1
|
Rubin F, Jameleddine E, Guiquerro S, Laccourreye O. Laryngeal tuberculosis in the early 21st century. Literature review of clinical, diagnostic and therapeutic data, according to SWiM guidelines. Eur Ann Otorhinolaryngol Head Neck Dis 2024; 141:147-152. [PMID: 38238187 DOI: 10.1016/j.anorl.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2024]
Abstract
OBJECTIVES Review of the scientific medical literature dedicated to clinical data, diagnosis and treatment for laryngeal tuberculosis published since the turn of the 21st century. MATERIAL AND METHODS Search of the Medline, Cochrane and Embase databases for the period 2000-2022. Selection of cohorts and case reports documenting clinical data, diagnosis and treatment for laryngeal tuberculosis. RESULTS In total, 119 articles were analyzed. Immunodepression, HIV infection, history of lung tuberculosis, general symptoms suggesting tuberculosis, smoking and associated laryngeal cancer were noted in 18%, 3%, 20% and 41% of cases, respectively. No pathognomonic symptoms or signs emerged. Voice impairment, of various types and severity, isolated and/or associated with other signs, was the most frequent laryngeal symptom, in 86% of cases. All laryngeal sites were involved, with numerous and various associations. Impaired laryngeal motion and tracheotomy were noted in 6% and 1% of cases, respectively. Time to diagnosis varied from less than 1month to 36months, for a median 3months, in case reports. Laryngeal tuberculosis was diagnosed bacteriologically with certainty in 28% of cases while diagnosis was based on indirect criteria and/or involvement of another site in the other 72%, with lung involvement in 54%. Treatment duration ranged from 6 to 24months (median, 6months), using 3 to 5 (median: 4) antitubercular antibiotics, with 4 used in 80% of cohorts and 77% of case reports. Overall rates of cure, death, treatment resistance, adverse events, and laryngeal sequelae were 99%, 0.5%, 0.5%, 6% and 5%, respectively. CONCLUSION The clinical presentation and diagnostic difficulty in laryngeal tuberculosis did not change since the end of the 20th century. Quadritherapy is highly effective, with a low resistance rate and few adverse effects or laryngeal sequelae.
Collapse
Affiliation(s)
- F Rubin
- Clinique St-Vincent, 8, rue de Paris, CS 71027, 97404 Saint-Denis cedex, Reunion.
| | - E Jameleddine
- Université Paris Cité, Service d'Otorhinolaryngologie et de Chirurgie Cervico-Faciale, HEGP, Assistance publique des Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France
| | - S Guiquerro
- Université Paris Cité, Bibliothèque Universitaire Necker, 160, rue de Vaugirard, 75015 Paris, France
| | - O Laccourreye
- Université Paris Cité, Service d'Otorhinolaryngologie et de Chirurgie Cervico-Faciale, HEGP, Assistance publique des Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France
| |
Collapse
|
2
|
Chung WY, Lee KS, Park JH, Jung YJ, Sheen SS, Park JE, Sun JS, Ko YH, Park KJ. TB Antigen-Stimulated CXCR3 Ligand Assay for Diagnosis of Tuberculous Lymphadenitis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158020. [PMID: 34360313 PMCID: PMC8345678 DOI: 10.3390/ijerph18158020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/23/2021] [Accepted: 07/25/2021] [Indexed: 12/21/2022]
Abstract
The diagnosis of tuberculous lymphadenitis (TB-LAP) is challenging. We evaluated the role of blood CXC chemokine receptor 3 (CXCR3) ligands in its diagnosis. A total of 65 lymphadenopathy patients were enrolled and lymph node sampling was performed. We also recruited 113 control subjects, consisting of 27 with positive results and 86 with negative results, in the interferon (IFN)-γ release assay (IGRA). In all study subjects, whole-blood samples were collected using the IGRA methodology. After incubation, plasma levels of IFN-γ and two CXCR3 ligands, IFN-inducible T-cell a chemoattractant (I-TAC) and monokine induced by IFN-γ (MIG), were measured using immunoassay. Fifty-three TB-LAP patients were enrolled. TB antigen-stimulated IFN-γ, I-TAC, and MIG levels were all significantly higher in the TB-LAP patients than in the controls and non-TB-LAP patients. The levels of I-TAC and MIG, but not IFN-γ, showed significant differences between the TB-LAP patients and IGRA-positive controls. Area under the receiver operating characteristic curves (AUROCs) of IFN-γ, I-TAC, and MIG were 0.955, 0.958, and 0.959, respectively, for differentiating TB-LAP from control group, and were 0.912, 0.956, and 0.936, respectively, for differentiating TB-LAP from non-TB-LAP. In conclusion, the TB antigen-stimulated MIG and I-TAC could be useful biomarkers in the diagnosis of TB-LAP.
