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Diel R, Breuer C, Bös L, Geerdes-Fenge H, Günther A, Häcker B, Hannemann J, Nienhaus A, Priwitzer M, Witte P, Bauer T. [Recommendations for Contact Tracing for Tuberculosis - Update 2023]. DAS GESUNDHEITSWESEN 2023; 85:1076-1098. [PMID: 37972583 DOI: 10.1055/a-2148-7769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
The aim of contact tracing for tuberculosis is in addition to active case finding the detection of chains of infection and the prevention of the further spread of the disease. In this context, a careful selection of contact persons is necessary, depending on the type and duration of contact, to identify persons who are recently infected and therefore to increase the benefit of a preventive therapy and to avoid unnecessary testing of persons who are not at risk of infection. Since the last update of the recommendations on contact tracing, data on the use of interferon-y release assays (IGRAs) in children has been improved markedly. These are the preferred test in contact tracing of adults. For children, both IGRAs and the tuberculin skin test can be used equivalently. Rifampicin for 4 months, rifampicin and isoniazid for 3 months, or isoniazid for 9 months are recommended as preventive therapy in cases of confirmed infection.The implementation of the contact tracing in different age groups as well as legal framework conditions and socio-medical aspects and challenges are dealt with in detail. In addition, special cases, such as environmental screening in day-care centers, schools, or other community facilities, are discussed separately.
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Affiliation(s)
- Roland Diel
- Universitätsklinikum Schleswig-Holstein, Campus Kiel
- Deutsches Zentrum für Lungenforschung, Airway Research Center North (ARCN), LungenClinic Grosshansdorf, Großhansdorf
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose, Berlin
| | - Cornelia Breuer
- Amt für Gesundheit und Prävention der Landeshauptstadt Dresden
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose, Berlin
| | | | | | | | - Brit Häcker
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose, Berlin
| | | | - Albert Nienhaus
- Berufsgenossenschaft für Gesundheits- und Wohlfahrtspflege, Hamburg
- Universitätskrankenhaus Eppendorf, Hamburg
| | | | - Peter Witte
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose, Berlin
- Institut für Krankenhaushygiene, Universitätsklinikum JWK, Minden
| | - Torsten Bauer
- Helios-Klinikum Emil von Behring, Berlin
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose, Berlin
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Diel R, Breuer C, Bös L, Geerdes-Fenge H, Günther A, Häcker B, Hannemann J, Nienhaus A, Priwitzer M, Witte P, Bauer T. [Recommendations for contact tracing for tuberculosis - update 2023]. Pneumologie 2023; 77:607-631. [PMID: 37536363 DOI: 10.1055/a-2107-2147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
The aim of contact tracing for tuberculosis is in addition to active case finding the detection of chains of infection and the prevention of the further spread of the disease. In this context, a careful selection of contact persons is necessary, depending on the type and duration of contact, to identify persons who are recently infected and therefore to increase the benefit of a preventive therapy and to avoid unnecessary testing of persons who are not at risk of infection. Since the last update of the recommendations on contact tracing, data on the use of interferon-y release assays (IGRAs) in children has been improved markedly. These are the preferred test in contact tracing of adults. For children, both IGRAs and the tuberculin skin test can be used equivalently. Rifampicin for 4 months, rifampicin and isoniazid for 3 months, or isoniazid for 9 months are recommended as preventive therapy in cases of confirmed infection.The implementation of the contact tracing in different age groups as well as legal framework conditions and socio-medical aspects and challenges are dealt with in detail. In addition, special cases, such as environmental screening in day-care centers, schools, or other community facilities, are discussed separately.
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Affiliation(s)
- Roland Diel
- Universitätsklinikum Schleswig-Holstein, Campus Kiel
- Deutsches Zentrum für Lungenforschung, Airway Research Center North (ARCN), LungenClinic Grosshansdorf, Großhansdorf
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose, Berlin
| | - Cornelia Breuer
- Amt für Gesundheit und Prävention der Landeshauptstadt Dresden
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose, Berlin
| | | | | | | | - Brit Häcker
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose, Berlin
| | | | - Albert Nienhaus
- Berufsgenossenschaft für Gesundheits- und Wohlfahrtspflege, Hamburg
- Universitätskrankenhaus Eppendorf, Hamburg
| | | | - Peter Witte
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose, Berlin
- Institut für Krankenhaushygiene, Universitätsklinikum JWK, Minden
| | - Torsten Bauer
- Helios-Klinikum Emil von Behring, Berlin
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose, Berlin
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3
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Pérez-Recio S, Grijota-Camino MD, Anibarro L, Rabuñal-Rey R, Sabria J, Gijón-Vidaurreta P, Pomar V, García-Gasalla M, Domínguez-Castellano Á, Trigo M, Santos MJ, Cebollero A, Rodríguez S, Moga E, Penas-Truque A, Martos C, Ruiz-Serrano MJ, Garcia-de-Cara EI, Alcaide F, Santin M. Reversions of QuantiFERON-TB Gold Plus in tuberculosis contact investigation: A prospective multicentre cohort study. PLoS One 2023; 18:e0285917. [PMID: 37647315 PMCID: PMC10468083 DOI: 10.1371/journal.pone.0285917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/11/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Interferon-y Release Assays (IGRA) reversions have been reported in different clinical scenarios for the diagnosis of tuberculosis (TB) infection. This study aimed to determine the rate of QuantiFERON-TB Gold Plus (QFT-Plus) reversions during contact investigation as a potential strategy to reduce the number of preventive treatments. METHODS Prospective, multicentre cohort study of immunocompetent adult contacts of patients with pulmonary TB tested with QFT-Plus. Contacts with an initial positive QFT-Plus (QFT-i) underwent a second test within 4 weeks (QFT-1), and if negative, underwent a repeat test 4 weeks later (QFT-2). Based on the QFT-2 result, we classified cases as sustained reversion if they remained negative and as temporary reversion if they turned positive. RESULTS We included 415 contacts, of whom 96 (23.1%) had an initial positive test (QFT-i). Following this, 10 had negative QFT-1 results and 4 (4.2%) of these persisted with a negative result in the QFT-2 (sustained reversions). All four sustained reversions occurred in contacts with IFN-γ concentrations between ≥0.35 and ≤0.99 IU•mL-1 in one or both QFT-i tubes. CONCLUSION In this study, TB contact investigations rarely reveal QFT-Plus reversion. These results do not support retesting cases with an initial positive result to reduce the number of preventive treatments.
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Affiliation(s)
- Sandra Pérez-Recio
- Tuberculosis Unit, Department of Infectious Diseases, Bellvitge University Hospital-Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
| | - Maria D. Grijota-Camino
- Tuberculosis Unit, Department of Infectious Diseases, Bellvitge University Hospital-Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Fundamental and Medical-Surgical Nursing, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Luis Anibarro
- Tuberculosis Unit, Department of Internal Medicine, Complexo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - Ramón Rabuñal-Rey
- Infectious Diseases Unit, Department of Internal Medicine, University Hospital Lucus Augusti, Lugo, Spain
| | - Josefina Sabria
- Tuberculosis Unit, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | - Paloma Gijón-Vidaurreta
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañon, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Virginia Pomar
- Infectious Diseases Unit, Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Mercedes García-Gasalla
- Department of Internal Medicine, Hospital Universitari Son Espases, Palma, Spain
- Balearic Islands Health Research Institute (IdISBa), Palma, Spain
| | | | - Matilde Trigo
- Microbiology Department, Complexo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | | | - Alba Cebollero
- Department of Clinical Analysis, CLILAB Diagnostics Laboratory, Vilafranca del Penedés, Barcelona, Spain
| | - Sara Rodríguez
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañon, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Esther Moga
- Department of Immunology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | | | - Carmen Martos
- Tuberculosis Unit, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | - M. Jesús Ruiz-Serrano
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañon, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
- Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Respiratorias- CIBERES (CB06/06/0058), Madrid, Spain
| | - Erika I. Garcia-de-Cara
- Department of Microbiology, Bellvitge University Hospital—Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
| | - Fernando Alcaide
- Department of Microbiology, Bellvitge University Hospital—Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Pathology and Experimental Therapy, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Miguel Santin
- Tuberculosis Unit, Department of Infectious Diseases, Bellvitge University Hospital-Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Clinical Sciences, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- Centre for Biomedical Research in Infectious Diseases Network (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
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Biomarkers Correlated with Tuberculosis Preventive Treatment Response: A Systematic Review and Meta-Analysis. Microorganisms 2023; 11:microorganisms11030743. [PMID: 36985316 PMCID: PMC10057454 DOI: 10.3390/microorganisms11030743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/07/2023] [Accepted: 03/11/2023] [Indexed: 03/17/2023] Open
Abstract
Background: There is a need to identify alternative biomarkers to predict tuberculosis (TB) preventive treatment response because observing the incidence decline renders a long follow-up period. Methods: We searched PubMed, Embase and Web of Science up to 9 February 2023. The biomarker levels during preventive treatment were quantitatively summarized by means of meta-analysis using the random-effect model. Results: Eleven eligible studies, published during 2006–2022, were included in the meta-analysis, with frequently heterogeneous results. Twenty-six biomarkers or testing methods were identified regarding TB preventive treatment monitoring. The summarized standard mean differences of interferon-γ (INF-γ) were −1.44 (95% CI: −1.85, −1.03) among those who completed preventive treatment (τ2 = 0.21; I2 = 95.2%, p < 0.001) and −0.49 (95% CI: −1.05, 0.06) for those without preventive treatment (τ2 = 0.13; I2 = 82.0%, p < 0.001), respectively. Subgroup analysis showed that the INF-γ level after treatment decreased significantly from baseline among studies with high TB burden (−0.98, 95% CI: −1.21, −0.75) and among those with a history of Bacillus Calmette–Guérin vaccination (−0.87, 95% CI: −1.10, −0.63). Conclusions: Our results suggested that decreased INF-γ was observed among those who completed preventive treatment but not in those without preventive treatment. Further studies are warranted to explore its value in preventive treatment monitoring due to limited available data and extensive between-study heterogeneity.
