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Khanna H, Gupta S, Sheikh Y. Cell-Mediated Immune Response Against Mycobacterium tuberculosis and Its Potential Therapeutic Impact. J Interferon Cytokine Res 2024; 44:244-259. [PMID: 38607324 DOI: 10.1089/jir.2024.0030] [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: 04/13/2024] Open
Abstract
Cell-mediated immune response is critical for Mycobacterium tuberculosis (M.tb) control. Understanding of pathophysiology and role played by different cell mediators is essential for vaccine development and better management of patients with M.tb. A complex array of cytokines and chemokines are involved in the immune response against M.tb; however, their relative contribution in protection remains to be further explored. The purpose of this review is to summarize the current understanding regarding the cytokine and chemokine profiles in M.tb infection in order to assist research in the field to pursue new direction in prevention and control. We have also summarized recent findings on vaccine trials that have been developed and or are under trials that are targeting these molecules.
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Affiliation(s)
- Harshika Khanna
- Department of Pediatrics, King George's Medical University, Lucknow, India
| | | | - Yasmeen Sheikh
- Department of Pediatrics, King George's Medical University, Lucknow, India
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To KW, Zhang R, Lee SS. Is the new tuberculous antigen-based skin test ready for use as an alternative to tuberculin skin test/interferon-gamma release assay for tuberculous diagnosis? A narrative review. Int J Infect Dis 2024; 141S:106992. [PMID: 38458426 DOI: 10.1016/j.ijid.2024.106992] [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] [Received: 01/23/2024] [Revised: 02/28/2024] [Accepted: 02/28/2024] [Indexed: 03/10/2024] Open
Abstract
In recent years, novel specific Mycobacteria tuberculous (TB) antigen-based skin test (TBST) has become available for clinical use. The mechanism of TBST is similar to the interferon-gamma release assay (IGRA), making it a potential alternative for identifying latent tuberculous infection (LTBI), especially in subjects with history of bacille Calmette-Guérin vaccination. Three different commercial brands have been developed in Denmark, Russia, and China. Clinical studies in the respective countries have shown promising sensitivity, specificity, and safety profile. Some studies attempted to address the applicability of TBST in specific subject groups but the discrepancy in defining LTBI and problematic methodologies undermine the generalisation of the results to other communities across the world. Limited cost-effectiveness studies for TBST have been conducted without exploring the health economics for preventing development of LTBI into active TB. Unlike IGRA, no clinical studies have addressed the correlation of TBST results (magnitude of induration) with the likelihood of development of active TB. Moreover, the different TBSTs are not widely available for clinical use. While TBST is a promising test to overcome the shortcomings of tuberculin skin tests, more clinical data are needed to support its general application globally for the diagnosis of LTBI.
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Affiliation(s)
- Kin Wang To
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China; S.H. Ho Research Centre for Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China.
| | - Rui Zhang
- S.H. Ho Research Centre for Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China
| | - Shui Shan Lee
- S.H. Ho Research Centre for Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China
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Lu P, Xu J, Wang R, Gong X, Liu Q, Ding X, Lu W, Zhu L. Diagnostic performance of a novel ESAT6-CFP10 skin test for tuberculosis infection in school tuberculosis outbreak in China. Front Public Health 2024; 11:1259106. [PMID: 38283285 PMCID: PMC10811131 DOI: 10.3389/fpubh.2023.1259106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 12/28/2023] [Indexed: 01/30/2024] Open
Abstract
Background The ESAT6-CFP10 (EC) skin test is recommended by the World Health Organization for latent tuberculosis infection (LTBI). However, it is still unknown how the EC skin test performs in students during a school tuberculosis outbreak. Methods We conducted an epidemiological investigation to assess the performance of the EC skin test in this high-risk population. Results A total of 9 active student patients were confirmed in the same class as the index case, with an incidence rate of 18.0% (9/50). Among the 50 close contacts, 14 (28%) were over 15 years old and had a chest X-ray (CXR), and none of them had abnormal CXR findings. The rates of positive tuberculin skin test (TST) ≥ 5 mm and < 10 mm, ≥ 10 mm and < 15 mm, and ≥ 15 mm were 12.0% (6/50), 16.0% (8/50), and 10.0% (5/50), respectively. On the second screening, 44 students with the same class as the index case had the EC skin test, of which 31 (70.5%) had positive EC tests. All patients had negative sputum smear results, of whom 4 (44.4%) had positive Xpert results; three had a TST induration diameter between 5 mm and 10 mm, but all of them had an EC diameter > 15 mm; 5 (55.6%) had abnormal CXR results, but all the confirmed patients had abnormal CT results; Except for four cases that were diagnosed by Xpert, the remaining five were confirmed by CT scan. Conclusion The novel EC skin test performed well in students during the school tuberculosis outbreak. In some special conditions, such as when the index case is bacteriologically positive for tuberculosis and the rate of LTBI is higher than the average for the local same-age group, secondary screening is recommended 2-3 months after the first screening. Furthermore, we cannot ignore the role of CT in the diagnosis of early student tuberculosis.