Collapse
Affiliation(s)
- Wou-Young Chung
- Department of Pulmonology and Critical Care Medicine, Ajou University Hospital, Suwon 16499, Korea; (W.-Y.C.); (K.-S.L.); (J.-H.P.); (Y.-J.J.); (S.-S.S.); (J.-E.P.)
| | - Keu-Sung Lee
- Department of Pulmonology and Critical Care Medicine, Ajou University Hospital, Suwon 16499, Korea; (W.-Y.C.); (K.-S.L.); (J.-H.P.); (Y.-J.J.); (S.-S.S.); (J.-E.P.)
| | - Joo-Hun Park
- Department of Pulmonology and Critical Care Medicine, Ajou University Hospital, Suwon 16499, Korea; (W.-Y.C.); (K.-S.L.); (J.-H.P.); (Y.-J.J.); (S.-S.S.); (J.-E.P.)
| | - Yun-Jung Jung
- Department of Pulmonology and Critical Care Medicine, Ajou University Hospital, Suwon 16499, Korea; (W.-Y.C.); (K.-S.L.); (J.-H.P.); (Y.-J.J.); (S.-S.S.); (J.-E.P.)
| | - Seung-Soo Sheen
- Department of Pulmonology and Critical Care Medicine, Ajou University Hospital, Suwon 16499, Korea; (W.-Y.C.); (K.-S.L.); (J.-H.P.); (Y.-J.J.); (S.-S.S.); (J.-E.P.)
| | - Ji-Eun Park
- Department of Pulmonology and Critical Care Medicine, Ajou University Hospital, Suwon 16499, Korea; (W.-Y.C.); (K.-S.L.); (J.-H.P.); (Y.-J.J.); (S.-S.S.); (J.-E.P.)
| | - Joo-Sung Sun
- Department of Radiology, Ajou University Hospital, Suwon 16499, Korea;
| | - Young-Hwa Ko
- Department of Pathology, Ajou University Hospital, Suwon 16499, Korea;
| | - Kwang-Joo Park
- Department of Pulmonology and Critical Care Medicine, Ajou University Hospital, Suwon 16499, Korea; (W.-Y.C.); (K.-S.L.); (J.-H.P.); (Y.-J.J.); (S.-S.S.); (J.-E.P.)
- Correspondence: ; Tel.: +82-31-219-5120
| |
Collapse
|
3
|
Zang J, Tian Y, Jiang X, Lin XY. Appearance and morphologic features of laryngeal tuberculosis using laryngoscopy: A retrospective cross-sectional study. Medicine (Baltimore) 2020; 99:e23770. [PMID: 33371143 PMCID: PMC7748357 DOI: 10.1097/md.0000000000023770] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 11/16/2020] [Indexed: 12/23/2022] Open
Abstract
Laryngeal tuberculosis (LTB) is highly contagious and can cause permanent laryngeal damage. Therefore, correctly identifying laryngoscopic LTB lesion locations, sizes, and morphologic features are essential for LTB diagnoses. This study aimed to explore the appearance and morphologic features of LTB and correlated these features with clinical symptoms.We retrospectively analysed 39 LTB patients in our hospital between January 2013 and December 2019. Medical records, including clinical presentation, lesion appearance (locations, sizes, and morphology), complementary examination results, and histopathologic features were summarized and analysed.In this patient cohort, dysphonia and sore throat were the two most common clinical symptoms. In LTB patients with extensive lesions, ulcerative lesions were most common, and the proportion of cases with concurrent pulmonary tuberculosis (86.4%, P = .033) infection was higher, as were the positive rates of sputum smears (72.7%, P = .011) and cultures (86.4%, P = .002) than patients without concurrent pulmonary TB and with more localized and exophytic lesions. The histopathologic features of LTB-related ulcerative lesions included fewer granulomas and more areas with caseous necrosis. These lesions were more likely to have acid-fast bacilli detected with a Ziehl-Neelsen stain than exophytic lesions that rarely showed detectable bacilli.A complete knowledge regarding the visual and morphologic features of LTB on laryngoscopy is needed for the early detection and diagnosis of LTB. Our study revealed the lesion sites, sizes, and morphologic features of LTB. These parameters were also correlated with patient clinical symptoms. Future studies are needed to support and expand the results of this retrospective study.