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Mpande CAM, Steigler P, Lloyd T, Rozot V, Mosito B, Schreuder C, Reid TD, Bilek N, Ruhwald M, Andrews JR, Hatherill M, Little F, Scriba TJ, Nemes E. Mycobacterium tuberculosis-Specific T Cell Functional, Memory, and Activation Profiles in QuantiFERON-Reverters Are Consistent With Controlled Infection. Front Immunol 2021; 12:712480. [PMID: 34526988 PMCID: PMC8435731 DOI: 10.3389/fimmu.2021.712480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 08/09/2021] [Indexed: 11/13/2022] Open
Abstract
Reversion of immune sensitization tests for Mycobacterium tuberculosis (M.tb) infection, such as interferon-gamma release assays or tuberculin skin test, has been reported in multiple studies. We hypothesized that QuantiFERON-TB Gold (QFT) reversion is associated with a decline of M.tb-specific functional T cell responses, and a distinct pattern of T cell and innate responses compared to persistent QFT+ and QFT- individuals. We compared groups of healthy adolescents (n=~30 each), defined by four, 6-monthly QFT tests: reverters (QFT+/+/-/-), non-converters (QFT-/-/-/-) and persistent positives (QFT+/+/+/+). We stimulated peripheral blood mononuclear cells with M.tb antigens (M.tb lysate; CFP-10/ESAT-6 and EspC/EspF/Rv2348 peptide pools) and measured M.tb-specific adaptive T cell memory, activation, and functional profiles; as well as functional innate (monocytes, natural killer cells), donor-unrestricted T cells (DURT: γδ T cells, mucosal-associated invariant T and natural killer T-like cells) and B cells by flow cytometry. Projection to latent space discriminant analysis was applied to determine features that best distinguished between QFT reverters, non-converters and persistent positives. No longitudinal changes in immune responses to M.tb were observed upon QFT reversion. M.tb-specific Th1 responses detected in reverters were of intermediate magnitude, higher than responses in QFT non-converters and lower than responses in persistent positives. About one third of reverters had a robust response to CFP-10/ESAT-6. Among those with measurable responses, lower proportions of TSCM (CD45RA+CCR7+CD27+) and early differentiated (CD45RA-) IFN-γ-TNF+IL-2- M.tb lysate-specific CD4+ cells were observed in reverters compared with non-converters. Conversely, higher proportions of early differentiated and lower proportions of effector (CD45RA-CCR7-) CFP10/ESAT6-specific Th1 cells were observed in reverters compared to persistent-positives. No differences in M.tb-specific innate, DURT or B cell functional responses were observed between the groups. Statistical modelling misclassified the majority of reverters as non-converters more frequently than they were correctly classified as reverters or misclassified as persistent positives. These findings suggest that QFT reversion occurs in a heterogeneous group of individuals with low M.tb-specific T cell responses. In some individuals QFT reversion may result from assay variability, while in others the magnitude and differentiation status of M.tb-specific Th1 cells are consistent with well-controlled M.tb infection.
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Affiliation(s)
- Cheleka A M Mpande
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, Division of Immunology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Pia Steigler
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, Division of Immunology, Department of Pathology, University of Cape Town, Cape Town, South Africa.,Wellcome Centre for Infectious Diseases Research (CIDRI) in Africa, Institute of Infectious Disease and Molecular Medicine and Division of Immunology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Tessa Lloyd
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, Division of Immunology, Department of Pathology, University of Cape Town, Cape Town, South Africa.,Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa
| | - Virginie Rozot
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, Division of Immunology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Boitumelo Mosito
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, Division of Immunology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Constance Schreuder
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, Division of Immunology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Timothy D Reid
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, Division of Immunology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Nicole Bilek
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, Division of Immunology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Morten Ruhwald
- Statens Serum Institut, Copenhagen, Denmark.,Foundation of Innovative New Diagnostics, Geneva, Switzerland
| | - Jason R Andrews
- Department of Medicine, Stanford University, Stanford, CA, United States
| | - Mark Hatherill
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, Division of Immunology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Francesca Little
- Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa
| | - Thomas J Scriba
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, Division of Immunology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Elisa Nemes
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, Division of Immunology, Department of Pathology, University of Cape Town, Cape Town, South Africa
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6
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Nardell EA. Time to Revise Our Tuberculosis Infection-Latency-Disease Model in High-burden Settings. Clin Infect Dis 2021; 72:2016-2017. [PMID: 32584981 DOI: 10.1093/cid/ciaa866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 06/22/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Edward A Nardell
- Brigham & Women's Hospital, Division of Global Health Equity, Boston, MA, USA.,Harvard Medical School, Department of Global Health and Social Medicine, Boston, MA, USA
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7
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Lalvani A, Fenn J, Pillay TD. Probing the in-vivo reservoir of latent tuberculosis infection. THE LANCET. MICROBE 2021; 2:e226-e227. [PMID: 35544168 DOI: 10.1016/s2666-5247(21)00080-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 03/22/2021] [Indexed: 11/22/2022]
Affiliation(s)
- Ajit Lalvani
- NIHR Health Protection Research Unit in Respiratory Infections, National Heart and Lung Institute, Imperial College London, London W2 1PG, UK.
| | - Joe Fenn
- NIHR Health Protection Research Unit in Respiratory Infections, National Heart and Lung Institute, Imperial College London, London W2 1PG, UK
| | - Timesh D Pillay
- NIHR Health Protection Research Unit in Respiratory Infections, National Heart and Lung Institute, Imperial College London, London W2 1PG, UK
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8
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Gutierrez J, Kroon EE, Möller M, Stein CM. Phenotype Definition for "Resisters" to Mycobacterium tuberculosis Infection in the Literature-A Review and Recommendations. Front Immunol 2021; 12:619988. [PMID: 33717116 PMCID: PMC7946835 DOI: 10.3389/fimmu.2021.619988] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/14/2021] [Indexed: 12/03/2022] Open
Abstract
Tuberculosis (TB) remains a worldwide problem. Despite the high disease rate, not all who are infected with Mycobacterium Tuberculosis (Mtb) develop disease. Interferon-γ (IFN-γ) specific T cell immune assays such as Quantiferon and Elispot, as well as a skin hypersensitivity test, known as a tuberculin skin test, are widely used to infer infection. These assays measure immune conversion in response to Mtb. Some individuals measure persistently negative to immune conversion, despite high and prolonged exposure to Mtb. Increasing interest into this phenotype has led to multiple publications describing various aspects of these responses. However, there is a lack of a unified "resister" definition. A universal definition will improve cross study data comparisons and assist with future study design and planning. We review the current literature describing this phenotype and make recommendations for future studies.
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Affiliation(s)
- Jesús Gutierrez
- Department of Population and Quantitative Health Science, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Elouise E. Kroon
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Marlo Möller
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Catherine M. Stein
- Department of Population and Quantitative Health Science, Case Western Reserve University School of Medicine, Cleveland, OH, United States
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9
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Lalvani A, Seshadri C. Understanding How BCG Vaccine Protects Against Mycobacterium tuberculosis Infection: Lessons From Household Contact Studies. J Infect Dis 2021; 221:1229-1231. [PMID: 31298279 DOI: 10.1093/infdis/jiz261] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 06/06/2019] [Indexed: 01/03/2023] Open
Affiliation(s)
- Ajit Lalvani
- Tuberculosis Research Centre, National Heart and Lung Institute, Imperial College London, United Kingdom.,National Institute for Health Research Health Protection Research Unit in Respiratory Infections, Imperial College London, United Kingdom
| | - Chetan Seshadri
- Department of Medicine, School of Medicine, University of Washington, Seattle.,Tuberculosis Research and Training Center, University of Washington, Seattle
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10
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Carranza C, Pedraza-Sanchez S, de Oyarzabal-Mendez E, Torres M. Diagnosis for Latent Tuberculosis Infection: New Alternatives. Front Immunol 2020; 11:2006. [PMID: 33013856 PMCID: PMC7511583 DOI: 10.3389/fimmu.2020.02006] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/24/2020] [Indexed: 12/29/2022] Open
Abstract
Latent tuberculosis infection (LTBI) is a subclinical mycobacterial infection defined on the basis of cellular immune response to mycobacterial antigens. The tuberculin skin test (TST) and the interferon gamma release assay (IGRA) are currently used to establish the diagnosis of LTB. However, neither TST nor IGRA is useful to discriminate between active and latent tuberculosis. Moreover, these tests cannot be used to predict whether an individual with LTBI will develop active tuberculosis (TB) or whether therapy for LTBI could be effective to decrease the risk of developing active TB. Therefore, in this article, we review current approaches and some efforts to identify an immunological marker that could be useful in distinguishing LTBI from TB and in evaluating the effectiveness of treatment of LTB on the risk of progression to active TB.
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Affiliation(s)
- Claudia Carranza
- Departamento de Microbiología, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Sigifredo Pedraza-Sanchez
- Unidad de Bioquímica Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico
| | | | - Martha Torres
- Departamento de Microbiología, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico.,Subdirección de Investigación Biomédica, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City, Mexico
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11
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Meier T, Enders M. High reproducibility of the interferon-gamma release assay T-SPOT.TB in serial testing. Eur J Clin Microbiol Infect Dis 2020; 40:85-93. [PMID: 32770282 DOI: 10.1007/s10096-020-03997-3] [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: 04/18/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
Abstract
Longitudinal studies regarding the reproducibility of Interferon-gamma release assay (IGRA) T-SPOT.TB for the diagnosis of Mycobacterium tuberculosis (M. tb) infection in serial testing are limited. We retrospectively analysed results of serially tested subjects in a medical laboratory in Germany over a time period of 14 years. From October 2004 to December 2018, a total of 5440 subjects were identified with a second T-SPOT.TB test after a median time interval of 258 days (interquartile range [IQR] 62-665). Consistently negative (n = 4520) or positive results (n = 682) were observed in 5202 (95.6%) subjects, indicating a high degree of concordance in serial testing (κ = 0.83). Test conversions occurred in 101 of 4621 (2.2%) subjects with initially negative tests. Of 819 subjects with initially positive test results, 137 (16.7%) had a test reversion which was associated with low spot numbers of the first test. Of 529 subjects retested within 1 year, only 60 (11.3%) displayed a test reversion. In subjects retested after more than 1 year, 77 of 290 (26.6%) tests reverted. This significantly higher rate of test reversions after more than 1 year was age-dependent and only observed in subjects above the age of 40 years. In the medical laboratory, the T-SPOT.TB test demonstrates a high reproducibility in serial testing.
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Affiliation(s)
- Thomas Meier
- Laboratory Prof. Gisela Enders and colleagues, MVZ, Rosenbergstrasse 85, D-70193, Stuttgart, Germany.
| | - Martin Enders
- Laboratory Prof. Gisela Enders and colleagues, MVZ, Rosenbergstrasse 85, D-70193, Stuttgart, Germany
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12
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Chai Q, Lu Z, Liu CH. Host defense mechanisms against Mycobacterium tuberculosis. Cell Mol Life Sci 2020; 77:1859-1878. [PMID: 31720742 PMCID: PMC11104961 DOI: 10.1007/s00018-019-03353-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/30/2019] [Accepted: 10/21/2019] [Indexed: 12/19/2022]
Abstract
Tuberculosis (TB), which is caused by Mycobacterium tuberculosis (Mtb), remains the leading cause of death worldwide from a single infectious pathogen. Mtb is a paradigmatic intracellular pathogen that primarily invades the lungs after host inhalation of bacteria-containing droplets via the airway. However, the majority of Mtb-exposed individuals can spontaneously control the infection by virtue of a robust immune defense system. The mucosal barriers of the respiratory tract shape the first-line defense against Mtb through various mucosal immune responses. After arriving at the alveoli, the surviving mycobacteria further encounter a set of host innate immune cells that exert multiple cellular bactericidal functions. Adaptive immunity, predominantly mediated by a range of different T cell and B cell subsets, is subsequently activated and participates in host anti-mycobacterial defense. During Mtb infection, host bactericidal immune responses are exquisitely adjusted and balanced by multifaceted mechanisms, including genetic and epigenetic regulation, metabolic regulation and neuroendocrine regulation, which are indispensable for maintaining host immune efficiency and avoiding excessive tissue injury. A better understanding of the integrated and equilibrated host immune defense system against Mtb will contribute to the development of rational TB treatment regimens especially novel host-directed therapeutics.
