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Shlomi D, Galor I, More A, Oberman B, Fireman L. Latent tuberculosis infection prevalence in second generation immigrants from high to low TB burden countries. Pulmonology 2023; 29:124-129. [PMID: 33408042 DOI: 10.1016/j.pulmoe.2020.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 11/14/2020] [Accepted: 12/09/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Latent tuberculosis infection (LTBI) diagnosis in a country with a low tuberculosis burden is complicated. Since the prevalence of LTBI in second generation immigrants has not been well recognized, we conducted a cross-sectional study which aimed to explore the differences in LTBI prevalence between offspring of immigrants from high tuberculosis (TB) burden countries and those whose parents were born in countries with a low TB burden. METHODS Between May 2014 and April 2018 young native Israelis who were required to perform pre-occupational tuberculin skin tests (TST) (medical and paramedical personnel or teaching assistants of immigrants from high TB burden countries) and who had a TST result of 10mm and above were tested for QuantiFERON-TB In Tube (QFT-GIT). Statistical comparisons were made between second generation immigrants and those with both parents from a low TB burden country. RESULTS Of 102 patients, 71 were born to parents both of whom were from low-risk countries, 14 to one parent from a high-risk country and 17 to parents both of whom were from a high-risk country. The odds ratio for LTBI was 4.5 (95% CI, 1.2...17.2; p=0.03) if both parents were born in a high-risk country compared to both parents being from a low-risk country and 4.01 (95% CI, 1.12...14.3; p=0.03) higher compared to persons for whom at least one parent was born in a low-risk country. CONCLUSION The risk for latent TB is significantly higher in second generation immigrants if both parents were born in a high-risk country. IGRA should be considered before treatment to patients with a positive TST if at least one parent was born in a low-risk country in order to confirm LTBI.
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Affiliation(s)
- D Shlomi
- Adelson School of Medicine, Ariel University, Ariel, Israel; Clalit Health Services, Dan- Petah-Tiqwa District, Israel.
| | - I Galor
- Israel Defense Forces Medical Corps, Israel
| | - A More
- The Obstetric and Gynecology Division, Delivery Room Department, Assaf Harofeh Medical Center, Israel
| | - B Oberman
- The Gertner Institute for Epidemiology and Health Policy Research, Tel-HaShomer, Israel
| | - L Fireman
- The Laboratory of Pulmonary and Allergic Diseases,Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
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2
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Coles C, Ottolini MG. Infectious Disease Clinical Research Program: Building the Bench. Mil Med 2020; 184:66-70. [PMID: 31778195 DOI: 10.1093/milmed/usz094] [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: 02/14/2019] [Revised: 03/15/2019] [Indexed: 11/13/2022] Open
Abstract
The role of physicians in the U.S. Armed Forces is diverse, encompassing a wide array of skills and responsibilities to provide superior healthcare to their patients and to advance military medicine. In addition to healthcare delivery and medical education, military physicians are engaged in public health, operational medicine, and cutting-edge medical research. Thus, clinical research is a crucial component of Graduate Medical Education (GME) and supports critical thinking (knowledge, skills, and abilities) and the development of leadership skills among U.S. military physicians. The Infectious Disease Clinical Research Program (IDCRP) education mission was established in 2005 with the overall goal of supporting the development and training of the next generation of clinical researchers in infectious diseases and related public health disciplines in the Armed Forces using several strategies, including didactic learning, mentored research, and research engagement. Through involvement in the IDCRP, infectious disease fellows, residents (e.g., surgical, internal medicine, and pediatrics), and Master of Public Health (MPH) students have continued their education and gained valuable skills related to clinical research. Trainees either conduct research with IDCRP mentors or participate in IDCRP-led practicum experiences, with research projects ranging from epidemiologic studies to microbiological assessments. Consistent with the needs of the Military Health System (MHS), and in accordance with Accreditation Council for Graduate Medical Education goals, the IDCRP provides opportunities for medical and graduate students, residents, and infectious disease fellows to conduct mentored research within the MHS, as well as gain important leadership skills in the conduct of clinical research. Overall, IDCRP continues to further infectious disease research through the support and education of the next generation of active-duty infectious disease researchers in the MHS.