Collapse
Affiliation(s)
- Jian Zang
- Department of Otolaryngology, The First Affiliated Hospital, China Medical University, Shenyang
| | - Ying Tian
- Department of Otolaryngology, The First Affiliated Hospital, China Medical University, Shenyang
| | - Xuejun Jiang
- Department of Otolaryngology, The First Affiliated Hospital, China Medical University, Shenyang
| | - Xu-Yong Lin
- Department of Pathology, The First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang, Liaoning, China
| |
Collapse
|
4
|
Takwoingi Y, Whitworth H, Rees-Roberts M, Badhan A, Partlett C, Green N, Boakye A, Lambie H, Marongiu L, Jit M, White P, Deeks JJ, Kon OM, Lalvani A. Interferon gamma release assays for Diagnostic Evaluation of Active tuberculosis (IDEA): test accuracy study and economic evaluation. Health Technol Assess 2020; 23:1-152. [PMID: 31138395 DOI: 10.3310/hta23230] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Interferon gamma release assays (IGRAs) are blood tests recommended for the diagnosis of tuberculosis (TB) infection. There is currently uncertainty about the role and clinical utility of IGRAs in the diagnostic workup of suspected active TB in routine NHS clinical practice. OBJECTIVES To compare the diagnostic accuracy and cost-effectiveness of T-SPOT.TB ® (Oxford Immunotec, Abingdon, UK) and QuantiFERON® TB GOLD In-Tube (Cellestis, Carnegie, VIC, Australia) for diagnosis of suspected active TB and to estimate the diagnostic accuracy of second-generation IGRAs. DESIGN Prospective within-patient comparative diagnostic accuracy study. SETTING Secondary care. PARTICIPANTS Adults (aged ≥ 16 years) presenting as inpatients or outpatients at 12 NHS hospital trusts in London, Slough, Oxford, Leicester and Birmingham with suspected active TB. INTERVENTIONS The index tests [T-SPOT.TB and QuantiFERON GOLD In-Tube (QFT-GIT)] and new enzyme-linked immunospot assays utilising novel Mycobacterium tuberculosis antigens (Rv3615c, Rv2654, Rv3879c and Rv3873) were verified against a composite reference standard applied by a panel of clinical experts blinded to IGRA results. MAIN OUTCOME MEASURES Sensitivity, specificity, predictive values and likelihood ratios were calculated to determine diagnostic accuracy. A decision tree model was developed to calculate the incremental costs and incremental health utilities [quality-adjusted life-years (QALYs)] of changing from current practice to using an IGRA as an initial rule-out test. RESULTS A total of 363 patients had active TB (culture-confirmed and highly probable TB cases), 439 had no active TB and 43 had an indeterminate final diagnosis. Comparing T-SPOT.TB and QFT-GIT, the sensitivities [95% confidence interval (CI)] were 82.3% (95% CI 77.7% to 85.9%) and 67.3% (95% CI 62.1% to 72.2%), respectively, whereas specificities were 82.6% (95% CI 78.6% to 86.1%) and 80.4% (95% CI 76.1% to 84.1%), respectively. T-SPOT.TB was more sensitive than QFT-GIT (relative sensitivity 1.22, 95% CI 1.14 to 1.31; p < 0.001), but the specificities were similar (relative specificity 1.02, 95% CI 0.97 to 1.08; p = 0.3). For both IGRAs the sensitivity was lower and the specificity was higher for human immunodeficiency virus (HIV)-positive than for HIV-negative patients. The most promising novel antigen was Rv3615c. The added value of Rv3615c to T-SPOT.TB was a 9% (95% CI 5% to 12%) relative increase in sensitivity at the expense of specificity, which had a relative decrease of 7% (95% CI 4% to 10%). The use of current IGRA tests for ruling out active TB is unlikely to be considered cost-effective if a QALY was valued at £20,000 or £30,000. For T-SPOT.TB, the probability of being cost-effective for a willingness to pay of £20,000/QALY was 26% and 21%, when patients with indeterminate test results were excluded or included, respectively. In comparison, the QFT-GIT probabilities were 8% and 6%. Although the use of IGRAs is cost saving, the health detriment is large owing to delay in diagnosing active TB, leading to prolonged illness. There was substantial between-patient variation in the tests used in the diagnostic pathway. LIMITATIONS The recruitment target for the HIV co-infected population was not achieved. CONCLUSIONS Although T-SPOT.TB was more sensitive than QFT-GIT for the diagnosis of active TB, the tests are insufficiently sensitive for ruling out active TB in routine clinical practice in the UK. Novel assays offer some promise. FUTURE WORK The novel assays require evaluation in distinct clinical settings and in immunosuppressed patient groups. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London, London, UK.