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Affiliation(s)
- Qiyao Chai
- CAS Key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, 100101, China.
- Savaid Medical School, University of Chinese Academy of Sciences, Beijing, 100049, China.
| | - Zhe Lu
- CAS Key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, 100101, China
- Savaid Medical School, University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Cui Hua Liu
- CAS Key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, 100101, China.
- Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, 430071, China.
- Savaid Medical School, University of Chinese Academy of Sciences, Beijing, 100049, China.
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13
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Choreño-Parra JA, Weinstein LI, Yunis EJ, Zúñiga J, Hernández-Pando R. Thinking Outside the Box: Innate- and B Cell-Memory Responses as Novel Protective Mechanisms Against Tuberculosis. Front Immunol 2020; 11:226. [PMID: 32117325 PMCID: PMC7034257 DOI: 10.3389/fimmu.2020.00226] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 01/28/2020] [Indexed: 12/31/2022] Open
Abstract
Tuberculosis (TB) is currently the deadliest infectious disease worldwide. Failure to create a highly effective vaccine has limited the control of the TB epidemic. Historically, the vaccine field has relied on the paradigm that IFN-γ-mediated CD4+ T cell memory responses are the principal correlate of protection in TB. Nonetheless, the demonstration that other cellular subsets offer protective memory responses against Mycobacterium tuberculosis (Mtb) is emerging. Among these are memory-like features of macrophages, myeloid cell precursors, natural killer (NK) cells, and innate lymphoid cells (ILCs). Additionally, the dynamics of B cell memory responses have been recently characterized at different stages of the clinical spectrum of Mtb infection, suggesting a role for B cells in human TB. A better understanding of the immune mechanisms underlying such responses is crucial to better comprehend protective immunity in TB. Furthermore, targeting immune compartments other than CD4+ T cells in TB vaccine strategies may benefit a significant proportion of patients co-infected with Mtb and the human immunodeficiency virus (HIV). Here, we summarize the memory responses of innate immune cells and B cells against Mtb and propose them as novel correlates of protection that could be harnessed in future vaccine development programs.
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Affiliation(s)
- José Alberto Choreño-Parra
- Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City, Mexico.,Laboratory of Immunobiology and Genetics, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - León Islas Weinstein
- Section of Experimental Pathology, Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Edmond J Yunis
- Department of Cancer Immunology and AIDS, Dana-Farber Cancer Institute, Boston, MA, United States.,Department of Pathology, Harvard Medical School, Boston, MA, United States
| | - Joaquín Zúñiga
- Laboratory of Immunobiology and Genetics, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico.,Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Mexico City, Mexico
| | - Rogelio Hernández-Pando
- Section of Experimental Pathology, Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Xin H, Cao X, Zhang H, Liu J, Pan S, Li X, Guan L, Shen F, Liu Z, Wang D, Guan X, Yan J, Li H, Feng B, Zhang M, Yang Q, Jin Q, Gao L. Dynamic changes of interferon gamma release assay results with latent tuberculosis infection treatment. Clin Microbiol Infect 2020; 26:1555.e1-1555.e7. [PMID: 32062048 DOI: 10.1016/j.cmi.2020.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/02/2020] [Accepted: 02/08/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Using QuantiFERON-TB Gold In-Tube (QFT-GIT) for monitoring tuberculosis (TB) and latent TB infection treatment effect is controversial. The present study aimed to evaluate the dynamic changes of interferon gamma (IFN-γ) levels along with latent TB infection treatment via a randomized controlled study. METHODS A total of 910 participants treated with 8 weeks of once-weekly rifapentine plus isoniazid (group A), 890 treated with 6 weeks of twice-weekly rifapentine plus isoniazid (group B) and 818 untreated controls (group C) were followed for 2 years to track active TB development. QFT-GIT tests were repeated three times for all groups: before treatment (T0), at completion of treatment (T1) and 3 months after completion of treatment (T2). RESULTS Similar rates of persistent QFT-GIT reversion were observed in groups A (19.0%, 173/910), B (18.5%, 165/890) and C (20.7%, 169/818) (p 0.512). The dynamic changes of IFN-γ levels were not statistically significant among the three groups. In treated participants, individuals with higher baseline IFN-γ levels showed increased TB occurrence (1.0%, 9/896) compared to those with lower baseline levels (0.2%, 2/904) (p 0.037). A similar but statistically insignificant trend was also observed in untreated controls (1.8% (7/400) vs. 0.5% (2/418), p 0.100). When TB cases were matched with non-TB cases on baseline IFN-γ levels, no significant differences were found with respect to the dynamic changes in IFN-γ levels with time, regardless of whether they received treatment. CONCLUSIONS QFT-GIT reversion or decreased IFN-γ levels should not be used for monitoring host response to latent TB infection treatment.
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Affiliation(s)
- H Xin
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - X Cao
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - H Zhang
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - J Liu
- The Sixth People's Hospital of Zhengzhou, PR China
| | - S Pan
- The Centers for Disease Prevention and Control of Zhongmu County, Zhengzhou, PR China
| | - X Li
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - L Guan
- The Sixth People's Hospital of Zhengzhou, PR China
| | - F Shen
- The Sixth People's Hospital of Zhengzhou, PR China
| | - Z Liu
- The Centers for Disease Prevention and Control of Zhongmu County, Zhengzhou, PR China
| | - D Wang
- The Centers for Disease Prevention and Control of Zhongmu County, Zhengzhou, PR China
| | - X Guan
- The Sixth People's Hospital of Zhengzhou, PR China
| | - J Yan
- The Centers for Disease Prevention and Control of Zhongmu County, Zhengzhou, PR China
| | - H Li
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - B Feng
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - M Zhang
- Guangdong Key Laboratory for Diagnosis &Treatment of Emerging Infectious Diseases, Shenzhen Third People's Hospital, Shenzhen University School of Medicine, Shenzhen, PR China
| | - Q Yang
- Guangdong Key Laboratory for Diagnosis &Treatment of Emerging Infectious Diseases, Shenzhen Third People's Hospital, Shenzhen University School of Medicine, Shenzhen, PR China
| | - Q Jin
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - L Gao
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China.
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15
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Ludwig L, Egan R, Baquero M, Mansz A, Plattner BL. WC1 + and WC1 neg γδ T lymphocytes in intestinal mucosa of healthy and Mycobacterium avium subspecies paratuberculosis-infected calves. Vet Immunol Immunopathol 2019; 216:109919. [PMID: 31446207 DOI: 10.1016/j.vetimm.2019.109919] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 07/22/2019] [Accepted: 08/05/2019] [Indexed: 02/07/2023]
Abstract
Mucosal surfaces such as the gastrointestinal tract, and skin are the front line of host defence and immunity against many pathogens. Gamma delta (γδ) T lymphocytes preferentially localize to the mucosal surfaces in several species including cattle, and are thought to play crucial roles in immunosurveillance and host defence, particularly against mycobacteria. Many γδ T cells are present in young calves, which is the period when calves are thought to be initially exposed to Mycobacterium avium subspecies paratuberculosis (Map). The role of mucosal γδ T cells in cattle, especially during host-pathogen interactions during early pre-clinical phases of infectious disease remains unclear. The purposes of this study were to investigate and characterize WC1+ and WC1neg γδ T cell subsets in various segments of the gastrointestinal (GI) tract of young calves, and then to examine γδ T cell subsets in the distal small intestine of calves after experimental intestinal Map infection by direct Peyer's patch inoculation. We show that in healthy calves, the relative proportion of γδ T cells is constant throughout the GI mucosa, though the ileum has significantly more γδ T cells. In the distal intestine, γδ T cells are mainly WC1neg and primarily located within the lamina propria of the jejunum and ileum. In Map-infected intestine, there are higher numbers of γδ T cells in the lamina propria and a greater proportion of WC1+ cells within the epithelial layer compared to control calves. While WC1neg γδ T cells preferentially localize to the distal small intestine of healthy calves, WC1+ γδ T cells are increased in the intestinal mucosa during Map infection, which is suggestive of effector cell function. Further, spectral microscopy and flow cytometry in tandem will lead to improved understanding of the functions of these cells during health and disease.
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Affiliation(s)
- Latasha Ludwig
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, Ontario, N1G 2W1, Canada
| | - Rebecca Egan
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, Ontario, N1G 2W1, Canada
| | - Monica Baquero
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, Ontario, N1G 2W1, Canada
| | - Amanda Mansz
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, Ontario, N1G 2W1, Canada
| | - Brandon L Plattner
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, Ontario, N1G 2W1, Canada.
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16
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Lin PL, Flynn JL. The End of the Binary Era: Revisiting the Spectrum of Tuberculosis. THE JOURNAL OF IMMUNOLOGY 2019; 201:2541-2548. [PMID: 30348659 DOI: 10.4049/jimmunol.1800993] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 07/28/2018] [Indexed: 11/19/2022]
Abstract
Human Mycobacterium tuberculosis infection was thought to result in either active symptomatic tuberculosis (TB) or latent asymptomatic infection. It is now clear that this binary classification is insufficient to describe the myriad of infection outcomes. In active TB, symptomatic disease can be mild to severe, with a range of lung and thoracic lymph node involvement or extrapulmonary manifestations. Most humans control the infection and develop latent TB infection, with differential risks of reactivation to active TB. However, some frequently exposed persons appear to be resistant to infection, whereas others may initially become infected yet subsequently eliminate all bacilli. The immunologic factors influencing these varied outcomes are still not clear, but likely involve a range of different responses. In this article, we review the data supporting the spectrum of M. tuberculosis infection in humans as well as data in nonhuman primates that allow dissection of the immune responses leading to the varied outcomes of infection.
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Affiliation(s)
- Philana Ling Lin
- Department of Pediatrics, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224; and
| | - JoAnne L Flynn
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261
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17
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Dahotre SN, Chang YM, Romanov AM, Kwong GA. DNA-Barcoded pMHC Tetramers for Detection of Single Antigen-Specific T Cells by Digital PCR. Anal Chem 2019; 91:2695-2700. [PMID: 30656939 PMCID: PMC6399736 DOI: 10.1021/acs.analchem.8b04153] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Antigen-specific T cells are found at low frequencies in circulation but carry important diagnostic information as liquid biomarkers in numerous biomedical settings, such as monitoring the efficacy of vaccines and cancer immunotherapies. To enable detection of antigen-specific T cells with high sensitivity, we develop peptide-MHC (pMHC) tetramers labeled with DNA barcodes to detect single T cells by droplet digital PCR (ddPCR). We show that site-specific conjugation of DNA via photocleavable linkers allows barcoded tetramers to stain T cells with similar avidity compared to conventional fluorescent tetramers and efficient recovery of barcodes by light with no loss in cell viability. We design an orthogonal panel of DNA-barcoded tetramers to simultaneously detect multiple antigen-specific T cell populations, including from a mouse model of viral infection, and discriminate single cancer-specific T cells with high diagnostic sensitivity and specificity. This approach of DNA-barcoding can be broadened to encompass additional rare cells for monitoring immunological health at the single cell level.
