1
|
Jonas DE, Riley SR, Lee LC, Coffey CP, Wang SH, Asher GN, Berry AM, Williams N, Balio C, Voisin CE, Kahwati LC. Screening for Latent Tuberculosis Infection in Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2023; 329:1495-1509. [PMID: 37129650 DOI: 10.1001/jama.2023.3954] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Importance Latent tuberculosis infection (LTBI) can progress to active tuberculosis disease, causing morbidity and mortality. Objective To review the evidence on benefits and harms of screening for and treatment of LTBI in adults to inform the US Preventive Services Task Force (USPSTF). Data Sources PubMed/MEDLINE, Cochrane Library, and trial registries through December 3, 2021; references; experts; literature surveillance through January 20, 2023. Study Selection English-language studies of LTBI screening, LTBI treatment, or accuracy of the tuberculin skin test (TST) or interferon-gamma release assays (IGRAs). Studies of LTBI screening and treatment for public health surveillance or disease management were excluded. Data Extraction and Synthesis Dual review of abstracts, full-text articles, and study quality; qualitative synthesis of findings; meta-analyses conducted when a sufficient number of similar studies were available. Main Outcomes and Measures Screening test accuracy; development of active tuberculosis disease, transmission, quality of life, mortality, and harms. Results A total of 113 publications were included (112 studies; N = 69 009). No studies directly evaluated the benefits and harms of screening. Pooled estimates for sensitivity of the TST were 0.80 (95% CI, 0.74-0.87) at the 5-mm induration threshold, 0.81 (95% CI, 0.76-0.87) at the 10-mm threshold, and 0.60 (95% CI, 0.46-0.74) at the 15-mm threshold. Pooled estimates for sensitivity of IGRA tests ranged from 0.81 (95% CI, 0.79-0.84) to 0.90 (95% CI, 0.87-0.92). Pooled estimates for specificity of screening tests ranged from 0.95 to 0.99. For treatment of LTBI, a large (n = 27 830), good-quality randomized clinical trial found a relative risk (RR) for progression to active tuberculosis at 5 years of 0.35 (95% CI, 0.24-0.52) for 24 weeks of isoniazid compared with placebo (number needed to treat, 112) and an increase in hepatotoxicity (RR, 4.59 [95% CI, 2.03-10.39]; number needed to harm, 279). A previously published meta-analysis reported that multiple regimens were efficacious compared with placebo or no treatment. Meta-analysis found greater risk for hepatotoxicity with isoniazid than with rifampin (pooled RR, 4.22 [95% CI, 2.21-8.06]; n = 7339). Conclusions and Relevance No studies directly evaluated the benefits and harms of screening for LTBI compared with no screening. TST and IGRAs were moderately sensitive and highly specific. Treatment of LTBI with recommended regimens reduced the risk of progression to active tuberculosis. Isoniazid was associated with higher rates of hepatotoxicity than placebo or rifampin.
Collapse
Affiliation(s)
- Daniel E Jonas
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center, Research Triangle Park
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus
| | - Sean R Riley
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center, Research Triangle Park
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus
| | - Lindsey C Lee
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus
| | - Cory P Coffey
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus
| | - Shu-Hua Wang
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus
- Global One Health Initiative, The Ohio State University, Columbus
| | - Gary N Asher
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center, Research Triangle Park
- Department of Family Medicine, University of North Carolina at Chapel Hill
| | - Anne M Berry
- Department of Family Medicine, University of North Carolina at Chapel Hill
- Department of Family Medicine and Community Health, Duke University, Durham, North Carolina
| | - Niketa Williams
- Department of Family Medicine, University of North Carolina at Chapel Hill
- North Carolina Department of Health and Human Services, Division of Public Health, Raleigh
| | - Casey Balio
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center, Research Triangle Park
- Center for Rural Health Research, East Tennessee State University, Johnson City
| | - Christiane E Voisin
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center, Research Triangle Park
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus
| | - Leila C Kahwati
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center, Research Triangle Park
- RTI International, Research Triangle Park, North Carolina
| |
Collapse
|
2
|
Luo Y, Xue Y, Liu W, Song H, Huang Y, Tang G, Wang X, Cai Y, Wang F, Guo X, Wang Q, Sun Z. Convolutional neural network based on T-SPOT.TB assay promoting the discrimination between active tuberculosis and latent tuberculosis infection. Diagn Microbiol Infect Dis 2023; 105:115892. [PMID: 36702072 DOI: 10.1016/j.diagmicrobio.2023.115892] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 12/27/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023]
Abstract
OBJECTIVES The study aims to investigate the potential of convolutional neural network (CNN) based on spot image of T-SPOT assay for distinguishing active tuberculosis (ATB) from latent tuberculosis infection (LTBI). METHODS CNN was applied to recognize and classify T-SPOT spot image. Logistic regression was used to establish prediction model based on CNN. RESULTS Areas under the receiver operating characteristic curve (AUCs) of early secreted antigenic target 6 (ESAT-6) CNN, culture filtrate protein 10 (CFP-10) CNN, and phytohemagglutinin (PHA) CNN were more than 0.7 in differentiating ATB from LTBI, while the performance of these indicators was significantly better than that of spot number. Furthermore, prediction model based on the combination of CNNs yielded an AUC of 0.898. The model presented a sensitivity of 85.76% and a specificity of 90.23%. CONCLUSIONS The current study identified CNN based on T-SPOT spot image with the potential to serve as a tool for TB diagnostics.
Collapse
Affiliation(s)
- Ying Luo
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Ying Xue
- Department of Immunology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Liu
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huijuan Song
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Huang
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guoxing Tang
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaochen Wang
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yimin Cai
- Department of Epidemiology and Biostatistics, Key Laboratory of Environmental Health of Ministry of Education, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Feng Wang
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xueyun Guo
- Department of Dermatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Eurofins Consumer Product Testing (Guangzhou) Co. Ltd., Guangzhou, China
| | - Qi Wang
- Télécom Physique Strasbourg, Illkirch-Graffenstaden, France.
| | - Ziyong Sun
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| |
Collapse
|
3
|
Screening for tuberculosis of patients with HIV-infection. New possibilities. ACTA BIOMEDICA SCIENTIFICA 2022. [DOI: 10.29413/abs.2022-7.2.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background. Tuberculosis associated with HIV infection is becoming almost a new disease, where not only new approaches to treatment are being formed, but there is also a need to improve the quality and search for new means of early diagnosis of tuberculosis infection.The aim. To evaluate the diagnostic performance of the T-SPOT.TB test for the detection of latent tuberculosis infection and clinical forms of tuberculosis in patients with HIV infection.Materials and methods. 396 patients registered at the AIDS Center for more than a year were examined. Everyone underwent standard examinations for pulmonary tuberculosis using sputum bacterioscopy techniques with Ziehl – Neelsen staining; a molecular genetic method based on hybridization technology – HAIN-GenoType MTBDRplus; crops on liquid media in the automated BACTEC MGIT 960 system and on Löwenstein–Jensen dense medium. T-SPOT.TB was conducted as a screening for everyone. With positive T-SPOT.TB results, negative results of the MBT search, absence of specific changes on the X-ray a conclusion was made about latent tuberculosis infection. Statistical data processing was carried out using the software package Statistica 10 (StatSoft Inc., USA).Results. According to the results of a comprehensive examination, tuberculosis was diagnosed in 174 patients, verified using various methods of searching for Mycobacterium tuberculosis in 116 patients (66.6 %). Infiltrative (63.8 %) and disseminated (24.7 %) tuberculosis were more often diagnosed. Latent tuberculosis infection was diagnosed in 52 patients, 170 HIV-infected patients have no data for tuberculosis at this stage.Conclusions. T-SPOT.TB can be used in the diagnostic complex of monitoring patients with HIV infections – as a screening method to detect latent tuberculosis, for preventive chemotherapy.
