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Khabibullina NF, Kutuzova DM, Burmistrova IA, Lyadova IV. The Biological and Clinical Aspects of a Latent Tuberculosis Infection. Trop Med Infect Dis 2022; 7:tropicalmed7030048. [PMID: 35324595 PMCID: PMC8955876 DOI: 10.3390/tropicalmed7030048] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/04/2022] [Accepted: 03/04/2022] [Indexed: 01/22/2023] Open
Abstract
Tuberculosis (TB), caused by bacilli from the Mycobacterium tuberculosis complex, remains a serious global public health problem, representing one of the main causes of death from infectious diseases. About one quarter of the world’s population is infected with Mtb and has a latent TB infection (LTBI). According to the World Health Organization (WHO), an LTBI is characterized by a lasting immune response to Mtb antigens without any TB symptoms. Current LTBI diagnoses and treatments are based on this simplified definition, although an LTBI involves a broad range of conditions, including when Mtb remains in the body in a persistent form and the immune response cannot be detected. The study of LTBIs has progressed in recent years; however, many biological and medical aspects of an LTBI are still under discussion. This review focuses on an LTBI as a broad spectrum of states, both of the human body, and of Mtb cells. The problems of phenotypic insusceptibility, diagnoses, chemoprophylaxis, and the necessity of treatment are discussed. We emphasize the complexity of an LTBI diagnosis and its treatment due to its ambiguous nature. We consider alternative ways of differentiating an LTBI from active TB, as well as predicting TB reactivation based on using mycobacterial “latency antigens” for interferon gamma release assay (IGRA) tests and the transcriptomic analysis of human blood cells.
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Nie W, Wang J, Jing W, Shi W, Wang Q, Huang X, Cai B, Ge Q, Nie L, Han X, Du Y, Wang J, Guo R, Chu N. Value of serum cytokine biomarkers TNF-α, IL-4, sIL-2R and IFN-γ for use in monitoring bacterial load and anti-tuberculosis treatment progress. Cytokine X 2021; 2:100028. [PMID: 33604556 PMCID: PMC7885884 DOI: 10.1016/j.cytox.2020.100028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/13/2020] [Accepted: 05/06/2020] [Indexed: 02/01/2023] Open
Abstract
Serum cytokine levels may correlate with tuberculosis patient disease status. Serum TNF-α level may be a useful biomarker for predicting bacillar burden. Serum TNF-α and IFN-γ levels may reliably monitor anti-TB treatment progress. Serum IL-4 level had no value while serum IL-2R level value awaits further study. Cytokine biomarkers are useful biomarkers in clinical TB patient care settings.
Tuberculosis (TB) patient serum cytokine levels may be predictive of anti-tuberculosis treatment progress. Here, serum levels of cytokines TNF-α, IL-4, sIL-2R and IFN-γ were measured then correlated to clinical TB manifestations, bacterial burden, chest imaging findings and clinical course. Study subjects included 67 newly diagnosed pulmonary TB (PTB) patients with active disease admitted to Beijing Chest Hospital for anti-TB chemotherapeutic treatment. Blood was drawn at 0 months (pre-treatment), 1–2 months (at any time between 1 and 2 month) and after 6 months completion of treatment and serum TNF-α, IL-4, sIL-2R and IFN-γ levels were measured in duplicate using enzyme-linked immunosorbent assays (ELISAs). Correlation analysis was conducted to evaluate sensitivity and specificity of cytokine levels as predictors of disease activity and treatment progress. The results indicated that the pre-treatment serum TNF-α level of the smear-negative group was lower than that of the smear 1+ group, while serum TNF-α after 6 months completion of treatment and IFN-γ levels at 1–2 months and after 6 months completion of treatment were significantly lower, respectively, than at 0 months (before treatment) (P < 0.05). Using a cut-off value of 845 pg/ml, serum TNF-α level was predictive of treatment progress, with a sensitivity of 51%, specificity of 60% and AUC of 0.594 (P = 0.013). Meanwhile, using a cut-off value of 393 pg/ml, serum IFN-γ provided superior monitoring efficacy, with a sensitivity of 60%, specificity of 64% and AUC of 0.651 (P = 0.017). In conclusion, both serum TNF-α and IFN-γ levels might be useful biomarkers for monitoring treatment progress.
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Affiliation(s)
- Wenjuan Nie
- Tuberculosis Department, Beijing Chest Hospital Affiliated to Capital Medical University, No 9, Beiguan Street, Tongzhou District, Beijing 101149, PR China
| | - Jun Wang
- Tuberculosis Department, Beijing Chest Hospital Affiliated to Capital Medical University, No 9, Beiguan Street, Tongzhou District, Beijing 101149, PR China
| | - Wei Jing
- Tuberculosis Department, Beijing Chest Hospital Affiliated to Capital Medical University, No 9, Beiguan Street, Tongzhou District, Beijing 101149, PR China
| | - Wenhui Shi
- Tuberculosis Department, Beijing Chest Hospital Affiliated to Capital Medical University, No 9, Beiguan Street, Tongzhou District, Beijing 101149, PR China
| | - Qingfeng Wang
- Tuberculosis Department, Beijing Chest Hospital Affiliated to Capital Medical University, No 9, Beiguan Street, Tongzhou District, Beijing 101149, PR China
| | - Xuerui Huang
- Tuberculosis Department, Beijing Chest Hospital Affiliated to Capital Medical University, No 9, Beiguan Street, Tongzhou District, Beijing 101149, PR China
| | - Baoyun Cai
- Tuberculosis Department, Beijing Chest Hospital Affiliated to Capital Medical University, No 9, Beiguan Street, Tongzhou District, Beijing 101149, PR China
| | - Qiping Ge
- Tuberculosis Department, Beijing Chest Hospital Affiliated to Capital Medical University, No 9, Beiguan Street, Tongzhou District, Beijing 101149, PR China
| | - Lihui Nie
- Tuberculosis Department, Beijing Chest Hospital Affiliated to Capital Medical University, No 9, Beiguan Street, Tongzhou District, Beijing 101149, PR China
| | - Xiqin Han
- Tuberculosis Department, Beijing Chest Hospital Affiliated to Capital Medical University, No 9, Beiguan Street, Tongzhou District, Beijing 101149, PR China
| | - Yadong Du
- Tuberculosis Department, Beijing Chest Hospital Affiliated to Capital Medical University, No 9, Beiguan Street, Tongzhou District, Beijing 101149, PR China
| | - Jing Wang
- Tuberculosis Department, Beijing Chest Hospital Affiliated to Capital Medical University, No 9, Beiguan Street, Tongzhou District, Beijing 101149, PR China
| | - Ru Guo
- Tuberculosis Department, Beijing Chest Hospital Affiliated to Capital Medical University, No 9, Beiguan Street, Tongzhou District, Beijing 101149, PR China
| | - Naihui Chu
- Tuberculosis Department, Beijing Chest Hospital Affiliated to Capital Medical University, No 9, Beiguan Street, Tongzhou District, Beijing 101149, PR China
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Khawcharoenporn T, Aksornchindarat W, Yodpinij N, Srisungngam S, Rudeeaneksin J, Bunchoo S, Klayut W, Sangkitporn S, Phetsuksiri B. T-SPOT ®.TB Test for Latent Tuberculosis Infection Diagnosis and Treatment Guidance in Thai Health-Care Professionals. Indian J Occup Environ Med 2020; 24:47-49. [PMID: 32435118 PMCID: PMC7227739 DOI: 10.4103/ijoem.ijoem_284_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 12/12/2019] [Accepted: 01/07/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Thana Khawcharoenporn
- Division of Infectious Diseases, Thammasat University, Pathumthani, Thailand.,Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | | | - Napat Yodpinij
- Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Sopa Srisungngam
- Department of Medical Sciences, National Institute of Health, Ministry of Public Health, Nonthaburi, Thailand
| | - Janisara Rudeeaneksin
- Department of Medical Sciences, National Institute of Health, Ministry of Public Health, Nonthaburi, Thailand
| | - Supranee Bunchoo
- Department of Medical Sciences, National Institute of Health, Ministry of Public Health, Nonthaburi, Thailand
| | - Wiphat Klayut
- Department of Medical Sciences, National Institute of Health, Ministry of Public Health, Nonthaburi, Thailand
| | - Somchai Sangkitporn
- Department of Medical Sciences, National Institute of Health, Ministry of Public Health, Nonthaburi, Thailand
| | - Benjawan Phetsuksiri
- Department of Medical Sciences, National Institute of Health, Ministry of Public Health, Nonthaburi, Thailand
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Kim BK, Kim HJ, Kim HJ, Cha JH, Lee JB, Jeon J, Kim CY, Kim Y, Kim JH, Shin C, Lee SH. Experiences of Latent Tuberculosis Infection Treatment for the North Korean Refugees. Tuberc Respir Dis (Seoul) 2019; 82:306-310. [PMID: 31172709 PMCID: PMC6778740 DOI: 10.4046/trd.2019.0034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 05/09/2019] [Accepted: 05/17/2019] [Indexed: 11/24/2022] Open
Abstract
Background Tuberculosis (TB) is increasing in immigrants. We aimed to investigate the current status of latent tuberculosis infection (LTBI) treatment for North Korean Refugees (NKR) compared to South Koreans Contacts (SKC). Methods TB close contacts in a closed facility of SKC and NKR who underwent LTBI screening in a settlement support center for NKR were analyzed retrospectively. Results Among tuberculin skin test (TST) ≥10 mm (n=298) reactors, the males accounted for 72.2% in SKC (n=126) and 19.5% in NKR (n=172) (p<0.01). The mean age was higher in South Korea (42.8±9.9 years vs. 35.4±10.0 years, p<0.01). Additionally, the mean TST size was significantly bigger in NKR (17.39±3.9 mm vs. 16.57±4.2 mm, p=0.03). The LTBI treatments were initiated for all screened NKR, and LTBI completion rate was only 68.0%. However, in NKR, LTBI treatment completion rate was significantly increased by shorter 4R regimen (odds ratio [OR], 9.296; 95% confidence interval [CI], 4.159–20.774; p<0.01) and male (OR, 3.447; 95% CI, 1.191–9.974; p=0.02). Conclusion LTBI treatment compliance must be improved in NKR with a shorter regimen. In addition, a larger study regarding a focus on LTBI with easy access to related data for NKR should be conducted.