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Affiliation(s)
- Peng Lu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu, China
| | - Jingjing Xu
- Center for Disease Control and Prevention of Yancheng City, Yancheng, Jiangsu, China
- School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Rong Wang
- Center for Disease Control and Prevention of Nanjing City, Nanjing, Jiangsu, China
| | - Xiaona Gong
- Center for Disease Control and Prevention of Lishui District, Nanjing, Jiangsu, China
| | - Qiao Liu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu, China
| | - Xiaoyan Ding
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu, China
| | - Wei Lu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu, China
| | - Limei Zhu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu, China
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Li LS, Yang L, Zhuang L, Ye ZY, Zhao WG, Gong WP. From immunology to artificial intelligence: revolutionizing latent tuberculosis infection diagnosis with machine learning. Mil Med Res 2023; 10:58. [PMID: 38017571 PMCID: PMC10685516 DOI: 10.1186/s40779-023-00490-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 11/06/2023] [Indexed: 11/30/2023] Open
Abstract
Latent tuberculosis infection (LTBI) has become a major source of active tuberculosis (ATB). Although the tuberculin skin test and interferon-gamma release assay can be used to diagnose LTBI, these methods can only differentiate infected individuals from healthy ones but cannot discriminate between LTBI and ATB. Thus, the diagnosis of LTBI faces many challenges, such as the lack of effective biomarkers from Mycobacterium tuberculosis (MTB) for distinguishing LTBI, the low diagnostic efficacy of biomarkers derived from the human host, and the absence of a gold standard to differentiate between LTBI and ATB. Sputum culture, as the gold standard for diagnosing tuberculosis, is time-consuming and cannot distinguish between ATB and LTBI. In this article, we review the pathogenesis of MTB and the immune mechanisms of the host in LTBI, including the innate and adaptive immune responses, multiple immune evasion mechanisms of MTB, and epigenetic regulation. Based on this knowledge, we summarize the current status and challenges in diagnosing LTBI and present the application of machine learning (ML) in LTBI diagnosis, as well as the advantages and limitations of ML in this context. Finally, we discuss the future development directions of ML applied to LTBI diagnosis.
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Affiliation(s)
- Lin-Sheng Li
- Beijing Key Laboratory of New Techniques of Tuberculosis Diagnosis and Treatment, Senior Department of Tuberculosis, the Eighth Medical Center of PLA General Hospital, Beijing, 100091, China
- Hebei North University, Zhangjiakou, 075000, Hebei, China
- Senior Department of Respiratory and Critical Care Medicine, the Eighth Medical Center of PLA General Hospital, Beijing, 100091, China
| | - Ling Yang
- Hebei North University, Zhangjiakou, 075000, Hebei, China
| | - Li Zhuang
- Hebei North University, Zhangjiakou, 075000, Hebei, China
| | - Zhao-Yang Ye
- Hebei North University, Zhangjiakou, 075000, Hebei, China
| | - Wei-Guo Zhao
- Senior Department of Respiratory and Critical Care Medicine, the Eighth Medical Center of PLA General Hospital, Beijing, 100091, China.
| | - Wen-Ping Gong
- Beijing Key Laboratory of New Techniques of Tuberculosis Diagnosis and Treatment, Senior Department of Tuberculosis, the Eighth Medical Center of PLA General Hospital, Beijing, 100091, China.
