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Carrascosa JM, Galán M, de Lucas R, Pérez-Ferriols A, Ribera M, Yanguas I. Expert Recommendations on Treating Psoriasis in Special Circumstances (Part II). ACTAS DERMO-SIFILIOGRAFICAS 2016; 107:712-729. [PMID: 27344068 DOI: 10.1016/j.ad.2016.04.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 04/15/2016] [Accepted: 04/19/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND There is insufficient information on how best to treat moderate to severe psoriasis in difficult clinical circumstances. MATERIAL AND METHODS We considered 5 areas where there is conflicting or insufficient evidence: pediatric psoriasis, risk of infection in patients being treated with biologics, psoriasis in difficult locations, biologic drug survival, and impact of disease on quality of life. Following discussion of the issues by an expert panel of dermatologists specialized in the management of psoriasis, participants answered a questionnaire survey according to the Delphi method. RESULTS Consensus was reached on 66 (70.9%) of the 93 items analyzed; the experts agreed with 49 statements and disagreed with 17. It was agreed that body mass index, metabolic comorbidities, and quality of life should be monitored in children with psoriasis. The experts also agreed that the most appropriate systemic treatment for this age group was methotrexate, while the most appropriate biologic treatment was etanercept. Although it was recognized that the available evidence was inconsistent and difficult to extrapolate, the panel agreed that biologic drug survival could be increased by flexible, individualized dosing regimens, continuous treatment, and combination therapies. Finally, consensus was reached on using the Dermatology Quality of Life Index to assess treatment effectiveness and aid decision-making in clinical practice. CONCLUSIONS The structured opinion of experts guides decision-making regarding aspects of clinical practice for which there is incomplete or conflicting information.
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Affiliation(s)
- J M Carrascosa
- Servei de Dermatologia, Hospital Universitari GermansTrias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, España.
| | - M Galán
- Servicio de Dermatología, Hospital de Jaén, Jaén, España
| | - R de Lucas
- Servicio de Dermatología, Hospital Universitario La Paz, Madrid, España
| | - A Pérez-Ferriols
- Servicio de Dermatología, Hospital General de Valencia, Valencia, España
| | - M Ribera
- Servicio de Dermatología, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España
| | - I Yanguas
- Servicio de Dermatología, Hospital Universitario de Navarra, Pamplona, España
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Expert Recommendations on Treating Psoriasis in Special Circumstances (Part II). ACTAS DERMO-SIFILIOGRAFICAS 2016. [DOI: 10.1016/j.adengl.2016.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Harris RC, Sumner T, Knight GM, White RG. Systematic review of mathematical models exploring the epidemiological impact of future TB vaccines. Hum Vaccin Immunother 2016; 12:2813-2832. [PMID: 27448625 PMCID: PMC5137531 DOI: 10.1080/21645515.2016.1205769] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 06/13/2016] [Accepted: 06/21/2016] [Indexed: 02/08/2023] Open
Abstract
Mathematical models are useful for assessing the potential epidemiological impact of future tuberculosis (TB) vaccines. We conducted a systematic review of mathematical models estimating the epidemiological impact of future human TB vaccines. PubMed, Embase and WHO Global Health Library were searched, 3-stage manual sifted, and citation- and reference-tracked, identifying 23 papers. An adapted quality assessment tool was developed, with a resulting median study quality score of 20/28. The literature remains divided as to whether vaccines effective pre- or post-infection would provide greatest epidemiological impact. However, all-age or adolescent/adult targeted prevention of disease vaccines achieve greater and more rapid impact than neonatal vaccines. Mass campaigns alongside routine neonatal vaccination can have profound additional impact. Economic evaluations found TB vaccines overwhelmingly cost-effective, particularly when targeted to adolescents/adults. The variability of impact by setting, age group and vaccine characteristics must be accounted for in the development and delivery of future TB vaccines.
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Affiliation(s)
- Rebecca C. Harris
- TB Modelling Group, TB Centre and Centre for the Mathematical Modelling of Infectious Diseases, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Tom Sumner
- TB Modelling Group, TB Centre and Centre for the Mathematical Modelling of Infectious Diseases, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Gwenan M. Knight
- TB Modelling Group, TB Centre and Centre for the Mathematical Modelling of Infectious Diseases, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, London, UK
| | - Richard G. White
- TB Modelling Group, TB Centre and Centre for the Mathematical Modelling of Infectious Diseases, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Nasreen S, Shokoohi M, Malvankar-Mehta MS. Prevalence of Latent Tuberculosis among Health Care Workers in High Burden Countries: A Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0164034. [PMID: 27711155 PMCID: PMC5053544 DOI: 10.1371/journal.pone.0164034] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 09/19/2016] [Indexed: 12/17/2022] Open
Abstract
Background Tuberculosis is one of the leading causes of death worldwide. Twenty-two high burden countries contributed to the majority of worldwide tuberculosis cases in 2015. Health care workers are at high risk of acquiring tuberculosis through occupational exposure. Objective To estimate the prevalence of latent tuberculosis infection (LTBI) among health care workers in high burden countries. Methods Databases including MEDLINE (Ovid), EMBASE (Ovid), CINAHL (Ovid) and ISI Web of Science (Thompson-Reuters), and grey literature were searched for English language records on relevant medical subject headings (MeSH) terms of LTBI and health care providers. Literature was systematically reviewed using EPPI-Reviewer4 software. Prevalence and incidence of LTBI and 95% confidence intervals (CI) were reported. Pooled prevalence of LTBI and 95% CI were calculated using random-effects meta-analysis models and heterogeneity was assessed using I2 statistics. Sub-group analysis was conducted to assess the cause of heterogeneity. Results A total of 990 records were identified. Of those, 18 studies from only 7 high burden countries representing 10,078 subjects were included. Tuberculin skin test results were available for 9,545 participants. The pooled prevalence of LTBI was 47% (95% CI 34% to 60%, I2 = 99.6%). In subgroup analyses according to the country of the study, the pooled prevalence of LTBI was lowest in Brazil (37%) and highest in South Africa (64%). The pooled prevalence of LTBI among medical and nursing students was 26% (95% CI 6% to 46%, I2 = 99.3%) while the prevalence among all types of health care workers was 57% (95% CI 44% to 70%, I2 = 99.1%). Incidence of LTBI was available for health care workers in four countries. The cumulative incidence ranged from 2.8% in Brazilian medical students to 38% among all types of health care workers in South Africa. Conclusion The findings of this study suggest that there is a high burden of LTBI among health care workers in high burden countries. Adequate infection control measures are warranted to prevent and control transmission in health care settings.
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Affiliation(s)
- Sharifa Nasreen
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- * E-mail: ;
| | - Mostafa Shokoohi
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Monali S. Malvankar-Mehta
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Ophthalmology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Durando P, Garbarino S, Orsi A, Alicino C, Dini G, Toletone A, Ciprani F, Conte G, Santorsa R, Icardi G. Prevalence and predictors of latent tuberculosis infection among Italian State Policemen engaged in assistance to migrants: a national cross-sectional study. BMJ Open 2016; 6:e012011. [PMID: 27697871 PMCID: PMC5073613 DOI: 10.1136/bmjopen-2016-012011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Better knowledge about tuberculosis (TB) and latent TB infection (LTBI) epidemiology is a crucial step for the development of effective strategies towards the control and elimination of this deadliest and persistent health threat. No study has investigated LTBI epidemiology in policemen who act as an interface with cross-border migrants. METHODS A survey to measure the LTBI prevalence and assess the demographic, professional and clinical features potentially associated with tuberculin skin test (TST) positivity was performed in Italian State Police (ISP) employees engaged, even occasionally, in relief activities, hospitality, photographical identification, escorting and accompanying of migrants, regardless of contact with active TB cases. Variables potentially associated with TST positivity were evaluated with univariate and multivariate analysis. RESULTS From September to December 2014, 4225 ISP workers underwent TST screening and completed the questionnaire for data collection, according to study procedures. The TST was positive in 9.9% of individuals: no active TB cases were registered among the entire study population. Age, previous BCG vaccination and work category resulted independently associated with TST positivity. CONCLUSIONS This is the first study providing updated data about LTBI epidemiology among ISP employees engaged in assistance to migrants and furnish preliminary evidence of possible associations between TST positivity and different conditions that need to be deeply investigated with prospective studies.