Collapse
|
4
|
Luo Y, Xue Y, Song H, Tang G, Liu W, Bai H, Yuan X, Tong S, Wang F, Cai Y, Sun Z. Machine learning based on routine laboratory indicators promoting the discrimination between active tuberculosis and latent tuberculosis infection. J Infect 2022; 84:648-657. [PMID: 34995637 DOI: 10.1016/j.jinf.2021.12.046] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/18/2021] [Accepted: 12/26/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Discriminating active tuberculosis (ATB) from latent tuberculosis infection (LTBI) remains challenging. The present study aims to evaluate the performance of diagnostic models established using machine learning based on routine laboratory indicators in differentiating ATB from LTBI. METHODS Participants were respectively enrolled at Tongji Hospital (discovery cohort) and Sino-French New City Hospital (validation cohort). Diagnostic models were established based on routine laboratory indicators using machine learning. RESULTS A total of 2619 participants (1025 ATB and 1594 LTBI) were enrolled in discovery cohort and another 942 subjects (388 ATB and 554 LTBI) were recruited in validation cohort. ATB patients had significantly higher levels of tuberculosis-specific antigen/phytohemagglutinin ratio and coefficient variation of red blood cell volume distribution width, and lower levels of albumin and lymphocyte count than those of LTBI individuals. Six models were built and the optimal performance was obtained from GBM model. GBM model derived from training set (n = 1965) differentiated ATB from LTBI in the test set (n = 654) with a sensitivity of 84.38% (95% CI, 79.42%-88.31%) and a specificity of 92.71% (95% CI, 89.73%-94.88%). Further validation by an independent cohort confirmed its encouraging value with a sensitivity of 87.63% (95% CI, 83.98%-90.54%) and specificity of 91.34% (95% CI, 88.70%-93.40%), respectively. CONCLUSIONS We successfully developed a model with promising diagnostic value based on machine learning for the first time. Our study proposed that GBM model may be of great benefit served as a tool for the accurate identification of ATB.
Collapse
Affiliation(s)
- Ying Luo
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang road 1095, Wuhan 430030, China.
| | - Ying Xue
- Department of Immunology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Huijuan Song
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang road 1095, Wuhan 430030, China
| | - Guoxing Tang
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang road 1095, Wuhan 430030, China
| | - Wei Liu
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang road 1095, Wuhan 430030, China
| | - Huan Bai
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang road 1095, Wuhan 430030, China
| | - Xu Yuan
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang road 1095, Wuhan 430030, China
| | - Shutao Tong
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang road 1095, Wuhan 430030, China.
| | - Feng Wang
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang road 1095, Wuhan 430030, China.
| | - Yimin Cai
- Department of Epidemiology and Biostatistics, Key Laboratory of Environmental Health of Ministry of Education, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong road 13, Wuhan, China.
| | - Ziyong Sun
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang road 1095, Wuhan 430030, China.
| |
Collapse
|
5
|
Yeh JJ, Lin HC, Yang YC, Hsu CY, Kao CH. Asthma Therapies on Pulmonary Tuberculosis Pneumonia in Predominant Bronchiectasis-Asthma Combination. Front Pharmacol 2022; 13:790031. [PMID: 35431916 PMCID: PMC9006509 DOI: 10.3389/fphar.2022.790031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 02/02/2022] [Indexed: 11/19/2022] Open
Abstract
Background: It is sometimes difficult to distinguish between asthma and bronchiectasis as their symptoms overlap, and these two diseases are associated with pulmonary tuberculosis (PTB) or pneumonia. Objective: The purpose of this study is to determine the effects of bronchodilator drugs, steroids, antidepressants drugs, and antianxiety drugs on the risks of PTB or pneumonia in patients with bronchiectasis–asthma combination or bronchiectasis–asthma–chronic obstructive pulmonary disease combination—BCAS cohort. Methods: After propensity score matching, we retrospectively studied patients with BCAS (N = 620) and without BCAS (N = 2,314) through an analysis. The cumulative incidence of PTB or pneumonia was analyzed through Cox proportional regression. After adjustment for sex, age, comorbidities, and medications [including long-acting beta2 agonist/muscarinic antagonists (LABAs/LAMAs), short-acting beta2 agonist/muscarinic antagonists (SABAs/SAMAs), leukotriene receptor antagonist, montelukast, steroids (inhaled corticosteroids, ICSs; oral steroids, OSs), anti-depressants (fluoxetine), and anti-anxiety drugs (benzodiazepines, BZDs)], we calculated the adjusted hazard ratios (aHR) and their 95% confidence intervals (95% CI) for these risks. Similar to OSs, ICSs are associated with an increased risk of PTB or pneumonia, lumping these two as steroids (ICSs/OSs). Results: For the aHR (95% CI), with non-LABAs/non-OSs as the reference 1, the use of LABAs [0.70 (0.52–0.94)]/OSs [0.35 (0.29–0.44)] was associated with a lower risk of PTB or pneumonia. However, the current use of LABAs [2.39 (1.31–4.34)]/SABAs [1.61 (1.31–1.96)], steroids [ICSs 3.23 (1.96–5.29)]/OSs 1.76 (1.45–2.14)], and BZDs [alprazolam 1.73 (1.08–2.75)/fludiazepam 7.48 (1.93–28.9)] was associated with these risks. The current use of LAMAs [0.52 (0.14–1.84)]/SAMAs [1.45 (0.99–2.11)] was not associated with these risks. Conclusion: The current use of LAMAs/SAMAs is relatively safe with respect to PTB or pneumonia risks, but LABAs/SABAs, steroids, and BZDs could be used after evaluation of the benefit for the BCAS cohort. However, we must take the possible protopathic bias into account.
Collapse
Affiliation(s)
- Jun-Jun Yeh
- Department of Family Medicine, Geriatric Medicine, Chest Medicine and Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Hui-Chuan Lin
- Department of Pharmacy, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Yu-Cih Yang
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Chung-Y Hsu
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.,Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan.,Center of Augmented Intelligence in Healthcare, China Medical University Hospital, Taichung, Taiwan
| |
Collapse
|
6
|
Luo Y, Xue Y, Tang G, Lin Q, Song H, Liu W, Yin B, Huang J, Wei W, Mao L, Wang F, Sun Z. Combination of HLA-DR on Mycobacterium tuberculosis-Specific Cells and Tuberculosis Antigen/Phytohemagglutinin Ratio for Discriminating Active Tuberculosis From Latent Tuberculosis Infection. Front Immunol 2021; 12:761209. [PMID: 34858413 PMCID: PMC8632229 DOI: 10.3389/fimmu.2021.761209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/11/2021] [Indexed: 12/27/2022] Open
Abstract
Background Novel approaches for tuberculosis (TB) diagnosis, especially for distinguishing active TB (ATB) from latent TB infection (LTBI), are urgently warranted. The present study aims to determine whether the combination of HLA-DR on Mycobacterium tuberculosis (MTB)-specific cells and TB antigen/phytohemagglutinin (TBAg/PHA) ratio could facilitate MTB infection status discrimination. Methods Between June 2020 and June 2021, participants with ATB and LTBI were recruited from Tongji Hospital (Qiaokou cohort) and Sino-French New City Hospital (Caidian cohort), respectively. The detection of HLA-DR on MTB-specific cells upon TB antigen stimulation and T-SPOT assay were simultaneously performed on all subjects. Results A total of 116 (54 ATB and 62 LTBI) and another 84 (43 ATB and 41 LTBI) cases were respectively enrolled from Qiaokou cohort and Caidian cohort. Both HLA-DR on IFN-γ+TNF-α+ cells and TBAg/PHA ratio showed discriminatory value in distinguishing between ATB and LTBI. Receiver operator characteristic (ROC) curve analysis showed that HLA-DR on IFN-γ+TNF-α+ cells produced an area under the ROC curve (AUC) of 0.886. Besides, TBAg/PHA ratio yield an AUC of 0.736. Furthermore, the combination of these two indicators resulted in the accurate discrimination with an AUC of 0.937. When the threshold was set as 0.36, the diagnostic model could differentiate ATB from LTBI with a sensitivity of 92.00% and a specificity of 81.82%. The performance obtained in Qiaokou cohort was further validated in Caidian cohort. Conclusions The combination of HLA-DR on MTB-specific cells and TBAg/PHA ratio could serve as a robust tool to determine TB disease states.