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Guo X, Du W, Li J, Dong J, Shen X, Su C, Zhao A, Wu Y, Xu M. A Comparative Study on the Mechanism of Delayed-Type Hypersensitivity Mediated by the Recombinant Mycobacterium tuberculosis Fusion Protein ESAT6-CFP10 and Purified Protein Derivative. Int J Mol Sci 2023; 24:16612. [PMID: 38068935 PMCID: PMC10706316 DOI: 10.3390/ijms242316612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/15/2023] [Accepted: 11/18/2023] [Indexed: 12/18/2023] Open
Abstract
While purified protein derivative (PPD) is commonly used as skin diagnostic reagent for tuberculosis (TB) infection, it cannot distinguish effectively Bacillus Calmette-Guérin (BCG) vaccination from Mycobacterium tuberculosis (MTB) complex and nontuberculous mycobacteria infection. The new skin reagent ESAT6-CFP10 (EC) has favorable sensitivity and specificity, which can overcome limitations associated with PPD. At present, EC skin test reactions are mainly characterized by erythema, while PPD mainly causes induration. We conducted a comparative study on the potential differences between EC-induced erythema and PPD-induced induration using a guinea pig model. The size of EC-dependent erythema was similar to that of PPD-induced induration, and an inflammatory response characterized by the infiltration of monocytes, macrophages and lymphocytes, as well as tissue damage, appeared at the injection site. The lymphocytes included CD4+ T and CD8+ T cells, which released IFN-γ as the main cytokine. Both EC erythema and PPD induration could lead to increased levels of acute-phase proteins, and the differential pathways were similar, thus indicating that the main induced immune pathways were similar. The above results indicated that erythema produced by EC could generate the main delayed-type hypersensitivity (DTH) response characteristic of PPD induration, thereby suggesting that erythema might also have a certain diagnostic significance and provide a possible theoretical basis for its use as a diagnostic indicator for detecting MTB infection.
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Affiliation(s)
- Xiaonan Guo
- National Engineering Laboratory for AIDS Vaccine, School of Life Sciences, Jilin University, Changchun 130012, China;
- Division of Tuberculosis Vaccine and Allergen Products, Institute of Biological Product Control, National Institutes for Food and Drug Control, Beijing 102629, China; (W.D.); (J.L.); (J.D.); (X.S.); (C.S.); (A.Z.)
| | - Weixin Du
- Division of Tuberculosis Vaccine and Allergen Products, Institute of Biological Product Control, National Institutes for Food and Drug Control, Beijing 102629, China; (W.D.); (J.L.); (J.D.); (X.S.); (C.S.); (A.Z.)
| | - Junli Li
- Division of Tuberculosis Vaccine and Allergen Products, Institute of Biological Product Control, National Institutes for Food and Drug Control, Beijing 102629, China; (W.D.); (J.L.); (J.D.); (X.S.); (C.S.); (A.Z.)
| | - Jiaxin Dong
- Division of Tuberculosis Vaccine and Allergen Products, Institute of Biological Product Control, National Institutes for Food and Drug Control, Beijing 102629, China; (W.D.); (J.L.); (J.D.); (X.S.); (C.S.); (A.Z.)
| | - Xiaobing Shen
- Division of Tuberculosis Vaccine and Allergen Products, Institute of Biological Product Control, National Institutes for Food and Drug Control, Beijing 102629, China; (W.D.); (J.L.); (J.D.); (X.S.); (C.S.); (A.Z.)
| | - Cheng Su
- Division of Tuberculosis Vaccine and Allergen Products, Institute of Biological Product Control, National Institutes for Food and Drug Control, Beijing 102629, China; (W.D.); (J.L.); (J.D.); (X.S.); (C.S.); (A.Z.)
| | - Aihua Zhao
- Division of Tuberculosis Vaccine and Allergen Products, Institute of Biological Product Control, National Institutes for Food and Drug Control, Beijing 102629, China; (W.D.); (J.L.); (J.D.); (X.S.); (C.S.); (A.Z.)
| | - Yongge Wu
- National Engineering Laboratory for AIDS Vaccine, School of Life Sciences, Jilin University, Changchun 130012, China;
| | - Miao Xu
- Division of Tuberculosis Vaccine and Allergen Products, Institute of Biological Product Control, National Institutes for Food and Drug Control, Beijing 102629, China; (W.D.); (J.L.); (J.D.); (X.S.); (C.S.); (A.Z.)