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Affiliation(s)
- Paolo Durando
- Department of Health Sciences, University of Genoa, Genoa, Italy
- IRCCS AOU San Martino—IST, Genoa, Italy
| | - Sergio Garbarino
- Department of Health Sciences, University of Genoa, Genoa, Italy
- State Police Health Service Department, Ministry of Interior, Rome, Italy
| | - Andrea Orsi
- Department of Health Sciences, University of Genoa, Genoa, Italy
- IRCCS AOU San Martino—IST, Genoa, Italy
| | | | - Guglielmo Dini
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | | | - Fabrizio Ciprani
- State Police Health Service Department, Ministry of Interior, Rome, Italy
| | - Giuseppe Conte
- State Police Health Service Department, Ministry of Interior, Rome, Italy
| | - Roberto Santorsa
- State Police Health Service Department, Ministry of Interior, Rome, Italy
| | - Giancarlo Icardi
- Department of Health Sciences, University of Genoa, Genoa, Italy
- IRCCS AOU San Martino—IST, Genoa, Italy
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Puma DV, Pérez-Quílez O, Roure S, Martínez-Cuevas O, Bocanegra C, Feijoo-Cid M, Valerio L. Risk of Active Tuberculosis among Index Case of Householders-A Long-Term Assessment after the Conventional Contacts Study. Public Health Nurs 2016; 34:112-117. [PMID: 27377204 DOI: 10.1111/phn.12279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of this study was to determine the incidence of active tuberculosis (TB) among household contacts of TB-index cases diagnosed during a 7-year period in a public Primary Care Center located in a high-incidence area. DESIGN AND SAMPLE A retrospective cohort study was performed. Data collection was based on the capture-recapture method; the two main sources crossed information from TB-index and contact cases from the El Fondo Primary Care Center (Santa Coloma de Gramenet, Spain) and their reports to the National Epidemiologic Surveillance Service. MEASURES Variables were divided into demographic and health data (result of the Mantoux test, chest X-ray, presence of risk factors, and indication for chemoprophylaxis). RESULTS Community nurses identified 103 household contacts that underwent the conventional contact study. Overall, 60.19% were male; the mean age was 29.08 years. Only one case of secondary active TB was found, representing an incidence of 0.56% per TB-index case and year. CONCLUSION The incidence of new secondary TB among household contacts with TB-index cases was of a case. Nevertheless, a long-term follow-up of these householders beyond the conventional contacts study should be considered in areas with higher incidences of TB or among specific high-risk populations.
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Affiliation(s)
- Daniela V Puma
- PROSICS-Catalan Institute of Health, North Metropolitan International Health Unit, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Olga Pérez-Quílez
- Catalan Institute of Health, Santa Coloma de Gramenet, El Fondo Primary Care Center, Barcelona, Spain
| | - Sílvia Roure
- PROSICS-Catalan Institute of Health, North Metropolitan International Health Unit, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Octavio Martínez-Cuevas
- PROSICS-Catalan Institute of Health, North Metropolitan International Health Unit, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Bocanegra
- PROSICS-Catalan Institute of Health, North Metropolitan International Health Unit, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria Feijoo-Cid
- Department of Nursing, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lluís Valerio
- PROSICS-Catalan Institute of Health, North Metropolitan International Health Unit, Universitat Autònoma de Barcelona, Barcelona, Spain
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Castañeda-Delgado JE, Cervantes-Villagrana A, Serrano-Escobedo CJ, Frausto-Lujan I, Rivas-Santiago C, Enciso-Moreno JA, Rivas-Santiago B. Tuberculin skin test and interferon-gamma release assay values are associated with antimicrobial peptides expression in polymorphonuclear cells during latent tuberculous infection. Mem Inst Oswaldo Cruz 2016; 109:330-4. [PMID: 24937049 PMCID: PMC4131785 DOI: 10.1590/0074-0276140348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 11/18/2013] [Indexed: 12/23/2022] Open
Abstract
It has been reported that patients with progressive tuberculosis (TB) express
abundant amounts of the antimicrobial peptides (AMPs) cathelicidin (LL-37) and human
neutrophil peptide-1 (HNP-1) in circulating cells, whereas latent TB infected donors
showed no differences when compared with purified protein derivative (PPD) and
QuantiFERON®-TB Gold (QFT)-healthy individuals. The aim of this study
was to determine whether LL-37 and HNP-1 production correlates with higher tuberculin
skin test (TST) and QFT values in TB household contacts. Twenty-six TB household
contact individuals between 26-58 years old TST and QFT positive with at last two
years of latent TB infection were recruited. AMPs production by polymorphonuclear
cells was determined by flow cytometry and correlation between TST and QFT values was
analysed. Our results showed that there is a positive correlation between levels of
HNP-1 and LL-37 production with reactivity to TST and/or QFT levels. This preliminary
study suggests the potential use of the expression levels of these peptides as
biomarkers for progression in latent infected individuals.
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Affiliation(s)
| | | | | | - Isabel Frausto-Lujan
- Medical Research Unit of Zacatecas, Mexican Institute of Social Security, Zacatecas, Mexico
| | - Cesar Rivas-Santiago
- Department of Environmental and Occupational Health, Center for Global Public Health, School of Public Health, University of Medicine and Dentistry New Jersey, Piscataway, NJ, USA
| | - Jose A Enciso-Moreno
- Medical Research Unit of Zacatecas, Mexican Institute of Social Security, Zacatecas, Mexico
| | - Bruno Rivas-Santiago
- Medical Research Unit of Zacatecas, Mexican Institute of Social Security, Zacatecas, Mexico
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Laurenti P, Raponi M, de Waure C, Marino M, Ricciardi W, Damiani G. Performance of interferon-γ release assays in the diagnosis of confirmed active tuberculosis in immunocompetent children: a new systematic review and meta-analysis. BMC Infect Dis 2016; 16:131. [PMID: 26993789 PMCID: PMC4797356 DOI: 10.1186/s12879-016-1461-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 03/10/2016] [Indexed: 11/17/2022] Open
Abstract
Background Tuberculosis (TB) is a global public health problem, causing morbidity and mortality in adults and children. The most reliable diagnostic tools currently available are the in vivo Tuberculin Skin Test (TST) and the ex vivo Interferon-γ release assays (IGRAs). Several clinical, radiological, and bacteriological features make the detection of active (overt disease) TB in children difficult. Although recently developed immunological assays such as QuantiFERON-TB Gold In-Tube (QFT-IT) and T-SPOT®.TB are commonly used to identify active TB in adults, different evidence is required for diagnosis in children. The purpose of this study was to reassess the sensitivity and specificity of IGRAs in detecting microbiologically confirmed active TB in immunocompetent children. Methods A systematic review and meta-analysis of studies reporting on the diagnostic accuracy of tests for TB in immunocompetent children aged 0–18 years, with confirmation by positive M. tuberculosis cultures, were undertaken. Electronic databases were searched up to September 2015 and study quality assessment was performed using QUADAS-2. Results Fifteen studies were included in our meta-analysis. Results showed that there were no significant differences in sensitivity between TST (88.2 %, 95 % confidence interval [CI] 79.4–94.2 %), QFT-IT (89.6 %, 95 % CI 79.7–95.7 %) and T SPOT (88.5 %, 95 % CI 80.4–94.1 %). However, both QFT-IT (95.4 %, 95 % CI 93.8–96.6 %) and T-SPOT (96.8 %, 95 % CI 94.2–98.5 %) have significantly higher specificity than TST (86.3 %, 95 % CI 83.9–88.6 %). Conclusions QFT-IT and T-SPOT have higher specificity than TST for detecting active TB cases in immunocompetent children.
