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Ismail MB, Zarriaa N, Osman M, Helfawi S, Kabbara N, Chatah AN, Kamaleddine A, Alameddine R, Dabboussi F, Hamze M. Prevalence of Latent Tuberculosis Infection among Patients Undergoing Regular Hemodialysis in Disenfranchised Communities: A Multicenter Study during COVID-19 Pandemic. Medicina (B Aires) 2023; 59:medicina59040654. [PMID: 37109612 PMCID: PMC10142838 DOI: 10.3390/medicina59040654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/21/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023] Open
Abstract
Background and Objectives: Due to their weakened immune response, hemodialysis (HD) patients with latent tuberculosis infection (LTBI) are at higher risk for active tuberculosis (TB) disease and are more subject to patient-to-patient transmission within dialysis units. Consequently, current guidelines advocate screening these patients for LTBI. To our knowledge, the epidemiology of LTBI in HD patients has never been examined before in Lebanon. In this context, this study aimed to determine LTBI prevalence among patients undergoing regular HD in Northern Lebanon and to identify potential factors associated with this infection. Notably, the study was conducted during the COVID-19 pandemic, which is likely to have catastrophic effects on TB and increase the risk of mortality and hospitalization in HD patients. Materials and Methods: A multicenter cross-sectional study was carried out in three hospital dialysis units in Tripoli, North Lebanon. Blood samples and sociodemographic and clinical data were collected from 93 HD patients. To screen for LTBI, all patient samples underwent the fourth-generation QuantiFERON-TB Gold Plus assay (QFT-Plus). Multivariable logistic regression analysis was used to identify the predictors of LTBI status in HD patients. Results: Overall, 51 men and 42 women were enrolled. The mean age of the study population was 58.3 ± 12.4 years. Nine HD patients had indeterminate QFT-Plus results and were therefore excluded from subsequent statistical analysis. Among the remaining 84 participants with valid results, QFT-Plus was positive in 16 patients, showing a positivity prevalence of 19% (95% interval for p: 11.3%, 29.1%). Multivariable logistic regression analysis showed that LTBI was significantly associated with age [OR = 1.06; 95% CI = 1.01 to 1.13; p = 0.03] and a low-income level [OR = 9.29; 95% CI = 1.62 to 178; p = 0.04]. Conclusion: LTBI was found to be prevalent in one in five HD patients examined in our study. Therefore, effective TB control measures need to be implemented in this vulnerable population, with special attention to elderly patients with low socioeconomic status.
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Hursitoglu M, Isıksacan N, Erismis B, Karandere F, Kural A, Kumbasar AB, Kart Yasar K. In-vitro cytokine production and nasopharyngeal microbiota composition in the early stage of COVID-19 infection. Cytokine 2022; 149:155757. [PMID: 34763156 PMCID: PMC8570934 DOI: 10.1016/j.cyto.2021.155757] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/26/2021] [Accepted: 10/26/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND To determine and compare nasopharyngeal microbiota (NM) composition, in vitro basal (Nil tube), provoked (Mitogen tube) production of cytokines at the early stage of COVID-19. METHODS This cross-sectional study included 4 age and sex-matched study groups; group 1 (recovered COVID-19) (n = 26), group 2 (mild COVID-19) (n = 24), group 3 (severe COVID-19) (n = 25), and group 4 (healthy controls) (n = 25). The study parameters obtained from the COVID-19 (group 2, and 3) at the early phase of hospital admission. RESULTS The results from the reaserch deoicted that the Mean ± SD age was 53.09 ± 14.51 years. Some of the in vitro cytokines production was significantly different between the study groups. Some of the findinggs on cytokines depicted a significant differences between study groups were interleukin (IL)-1β Nil, IL-1β Mitogen, and their subtraction (i.e Mitogen-Nil). Regarding IL-10, and IL-17a levels, Mitogen, and Mitogen-Nil tube production levels were significantly different between the groups. Surprisingly, most of these measures were lowest in the severe COVID-19 patients' group. Using discriminant analysis effect size (LEfSe), Taxa of NM with significant abundance was determined. About 20 taxa with an LDA score > 4 were identified as candidate biomarkers. Some of these taxa showed a significant correlation with IL-1β and IL-10 Mitogen and Mitogen- Nil levels (R > 0.3 or < -0.3, p < 0.05). CONCLUSIONS The findings of this perticular study regarting the early stage of COVID-19 showed that in vitro cytokines production, studies might be more useful than the ordinary cytokines' blood level measurement. Besides, the study identified some NM species that could be candidate biomarkers in managing this infection. However, further detailed studies are needed in these fields.