Collapse
Affiliation(s)
- Ying Luo
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ying Xue
- Department of Immunology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guoxing Tang
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qun Lin
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huijuan Song
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Liu
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Botao Yin
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jin Huang
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Wei
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liyan Mao
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Feng Wang
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ziyong Sun
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
7
|
Luo Y, Xue Y, Mao L, Lin Q, Tang G, Song H, Liu W, Tong S, Hou H, Huang M, Ouyang R, Wang F, Sun Z. Activation Phenotype of Mycobacterium tuberculosis-Specific CD4 + T Cells Promoting the Discrimination Between Active Tuberculosis and Latent Tuberculosis Infection. Front Immunol 2021; 12:721013. [PMID: 34512645 PMCID: PMC8426432 DOI: 10.3389/fimmu.2021.721013] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 07/29/2021] [Indexed: 12/13/2022] Open
Abstract
Background Rapid and effective discrimination between active tuberculosis (ATB) and latent tuberculosis infection (LTBI) remains a challenge. There is an urgent need for developing practical and affordable approaches targeting this issue. Methods Participants with ATB and LTBI were recruited at Tongji Hospital (Qiaokou cohort) and Sino-French New City Hospital (Caidian cohort) based on positive T-SPOT results from June 2020 to January 2021. The expression of activation markers including HLA-DR, CD38, CD69, and CD25 was examined on Mycobacterium tuberculosis (MTB)-specific CD4+ T cells defined by IFN-γ, TNF-α, and IL-2 expression upon MTB antigen stimulation. Results A total of 90 (40 ATB and 50 LTBI) and another 64 (29 ATB and 35 LTBI) subjects were recruited from the Qiaokou cohort and Caidian cohort, respectively. The expression patterns of Th1 cytokines including IFN-γ, TNF-α, and IL-2 upon MTB antigen stimulation could not differentiate ATB patients from LTBI individuals well. However, both HLA-DR and CD38 on MTB-specific cells showed discriminatory value in distinguishing between ATB patients and LTBI individuals. As for developing a single candidate biomarker, HLA-DR had the advantage over CD38. Moreover, HLA-DR on TNF-α+ or IL-2+ cells had superiority over that on IFN-γ+ cells in differentiating ATB patients from LTBI individuals. Besides, HLA-DR on MTB-specific cells defined by multiple cytokine co-expression had a higher ability to discriminate patients with ATB from LTBI individuals than that of MTB-specific cells defined by one kind of cytokine expression. Specially, HLA-DR on TNF-α+IL-2+ cells produced an AUC of 0.901 (95% CI, 0.833–0.969), with a sensitivity of 93.75% (95% CI, 79.85–98.27%) and specificity of 72.97% (95% CI, 57.02–84.60%) as a threshold of 44% was used. Furthermore, the performance of HLA-DR on TNF-α+IL-2+ cells for differential diagnosis was obtained with validation cohort data: 90.91% (95% CI, 72.19–97.47%) sensitivity and 68.97% (95% CI, 50.77–82.73%) specificity. Conclusions We demonstrated that HLA-DR on MTB-specific cells was a potentially useful biomarker for accurate discrimination between ATB and LTBI.
Collapse
Affiliation(s)
- Ying Luo
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ying Xue
- Department of Immunology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liyan Mao
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qun Lin
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guoxing Tang
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huijuan Song
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Liu
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shutao Tong
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongyan Hou
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Min Huang
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Renren Ouyang
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Feng Wang
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ziyong Sun
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
8
|
Huang SF, Yang YY, Chou KT, Fung CP, Wang FD, Su WJ. Systemic proinflammation after Mycobacterium tuberculosis infection was correlated to the gut microbiome in HIV-uninfected humans. Eur J Clin Invest 2019; 49:e13068. [PMID: 30620398 DOI: 10.1111/eci.13068] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 01/01/2019] [Accepted: 01/06/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND The dysbiosis of gut microbiome and interaction with host immunity after Mycobacterium tuberculosis (MTB) infection are under investigation. We had found fatigue symptom concurrent with dysbiosis by decreasing the ratio of Firmicutes to Bacteroidetes (F/B ratio) in active tuberculosis (TB). The study aims to assess the inflammatory biomarkers and their interaction with gut microbiome in active TB and latent TB infection before starting anti-TB regimens. MATERIALS AND METHOD Interleukin-1 beta (IL-1B), IL-4, IL-6, IL-10, CD3+, CD4+, CD8+ T cells and interferon-gamma (IFN-γ) releasing assay (IGRA) were measured in 25 active TB patients, 32 LTBI subjects and 23 healthy controls (HC). Gut microbiome profiles were obtained using 16S rRNA MiSeq sequencing method. RESULTS The leucocytosis (7032 ± 387 cell/cum, P < 0.05), increase in IL-6 (229.7 ± 104 µg/dL, P < 0.05), and decrease in IL-4 (0.27 µg/dL ± 0.1, P < 0.05) were presented in active TB. The proportion of polymorphic neutrophil (PMN) in peripheral blood was positively related to the relative abundance of Bacteroidetes in LTBI and active TB (R2 = 0.23, P < 0.05). The F/B ratio was positively related to the detectable IL-1B in TB (R2 = 0.97, P < 0.01) and to the IL-4 in LTBI (R2 = 0.27, P < 0.05). In LTBI, the relative abundances of Coriobacteriaceae were positively related to the secretion of IFN-gamma against MTB-antigens more likely associated with of CD4+ T cell (R2 = 0.42, P < 0.05). CONCLUSION In active TB, dysbiosis with higher relative abundances of Bacteroidetes in stool and low F/B ratio was related to systemic proinflammation. In LTBI, dose-response relationship between peripheral PMN and relative abundances of Bacteroidetes was remained but not leads to systemic inflammation.
Collapse
Affiliation(s)
- Shiang-Fen Huang
- Institution of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.,Division of Infectious Disease, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.,Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
| | - Ying-Ying Yang
- Institution of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.,Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.,Institute of Public Health, Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C
| | - Kun-Ta Chou
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.,Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
| | - Chang-Phone Fung
- Institution of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.,Division of Infectious Disease, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
| | - Fu-Der Wang
- Division of Infectious Disease, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.,School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Wei-Juin Su
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.,Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
| |
Collapse
|
9
|
Kim YJ, Kang JY, Kim SI, Chang MS, Kim YR, Park YJ. Predictors for false-negative QuantiFERON-TB Gold assay results in patients with extrapulmonary tuberculosis. BMC Infect Dis 2018; 18:457. [PMID: 30200884 PMCID: PMC6131843 DOI: 10.1186/s12879-018-3344-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 08/20/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUNDS Extrapulmonary tuberculosis (EPTB) is a heterogeneous disease, and diagnosis is sometimes difficult. We investigated the diagnostic performance of the QuantiFERON-TB Gold assay (QFT-GIT) according to sites of EPTB and predictors for false-negative QFT-GIT results. METHODS A total of 2176 patients were registered with active TB from January 2012 to December 2016 in Seoul St. Mary's Hospital, a 1200-bed tertiary teaching hospital in Seoul, Korea. We retrospectively reviewed the medical records of 163 EPTB patients who underwent QFT-GIT. RESULTS False negative QFT-GIT results were found in 28.8% (95% CI 0.22-0.36) of patients with EPTB. In the proven TB group, negative QFT-GIT results were found in 28.6% (95% CI 0.04-0.71) of pleural, 8.3% 0.002-0.38of lymph node, 8.3% (95% CI 0.002-0.38) of skeletal and 5.8% (95% CI 0.001-0.28) of gastrointestinal TB cases. Among probable TB cases, QFT-GIT negative results were identified in 46.2% (95% CI 0.19-0.75) of skeletal, 33.3% (95% CI 10-0.65) of pericardial, 30.8% (95% CI 0.09-0.61) of pleural and 17.2% (95% CI 0.10-0.56) of gastrointestinal TB cases. In the possible TB cases, central nervous system TB (n = 21) was most frequent, and 66.7% (95% CI 0.43-0.85) of those showed QFT-GIT negative results. By multivariate analysis, possible TB was independently associated with false-negative QFT-GIT results (OR 4.92, 95% CI 1.51-16.06, p = 0.008). CONCLUSIONS Prudent interpretation of QFT-GIT results might be needed according to anatomic site of involvement and diagnostic criteria in patients with high suspicion of EPTB.
