Elevated antigen-specific IFN-γ responses in bronchoalveolar lavage fluid impervious to clinical comorbidities improve the pulmonary tuberculosis diagnosis

Pulmonary tuberculosis and diabetes mellitus: Epidemiology, pathogenesis and therapeutic management (Review)

The dual burden of pulmonary tuberculosis (PTB) and diabetes mellitus (DM) is a major global public health concern. There is increasing evidence to indicate an association between PTB and DM. DM is associated with immune dysfunction and altered immune components. Hyperglycemia weakens the innate immune response by affecting the function of macrophages, dendritic cells, neutrophils, and natural killer cells, and also disrupts the adaptive immune response, thus promoting the susceptibility of PTB in patients with DM. Antituberculosis drugs often cause the impairment of liver and kidney function in patients with PTB, and the infection with Mycobacterium tuberculosis weaken pancreatic endocrine function by causing islet cell amyloidosis, which disrupts glucose metabolism and thus increases the risk of developing DM in patients with PTB. The present review discusses the association between PTB and DM from the perspective of epidemiology, pathogenesis, and treatment management. The present review aims to provide information for the rational formulation of treatment strategies for patients with PTB-DM.

Determination of the predictive factors for diagnostic positivity of nucleic acid amplification tests for diagnosing pulmonary tuberculosis

BACKGROUND

Tuberculosis (TB) remains a major threat to human health, and TB diagnostic methods remain unsatisfactory. Nucleic acid amplification tests (NAATs) show higher sensitivity compared with culture for the diagnosis of pulmonary TB (PTB). However, NAATs are expensive and cannot be easily implemented outside major medical centers. To improve the sensitivity of NAATs for PTB diagnosis, we investigated the predictive factors that might optimize NAAT utilization.

METHODS

A total of 1263 patients with suspected PTB were enrolled for evaluation. The sensitivity, specificity, and accuracy of methods including smear-microbiology, culture of Mtb and NAAT for Mycobacterium tuberculosis (Mtb) detection in sputum and bronchoalveolar lavage fluid samples were compared. Odds ratios and 95% confidence intervals were used to assess variables that might be associated with positive NAAT results for sputum and bronchoalveolar lavage fluid from patients with suspected PTB.

RESULTS

NAAT showed higher sensitivity for Mtb detection (61.1%) when compared with smear (9.0%) and Mtb culture (47.8%). We found that an elevated erythrocyte sedimentation rate, the presence of cavities, and positive interferon-γ release assay (IGRA) results were indicative of positive Mtb detection by NAAT. Moreover, individuals who had all three of these characteristics showed an 86% diagnostic positivity for PTB from Mtb detection by NAAT.

CONCLUSIONS

Our study suggests that an elevated erythrocyte sedimentation rate, a positive IGRA result, and the presence of pulmonary cavities are helpful factors for predicting positive Mtb detection by NAAT. Patients with the three positive clinical markers should undergo NAAT for Mtb detection because they are the most likely individuals to be bacteriologically confirmed as having TB.

Diagnostic value of microRNA-155 in active tuberculosis: A systematic review and meta-analysis

BACKGROUND

Tuberculosis (TB) is a preventable and treatable disease, but the increased mortality and morbidity associated with TB continues to be a leading cause of death globally. MicroRNA (miRNA)-155 has been recognized as a marker of many lung diseases. However, the effectiveness of this marker for diagnosing TB remains unclear.

METHODS

A detailed search (updated on February 6, 2021) of literature published in the Wanfang database, EMBASE, PubMed, CNKI, and Cochrane Library was conducted to identify eligible studies suitable for inclusion in the current research. The positive likelihood ratio, negative likelihood ratio, specificity, area under the curve, sensitivity, and diagnostic odds ratio were used to investigate the diagnostic potential of miRNA-155.

RESULTS

A total of 122 studies related to active TB, which completely complied with the inclusion and exclusion criteria of our meta-analysis, were included. The overall results suggested a moderately high diagnostic accuracy and efficacy of miRNA-155, with a specificity of 0.85 (95% confidence interval = 0.77-0.91) and sensitivity of 0.87 (95% confidence interval = 0.76-0.93). The result based on dysregulated status demonstrated that the upregulated group yielded better accuracy and efficacy than the downregulated group. Notably, the accuracy and efficacy of miRNA-155 in pediatric TB were higher than those in adult TB. The results showed that the accuracy and efficacy of miRNA-155 in children were higher than those in adults.

CONCLUSION

The results of the meta-analysis suggested that miRNA-155 could serve as an effective biomarker for identifying active TB.