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Affiliation(s)
- Christian Coles
- Infectious Disease Clinical Research Program, Preventive Medicine & Biostatistics Department, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Bethesda, MD 20817
| | - Martin G Ottolini
- Preventive Medicine & Biostatistics Department, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
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Point of Care Tuberculosis Sero-Diagnosis Kit for Wild Animals: Combination of Proteins for Improving the Diagnostic Sensitivity and Specificity. Indian J Microbiol 2017; 58:81-92. [PMID: 29434401 DOI: 10.1007/s12088-017-0688-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 10/26/2017] [Indexed: 12/29/2022] Open
Abstract
Tuberculosis is a significant problem globally for domestic animals as well as captive and free ranging wild life. Rapid point of care (POC) serology kits are well suited for the diagnosis of TB in wild animals. However, wild animals are invariably exposed to environmental non-pathogenic mycobacterium species with the development of cross reacting antibodies. In the present study, POC TB diagnosis kit was developed using a combination of pathogenic Mycobacteria specific recombinant antigens and purified protein derivatives of pathogenic and non-pathogenic Mycobacteria. To benchmark the TB antibody detection kit, particularly in respect to specificity which could not be determined in wildlife due to the lack of samples from confirmed uninfected animals, we first tested well-characterized sera from 100 M. bovis infected and 100 uninfected cattle. Then we investigated the kit's performance using sera samples from wildlife, namely Sloth Bears (n = 74), Elephants (n = 9), Cervidae (n = 14), Felidae (n = 21), Cape buffalo (n = 2), Wild bear (n = 1) and Wild dog (n = 1).In cattle, a sensitivity of 81% and a specificity of 90% were obtained. The diagnostic sensitivity of the kit was 94% when the kit was tested using known TB positive sloth bear sera samples. 47.4% of the in-contact sloth bears turned seropositive using the rapid POC TB diagnostic kit. Seropositivity in other wild animals was 25% when the sera samples were tested using the kit. A point of care TB sero-diagnostic kit with the combination of proteins was developed and the kit was validated using the sera samples of wild animals.
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de Araujo LS, de Bárbara Moreira da Silva Lins N, Leung JAM, Mello FCQ, Saad MHF. Close contact interferon-gamma response to the new PstS1 (285-374):CPF10: a preliminary 1-year follow-up study. BMC Res Notes 2017; 10:59. [PMID: 28114976 PMCID: PMC5259914 DOI: 10.1186/s13104-016-2360-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 12/21/2016] [Indexed: 12/15/2022] Open
Abstract
Background The available diagnostic tools for latent tuberculosis (TB) infection (LTBI) via interferon-gamma (IFN-g) release assays (IGRA) are based on ESAT6:CFP10 stimulation. However, the mycobacterial antigen PstS1 is also highly immunogenic and some of its fragments, such as PstS1(285–374), have shown higher immunoreactivity in LTBI than in active TB. PstS1(285–374), therefore, could increase the accuracy of the existing IGRA to detect LTBI. Thus, a new chimeric protein has recently been developed (PstS1(285–374):CFP10) showing potential for LTBI screening of recent close contacts (rCt) exposed to Mycobacterium tuberculosis. The aim of this study was to analyze the PstS1(285–374):CFP10 longitudinal IFN-g profile in comparison to ESAT6:CFP10 and full PstS1/CFP10 stimulation in a rCt cohort and correlate the responses to these in-house IGRA with any clinical changes/interventions that might occur. Methods A free-of-cost, one-year follow up was offered to 120 rCt recruited in Rio de Janeiro, RJ, Brazil. Whole blood short-term (WBA), long-term stimulation (LSA) assays, and the tuberculin skin test (TST) were performed during follow up. Results Among the enrolled rCt, 44.2% (53/120) returned for re-evaluation and the control group (TST negative, n = 17) showed low IFN-g reactivity to all antigen stimulations during the entire follow up, except for one participant who had shown radiological evidence of past TB/LTBI. Both incident cases were detected by IGRA-PstS1(285–374):CFP10 during LTBI and after disease progression. Moreover, subsequent to the prophylactic treatment for LTBI (tLTBI), a significant regression in the LSA response was predominantly observed through stimulation of the new chimeric protein (8/10, 80%) followed by ESAT6:CFP10 (5/10, 50%) and PstS1/CFP10 (4/10, 40%). No clinical or epidemiological characteristics were exclusively shared among IGRA convertors. Conclusion It was demonstrated that the TST negative rCt without radiological evidence of LTBI/TB did not develop an IGRA-PstS1(285–374):CFP10 response during the one-year follow up. Moreover, all incident cases were detected by our new IGRA; and a significant decrement of LSA-PstS1(285–374):CFP10 reactivity post-prophylactic tLTBI was found. To our knowledge, this is the first study to monitor changes in the immune response profile of IGRA-PstS1(285–374):CFP10 among rCt during a consecutive one-year period, thus providing additional evidence of its potential in the detection of LTBI. Electronic supplementary material The online version of this article (doi:10.1186/s13104-016-2360-4) contains supplementary material, which is available to authorized users.