Collapse
Affiliation(s)
- Youn Jeong Kim
- Division of Infectious disease, Department of Internal medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Young Kang
- Division of Pulmonology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang Il Kim
- Division of Infectious disease, Department of Internal medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| | - Mee Soo Chang
- Department of Pathology, Seoul National University Boramae Hospital, Seoul National University College of Medicine, Seoul, Korea.
| | - Yang Ree Kim
- Division of Infectious disease, Department of Internal medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yeon Joon Park
- Department of Laboratory medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| |
Collapse
|
10
|
Chandrasekaran P, Mave V, Thiruvengadam K, Gupte N, Shivakumar SVBY, Hanna LE, Kulkarni V, Kadam D, Dhanasekaran K, Paradkar M, Thomas B, Kohli R, Dolla C, Bharadwaj R, Sivaramakrishnan GN, Pradhan N, Gupte A, Murali L, Valvi C, Swaminathan S, Gupta A. Tuberculin skin test and QuantiFERON-Gold In Tube assay for diagnosis of latent TB infection among household contacts of pulmonary TB patients in high TB burden setting. PLoS One 2018; 13:e0199360. [PMID: 30067752 PMCID: PMC6070176 DOI: 10.1371/journal.pone.0199360] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 06/06/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND World Health Organization (WHO) recommends systematic screening of high-risk populations, including household contacts (HHCs) of adult pulmonary tuberculosis (TB) patients, as a key strategy for elimination of TB. QuantiFERON-TB Gold In-Tube (QFT-GIT) assay and tuberculin skin test (TST) are two commonly used tools for the detection of latent tuberculosis infection (LTBI) but may yield differential results, affecting eligibility for TB preventive therapy. MATERIALS AND METHODS A prospective cohort study of adult pulmonary TB patients and their HHCs were recruited in 2 cities of India, Pune and Chennai. HHCs underwent QFT-GIT (QIAGEN) and TST (PPD SPAN 2TU/5TU). A positive QFT-GIT was defined as value ≥0.35 IU/ml and a positive TST as an induration of ≥5 mm. A secondary outcome of TST induration ≥10mm was explored. Proportion positive by either or both assays, discordant positives and negatives were calculated; test concordance was assessed using percentage agreement and kappa statistics; and risk factors for concordance and discordance including age categories were assessed using logistic regression. Sensitivity and specificity was estimated by latent class model. RESULTS Of 1048 HHCs enrolled, 869 [median (IQR) age: 27 years (15-40)] had both TST and QFT-GIT results available and prevalence of LTBI by QFT-GIT was 54% [95% CI (51, 57)], by TST was 55% [95% CI (52, 58)], by either test was 74% [95% CI (71, 77) and by both tests was 35% [95% CI (31, 38)]. Discordance of TST+/QFT-GIT- was 21% while TST-/QFT-GIT+ was 26%. Poor to fair agreement occurred with TST 5mm or 10mm cutoff (60 and 61% agreement with kappa value of 0.20 and 0.25 respectively). Test agreement varied by age, TST strength and induration cut-off. In multivariate analysis, span PPD was a risk factor for QFT-GIT+ and TST- while absence of BCG scar was for TST+ and QFT-GIT-. Being employed and exposure to TB case outside the household case were associated with positivity by both the tests. Sensitivity of TST and QFT-GIT to diagnose LTBI was 77% and 69%. Probability of having LTBI was >90% when both tests were positive irrespective of exposure gradient. CONCLUSION Prevalence of LTBI among HHCs of adult pulmonary TB patients in India is very high and varies by test type, age, and exposure gradient. In our high TB burden setting, a strategy to treat all HHCs or a targeted strategy whereby an exposure index is used should be assessed in future preventive therapy and vaccine studies as HHCs have several factors that place them at high risk for progression to TB disease.
Collapse
Affiliation(s)
| | - Vidya Mave
- Johns Hopkins University School of Medicine, Baltimore, United States of America
- Byramjee- Jeejeebhoy Government Medical College- Johns Hopkins University Clinical Research Site, Pune, India
| | - Kannan Thiruvengadam
- Department of Clinical Research, National Institute for Research in Tuberculosis, Chennai, India
| | - Nikhil Gupte
- Johns Hopkins University School of Medicine, Baltimore, United States of America
- Byramjee- Jeejeebhoy Government Medical College- Johns Hopkins University Clinical Research Site, Pune, India
| | | | - Luke Elizabeth Hanna
- Department of Clinical Research, National Institute for Research in Tuberculosis, Chennai, India
| | - Vandana Kulkarni
- Byramjee- Jeejeebhoy Government Medical College- Johns Hopkins University Clinical Research Site, Pune, India
| | - Dileep Kadam
- Department of Medicine, Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Kavitha Dhanasekaran
- Department of Clinical Research, National Institute for Research in Tuberculosis, Chennai, India
| | - Mandar Paradkar
- Byramjee- Jeejeebhoy Government Medical College- Johns Hopkins University Clinical Research Site, Pune, India
| | - Beena Thomas
- Department of Clinical Research, National Institute for Research in Tuberculosis, Chennai, India
| | - Rewa Kohli
- Byramjee- Jeejeebhoy Government Medical College- Johns Hopkins University Clinical Research Site, Pune, India
| | - Chandrakumar Dolla
- Department of Clinical Research, National Institute for Research in Tuberculosis, Chennai, India
| | - Renu Bharadwaj
- Department of Medicine, Byramjee Jeejeebhoy Government Medical College, Pune, India
| | | | - Neeta Pradhan
- Byramjee- Jeejeebhoy Government Medical College- Johns Hopkins University Clinical Research Site, Pune, India
| | - Akshay Gupte
- Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America
| | - Lakshmi Murali
- Department of Chest Medicine, Government Headquarters Hospital, Thiruvallur, India
| | - Chhaya Valvi
- Department of Medicine, Byramjee Jeejeebhoy Government Medical College, Pune, India
| | | | - Amita Gupta
- Johns Hopkins University School of Medicine, Baltimore, United States of America
- Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America
| | | |
Collapse
|
11
|
Lu X, Li C, Li W, Long X, Fang Y, Sun R, Jin F, Fu E, Xie Y. Use of Interferon-γ release assay for the diagnosis of female genital tuberculosis in Northwest China. J Clin Lab Anal 2018; 33:e22621. [PMID: 30006939 DOI: 10.1002/jcla.22621] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 06/20/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Female genital tuberculosis (FGTB) is one of the major causes of infertility. However, nonspecific manifestations and the lack of easy access to gold-standard diagnostic test render a diagnostic difficult for FGTB. The objective of this study was to determine T-SPOT.TB (an interferon-γ release assay, IGRA) performance in patients with FGTB. METHODS A total of 213 female patients with validated T-SPOT.TB results were recruited in this retrospective study. Among which, 103 were confirmed FGTB, and 110 were excluded from tuberculosis (control). Of the confirmed FGTB patients, 52 were confirmed by microbiologically/histopathologically examination, while the remaining 51 were clinically confirmed (successfully responsive to anti-tuberculosis treatment). T-SPOT.TB test was performed in both FGTB and control group during the diagnostic procedure. RESULTS The overall sensitivity and specificity of T-SPOT.TB were 86.41% and 75.45% respectively. Sensitivity of T-SPOT.TB was significantly higher when compared with conventional tuberculosis diagnostic tests. Moreover, T-SPOT.TB test using pelvic effusion (PE) showed higher sensitivity than using corresponding peripheral blood (PB) (94.44% vs 72.22%, P < 0.001). Mean value of spot forming cells (SFCs) of T-SPOT.TB using PE was significantly higher than that of PB in FGTB group (193 (IQR 105-280) SFCs/2.5 × 105 PEMCs vs 71 (IQR 36-107) SFCs/2.5 × 105 PBMCs, P = 0.01), while this was not detected in control group (11 (IQR 0-22) SFCs/2.5 × 105 PEMCs vs 9 (IQR 0-18) SFCs/2.5 × 105 PBMCs, P = 0.77). CONCLUSION These results demonstrated that T-SPOT.TB, especially PE T-SPOT.TB, is an useful adjunct in FGTB diagnosis.