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Affiliation(s)
- Mehmet Hursitoglu
- Internal Medicine Department, Basaksehir Cam & Sakura Sehir Hospital, University of Health Sciences, Istanbul, Turkey; Internal Medicine Department, Bakirkoy Dr. Sadi Konuk Training & Research Hospital, University of Health Sciences, Istanbul, Turkey.
| | - Nilgun Isıksacan
- Biochemistry Department, Bakirkoy Dr. Sadi Konuk Training & Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Betul Erismis
- Internal Medicine Department, Bakirkoy Dr. Sadi Konuk Training & Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Faruk Karandere
- Internal Medicine Department, Bakirkoy Dr. Sadi Konuk Training & Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Alev Kural
- Biochemistry Department, Bakirkoy Dr. Sadi Konuk Training & Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - A Baki Kumbasar
- Internal Medicine Department, Bakirkoy Dr. Sadi Konuk Training & Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Kadriye Kart Yasar
- Clinical Microbiology and Infectious Diseases Department, Bakirkoy Dr. Sadi Konuk Training & Research Hospital, University of Health Sciences, Istanbul, Turkey
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Rahimifard N, Mahmoudi S, Mamishi S, Pourakbari B. Prevalence of latent tuberculosis infection in transplant candidates: A systematic review and meta-analysis. Microb Pathog 2018; 125:401-410. [PMID: 30291870 DOI: 10.1016/j.micpath.2018.09.040] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 09/23/2018] [Accepted: 09/27/2018] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Tuberculosis (TB) is considered as a serious complication for organ transplant recipients; therefore, the detection and appropriate treatment of latent infection are recommended for preventing active TB infections in the future. The objective of this review is to conduct a systematic review and meta-analysis of studies assessing the prevalence of latent TB infection (LTBI) in transplant candidates. METHODS Electronic databases, including MEDLINE (via PubMed), SCOPUS were searched until 30 June 2017. The prevalence of LTBI was estimated using the random effects meta-analysis. Heterogeneity was evaluated by subgroup analysis. Data were analyzed by STATA version 14. RESULTS The pooled prevalence of LTBI based on tuberculin skin test (TST) in different transplant types was as follows: liver 24% (14%-33%, 95% CI), lung 22% (18%-26%), renal 21% (16%-27%, 95% CI) and hematopoietic stem cell transplantation (HCT) 14% (9%-19%). The prevalence of LTBI based on Interferon Gamma Release Assay (IGRA) tests in renal transplant candidates was 31% (95% CI; 25-37%), which was much higher than the prevalence of LTBI in liver transplant candidates (25%, 95% CI; 17-33%) and HCT transplant candidates (13%, 95% CI; 10-16%) and there was statistically significant differences between them. The pooled prevalence of indeterminate results based on IGRAs test in different transplant types was as follows: renal 6% (4%-8%, 95% CI) and liver 12% (2%-21%, 95% CI). Subgroup analysis revealed that there were statistically significant differences between the overall prevalence of indeterminate results by using IGRA tests in liver transplant candidates (12%, 95% CI; 2-21%) and renal transplant candidates (6%, 95% CI; 4-8%). The pooled prevalence of post-transplant TB was 2% (1%-2%, 95% CI) and its occurrence was more common in renal recipients (4% (2%-7%, 95% CI)) than in the liver transplant patients (1% (0%-2%, 95% CI)). The prevalence of LTBI in the subgroup (i.e. the patients' mean age was <50 years) was significantly higher than the prevalence of LTBI by using TST/IGRAs in the other subgroup (i.e. the patients' mean age was ≥50 years). CONCLUSION Our study suggests fair overall agreement between IGRAs and TST in patients requiring liver and HCT transplantation, while a superiority of IGRAs over TST in patients requiring renal transplantation was seen.