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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
| | | | - Janaina Aparecida Medeiros Leung
- Federal University of Rio de Janeiro, Helio Fraga Filho Hospital, Professor Rodolpho Paulo Rocco Street, 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, Professor Rodolpho Paulo Rocco Street, 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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Lewinsohn DM, Leonard MK, LoBue PA, Cohn DL, Daley CL, Desmond E, Keane J, Lewinsohn DA, Loeffler AM, Mazurek GH, O'Brien RJ, Pai M, Richeldi L, Salfinger M, Shinnick TM, Sterling TR, Warshauer DM, Woods GL. Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention Clinical Practice Guidelines: Diagnosis of Tuberculosis in Adults and Children. Clin Infect Dis 2016; 64:e1-e33. [PMID: 27932390 DOI: 10.1093/cid/ciw694] [Citation(s) in RCA: 268] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 10/14/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Individuals infected with Mycobacterium tuberculosis (Mtb) may develop symptoms and signs of disease (tuberculosis disease) or may have no clinical evidence of disease (latent tuberculosis infection [LTBI]). Tuberculosis disease is a leading cause of infectious disease morbidity and mortality worldwide, yet many questions related to its diagnosis remain. METHODS A task force supported by the American Thoracic Society, Centers for Disease Control and Prevention, and Infectious Diseases Society of America searched, selected, and synthesized relevant evidence. The evidence was then used as the basis for recommendations about the diagnosis of tuberculosis disease and LTBI in adults and children. The recommendations were formulated, written, and graded using the Grading, Recommendations, Assessment, Development and Evaluation (GRADE) approach. RESULTS Twenty-three evidence-based recommendations about diagnostic testing for latent tuberculosis infection, pulmonary tuberculosis, and extrapulmonary tuberculosis are provided. Six of the recommendations are strong, whereas the remaining 17 are conditional. CONCLUSIONS These guidelines are not intended to impose a standard of care. They provide the basis for rational decisions in the diagnosis of tuberculosis in the context of the existing evidence. No guidelines can take into account all of the often compelling unique individual clinical circumstances.