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Affiliation(s)
- Beong Ki Kim
- Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Hee Jin Kim
- Korea Institute of Tuberculosis, Cheongju, Korea
| | - Ho Jin Kim
- Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Jae Hyung Cha
- Medical Science Research Center, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Jin Beom Lee
- Korea Institute of Tuberculosis, Cheongju, Korea
| | - Jeonghe Jeon
- Settlement Support Center for North Korean Refugees (Hanawon), Hwacheon, Korea
| | - Chi Young Kim
- Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Young Kim
- Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Je Hyeong Kim
- Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Chol Shin
- Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Seung Heon Lee
- Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea.
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Le Palud P, Herrmann JL, Bergot E. [Interferon gamma release assay (IGRA) tests]. Rev Mal Respir 2018; 35:862-865. [PMID: 30224210 DOI: 10.1016/j.rmr.2018.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 03/21/2018] [Indexed: 10/28/2022]
Affiliation(s)
- P Le Palud
- Service de pneumologie, CHRU Côte de Nacre, 14033 Caen, France
| | - J-L Herrmann
- UMR1173, Inserm, université de Versailles Saint Quentin, UFR des sciences de la santé, 78180 Montigny le Bretonneux, France; Laboratoire de bactériologie-hygiène, GHU hôpitaux Île de France-Ouest, hôpital Raymond Poincaré, AP-HP, 92380 Garches, France.
| | - E Bergot
- Service de pneumologie, CHRU Côte de Nacre, 14033 Caen, France
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Reversion of QuantiFERON-TB Gold In-Tube test in individuals with and without prophylactic treatment for latent tuberculosis infection: A systematic review and meta-analysis. J Infect 2018; 77:276-282. [PMID: 29746953 DOI: 10.1016/j.jinf.2018.04.009] [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: 11/20/2017] [Revised: 03/09/2018] [Accepted: 04/02/2018] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Reversion of tuberculosis (TB) infection testing has been suggested to be associated with prophylactic treatment efficacy. However, evidences based on randomized controlled study were sparse. METHODS Studies on serial QuantiFERON-TB Gold In-Tube (QFT) test, among individuals with and without prophylactic treatment were identified in the databases of PubMed, MEDLINE and EMBASE up to 28 February 2018. The reversion rates were quantitatively summarized by means of meta-analysis using the random-effect model. RESULTS A total of 52 eligible studies were included in the meta-analysis on QFT test reversion rate among participants with (20 studies) and without (32 studies) prophylactic treatment. Summarized reversion rate was found to be 24.9% (95% confidence interval [CI]: 18.4-32.9%) and 25.3% (95% CI: 19.6-32.0%) for those completed or without treatment, respectively. When the analysis was restricted to the participants completed treatment, higher summarized rate of QFT reversion was found among those with longer course therapy (9INH vs. the other regimens), studies from Asia (vs. Europe and America), and individuals with immunosuppression disorders (vs. general populations). CONCLUSIONS Our results suggested that QFT reversion was frequently observed regardless of with or without prophylactic treatment. Serial QFT testing might be inappropriate for evaluating preventive treatment efficacy.
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Doan TN, Eisen DP, Rose MT, Slack A, Stearnes G, McBryde ES. Interferon-gamma release assay for the diagnosis of latent tuberculosis infection: A latent-class analysis. PLoS One 2017; 12:e0188631. [PMID: 29182688 PMCID: PMC5705142 DOI: 10.1371/journal.pone.0188631] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 11/11/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Accurate diagnosis and subsequent treatment of latent tuberculosis infection (LTBI) is essential for TB elimination. However, the absence of a gold standard test for diagnosing LTBI makes assessment of the true prevalence of LTBI and the accuracy of diagnostic tests challenging. Bayesian latent class models can be used to make inferences about disease prevalence and the sensitivity and specificity of diagnostic tests using data on the concordance between tests. We performed the largest meta-analysis to date aiming to evaluate the performance of tuberculin skin test (TST) and interferon-gamma release assays (IGRAs) for LTBI diagnosis in various patient populations using Bayesian latent class modelling. METHODS Systematic search of PubMeb, Embase and African Index Medicus was conducted without date and language restrictions on September 11, 2017 to identify studies that compared the performance of TST and IGRAs for LTBI diagnosis. Two IGRA methods were considered: QuantiFERON-TB Gold In Tube (QFT-GIT) and T-SPOT.TB. Studies were included if they reported 2x2 agreement data between TST and QFT-GIT or T-SPOT.TB. A Bayesian latent class model was developed to estimate the sensitivity and specificity of TST and IGRAs in various populations, including immune-competent adults, immune-compromised adults and children. A TST cut-off value of 10 mm was used for immune-competent subjects and 5 mm for immune-compromised individuals. FINDINGS A total of 157 studies were included in the analysis. In immune-competent adults, the sensitivity of TST and QFT-GIT were estimated to be 84% (95% credible interval [CrI] 82-85%) and 52% (50-53%), respectively. The specificity of QFT-GIT was 97% (96-97%) in non-BCG-vaccinated and 93% (92-94%) in BCG-vaccinated immune-competent adults. The estimated figures for TST were 100% (99-100%) and 79% (76-82%), respectively. T-SPOT.TB has comparable specificity (97% for both tests) and better sensitivity (68% versus 52%) than QFT-GIT in immune-competent adults. In immune-compromised adults, both TST and QFT-GIT display low sensitivity but high specificity. QFT-GIT and TST are equally specific (98% for both tests) in non-BCG-vaccinated children; however, QFT-GIT is more specific than TST (98% versus 82%) in BCG-vaccinated group. TST is more sensitive than QFT-GIT (82% versus 73%) in children. CONCLUSIONS This study is the first to assess the utility of TST and IGRAs for LTBI diagnosis in different population groups using all available data with Bayesian latent class modelling. Our results challenge the current beliefs about the performance of LTBI screening tests, and have important implications for LTBI screening policy and practice. We estimated that the performance of IGRAs is not as reliable as previously measured in the general population. However, IGRAs are not or minimally affected by BCG and should be the preferred tests in this setting. Adoption of IGRAs in settings where BCG is widely administered will allow for a more accurate identification and treatment of LTBI.