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Affiliation(s)
- Shreyas N. Dahotre
- Department of Biomedical Engineering, Wallace H. Coulter, Georgia Tech and Emory School of Medicine, Atlanta, GA 30332, United States
| | - Yun Min Chang
- Department of Biomedical Engineering, Wallace H. Coulter, Georgia Tech and Emory School of Medicine, Atlanta, GA 30332, United States
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA 30322, United States
| | - Anna M. Romanov
- Department of Biomedical Engineering, Wallace H. Coulter, Georgia Tech and Emory School of Medicine, Atlanta, GA 30332, United States
| | - Gabriel A. Kwong
- Department of Biomedical Engineering, Wallace H. Coulter, Georgia Tech and Emory School of Medicine, Atlanta, GA 30332, United States
- Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Tech, Atlanta, GA 30332, United States
- Institute for Electronics and Nanotechnology, Georgia Tech, Atlanta, GA, 30332, United States
- Integrated Cancer Research Center, Georgia Tech, Atlanta, GA, 30332, United States
- Georgia ImmunoEngineering Consortium, Georgia Tech and Emory University, Atlanta, GA 30332, United States
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18
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Xin H, Zhang H, Cao X, Li X, Li M, Feng B, Jin Q, Gao L. Serum level of IL-8 is associated with reversion of QuantiFERON-TB gold in-tube tests. J Infect 2018; 78:292-298. [PMID: 30138640 DOI: 10.1016/j.jinf.2018.08.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 08/03/2018] [Accepted: 08/04/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Frequent reversion has been commonly observed in serial QuantiFERON-TB Gold In-Tube (QFT) tests, which limited its accuracy in defining the status of Mycobacterium tuberculosis (MTB) infection. Serum cytokine profiles might provide additional information to clarify the infection status. METHOD Based on a population-based cohort study aiming to track MTB infection acquisition and disease development, serum profiles of 12 cytokines were determined by bead-based multiplex assays in parallel with QFT and tuberculin skin tests (TST) to explore potential relation between serum cytokines and MTB infection status. RESULTS Totally, 309 subjects got QFT conversion in one year (2013-2014) and 46.92% (145/309) of them got reversion in 2015. The study subjects were classified into three groups according to their QFT and TST results in 2015 (QFT persistence positive, QFT-/TST + and QFT-/TST-). The serum levels of MCP-1 and IL-8 were significantly different among the three groups. Furthermore, level of IL-8 was dramatically lower in QFT-/TST- group as compared to the other two groups, and no significant difference was observed for QFT-/TST + group as comparing with persistent positive group. CONCLUSION Our results suggested that the decreased serum level of IL-8 might be potential biomarker to identify QFT reversion caused by infection clearance.
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Affiliation(s)
- Henan Xin
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 9 Dong Dan San Tiao, Dongcheng District, Beijing 100730, China
| | - Haoran Zhang
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 9 Dong Dan San Tiao, Dongcheng District, Beijing 100730, China
| | - Xuefang Cao
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 9 Dong Dan San Tiao, Dongcheng District, Beijing 100730, China
| | - Xiangwei Li
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 9 Dong Dan San Tiao, Dongcheng District, Beijing 100730, China
| | - Mufei Li
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 9 Dong Dan San Tiao, Dongcheng District, Beijing 100730, China
| | - Boxuan Feng
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 9 Dong Dan San Tiao, Dongcheng District, Beijing 100730, China
| | - Qi Jin
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 9 Dong Dan San Tiao, Dongcheng District, Beijing 100730, China
| | - Lei Gao
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 9 Dong Dan San Tiao, Dongcheng District, Beijing 100730, China.
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Comparison of the QuantiFERON-TB Gold Plus and QuantiFERON-TB Gold In-Tube Interferon Gamma Release Assays in Patients at Risk for Tuberculosis and in Health Care Workers. J Clin Microbiol 2018; 56:JCM.00614-18. [PMID: 29743310 DOI: 10.1128/jcm.00614-18] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 05/05/2018] [Indexed: 12/15/2022] Open
Abstract
The QuantiFERON-TB Gold Plus (QFT-Plus; Qiagen, Germantown, MD) interferon gamma release assay (IGRA) received FDA clearance in 2017 and will replace the prior version of the assay, the QFT-Gold In-Tube (QFT-GIT). Here, we compared performances of the QFT-Plus assay and the QFT-GIT version in a diverse patient population, including patients undergoing evaluation for or follow-up of latent tuberculosis infection (LTBI; n = 39) or active TB infection (n = 3), and in health care workers (HCWs; n = 119) at Mayo Clinic (Rochester, MN). Compared to the QFT-GIT, the QFT-Plus assay showed 91.2% (31/34) positive, 98.4% (124/126) negative, and 96.6% (156/161) overall qualitative agreement among the 161 enrolled subjects, with a Cohen's kappa value of 0.91 (excellent interrater agreement). Among the 28 patients diagnosed with LTBI at the time of enrollment, the QFT-GIT and QFT-Plus assays agreed in 24 (85.7%) patients; in all four discordant patients, the positivity of the QFT-GIT or QFT-Plus IGRA was associated with low-level interferon gamma (IFN-γ) reactivity, ranging from 0.36 IU/ml to 0.66 IU/ml. Additionally, we document a high degree of correlation between IFN-γ levels in the QFT-GIT TB antigen tube and each of the two QFT-Plus TB antigen tubes, as well as between the QFT-Plus TB1 and TB2 tubes (Pearson's correlation coefficients [R] > 0.95). Overall, we show comparable results between the QFT-GIT and QFT-Plus assays in our study population composed of subjects presenting with a diverse spectrum of TB infections. Our findings suggest that the necessary transition to the QFT-Plus assay will be associated with a minimal difference in assay performance characteristics.
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20
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Reversion of QuantiFERON-TB Gold In-Tube test in individuals with and without prophylactic treatment for latent tuberculosis infection: A systematic review and meta-analysis. J Infect 2018; 77:276-282. [PMID: 29746953 DOI: 10.1016/j.jinf.2018.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 03/09/2018] [Accepted: 04/02/2018] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Reversion of tuberculosis (TB) infection testing has been suggested to be associated with prophylactic treatment efficacy. However, evidences based on randomized controlled study were sparse. METHODS Studies on serial QuantiFERON-TB Gold In-Tube (QFT) test, among individuals with and without prophylactic treatment were identified in the databases of PubMed, MEDLINE and EMBASE up to 28 February 2018. The reversion rates were quantitatively summarized by means of meta-analysis using the random-effect model. RESULTS A total of 52 eligible studies were included in the meta-analysis on QFT test reversion rate among participants with (20 studies) and without (32 studies) prophylactic treatment. Summarized reversion rate was found to be 24.9% (95% confidence interval [CI]: 18.4-32.9%) and 25.3% (95% CI: 19.6-32.0%) for those completed or without treatment, respectively. When the analysis was restricted to the participants completed treatment, higher summarized rate of QFT reversion was found among those with longer course therapy (9INH vs. the other regimens), studies from Asia (vs. Europe and America), and individuals with immunosuppression disorders (vs. general populations). CONCLUSIONS Our results suggested that QFT reversion was frequently observed regardless of with or without prophylactic treatment. Serial QFT testing might be inappropriate for evaluating preventive treatment efficacy.
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21
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Shen F, Han C, Wang MS, He Y. Poor agreement between repeated T-SPOT.TB in a short time period in a high TB burden country. Infect Dis (Lond) 2018; 50:771-774. [PMID: 29569507 DOI: 10.1080/23744235.2018.1455007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Affiliation(s)
- Feng Shen
- a Department of Lab Medicine , Maternal and Child Health Care Hospital of Shandong Province , Jinan , China
| | - Chao Han
- b Department of Geriatrics , Shandong Mental Health Center , Jinan , Shandong , China
| | - Mao-Shui Wang
- c Department of Lab Medicine , Shandong Provincial Chest Hospital , Jinan , Shandong , China.,d Department of Pediatrics , Qilu Hospital, Shandong University , Jinan , Shandong , China
| | - Yu He
- e Department of Clinical Laboratory , First Affiliated Hospital of Guangxi Medical University , Nanning , China
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22
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Practice Guidelines for Clinical Microbiology Laboratories: Mycobacteria. Clin Microbiol Rev 2018; 31:31/2/e00038-17. [PMID: 29386234 DOI: 10.1128/cmr.00038-17] [Citation(s) in RCA: 144] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Mycobacteria are the causative organisms for diseases such as tuberculosis (TB), leprosy, Buruli ulcer, and pulmonary nontuberculous mycobacterial disease, to name the most important ones. In 2015, globally, almost 10 million people developed TB, and almost half a million patients suffered from its multidrug-resistant form. In 2016, a total of 9,287 new TB cases were reported in the United States. In 2015, there were 174,608 new case of leprosy worldwide. India, Brazil, and Indonesia reported the most leprosy cases. In 2015, the World Health Organization reported 2,037 new cases of Buruli ulcer, with most cases being reported in Africa. Pulmonary nontuberculous mycobacterial disease is an emerging public health challenge. The U.S. National Institutes of Health reported an increase from 20 to 47 cases/100,000 persons (or 8.2% per year) of pulmonary nontuberculous mycobacterial disease among adults aged 65 years or older throughout the United States, with 181,037 national annual cases estimated in 2014. This review describes contemporary methods for the laboratory diagnosis of mycobacterial diseases. Furthermore, the review considers the ever-changing health care delivery system and stresses the laboratory's need to adjust and embrace molecular technologies to provide shorter turnaround times and a higher quality of care for the patients who we serve.