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Affiliation(s)
| | | | - Philip A LoBue
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - David L Cohn
- Denver Public Health Department, Denver, Colorado
| | - Charles L Daley
- National Jewish Health and the University of Colorado Denver, and
| | - Ed Desmond
- California Department of Public Health, Richmond
| | | | | | - Ann M Loeffler
- Francis J. Curry International TB Center, San Francisco, California
| | | | | | - Madhukar Pai
- McGill University and McGill International TB Centre, Montreal, Canada
| | | | | | | | - Timothy R Sterling
- Vanderbilt University School of Medicine, Vanderbilt Institute for Global Health, Nashville, Tennessee
| | | | - Gail L Woods
- University of Arkansas for Medical Sciences, Little Rock
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Foster R, Ferguson TW, Rigatto C, Lerner B, Tangri N, Komenda P. A retrospective review of the two-step tuberculin skin test in dialysis patients. Can J Kidney Health Dis 2016; 3:28. [PMID: 27274397 PMCID: PMC4895873 DOI: 10.1186/s40697-016-0119-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 04/19/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Reactivation of latent Mycobacterium tuberculosis infection (LTBI) is a health concern for patients on dialysis or receiving a kidney transplant, as these patients are often immunosuppressed. The most frequently used test for LTBI screening in this population is the tuberculin skin test (TST). The diagnostic accuracy (sensitivity and specificity) of the TST in a contemporary North American or Western European dialysis population is unknown. OBJECTIVES Our objective was to determine the diagnostic accuracy and clinical utility of the two-step TST in patients receiving dialysis. DESIGN This is a retrospective cohort study. SETTING This study is set at four tertiary dialysis units across Winnipeg, Manitoba. PATIENTS There are 483 chronic hemodialysis and peritoneal dialysis patients in the study. MEASUREMENTS The measurements are sensitivity and specificity of the TST with respect to abnormal chest X-ray. METHODS All patients received a two-step TST and assessment of risk factors for prior tuberculosis (TB) infection between February 2008 and December 2008. This cohort was retrospectively linked to our tuberculosis registry to ascertain if prophylaxis was received for LTBI. RESULTS At an induration cutoff of 5 mm, 62 (13 %) patients had a positive two-step TST. Patients with a known Bacillus Calmette-Guérin (BCG) vaccination were more likely to test positive (50 % of those with a positive TST had a BCG versus 34 % with a negative TST, p = 0.05). Using a diagnostic gold standard of an abnormal chest X-ray as a proxy for LTBI, the sensitivity of the TST was only 14 % and the specificity was 88 %. Only 8 of 62 patients with a positive TST (13 %) received prophylaxis for LTBI. None of the patients who tested negative were treated. LIMITATIONS There is a lack of a truly accurate gold standard for LTBI. CONCLUSIONS The TST has limited diagnostic and clinical utility for LTBI screening in patients on dialysis. Further research into the diagnostic accuracy of interferon-gamma release assays and a revision of LTBI screening guidelines in patients on dialysis should be considered.
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Affiliation(s)
- Rukhsana Foster
- />Seven Oaks General Hospital Renal Program, 2PD12 - 2300 McPhillips Street, Winnipeg, MB R2V 3M3 Canada
- />Department of Medicine, University of Manitoba, Winnipeg, Canada
| | - Thomas W. Ferguson
- />Seven Oaks General Hospital Renal Program, 2PD12 - 2300 McPhillips Street, Winnipeg, MB R2V 3M3 Canada
- />Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Canada
- />Department of Medicine, University of Manitoba, Winnipeg, Canada
| | - Claudio Rigatto
- />Seven Oaks General Hospital Renal Program, 2PD12 - 2300 McPhillips Street, Winnipeg, MB R2V 3M3 Canada
- />Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Canada
- />Department of Medicine, University of Manitoba, Winnipeg, Canada
| | - Blake Lerner
- />Seven Oaks General Hospital Renal Program, 2PD12 - 2300 McPhillips Street, Winnipeg, MB R2V 3M3 Canada
| | - Navdeep Tangri
- />Seven Oaks General Hospital Renal Program, 2PD12 - 2300 McPhillips Street, Winnipeg, MB R2V 3M3 Canada
- />Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Canada
- />Department of Medicine, University of Manitoba, Winnipeg, Canada
| | - Paul Komenda
- />Seven Oaks General Hospital Renal Program, 2PD12 - 2300 McPhillips Street, Winnipeg, MB R2V 3M3 Canada
- />Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Canada
- />Department of Medicine, University of Manitoba, Winnipeg, Canada
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Mancuso JD, Geurts M. Challenges in Obtaining Estimates of the Risk of Tuberculosis Infection During Overseas Deployment. Am J Trop Med Hyg 2015; 93:1172-8. [PMID: 26416114 DOI: 10.4269/ajtmh.15-0539] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 08/10/2015] [Indexed: 11/07/2022] Open
Abstract
Estimates of the risk of tuberculosis (TB) infection resulting from overseas deployment among U.S. military service members have varied widely, and have been plagued by methodological problems. The purpose of this study was to estimate the incidence of TB infection in the U.S. military resulting from deployment. Three populations were examined: 1) a unit of 2,228 soldiers redeploying from Iraq in 2008, 2) a cohort of 1,978 soldiers followed up over 5 years after basic training at Fort Jackson in 2009, and 3) 6,062 participants in the 2011-2012 National Health and Nutrition Examination Survey (NHANES). The risk of TB infection in the deployed population was low-0.6% (95% confidence interval [CI]: 0.1-2.3%)-and was similar to the non-deployed population. The prevalence of latent TB infection (LTBI) in the U.S. population was not significantly different among deployed and non-deployed veterans and those with no military service. The limitations of these retrospective studies highlight the challenge in obtaining valid estimates of risk using retrospective data and the need for a more definitive study. Similar to civilian long-term travelers, risks for TB infection during deployment are focal in nature, and testing should be targeted to only those at increased risk.