Collapse
Affiliation(s)
- Yemisi Takwoingi
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Hilary Whitworth
- Tuberculosis Research Centre, National Heart and Lung Institute, Imperial College London, London, UK.,Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Melanie Rees-Roberts
- Tuberculosis Research Centre, National Heart and Lung Institute, Imperial College London, London, UK.,National Institute for Health Research (NIHR) Health Protection Research Unit in Respiratory Infections, Imperial College London, London, UK
| | - Amarjit Badhan
- Tuberculosis Research Centre, National Heart and Lung Institute, Imperial College London, London, UK.,National Institute for Health Research (NIHR) Health Protection Research Unit in Respiratory Infections, Imperial College London, London, UK
| | | | - Nathan Green
- NIHR Health Protection Research Unit in Modelling Methodology, Imperial College London, London, UK.,Medical Research Council (MRC) Centre for Outbreak Analysis and Modelling, Imperial College London, London, UK.,Department of Infectious Disease Epidemiology, Imperial College London, London, UK.,Modelling and Economics Unit, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Aime Boakye
- Tuberculosis Research Centre, National Heart and Lung Institute, Imperial College London, London, UK.,National Institute for Health Research (NIHR) Health Protection Research Unit in Respiratory Infections, Imperial College London, London, UK
| | - Heather Lambie
- Tuberculosis Research Centre, National Heart and Lung Institute, Imperial College London, London, UK
| | - Luigi Marongiu
- Tuberculosis Research Centre, National Heart and Lung Institute, Imperial College London, London, UK
| | - Mark Jit
- Modelling and Economics Unit, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK.,Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Peter White
- NIHR Health Protection Research Unit in Modelling Methodology, Imperial College London, London, UK.,Medical Research Council (MRC) Centre for Outbreak Analysis and Modelling, Imperial College London, London, UK.,Department of Infectious Disease Epidemiology, Imperial College London, London, UK.,Modelling and Economics Unit, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Jonathan J Deeks
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Onn Min Kon
- Tuberculosis Research Centre, National Heart and Lung Institute, Imperial College London, London, UK.,National Institute for Health Research (NIHR) Health Protection Research Unit in Respiratory Infections, Imperial College London, London, UK.,St Mary's Hospital, Imperial College Healthcare Trust, London, UK
| | - Ajit Lalvani
- Tuberculosis Research Centre, National Heart and Lung Institute, Imperial College London, London, UK.,National Institute for Health Research (NIHR) Health Protection Research Unit in Respiratory Infections, Imperial College London, London, UK
| |
Collapse
|
5
|
Yu D, Li X, Gong J, Li J, Xie F, Hu J. Left-sided portal hypertension caused by peripancreatic lymph node tuberculosis misdiagnosed as pancreatic cancer: a case report and literature review. BMC Gastroenterol 2020; 20:276. [PMID: 32811429 PMCID: PMC7436982 DOI: 10.1186/s12876-020-01420-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/11/2020] [Indexed: 02/06/2023] Open
Abstract
Background Left-sided portal hypertension (LSPH) is an extremely rare clinical syndrome, and it is the only form of curable portal hypertension. It is primarily caused by pancreatic disease, and is associated with complications that cause spleen vein compression. Specific symptoms are often lacking, rendering it difficult to diagnose. Splenectomy is the main treatment for cases complicated by variceal bleeding, and the effects of treatment primarily depend on the condition of the primary disease. Case presentation The patient was a 29-year-old woman who was admitted to the hospital for repeated hematemesis and black stool. She had been misdiagnosed with pancreatic cancer 7 years prior. Combined imaging and endoscopic examination indicated varicose gastric fundus veins, a pancreatic mass, and enlarged peripancreatic lymph nodes. Laboratory investigations revealed reduced erythrocyte, platelet, and leukocyte counts, the interferon gamma release assay was positive, and liver function was normal. Abdominal exploration, splenectomy, varicose vein dissection, and lesion resection were performed via laparotomy. Postoperative biopsy analysis confirmed the diagnosis of lymph node tuberculosis. Based on the above-described factors, LSPH caused by peripancreatic lymph node tuberculosis was a diagnosed. Conclusions Herein we describe the first reported case of LSPH caused by peripancreatic lymph node tuberculosis. When left portal hypertension occurs simultaneously, peripancreatic lymph node tuberculosis is often misdiagnosed as pancreatic cancer. Further studies are necessary to develop a more favorable diagnostic method for pancreas masses and more advantageous therapy for LSPH, especially in cases caused by mechanical compression.