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Affiliation(s)
- Patrizia Laurenti
- Institute of Public Health - Section of Hygiene, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1-00168, Rome, Italy
| | - Matteo Raponi
- Institute of Public Health - Section of Hygiene, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1-00168, Rome, Italy.
| | - Chiara de Waure
- Institute of Public Health - Section of Hygiene, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1-00168, Rome, Italy
| | - Marta Marino
- Institute of Public Health - Section of Hygiene, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1-00168, Rome, Italy
| | - Walter Ricciardi
- Institute of Public Health - Section of Hygiene, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1-00168, Rome, Italy
| | - Gianfranco Damiani
- Institute of Public Health - Section of Hygiene, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1-00168, Rome, Italy
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Pathak RR, Mishra BK, Moonan PK, Nair SA, Kumar AMV, Gandhi MP, Mannan S, Ghosh S. Can Intensified Tuberculosis Case Finding Efforts at Nutrition Rehabilitation Centers Lead to Pediatric Case Detection in Bihar, India? ACTA ACUST UNITED AC 2016; 4:46-54. [PMID: 27066518 PMCID: PMC4826071 DOI: 10.4236/jtr.2016.41006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Introduction Seven district-level Nutritional Rehabilitation Centres (NRCs) in Bihar, India provide clinical and nutritional care for children with severe acute malnutrition (SAM). Aim To assess whether intensified case finding (ICF) strategies at NRCs can lead to pediatric case detection among SAM children and link them to TB treatment under the Revised National Tuberculosis Control Programme (RNTCP). Materials and Methods A retrospective cohort study was conducted that included medical record reviews of SAM children registered for TB screening and RNTCP care during July–December 2012. Results Among 440 SAM children screened, 39 (8.8%) were diagnosed with TB. Among these, 34 (87%) initiated TB treatment and 18 (53%) were registered with the RNTCP. Of 16 children not registered under the RNTCP, nine (56%) weighed below six kilograms—the current weight requirement for receiving drugs under RNTCP. Conclusion ICF approaches are feasible at NRCs; however, screening for TB entails diagnostic challenges, especially among SAM children. However, only half of the children diagnosed with TB were treated by the RNTCP. More effort is needed to link this vulnerable population to TB services in addition to introducing child-friendly drug formulations for covering children weighing less than six kilograms.
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Affiliation(s)
| | | | - Patrick K Moonan
- US Centers for Disease Control and Prevention, Division of TB Elimination, Atlanta, USA
| | | | - Ajay M V Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi, India
| | | | | | - Smita Ghosh
- US Centers for Disease Control and Prevention, Division of TB Elimination, Atlanta, USA
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Shapovalova O, Sacadura‐Leite E, Mendonça Galaio L, Pereira I, Rocha R, Sousa‐Uva A. Tuberculose latente em profissionais de saúde: concordância entre 2 testes diagnósticos. REVISTA PORTUGUESA DE SAÚDE PÚBLICA 2016. [DOI: 10.1016/j.rpsp.2015.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Abstract
BACKGROUND High immigration rates from tuberculosis (TB) endemic countries to low-incidence countries have caused new TB guidelines in these countries to reconsider latent TB infection (LTBI) screening in these immigrants. OBJECTIVES We performed a systematic review with the primary outcome of evaluating the number of cases recommended LTBI treatment with the tuberculin skin test (TST) or interferon gamma release assay (IGRA). Secondary objectives were to examine prevalence of positive LTBI diagnostic tests stratified by age and incidence of TB in country of origin. METHODS We performed a systematic search of seven electronic databases for studies assessing TST and/or IGRA performance in immigrant populations to low incidence countries. Demographics, LTBI diagnosis, longitudinal TB development, and test result data were the primary data extracted from the studies. Prevalence of positive test data was stratified by age and country of origin. Studies were evaluated using a modified SIGN checklist for diagnostic studies. Data was compared using Fisher's exact test or χ (2) test, where appropriate. RESULTS Our literature search yielded 51 studies (n = 34 TST, n = 9 IGRA, n = 8 both). Recommendation of LTBI treatment was less common in those tested with an IGRA compared to TST (p < 0.0001), while long-term development of active TB appears higher in those with a positive IGRA. There was no difference in the sensitivity and specificity of the IGRA and TST for prevalent TB (p > 0.05). Prevalence of a positive test was significantly lower in those who were <18 years of age compared to those ≥18 years of age (p < 0.0001) and those from low TB incidence countries compared to high incidence countries (p < 0.0001) for both TST and IGRA. When comparing the two tests within the 2 subgroups: age and TB incidence in country of origin, the prevalence of positive results was significantly lower for the IGRA than the TST (p < 0.0001). LIMITATIONS The number of available studies evaluating the IGRA and longitudinal active TB development in those tested limits this study. CONCLUSION Prevalence of positive test results were significantly lower in immigrants who were tested with an IGRA, resulting in fewer immigrants being recommended for LTBI treatment compared to TST. Coupled with comparable performance for detecting prevalent TB cases, the IGRA appears to exhibit better specificity than the TST and may be preferred as the standard of care for detecting LTBI in immigrants moving to low TB incidence countries.
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Jung YJ, Woo HI, Jeon K, Koh WJ, Jang DK, Cha HS, Koh EM, Lee NY, Kang ES. The Significance of Sensitive Interferon Gamma Release Assays for Diagnosis of Latent Tuberculosis Infection in Patients Receiving Tumor Necrosis Factor-α Antagonist Therapy. PLoS One 2015; 10:e0141033. [PMID: 26474294 PMCID: PMC4608840 DOI: 10.1371/journal.pone.0141033] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 10/01/2015] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE We compared two interferon gamma release assays (IGRAs), QuantiFERON-TB Gold In-Tube (QFT-GIT) and T-SPOT.TB, for diagnosis of latent tuberculosis infection (LTBI) in patients before and while receiving tumor necrosis factor (TNF)-α antagonist therapy. This study evaluated the significance of sensitive IGRAs for LTBI screening and monitoring. METHODS Before starting TNF-α antagonist therapy, 156 consecutive patients with rheumatic diseases were screened for LTBI using QFT-GIT and T-SPOT.TB tests. According to our study protocol, QFT-GIT-positive patients received LTBI treatment. Patients positive by any IGRAs were subjected to follow-up IGRA tests after completing LTBI-treatment and/or during TNF-α antagonist therapy. RESULTS At the initial LTBI screening, 45 (28.9%) and 70 (44.9%) patients were positive by QFT-GIT and T-SPOT.TB, respectively. The agreement rate between IGRA results was 78.8% (k = 0.56; 95% confidence interval [95% CI] = 0.43 to 0.68). Of 29 patients who were positive only by T-SPOT.TB in the initial screening, 83% (19/23) were persistently positive by T-SPOT.TB, while QFT-GIT testing showed that 36% (9/25) had conversion during TNF-α antagonist therapy. By the end of the follow-up period (218 to 1,264 days), four patients (4/137, 2.9%) developed active tuberculosis (TB) diseases during receiving TNF-α antagonist therapy. Among them, one was Q-T+, one was Q+T-, and the remaining two were Q-T- at the initial screening (Q, QuantiFERON-TB Gold In-Tube; T, T-SPOT.TB; +, positive; -, negative). Two (2/4, 50%) patients with TB reactivation had at least one prior risk factor consistent with previous TB infection. CONCLUSION This study demonstrated the need to capitalize on sensitive IGRAs to monitor for LTBI in at-risk patients for a more sensitive diagnosis in countries with an intermediate TB burden.