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Hamada Y, Kontsevaya I, Surkova E, Wang TT, Wan-Hsin L, Matveev A, Ziganshina LE, Denkinger CM, Korobitsyn A, Ismail N, Abubakar I, Rangaka MX. A Systematic Review on the Safety of Mycobacterium tuberculosis-Specific Antigen-Based Skin Tests for Tuberculosis Infection Compared With Tuberculin Skin Tests. Open Forum Infect Dis 2023; 10:ofad228. [PMID: 37234516 PMCID: PMC10205553 DOI: 10.1093/ofid/ofad228] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
Background A systematic review showed that the accuracy of Mycobacterium tuberculosis antigen-based skin tests (TBSTs) for tuberculosis is similar to that of interferon γ release assay, but the safety of TBSTs has not been systematically reviewed. Methods We searched for studies reporting injection site reactions (ISRs) and systemic adverse events associated with TBSTs. We searched Medline, Embase, e-library, the Chinese Biomedical Literature Database, and the China National Knowledge Infrastructure database for studies through 30 July 2021, and the database search was updated until 22 November 2022. Results We identified 7 studies for Cy-Tb (Serum Institute of India), 7 (including 2 found through the updated search) for C-TST (Anhui Zhifei Longcom), and 11 for Diaskintest (Generium). The pooled risk of any injection site reactions (ISRs) due to Cy-Tb (n = 2931; 5 studies) did not differ significantly from that for tuberculin skin tests (TSTs; risk ratio, 1.05 [95% confidence interval, .70-1.58]). More than 95% of ISRs were reported as mild or moderate; common ISRs included pain, itching, and rash. In 1 randomized controlled study, 49 of 153 participants (37.6%) given Cy-Tb experience any systemic adverse event (eg, fever and headache), compared with 56 of 149 participants (37.6%) given TST (risk ratio, 0.85 [95% confidence interval, .6-1.2]). In a randomized controlled study in China (n = 14 579), the frequency of systemic adverse events in participants given C-TST was similar to that for TST, and the frequency of ISRs was similar to or lower than that for TST. Reporting of the safety data on Diaskintest was not standardized, precluding meta-analysis. Conclusion The safety profile of TBSTs appears similar to that of TSTs and is associated with mostly mild ISRs.
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Affiliation(s)
- Yohhei Hamada
- Institute for Global Health, University College London, London, United Kingdom
| | - Irina Kontsevaya
- Division of Clinical Infectious Diseases, Research Center Borstel, Leibniz Lung Center, Borstel, Germany
- German Center for Infection Research (DZIF), Partner Site Hamburg- Lübeck-Borstel-Riems, Borstel, Germany
- Respiratory Medicine & International Health, University of Lübeck, Lübeck, Germany
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Elena Surkova
- Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas’ NHS Foundation Trust London, London, United Kingdom
| | - Ting Ting Wang
- Institute for Global Health, University College London, London, United Kingdom
| | - Liu Wan-Hsin
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Aleksandr Matveev
- Department of Clinical Pharmacology and Therapy named after Acad. B. Ye. Votchal, Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
| | - Liliya Eugenevna Ziganshina
- Russian Medical Academy for Continuing Professional Education of the Ministry of Health, Cochrane Russia, Centre for Knowledge Translation, Moscow, Russian Federation
- Department of Pharmacology, Kazan Medical University, Kazan, Russian Federation
- Department of General and Clinical Pharmacology, RUDN University, Moscow, Russian Federation
| | - Claudia M Denkinger
- Division of Tropical Medicine, Centre of Infectious Disease, Heidelberg University Hospital, Heidelberg, Germany
- German Center of Infection Research, Partner Site Heidelberg University Hospital, Heidelberg, Germany
| | - Alexei Korobitsyn
- Unit for Prevention, Diagnosis, Treatment, Care and Innovation, Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
| | - Nazir Ismail
- Unit for Prevention, Diagnosis, Treatment, Care and Innovation, Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, United Kingdom
| | - Molebogeng X Rangaka
- Institute for Global Health, University College London, London, United Kingdom
- Division of Epidemiology and Biostatistics & CIDRI-AFRICA, University of Cape Town, Cape Town, South Africa
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Yuan Y, Xia L, Wu Q, Liu X, Lu S. Utility of recombinant fusion protein ESAT6-CFP10 skin test for differential diagnosis of active tuberculosis: A prospective study. Front Immunol 2023; 14:1162177. [PMID: 37180124 PMCID: PMC10169909 DOI: 10.3389/fimmu.2023.1162177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 03/29/2023] [Indexed: 05/15/2023] Open
Abstract
Background The recombinant mycobacterium tuberculosis fusion protein ESAT6-CFP10 skin test (ECST) is a novel test for tuberculosis (TB) infection; however, its accuracy in active tuberculosis (ATB) remains uncertain. This study aimed to evaluate the accuracy of ECST in the differential diagnosis of ATB for an early real-world assessment. Methods This prospective cohort study recruited patients suspected of ATB in Shanghai Public Health Clinical Center from January 2021 to November 2021. The diagnostic accuracy of the ECST was evaluated under the gold standard and composite clinical reference standard (CCRS) separately. The sensitivity, specificity, and corresponding confidence interval of ECST results were calculated, and subgroup analyses were conducted. Results Diagnostic accuracy was analyzed using data from 357 patients. Based on the gold standard, the sensitivity and specificity of the ECST for patients were 72.69% (95%CI 66.8%-78.5%) and 46.15% (95%CI 37.5%-54.8%), respectively. Based on the CCRS, the sensitivity and specificity of the ECST for patients were 71.52% (95%CI 66.4%-76.6%) and 65.45% (95%CI 52.5%-78.4%), respectively. The consistency between the ECST and the interferon-γ release (IGRA) test is moderate (Kappa = 0.47). Conclusion The ECST is a suboptimum tool for the differential diagnosis of active tuberculosis. Its performance is similar to IGRA, an adjunctive diagnostic test for diagnosing active tuberculosis. Clinical trial registration http://www.chictr.org.cn, identifier ChiCTR2000036369.