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23
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Xiao JN, Xiong Y, Chen Y, Xiao YJ, Ji P, Li Y, Wang SJ, Zhao GP, Cheng QJ, Lu SH, Wang Y. Determination of Lipoprotein Z-Specific IgA in Tuberculosis and Latent Tuberculosis Infection. Front Cell Infect Microbiol 2017; 7:495. [PMID: 29250493 PMCID: PMC5715530 DOI: 10.3389/fcimb.2017.00495] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 11/15/2017] [Indexed: 11/13/2022] Open
Abstract
Tuberculosis (TB) remains one of the most severe infectious diseases. It is still of paramount importance to establish more accurate, rapid, and efficient diagnostic methods. Since infection with Mycobacterium tuberculosis (M. tb) is largely mediated through the respiratory tract, IgA responses against mycobacterial proteins are worthy of investigation for their potential clinical utility. In this study, the IgA response targeting lipoprotein Z (LppZ) was determined by using a homemade ELISA with plasma of TB patients (N = 125), LTBI individuals (N = 92), healthy controls (HCs) (N = 165), as well as TB patients undergoing anti-TB treatment (N = 9). In parallel the antigen-specific IFN-γ release from PBMCs triggered by LppZ and M. tb-specific ESAT-6 or CFP-10 was detected by using an ELISPOT assay. It was found that the LppZ-specific IgA level was dramatically higher in TB patients than in HCs (p < 0.0001). Compared to that before anti-TB treatment, the LppZ-specific IgA level decreased substantially after 2 months of anti-TB treatment (p = 0.0297) and remained at low levels until the end of the treatment. What is more, pulmonary TB patients exhibited significantly higher LppZ-specific IgA-values than extra-pulmonary TB patients (p = 0.0296). Interestingly, the LppZ-specific IgA-values were negatively correlated to the amounts of IFN-γ released in response to LppZ with statistical significance (r = -0.5806, p = 0.0002). LppZ-specific IgA level was also higher in LTBI individuals than in HCs (p < 0.0001). Additionally there were some PPD+ HC individuals with high LppZ-specific IgA levels but the potential of this assay for identifying leaky LTBI in PPD+ HCs needs to be further investigated through follow-up studies. The sensitivity of detecting TB solely with ESAT-6 or CFP-10-specific IFN-γ release was increased by including the LppZ-specific IgA results, respectively, from 86.11 to 100% and 88.89 to 100%; the sensitivity of screening for LTBI was increased from 80.36 to 83.93% and 57.14 to 69.64%, respectively. The higher LppZ-specific IgA responses in TB and LTBI populations than in controls indicated high immunoreactivity to LppZ upon M. tb infection. Although the assay was not efficient enough for independent application in sero-diagnosis, LppZ-specific IgA might become a complementary biomarker for the improvement of TB and LTBI screening.
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Affiliation(s)
- Jia-Ni Xiao
- Department of Microbiology and Immunology, Shanghai Institute of Immunology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yanqing Xiong
- Key Laboratory of Medical Molecular Virology of MOE/MOH, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Yingying Chen
- Department of Microbiology and Immunology, Shanghai Institute of Immunology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yang-Jiong Xiao
- Department of Microbiology and Immunology, Shanghai Institute of Immunology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ping Ji
- Department of Microbiology and Immunology, Shanghai Institute of Immunology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yong Li
- Department of Microbiology and Immunology, Shanghai Institute of Immunology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shu-Jun Wang
- Department of Microbiology and Immunology, Shanghai Institute of Immunology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guo-Ping Zhao
- Shanghai-MOST Key Laboratory of Health and Disease Genomics, Chinese National Human Genome Center at Shanghai, Shanghai, China
| | - Qi-Jian Cheng
- Department of Respiratory Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shui-Hua Lu
- Key Laboratory of Medical Molecular Virology of MOE/MOH, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Ying Wang
- Department of Microbiology and Immunology, Shanghai Institute of Immunology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Introducing the ESAT-6 free IGRA, a companion diagnostic for TB vaccines based on ESAT-6. Sci Rep 2017; 7:45969. [PMID: 28387329 PMCID: PMC5384086 DOI: 10.1038/srep45969] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 03/07/2017] [Indexed: 12/11/2022] Open
Abstract
There is a need for an improved vaccine for tuberculosis. ESAT-6 is a cardinal vaccine antigen with unique properties and is included in several vaccine candidates in development. ESAT-6 is also the core antigen in the IFN-γ release assays (IGRA) used to diagnose latent infection, rendering IGRA tests unspecific after vaccination. This challenge has prompted the development of a companion diagnostic for ESAT-6 based vaccines, an ESAT-6 free IGRA. We screened a panel of seven potential new diagnostic antigens not recognized in BCG vaccinated individuals. Three highly recognized antigens EspC, EspF and Rv2348c were identified and combined with CFP10 in an ESAT-6 free antigen cocktail. The cocktail was prepared in a field-friendly format, lyophilized with heparin in ready-to-use vacutainer tubes. The diagnostic performance of the ESAT-6 free IGRA was determined in a cross-validation study. Compared IGRA, the ESAT-6 free IGRA induced a comparable magnitude of IFN-γ release, and the diagnostic performance was on par with Quantiferon (sensitivity 84% vs 79%; specificity 99% vs 97%). The comparable performance of the ESAT-6 free IGRA to IGRA suggests potential as companion diagnostic for ESAT-6 containing vaccines and as adjunct test for latent infection.
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Proteomic Analysis of Kveim Reagent Identifies Targets of Cellular Immunity in Sarcoidosis. PLoS One 2017; 12:e0170285. [PMID: 28114394 PMCID: PMC5256960 DOI: 10.1371/journal.pone.0170285] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 01/03/2017] [Indexed: 02/07/2023] Open
Abstract
Background Kveim-reagent (Kv) skin testing was a historical method of diagnosing sarcoidosis. Intradermal injection of treated sarcoidosis spleen tissue resulted in a granuloma response at injection site by 4–6 weeks. Previous work indicates proteins as the possible trigger of this reaction. We aimed to identify Kv-specific proteins and characterise the ex vivo response of Peripheral Blood Mononuclear Cells (PBMCs) from sarcoidosis, tuberculosis and healthy control patients when stimulated with both Kv and selected Kv-specific proteins. Methods Kv extracts were separated by 1D-SDS-PAGE and 2D-DIGE and then underwent mass spectrometric analysis for protein identification. Sarcoidosis and control PBMCs were first stimulated with Kv and then with three selected recombinant protein candidates which were identified from the proteomic analysis. PBMC secreted cytokines were subsequently measured by Multiplex Cytokine Assay. Results We observed significantly increased IFN-γ and TNF-α secretion from Kv-stimulated PBMCs of sarcoidosis patients vs. PBMCs from healthy volunteers (IFN-γ: 207.2 pg/mL vs. 3.86 pg/mL, p = 0.0018; TNF-α: 2375 pg/mL vs. 42.82 pg/mL, p = 0.0003). Through proteomic approaches we then identified 74 sarcoidosis tissue-specific proteins. Of these, 3 proteins (vimentin, tubulin and alpha-actinin-4) were identified using both 1D-SDS-PAGE and 2D-DIGE. Data are available via ProteomeXchange with identifier PXD005150. Increased cytokine secretion was subsequently observed with vimentin stimulation of sarcoidosis PBMCs vs. tuberculosis PBMCs (IFN-γ: 396.6 pg/mL vs 0.1 pg/mL, p = 0.0009; TNF-α: 1139 pg/mL vs 0.1 pg/mL, p<0.0001). This finding was also observed in vimentin stimulation of sarcoidosis PBMCs compared to PBMCs from healthy controls (IFN-γ: 396.6 pg/mL vs. 0.1 pg/mL, p = 0.014; TNF-α: 1139 pg/mL vs 42.29 pg/mL, p = 0.027). No difference was found in cytokine secretion between sarcoidosis and control PBMCs when stimulated with either tubulin or alpha-actinin-4. Conclusions Stimulation with both Kveim reagent and vimentin induces a specific pro-inflammatory cytokine secretion from sarcoidosis PBMCs. Further investigation of cellular immune responses to Kveim-specific proteins may identify novel biomarkers to assist the diagnosis of sarcoidosis.
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Agarwal S, Nguyen DT, Lew JD, Teeter LD, Yamal JM, Restrepo BI, Brown EL, Dorman SE, Graviss EA. Differential positive TSPOT assay responses to ESAT-6 and CFP-10 in health care workers. Tuberculosis (Edinb) 2016; 101S:S83-S91. [PMID: 27727133 DOI: 10.1016/j.tube.2016.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The TSPOT.TB (TSPOT) diagnostic test for latent tuberculosis infection is based on a cell-mediated response to the Mycobacteria tuberculosis antigens, ESAT-6 and/or CFP-10, producing an "interferon-gamma footprint". We investigated the within-sample and within-subject variability of positive TSPOT assays due to the individual assay antigens' reactivity. METHODS Positive TSPOT assay frequencies due to ESAT-6 or CFP-10 among health care workers (HCWs) at 6-month intervals for 18 months were compared. Differences in result interpretation (positive or negative) for ESAT-6 and CFP10 and potential prognostic factors were investigated. RESULTS There were 576 positive results in 8805 TSPOT assays representing 2418 participants. A significant difference was detected in positive TSPOT results due to a positive response to either ESAT-6, CFP-10 or both antigens at baseline through 12 M (p < 0.001), but not for the 18 M follow-up. Gender, ethnicity, occupation, previous positive tuberculin skin test (TST) and study site were significantly associated with specific antigen positivity. CONCLUSIONS Among our HCW samples with positive TSPOT assays, CFP-10 induced a larger proportion of positive TSPOT results than ESAT-6. Potential causes for this finding include: BCG vaccinated subpopulations, certain jobs, history of positive TST, U.S. birth, and study site. A high proportion of single-positive specimens may reflect false-positives results.
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Affiliation(s)
- Saroochi Agarwal
- Houston Methodist Hospital Institute, 6670 Bertner Ave, Houston, TX, 77030, USA; University of Texas School of Public Health, Center for Infectious Diseases, 1200 Pressler St, Houston, TX, 77030, USA.
| | - Duc T Nguyen
- Houston Methodist Hospital Institute, 6670 Bertner Ave, Houston, TX, 77030, USA.
| | - Justin D Lew
- Houston Methodist Hospital Institute, 6670 Bertner Ave, Houston, TX, 77030, USA.
| | - Larry D Teeter
- Houston Methodist Hospital Institute, 6670 Bertner Ave, Houston, TX, 77030, USA.
| | - Jose-Miguel Yamal
- University of Texas School of Public Health, Center for Infectious Diseases, 1200 Pressler St, Houston, TX, 77030, USA.
| | - Blanca I Restrepo
- University of Texas School of Public Health, Center for Infectious Diseases, 1200 Pressler St, Houston, TX, 77030, USA.
| | - Eric L Brown
- University of Texas School of Public Health, Center for Infectious Diseases, 1200 Pressler St, Houston, TX, 77030, USA.
| | - Susan E Dorman
- Johns Hopkins Medicine, 733 North Broadway, Baltimore, MD, 21205, USA.
| | - Edward A Graviss
- Houston Methodist Hospital Institute, 6670 Bertner Ave, Houston, TX, 77030, USA.