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Affiliation(s)
- Tan N. Doan
- Department of Medicine at The Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- * E-mail:
| | - Damon P. Eisen
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Morgan T. Rose
- Department of Infectious Diseases, Alfred Health, Melbourne, Victoria, Australia
| | - Andrew Slack
- Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Grace Stearnes
- Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Emma S. McBryde
- Department of Medicine at The Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
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Kim Y, Kim BK, Choi HJ, Ryu SW, Kim ES, Chang YS, Kim HJ, Cha JH, Kim JH, Shin C, Lee SH. Lessons learned from continued TB outbreaks in a high school. PLoS One 2017; 12:e0188076. [PMID: 29145443 PMCID: PMC5690470 DOI: 10.1371/journal.pone.0188076] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 10/31/2017] [Indexed: 11/18/2022] Open
Abstract
We investigated the aftereffects of confirmatory QuantiFERON testing (QFT) added to a positive tuberculin skin test (TST). We reviewed the pre and post course of sequential tuberculosis (TB) outbreaks in a high school where massive 43 active TB cases had been found within one year before delayed contact investigation. And we investigated the TB development in relation to initial TST and QFT during mean follow-up of 3.9 ± 0.9 years. After delayed contact investigation for two subsequent TB outbreaks, 925 contacts were divided into the following 3 groups: TST- (n = 632), TST+/QFT+ (n = 24), TST+/QFT- (n = 258). QFT- was more prevalent than QFT+ in contacts with 10mm ≤ TST <15mm (158, 61.2%) compared with TST ≥15mm (100, 38.8%) among the TST+ reactors (P < 0.001). Among the 258 TST+/QFT- subjects, 256 received no latent TB infection (LTBI) treatment, but 7 contacts developed TB during follow-up. Among these 7 patients, 4 had initial TST ≥15mm and 3 had 10mm ≤ TST <15mm. In conclusion, the delayed contact investigation for LTBI in a high school resulted in continued TB developments. False-negative QFT performed late among the TST+ reactors should not be considered criteria for LTBI treatment. Additionally, the contacts only with TST ≥15mm should be considered for LTBI treatment in congregate settings of intermediate-burden countries.
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Affiliation(s)
- Young Kim
- Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byeong Ki Kim
- Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - Hong Jo Choi
- Korea Institute of Tuberculosis, Osong, Republic of Korea
| | - Sung Weon Ryu
- Korea Institute of Tuberculosis, Osong, Republic of Korea
| | - Eui Sook Kim
- Public Healthcare Center, Ansan, Republic of Korea
| | - Yoon Soo Chang
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hee Jin Kim
- Korea Institute of Tuberculosis, Osong, Republic of Korea
| | - Jae Hyung Cha
- Medical Science Research Center, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - Je Hyeong Kim
- Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - Chol Shin
- Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - Seung Heon Lee
- Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
- * E-mail:
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Bedini A, Garlassi E, Stentarelli C, Petrella S, Meacci M, Meccugni B, Meschiari M, Franceschini E, Cerri S, Brasacchio A, Rumpianesi F, Richeldi L, Mussini C. Multidrug-resistant tuberculosis outbreak in an Italian prison: tolerance of pyrazinamide plus levofloxacin prophylaxis and serial interferon gamma release assays. New Microbes New Infect 2016; 12:45-51. [PMID: 27222718 PMCID: PMC4872473 DOI: 10.1016/j.nmni.2016.03.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 03/16/2016] [Accepted: 03/23/2016] [Indexed: 10/27/2022] Open
Abstract
The optimal treatment for latent tuberculosis infection (LTBI) in subjects exposed to multidrug-resistant (MDR) tuberculosis (TB) remains unclear, and the change in response of the QuantiFERON-TB Gold In-Tube (QTB-IT) test during and after treatment is unknown. Between May 2010 and August 2010, 39 prisoners at the 'Casa Circondariale' of Modena, Italy, were exposed to a patient with active pulmonary MDR TB. All contacts were tested with the tuberculin skin test and QTB-IT. Upon exclusion of active TB, subjects positive to both tests were offered 6 months' treatment with pyrazinamide (PZA) and levofloxacin (LVX). QTB-IT testing was repeated at 3 and 6 months after initial testing in all subjects who were offered LTBI treatment. Seventeen (43.5%) of 39 subjects tested positive to both tuberculin skin test and QTB-IT test, and 12 (70.5%) agreed to receive therapy with PZA and LVX at standard doses. Only five (41.6%) of 12 subjects completed 6 months' treatment. Reasons for discontinuation were asymptomatic hepatitis, gastritis and diarrhoea. The QTB-IT values decreased in all subjects who completed the treatment, in two (33%) of six of those who received treatment for less than 3 months and in one (50%) of two patients who discontinued therapy after 3 months. The QTB-IT test results never turned negative. Despite the small number of subjects, the study confirmed that PZA plus LVX is a poorly tolerated option for MDR LTBI treatment. We observed a large degree of variation in the results of the QTB-IT test results among participants. The study confirmed that the interferon gamma release assay is not a reliable tool for monitoring the treatment of MDR LTBI in clinical practice.
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Affiliation(s)
- A Bedini
- Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, Modena, Italy
| | - E Garlassi
- Department of Infectious Diseases, Ospedale Santa Maria Nuova, Reggio Emilia, Italy
| | - C Stentarelli
- Medical Department, Sant'Anna Penitentiary, Modena, Italy
| | - S Petrella
- Medical Department, Sant'Anna Penitentiary, Modena, Italy
| | - M Meacci
- Service of Microbiology, Azienda Ospedaliero-Universitaria, Policlinico of Modena, Modena, Italy
| | - B Meccugni
- Service of Microbiology, Azienda Ospedaliero-Universitaria, Policlinico of Modena, Modena, Italy
| | - M Meschiari
- Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, Modena, Italy
| | - E Franceschini
- Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, Modena, Italy
| | - S Cerri
- Clinic of Lung Diseases, University of Modena, Modena, Italy
| | - A Brasacchio
- Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, Modena, Italy
| | - F Rumpianesi
- Service of Microbiology, Azienda Ospedaliero-Universitaria, Policlinico of Modena, Modena, Italy
| | - L Richeldi
- University of Southampton, Southampton, UK
| | - C Mussini
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
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Two-Year Follow-up Study of Mycobacterium tuberculosis Antigen-Driven IFN-γ Responses and Macrophage sCD14 Levels After Tuberculosis Contact. Indian J Microbiol 2016; 56:205-13. [PMID: 27570313 DOI: 10.1007/s12088-016-0571-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 02/16/2016] [Indexed: 02/07/2023] Open
Abstract
Clinical data regarding the prediction of active tuberculosis (TB) development in close TB contacts are scarce. To address this problem, we performed a 2-year follow-up study of Mycobacterium tuberculosis (M.tb) antigen-driven IFN-gamma responses and serum levels of soluble macrophage CD14 receptor in individuals with recent or prolonged M.tb exposure. Between June 2011 and June 2013, we studied 60 healthy Polish adults with recent household or long-term work TB contact and individuals without known M.tb exposure. All of them underwent baseline and repeated testing with IGRA (IFN-gamma release assay) and serum sCD14 ELISA quantification. Frequencies of IGRA results differed at the baseline and follow-up testing. IGRA reversions were noticed in almost one-third of Work TB Contacts and no participants from the Household TB Contact group. IGRA conversions were found in 40 % of Household TB Contacts. No correlation between the IGRA result and the sCD14 level was observed. IFN-γ variability has important implications for clinical practice and requires caution in interpreting the results to distinguish new infections from nonspecific inter-individual variations in cytokine responses. The impairment of IFN-γ response in some individuals with prolonged M.tb exposure representing a resistant immune status does not allow considering IGRA results as reliable and credible. Monitoring the serum sCD14 level can reduce the likelihood of a false prediction of active TB development in close TB contacts showing an M.tb-specific increase in the IFN-gamma production in repeated IGRA testing.