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Affiliation(s)
- Yu Jung Jung
- Departments of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hye In Woo
- Department of Laboratory Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Kyeongman Jeon
- Division of Pulmonary and Clinical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won-Jung Koh
- Division of Pulmonary and Clinical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Kyoung Jang
- Department of Gastroenterology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hoon Suk Cha
- Division of Rheumatology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Mi Koh
- Division of Rheumatology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Nam Yong Lee
- Departments of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun-Suk Kang
- Departments of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Oren E, Alatorre-Izaguirre G, Vargas-Villarreal J, Moreno-Treviño MG, Garcialuna-Martinez J, Gonzalez-Salazar F. Interferon Gamma-Based Detection of Latent Tuberculosis Infection in the Border States of Nuevo Leon and Tamaulipas, Mexico. Front Public Health 2015; 3:220. [PMID: 26484340 PMCID: PMC4588115 DOI: 10.3389/fpubh.2015.00220] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 09/17/2015] [Indexed: 01/26/2023] Open
Abstract
Nearly one-third of the world’s population is infected with latent tuberculosis (LTBI). Tuberculosis (TB) rates in the border states are higher than national rates in both the US and Mexico, with the border accounting for 30% of total registered TB cases in both countries. However, LTBI rates in the general population in Mexican border states are unknown. In this region, LTBI is diagnosed using the tuberculin skin test (TST). New methods of detection more specific than TST have been developed, although there is currently no gold standard for LTBI detection. Our objective is to demonstrate utility of the Quantiferon TB gold In-Tube (QFT-GIT) test compared with the TST to detect LTBI among border populations. This is an observational, cross-sectional study carried out in border areas of the states of Nuevo Leon and Tamaulipas, Mexico. Participants (n = 210) provided a TST and blood sample for the QFT-GIT. Kappa coefficients assessed the agreement between TST and QFT-GIT. Participant characteristics were compared using Fisher exact tests. Thirty-eight percent of participants were diagnosed with LTBI by QFT-GIT. The proportion of LTBI detected using QFT-GIT was almost double [38% (79/210)] that found by TST [19% (39/210)] (P < 0.001). Concordance between TST and QFT-GIT was low (kappa = 0.37). We recommend further studies utilizing the QFT-GIT test to detect LTBI among border populations.
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Affiliation(s)
- Eyal Oren
- Division of Epidemiology and Biostatistics, University of Arizona , Tucson, AZ , USA
| | | | | | | | | | - Francisco Gonzalez-Salazar
- Health Division, Basic Sciences, University of Monterrey , San Pedro Garza Garcia , Mexico ; Northeast Biomedical Research, Mexican Social Security Institute , Monterrey , Mexico
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Monárrez-Espino J, Enciso-Moreno JA, Laflamme L, Serrano CJ. Serial QuantiFERON-TB Gold In-Tube assay and tuberculin skin test to diagnose latent tuberculosis in household Mexican contacts: conversion and reversion rates and associated factors using conventional and borderline zone definitions. Mem Inst Oswaldo Cruz 2015; 109:863-70. [PMID: 25410989 PMCID: PMC4296490 DOI: 10.1590/0074-0276140085] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 08/19/2014] [Indexed: 01/19/2023] Open
Abstract
A cohort of 123 adult contacts was followed for 18‐24 months (86 completed the
follow-up) to compare conversion and reversion rates based on two serial measures of
QuantiFERON (QFT) and tuberculin skin test (TST) (PPD from TUBERSOL, Aventis Pasteur,
Canada) for diagnosing latent tuberculosis (TB) in household contacts of TB patients
using conventional (C) and borderline zone (BZ) definitions. Questionnaires were used
to obtain information regarding TB exposure, TB risk factors and socio-demographic
data. QFT (IU/mL) conversion was defined as <0.35 to ≥0.35 (C) or <0.35 to
>0.70 (BZ) and reversion was defined as ≥0.35 to <0.35 (C) or ≥0.35 to <0.20
(BZ); TST (mm) conversion was defined as <5 to ≥5 (C) or <5 to >10 (BZ) and
reversion was defined as ≥5 to <5 (C). The QFT conversion and reversion rates were
10.5% and 7% with C and 8.1% and 4.7% with the BZ definitions, respectively. The TST
rates were higher compared with QFT, especially with the C definitions (conversion
23.3%, reversion 9.3%). The QFT conversion and reversion rates were higher for TST
≥5; for TST, both rates were lower for QFT <0.35. No risk factors were associated
with the probability of converting or reverting. The inconsistency and apparent
randomness of serial testing is confusing and adds to the limitations of these tests
and definitions to follow-up close TB contacts.
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Affiliation(s)
| | | | - Lucie Laflamme
- Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
| | - Carmen J Serrano
- Medical Research Unit Zacatecas, Mexican Institute of Social Security, Zacatecas, Mexico
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Armstrong F, Jordan L. Comprehensive Tuberculosis Testing for the Dermatologist. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2015; 8:44-47. [PMID: 26060517 PMCID: PMC4456800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Tuberculosis remains a noteworthy disease worldwide, rendering detection of latent tuberculosis of great importance. As healthcare workers, dermatologists should be aware of the available testing options and how they compare. In general, the tuberculin skin test has been around longer and, thus, there have been more studies performed on its sensitivity and specificity compared to interferon gamma release assays, which are newer to the market. The tuberculin skin test requires more office visits, takes longer to obtain results, is subject to healthcare worker bias, and can cause a booster phenomenon; whereas, interferon gamma release assays have a higher cost and less data available on their use in children under five years old. Both the tuberculin skin test and interferon gamma release assays fail to differentiate between recent and remote infections, have a low predictive value for active tuberculosis, and a lower sensitivity in people living with human immunodeficiency virus/acquired immunodeficiency syndrome.
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Affiliation(s)
- Frank Armstrong
- Armstrong Dermatology and Skin Cancer Center, Seminole, Florida
| | - Laura Jordan
- Lake Erie College of Osteopathic Medicine, Bradenton Campus, Bradenton, Florida
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Lamberti M, Uccello R, Monaco MGL, Muoio M, Sannolo N, Arena P, Mazzarella G, Arnese A, La Cerra G. Prevalence of latent tuberculosis infection and associated risk factors among 1557 nursing students in a context of low endemicity. Open Nurs J 2015; 9:10-4. [PMID: 25852786 PMCID: PMC4382560 DOI: 10.2174/1874434601509010010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 07/23/2014] [Accepted: 08/09/2014] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION The risk of tuberculosis (TBC) in nurses is related to its incidence in the general population. Nursing students involved in clinical training could be exposed to occupational risks similar to those of healthcare workers (HCWs). To better understand the epidemiology of nosocomial TBC among nurses in a context of low endemicity, we recruited a cohort of young nursing trainees at the Second University of Naples. METHODS A screening programme for LTBI in nursing students was conducted between January 2012 and December 2013, at the Second University of Naples, with clinical evaluations, tuberculin skin test (TST) and, in positive TST student, the interferon-g release assays (IGRA). Putative risk factors for LTBI were assessed by a standardized questionnaire. RESULTS 1577 nursing students attending the Second University of Naples have been submitted to screening programme for TBC. 1575 have performed TST as first level test and 2 Quantiferon test (QFT). 19 students were TST positive and continued the diagnostic workup practicing QFT, that was positive in 1 student. Of the 2 subjects that have practiced QFT as first level test only 1 was positive. In 2 students positive to QFT test we formulated the diagnosis of LTBI by clinical and radiographic results. CONCLUSION The prevalence of LTBI among nursing students in our study resulted very low. In countries with a low incidence of TBC, the screening programs of healthcare students can be useful for the early identification and treatment of the sporadic cases of LTBI.
