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  • Second Line LPA [SLLPA]

    Learning Objectives

    Provide an overview of the SLPA

    Indications for use of SLLPA

    Results it provides and its interpretations

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Second-line Line Probe Assay (SL-LPA) is a LPA to detect resistance to the second-line anti-TB drugs. This test is recommended for identifying TB patients with Multidrug-resistance (MDR) or rifampicin-resistance and those who can be placed on the shorter MDR-TB regimen.

 

The SL-LPA produces results in just 24-48 hours.

 

  • It is performed using GenoType MTBDRsl Version 2.
  • This is a DNA-based test that identifies genetic mutations in MDR-TB strains, making them resistant to fluoroquinolones and injectable second-line TB drugs.
  • GenoType MTBDRsl Version 2 (Figure) identifies:
    • Quinolone-resistance determining region (QRDR) of gyrA (from codon 85 to 96) and of gyrB (from codon 536 to 541) genes for detection of resistance to fluoroquinolones
    • rrs (nucleic acid position 1401, 1402 and 1484), eis promoter region (from -37
      to -2 nucleotides upstream, low level kanamycin resistance) for detection of resistance to SLI drugs.
  • Single mutation in gyrA confers low level fluoroquinolone resistance.
  • Concurrent mutations in gyrA or both gyrA and gyrB confer high level fluoroquinolone resistance.

 

Figure: GenoType MTBDRsl Version 2 SL-LPA strip to determine Wild Type genes and mutations responsible for Resistance to Fluoroquinolones and Second-line Injectable Drugs; Source: GLI LPA Guidance Document.

 

 

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