Collapse
Affiliation(s)
- Xi Lu
- Department of Respiration, Tangdu hospital, the Second Affiliated Hospital of Air Force Medical University, Xi'an, China
| | - Chunmeng Li
- Department of Clinical Laboratory, Shaanxi Province Hospital of Traditional Chinese Medicine, Xi'an, China
| | - Wangping Li
- Department of Respiration, Tangdu hospital, the Second Affiliated Hospital of Air Force Medical University, Xi'an, China
| | - Xiaoheng Long
- School of Pharmacy, East China University of Science and Technology, Shanghai, China
| | - Yanfeng Fang
- Department of Respiration, Tangdu hospital, the Second Affiliated Hospital of Air Force Medical University, Xi'an, China
| | - Ruilin Sun
- Department of Respiration, Tangdu hospital, the Second Affiliated Hospital of Air Force Medical University, Xi'an, China
| | - Faguang Jin
- Department of Respiration, Tangdu hospital, the Second Affiliated Hospital of Air Force Medical University, Xi'an, China
| | - Enqing Fu
- Department of Respiration, Tangdu hospital, the Second Affiliated Hospital of Air Force Medical University, Xi'an, China
| | - Yonghong Xie
- Department of Respiration, Tangdu hospital, the Second Affiliated Hospital of Air Force Medical University, Xi'an, China
| |
Collapse
|
12
|
Yang C, Zhang S, Yao L, Fan L. Evaluation of risk factors for false-negative results with an antigen-specific peripheral blood-based quantitative T cell assay (T-SPOT ®. TB) in the diagnosis of active tuberculosis: A large-scale retrospective study in China. J Int Med Res 2018. [PMID: 29529901 PMCID: PMC5991236 DOI: 10.1177/0300060518757381] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To investigate the diagnostic efficacy of an interferon-γ release assay, T-SPOT®. TB, for diagnosing active tuberculosis (TB) and to identify risk factors for false-negative results. Methods This retrospective study enrolled consecutive patients with active TB and with non-TB respiratory diseases to evaluate the risk factors for false-negative results when using the T-SPOT®. TB assay for the diagnosis of active TB. Patients with active TB were categorized as having confirmed pulmonary TB, clinically diagnosed pulmonary TB or extrapulmonary TB (EPTB). Results This study analysed 4964 consecutive patients; 2425 with active TB and 2539 with non-TB respiratory diseases. Multivariate logistic regression analyses identified the following five factors that were all associated with an increased false-negative rate with the T-SPOT®. TB assay: increased age (odds ratio [OR] 1.018; 95% confidence interval [CI] 1.013, 1.024); decreased CD8+ count (OR 0.307; 95% CI 0.117, 0.803); negative sputum acid-fast bacilli (AFB) smear staining (OR 1.821; 95% CI 1.338, 2.477); negative mycobacterial cultures (OR 1.379; 95% CI 1.043, 1.824); and absence of EPTB (OR 1.291; 95% CI 1.026, 1.623). Conclusions Increased age, decreased CD8+ count, negative sputum AFB smear results, negative sputum mycobacterial cultures and absence of EPTB might lead to an increased false-negative rate when using the T-SPOT®. TB assay.
Collapse
Affiliation(s)
- Chi Yang
- Clinic and Research Centre of Tuberculosis, Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shaojun Zhang
- Clinic and Research Centre of Tuberculosis, Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lan Yao
- Clinic and Research Centre of Tuberculosis, Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lin Fan
- Clinic and Research Centre of Tuberculosis, Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| |
Collapse
|
13
|
Wang L, Tian XD, Yu Y, Chen W. Evaluation of the performance of two tuberculosis interferon gamma release assays (IGRA-ELISA and T-SPOT.TB) for diagnosing Mycobacterium tuberculosis infection. Clin Chim Acta 2018; 479:74-78. [PMID: 29325798 DOI: 10.1016/j.cca.2018.01.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 11/12/2017] [Accepted: 01/08/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The IGRA-ELISA and T-SPOT.TB are widely used in China. The aim of the study was to evaluate the performance of the two assays in diagnosis Mycobacterium tuberculosis infection. METHODS Of the 3727 patients in the study, 204 underwent testing using both the T-SPOT.TB and IGRA-ELISA, 1794 were tested using the T-SPOT.TB only, and 1729 were tested using the IGRA-ELISA only. The positive rate and consistency of the two assays were analyzed, and their sensitivity and specificity for diagnosing active tuberculosis were compared. RESULTS There were no significant differences in the positive rate between the T-SPOT.TB test (25.8%) and IGRA-ELISA (28.6%), p = .065. The two assays were highly consistent, with a kappa value of 0.852 (p < .0001) and a total coincidence rate of 92.7%. For the diagnosis of active tuberculosis, the sensitivity and specificity values of the T-SPOT.TB test were 82.9% (107/129) and 78.6% (1309/1665), respectively, and those of IGRA-ELISA were 81.7% (94/115) and 75.2% (1214/1614), respectively. There were no significant differences in sensitivity (p > .05), but the specificity of the T-SPOT.TB test was slightly higher than that of IGRA-ELISA (p = .023). CONCLUSION Both in terms of diagnosing M. tuberculosis infection and ruling out active tuberculosis, the performance of the IGRA-ELISA-a simple, almost labor-free assay that allows simultaneous processing of a very large number of samples-was well-matched with that of T-SPOT.TB test. However, IGRAs cannot be used as the only test to diagnose active tuberculosis.
Collapse
Affiliation(s)
- Linchuan Wang
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Xu-Dong Tian
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Yan Yu
- Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.
| | - Wei Chen
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.
| |
Collapse
|
14
|
Li J, Liu Y, Ma L, Gu L, Wang Q, Xu M, Ma R, Zhang Y, Yang Z, Deng J, Yi X. The performance of T-cell Xtend reagent in increasing blood storage times for interferon gamma release assays. J Clin Lab Anal 2017; 32. [PMID: 28670691 DOI: 10.1002/jcla.22253] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 04/10/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND T-cell Xtend (TCX) was introduced to extend the blood storage time for T-SPOT.TB test, a widely used commercial interferon gamma release assay (IGRA) for rapid in vitro tuberculosis. METHODS A total of 99 Uyghur suspected tuberculosis patients were recruited in this study. T-SPOT.TB test was performed with fresh blood (controls), 36 hours delayed blood and delayed and TCX-treated (at 36 hours) blood from each patient, respectively. RESULTS White blood cells and lymphocytes proportion in peripheral blood mononuclear cells s and spot-forming cells in positive control wells decreased significantly in delayed blood samples when compared with controls, while this decrease was not detected in TCX-treated group. In the 58 patients with paired T-SPOT.TB results of three groups of samples, a higher positive rate was observed in TCX-treated group than both in controls and untreated group (41.4% vs 37.9% and 25.9%). The concordance of T-SPOT.TB results between the treated group and controls was 0.856, whereas the agreement between controls and untreated group was unsatisfactory (0.649). In the 23 elderly patients (>70 years old) with paired T-SPOT.TB results of controls and TCX group, treated group showed a non-significant trend toward higher positive rate than controls (43.5% vs 26.1%, P=.22). Meanwhile, TCX treatment reduced the risk of false negative T-SPOT.TB results in the elderly population. CONCLUSION Deterioration of blood sample caused by long storage time can be neutralized by TCX treatment. The results provide data for the utility of TCX in a novel population and in Asian region, and reveal the potential of TCX to improve the accuracy of T-SPOT.TB test in elderly population.