Collapse
Affiliation(s)
- Dajun Yu
- Department of General Surgery, Wushan County People's Hospital of Chongqing, Wushan, Chongqing, 404700, China
| | - Xiaolan Li
- Department of General Surgery, Wushan County People's Hospital of Chongqing, Wushan, Chongqing, 404700, China
| | - Jianping Gong
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, 74 Linjiang Road, Yuzhong District, Chongqing, 400010, China
| | - Jinzheng Li
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, 74 Linjiang Road, Yuzhong District, Chongqing, 400010, China
| | - Fei Xie
- Department of Hepatobiliary Surgery, The First People's Hospital of Neijiang, Neijiang, 64100, Sichuan, China
| | - Jiejun Hu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, 74 Linjiang Road, Yuzhong District, Chongqing, 400010, China.
| |
Collapse
|
6
|
Cystic form of cervical lymphadenopathy. Guidelines of the French Society of Otorhinolaryngology - Head and Neck Surgery (SFORL). Part 1: Diagnostic procedures for lymphadenopathy in case of cervical mass with cystic aspect. Eur Ann Otorhinolaryngol Head Neck Dis 2019; 136:489-496. [PMID: 31186166 DOI: 10.1016/j.anorl.2019.05.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The authors present the guidelines of the French Society of Otorhinolaryngology - Head and Neck Surgery Society on diagnostic procedures for lymphadenopathy in case of a cervical mass with cystic aspect. METHODS A multidisciplinary work-group was entrusted with a review of the scientific literature on the topic. Guidelines were drawn up, then read over by an editorial group independent of the work-group, and the final version was drawn up. Guidelines were graded as A, B, C or expert opinion, by decreasing level of evidence. RESULTS In adults presenting a cystic cervical mass, it is recommended to suspect cervical lymphadenopathy: in order of decreasing frequency, cystic metastasis of head and neck squamous cell carcinoma, of undifferentiated nasopharyngeal carcinoma, and of thyroid papillary carcinoma (Grade C). On discovery of a cystic cervical mass on ultrasound, architectural elements indicating a lymph node and a thyroid nodule with signs of malignancy should be screened for, especially if the mass is located in levels III, IV or VI (Grade A). Malignant lymphadenopathy should be suspected in case of cervical mass with cystic component on CT (Grade B), but benign or malignant status cannot be diagnosed only on radiological data (CT or MRI) (Grade A), and 18-FDG PET-CT should be performed, particularly in case of inconclusive ultrasound-guided fine needle aspiration biopsy (Grade C).
Collapse
|
7
|
Head and neck tuberculosis: Literature review and meta-analysis. Tuberculosis (Edinb) 2019; 116S:S78-S88. [DOI: 10.1016/j.tube.2019.04.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 11/12/2018] [Indexed: 12/13/2022]
|
8
|
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
|
9
|
Dai Y, Wen Z, Ye T, Deng G, Zhang M, Deng Q, Yang Q, Shan W, Kornfeld H, Cai Y, Chen X. Empirical treatment with non-anti-tuberculosis antibiotics decreased microbiological detection in cervical tuberculous lymphadenitis. Diagn Microbiol Infect Dis 2018; 92:245-249. [PMID: 30076042 DOI: 10.1016/j.diagmicrobio.2018.06.008] [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] [Received: 12/01/2017] [Revised: 05/29/2018] [Accepted: 06/10/2018] [Indexed: 01/18/2023]
Abstract
Diagnosis of cervical tuberculous lymphadenitis (CTL), the most commonly occurring form of extrapulmonary tuberculosis, remains as a challenge in clinic. Detection of the presence of Mycobacterium tuberculosis (Mtb) in fine needle aspiration cytology (FNAC) samples is one golden criterion to confirm the CTL diagnosis. Due to the non-specific clinical presentation, CTL might be confused with other lymph node enlargement diseases; therefore empirical treatment with non-anti-TB antibiotics is often initially administered. However, it is still unclear whether this diagnostic antibiotic treatment affects the positivity of Mtb detection in FNAC. The demographics and clinical characteristics of 732 lymph node enlargement patients who had underwent FNAC were retrospectively analyzed and 605 (82.65%) of them were diagnosed as CTL. A total of 279 CTL cases (279/605, 46.11%) with completion of three Mtb tests (AFB, NAAT, and Mtb culture) in FNAC samples were selected for analyzing the effect of empirical antibiotic treatment on the positivity of Mtb tests. Compared to CTL patients without antibiotic treatment prior to FNAC, patients received empirical non anti-TB treatment had significantly lower positivity for acid fast bacilli staining (adjusted OR 0.11, 95% CI 0.06-0.21), nucleic acid amplification test (NAAT) (adjusted OR 0.38, 95% CI 0.21-0.71), and Mtb culture (adjusted OR 0.11, 95% CI 0.06-0.19). In conclusion, this study demonstrated that empirical non anti-TB antibiotic treatment reduced the opportunity to confirm CTL by microbiological analysis. Patients with cervical lymph node enlargement should undergo FNAC for Mtb tests prior to initiation of empirical non anti-TB treatment.