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Effect of IFN-γ, IL-12 and IL-10 cytokine production and mRNA expression in tuberculosis patients with diabetes mellitus and their household contacts. Cytokine 2016; 81:127-36. [DOI: 10.1016/j.cyto.2016.03.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 03/03/2016] [Accepted: 03/09/2016] [Indexed: 11/18/2022]
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Bedini A, Garlassi E, Stentarelli C, Petrella S, Meacci M, Meccugni B, Meschiari M, Franceschini E, Cerri S, Brasacchio A, Rumpianesi F, Richeldi L, Mussini C. Multidrug-resistant tuberculosis outbreak in an Italian prison: tolerance of pyrazinamide plus levofloxacin prophylaxis and serial interferon gamma release assays. New Microbes New Infect 2016; 12:45-51. [PMID: 27222718 PMCID: PMC4872473 DOI: 10.1016/j.nmni.2016.03.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 03/16/2016] [Accepted: 03/23/2016] [Indexed: 10/27/2022] Open
Abstract
The optimal treatment for latent tuberculosis infection (LTBI) in subjects exposed to multidrug-resistant (MDR) tuberculosis (TB) remains unclear, and the change in response of the QuantiFERON-TB Gold In-Tube (QTB-IT) test during and after treatment is unknown. Between May 2010 and August 2010, 39 prisoners at the 'Casa Circondariale' of Modena, Italy, were exposed to a patient with active pulmonary MDR TB. All contacts were tested with the tuberculin skin test and QTB-IT. Upon exclusion of active TB, subjects positive to both tests were offered 6 months' treatment with pyrazinamide (PZA) and levofloxacin (LVX). QTB-IT testing was repeated at 3 and 6 months after initial testing in all subjects who were offered LTBI treatment. Seventeen (43.5%) of 39 subjects tested positive to both tuberculin skin test and QTB-IT test, and 12 (70.5%) agreed to receive therapy with PZA and LVX at standard doses. Only five (41.6%) of 12 subjects completed 6 months' treatment. Reasons for discontinuation were asymptomatic hepatitis, gastritis and diarrhoea. The QTB-IT values decreased in all subjects who completed the treatment, in two (33%) of six of those who received treatment for less than 3 months and in one (50%) of two patients who discontinued therapy after 3 months. The QTB-IT test results never turned negative. Despite the small number of subjects, the study confirmed that PZA plus LVX is a poorly tolerated option for MDR LTBI treatment. We observed a large degree of variation in the results of the QTB-IT test results among participants. The study confirmed that the interferon gamma release assay is not a reliable tool for monitoring the treatment of MDR LTBI in clinical practice.
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Affiliation(s)
- A Bedini
- Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, Modena, Italy
| | - E Garlassi
- Department of Infectious Diseases, Ospedale Santa Maria Nuova, Reggio Emilia, Italy
| | - C Stentarelli
- Medical Department, Sant'Anna Penitentiary, Modena, Italy
| | - S Petrella
- Medical Department, Sant'Anna Penitentiary, Modena, Italy
| | - M Meacci
- Service of Microbiology, Azienda Ospedaliero-Universitaria, Policlinico of Modena, Modena, Italy
| | - B Meccugni
- Service of Microbiology, Azienda Ospedaliero-Universitaria, Policlinico of Modena, Modena, Italy
| | - M Meschiari
- Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, Modena, Italy
| | - E Franceschini
- Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, Modena, Italy
| | - S Cerri
- Clinic of Lung Diseases, University of Modena, Modena, Italy
| | - A Brasacchio
- Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, Modena, Italy
| | - F Rumpianesi
- Service of Microbiology, Azienda Ospedaliero-Universitaria, Policlinico of Modena, Modena, Italy
| | - L Richeldi
- University of Southampton, Southampton, UK
| | - C Mussini
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
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Arroyo L, Rojas M, Ortíz BL, Franken KLMC, García LF, Ottenhoff THM, Barrera LF. Dynamics of the T cell response to Mycobacterium tuberculosis DosR and Rpf antigens in a Colombian population of household contacts of recently diagnosed pulmonary tuberculosis patients. Tuberculosis (Edinb) 2016; 97:97-107. [PMID: 26980501 DOI: 10.1016/j.tube.2015.12.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 12/21/2015] [Accepted: 12/26/2015] [Indexed: 11/28/2022]
Abstract
Immune response to DosR and Rpf antigens from Mycobacterium tuberculosis (Mtb) seems to be important for latency maintenance. Little is known about the dynamics of the immune response to these antigens in an endemic community. Thus, the IFNγ response and cytokine production in response to PPD, Esat6-Cfp10 (E6-C10), DosR and Rpf antigens in healthy HHC of tuberculosis (TB) patients over a 12 (T12) months period (short-term, stLTBI) was investigated. This response was compared with a group of LTBI, who have remained healthy for 5-7 years (long-term, ltLTBI). According to the IFNγ response, two groups of HHCs were identified in stLTBI in response to E6-C10. At T12, E6-C10(+) HHCs displayed a decrease in the IFNγ levels and a generalized decrease in cytokines production. The E6-C10(-) HHC showed an increase in the IFNγ response and cytokine levels. In stLTBI, the responses to E6-C10, DosR, and Rpf may be interpreted as a protective immune response controlling Mtb infection and may be leading to a state of latent infection. Comparing the response of stLTBI and ltLTBI, we observed significant changes in the proportions of CD45RO(+)CD27(+) T cells to specific DosR and Rpf, which may indicate a persistent immune response to Mtb antigens in ltLTBI.
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Affiliation(s)
- Leonar Arroyo
- Grupo de Inmunología Celular e Inmunogenética (GICIG), Colombia.
| | - Mauricio Rojas
- Grupo de Inmunología Celular e Inmunogenética (GICIG), Colombia; Instituto de Investigaciones Médicas, Facultad de Medicina, Universidad de Antioquia, UdeA, Calle 70 No. 52-21, Medellín, Colombia.
| | - Blanca L Ortíz
- Grupo de Inmunología Celular e Inmunogenética (GICIG), Colombia; Instituto de Investigaciones Médicas, Facultad de Medicina, Universidad de Antioquia, UdeA, Calle 70 No. 52-21, Medellín, Colombia.
| | - Kees L M C Franken
- Department of Infectious Diseases, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, Netherlands.
| | - Luis F García
- Grupo de Inmunología Celular e Inmunogenética (GICIG), Colombia; Instituto de Investigaciones Médicas, Facultad de Medicina, Universidad de Antioquia, UdeA, Calle 70 No. 52-21, Medellín, Colombia.
| | - Tom H M Ottenhoff
- Department of Infectious Diseases, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, Netherlands.
| | - Luis F Barrera
- Grupo de Inmunología Celular e Inmunogenética (GICIG), Colombia; Instituto de Investigaciones Médicas, Facultad de Medicina, Universidad de Antioquia, UdeA, Calle 70 No. 52-21, Medellín, Colombia.
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Rangaka MX, Cavalcante SC, Marais BJ, Thim S, Martinson NA, Swaminathan S, Chaisson RE. Controlling the seedbeds of tuberculosis: diagnosis and treatment of tuberculosis infection. Lancet 2015; 386:2344-53. [PMID: 26515679 PMCID: PMC4684745 DOI: 10.1016/s0140-6736(15)00323-2] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The billions of people with latent tuberculosis infection serve as the seedbeds for future cases of active tuberculosis. Virtually all episodes of tuberculosis disease are preceded by a period of asymptomatic Mycobacterium tuberculosis infection; therefore, identifying infected individuals most likely to progress to disease and treating such subclinical infections to prevent future disease provides a crucial opportunity to interrupt tuberculosis transmission and reduce the global burden of tuberculosis disease. Programmes focusing on single strategies rather than comprehensive programmes that deliver an integrated arsenal for tuberculosis control might continue to struggle. Tuberculosis preventive therapy is a poorly used method that is essential for controlling the reservoirs of disease that drive the epidemic. Comprehensive control strategies that combine preventive therapy for the most high-risk populations and communities with improved case-finding and treatment, control of transmission, and health systems strengthening could ultimately lead to worldwide tuberculosis elimination. In this Series paper we outline challenges to implementation of preventive therapy and provide pragmatic suggestions for overcoming them. We further advocate for tuberculosis preventive therapy as the core of a renewed worldwide focus to implement a comprehensive epidemic control strategy that would reduce new tuberculosis cases to elimination targets. This strategy would be underpinned by accelerated research to further understand the biology of subclinical tuberculosis infections, develop novel diagnostics and drug regimens specifically for subclinical tuberculosis infection, strengthen health systems and community engagement, and enhance sustainable large scale implementation of preventive therapy programmes.
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Affiliation(s)
- Molebogeng X Rangaka
- Institute of Epidemiology and Health, University College London, London, UK; Department of Medicine, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Solange C Cavalcante
- Evandro Chagas National Institute of Infectious Diseases, Rio de Janeiro, Brazil
| | - Ben J Marais
- Children's Hospital at Westmead and the Centre for Research Excellence in Tuberculosis, University of Sydney, Australia
| | - Sok Thim
- Cambodian Health Committee, Phnom Penh, Cambodia
| | - Neil A Martinson
- Perinatal HIV Research Unit, University of Witwatersrand, Soweto, South Africa
| | | | - Richard E Chaisson
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Interferon gamma release assays for monitoring the response to treatment for tuberculosis: A systematic review. Tuberculosis (Edinb) 2015; 95:639-650. [DOI: 10.1016/j.tube.2015.07.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 07/04/2015] [Indexed: 11/20/2022]
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Escalante P, Peikert T, Van Keulen VP, Erskine CL, Bornhorst CL, Andrist BR, McCoy K, Pease LR, Abraham RS, Knutson KL, Kita H, Schrum AG, Limper AH. Combinatorial Immunoprofiling in Latent Tuberculosis Infection. Toward Better Risk Stratification. Am J Respir Crit Care Med 2015; 192:605-17. [PMID: 26030344 DOI: 10.1164/rccm.201412-2141oc] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Most immunocompetent patients diagnosed with latent tuberculosis infection (LTBI) will not progress to tuberculosis (TB) reactivation. However, current diagnostic tools cannot reliably distinguish nonprogressing from progressing patients a priori, and thus LTBI therapy must be prescribed with suboptimal patient specificity. We hypothesized that LTBI diagnostics could be improved by generating immunomarker profiles capable of categorizing distinct patient subsets by a combinatorial immunoassay approach. OBJECTIVES A combinatorial immunoassay analysis was applied to identify potential immunomarker combinations that distinguish among unexposed subjects, untreated patients with LTBI, and treated patients with LTBI and to differentiate risk of reactivation. METHODS IFN-γ release assay (IGRA) was combined with a flow cytometric assay that detects induction of CD25(+)CD134(+) coexpression on TB antigen-stimulated T cells from peripheral blood. The combinatorial immunoassay analysis was based on receiver operating characteristic curves, technical cut-offs, 95% bivariate normal density ellipse prediction, and statistical analysis. Risk of reactivation was estimated with a prediction formula. MEASUREMENTS AND MAIN RESULTS Sixty-five out of 150 subjects were included. The combinatorial immunoassay approach identified at least four different T-cell subsets. The representation of these immune phenotypes was more heterogeneous in untreated patients with LTBI than in treated patients with LTBI or unexposed groups. Patients with IGRA(+) CD4(+)CD25(+)CD134(+) T-cell phenotypes had the highest estimated reactivation risk (4.11 ± 2.11%). CONCLUSIONS These findings suggest that immune phenotypes defined by combinatorial assays may potentially have a role in identifying those at risk of developing TB; this potential role is supported by risk of reactivation modeling. Prospective studies will be needed to test this novel approach.
