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Moore N, Maher M, Murphy G, O'Callaghan Maher M, O'Connor OJ, McEntee MF. CT in the detection of latent tuberculosis: a systematic review. Clin Radiol 2023; 78:568-575. [PMID: 37270335 DOI: 10.1016/j.crad.2023.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/07/2023] [Accepted: 04/23/2023] [Indexed: 06/05/2023]
Abstract
AIM To evaluate the use of computed tomography (CT) and low-dose CT in the detection of latent tuberculosis (TB). MATERIALS AND METHODS A systematic search of literature in adherence with the PRISMA guidelines was carried out. Quality assessment of the included studies was conducted. RESULTS The search strategy identified a total of 4,621 studies. Sixteen studies were considered eligible and included in the review. There was high heterogeneity among all studies. CT was identified as much more sensitive for the detection of latent TB in all studies despite chest radiography often being recommended in guidelines to assess patients for latent TB. Low-dose CT showed promising results in four of the studies; however, these results were limited due to small sample sizes. CONCLUSION CT is much superior to chest radiography consistently identifying additional cases of latent TB. There are limited high-quality publications available using low-dose CT but findings thus far suggest low-dose CT could be used as an alternative to standard-dose CT for the detection of latent TB. It is recommended that a randomised controlled trial investigating low-dose CT should be carried out.
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Affiliation(s)
- N Moore
- Medical Imaging and Radiation Therapy, University College Cork, Ireland.
| | - M Maher
- Department of Radiology, University College Cork, Cork, Ireland; Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - G Murphy
- Department of Rheumatology, Cork University Hospital, Cork, Ireland
| | | | - O J O'Connor
- Department of Radiology, University College Cork, Cork, Ireland; Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - M F McEntee
- Medical Imaging and Radiation Therapy, University College Cork, Ireland
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The usefulness of routine chest radiograph examinations in patients treated with TNF inhibitors for inflammatory arthritis in South Korea. Respir Med 2018; 143:109-115. [PMID: 30261981 DOI: 10.1016/j.rmed.2018.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 07/17/2018] [Accepted: 09/06/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVES We aimed to investigate the usefulness of routine chest radiograph (CXR) examinations for patients with inflammatory arthritis treated with a tumor necrosis factor (TNF) inhibitor in terms of (i) the role of CXR in baseline latent tuberculosis infection (LTBI) screening and (ii) detecting asymptomatic active tuberculosis after TNF inhibitor initiation. METHODS From January 2011 to June 2017, 469 patients with inflammatory arthritis were enrolled in the study at a tertiary referral center in South Korea. At our institution, CXR was performed for all patients undergoing a tuberculin skin test (TST) and/or an interferon-gamma release assay (IGRA) at the LTBI screening visit. LTBI treatment was determined by (i) positive TST or IGRA or (ii) CXR findings suggestive of spontaneously healed tuberculosis. After TNF inhibitor initiation, patients were recommended to undergo CXR at a specified interval. RESULTS Of 469 patients, 187 were treated for LTBI. Among them, 181 patients were treated for LTBI because of a positive TST or IGRA result. TST was considered positive if induration size was ≥10 mm. The remaining six patients were considered positive on the basis of CXR findings compatible with spontaneously healed tuberculosis, such as noncalcified nodules with distinct margins and fibrotic linear opacity, despite demonstrating negative results for TST and IGRA. Thus, CXR had a diagnostic value as a baseline LTBI test in 6 (1.3%) patients. After TNF inhibitor initiation, 2 patients who had respiratory symptoms were diagnosed with active tuberculosis. For asymptomatic patients, routine CXR follow-up could not detect any case of active pulmonary tuberculosis within 1 year (n = 219) or after 1 year (n = 217). CONCLUSIONS CXR should be performed as one of the LTBI screening tests for patients with inflammatory arthritis in a tuberculosis-prevalent country. However, after TNF inhibitor treatment, routine CXR follow-up was not advantageous.
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Silva BDS, Tannus-Silva DGS, Rabahi MF, Kipnis A, Junqueira-Kipnis AP. The use of Mycobacterium tuberculosis HspX and GlcB proteins to identify latent tuberculosis in rheumatoid arthritis patients. Mem Inst Oswaldo Cruz 2015; 109:29-37. [PMID: 25317705 PMCID: PMC4238770 DOI: 10.1590/0074-0276140140] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 10/03/2013] [Indexed: 01/22/2023] Open
Abstract
Understanding the social conditions and immunological characteristics that allow some
human immunodeficiency virus (HIV)-exposed patients to remain uninfected represents
an on-going challenge. In this study, the socio-demographic and sexual behaviour
characteristics and immune activation profiles of uninfected individuals exposed to
HIV-infected partners were investigated. A confidential and detailed questionnaire
was administered and venous blood was tested using HIV-1/enzyme immunoassays, plasma
HIV-1 RNA levels/bDNA and immunophenotyping/flow cytometry to determine the
frequencies of CD4 and CD8 T cells expressing activation markers. The data analysis
showed significant differences (p < 0.05) for immune parameters in individuals who
were uninfected, albeit exposed to HIV-infected partners, compared with unexposed
individuals. In particular, the exposed, uninfected individuals had a higher
frequency (median, minimum-maximum) of CD4+HLA-DR+ (4.2,
1.8-6.1), CD8+HLA-DR+ (4.6, 0.9-13.7),
CD4+CD45RO+ (27.5, 14.2-46.6),
CD4+CD45RO+CD62L+ (46.7, 33.9-67.1),
CD8+CD45RA+HLA-DR+ (12.1, 3.4-35.8) and
CD8+CD45RO+HLA-DR+ (9.0, 3.2-14.8) cells, a
decreased percentage of CD8+CD28+ cells (11.7, 4.5-24.0) and a
lower cell-surface expression of Fcγ-R/CD16 on monocytes (56.5, 22.0-130.0). The
plasma HIV-1 RNA levels demonstrated detectable RNA virus loads in 57% of the
HIV-1+ female partners. These findings demonstrate an activation
profile in both CD4 and CD8 peripheral T cells from HIV-1 exposed seronegative
individuals of serodiscordant couples from a referral centre in Belo Horizonte, state
of Minas Gerais.
