urea / Q000032:analysis*; D014510:Urease / Q000235:genetics / Q000378:metabolism*; D055815:Young Adult
chemical_list: D014508:Urea; D014510:Urease