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Affiliation(s)
- Nahid Rahimifard
- Department of Microbiology, Food and Drug Control Laboratories (FDCL), Food And Drug Laboratories Research Centre(FDLRC), Ministry of Health and Medical Education (MOH), Tehran, Iran
| | - Shima Mahmoudi
- Pediatric Infectious Disease Research Center, Tehran University of Medical Science, Tehran, Iran
| | - Setareh Mamishi
- Pediatric Infectious Disease Research Center, Tehran University of Medical Science, Tehran, Iran; Department of Infectious Diseases, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Babak Pourakbari
- Pediatric Infectious Disease Research Center, Tehran University of Medical Science, Tehran, Iran.
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Henry B, Bourgarit A. [Interferon gamma release assay tests for the diagnosis of latent and active tuberculosis in hemodialysis patients or solid organ transplant recipients]. Rev Mal Respir 2018; 35:890-893. [PMID: 30268409 DOI: 10.1016/j.rmr.2018.08.015] [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: 11/28/2022]
Affiliation(s)
- B Henry
- Service des maladies infectieuses et tropicales, centre d'infectiologie Necker Pasteur, institut Imagine, hôpital Necker-Enfants malades, université Paris Descartes, Sorbonne Paris Cité, AP-HP, 75006 Paris, France
| | - A Bourgarit
- Université Paris 13, SmBH, HUPSSD, service de médecine interne, hôpital Jean-Verdier, AP-HP, 93140 Bondy, France; Inserm UMR 1149 CRI, 75013 Paris, France.
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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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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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Domínguez J, Latorre I, Altet N, Mateo L, De Souza-Galvão M, Ruiz-Manzano J, Ausina V. IFN-γ-release assays to diagnose TB infection in the immunocompromised individual. Expert Rev Respir Med 2014; 3:309-27. [DOI: 10.1586/ers.09.20] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Heparin-binding haemagglutinin, a new tool for the detection of latent Mycobacterium tuberculosis infection in hemodialysis patients. PLoS One 2013; 8:e71088. [PMID: 23940693 PMCID: PMC3733734 DOI: 10.1371/journal.pone.0071088] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 06/25/2013] [Indexed: 11/19/2022] Open
Abstract
Background Patients with end-stage renal disease (ESRD) and latently infected with Mycobacterium tuberculosis (LTBI) are at higher risk to develop tuberculosis (TB) than healthy subjects. Interferon-gamma release assays (IGRAs) were reported to be more sensitive than tuberculin skin tests for the detection of infected individuals in dialysis patients. Methods On 143 dialysis patients prospectively enrolled, we compared the results from the QuantiFERON®-TB Gold assay (QFT), to those of an IGRA in response to in vitro stimulation of circulating mononuclear cells with the mycobacterial latency antigen Heparin-Binding Haemagglutinin purified from Mycobacterium bovis BCG (native HBHA, nHBHA). Results Seven patients had a past history of active TB and 1 had an undetermined result with both IGRAs. Among the other 135 patients, 94 had concordant results with the QFT and nHBHA-IGRA, 40.0% being negative and therefore not latently infected, and 29.6% being positive and thus LTBI. Discrepant results between these tests were found for 36 patients positive only with the nHBHA-IGRA and 5 only with the QFT. Conclusions The nHBHA-IGRA is more sensitive than the QFT for the detection of LTBI dialysis patients, and follow-up of the patients will allow us to define the clinical significance of discrepant results between the nHBHA-IGRA and the QFT.
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Nellore A, Kotton CN. Screening Strategies for Tuberculosis in Children With Kidney Disease: What Is Cost-Effective? Am J Kidney Dis 2013; 61:3-5. [DOI: 10.1053/j.ajkd.2012.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 10/04/2012] [Indexed: 11/11/2022]
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Abstract
BACKGROUND Tuberculosis (TB) remains a leading cause of death in endemic countries and is 20 to 70 times more common in renal transplant recipients, where it contributes to both increased morbidity and mortality. This review will focus on the epidemiology of TB in renal transplant recipients and critically appraise the published literature on isoniazid prophylaxis in renal transplantation. METHODS A literature search for randomized and nonrandomized studies investigating the use of isoniazid prophylaxis in renal transplant recipients was conducted using Ovid MEDLINE, the Cochrane Library, the Transplant Library, and EMBASE. Relative risks (RRs) with 95% confidence intervals (CIs) are reported. Meta-analysis of the randomized controlled trials (RCTs) was performed with a fixed-effects model. RESULTS Eleven relevant studies were identified; six nonrandomized and five RCTs. The nonrandomized studies indicate a reduced risk of TB with isoniazid prophylaxis. The RCTs demonstrated conflicting results, with two studies finding a reduction in TB with prophylaxis and two studies finding no difference. Meta-analysis of the 709 patients from the four RCTs demonstrated a reduced risk of TB with isoniazid prophylaxis (RR, 0.31; 95% CI, 0.19-0.51). No significant difference was found in the incidence of hepatitis (RR, 1.22; 95% CI, 0.91-1.65). CONCLUSION Both randomized and nonrandomized studies support the value of isoniazid as TB prophylaxis in renal transplant recipients at risk of active infection. Clinicians should consider prophylaxis in renal transplant recipients in endemic areas or in recipients in nonendemic countries who are at risk. However, the evidence for the benefit of isoniazid prophylaxis in renal transplantation is not robust and there is still a need for a large multicenter trial of isoniazid prophylaxis in kidney transplantation in an endemic area.