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11
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Interferon gamma release assays for monitoring the response to treatment for tuberculosis: A systematic review. Tuberculosis (Edinb) 2015; 95:639-650. [DOI: 10.1016/j.tube.2015.07.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 07/04/2015] [Indexed: 11/20/2022]
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Ayubi E, Doosti-Irani A, Mostafavi E. Do the tuberculin skin test and the QuantiFERON-TB Gold in-tube test agree in detecting latent tuberculosis among high-risk contacts? A systematic review and meta-analysis. Epidemiol Health 2015; 37:e2015043. [PMID: 26493775 PMCID: PMC4652063 DOI: 10.4178/epih/e2015043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 10/03/2015] [Accepted: 10/03/2015] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES: The QuantiFERON-TB Gold in-tube test (QFT-GIT) and the tuberculin skin test (TST) are used to diagnose latent tuberculosis infection (LTBI). However, conclusive evidence regarding the agreement of these two tests among high risk contacts is lacking. This systematic review and meta-analysis aimed to estimate the agreement between the TST and the QFT-GIT using kappa statistics. METHODS: According to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines, scientific databases including PubMed, Scopus, and Ovid were searched using a targeted search strategy to identify relevant studies published as of June 2015. Two researchers reviewed the eligibility of studies and extracted data from them. The pooled kappa estimate was determined using a random effect model. Subgroup analysis, Egger’s test and sensitivity analysis were also performed. RESULTS: A total of 6,744 articles were retrieved in the initial search, of which 24 studies had data suitable for meta-analysis. The pooled kappa coefficient and prevalence-adjusted bias-adjusted kappa were 0.40 (95% confidence interval [CI], 0.34 to 0.45) and 0.45 (95% CI, 0.38 to 0.49), respectively. The results of the subgroup analysis found that age group, quality of the study, location, and the TST cutoff point affected heterogeneity for the kappa estimate. No publication bias was found (Begg’s test, p=0.53; Egger’s test, p=0.32). CONCLUSIONS: The agreement between the QFT-GIT and the TST in diagnosing LTBI among high-risk contacts was found to range from fair to moderate.
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Affiliation(s)
- Erfan Ayubi
- Department of Epidemiology, Pasteur Institute of Iran, Tehran, Iran.,Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Amin Doosti-Irani
- Department of Epidemiology, Pasteur Institute of Iran, Tehran, Iran.,Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ehsan Mostafavi
- Department of Epidemiology, Pasteur Institute of Iran, Tehran, Iran.,Research Center for Emerging and Reemerging Infectious Diseases, Pasteur institute of Iran, Akanlu, Kabudar Ahang, Hamadan, Iran
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Kim HJ, Chun BC, Kwon A, Lee GH, Ryu S, Oh SY, Lee JB, Yoo SH, Kim ES, Kim JH, Shin C, Lee SH. The Prevalence Rate of Tuberculin Skin Test Positive by Contacts Group to Predict the Development of Active Tuberculosis After School Outbreaks. Tuberc Respir Dis (Seoul) 2015; 78:349-55. [PMID: 26508922 PMCID: PMC4620328 DOI: 10.4046/trd.2015.78.4.349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 03/14/2015] [Accepted: 05/08/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The tuberculin skin test (TST) is the standard tool to diagnose latent tuberculosis infection (LTBI) in mass screening. The aim of this study is to find an optimal cut-off point of the TST+ rate within tuberculosis (TB) contacts to predict the active TB development among adolescents in school TB outbreaks. METHODS The Korean National Health Insurance Review and Assessment database was used to identify active TB development in relation to the initial TST (cut-off, 10 mm). The 7,475 contacts in 89 schools were divided into two groups: Incident TB group (43 schools) and no incident TB group (46 schools). LTBI treatment was initiated in 607 of the 1,761 TST+ contacts. The association with active TB progression was examined at different cut-off points of the TST+ rate. RESULTS The mean duration of follow-up was 3.9±0.9 years. Thirty-three contacts developed active TB during the 4,504 person-years among the TST+ contacts without LTBI treatment (n=1,154). The average TST+ rate for the incident TB group (n=43) and no incident TB group (n=46) were 31.0% and 15.5%, respectively. The TST+ rate per group was related with TB progression (odds ratio [OR], 1.025; 95% confidence interval [CI], 1.001-1.050; p=0.037). Based on the TST+ rate per group, active TB was best predicted at TST+ ≥ 16% (OR, 3.11; 95% CI, 1.29-7.51; area under curve, 0.64). CONCLUSION Sixteen percent of the TST+ rate per group within the same grade students can be suggested as an optimal cut-off to predict active TB development in middle and high schools TB outbreaks.
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Affiliation(s)
- Hee Jin Kim
- Korean Institute of Tuberculosis, Cheongwon, Korea
| | - Byung Chul Chun
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - AmyM Kwon
- SRC, Department of Statistics, Seoul National University, Seoul, Korea
| | | | - Sungweon Ryu
- Korean Institute of Tuberculosis, Cheongwon, Korea
| | - Soo Yeon Oh
- Korean Institute of Tuberculosis, Cheongwon, Korea
| | - Jin Beom Lee
- Korean Institute of Tuberculosis, Cheongwon, Korea
| | - Se Hwa Yoo
- Health Insurance Review and Assessment Service, Seoul, Korea
| | | | - Je Hyeong Kim
- Division of Pulmonary, Sleep, and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Chol Shin
- Division of Pulmonary, Sleep, and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Seung Heon Lee
- Division of Pulmonary, Sleep, and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
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Lee SH, Kim HJ, Park SJ, Kim TH, Park SJ, Kang SW, Kim YH, Menzies D. Serial interferon-gamma release assays for latent tuberculosis in dialysis patients with end stage renal disease in a Korean population. BMC Infect Dis 2015; 15:381. [PMID: 26392175 PMCID: PMC4578420 DOI: 10.1186/s12879-015-1117-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 09/09/2015] [Indexed: 11/16/2022] Open
Abstract
Background Serial interferon-gamma-release-assay (IGRA) result can show variance due to within-subject variation and difference in host immune status, and may be affected by latent tuberculosis infection (LTBI) treatment. We aimed to know the changes in QFT-IT (QuantiFERON-TB Gold In-Tube) results measured at a 4 month interval in end stage renal disease patients and whether these changes were influenced by dialysis method or LTBI treatment. Methods We prospectively performed serial QFT-IT tests at 4 month interval in 93 end stage renal disease (ESRD) patients on HD (hemodialysis) or PD (peritoneal dialysis). LTBI treatment was given to 18 of 39 patients with initial positive QFT-IT result. Agreement between the two results was estimated for all 93 patients and reversion rates were estimated among the 39 patients with initial positive QFT-IT. Results Positive QFT-IT at the first and 2nd tests were 41.9 and 34.4 %, respectively. The concordance rate between baseline QFT-IT and 2nd QFT in 93 ESRD patients was excellent (90.3 %, kappa = 0.80, p < 0.001). Agreement between the first QFT-IT and 2nd QFT-IT in HD (95.3 %, kappa = 0.91, p < 0.001) was higher than in PD patients (86.0 %, kappa = 0.69, p < 0.001). Among all ESRD patients, the odds of reversion of QFT-IT was not different in those who were, or were not treated for LTBI [odds ratio = 2.3 (0.5–11.4), p = 0.43]. Conclusions In a group of 93 dialyzed ESRD patients 8.6 % showed reversion of initial positive QFT to negative within 4 months. Reversion seemed not to be associated with LTBI treatment. Further study with larger numbers of patients is needed to investigate the variation of QFT-IT tests in dialyzed ESRD patients.