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Affiliation(s)
- Yuan Yuan
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Lu Xia
- National Clinical Research Center for Infectious Diseases, The Third People’s Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Qiaoyu Wu
- Bengbu Medical College, School of Life Science, Bengbu, Anhui, China
| | - Xuhui Liu
- National Clinical Research Center for Infectious Diseases, The Third People’s Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Shuihua Lu
- National Clinical Research Center for Infectious Diseases, The Third People’s Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, Guangdong, China
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Lu P, Wu K, Zhou H, Yu H, Yuan J, Dong L, Liu Q, Ding X, Lu W, Yang H, Zhu L, Martinez L. Evaluation of ESAT6-CFP10 Skin Test for Mycobacterium tuberculosis Infection among Persons Living with HIV in China. J Clin Microbiol 2023; 61:e0181622. [PMID: 36946732 PMCID: PMC10117090 DOI: 10.1128/jcm.01816-22] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
Recent global guidelines recommend Mycobacterium tuberculosis antigen-based skin tests, such as the ESAT6-CFP10 (EC) skin test, as acceptable alternatives to the tuberculin skin test (TST) and the QuantiFERON-TB Gold In-Tube test (QFT). However, the diagnostic value of these tests among persons living with HIV (PLHIV) is unknown. We aimed to assess the diagnostic accuracy of the EC among a cohort of PLHIV in China. We recruited PLHIV in Jiangsu Province, China, to assess sensitivity and specificity of the EC test. Participants were tested with the QFT, TST, and EC skin test. Results were stratified by age, M. tuberculosis BCG vaccination, and CD4 count. The sensitivity and specificity of the EC skin test was assessed using distinct cutoffs of the QFT and TST. Of 350 PLHIV enrolled in the study, 58 (16.6%), 89 (25.4%), and 59 (16.9%) tested positive with the EC test, the QFT, and the TST, respectively. Positivity increased with CD4 count; however, these trends were similar across tests. At a 5-mm cutoff, EC skin test specificity was high (99.6%, 95% confidence interval [CI] 95% CI = 97.7 to 100.0); however, sensitivity was moderate (81.4%; 95% CI = 66.6 to 91.6). After stratifying by BCG, the sensitivity and specificity were 86.4% (95% CI = 65.1 to 97.1) and 99.1% (95% CI = 95.0 to 100.0) among vaccinated PLHIV and 76.2% (95% CI = 52.8 to 91.8) and 100.0% (95% CI = 97.2 to 100.0) among unvaccinated PLHIV, respectively. Among PLHIV, the diagnostic value of the EC skin test remained high, regardless of BCG vaccination or CD4 count. The EC skin test performed comparably to TST and may be a valid alternative diagnostic test to use in settings or populations with high HIV prevalence and BCG vaccination. To our knowledge, this is the first study to evaluate the novel ESAT6-CFP10 skin test among PLHIV. Among 350 PLHIV, the test displayed high specificity and sensitivity, a finding which did not markedly differ based on BCG vaccination and CD4 count.