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Kim SH, Lee SO, Park IA, Park S, Choi SH, Kim Y, Woo J, Park SK, Park J, Kim S, Han D. Diagnostic usefulness of a T cell-based assay for latent tuberculosis infection in kidney transplant candidates before transplantation. Transpl Infect Dis 2010; 12:113-9. [DOI: 10.1111/j.1399-3062.2010.00495.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Diel R, Loddenkemper R, Nienhaus A. Evidence-based comparison of commercial interferon-gamma release assays for detecting active TB: a metaanalysis. Chest 2009; 137:952-68. [PMID: 20022968 DOI: 10.1378/chest.09-2350] [Citation(s) in RCA: 269] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Test accuracy of interferon-gamma release assays (IGRAs) for diagnosing TB differs when using older or precommercial tools and inconsistent diagnostic criteria. This metaanalysis critically appraises studies investigating sensitivity and specificity of the commercial T-Spot.TB and the QuantiFERON-TB Gold In-Tube Assay (QFT-IT) among definitely confirmed TB cases. We searched Medline, EMBASE, and Cochrane bibliographies of relevant articles. Sensitivities, specificities, and indeterminate rates were pooled using a fixed effect model. Sensitivity of the tuberculin skin test (TST) was evaluated in the context of IGRA studies. In addition, the rates of indeterminates of both IGRAs were assessed. The pooled sensitivity of TST was 70% (95% CI, 0.67-0.72) compared with 81% (95% CI, 0.78-0.83) for the QFT-IT and 88% (95% CI, 0.85-0.90) for the T-Spot.TB. Sensitivity increased to 84% (95%CI, 0.81-0.87) and 89% (95% CI, 0.86-0.91) for the QFT-IT and T-Spot.TB, respectively, when restricted to performance in developed countries. In contrast, specificity of the QFT-IT was 99% (95% CI, 0.98-1.00) vs 86% for the T-Spot.TB (95% CI, 0.81-0.90). The pooled rate of indeterminate results was low, 2.1% (95% CI, 0.02-0.023) for the QFT-IT and 3.8% (95% CI, 0.035-0.042) for the T-Spot.TB, increasing to 4.4% (95% CI, 0.039-0.05) and 6.1% (95% CI, 0.052-0.071), respectively, among immunosuppressed hosts. The newest commercial IGRAs are superior, in comparison with the TST, for detecting confirmed active TB disease, especially when performed in developed countries.
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Affiliation(s)
- Roland Diel
- Department of Pulmonary Medicine, Hannover Medical School (MHH), Carl-Neuberg-Strasse 1, 30625 Hannover, Germany.
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Abstract
The 2009 Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guideline on the monitoring, management, and treatment of kidney transplant recipients is intended to assist the practitioner caring for adults and children after kidney transplantation. The guideline development process followed an evidence-based approach, and management recommendations are based on systematic reviews of relevant treatment trials. Critical appraisal of the quality of the evidence and the strength of recommendations followed the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) approach. The guideline makes recommendations for immunosuppression, graft monitoring, as well as prevention and treatment of infection, cardiovascular disease, malignancy, and other complications that are common in kidney transplant recipients, including hematological and bone disorders. Limitations of the evidence, especially on the lack of definitive clinical outcome trials, are discussed and suggestions are provided for future research.
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