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Affiliation(s)
- Bruna Daniella Souza Silva
- Departamento de Microbiologia, Imunologia, Parasitologia e Patologia, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, GoiâniaGO, Brasil, Departamento de Microbiologia, Imunologia, Parasitologia e Patologia , Instituto de Patologia Tropical e Saúde Pública , Universidade Federal de Goiás , Goiânia , GO , Brasil
| | - Daniela Graner Schuwartz Tannus-Silva
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Goiás, GoiâniaGO, Brasil, Departamento de Clínica Médica , Faculdade de Medicina , Universidade Federal de Goiás , Goiânia , GO , Brasil
| | - Marcelo Fouad Rabahi
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Goiás, GoiâniaGO, Brasil, Departamento de Clínica Médica , Faculdade de Medicina , Universidade Federal de Goiás , Goiânia , GO , Brasil
| | - Andre Kipnis
- Departamento de Microbiologia, Imunologia, Parasitologia e Patologia, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, GoiâniaGO, Brasil, Departamento de Microbiologia, Imunologia, Parasitologia e Patologia , Instituto de Patologia Tropical e Saúde Pública , Universidade Federal de Goiás , Goiânia , GO , Brasil
| | - Ana Paula Junqueira-Kipnis
- Departamento de Microbiologia, Imunologia, Parasitologia e Patologia, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, GoiâniaGO, Brasil, Departamento de Microbiologia, Imunologia, Parasitologia e Patologia , Instituto de Patologia Tropical e Saúde Pública , Universidade Federal de Goiás , Goiânia , GO , Brasil
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Silva BDS, Tannus-Silva DGS, Rabahi MF, Kipnis A, Junqueira-Kipnis AP. The use of Mycobacterium tuberculosis HspX and GlcB proteins to identify latent tuberculosis in rheumatoid arthritis patients. Mem Inst Oswaldo Cruz 2015. [PMID: 24626307 PMCID: PMC4005526 DOI: 10.1590/0074-02760140140] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Rheumatoid arthritis (RA) is an autoimmune disease characterised by the destruction
of articular cartilage and bone damage. The chronic treatment of RA patients causes a
higher susceptibility to infectious diseases such as tuberculosis (TB); one-third of
the world’s population is latently infected (LTBI) with Mycobacterium
tuberculosis (Mtb). The tuberculin skin test is used to identify
individuals LTBI, but many studies have shown that this test is not suitable for RA
patients. The goal of this work was to test the specific cellular immune responses to
the Mtb malate synthase (GlcB) and heat shock protein X (HspX) antigens of RA
patients and to correlate those responses with LTBI status. The T-helper (Th)1, Th17
and Treg-specific immune responses to the GlcB and HspX Mtb antigens were analysed in
RA patients candidates for tumour necrosis factor-α blocker treatment. Our results
demonstrated that LTBI RA patients had Th1-specific immune responses to GlcB and
HspX. Patients were followed up over two years and 14.3% developed active TB. After
the development of active TB, RA patients had increased numbers of Th17 and Treg
cells, similar to TB patients. These results demonstrate that a GlcB and HspX antigen
assay can be used as a diagnostic test to identify LTBI RA patients.
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Affiliation(s)
- Bruna Daniella Souza Silva
- Departamento de Microbiologia, Imunologia, Parasitologia e Patologia, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, GoiâniaGO, Brasil, Departamento de Microbiologia, Imunologia, Parasitologia e Patologia , Instituto de Patologia Tropical e Saúde Pública , Universidade Federal de Goiás , Goiânia , GO , Brasil
| | - Daniela Graner Schuwartz Tannus-Silva
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Goiás, GoiâniaGO, Brasil, Departamento de Clínica Médica , Faculdade de Medicina , Universidade Federal de Goiás , Goiânia , GO , Brasil
| | - Marcelo Fouad Rabahi
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Goiás, GoiâniaGO, Brasil, Departamento de Clínica Médica , Faculdade de Medicina , Universidade Federal de Goiás , Goiânia , GO , Brasil
| | - Andre Kipnis
- Departamento de Microbiologia, Imunologia, Parasitologia e Patologia, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, GoiâniaGO, Brasil, Departamento de Microbiologia, Imunologia, Parasitologia e Patologia , Instituto de Patologia Tropical e Saúde Pública , Universidade Federal de Goiás , Goiânia , GO , Brasil
| | - Ana Paula Junqueira-Kipnis
- Departamento de Microbiologia, Imunologia, Parasitologia e Patologia, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, GoiâniaGO, Brasil, Departamento de Microbiologia, Imunologia, Parasitologia e Patologia , Instituto de Patologia Tropical e Saúde Pública , Universidade Federal de Goiás , Goiânia , GO , Brasil
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