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Affiliation(s)
- Seung Heon Lee
- Division of Pulmonary, Sleep, and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, 425-707, Republic of Korea.
| | - Hee Jin Kim
- Korean Institute of Tuberculosis, Cheongwongun, 363-954, Republic of Korea.
| | - Seok Ju Park
- Division of Nephrology, Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, 614-735, Republic of Korea.
| | - Tae Hee Kim
- Division of Nephrology, Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, 614-735, Republic of Korea.
| | - So Jeong Park
- Division of Nephrology, Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, 614-735, Republic of Korea.
| | - Sun Woo Kang
- Division of Nephrology, Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, 614-735, Republic of Korea.
| | - Yeong Hoon Kim
- Division of Nephrology, Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, 614-735, Republic of Korea.
| | - Dick Menzies
- Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University, Montreal, QC, H2X 2P4, Canada.
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Araujo LSD, da Silva NDBM, da Silva RJ, Leung JAM, Mello FCQ, Saad MHF. Profile of interferon-gamma response to latency-associated and novel in vivo expressed antigens in a cohort of subjects recently exposed to Mycobacterium tuberculosis. Tuberculosis (Edinb) 2015; 95:751-757. [PMID: 26421415 DOI: 10.1016/j.tube.2015.08.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 07/29/2015] [Accepted: 08/04/2015] [Indexed: 02/08/2023]
Abstract
Recently some latency-associated antigens (LAA) of Mycobacterium tuberculosis were described, as Rv2029c, Rv2031c, Rv2034, Rv2628 and Rv3353c. Of which, the Rv2034 and Rv3353c also demonstrated in vivo expression. Therefore evaluating the immune response to these antigens may help to understand their role in latent TB infection. In a 1-year longitudinal study, IFN-γ response by in vitro peripheral blood mononuclear cells stimulation with LAA was investigated in subjects recently exposed to TB, classified by IFN-γ release assay (IGRA) using RD1 antigens (ESAT-6:CFP-10) and tuberculin skin test (TST) response. Except for Rv3353c, all the LAA triggered higher mean IFN-γ response in IGRA-RD1(+) groups (p < 0.05). Combining the IFN-γ-responders to Rv2029c, Rv2031c plus Rv2034 detected 90.3% (28/31) of IGRA-RD1(+) and 66.7% (24/36) of TST(+) contacts, while 95% (19/20) and 11% (2/17) were identified by classifying them according to a TST and IGRA-RD1 double-positive or double-negative response, respectively. In the follow-up, the TST convertors (negative to positive) also demonstrated an IFN-γ conversion to Rv2029c and Rv2031c, whereas the unique TB incident case was exclusively detected via IGRA-Rv2029c and TST before developing TB. A reversion rate to LAA (60%-100%) after prophylactic treatment was observed at TST(+)/IGRA-RD1(+) group. Further studies into the performance of these antigens are thus warranted.
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Affiliation(s)
- Leonardo Silva de Araujo
- Laboratory of Cellular Microbiology, Oswaldo Cruz Institute, Fiocruz, Avenida Brasil, 4365, Rio de Janeiro, RJ 20045-360, Brazil.
| | | | - Renan Jeremias da Silva
- Laboratory of Cellular Microbiology, Oswaldo Cruz Institute, Fiocruz, Avenida Brasil, 4365, Rio de Janeiro, RJ 20045-360, Brazil.
| | - Janaina Aparecida Medeiros Leung
- Federal University of Rio de Janeiro, Helio Fraga Filho Hospital, Av. Professor Rodolpho Paulo Rocco, 255, 1st Floor, Ilha do Fundão, Rio de Janeiro, RJ 21941-913, Brazil.
| | - Fernanda Carvalho Queiroz Mello
- Federal University of Rio de Janeiro, Helio Fraga Filho Hospital, Av. Professor Rodolpho Paulo Rocco, 255, 1st Floor, Ilha do Fundão, Rio de Janeiro, RJ 21941-913, Brazil.
| | - Maria Helena Féres Saad
- Laboratory of Cellular Microbiology, Oswaldo Cruz Institute, Fiocruz, Avenida Brasil, 4365, Rio de Janeiro, RJ 20045-360, Brazil.
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Mthiyane T, Rustomjee R, Pym A, Connolly C, Onyebujoh P, Theron G, Dheda K. Impact of tuberculosis treatment and antiretroviral therapy on serial RD-1-specific quantitative T-cell readouts (QuantiFERON-TB Gold In-Tube), and relationship to treatment-related outcomes and bacterial burden. Int J Infect Dis 2015; 36:46-53. [PMID: 26003404 DOI: 10.1016/j.ijid.2015.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 05/04/2015] [Accepted: 05/05/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND The impact of anti-tuberculosis treatment with and without antiretroviral therapy (ART) on standardized interferon gamma release assay (IGRA) readouts has been studied inadequately in high-burden countries. METHODS The QuantiFERON-TB Gold In-Tube (QFT-GIT) test was used to evaluate interferon gamma (IFN-γ) responses longitudinally (0, 3, 6, and 12 months post initiation of tuberculosis (TB)-HIV co-treatment or ART alone) in 82 HIV-infected patients. RESULTS Of the 65 evaluable participants, 30 were co-infected on ART, 17 were co-infected but not on ART, and 18 were HIV-infected alone and on ART. In HIV-infected and HIV-TB-infected patients on ART, IFN-γ responses increased, whilst they decreased in those not on ART. However, baseline, month 3, and month 6 IFN-γ responses, irrespective of ART, did not differ in TB-HIV co-infected patients who culture-converted compared to those who did not (1.25 vs. 1.05, p=0.5 at baseline; 3.76 vs. 1.15, p=0.2 for month 3; 0.06 vs. 0.7, p=0.3 for month 6). IFN-γ levels did not correlate with the magnitude of sputum bacillary load, smear status, or liquid culture time-to-positivity. CONCLUSION As IGRAs do not correlate with 2- or 6-month culture conversion or with markers of bacillary burden, they are unlikely to be useful for the prognostication of treatment outcome in co-infected patients.
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Affiliation(s)
- Thuli Mthiyane
- South African Medical Research Council, Parow Valley, Cape Town, South Africa
| | - Roxana Rustomjee
- South African Medical Research Council, Parow Valley, Cape Town, South Africa
| | - Alex Pym
- KwaZulu-Natal Research Institute for Tuberculosis and HIV (K-RITH), Nelson Mandela School of Medicine, Durban, South Africa
| | - Cathy Connolly
- South African Medical Research Council, Biostatistics Department, Durban, South Africa
| | - Philip Onyebujoh
- World Health Organization/Special Programme for Research and Training in Tropical diseases (TDR), Geneva, Switzerland
| | - Grant Theron
- Lung Infection and Immunity Unit, Division of Pulmonology, Department of Medicine, University of Cape Town, J flr, Old Main Bldg, Groote Schuur Hospital, Observatory, Cape Town, 7925, South Africa
| | - Keertan Dheda
- Lung Infection and Immunity Unit, Division of Pulmonology, Department of Medicine, University of Cape Town, J flr, Old Main Bldg, Groote Schuur Hospital, Observatory, Cape Town, 7925, South Africa.
