A new colorimetric method for rapid detection of ethambutol and streptomycin resistance in Mycobacterium tuberculosis: crystal violet decolorization assay (CVDA)

Antonie Van Leeuwenhoek. 2019 May;112(5):679-685. doi: 10.1007/s10482-018-1198-2. Epub 2018 Nov 11.


Streptomycin (STR) and ethambutol (EMB) are important drugs used for the treatment of tuberculosis. There is a need for fast, reliable and inexpensive methods for detecting resistance to these drugs. The aim of this study was to evaluate the performance of the crystal violet decolorization assay (CVDA) for the detection of STR and EMB resistance that is important drugs in tuberculosis treatment. In this study, drug susceptibility testing was performed on 140 Mycobacterium tuberculosis isolates provided from nine centers. Three tubes were used for each isolate. One of the tubes had a concentration of 2 mg/L STR and the other 5 mg/L EMB. The third was drug-free control tube. Sensitivity, specificity, positive predictive value (PPD), negative predictive value (NPD) and agreement for STR were found to be 81.8%, 94.6%, 87.8%, 91.5% and 90.57%, respectively. For EMB, sensitivity, specificity, PPD, NPD, and agreement were found to be 76%, 98.23%, 90.47%, 94.87% and 94.2%, respectively. The results were obtained in 11.3 ± 2.7 days (8-21 days). CVDA is rapid, reliable, inexpensive, and easy to perform for rapid detection of STR and EMB resistance, and it could be adapted for drug susceptibility testing.

Keywords: CVDA; EMB; Mycobacterium tuberculosis; STR; Susceptibility testing.

Publication types

  • Evaluation Study

MeSH terms

  • Anti-Bacterial Agents / pharmacology*
  • Bacterial Typing Techniques / methods*
  • Colorimetry / methods*
  • Drug Resistance, Bacterial
  • Ethambutol / pharmacology*
  • Gentian Violet / chemistry
  • Humans
  • Mycobacterium tuberculosis / chemistry
  • Mycobacterium tuberculosis / drug effects
  • Mycobacterium tuberculosis / isolation & purification*
  • Streptomycin / pharmacology*
  • Tuberculosis / microbiology


  • Anti-Bacterial Agents
  • Ethambutol
  • Gentian Violet
  • Streptomycin