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Affiliation(s)
- Peng Lu
- Department of Chronic Communicable Disease, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, People's Republic of China
| | - Kai Wu
- Central Hospital, Jiangsu Prison Administration, Changzhou, Jiangsu, People's Republic of China
| | - Hongxi Zhou
- Central Hospital, Jiangsu Prison Administration, Changzhou, Jiangsu, People's Republic of China
| | - Haibing Yu
- Central Hospital, Jiangsu Prison Administration, Changzhou, Jiangsu, People's Republic of China
| | - Ju Yuan
- Central Hospital, Jiangsu Prison Administration, Changzhou, Jiangsu, People's Republic of China
| | - Lang Dong
- Central Hospital, Jiangsu Prison Administration, Changzhou, Jiangsu, People's Republic of China
| | - Qiao Liu
- Department of Chronic Communicable Disease, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, People's Republic of China
| | - Xiaoyan Ding
- Department of Chronic Communicable Disease, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, People's Republic of China
| | - Wei Lu
- Department of Chronic Communicable Disease, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, People's Republic of China
| | - Haitao Yang
- Jiangsu Provincial Health Development Research Center, Nanjing, Jiangsu, People's Republic of China
| | - Limei Zhu
- Department of Chronic Communicable Disease, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, People's Republic of China
| | - Leonardo Martinez
- Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts, USA
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High accuracy of recombinant fusion protein early secretory antigenic target protein 6-culture filtrate protein 10 skin test for the detection of tuberculosis infection: a phase III, multi-centered, double-blind, hospital-based, randomized controlled trial. Int J Infect Dis 2023; 126:98-103. [PMID: 36400376 DOI: 10.1016/j.ijid.2022.11.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To verify the diagnostic utility of recombinant fusion protein ESAT6-CPF10 (EC), a novel skin test reagent to detect Mycobacterium tuberculosis infection. METHODS A multi-centered, double-blind, randomized controlled trial was conducted from December 17, 2015, to March 2, 2018. Participants involved in this study included those with active tuberculosis (TB), suspected pulmonary TB, or non-TB pulmonary disease. Each participant received three tests simultaneously, TB-specific enzyme-linked immunospot assay (T-SPOT.TB), tuberculin skin test (TST), and EC skin test (ECST), and adverse events were reported. RESULTS Diagnostic accuracy was analyzed using data from 1085 protocol-compliant participants. The sensitivities of the ECST, TST, and T-SPOT.TB were 91.2% (95% CI, 89.0-93.2%), 91.4% (95% CI, 89.1-93.3%), and 92.1% (95% CI, 89.9-93.9%), respectively. The specificities of the ECST (69.7%, 95% CI, 64.5-74.5%) and T-SPOT.TB (76.1%, 95% CI, 71.2-80.5%) were significantly higher than the TST (54.4%, 95% CI, 48.9-59.7%). The agreements between ECST and TST (kappa = 0.632) and between ECST and T-SPOT.TB (kappa = 0.780) were substantial. No severe adverse event was reported. CONCLUSION The diagnostic performance of the ECST was close to the T-SPOT.TB assay in the detection of TB infection and indicated good potential for clinical application in common scenarios.
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Zhang Y, Lu P, Wu K, Zhou H, Yu H, Yuan J, Dong L, Liu Q, Lu W, Yang H, Cao D, Zhu L. Positive rate and risk factors of latent tuberculosis infection among persons living with HIV in Jiangsu Province, China. Front Cell Infect Microbiol 2023; 13:1051060. [PMID: 36960041 PMCID: PMC10029977 DOI: 10.3389/fcimb.2023.1051060] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 02/16/2023] [Indexed: 03/09/2023] Open
Abstract
Objective To analyze the latent tuberculosis infection (LTBI) among persons living with HIV(PLWH) in Jiangsu Province, to explore the factors affecting the positive rate of LTBI, and to take appropriate measures to control tuberculosis (TB) infection. Methods A cross-sectional study was conducted among PLWH in Jiangsu Province from June to July 2021. All PLWH in Jiangsu Province were used as the study population. Currently, the diagnosis of LTBI lacks a "gold standard" and can only be assisted by the immunological method. In this study, Tuberculin skin test (TST), ESAT6-CFP10 test (EC), and QuantiFERON-TB gold in-tube (QFT) were used to detect the positive rate of LTBI among PLWH and to analyze their risk factors. Results A total of 340 prisoners were included, 89.7% were male, the median age was 38 years [Interquartile Range (IQR):32-46 years], these patients were on Antiviral Therapy (ART), and median CD4 counts was 376 (IQR: 261-496), 103 (30.3%) were positive in at least one test, LTBI by TST was 16.5%, LTBI by EC was 15.9%, LTBI by QFT was 26.2%. Univariate analysis showed the results for TST, EC, and QFT were not affected by CD4 counts (p>0.05), and multivariate analysis showed that a history of incarceration was associated with an increased risk of positive TST (adjusted odds ratio [aOR]=1.98;95% CI,1.03-3.82), EC (aOR=2.65;95% CI,1.37-5.12) and QFT (aOR=2.01;95%CI,1.12-3.57), in addition, female gender was associated with increased risk of positive TST (aOR=3.66;95%CI,1.60-8.37) and EC (aOR=3.43;95%CI,1.46-8.07), and contact history of TB patients was associated with increased risk of TST (aOR= 2.54;95%CI,1.23-5.22) and QFT (aOR=2.03;95%CI,1.03-3.99), and ethnic minorities (aOR=0.26;95%CI,0.12-0.57), longer duration of incarceration was associated with an increased risk of positive QFT (aOR=1.12;95%CI,1.02-1.24). Conclusions Female gender, and ethnic minorities, history of incarceration, longer duration of incarceration, and contact history of TB patients are risk factors for LTBI among PLWH in Jiangsu Province, and attention should be paid to TB control in this population.