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Salgame P, Geadas C, Collins L, Jones-López E, Ellner JJ. Latent tuberculosis infection--Revisiting and revising concepts. Tuberculosis (Edinb) 2015; 95:373-84. [PMID: 26038289 DOI: 10.1016/j.tube.2015.04.003] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 04/09/2015] [Indexed: 12/14/2022]
Abstract
Host- and pathogen-specific factors interplay with the environment in a complex fashion to determine the outcome of infection with Mycobacterium tuberculosis (Mtb), resulting in one of three possible outcomes: cure, latency or active disease. Although much remains unknown about its pathophysiology, latent tuberculosis infection (LTBI) defined by immunologic evidence of Mtb infection is a continuum between self-cure and asymptomatic, yet active tuberculosis (TB) disease. Strain virulence, intensity of exposure to the index case, size of the bacterial inoculum, and host factors such as age and co-morbidities, each contribute to where one settles on the continuum. Currently, the diagnosis of LTBI is based on reactive tuberculin skin testing (TST) and/or a positive interferon-gamma release assay (IGRA). Neither diagnostic test reflects the activity of the infectious focus or the risk of progression to active TB. This is a critical shortcoming, as accurate and efficient detection of those with LTBI at higher risk of progression to TB disease would allow for provision of targeted preventive therapy to those most likely to benefit. Host biomarkers may prove of value in stratifying risk of development of TB. New guidelines are required for interpretation of discordance between TST and IGRA, which may be due in part to a lack of stability (that is reproducibility) of IGRA or TST results or to a delay in conversion of IGRA to positivity compared to TST. In this review, the authors elaborate on the definition, diagnosis, pathophysiology and natural history of LTBI, as well as promising methods for better stratifying risk of progression to TB. The review is centered on the human host and the clinical and epidemiologic features of LTBI that are relevant to the development of new and improved diagnostic tools.
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Affiliation(s)
- Padmini Salgame
- Division of Infectious Diseases, Department of Medicine, New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | - Carolina Geadas
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - Lauren Collins
- Department of Internal Medicine, Duke University Medical Center, Durham, NC, USA
| | - Edward Jones-López
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - Jerrold J Ellner
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA.
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Torres M, García-García L, Cruz-Hervert P, Guio H, Carranza C, Ferreyra-Reyes L, Canizales S, Molina S, Ferreira-Guerrero E, Téllez N, Montero-Campos R, Delgado-Sánchez G, Mongua-Rodriguez N, Sifuentes-Osornio J, Ponce-de Leon A, Sada E, Young DB, Wilkinson RJ. Effect of isoniazid on antigen-specific interferon-γ secretion in latent tuberculosis. Eur Respir J 2014; 45:473-82. [PMID: 25359354 PMCID: PMC4318657 DOI: 10.1183/09031936.00123314] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Treatment of persons with latent tuberculosis (TB) infection at greatest risk of reactivation is an important component of TB control and elimination strategies. Biomarkers evaluating the effectiveness of treatment of latent TB infection have not yet been identified. This information would enhance control efforts and assist the evaluation of new treatment regimes. We designed a two-group, two-arm, randomised clinical study of tuberculin skin test-positive participants: 26 with documented contact with TB patients and 34 with non-documented contact. Participants in each group were randomly assigned to the immediate- or deferred-isoniazid treatment arms. Assays of in vitro interferon (IFN)-γ secretion in response to recombinant Rv1737 and overlapping synthetic peptide pools from various groups of immunodominant proteins were performed. During isoniazid therapy, a significant increase from baseline in the proportion of IFN-γ responders to the 10-kDa culture filtrate protein, Rv2031, Rv0849, Rv1986, Rv2659c, Rv2693c and the recombinant Rv1737 protein was observed (p⩽0.05). The peptide pool of Rv0849 and Rv1737 recombinant proteins induced the highest percentage of IFN-γ responders after isoniazid therapy. The in vitro IFN-γ responses to these proteins might represent useful markers to evaluate changes associated with treatment of latent TB infection. Peptide pool of Rv0849 and recombinant protein Rv1737 may be useful to test the efficacy of treatment of latentTBhttp://ow.ly/Catld
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Affiliation(s)
- Martha Torres
- Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | | | | | | | - Claudia Carranza
- Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | | | | | - Susana Molina
- Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | | | - Norma Téllez
- Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | | | | | | | - Jose Sifuentes-Osornio
- Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Alfredo Ponce-de Leon
- Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Eduardo Sada
- Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Douglas B Young
- Dept of Medicine, Imperial College, London, UK MRC National Institute for Medical Research, London, UK
| | - Robert J Wilkinson
- Dept of Medicine, Imperial College, London, UK MRC National Institute for Medical Research, London, UK Clinical Infectious Diseases Research Initiative, Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Ma N, Zalwango S, Malone LL, Nsereko M, Wampande EM, Thiel BA, Okware B, Igo RP, Joloba ML, Mupere E, Mayanja-Kizza H, Boom WH, Stein CM. Clinical and epidemiological characteristics of individuals resistant to M. tuberculosis infection in a longitudinal TB household contact study in Kampala, Uganda. BMC Infect Dis 2014; 14:352. [PMID: 24970328 PMCID: PMC4091673 DOI: 10.1186/1471-2334-14-352] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 06/18/2014] [Indexed: 01/06/2023] Open
Abstract
Background Despite sustained exposure to a person with pulmonary tuberculosis (TB), some M. tuberculosis (Mtb) exposed individuals maintain a negative tuberculin skin test (TST). Our objective was to characterize these persistently negative TST (PTST-) individuals and compare them to TST converters (TSTC) and individuals who are TST positive at study enrollment. Methods During a TB household contact study in Kampala, Uganda, PTST-, TSTC, and TST + individuals were identified. PTST- individuals maintained a negative TST over a 2 year observation period despite prolonged exposure to an infectious tuberculosis (TB) case. Epidemiological and clinical characteristics were compared, a risk score developed by another group to capture risk for Mtb infection was computed, and an ordinal regression was performed. Results When analyzed independently, epidemiological risk factors increased in prevalence from PTST- to TSTC to TST+. An ordinal regression model suggested age (p < 0.01), number of windows (p < 0.01) and people (p = 0.07) in the home, and sleeping in the same room (p < 0.01) were associated with PTST- and TSTC. As these factors do not exist in isolation, we examined a risk score, which reflects an accumulation of risk factors. This compound exposure score did not differ significantly between PTST-, TSTC, and TST+, except for the 5–15 age group (p = 0.009). Conclusions Though many individual factors differed across all three groups, an exposure risk score reflecting a collection of risk factors did not differ for PTST-, TSTC and TST + young children and adults. This is the first study to rigorously characterize the epidemiologic risk profile of individuals with persistently negative TSTs despite close exposure to a person with TB. Additional studies are needed to characterize possible epidemiologic and host factors associated with this phenotype.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Catherine M Stein
- Department of Epidemiology & Biostatistics, Case Western Reserve University, 2103 Cornell Rd, Wolstein Research Building room 1316, Cleveland, OH 44106, USA.
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Seo KW, Ahn JJ, Ra SW, Kwon WJ, Jegal Y. Persistently retained interferon-gamma responsiveness in individuals with a history of pulmonary tuberculosis. TOHOKU J EXP MED 2014; 233:123-8. [PMID: 24881649 DOI: 10.1620/tjem.233.123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The interferon gamma (IFN-γ) release assays (IGRAs) are the best method of detecting Mycobacterium tuberculosis infection. However, reports on IGRAs results obtained during and right after the treatment of tuberculosis (TB) have presented differing results. Some studies have shown declining responses, whereas other reports described persistent, fluctuating, or increasing responses. We postulated that the IGRA-positivity will decrease or revert long time after treatment of TB, and thus, evaluated the response of IGRA in subjects with a history of pulmonary TB. Seventy subjects (M:F = 51:19; age = 53.2 ± 11.8 years) underwent tuberculin skin tests (TSTs) and IGRA. The interval of time elapsed after the completion of anti-TB treatment was < 10 years for 16 subjects, 10-20 years for 13 subjects, 20-30 years for 16 subjects, and ≥ 30 years for 25 subjects. The TST was positive in 49 subjects (74%) and negative in 17 subjects (26%). The IGRA was positive in 52 subjects (74%) and negative in 18 subjects (26%). The IFN-γ level and the size of induration showed good correlation (r = 0.525, P < 0.001). However, the correlation between time elapsed after the completion of anti-TB treatment and the size of induration or that between time and the IFN-γ level was not significant. The TST and IGRA were positive in 72.7% and 68.0% of subjects ≥ 30 years after the treatment of pulmonary TB. In conclusion, majority of subjects with a history of pulmonary TB are IGRA-positive, even a few decades after the completion of anti-TB treatment.