Collapse
Affiliation(s)
- Junlian Li
- Department of Clinical Laboratory, Chest Hospital of Xinjiang Uyghur Autonomous Region, Urumqi, Xinjiang, China
| | - Yan Liu
- Department of Clinical Laboratory, Chest Hospital of Xinjiang Uyghur Autonomous Region, Urumqi, Xinjiang, China
| | - Liyamu Ma
- Department of Clinical Laboratory, Chest Hospital of Xinjiang Uyghur Autonomous Region, Urumqi, Xinjiang, China
| | - Libike Gu
- Department of Clinical Laboratory, Chest Hospital of Xinjiang Uyghur Autonomous Region, Urumqi, Xinjiang, China
| | - Quan Wang
- Department of Clinical Laboratory, Chest Hospital of Xinjiang Uyghur Autonomous Region, Urumqi, Xinjiang, China
| | - Miao Xu
- Department of Clinical Laboratory, Chest Hospital of Xinjiang Uyghur Autonomous Region, Urumqi, Xinjiang, China
| | - Ruiying Ma
- Department of Clinical Laboratory, Chest Hospital of Xinjiang Uyghur Autonomous Region, Urumqi, Xinjiang, China
| | - Yali Zhang
- Department of Clinical Laboratory, Chest Hospital of Xinjiang Uyghur Autonomous Region, Urumqi, Xinjiang, China
| | - Zhenping Yang
- Department of Clinical Laboratory, Chest Hospital of Xinjiang Uyghur Autonomous Region, Urumqi, Xinjiang, China
| | - Junjie Deng
- Department of Clinical Laboratory, Chest Hospital of Xinjiang Uyghur Autonomous Region, Urumqi, Xinjiang, China
| | - Xing Yi
- Department of Clinical Laboratory, Chest Hospital of Xinjiang Uyghur Autonomous Region, Urumqi, Xinjiang, China
| |
Collapse
|
15
|
Liu Q, Li W, Chen Y, Du X, Wang C, Liang B, Tang Y, Feng Y, Tao C, He JQ. Performance of interferon- γ release assay in the diagnosis of tuberculous lymphadenitis: a meta-analysis. PeerJ 2017; 5:e3136. [PMID: 28413722 PMCID: PMC5391793 DOI: 10.7717/peerj.3136] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 03/01/2017] [Indexed: 02/05/2023] Open
Abstract
Background The diagnostic values of interferon-gamma release assays (IGRA) in tuberculosis (TB) vary a lot with different site of infections, with especially higher sensitivities in chronic forms of TB such as tuberculosis of the lymph node. We conducted a meta-analysis to comprehensively evaluate the overall accuracy of diagnostic IGRA for tuberculous lymphadenitis. Methods Pubmed, Web of Science, EMBASE, Wanfang and CNKI databases up to February 17, 2017 were searched to identify published studies. The study quality was evaluated using the QUADAS-2 checklist. The pooled estimates of diagnostic parameters were generated using a bivariate random-effects model and summary receiver operating characteristic (SROC) curves were used to summarize global performance. Results A total of ten qualified studies, performed in Korea or China, including 1,084 patients, were enrolled in this meta-analysis. The pooled estimates of diagnostic accuracy were as follows: sensitivity, 0.89 (95% CI [0.85–0.92]); specificity, 0.81 (95% CI [0.77–0.83]); positive likelihood ratio (PLR), 4.25 (95% CI [2.79–6.47]); negative likelihood ratio (NLR), 0.16 (95% CI [0.12–0.22]); and area under the curve (AUC) was 0.93. According to subgroup analyses, studies conducted using QuantiFERON-TB, in Korean population and focusing on cervical lymphadenitis exhibited relative higher specificity while lower sensitivity. No evidence of publication bias was identified. Conclusions IGRA exhibits high diagnostic accuracy in tuberculous lymphadenitis. The diagnostic value of IGRA differed by different IGRA methods, ethnicity and lymphadenitis location. Our conclusion may be more applicable to population from TB prevalent areas.
Collapse
Affiliation(s)
- Qianqian Liu
- Department of Respiratory Diseases, Chengdu Municipal First People's Hospital, Chengdu, Sichuan, China.,Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wenzhang Li
- Department of Cardiology, First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Yunfeng Chen
- Department of Respiratory Diseases, Chengdu Municipal First People's Hospital, Chengdu, Sichuan, China
| | - Xinmiao Du
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chengdi Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Binmiao Liang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yin Tang
- State Key Laboratory of Oral Disease, West China School & Hospital of Stomotology, Sichuan University, Chengdu, Sichuan, China.,Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - Yulin Feng
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chuanmin Tao
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jian-Qing He
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| |
Collapse
|
16
|
Chang PC, Wang PH, Chen KT. Use of the QuantiFERON-TB Gold In-Tube Test in the Diagnosis and Monitoring of Treatment Efficacy in Active Pulmonary Tuberculosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14030236. [PMID: 28264462 PMCID: PMC5369072 DOI: 10.3390/ijerph14030236] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 02/09/2017] [Accepted: 02/23/2017] [Indexed: 12/17/2022]
Abstract
The value of QuantiFERON in the diagnosis of tuberculosis disease and in the monitoring of the response to anti-tuberculosis treatment is unclear. The aims of this study were to evaluate the accuracy of the QuantiFERON-TB Gold In-Tube (QFT-GIT) test in the diagnosis of tuberculosis and in the monitoring of the response to anti-tuberculosis treatment in patients with active pulmonary tuberculosis (PTB). Between January 2013 and December 2015, 133 cases with active PTB and 133 controls with no mycobacterial infection, matched by age (within 3 years) and by the week that they visited Tainan Chest Hospital, were enrolled in the study. Serial testing by QFT-GIT at baseline and after 2 and 6 months of treatment was performed. At these time points, a comparison of the performance of QFT-GIT with that of sputum culture status among study subjects was conducted. Compared to baseline, 116 (87.2%) cases showed a decreased response, whereas 17 (12.8%) showed persistent or stronger interferon-gamma (IFN-γ) responses at 2 months. PTB patients IFN-γ responses declined significantly from baseline to 2 months (median, 6.32 vs. 4.12; p < 0.005). The sensitivity values of the QFT-GIT test for the detection of pulmonary tuberculosis at cut-off points of 0.35 IU/mL, 0.20 IU/mL, and 0.10 IU/mL were 74.4%, 78.2%, and 80.5%, respectively. The specificity values at cut-off points of 0.35 IU/mL, 0.20 IU/mL, and 0.10 IU/mL were 66.2%, 63.9%, and 57.1%, respectively. Our results support the QFT-GIT assay as a potential tool for diagnosing tuberculosis and for monitoring the efficacy of anti-tuberculosis treatment.
Collapse
Affiliation(s)
- Ping-Chin Chang
- Division of Infectious Diseases, Department of Internal Medicine, Chi-Mei Medical Center, Liouying, Tainan 736, Taiwan.
| | - Pin-Hui Wang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan.
| | - Kow-Tong Chen
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan.
- Department of Occupational Medicine, Tainan Municipal Hospital, Tainan 701, Taiwan.
| |
Collapse
|
17
|
Naidoo N, Pillay M. Bacterial pili, with emphasis on Mycobacterium tuberculosis curli pili: potential biomarkers for point-of care tests and therapeutics. Biomarkers 2016; 22:93-105. [PMID: 27797276 DOI: 10.1080/1354750x.2016.1252960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
CONTEXT Novel biomarkers are essential for developing rapid diagnostics and therapeutic interventions Objective: This review aimed to highlight biomarker characterisation and assessment of unique bacterial pili. METHODS A PubMed search for bacterial pili, diagnostics, vaccine and therapeutics was performed, with emphasis on the well characterised pili. RESULTS In total, 46 papers were identified and reviewed. CONCLUSION Extensive analyses of pili enabled by advanced nanotechnology and whole genome sequencing provide evidence that they are strong biomarker candidates. Mycobacterium tuberculosis curli pili are emphasised as important epitopes for the development of much needed point-of-care diagnostics and therapeutics.
Collapse
Affiliation(s)
- Natasha Naidoo
- a Medical Microbiology and Infection Control , School of Laboratory Medicine and Medical Sciences, College of Health Science, University of KwaZulu-Natal, Congella , Durban , South Africa
| | - Manormoney Pillay
- a Medical Microbiology and Infection Control , School of Laboratory Medicine and Medical Sciences, College of Health Science, University of KwaZulu-Natal, Congella , Durban , South Africa
| |
Collapse
|
18
|
Early diagnosis of spinal tuberculosis. J Formos Med Assoc 2016; 115:825-836. [PMID: 27522334 DOI: 10.1016/j.jfma.2016.07.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 06/28/2016] [Accepted: 07/02/2016] [Indexed: 11/23/2022] Open
Abstract
Spinal tuberculosis (STB) is a common manifestation of extrapulmonary tuberculosis (TB). STB accounts for around 2% of all cases of TB and around 15% of extrapulmonary TB cases. The World Health Organization has proposed a global strategy and targets for TB prevention, care, and control after 2015. Under this strategy, patients will receive standard care according to the recommendations and guidelines after confirmation of STB diagnosis. However, current recommendations and guidelines focus on disease and medication therapy management, and recommendations for early detection or decision-making algorithms regarding STB are lacking. In this review, we identified five key components for early diagnosis: (1) risk factors for STB; (2) common symptoms/signs of STB; (3) significant neuroradiological findings of STB; (4) significant laboratory findings of STB, including positive interferon-γ release assays and nonpyogenic evidence in initial laboratory data; and (5) significant clinical findings of STB. Individualized consideration for each patient with STB is essential, and we hope that the algorithm established in this review will provide a valuable tool for physicians who encounter cases of STB.