Collapse
Affiliation(s)
- Youchao Dai
- Department of Pathogen Biology, Shenzhen University School of Medicine, Shenzhen, China; Shenzhen Key Laboratory of Infection &Immunity, Shenzhen Third People's Hospital, Shenzhen University School of Medicine, Shenzhen, China; Guangzhou Medical University, Guangzhou, China
| | - Zhihua Wen
- Yuebei Second People's Hospital, Shaoguan, China
| | - Taosheng Ye
- Shenzhen Key Laboratory of Infection &Immunity, Shenzhen Third People's Hospital, Shenzhen University School of Medicine, Shenzhen, China
| | - Guofang Deng
- Shenzhen Key Laboratory of Infection &Immunity, Shenzhen Third People's Hospital, Shenzhen University School of Medicine, Shenzhen, China
| | - Mingxia Zhang
- Shenzhen Key Laboratory of Infection &Immunity, Shenzhen Third People's Hospital, Shenzhen University School of Medicine, Shenzhen, China
| | - Qunyi Deng
- Shenzhen Key Laboratory of Infection &Immunity, Shenzhen Third People's Hospital, Shenzhen University School of Medicine, Shenzhen, China
| | - Qianting Yang
- Shenzhen Key Laboratory of Infection &Immunity, Shenzhen Third People's Hospital, Shenzhen University School of Medicine, Shenzhen, China
| | - Wanshui Shan
- Shenzhen Key Laboratory of Infection &Immunity, Shenzhen Third People's Hospital, Shenzhen University School of Medicine, Shenzhen, China
| | - Hardy Kornfeld
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01655, USA
| | - Yi Cai
- Department of Pathogen Biology, Shenzhen University School of Medicine, Shenzhen, China
| | - Xinchun Chen
- Department of Pathogen Biology, Shenzhen University School of Medicine, Shenzhen, China.
| |
Collapse
|
10
|
Di L, Li Y. The risk factor of false-negative and false-positive for T-SPOT.TB in active tuberculosis. J Clin Lab Anal 2017; 32. [PMID: 28594104 DOI: 10.1002/jcla.22273] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 05/04/2017] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES T-SPOT.TB is a promising diagnosis tool to identify both pulmonary tuberculosis and extrapulmonary tuberculosis, as well as latent tuberculosis; however, the factors that affect the results of T-SPOT.TB remains unclear. In this study, we aim to figure out the risk factor of T-SPOT.TB for active TB. METHODS A total of 349 patients were recruited between January 1st, 2016 and January 22st, 2017 at Renmin Hospital of Wuhan University, including 98 subjects with TB and 251 subjects with non-TB disease, and received T-SPOT.TB (Oxford Immunotec Ltd). Statistics were analyzed by SPSS 19.0 using logistic regression. RESULTS The overall specificity and sensitivity of the T-SPOT.TB was 92.83% (233/251; 95%CI 0.8872-0.9557) and 83.67% (82/98; 95%CI 0.7454-0.9010), respectively. Patients with tuberculous meningitis were more likely to have false-negative results (OR 17.4, 95%CI 3.068-98.671; P<.001) while patients with cured TB tended to induce false-positive results (OR 30.297; 95%CI 7.069-129.849; P<.001). The results were not affected by sex, age, onset time, smoke, alcohol, treatment, allergic history, co-morbidity, TB (exclude tuberculous meningitis) (P>.05). CONCLUSION Tuberculous meningitis was a risk factor of false-negative for T-SPOT.TB, while cured TB was a risk factor of false-positive.
Collapse
Affiliation(s)
- Li Di
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yan Li
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, China
| |
Collapse
|
11
|
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
|