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Affiliation(s)
- Patricio Escalante
- 1 Division of Pulmonary and Critical Care Medicine, Department of Medicine.,2 Public Health Department, Olmsted County Tuberculosis Clinic, Rochester, Minnesota; and.,3 Mayo Clinic Center for Tuberculosis, Rochester, Minnesota
| | - Tobias Peikert
- 1 Division of Pulmonary and Critical Care Medicine, Department of Medicine.,4 Department of Immunology, and
| | | | | | - Cathy L Bornhorst
- 1 Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - Boleyn R Andrist
- 1 Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - Kevin McCoy
- 2 Public Health Department, Olmsted County Tuberculosis Clinic, Rochester, Minnesota; and.,3 Mayo Clinic Center for Tuberculosis, Rochester, Minnesota
| | | | - Roshini S Abraham
- 5 Department of Laboratory Medicine, Mayo Clinic, Rochester, Minnesota
| | | | | | | | - Andrew H Limper
- 1 Division of Pulmonary and Critical Care Medicine, Department of Medicine
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Biraro IA, Egesa M, Kimuda S, Smith SG, Toulza F, Levin J, Joloba M, Katamba A, Cose S, Dockrell HM, Elliott AM. Effect of isoniazid preventive therapy on immune responses to mycobacterium tuberculosis: an open label randomised, controlled, exploratory study. BMC Infect Dis 2015; 15:438. [PMID: 26493989 PMCID: PMC4619204 DOI: 10.1186/s12879-015-1201-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 10/12/2015] [Indexed: 11/17/2022] Open
Abstract
Background With the renewed emphasis to implement isoniazid preventive therapy (IPT) in Sub-Saharan Africa, we investigated the effect of IPT on immunological profiles among household contacts with latent tuberculosis. Methods Household contacts of confirmed tuberculosis patients were tested for latent tuberculosis using the QuantiFERON®-TB Gold In-Tube (QFN) assay and tuberculin skin test (TST). HIV negative contacts aged above 5 years, positive to both QFN and TST, were randomly assigned to IPT and monthly visits or monthly visits only. QFN culture supernatants from enrolment and six months’ follow-up were analysed for M.tb-specific Th1, Th2, Th17, and regulatory cytokines by Luminex assay, and for M.tb-specific IgG antibody concentrations by ELISA. Effects of IPT were assessed as the net cytokine and antibody production at the end of six months. Results Sixteen percent of contacts investigated (47/291) were randomised to IPT (n = 24) or no IPT (n = 23). After adjusting for baseline cytokine or antibody responses, and for presence of a BCG scar, IPT (compared to no IPT) resulted in a relative decline in M.tb-specific production of IFN gamma (adjusted mean difference at the end of six months (bootstrap 95 % confidence interval (CI), p-value) -1488.6 pg/ml ((−2682.5, −294.8), p = 0.01), and IL- 2 (−213.1 pg/ml (−419.2, −7.0), p = 0.04). A similar decline was found in anti-CFP-10 antibody levels (adjusted geometric mean ratio (bootstrap 95 % CI), p-value) 0.58 ((0.35, 0.98), p = 0.04). We found no effect on M.tb-specific Th2 or regulatory or Th17 cytokine responses, or on antibody concentrations to PPD and ESAT-6. Conclusions IPT led to a decrease in Th1 cytokine production, and also in the anti CFP-10 antibody concentration. This could be secondary to a reduction in mycobacterial burden or as a possible direct effect of isoniazid induced T cell apoptosis, and may have implications for protective immunity following IPT in tuberculosis-endemic countries. Trial registration ISRCTN registry, ISRCTN15705625. Registered on 30th September 2015.
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Affiliation(s)
- Irene Andia Biraro
- Department of Internal Medicine, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda.
| | - Moses Egesa
- Department of Internal Medicine, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda.
| | - Simon Kimuda
- Department of Internal Medicine, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda.
| | - Steven G Smith
- Department of Immunology and Infection, London School of Hygiene &Tropical Medicine, London, UK.
| | - Frederic Toulza
- Department of Immunology and Infection, London School of Hygiene &Tropical Medicine, London, UK.
| | - Jonathan Levin
- Medical Research Council/Uganda Virus Research Institute, Uganda Research Unit on AIDS, Entebbe, Uganda. .,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Moses Joloba
- Department of Internal Medicine, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda.
| | - Achilles Katamba
- Department of Internal Medicine, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda.
| | - Stephen Cose
- Medical Research Council/Uganda Virus Research Institute, Uganda Research Unit on AIDS, Entebbe, Uganda. .,Department of Clinical Research, London School of Hygiene &Tropical Medicine, London, UK.
| | - Hazel M Dockrell
- Department of Immunology and Infection, London School of Hygiene &Tropical Medicine, London, UK.
| | - Alison M Elliott
- Medical Research Council/Uganda Virus Research Institute, Uganda Research Unit on AIDS, Entebbe, Uganda. .,Department of Clinical Research, London School of Hygiene &Tropical Medicine, London, UK.
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Lee SH, Kim HJ, Park SJ, Kim TH, Park SJ, Kang SW, Kim YH, Menzies D. Serial interferon-gamma release assays for latent tuberculosis in dialysis patients with end stage renal disease in a Korean population. BMC Infect Dis 2015; 15:381. [PMID: 26392175 PMCID: PMC4578420 DOI: 10.1186/s12879-015-1117-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 09/09/2015] [Indexed: 11/16/2022] Open
Abstract
Background Serial interferon-gamma-release-assay (IGRA) result can show variance due to within-subject variation and difference in host immune status, and may be affected by latent tuberculosis infection (LTBI) treatment. We aimed to know the changes in QFT-IT (QuantiFERON-TB Gold In-Tube) results measured at a 4 month interval in end stage renal disease patients and whether these changes were influenced by dialysis method or LTBI treatment. Methods We prospectively performed serial QFT-IT tests at 4 month interval in 93 end stage renal disease (ESRD) patients on HD (hemodialysis) or PD (peritoneal dialysis). LTBI treatment was given to 18 of 39 patients with initial positive QFT-IT result. Agreement between the two results was estimated for all 93 patients and reversion rates were estimated among the 39 patients with initial positive QFT-IT. Results Positive QFT-IT at the first and 2nd tests were 41.9 and 34.4 %, respectively. The concordance rate between baseline QFT-IT and 2nd QFT in 93 ESRD patients was excellent (90.3 %, kappa = 0.80, p < 0.001). Agreement between the first QFT-IT and 2nd QFT-IT in HD (95.3 %, kappa = 0.91, p < 0.001) was higher than in PD patients (86.0 %, kappa = 0.69, p < 0.001). Among all ESRD patients, the odds of reversion of QFT-IT was not different in those who were, or were not treated for LTBI [odds ratio = 2.3 (0.5–11.4), p = 0.43]. Conclusions In a group of 93 dialyzed ESRD patients 8.6 % showed reversion of initial positive QFT to negative within 4 months. Reversion seemed not to be associated with LTBI treatment. Further study with larger numbers of patients is needed to investigate the variation of QFT-IT tests in dialyzed ESRD patients.
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Affiliation(s)
- Seung Heon Lee
- Division of Pulmonary, Sleep, and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, 425-707, Republic of Korea.
| | - Hee Jin Kim
- Korean Institute of Tuberculosis, Cheongwongun, 363-954, Republic of Korea.
| | - Seok Ju Park
- Division of Nephrology, Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, 614-735, Republic of Korea.
| | - Tae Hee Kim
- Division of Nephrology, Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, 614-735, Republic of Korea.
| | - So Jeong Park
- Division of Nephrology, Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, 614-735, Republic of Korea.
| | - Sun Woo Kang
- Division of Nephrology, Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, 614-735, Republic of Korea.
| | - Yeong Hoon Kim
- Division of Nephrology, Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, 614-735, Republic of Korea.
| | - Dick Menzies
- Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University, Montreal, QC, H2X 2P4, Canada.
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Araujo LSD, da Silva NDBM, da Silva RJ, Leung JAM, Mello FCQ, Saad MHF. Profile of interferon-gamma response to latency-associated and novel in vivo expressed antigens in a cohort of subjects recently exposed to Mycobacterium tuberculosis. Tuberculosis (Edinb) 2015; 95:751-757. [PMID: 26421415 DOI: 10.1016/j.tube.2015.08.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 07/29/2015] [Accepted: 08/04/2015] [Indexed: 02/08/2023]
Abstract
Recently some latency-associated antigens (LAA) of Mycobacterium tuberculosis were described, as Rv2029c, Rv2031c, Rv2034, Rv2628 and Rv3353c. Of which, the Rv2034 and Rv3353c also demonstrated in vivo expression. Therefore evaluating the immune response to these antigens may help to understand their role in latent TB infection. In a 1-year longitudinal study, IFN-γ response by in vitro peripheral blood mononuclear cells stimulation with LAA was investigated in subjects recently exposed to TB, classified by IFN-γ release assay (IGRA) using RD1 antigens (ESAT-6:CFP-10) and tuberculin skin test (TST) response. Except for Rv3353c, all the LAA triggered higher mean IFN-γ response in IGRA-RD1(+) groups (p < 0.05). Combining the IFN-γ-responders to Rv2029c, Rv2031c plus Rv2034 detected 90.3% (28/31) of IGRA-RD1(+) and 66.7% (24/36) of TST(+) contacts, while 95% (19/20) and 11% (2/17) were identified by classifying them according to a TST and IGRA-RD1 double-positive or double-negative response, respectively. In the follow-up, the TST convertors (negative to positive) also demonstrated an IFN-γ conversion to Rv2029c and Rv2031c, whereas the unique TB incident case was exclusively detected via IGRA-Rv2029c and TST before developing TB. A reversion rate to LAA (60%-100%) after prophylactic treatment was observed at TST(+)/IGRA-RD1(+) group. Further studies into the performance of these antigens are thus warranted.
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Affiliation(s)
- Leonardo Silva de Araujo
- Laboratory of Cellular Microbiology, Oswaldo Cruz Institute, Fiocruz, Avenida Brasil, 4365, Rio de Janeiro, RJ 20045-360, Brazil.
| | | | - Renan Jeremias da Silva
- Laboratory of Cellular Microbiology, Oswaldo Cruz Institute, Fiocruz, Avenida Brasil, 4365, Rio de Janeiro, RJ 20045-360, Brazil.
| | - Janaina Aparecida Medeiros Leung
- Federal University of Rio de Janeiro, Helio Fraga Filho Hospital, Av. Professor Rodolpho Paulo Rocco, 255, 1st Floor, Ilha do Fundão, Rio de Janeiro, RJ 21941-913, Brazil.
| | - Fernanda Carvalho Queiroz Mello
- Federal University of Rio de Janeiro, Helio Fraga Filho Hospital, Av. Professor Rodolpho Paulo Rocco, 255, 1st Floor, Ilha do Fundão, Rio de Janeiro, RJ 21941-913, Brazil.
| | - Maria Helena Féres Saad
- Laboratory of Cellular Microbiology, Oswaldo Cruz Institute, Fiocruz, Avenida Brasil, 4365, Rio de Janeiro, RJ 20045-360, Brazil.