Collapse
|
19
|
Anwar A, Hamdan AJ, Salim B, Yosra A, Hani M, Abdullah AH. Diagnostic Utility of QuantiFERON-TB Gold (QFT-G) in Active Pulmonary Tuberculosis. J Glob Infect Dis 2015; 7:108-12. [PMID: 26392718 PMCID: PMC4557139 DOI: 10.4103/0974-777x.162231] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The utility of QuantiFERON-TB Gold In-Tube (QFT-G) test in the diagnosis of tuberculosis disease has been validated in high and low tuberculosis-prevalent (TB) countries. Aim: The aim of this study is to assess the performance of the QFT-G test in the diagnosis of tuberculosis disease among tuberculosis patients in an intermediate prevalent country. Setting and Design: A retrospective study at the King Abdulaziz Medical City-Riyadh (KAMC-R) Materials and Methods: We retrospectively reviewed all the patients with a diagnosis of pneumonia, including tuberculosis, admitted to KAMC-R between 1 January 2009 and 31 December 2013. We included only patients with an available result of the QFT-G test. A total of 142 tuberculosis cases and 226 pneumonia cases were studied, to assess the utility of the QFT-G test in diagnosing tuberculosis cases. Results: Among the tuberculosis (n = 142) cases, the QFT-G tested positive in 68.3%, negative in 23.2%, and indeterminate in 12 cases (8.5%). Of the 226 pneumonia cases, the QFT-G tested positive in only 20.4%, while a majority of 66.4% tested negative, with 30 cases (13.3%) being indeterminate. When we excluded 42 patients with indeterminate results, the QFT-G test achieved a sensitivity of 74.6% [95% CI: 66.09 to 81.65%] and specificity of 76.53 % [95% CI: 69.85 to 82.15%] in the diagnosis of tuberculosis cases. Conclusions: This study concludes that the QFT-G test is a useful tool for detecting tuberculosis disease when used as an adjunct tool for the diagnosis of active TB cases. It certainly cannot be used solely and indiscriminately, separate from other clinical and radiological information, in the diagnosis of active tuberculosis cases.
Collapse
Affiliation(s)
- Ahmed Anwar
- King Abdullah International Medical Research Center/College of Public Health and Health Informatics, Riyadh, Kingdom of Saudi Arabia
| | - Al-Jahdali Hamdan
- Department of Medicine, Pulmonary Division-ICU, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Baharoon Salim
- Department of Medicine, Pulmonary Division-ICU, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Ali Yosra
- King Abdullah International Medical Research Center/College of Public Health and Health Informatics, Riyadh, Kingdom of Saudi Arabia
| | - Mohamed Hani
- The George Washington University, Washington, DC, USA
| | - Al-Harbi Abdullah
- Department of Medicine, Pulmonary Division-ICU, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| |
Collapse
|
20
|
Kwon YS, Kim YH, Jeon K, Jeong BH, Ryu YJ, Choi JC, Kim HC, Koh WJ. Factors that Predict Negative Results of QuantiFERON-TB Gold In-Tube Test in Patients with Culture-Confirmed Tuberculosis: A Multicenter Retrospective Cohort Study. PLoS One 2015; 10:e0129792. [PMID: 26070207 PMCID: PMC4466377 DOI: 10.1371/journal.pone.0129792] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 05/14/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Interferon-γ release assays such as the QuantiFERON-TB Gold In-Tube Test (QFT-GIT) are designed to detect Mycobacterium tuberculosis infections, whether latent or manifesting as disease. However, a substantial number of persons with culture-confirmed tuberculosis (TB) have negative QFT-GITs. Information on host factors contributing to false-negative and indeterminate results are limited. METHODS A multicenter retrospective cohort study was performed with 1,264 culture-confirmed TB patients older than 18 years who were subjected to the QFT-GIT at one of the six hospitals between May 2007 and February 2014. Patients with human immunodeficiency virus infection were excluded. Clinical and laboratory data were collected in South Korea. RESULTS Of all patients, 87.6% (1,107/1,264) were diagnosed with pulmonary TB and 12.4% (157/1,264) with extrapulmonary TB. The rate of negative results was 14.4% (182/1,264). The following factors were highly correlated with false-negative results in the QFT-GIT: advanced age (age ≥ 65 years, odds ratio [OR] 1.57, 95% confidence interval [CI] 1.03-2.39), bilateral disease as determined by chest radiography (OR 1.75, 95% CI 1.13-2.72), malignancy (OR 2.42, 95% CI 1.30-4.49), and lymphocytopenia (total lymphocyte count < 1.0 × 109/L, OR 1.86, 95% CI 1.21-2.87). CONCLUSIONS Consequently, QFT-GIT results need to be interpreted with caution in patients with these host risk factors such as the elderly, bilateral disease on chest radiography, or malignancy, or lymphocytopenia.
Collapse
Affiliation(s)
- Yong-Soo Kwon
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Yee Hyung Kim
- Department of Pulmonary and Critical Care Medicine, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Kyeongman Jeon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byeong-Ho Jeong
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yon Ju Ryu
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Ewha Medical Center and Ewha Medical Research Institute, Ewha Womans University School of Medicine, Mokdong Hospital, Seoul, Korea
| | - Jae Chol Choi
- Department of Internal Medicine, Chung-Ang University School of Medicine, Seoul, Korea
| | - Ho Cheol Kim
- Department of Internal Medicine, College of Medicine, Gyeongsang Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
| | - Won-Jung Koh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- * E-mail:
| |
Collapse
|
21
|
Pan L, Jia H, Liu F, Sun H, Gao M, Du F, Xing A, Du B, Sun Q, Wei R, Gu S, Zhang Z. Risk factors for false-negative T-SPOT.TB assay results in patients with pulmonary and extra-pulmonary TB. J Infect 2015; 70:367-80. [DOI: 10.1016/j.jinf.2014.12.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 11/28/2014] [Accepted: 12/01/2014] [Indexed: 10/24/2022]
|
22
|
Evaluation of the characteristics of the enzyme-linked immunospot assay for diagnosis of active tuberculosis in China. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2015; 22:510-5. [PMID: 25739918 DOI: 10.1128/cvi.00023-15] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 03/03/2015] [Indexed: 11/20/2022]
Abstract
The purpose of this study was to evaluate the characteristics of the T-SPOT.TB test for the diagnosis of active tuberculosis (ATB) and to distinguish ATB from other diseases using a receiver operating characteristic (ROC) curve. A total of 535 patients with suspected active tuberculosis were enrolled in the study and divided into ATB and nonactive tuberculosis (NATB) groups, as well as pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (EPTB) subgroups. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio of the T-SPOT.TB test for the diagnosis of ATB were 84.95%, 85.12%, 82.94%, 86.93%, 5.71, and 0.18, respectively. The median number of spot-forming cells (SFCs) in the ATB group was higher than that in the NATB group (71 versus 1; P < 0.0001). The sensitivities in the PTB and EPTB subgroups were 92.31% and 81.77%. The areas under the curve (AUC) for the diagnosis of ATB using the T-SPOT.TB, early secreted antigenic target 6 (ESAT-6), and culture filtrate protein 10 (CFP-10) were 0.906, 0.884, and 0.877, respectively. A cutoff of 42.5 SFCs for ATB yielded a positive predictive value of 100%. Our study shows that the T-SPOT.TB test is useful for the diagnosis of ATB. Utilizing an ROC curve to select an appropriate cutoff made it possible to discriminate ATB from NATB.