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Affiliation(s)
- Kwang Won Seo
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan, College of Medicine
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Contribution of Interferon-γ Release Assays (IGRAs) to the Diagnosis of Latent Tuberculosis Infection After Renal Transplantation. Transplantation 2013; 95:1485-90. [DOI: 10.1097/tp.0b013e3182907073] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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22
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To KW, Reino JJG, Yoo DH, Tam LS. Tumour necrosis factor antagonist and tuberculosis in patients with rheumatoid arthritis: An Asian perspective. Respirology 2013; 18:765-73. [PMID: 23627398 DOI: 10.1111/resp.12106] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 04/01/2013] [Accepted: 04/17/2013] [Indexed: 12/31/2022]
Affiliation(s)
- Kin Wang To
- Division of Respiratory Medicine; Prince of Wales Hospital, The Chinese University of Hong Kong; Hong Kong, SAR; China
| | - Juan J Gomez Reino
- Department of Medicine and Rheumatology Unit; Hospital Clínico Universitario, USC; Santiago de Compostela; Spain
| | - Dae Hyun Yoo
- Division of Rheumatology, Department of Internal Medicine; Hanyang University Hospital, Hanyang University College of Medicine; Seoul; Korea
| | - Lai Shan Tam
- Division of Rheumatology; Department of Medicine and Therapeutics; Prince of Wales Hospital, The Chinese University of Hong Kong; Hong Kong, SAR; China
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Bartalesi F, Goletti D, Spinicci M, Cavallo A, Attala L, Mencarini J, Fiori G, Li Gobbi F, Mantella A, Benucci M, Prignano F, Pimpinelli N, Matucci Cerinic M, Girardi E, Bartoloni A. Serial QuantiFERON TB-Gold in-tube testing during LTBI therapy in candidates for TNFi treatment. J Infect 2013; 66:346-56. [DOI: 10.1016/j.jinf.2012.10.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 10/16/2012] [Accepted: 10/18/2012] [Indexed: 12/11/2022]
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Trajman A, Steffen RE, Menzies D. Interferon-Gamma Release Assays versus Tuberculin Skin Testing for the Diagnosis of Latent Tuberculosis Infection: An Overview of the Evidence. Pulm Med 2013; 2013:601737. [PMID: 23476763 PMCID: PMC3582085 DOI: 10.1155/2013/601737] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 01/10/2013] [Indexed: 11/18/2022] Open
Abstract
A profusion of articles have been published on the accuracy and uses of interferon-gamma releasing assays. Here we review the clinical applications, advantages, and limitations of the tuberculin skin test and interferon-gamma release assays and provide an overview of the most recent systematic reviews conducted for different indications for the use of these tests. We conclude that both tests are accurate to detect latent tuberculosis, although interferon-gamma release assays have higher specificity than tuberculin skin testing in BCG-vaccinated populations, particularly if BCG is received after infancy. However, both tests perform poorly to predict risk for progression to active tuberculosis. Interferon-gamma release assays have significant limitations in serial testing because of spontaneous variability and lack of a validated definition of conversion and reversion, making it difficult for clinicians to interpret changes in category (conversions and reversions). So far, the most important clinical evidence, that is, that isoniazid preventive therapy reduces the risk for progression to disease, has been produced only in tuberculin skin test-positive individuals.
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Affiliation(s)
- A. Trajman
- Gama Filho University, 20740-900 Rio de Janeiro, RJ, Brazil
- Montreal Chest Institute, McGill University, Montreal, QC, Canada H2X 2P4
| | - R. E. Steffen
- Federal University of Rio de Janeiro, 21941-913 Rio de Janeiro, RJ, Brazil
| | - D. Menzies
- Montreal Chest Institute, McGill University, Montreal, QC, Canada H2X 2P4
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Adetifa IM, Ota MOC, Jeffries DJ, Lugos MD, Hammond AS, Battersby NJ, Owiafe PK, Donkor SD, Antonio M, Ibanga HB, Brookes RH, Aka P, Walton R, Adegbola RA, Hill PC. Interferon-γ ELISPOT as a biomarker of treatment efficacy in latent tuberculosis infection: a clinical trial. Am J Respir Crit Care Med 2012; 187:439-45. [PMID: 23220919 DOI: 10.1164/rccm.201208-1352oc] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Biomarkers that can be used to evaluate new interventions against latent tuberculosis infection (LTBI) and predict reactivation TB disease are urgently required. OBJECTIVES To evaluate ESAT-6 and CFP-10 (EC) IFN-γ ELISPOT as a biomarker for treatment efficacy in LTBI. METHODS This was a randomized, blinded, and placebo-controlled trial of INH in EC ELISPOT and Mantoux test positive participants. MEASUREMENTS AND MAIN RESULTS Participants received a 6-month course of 900 mg INH twice weekly or a matching placebo. INH acetylator genotypes were determined and urine tested for INH metabolites to confirm adherence. The proportion of positive responders for CFP-10 and ESAT-6 between treatment arms was compared using mixed effects logistic regression models. A Tweedie (compound Poisson) model was fitted to allow for zero inflation and overdispersion of quantitative response. The proportions of EC ELISPOT-positive subjects reduced over time (P < 0.001) but did not differ by study arm (P = 0.36). Median spot-forming units for ESAT-6 and CFP-10 also declined significantly with time (P < 0.001) but did not differ by study arm (P = 0.74 and 0.71, respectively). There was no evidence of an interaction between acetylator status and INH treatment with respect to ELISPOT results over time. CONCLUSIONS In contacts with LTBI, INH therapy plays no role in observed decreases in Mycobacterium tuberculosis antigen-specific T-cell responses over time. IFN-γ ELISPOT is probably not a useful biomarker of treatment efficacy in LTBI. Clinical trial registered with www.clinicaltrials.gov (NCT 00130325).
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Affiliation(s)
- Ifedayo M Adetifa
- Medical Research Council Unit, The Gambia, Fajara, P.O. Box 273, Banjul, The Gambia.
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Serial T-SPOT.TB and quantiFERON-TB-Gold In-Tube assays to monitor response to antitubercular treatment in Italian children with active or latent tuberculosis infection. Pediatr Infect Dis J 2012; 31:974-7. [PMID: 22572749 DOI: 10.1097/inf.0b013e31825d0d67] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We performed a prospective study to investigate T-SPOT.TB and QuantiFERON-TB Gold In-Tube (QFT-G-IT) dynamics during antitubercular treatment in active tuberculosis (TB) or latent TB. Eighteen children with latent TB and 26 with TB were enrolled. At 6 months of follow-up reversion rate was 5.88% (95% CI:0-13.79) for QFT-G-IT; 9.09% (95% CI:0.59-17.58) for T-SPOT.TB (P=0.921) in TB cases. Significant decline in quantitative response was observed exclusively in TB cases. Our results suggest that serial IGRA have limited use in children receiving antitubercular treatment.
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Serial interferon-gamma release assays after chemoprophylaxis in a tuberculosis outbreak cohort. Infection 2012; 40:431-5. [PMID: 22585454 DOI: 10.1007/s15010-012-0265-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Accepted: 04/19/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Interferon-gamma release assay (IGRA) results have been suggested as a surrogate marker of treatment response in latent tuberculosis infection (LTBI). However, data have not been consistent, and most previous studies focused on participants taking isoniazid prophylaxis. The aim of this study was to elucidate the changes in the IGRA results in patients who underwent chemoprophylaxis with isoniazid and rifampicin daily for 3 months. METHODS In a TB outbreak cohort, 26 asymptomatic close contacts with normal chest radiographs and positive QuantiFERON-TB Gold In-Tube assay (QFT-GIT) results were recruited. These patients were treated with isoniazid and rifampicin daily for 3 months. The QFT-GIT was repeated at 3 and 6 months following treatment initiation. RESULTS Compared with the initial QFT-GIT results (3.59 ± 3.39 IU/mL), the interferon-gamma (IFN-γ) levels had decreased significantly at 6 months (0.84 ± 1.14 IU/mL; P = 0.005), but not at 3 months (3.58 ± 3.64 IU/mL; P = 0.98). Reversions occurred in seven (26.9 %) patients at 3 months and in an additional two participants at 6 months; a total of nine participants (34.6 %) had reversions. Recent conversion was associated with reversion of the test results (odds ratio 26.3, 95 % confidence interval 3.04-226.6). CONCLUSION Chemoprophylaxis with isoniazid and rifampicin generally decreased IFN-γ levels among tuberculosis contacts. However, only a small portion of participants achieved reversion.