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Affiliation(s)
- James D Mancuso
- Division of Tropical Public Health, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Office of Student Affairs, Harvard Medical School, Boston, Massachusetts
| | - Mia Geurts
- Division of Tropical Public Health, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Office of Student Affairs, Harvard Medical School, Boston, Massachusetts
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Zellweger JP, Sotgiu G, Block M, Dore S, Altet N, Blunschi R, Bogyi M, Bothamley G, Bothe C, Codecasa L, Costa P, Dominguez J, Duarte R, Fløe A, Fresard I, García-García JM, Goletti D, Halm P, Hellwig D, Henninger E, Heykes-Uden H, Horn L, Kruczak K, Latorre I, Pache G, Rath H, Ringshausen FC, Ruiz AS, Solovic I, Souza-Galvão MLD, Widmer U, Witte P, Lange C. Risk Assessment of Tuberculosis in Contacts by IFN-γ Release Assays. A Tuberculosis Network European Trials Group Study. Am J Respir Crit Care Med 2015; 191:1176-84. [DOI: 10.1164/rccm.201502-0232oc] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Goletti D, Sester M. Screening for latent infection withMycobacterium tuberculosis: a plea for targeted testing in low endemic regions. Expert Rev Mol Diagn 2014; 12:231-4. [DOI: 10.1586/erm.12.14] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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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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Mancuso JD, Mazurek GH, Tribble D, Olsen C, Aronson NE, Geiter L, Goodwin D, Keep LW. Discordance among commercially available diagnostics for latent tuberculosis infection. Am J Respir Crit Care Med 2011; 185:427-34. [PMID: 22161162 DOI: 10.1164/rccm.201107-1244oc] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE There is uncertainty regarding how to interpret discordance between tests for latent tuberculosis infection. OBJECTIVES The objective of this study was to assess discordance between commercially available tests for latent tuberculosis in a low-prevalence population, including the impact of nontuberculous mycobacteria. METHODS This was a cross-sectional comparison study among 2,017 military recruits at Fort Jackson, South Carolina, from April to June 2009. Several tests were performed simultaneously with a risk factor questionnaire, including (1) QuantiFERON-TB Gold In-Tube test, (2) T-SPOT.TB test, (3) tuberculin skin test, and (4) Battey skin test using purified protein derivative from the Battey bacillus. MEASUREMENTS AND MAIN RESULTS In this low-prevalence population, the specificities of the three commercially available diagnostic tests were not significantly different. Of the 88 subjects with a positive test, only 10 (11.4%) were positive to all three tests; 20 (22.7%) were positive to at least two tests. Bacille Calmette-Guérin vaccination, tuberculosis prevalence in country of birth, and Battey skin test reaction size were associated with tuberculin skin test-positive, IFN-γ release assay-negative test discordance. Increasing agreement between the three tests was associated with epidemiologic criteria indicating risk of infection and with quantitative test results. CONCLUSIONS For most positive results the three tests identified different people, suggesting that in low-prevalence populations most discordant results are caused by false-positives. False-positive tuberculin skin test reactions associated with reactivity to nontuberculous mycobacteria and bacille Calmette-Guérin vaccination may account for a proportion of test discordance observed.
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Affiliation(s)
- James D Mancuso
- Division of Preventive Medicine, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA.
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