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Affiliation(s)
- Yu Zhang
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu, China
- School of Public Health, Southeast University, Nanjing, Jiangsu, China
| | - Peng Lu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu, China
| | - Kai Wu
- Jiangsu Prison Administration, Central Hospital, Changzhou, Jiangsu, China
| | - Hongxi Zhou
- Jiangsu Prison Administration, Central Hospital, Changzhou, Jiangsu, China
| | - Haibing Yu
- Jiangsu Prison Administration, Central Hospital, Changzhou, Jiangsu, China
| | - Ju Yuan
- Jiangsu Prison Administration, Central Hospital, Changzhou, Jiangsu, China
| | - Lang Dong
- Jiangsu Prison Administration, Central Hospital, Changzhou, Jiangsu, China
| | - Qiao Liu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu, China
| | - Wei Lu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu, China
| | - Haitao Yang
- School of Public Health, Southeast University, Nanjing, Jiangsu, China
- Health Policy Research Department, Jiangsu Provincial Health Development Research Center, Jiangsu, China
| | - Dianyi Cao
- Jiangsu Prison Administration, Central Hospital, Changzhou, Jiangsu, China
- *Correspondence: Limei Zhu, ; Dianyi Cao,
| | - Limei Zhu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu, China
- *Correspondence: Limei Zhu, ; Dianyi Cao,
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Yang Y, Fang Z, Huang W, Zhang H, Luo S, Lin S, Li S, Lu S. Safety of a Novel ESAT6-CFP10 skin test compared with tuberculin skin test in a double-blind, randomized, controlled study. BMC Infect Dis 2022; 22:780. [PMID: 36221062 PMCID: PMC9552410 DOI: 10.1186/s12879-022-07765-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 09/29/2022] [Indexed: 11/16/2022] Open
Abstract
Background ESAT6-CFP10 (EC) skin test has been reported accurate and safe in identifying tuberculosis infection. We aimed to demonstrate the safety of EC skin test compared with tuberculin skin test (TST) in university freshmen. Methods We conducted a double-blind, randomized, controlled clinical study in a university freshmen population with 16,680 participates in China, and finally 14,579 completed the study. About a half received an EC skin test and the others received TST. Adverse reactions were evaluated. Results Out of the 14,579 participants, 48.2% (7029/14,579) were males. The average age was 18.1 ± 0.8 years and the average BMI was 20.9 ± 3.1 kg/m2. 50.4% (7351/14,579) participants received EC skin test and 49.6% (7228/14,579) received TST. The EC group had significantly less adverse reactions compared with the TST group (21.3%, 1565/7351 vs. 34.6%, 2499/7228, P = 0.000). The most common adverse reactions for EC were bleeding (5.63%, 414), dermatodyschroia (4.27%, 314), induration (3.90%, 287), swelling (2.49%, 183), pain (1.59%, 117) and pruritus (1.48%, 109). Bleeding, dermatodyschroia, swelling and erythema were significantly less in EC group (P < 0.05), while others were similar to those of TST. Conclusion the EC skin test was safe in our cohort. And its incidence of total adverse drug reactions (ADRs) is less than that of TST. Most adverse reactions were mild or moderate, lasting less than 48 h and self-limiting. Considering the satisfactory diagnostic accuracy in identifying tuberculosis infection, the cost and safety, the EC skin test might be a potential candidate for replacing TST in high burden countries or those with routine BCG vaccination. Clinical Trials Registration. ChiCTR2000038622, Safety of the EC skin test to screen tuberculosis infection in two universities, compared with the tuberculin skin test: a double-blind, randomized, controlled trial. registered on 26/09/2020 at http://www.chictr.org.cn.