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Affiliation(s)
- Monica Lamberti
- Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic Medicine, Second University of Naples, Naples, Italy
| | - Rossella Uccello
- Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic Medicine, Second University of Naples, Naples, Italy
| | - Maria Grazia Lourdes Monaco
- Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic Medicine, Second University of Naples, Naples, Italy
| | - Mariarosaria Muoio
- Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic Medicine, Second University of Naples, Naples, Italy
| | - Nicola Sannolo
- Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic Medicine, Second University of Naples, Naples, Italy
| | - Paola Arena
- Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic Medicine, Second University of Naples, Naples, Italy
| | - Gennaro Mazzarella
- Department of Cardio-Thoracic and Respiratory Science, Second University of Naples, Naples, Italy
| | - Antonio Arnese
- Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic Medicine, Second University of Naples, Naples, Italy
| | - Giuseppe La Cerra
- Department of Cardio-Thoracic and Respiratory Science, Second University of Naples, Naples, Italy
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Lamberti M, Uccello R, Monaco MGL, Muoio M, Feola D, Sannolo N, Nienhaus A, Chiodini P. Tuberculin skin test and Quantiferon test agreement and influencing factors in tuberculosis screening of healthcare workers: a systematic review and meta-analysis. J Occup Med Toxicol 2015; 10:2. [PMID: 25670962 PMCID: PMC4323208 DOI: 10.1186/s12995-015-0044-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 01/15/2015] [Indexed: 11/28/2022] Open
Abstract
Objective A systematic review and meta-analysis was conducted to evaluate the agreement between Tuberculin Skin Test (TST) and Quantiferon (QFT) in screening for tuberculosis (TB) infection among healthcare workers (HCWs) and to estimate associations between TST and QFT agreement and variables of interest, such as Bacillus Calmette-Guérin (BCG) vaccination and incidence of TB. Methods Cross-sectional and longitudinal studies on HCWs, published in English until October 2013, comparing TST and QFT results, were selected. For each study Cohen’s κ value and a 95% confidence interval were calculated. Summary measures and indexes of heterogeneity between studies were calculated. Results 29 studies were selected comprising a total of 11,434 HCWs. Cohen’s κ for agreement between TST and QFT for 24 of them was 0.28 (95% CI 0.22 to 0.35), with the best value in high TB incidence countries and the lowest rate of BCG vaccination. Conclusion Currently, there is no gold standard for TB screening and the most-used diagnostic tools show low agreement. For evidence-based health surveillance in HCWs, occupational physicians need to consider a number of factors influencing screening results, such as TB incidence, vaccination status, age and working seniority.
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Affiliation(s)
- Monica Lamberti
- Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic, Medicine, Second University of Naples, Naples, Italy
| | - Rossella Uccello
- Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic, Medicine, Second University of Naples, Naples, Italy
| | - Maria Grazia Lourdes Monaco
- Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic, Medicine, Second University of Naples, Naples, Italy
| | - Mariarosaria Muoio
- Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic, Medicine, Second University of Naples, Naples, Italy
| | - Daniela Feola
- Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic, Medicine, Second University of Naples, Naples, Italy
| | - Nicola Sannolo
- Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic, Medicine, Second University of Naples, Naples, Italy
| | - Albert Nienhaus
- Center of Excellence for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), Institute for Health Service Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Principles of Prevention and Rehabilitation Department (GPR), Institute for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW), Hamburg, Germany
| | - Paolo Chiodini
- Medical Statistics Unit, Second University of Naples, Naples, Italy
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Lamberti M, Muoio M, Monaco MGL, Uccello R, Sannolo N, Mazzarella G, Garzillo EM, Arnese A, La Cerra G, Coppola N. Prevalence of latent tuberculosis infection and associated risk factors among 3,374 healthcare students in Italy. J Occup Med Toxicol 2014; 9:34. [PMID: 25302073 PMCID: PMC4190494 DOI: 10.1186/s12995-014-0034-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 09/23/2014] [Indexed: 12/29/2022] Open
Abstract
Introduction The risk of tuberculosis (TB) in healthcare personnel (HCP) is related to its incidence in the general population. Healthcare students involved in clinical training could be exposed to occupational risks similar to those that HCP face. The prevalence of latent tuberculosis infection (LTBI) among undergraduate healthcare students with different working seniority in Italy was analysed. Methods A cross-sectional study under a screening programme for LTBI among undergraduate and postgraduate students attending Medical School at the Second University of Naples was conducted between January 2012 and December 2013 with clinical evaluations, tuberculin skin testing (TST) and, in positive TST students, Interferon-γ release assays (IGRA). Putative risk factors for LTBI were assessed by means of a standardised questionnaire. Results 3,374 students attending the Medical School of the Second University of Naples were submitted to a screening programme for TBC. 3,331 performed TST as a first-level test and 43 performed a Quantiferon test (QFT). 128 students were TST-positive and continued the diagnostic work with QFT, which was positive in 34 students. Of the 43 subjects who took the QFT as a first-level test only 1 was positive. In 35 students positive to the QFT test we formulated the diagnosis of LTBI by clinical and radiographic results. A correlation was found between age, non-Italian born persons, studying age, post-medical school status and LTBI. Conclusions The prevalence of LTBI among healthcare students in our study was very low. In countries with a low incidence of TB, the screening programmes of healthcare students can be useful for early identification and treatment of sporadic cases of LTBI. Electronic supplementary material The online version of this article (doi:10.1186/s12995-014-0034-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Monica Lamberti
- Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic Medicine, Second University of Naples, Naples, Italy
| | - Mariarosaria Muoio
- Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic Medicine, Second University of Naples, Naples, Italy
| | - Maria Grazia Lourdes Monaco
- Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic Medicine, Second University of Naples, Naples, Italy
| | - Rossella Uccello
- Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic Medicine, Second University of Naples, Naples, Italy
| | - Nicola Sannolo
- Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic Medicine, Second University of Naples, Naples, Italy
| | - Gennaro Mazzarella
- Department of Cardio-Thoracic and Respiratory Science, Second University of Naples, Naples, Italy
| | - Elpidio Maria Garzillo
- Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic Medicine, Second University of Naples, Naples, Italy
| | - Anonio Arnese
- Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic Medicine, Second University of Naples, Naples, Italy
| | - Giuseppe La Cerra
- Department of Cardio-Thoracic and Respiratory Science, Second University of Naples, Naples, Italy
| | - Nicola Coppola
- Department of Mental Health and Public Medicine, Second University of Naples, Naples, Italy
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Zhou J, Kong C, Shi Y, Zhang Z, Yuan Z. Comparison of the interferon-gamma release assay with the traditional methods for detecting Mycobacterium tuberculosis infection in children. Medicine (Baltimore) 2014; 93:e87. [PMID: 25275527 PMCID: PMC4616289 DOI: 10.1097/md.0000000000000087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 06/09/2014] [Accepted: 08/02/2014] [Indexed: 12/03/2022] Open
Abstract
The purpose of the article is to compare the whole blood interferon-γ release assay (IGRA) with the traditional methods for detecting Mycobacterium tuberculosis (MTB) infection in children. Fifteen childhood patients with tuberculosis and 15 healthy children were recruited. Sputa samples and venous blood were collected, and according to different procedures, IGRA, sputum smear, colloidal gold assay (CGA), fluorescence quantitation polymerase chain reaction (FQ-PCR), and tuberculosis skin test (TST) were, respectively, performed. Thirty healthy children vaccinated with Bacillus Calmette-Guérin (BCG) were also recruited, and the comparative test was carried out between IGRA and TST. In all of 15 childhood patients with TB, the positive rates were 86.7%, 20.0%, 26.7%, 40%, and 66.7% in IGRA, sputum smear, CGA, FQ-PCR, and TST, respectively. In the children vaccinated with BCG, the positive rate of IGRA was significantly lower than that of TST (6.7% vs 76.7%). From high to low, the specificities of the five methods were sputum smear (100%), IGRA (86.7%), FQ-PCR (86.7%), TST (40%), and CGA (26.7%). Although the specificities of sputum smear and FQ-PCR were more than or equal to that of IGRA, the relative sensitivities limited their applications in populations of children. IGRA is a sensitive and specific method, and could be taken as a first choice for detecting MTB infection in populations of children.