Collapse
|
23
|
Kim HC, Jo KW, Jung YJ, Yoo B, Lee CK, Kim YG, Yang SK, Byeon JS, Kim KJ, Ye BD, Shim TS. Diagnosis of latent tuberculosis infection before initiation of anti-tumor necrosis factor therapy using both tuberculin skin test and QuantiFERON-TB Gold In Tube assay. ACTA ACUST UNITED AC 2014; 46:763-9. [PMID: 25195652 DOI: 10.3109/00365548.2014.938691] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Reactivation of latent tuberculosis infection (LTBI) is an important complication in patients treated with tumor necrosis factor-alpha (TNF-α) blocking agents. However, the best method for LTBI detection before initiation of anti-TNF therapy remains to be determined. METHODS From January 2010 to August 2013, anti-TNF therapy was initiated in 426 patients with immune-mediated inflammatory diseases (IMIDs). Tuberculin skin test (TST) and Quantiferon-TB Gold In Tube (QFT-GIT) assay were performed before starting anti-TNF treatment. LTBI was defined as a positive TST (induration ≥ 10 mm) or as a positive QFT-GIT result. Patients were followed up until December 2013. RESULTS The positive TST and QFT-GIT rates were 22.3% (95/426) and 16.0% (68/426), respectively, yielding a total of 27.0% (115/426) of positive LTBI results. LTBI treatment was initiated in 25.1% (107/426) and was completed in 100% (107/107) of patients. During a median 294 days of follow-up, active TB occurred in 1.4% (6/426) of the patients with negative TST and QFT-GIT results at baseline. CONCLUSION The either test positive strategy, using both TST and QFT-GIT assay, is acceptable for LTBI screening before commencing anti-TNF therapy in patients with IMIDs.
Collapse
Affiliation(s)
- Ho-Cheol Kim
- Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center , Seoul , South Korea
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Mycobacterial bone marrow infections at a medical centre in Taiwan, 2001-2009. Epidemiol Infect 2013; 142:1524-32. [PMID: 24168831 DOI: 10.1017/s0950268813002707] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Mycobacterial bone marrow (BM) infection is the most common diagnosis established by BM examinations for fever of unknown origin. In this study, clinical features and outcomes of patients who fulfilled the criteria for BM infection due to Mycobacterium tuberculosis (MTB) and non-tuberculous mycobacteria (NTM) at a medical centre in Taiwan from 2001 to 2009 were investigated. The BM histopathological findings were also analysed. A total of 24 patients (16 men, eight women) with mycobacterial BM infections were found. Of these, nine (38%) were positive for human immunodeficiency virus (HIV) and six (25%) had no pre-existing immunocompromised conditions. MTB isolates were obtained from 11 (46%) patients and NTM species were isolated from 10 (42%) patients, including M. avium complex (MAC, n = 7) and M. kansasii (n = 3). Patients with MTB infections were significantly older than those with NTM infections (60·5 vs. 47·7 years, P = 0·043) and were less likely to have a positive BM culture (45% vs. 100%, P = 0·012). The 90-day survival rates for MTB and NTM BM infections were 68% and 60%, respectively (P = 0·61). In addition, the presence of BM granulomas was significantly more common in patients with MTB BM infections than in those with NTM infections (82% vs. 30%, P = 0·030). In Taiwan, the importance of NTM was not inferior to MTB and besides MAC, M. kansasii might be an important pathogen in non-HIV-infected patients. The presence of BM granulomas and caseation provides valuable information regarding early treatment pending culture results.
Collapse
|
25
|
Lee MR, Chung KP, Wang HC, Lin CB, Yu CJ, Lee JJ, Hsueh PR. Evaluation of the Cobas TaqMan MTB real-time PCR assay for direct detection of Mycobacterium tuberculosis in respiratory specimens. J Med Microbiol 2013; 62:1160-1164. [PMID: 23657531 DOI: 10.1099/jmm.0.052043-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The Cobas TaqMan MTB assay is a real-time PCR (qPCR) kit for rapid detection of Mycobacterium tuberculosis from clinical specimens. There are, however, limited studies validating its performance. We performed a prospective study in two hospitals in Taiwan on 586 respiratory specimens. By using culture as the reference method, the sensitivity and specificity of the Cobas TaqMan MTB assay were found to be 82.7 and 96.5 %, respectively. The sensitivity of the Cobas TaqMan MTB assay in acid-fast stain-negative respiratory specimens was only 34.9 %. Five specimens from five patients were positive for M. tuberculosis by the Cobas TaqMan MTB assay but were negative for M. tuberculosis by conventional culture methods. A diagnosis of pulmonary tuberculosis (TB) was made based on clinical and radiological findings as well as the response to anti-TB treatment in these five patients. Addition of data from these five specimens with discrepant results (PCR vs culture) from patients with symptoms clinically compatible with TB increased the sensitivity of the Cobas TaqMan MTB assay to 83.1 %. The Cobas TaqMan MTB assay is a rapid identification tool with a high degree of specificity for the direct detection of M. tuberculosis in respiratory specimens. The sensitivity for detecting acid-fast smear-negative respiratory specimens, however, is low.
Collapse
Affiliation(s)
- Meng-Rui Lee
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC.,Department of Internal Medicine, Taoyuan General Hospital, Taoyuan County, Taiwan, ROC
| | - Kuei-Pin Chung
- Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan, ROC.,Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Hao-Chien Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Chih-Bin Lin
- Department of Internal Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan, ROC
| | - Chong-Jen Yu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Jen-Jyh Lee
- Department of Internal Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan, ROC
| | - Po-Ren Hsueh
- Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan, ROC.,Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC
| |
Collapse
|
26
|
Su SY, Chao CM, Lai CC. Diagnostic performance of interferon-Gamma assay for tuberculosis in immunocompromised patients. Ann Thorac Med 2013; 8:64. [PMID: 23437019 PMCID: PMC3573562 DOI: 10.4103/1817-1737.105723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Shih-Yang Su
- Department of Emergency Medicine, Tainan Municipal Hospital, Liouying, Taiwan E-mail:
| | | | | |
Collapse
|
27
|
Kang JY, Rhee CK, Kang NH, Kim JS, Yoon HK, Song JS. Clinical Utility of Two Interferon-gamma Release Assays on Pleural Fluid for the Diagnosis of Tuberculous Pleurisy. Tuberc Respir Dis (Seoul) 2012; 73:143-50. [PMID: 23166547 PMCID: PMC3492399 DOI: 10.4046/trd.2012.73.3.143] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Revised: 01/30/2012] [Accepted: 08/02/2012] [Indexed: 11/24/2022] Open
Abstract
Background The release of interferon-gamma (IFN-γ) by T lymphocytes increases after rechallenge with Mycobacterium tuberculosis antigen, especially, at a localized site of tuberculosis (TB) infection. We aimed to compare the clincial efficacy of two commercial IFN-γ release assays from pleural fluid for the diagnosis in tuberculous pleurisy. Methods We performed T-SPOT.TB and QuantiFERON-TB Gold tests simultaneously on pleural fluid and peripheral blood samples from patients with pleural effusion, in South Korea, an area with intermediate TB burden. Results Thirty-six patients were enrolled prospectively, and tuberculous pleurisy was found in 21 patients. Both the numbers of IFN-γ secreting T cells and the concentration of IFN-γ were greater in the pleural tuberculous group, comparing with the non-tuberculous group. Moreover, in the tuberculous group, there was a significant difference in IFN-γ producing spot-forming cells using the T-SPOT.TB method between pleural fluid and peripheral blood. The receiver operating characteristic (ROC) curve, was the greatest for pleural fluid T-SPOT.TB test, followed by peripheral blood T-SPOT.TB test, peripheral blood QuantiFERON-TB Gold test, and pleural fluid QuantiFERON-TB Gold test (area under the ROC curve of 0.956, 0.890, 0.743, and 0.721, respectively). The T-SPOT.TB assay produced less indeterminate results than did QuantiFERON-TB Gold assay in both pleural fluid and peripheral blood. Conclusion These findings suggest that the pleural fluid T-SPOT.TB test could be the most useful test among the IFN-γ release assays for diagnosing tuberculous pleurisy in an area with an intermediate prevalence of TB infection.
Collapse
Affiliation(s)
- Ji Young Kang
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | | | | | | | | | | |
Collapse
|
28
|
Lai CC, Wang HC. Diagnostic performance of enzyme-linked immunospot assay and whole-blood interferon-γ assay for the diagnosis of extrapulmonary tuberculosis. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2011; 44:406-7. [DOI: 10.1016/j.jmii.2011.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|