Causes of Pneumonia in Yangon

NCT ID: NCT03578133

Last Updated: 2020-01-13

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

300 participants

Study Classification

OBSERVATIONAL

Study Start Date

2018-07-09

Study Completion Date

2019-04-04

Brief Summary

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This study will evaluate a new point of care diagnostic test for the diagnosis of melioidosis pneumonia in patients attending outpatient clinics in Yangon, Myanmar

Detailed Description

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Melioidosis is caused by Burkholderia pseudomallei, a Gram-negative saprophytic environmental bacterium that is an important emerging tropical infection. There are an estimated 165,000 cases and 89,000 deaths world-wide each year. Eighty-four percent of cases are in SE Asia where mortality is 40%; far exceeding most recognised neglected tropical diseases. Pneumonia, secondary to either inhalation of B.pseudomallei or to bacteraemic spread to the lung is the commonest presentation (51%). Annually the highest burden (75%) of infection occurs in the rainy season in (75% in Thailand). Up to 80% patients have at least one recognised risk factor for melioidosis including; diabetes, alcohol-dependence, glucocorticoid therapy, chronic obstructive pulmonary disease (COPD), chronic renal disease and cancer. COPD and diabetes mellitus are amongst the top ten causes of death in Myanmar (2018). Patients with HIV have not been shown to have greater risk of B. pseudomallei than immunocompetent patients.

Melioidosis was discovered in Myanmar in 1911 by British pathologist Alfred Whitmore and his assistant CS Krishnaswami. Yet since 1949 there have been few published cases. Under-reporting is partly due to difficulty in diagnosing melioidosis. Clinical and radiological findings are indistinguishable from tuberculosis. Laboratory diagnosis is challenging, lack of facilities, expertise and awareness of B.pseudomallei results in missed diagnostic opportunities.

Culture is the gold-standard diagnostic method but requires appropriate facilities and expertise which are not readily available in many developing countries like Myanmar. A rapid diagnostic (RDT) test has been developed for low resource settings that has been evaluated in Laos and India. The InBios® Active Melioidosis DetectTM-Lateral Flow Assay (AMD-LFA) detects B.pseudomallei 6-deoxyheptan capsular polysaccharide antigen. Shaw et al demonstrated sensitivity 85.71% (CI:74.61% to 93.25%) and specificity 93.62% (CI:88.23% to 97.04%), with positive predictive value of 85.71% (CI: 75.98% to 91.92%) compared to culture. We propose to evaluate this test for the diagnosis of melioidosis pneumonia in Myanmar.

Conditions

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Melioidosis Pneumonia

Study Design

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Observational Model Type

OTHER

Study Time Perspective

CROSS_SECTIONAL

Interventions

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InBios® Active Melioidosis DetectTM-Lateral Flow Assay

Evaluation of a lateral flow assay for the detection of B.pseudomallei 6-deoxyheptan capsular polysaccharide antigen from sputum

Intervention Type DIAGNOSTIC_TEST

Eligibility Criteria

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Inclusion Criteria

1. \>18 years old
2. Reported fever or axillary temperature \> 37.5 °C
3. Productive cough
4. Written informed consent

Exclusion Criteria

1\. Inability to provide a sputum specimen
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Medical Action Myanmar

OTHER

Sponsor Role collaborator

Department of Medical Research, Myanmar

UNKNOWN

Sponsor Role collaborator

Lao-Oxford-Mahosot Hospital Wellcome Trust Research Unit

OTHER

Sponsor Role collaborator

Myanmar Oxford Clinical Research Unit

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Elizabeth A Ashley, Dr

Role: PRINCIPAL_INVESTIGATOR

Myanmar Oxford Clinical Research Unit

Frank Smithuis, Prof

Role: PRINCIPAL_INVESTIGATOR

Myanmar Oxford Clinical Research Unit and Medical Action Myanmar

Clare Warrell, Dr

Role: STUDY_DIRECTOR

Myanmar Oxford Clinical Research Unit and Medical Action Myanmar

David Dance, Prof

Role: STUDY_DIRECTOR

Lao-Oxford-Mahosot Hospital Wellcome Trust Research Unit

Ni Ni Tun, Dr

Role: STUDY_DIRECTOR

Medical Action Myanmar

Mo Mo Win, Dr

Role: STUDY_DIRECTOR

Department of Medical Research, Myanmar

Alistair McLean, Dr

Role: STUDY_DIRECTOR

Myanmar Oxford Clinical Research Unit

Kyaw Soe

Role: STUDY_DIRECTOR

Myanmar Oxford Clinical Research Unit

Locations

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Medical Action Myanmar Clinics

Yangon, , Burma

Site Status

Countries

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Burma

References

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Limmathurotsakul D, Golding N, Dance DA, Messina JP, Pigott DM, Moyes CL, Rolim DB, Bertherat E, Day NP, Peacock SJ, Hay SI. Predicted global distribution of Burkholderia pseudomallei and burden of melioidosis. Nat Microbiol. 2016 Jan 11;1:15008. doi: 10.1038/nmicrobiol.2015.8.

Reference Type BACKGROUND
PMID: 27571754 (View on PubMed)

Houghton RL, Reed DE, Hubbard MA, Dillon MJ, Chen H, Currie BJ, Mayo M, Sarovich DS, Theobald V, Limmathurotsakul D, Wongsuvan G, Chantratita N, Peacock SJ, Hoffmaster AR, Duval B, Brett PJ, Burtnick MN, Aucoin DP. Development of a prototype lateral flow immunoassay (LFI) for the rapid diagnosis of melioidosis. PLoS Negl Trop Dis. 2014 Mar 20;8(3):e2727. doi: 10.1371/journal.pntd.0002727. eCollection 2014 Mar.

Reference Type BACKGROUND
PMID: 24651568 (View on PubMed)

Chierakul W, Wuthiekanun V, Chaowagul W, Amornchai P, Cheng AC, White NJ, Day NP, Peacock SJ. Short report: disease severity and outcome of melioidosis in HIV coinfected individuals. Am J Trop Med Hyg. 2005 Dec;73(6):1165-6.

Reference Type BACKGROUND
PMID: 16354832 (View on PubMed)

Shaw T, Tellapragada C, Ke V, AuCoin DP, Mukhopadhyay C. Performance evaluation of Active Melioidosis Detect-Lateral Flow Assay (AMD-LFA) for diagnosis of melioidosis in endemic settings with limited resources. PLoS One. 2018 Mar 26;13(3):e0194595. doi: 10.1371/journal.pone.0194595. eCollection 2018.

Reference Type BACKGROUND
PMID: 29579128 (View on PubMed)

Woods KL, Boutthasavong L, NicFhogartaigh C, Lee SJ, Davong V, AuCoin DP, Dance DAB. Evaluation of a Rapid Diagnostic Test for Detection of Burkholderia pseudomallei in the Lao People's Democratic Republic. J Clin Microbiol. 2018 Jun 25;56(7):e02002-17. doi: 10.1128/JCM.02002-17. Print 2018 Jul.

Reference Type BACKGROUND
PMID: 29720430 (View on PubMed)

Wiersinga WJ, Currie BJ, Peacock SJ. Melioidosis. N Engl J Med. 2012 Sep 13;367(11):1035-44. doi: 10.1056/NEJMra1204699. No abstract available.

Reference Type BACKGROUND
PMID: 22970946 (View on PubMed)

Other Identifiers

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OXTREC 19-18

Identifier Type: -

Identifier Source: org_study_id

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