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Affiliation(s)
- Jianwei Zhou
- Clinical Laboratory (JZ, ZZ); Department of Cardiology (CK), Affiliated Hospital of Jining Medical College; Tuberculosis Prevention and Control Institute (YS), Infectious Disease Hospital of Jining City; and Department of Pediatrics (ZY), Affiliated Hospital of Jining Medical College, Jining, Shandong, China
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de Souza FM, do Prado TN, Pinheiro JDS, Peres RL, Lacerda TC, Loureiro RB, Carvalho JA, Fregona G, Dias ES, Cosme LB, Rodrigues RR, Riley LW, Maciel ELN. Comparison of interferon-γ release assay to two cut-off points of tuberculin skin test to detect latent Mycobacterium tuberculosis infection in primary health care workers. PLoS One 2014; 9:e102773. [PMID: 25137040 PMCID: PMC4138087 DOI: 10.1371/journal.pone.0102773] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Accepted: 06/23/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND An interferon-γ release assay, QuantiFERON-TB (QFT) test, has been introduced an alternative test for the diagnosis of latent Mycobacterium tuberculosis infection (LTBI). Here, we compared the performance of QFT with tuberculin skin test (TST) measured at two different cut-off points among primary health care work (HCW) in Brazil. METHODS A cross-sectional study was carried out among HCWs in four Brazilian cities with a known history of high incidence of TB. Results of the QFT were compared to TST results based on both ≥5 mm and ≥10 mm as cut-off points. RESULTS We enrolled 632 HCWs. When the cut-off value of ≥10 mm was used, agreement between QFT and TST was 69% (k = 0.31), and when the cut-off of ≥5 mm was chosen, the agreement was 57% (k = 0.22). We investigated possible factors of discordance of TST vs QFT. Compared to the TST-/QFT- group, risk factors for discordance in the TST+/QFT- group with TST cut-off of ≥5 mm included age between 41-45 years [OR = 2.70; CI 95%: 1.32-5.51] and 46-64 years [OR = 2.04; CI 95%: 1.05-3.93], BCG scar [OR = 2.72; CI 95%: 1.40-5.25], and having worked only in primary health care [OR = 2.30; CI 95%: 1.09-4.86]. On the other hand, for the cut-off of ≥10 mm, BCG scar [OR = 2.26; CI 95%: 1.03-4.91], being a household contact of a TB patient [OR = 1.72; CI 95%: 1.01-2.92] and having had a previous TST [OR = 1.66; CI 95%: 1.05-2.62], were significantly associated with the TST+/QFT- group. No statistically significant associations were found among the TST-/QFT+ discordant group with either TST cut-off value. CONCLUSIONS Although we identified BCG vaccination to contribute to the discordance at both TST cut-off measures, the current Brazilian recommendation for the initiation of LTBI treatment, based on information gathered from medical history, TST, chest radiograph and physical examination, should not be changed.
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Affiliation(s)
- Fernanda Mattos de Souza
- Laboratório de Epidemiologia of Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
- Núcleo de Doenças Infecciosas of Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Thiago Nascimento do Prado
- Laboratório de Epidemiologia of Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
- Núcleo de Doenças Infecciosas of Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Jair dos Santos Pinheiro
- Coordenador do Núcleo de Controle da Tuberculose - Secretaria Municipal de Saúde - Manaus, Amazonas, Brazil
| | - Renata Lyrio Peres
- Laboratório de Epidemiologia of Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
- Núcleo de Doenças Infecciosas of Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Thamy Carvalho Lacerda
- Laboratório de Epidemiologia of Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
- Programa de Pós-graduação em Saúde Coletiva of Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Rafaela Borge Loureiro
- Laboratório de Epidemiologia of Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
- Departamento de Epidemiologia do Instituto de Medicina Social, Universidade Estadual do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jose Américo Carvalho
- Programa de Controle de Tuberculose - Hospital Universitário Cassiano Antônio Moraes of Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Geisa Fregona
- Laboratório de Epidemiologia of Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
- Programa de Pós-graduação em Saúde Coletiva of Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
- Programa de Controle de Tuberculose - Hospital Universitário Cassiano Antônio Moraes of Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Elias Santos Dias
- Laboratório de Epidemiologia of Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
- Estudantes de Graduação em Enfermagem e Obstetrícia da Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Lorrayne Beliqui Cosme
- Laboratório de Epidemiologia of Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
- Estudantes de Graduação em Enfermagem e Obstetrícia da Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Rodrigo Ribeiro Rodrigues
- Núcleo de Doenças Infecciosas of Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Lee Wood Riley
- Division of Infectious Disease and Vaccinology, School of Public Health, University of California, Berkeley, California, United States of America
| | - Ethel Leonor Noia Maciel
- Laboratório de Epidemiologia of Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
- Programa de Pós-graduação em Saúde Coletiva of Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
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New Advances in Diagnosis of Latent Tuberculosis Infection: A Review Article. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2014. [DOI: 10.5812/pedinfect.22368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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The ID93 tuberculosis vaccine candidate does not induce sensitivity to purified protein derivative. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2014; 21:1309-13. [PMID: 25030053 DOI: 10.1128/cvi.00372-14] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The tuberculin skin test (TST) is a simple and inexpensive test to determine whether individuals have been exposed to Mycobacterium tuberculosis. This test is not always reliable, however, in people previously immunized with BCG and/or who have been exposed to environmental mycobacterial species due to a reaction to purified protein derivative (PPD) used in the skin test. An issue with BCG, therefore, is that the resulting sensitization to PPD in some individuals compromises the diagnostic use of the skin test. The ability to induce protective immune responses without sensitizing to the tuberculin skin test will be important properties of next-generation tuberculosis (TB) vaccine candidates. We show here that guinea pigs immunized with the candidate TB vaccine ID93/GLA-SE, currently in clinical trials, do not react to intradermal PPD administration. In contrast, positive DTH responses to both ID93 and components thereof were induced in ID93/GLA-SE-immunized animals, indicating robust but specific cellular responses were present in the immunized animals. Noninterference with the TST is an important factor for consideration in the development of a vaccine against M. tuberculosis.
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Souza JMO, Evangelista MDSN, Trajman A. Added value of QuantiFERON TB-gold in-tube for detecting latent tuberculosis infection among persons living with HIV/AIDS. BIOMED RESEARCH INTERNATIONAL 2014; 2014:294963. [PMID: 24991546 PMCID: PMC4058839 DOI: 10.1155/2014/294963] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 05/13/2014] [Indexed: 12/03/2022]
Abstract
OBJECTIVE To evaluate the added value of QuantiFERON TB-Gold in-Tube (QTF-GIT) over the tuberculin skin testing (TST) for detecting latent tuberculosis (TB) infection (LTBI) among patients with AIDS in a city with a low TB incidence rate (11.1/100,000 inhabitants) and universal BCG coverage. METHODS Three hundred consecutive patients with AIDS in eight outpatient sexually transmitted disease public clinics in Brasilia were submitted to QFT-IT and TST between May 2011 and March 2013. A positive result of either test was considered to be LTBI. RESULTS Median CD4-cell count was 477.5 cells/mm(3); 295 (98.3%) were using antiretroviral therapy. Eighteen patients (6%, 95% CI: 3.6%-9.3%) had LTBI, of whom 4 (1.3%, 95% CI: 0.04%-2.63%) had only a positive TST, 8 (2.7%, 95% CI: 0.8%-4.5%) had only a QFT-GIT positive test, and 6 (2%, 95% CI: 0.4%-3.6%) had positive results for both tests. This represents an 81.8% relative increase in LTBI detection when QFT-GIT is added to TST. The concordance between both tests was 96% (k = 0.48). CONCLUSIONS The QFT-GIT alone was more effective to detect LTBI than TST alone and had an 81% added value as an add-on sequential test in this population with mild immunosuppression. The cost-effectiveness of these strategies remains to be evaluated.