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Chiappini E, Fossi F, Bonsignori F, Sollai S, Galli L, de Martino M. Utility of interferon-γ release assay results to monitor anti-tubercular treatment in adults and children. Clin Ther 2012; 34:1041-8. [PMID: 22512899 DOI: 10.1016/j.clinthera.2012.03.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 03/13/2012] [Accepted: 03/19/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Interferon-γ release assays (IGRAs), including the commercially available T-SPOT.TB, QuantiFERON-TB Gold (QFT-G), and QuantiFERON-TB Gold In-Tube (QTF-G-IT), enable detection of circulating T lymphocytes responsive to specific Mycobacterium tuberculosis antigens. Studies of the potential role of serial IGRAs for assessment of response to anti-tubercular therapy are accumulating. OBJECTIVE The objective of this systematic review was to evaluate the potential clinical utility of serial IGRAs in anti-tubercular therapy. METHODS We conducted a literature search of the Cochrane Library and MEDLINE by PubMed, from database inception through October 1, 2011, for serial IGRA results in anti-tubercular therapy, in adults and children, using commercial stardardized assays. All types of articles in the English language were included. Meta-analysis was performed to estimate the pooled percentage of reversion from a positive to a negative IGRA value at 3- to 6-month follow-up. RESULTS According to inclusion and exclusion criteria, three T-SPOT.TB-based (n = 319 patients), three QFT-G-based (n = 75 patients), and seven QFT-G-IT-based (n = 558 patients) longitudinal studies were included. The percentage of patients with reversion from a positive to a negative IGRA value ranged from 5.71% to 13.93% for T-SPOT.TB, 5.26% to 71.05% for QFT-G, and 14.28% to 41.89% for QFT-G-IT assays. Meta-analysis estimation of reversion was feasible only for the QFT-G-IT assay, at 30.54% (95% CI, 22.89-38.75). In two pediatric studies, which were QFT-G-IT based (n = 122 children), the reported reversion rates were 14.28% and 20.33%, respectively. CONCLUSIONS Because IGRAs require time and cost resources, and reversion from positive to negative IGRA values occurs in a minority of treated patients, monitoring IGRA changes over time seems to have only speculative value in adults. Data in children are poor, but are in line with results reported in adults.
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Affiliation(s)
- Elena Chiappini
- Department of Science for Woman and Child's Health, Meyer Children's Hospital, University of Florence, Italy.
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Chan PC, Yang CH, Chang FY. Scaling up of latent tuberculosis infection treatment for close contacts of tuberculosis in Taiwan. J Formos Med Assoc 2011; 110:733-6. [DOI: 10.1016/j.jfma.2011.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Adverse events and development of tuberculosis after 4 months of rifampicin prophylaxis in a tuberculosis outbreak. Epidemiol Infect 2011; 140:1028-35. [PMID: 21835069 DOI: 10.1017/s0950268811001476] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We screened tuberculosis (TB) contacts as an outbreak investigation with tuberculin skin test (TST) and interferon-gamma release assay (IGRA). We evaluated adverse events and TB incidence in all persons screened after rifampicin (RFP) prophylaxis, and specifically assessed the new TB cases in relation to initial TST and IGRA results. The 180 contacts were divided into four groups: TST+/IGRA+ (n = 101), TST+/IGRA- (n = 22), TST-/IGRA+ (n = 16), and TST-/IGRA- (n = 41). RFP treatment (4 months) was prescribed only to the TST+/IGRA+ group. Of 87 contacts who initiated prophylaxis, adverse events occurred in 21 contacts (24.1%) including hepatotoxicity (11.5%), flu-like syndrome (5.7%), and thrombocytopenia (3.4%). TB developed in two TST+/IGRA+ subjects after completion of prophylaxis, including one multidrug-resistant (MDR)-TB case during 21.8 months of follow-up. Adverse events were frequent, and development of TB including MDR-TB occurred after RFP prophylaxis.
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Herrera V, Perry S, Parsonnet J, Banaei N. Clinical Application and Limitations of Interferon- Release Assays for the Diagnosis of Latent Tuberculosis Infection. Clin Infect Dis 2011; 52:1031-7. [DOI: 10.1093/cid/cir068] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Park HY, Jeon K, Suh GY, Kwon OJ, Chung DR, Yoonchang SW, Kang ES, Koh WJ. Interferon-γ release assay for tuberculosis screening of healthcare workers at a Korean tertiary hospital. ACTA ACUST UNITED AC 2010; 42:943-5. [PMID: 20936910 DOI: 10.3109/00365548.2010.524658] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aim of this study was to evaluate the annual incidence of tuberculosis infection among newly employed doctors and nurses in Korea. The annual incidence of tuberculosis infection ranged from 3.3% to 5.7%, based on the definition of conversion of an interferon-γ release assay, which suggests that stricter preventive strategies against nosocomial TB infection should be employed. Follow-up interferon-γ levels measured after 3 months of isoniazid and rifampicin treatment showed considerable variation. Therefore, serial testing with interferon-γ release assays after treatment of latent TB infection may be insufficient for evaluating the effects of treatment due to the variable responses.
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Affiliation(s)
- Hye Yun Park
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Shah SQ, Khan AU, Khan MR. Radiosynthesis and biodistribution of (99m)Tc-rifampicin: a novel radiotracer for in-vivo infection imaging. Appl Radiat Isot 2010; 68:2255-60. [PMID: 20538473 DOI: 10.1016/j.apradiso.2010.05.014] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2010] [Revised: 05/18/2010] [Accepted: 05/20/2010] [Indexed: 11/25/2022]
Abstract
(99m)Tc-rifampicin ((99m)Tc-RMP) a new radioantibiotic complex was synthesized specifically for the infection localization caused by methicillin-resistant Staphylococcus aureus (MRSA). The in-vitro radiochemical purity (RCP) yield, in-vivo biodistribution behavior in artificially infected rats (AIT) and scintigraphic accuracy in artificially infected rabbit (AIB) of the (99m)Tc-RMP complex was investigated using different concentration of the RMP, sodium pertechnetate (Na(99m)TcO(4)), stannous chloride dihydrate (SnCl(2) x 2H(2)O) at different pH ranges 5-6. The best RCP yield observed at 30, 60, 90 and 120 min after labeling was; 98.95+/-0.20, 98.15+/-0.24, 96.50+/-0.27 and 91.55+/-0.22%, respectively, using 1.5 mg RMP, 175 microL of SnCl(2) x 2H(2)O (1 microg/microL in 0.01 N HCl), 3 mCi of Na(99m)TcO(4), at pH 5.6. Initially in the infected muscle (INM) of the AIT the activity was lower but after 90 min it went up to 18.35+/-0.20% from 5.95+/-0.25%. The activity in the inflamed muscle (IMM), normal (NM) muscle, blood, liver and spleen was initially high that decreased with time. The ratios of the INM/NM and IMM/NM were 7.34+/-0.74 and 1.20+/-0.85, respectively. The whole body static (WBS) imaging of the MRSA infected rabbit confirmed the usefulness of the (99m)Tc-RMP as a precise radiotracer for MRSA infection imaging. On the basis of in-vitro RCP, in-vivo biodistribution and scintigraphic precision, we recommend the (99m)Tc-RMP complex prepared aseptically for in-vivo assessment of MRSA infection.
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Affiliation(s)
- Syed Qaiser Shah
- Nuclear Medicine Research Laboratory (NMRL), University of Peshawar, Room no 111, Academic Block I, Peshawar, NWFP, Pakistan.
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