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Affiliation(s)
- Yang Yang
- Shanghai Public Health Clinical Center Affiliated to Fudan University, 201508, Shanghai, China
| | - Zhixiong Fang
- Department of Infectious Disease and Public Health, Central Hospital of Xiangtan, Xiangtan, Hunan province, China
| | - Wei Huang
- Shanghai Public Health Clinical Center Affiliated to Fudan University, 201508, Shanghai, China
| | - Haiming Zhang
- Department of Infectious Disease and Public Health, Central Hospital of Xiangtan, Xiangtan, Hunan province, China
| | - Si Luo
- Xiangtan Center for Disease Control and Prevention, Xiangtan, Hunan province, China
| | - Sha Lin
- Department of Infectious Disease and Public Health, Central Hospital of Xiangtan, Xiangtan, Hunan province, China
| | - Shaojie Li
- Department of General Surgery, Xiangtan First People's Hospital, Xiangtan, Hunan province, China.
| | - Shuihua Lu
- Department of Pulmonary Medicine, The Second Affiliated Hospital, School of Medicine, National Clinical Research Center for Infectious Disease, Shenzhen Third People's Hospital, Southern University of Science and Technology, 518112, Shenzhen, Guangdong Province, China.
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The Rv3874-Rv3875 chimeric protein shows a promiscuous serodiagnostic potential for tuberculosis. Tuberculosis (Edinb) 2022; 136:102253. [PMID: 36067572 PMCID: PMC9424118 DOI: 10.1016/j.tube.2022.102253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 08/22/2022] [Accepted: 08/24/2022] [Indexed: 11/21/2022]
Abstract
Tuberculosis (TB) stays a major cause of death globally after COVID-19 and HIV. An early diagnosis to control TB effectively, needs a fast reliable diagnostic method with high sensitivity. Serodiagnosis involving polyclonal antibodies detection against an antigen of Mycobacterium tuberculosis (Mtb) in serum samples can be instrumental. In our study, Rv3874 and Rv3875 antigens were cloned, expressed, and purified individually and as a chimeric construct in Escherichia coli BL21. Enzyme-Linked Immunosorbent Assay (ELISA) based findings revealed that the Rv3874-Rv3875 chimeric construct was two-fold more sensitive (59.7%) than the individual sensitivities of Rv3874 (28.4%) and Rv3875 (24.9%) for 201 serum TB positive samples. Furthermore, the fusion construct was a little more sensitive (60.4%) for male subjects than that for females (58.8%). Lastly, our preliminary findings, molecular insights of secondary structure, and statistical and in silico analysis of each construct also advocate that CEP can be considered a better immunodiagnostic tool in addition to previously reported EC skin test.
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Are mRNA based transcriptomic signatures ready for diagnosing tuberculosis in the clinic? - A review of evidence and the technological landscape. EBioMedicine 2022; 82:104174. [PMID: 35850011 PMCID: PMC9294474 DOI: 10.1016/j.ebiom.2022.104174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 05/11/2022] [Accepted: 07/01/2022] [Indexed: 11/20/2022] Open
Abstract
Funding
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The effect of BCG vaccination and risk factors for latent tuberculosis infection among college freshmen in China. Int J Infect Dis 2022; 122:321-326.2. [PMID: 35700876 DOI: 10.1016/j.ijid.2022.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 06/01/2022] [Accepted: 06/08/2022] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES In this study, we aimed to verify whether Bacillus Calmette-Guérin (BCG) can protect first-year college students against Mycobacterium tuberculosis (MTB) infection by the recombinant fusion protein ESAT6-CFP10 skin test (ECST) or the tuberculin skin test (TST). METHODS We conducted a cross-sectional study to assess risk factors for latent tuberculosis infection (LTBI). Vaccine effectiveness of BCG against LTBI, measured by ECST and TST separately, was assessed using multivariable logistic regression. RESULTS A total of 7351 college freshmen accepted ECST, whereas 7228 accepted TST. A total of 263 (3.58%) tested positive with ECST and 581 (8.04%) tested positive with TST. BCG was significantly associated with LTBI (ECST: adjusted odds ratio (aOR) = 0.26; 95% CI 0.09 to 0.73; TST: aOR = 0.25; 95% CI 0.13 to 0.49). The BCG protective effect on freshmen living in rural areas (ECST: aOR = 0.16; 95% CI 0.04 to 0.55; TST: aOR = 0.12; 95% CI 0.04 to 0.33) is better than that of freshmen living in cities (ECST: aOR = 0.53; 95% CI 0.07 to 4.03; TST: aOR = 0.44; 95% CI 0.17 to 1.16). CONCLUSIONS Protection against LTBI was strongly associated with BCG vaccination. A novel skin test (ECST) may underestimate the protective effects of BCG in college freshmen. BCG has better protection in areas with a slightly higher incidence of LTBI.
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