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Affiliation(s)
- Josiane Maria Oliveira Souza
- University of Brasilia (UnB), Campus Universitário Darcy Ribeiro, 70910-900 Brasília, DF, Brazil
- SHA, Conjunto 5 chácara 47, Quadra D, Arniqueiras, 71995-297 Taguatinga, DF, Brazil
| | - Maria do Socorro Nantua Evangelista
- University of Brasilia (UnB), Campus Universitário Darcy Ribeiro, 70910-900 Brasília, DF, Brazil
- Catholic University of Brasilia (UCB), Campus I, QS 07 Lote 01 EPCT, Águas Claras, 71966-700 Taguatinga, DF, Brazil
| | - Anete Trajman
- Federal University of Rio de Janeiro (UFRJ), Avenida Brigadeiro Trompowsky s/n°, Ilha do Fundão Prédio do Hospital Universitário Clementino Fraga Filho, 11° andar Bloco F, Sala 4, 21941-590 Rio de Janeiro, RJ, Brazil
- Montreal Chest Institute, McGill University, 3650 St. Urbain Street, Montreal, QC, Canada H2X 2P4
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Discordance of tuberculin skin test and interferon gamma release assay in recently exposed household contacts of pulmonary TB cases in Brazil. PLoS One 2014; 9:e96564. [PMID: 24819060 PMCID: PMC4018294 DOI: 10.1371/journal.pone.0096564] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 04/09/2014] [Indexed: 11/19/2022] Open
Abstract
Interferon-gamma (IFN-γ) release assays (IGRAs) such as the Quantiferon Gold In-tube test are in vitro assays that measure IFN-γ release from T cells in response to M. tuberculosis (Mtb)-specific antigens. Unlike the tuberculin skin test (TST), IGRA is specific and able to distinguish Mtb-infection from BCG vaccination. In this study we evaluated the concordance between TST and IGRA and the efficacy of IGRA in diagnosing new Mtb infection in household contacts (HHC) of pulmonary tuberculosis (PTB) cases. A total of 357 HHC of TB cases in Vitória, Brazil were studied. A TST was performed within 2 weeks following enrollment of the HHC and if negative a second TST was performed at 8-12 weeks. HHC were categorized as initially TST positive (TST+), persistently TST negative (TST-), or TST converters (TSTc), the latter representative of new infection. IGRA was performed at 8–12 weeks following enrollment and the test results were positive in 82% of TST+, 48% of TSTc, and 12% of TST-, indicating poor concordance between the two test results among HHC in each category. Evaluating CXCL10 levels in a subset of IGRA supernatants or lowering the IGRA cutoff value to define a positive test increased agreement between TST and IGRA test results. However, ROC curves demonstrated that this resulted in a trade-off between sensitivity and specificity of IGRA with respect to TST. Together, the findings suggest that until the basis for the discordance between TST and IGRA is fully understood, it may be necessary to utilize both tests to diagnose new Mtb infection in recently exposed HHC. Operationally, in IGRA negative HHC, it may be useful to employ a lower cutoff value for IGRA to allow closer monitoring for potential conversion.
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75
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Tuberculosis in patients with haematological malignancies. Mediterr J Hematol Infect Dis 2014; 6:e2014026. [PMID: 24803999 PMCID: PMC4010605 DOI: 10.4084/mjhid.2014.026] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 03/10/2014] [Indexed: 02/01/2023] Open
Abstract
Tuberculosis (TB) is an infectious disease that causes more than 1 million deaths worldwide every year. In addition, it is estimated that one third of the world population is infected with M. tuberculosis in a latent state, which involves an eventual risk of progressing to active TB disease. Patients with immunodeficiencies, such as those suffering from haematological malignancies, have a greater risk of progressing to TB disease once infected. It is estimated that the Relative Risk of TB disease in patients with hematologic malignancies is 2–40 times that of the general population. The diagnosis of TB in these patients is often challenging as they often present clinical characteristics that are distinct to those of patients without any other underlying disease. Mortality due to TB is higher. Therefore, it is recommended to diagnose latent TB infection and consider preventive therapy that could avoid the progression from a latent state to active TB disease. There are currently two methods for diagnosing latent TB infection: the Tuberculin Skin Test (TST) and the Interferon-Gamma Release Assays (IGRA). Due to the lack of sensitivity in patients with immunodeficient conditions, a combined TST-IGRA testing is probably the best way for latent TB diagnosis in order to gain sensitivity. Treatment of latent TB infection and TB disease should follow the general principles to that in the general population.
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76
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Babayigit C, Ozer B, Ozer C, Inandi T, Duran N, Gocmen O. Performance of QuantiFERON-TB Gold In-Tube test and Tuberculin Skin Test for diagnosis of latent tuberculosis infection in BCG vaccinated health care workers. Med Sci Monit 2014; 20:521-9. [PMID: 24681806 PMCID: PMC3976198 DOI: 10.12659/msm.889943] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Tuberculin skin test (TST) has been used for years as an aid in diagnosing latent tuberculosis infection (LTBI) but it suffers from a number of well-documented performance and logistic problems. Quantiferon-TB Gold In Tube test (QFT-GIT) has been reported to have better sensitivity and specifity than TST. In this study, it was aimed to compare the performance of a commercial IFN-γ release assay (QFT-GIT) with TST in the diagnosis of HCWs at risk for latent TB infection in BCG vaccinated population. Material/Methods Hundred healthy volunteer health care workers were enrolled. All were subjected to TST and QFT-GIT. Results were compared among Health Care Workers (HCWs) groups in terms of profession, workplace, working duration. Results TST is affected by previous BCG vaccinations and number of cases with QFT-GIT positivity is increased in accordance with the TST induration diameter range. QFT-GIT result was negative in 17 of 32 TST positive (≥15 mm) cases and positive in 4 of 61 cases whose TST diameters are between 6–14 mm, that is attritutable to previous BCG vaccination(s). It was negative in all cases with TST diameters between 0–5 mm. HCWs with positive QFT-GIT results were significantly older than the ones with negative results. Furthermore duration of work was significantly longer in QFT-GIT positive than in negative HCWs. Conclusions There was a moderate concordance between QFT-GIT and TST, when TST result was defined as positive with a ≥15 mm diameter of induration. We suggest that QFT-GIT can be used as an alternative to TST for detection of LTBI, especially in groups with high risk of LTBI and in population with routine BCG vaccination program.
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Affiliation(s)
- Cenk Babayigit
- Department of Chest Diesases and Tuberculosis, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - Burcin Ozer
- Department of Microbiology, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - Cahit Ozer
- Department of Family Medicine, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - Tacettin Inandi
- Department of Public Health, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - Nizami Duran
- Department of Microbiology and Clinical Microbiology, Mustafa Kemal University, Antakya-Hatay, Turkey
| | - Orhan Gocmen
- Department of Tuberculosis Control Dispensary, Mustafa Kemal University, Hatay, Turkey
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77
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Person AK, Pettit AC, Sterling TR. Diagnosis and treatment of latent tuberculosis infection: an update. CURRENT RESPIRATORY CARE REPORTS 2013; 2:199-207. [PMID: 25298921 PMCID: PMC4185413 DOI: 10.1007/s13665-013-0064-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
It is estimated that more than two billion people have latent M. tuberculosis infection, and this population serves as an important reservoir for future tuberculosis cases. Prevalence estimates are limited by difficulties in diagnosing the infection, including the lack of an ideal test, and an incomplete understanding of latency. Current tests include the tuberculin skin test and two interferon-γ release assays: QuantiFERON Gold In-Tube and T-SPOT.TB. This update focuses on recent publications regarding the ability of these tests to predict tuberculosis disease, their reproducibility over serial tests, and discordance between tests. We also discuss recent advances in the treatment of latent M. tuberculosis infection, including the three-month regimen of once-weekly rifapentine plus isoniazid, and prolonged isoniazid therapy for HIV-infected persons living in high-tuberculosis-incidence settings. We provide an update on the tolerability of the three-month regimen.
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Affiliation(s)
- Anna K. Person
- Division of Infectious Diseases, Vanderbilt University Medical Center, A2209 Medical Center North, 1161 21st Avenue South, Nashville, TN 37232, USA. Vanderbilt Tuberculosis Center, A2209 Medical Center North, 1161 21st Avenue South, Nashville, TN 37232, USA
| | - April C. Pettit
- Division of Infectious Diseases, Vanderbilt University Medical Center, A2209 Medical Center North, 1161 21st Avenue South, Nashville, TN 37232, USA. Vanderbilt Tuberculosis Center, A2209 Medical Center North, 1161 21st Avenue South, Nashville, TN 37232, USA
| | - Timothy R. Sterling
- Division of Infectious Diseases, Vanderbilt University Medical Center, A2209 Medical Center North, 1161 21st Avenue South, Nashville, TN 37232, USA. Vanderbilt Tuberculosis Center, A2209 Medical Center North, 1161 21st Avenue South, Nashville, TN 37232, USA
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78
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Murthy M, Selvam S, Jesuraj N, Bennett S, Doherty M, Grewal HMS, Vaz M. Two-step tuberculin skin testing in school-going adolescents with initial 0-4 millimeter responses in a high tuberculosis prevalence setting in South India. PLoS One 2013; 8:e71470. [PMID: 24039716 PMCID: PMC3765300 DOI: 10.1371/journal.pone.0071470] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 06/29/2013] [Indexed: 12/03/2022] Open
Abstract
Background The utility of two-step tuberculin skin testing among adolescents in high tuberculosis prevalence settings is not well established. Objectives To determine the proportion and determinants of a 0-4 mm response to an initial standard tuberculin skin test (TST) and evaluating 'boosting' with repeat testing. Methods Adolescents between 11 and 18 years attending schools/colleges underwent a TST; those with a response of between 0–4 mm had a repeat TST 1-4 weeks later. Results Initial TST was done for 6608/6643 participants; 1257 (19%) developed a 0-4 mm response to the initial TST. Younger age and under-nutrition were more likely to be associated with a 0-4 mm response, while the presence of BCG (Bacillus Calmette Guerin) scar and higher socio-economic class were less likely to be associated with a 0-4 mm response. On repeat testing boosting was seen in 13.2% (145/1098; ≥ 6 mm over the initial test) while 4.3% showed boosting using a more conservative cutoff of a repeat TST ≥ 10 mm with an increment of at least 6 mm (47/1098). History of exposure to a tuberculosis (TB) case was associated with enhanced response. Conclusion The proportion of adolescents who demonstrated boosting on two-step TST testing in our study was relatively low. As a result repeat testing did not greatly alter the prevalence of TST positivity. However, the two-step TST helps identify individuals who can potentially boost their immune response to a second test, and thus, prevents them from being misclassified as those with newly acquired infection, or tuberculin converters. While two-step tuberculin skin testing may have a limited role in population- level TST surveys, it may be useful where serial tuberculin testing needs to be performed to distinguish those who show an enhanced response or boosters from those who indeed have a new infection, or converters.
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Affiliation(s)
- Maitreyi Murthy
- Department of Clinical Science, Infection, Faculty of Medicine and Dentistry, University of Bergen
- Department of Microbiology, Haukeland University Hospital, Bergen, Norway
- St. John’s Research Institute, Bangalore, Karnataka, India
| | - Sumithra Selvam
- Division of Epidemiology, Biostatistics and Population Health, St. John’s Research Institute, Bangalore, Karnataka, India
| | - Nelson Jesuraj
- Division of Epidemiology, Biostatistics and Population Health, St. John’s Research Institute, Bangalore, Karnataka, India
| | - Sean Bennett
- Infectious Disease Epidemiology, St. John’s Research Institute, Bangalore, Karnataka, India
| | - Mark Doherty
- Clinical Development, Aeras Global TB Vaccine Foundation, Rockville, Maryland, United States of America
| | - Harleen M. S. Grewal
- Department of Infectious Disease Immunology, GlaxoSmithKline, Copenhagen, Denmark
- * E-mail: (HMSG); (MV)
| | - Mario Vaz
- Department of Clinical Science, Infection, Faculty of Medicine and Dentistry, University of Bergen and Department of Microbiology, Haukeland University Hospital, Bergen, Norway
- * E-mail: (HMSG); (MV)
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Braun K, Larcombe L, Orr P, Nickerson P, Wolfe J, Sharma M. Killer immunoglobulin-like receptor (KIR) centromeric-AA haplotype is associated with ethnicity and tuberculosis disease in a Canadian First Nations cohort. PLoS One 2013; 8:e67842. [PMID: 23861818 PMCID: PMC3701593 DOI: 10.1371/journal.pone.0067842] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 05/21/2013] [Indexed: 01/12/2023] Open
Abstract
Killer immunoglobulin-like receptors (KIR) on natural killer (NK) cells interact with other immune cells to monitor the immune system and combat infectious diseases, such as tuberculosis (TB). The balance of activating and inhibiting KIR interactions helps determine the NK cell response. In order to examine the enrichment or depletion of KIRs as well as to explore the association between TB status and inhibitory/stimulatory KIR haplotypes, we performed KIR genotyping on samples from 93 Canadian First Nations (Dene, Cree, and Ojibwa) individuals from Manitoba with active, latent, or no TB infection, and 75 uninfected Caucasian controls. There were significant differences in KIR genes between Caucasians and First Nations samples and also between the First Nations ethnocultural groups (Dene, Cree, and Ojibwa). When analyzing ethnicity and tuberculosis status in the study population, it appears that the KIR profile and centromeric haplotype are more predictive than the presence or absence of individual genes. Specifically, the decreased presence of haplotype B centromeric genes and increased presence of centromeric-AA haplotypes in First Nations may contribute to an inhibitory immune profile, explaining the high rates of TB in this population.
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MESH Headings
- Adolescent
- Adult
- Aged
- Centromere
- Cohort Studies
- Female
- Gene Frequency
- Genetic Predisposition to Disease
- Haplotypes
- Humans
- Indians, North American
- Inuit
- Killer Cells, Natural/immunology
- Killer Cells, Natural/microbiology
- Latent Tuberculosis/ethnology
- Latent Tuberculosis/genetics
- Latent Tuberculosis/immunology
- Latent Tuberculosis/microbiology
- Linkage Disequilibrium
- Male
- Manitoba/epidemiology
- Middle Aged
- Receptors, KIR/classification
- Receptors, KIR/genetics
- Receptors, KIR/immunology
- Telomere
- Tuberculosis, Pulmonary/ethnology
- Tuberculosis, Pulmonary/genetics
- Tuberculosis, Pulmonary/immunology
- Tuberculosis, Pulmonary/microbiology
- White People
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Affiliation(s)
- Kali Braun
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Linda Larcombe
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Pamela Orr
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Peter Nickerson
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Joyce Wolfe
- National Reference Centre for Mycobacteriology, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Meenu Sharma
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada
- National Reference Centre for Mycobacteriology, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
- * E-mail:
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