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Ayele HT, van Mourik MSM, Bonten MJM. Effect of isoniazid preventive therapy on tuberculosis or death in persons with HIV: a retrospective cohort study. BMC Infect Dis 2015; 15:334. [PMID: 26269094 PMCID: PMC4535686 DOI: 10.1186/s12879-015-1089-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 08/04/2015] [Indexed: 11/13/2022] Open
Abstract
Background Isoniazid preventive therapy (IPT) is a recommended strategy for prevention of tuberculosis (TB) in persons with Human Immunodeficiency Virus (HIV) although the benefits have not been unequivocally demonstrated in routine clinical practice with widespread ART adoption. Therefore, we assessed the effectiveness of IPT in prevention of TB or death in patients treated with antiretroviral therapy (ART) in a chronic care setting. Methods Retrospective cohort study of HIV patients enrolled in chronic care from 2007 to 2013. Eligible participants were HIV infected subjects (age > 15 years) with no (history of) TB. The combined effect of IPT and ART on the composite outcome (TB or death) was estimated using time-dependent Cox regression with adjustment for baseline covariates. Results 1,922 patients were included, 374 (19.4 %) received IPT and 258 (13.4 %) developed TB or deceased. The median follow-up duration of the cohort was 839 days, with a total of 5491 person years. In unadjusted analysis, the combination of IPT and ART lowered the hazard of TB or death by 65 % [HR = 0.35; 95 % CI (0.16, 0.77)] compared to ART alone. Even after adjustment for confounders, the combined effect of ART and IPT resulted in a 60 % hazard reduction of TB or death in comparison to participants who received ART without IPT [HR = 0.40; 95 % CI (0.18, 0.87)]. The IPT-specific benefit in patients not receiving ART could not be reliably estimated due to high rates of ART adoption. Conclusion The combined effect of IPT and ART to prevent TB or death in HIV patients in a non-experimental setting in comparison to ART alone was estimated to be 60 %.
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Affiliation(s)
- Henok Tadesse Ayele
- Julius Center for Health Sciences and Primary Care, Infectious Diseases Epidemiology, University Medical Center Utrecht, Utrecht, The Netherlands. .,Department of Public Health, Dilla University College of Medicine & Health Sciences and Referral Hospital, Dilla, Gedeo Zone, Ethiopia.
| | - Maaike S M van Mourik
- Department of Medical Microbiology and Infection Control, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Marc J M Bonten
- Julius Center for Health Sciences and Primary Care, Infectious Diseases Epidemiology, University Medical Center Utrecht, Utrecht, The Netherlands. .,Department of Medical Microbiology and Infection Control, University Medical Center Utrecht, Utrecht, The Netherlands.
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Monárrez-Espino J, Enciso-Moreno JA, Laflamme L, Serrano CJ. Serial QuantiFERON-TB Gold In-Tube assay and tuberculin skin test to diagnose latent tuberculosis in household Mexican contacts: conversion and reversion rates and associated factors using conventional and borderline zone definitions. Mem Inst Oswaldo Cruz 2015; 109:863-70. [PMID: 25410989 PMCID: PMC4296490 DOI: 10.1590/0074-0276140085] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 08/19/2014] [Indexed: 01/19/2023] Open
Abstract
A cohort of 123 adult contacts was followed for 18‐24 months (86 completed the
follow-up) to compare conversion and reversion rates based on two serial measures of
QuantiFERON (QFT) and tuberculin skin test (TST) (PPD from TUBERSOL, Aventis Pasteur,
Canada) for diagnosing latent tuberculosis (TB) in household contacts of TB patients
using conventional (C) and borderline zone (BZ) definitions. Questionnaires were used
to obtain information regarding TB exposure, TB risk factors and socio-demographic
data. QFT (IU/mL) conversion was defined as <0.35 to ≥0.35 (C) or <0.35 to
>0.70 (BZ) and reversion was defined as ≥0.35 to <0.35 (C) or ≥0.35 to <0.20
(BZ); TST (mm) conversion was defined as <5 to ≥5 (C) or <5 to >10 (BZ) and
reversion was defined as ≥5 to <5 (C). The QFT conversion and reversion rates were
10.5% and 7% with C and 8.1% and 4.7% with the BZ definitions, respectively. The TST
rates were higher compared with QFT, especially with the C definitions (conversion
23.3%, reversion 9.3%). The QFT conversion and reversion rates were higher for TST
≥5; for TST, both rates were lower for QFT <0.35. No risk factors were associated
with the probability of converting or reverting. The inconsistency and apparent
randomness of serial testing is confusing and adds to the limitations of these tests
and definitions to follow-up close TB contacts.
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Affiliation(s)
| | | | - Lucie Laflamme
- Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
| | - Carmen J Serrano
- Medical Research Unit Zacatecas, Mexican Institute of Social Security, Zacatecas, Mexico
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Delogu G, Provvedi R, Sali M, Manganelli R. Mycobacterium tuberculosis virulence: insights and impact on vaccine development. Future Microbiol 2015; 10:1177-94. [PMID: 26119086 DOI: 10.2217/fmb.15.26] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The existing TB vaccine, the attenuated Mycobacterium bovis strain BCG, is effective in protecting infants from severe forms of the disease, while its efficacy in protecting adults from pulmonary TB is poor. In the last two decades, a renewed interest in TB resulted in the development of several candidate vaccines that are now entering clinical trials. However, most of these vaccines are based on a common rationale and aim to induce a strong T-cell response against Mycobacterium tuberculosis. Recent advancements in the understanding of M. tuberculosis virulence determinants and associated pathogenic strategies are opening a new and broader view of the complex interaction between this remarkable pathogen and the human host, providing insights at molecular level that could lead to a new rationale for the design of novel antitubercular vaccines. A vaccination strategy that simultaneously targets different steps in TB pathogenesis may result in improved protection and reduced TB transmission.
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Affiliation(s)
- Giovanni Delogu
- Institute of Microbiology, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Roberta Provvedi
- Department of Molecular Medicine, University of Padova, Via Aristide Gabelli 63, 35121, Padova, Italy
| | - Michela Sali
- Institute of Microbiology, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Riccardo Manganelli
- Department of Molecular Medicine, University of Padova, Via Aristide Gabelli 63, 35121, Padova, Italy
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Ellis R, Hatherill M, Tait D, Snowden M, Churchyard G, Hanekom W, Evans T, Ginsberg A. Innovative clinical trial designs to rationalize TB vaccine development. Tuberculosis (Edinb) 2015; 95:352-7. [DOI: 10.1016/j.tube.2015.02.036] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 02/04/2015] [Accepted: 02/06/2015] [Indexed: 12/22/2022]
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Tomlinson AJ, Chambers MA, McDonald RA, Delahay RJ. Association of quantitative interferon-γ responses with the progression of naturally acquired Mycobacterium bovis infection in wild European badgers (Meles meles). Immunology 2015; 144:263-70. [PMID: 25109384 DOI: 10.1111/imm.12369] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 08/01/2014] [Accepted: 08/07/2014] [Indexed: 01/07/2023] Open
Abstract
Bovine tuberculosis is one of the biggest challenges facing cattle farming in Great Britain. European badgers (Meles meles) are a reservoir host for the causal agent, Mycobacterium bovis. There have been significant recent advances in diagnostic testing for tuberculosis in humans, cattle and badgers, with the development of species-specific assays for interferon-γ (IFN-γ), an important cytokine in tuberculous infections. Using data collected from longitudinal studies of naturally infected wild badgers, we report that the magnitude of the IFN-γ response to M. bovis antigens at the disclosing test event was positively correlated with subsequent progression of disease to a seropositive or excreting state. In addition, we show that the magnitude of the IFN-γ response, despite fluctuation, declined with time after the disclosing event for all badgers, but remained significantly higher in those animals with evidence of disease progression. We discuss how our findings may be related to the immunopathogenesis of natural M. bovis infection in badgers.
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Affiliation(s)
- Alexandra J Tomlinson
- National Wildlife Management Centre, Animal Health and Veterinary Laboratories Agency, Nympsfield, Gloucestershire, UK
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Xia H, Wang X, Li F, Longuet C, Vernet G, Goletti D, Zhao Y, Lagrange PH. Diagnostic values of the QuantiFERON-TB Gold In-tube assay carried out in China for diagnosing pulmonary tuberculosis. PLoS One 2015; 10:e0121021. [PMID: 25867946 PMCID: PMC4395092 DOI: 10.1371/journal.pone.0121021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Accepted: 02/09/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Interferon-release assays (IGRAs) for diagnosing active pulmonary tuberculosis (PTB) are not yet fully validated, particularly in high TB-endemic areas as the People's Republic of China (PRC). The aim of this report was to assess the performance of the QuantiFERON-TB Gold In-tube (QFT-GIT) and tuberculin skin test (TST), in addition to microbiological results, as contributors for diagnosing active PTB in the PRC. METHODS/PRINCIPAL FINDINGS A total of 300 PTB patients, 41 disease controls (DC) and 59 healthy community controls (HCC) were included prospectively between May 2010 and April 2011 from two provinces of the PRC (Heilongjiang and Zhejiang). The QFT-GIT and TST yielded an overall sensitivity for active TB of 80.9% and 86.2%, and a specificity of 36.6% and 26.8%, respectively. The province of origin and smear microscopy status did not significantly impact the diagnostic values for PTB. However, using the TST with a 10 mm cut-off point, a significantly higher proportion of LTBI was observed in the DC than the HCC (p=0.01). Discordant results between the QFT-GIT and TST were found among 1/3 of the PTB, HCC and DC. Two-thirds of the individuals presented TST-positive/QFT-GIT-negative discordant results. The TST-negative/QFT-GIT-positive result was not associated with age or bacillary load. Cumulative QFT-GIT and TST positive results increased the overall sensitivity (95.9%), but it was associated with a dramatic decrease of the overall specificity (24.8%) leading to a suboptimal PPV (80.1%) and a low NPV (61.1%). CONCLUSIONS/SIGNIFICANCE The usefulness of the QFT-GIT to diagnose active TB in high TB-endemic countries remains doubtful because like the TST, the QFT-GIT cannot distinguish between LTBI and active TB. Used as single stand-alone tests, both the QFT-GIT and TST have very limited roles in the diagnosis of active PTB. However, the combined use of SM, the TST and QFT-GIT may allow for the exclusion of ATB.
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Affiliation(s)
- Hui Xia
- National Tuberculosis Reference Laboratory, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Xiaomen Wang
- Tuberculosis Control Center of Heilongjiang Province, Harbin, Heilongjiang, People’s Republic of China
| | - Fabin Li
- Zhejiang Provincial Center for Disease Control and Prevention, Binjiang District, Hangzhou, Zhejiang, People’s Republic of China
| | | | | | - Delia Goletti
- Department of Epidemiology and Preclinical Research, L. Spallanzani National Institute for Infectious Diseases (INMI), Rome, Italy
| | - Yanlin Zhao
- National Tuberculosis Reference Laboratory, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
- * E-mail: (PHL); (YZ)
| | - Philippe H. Lagrange
- Service de Microbiologie, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris, Paris VII Denis Diderot University, Paris, France
- * E-mail: (PHL); (YZ)
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Latent tuberculosis infection: myths, models, and molecular mechanisms. Microbiol Mol Biol Rev 2015; 78:343-71. [PMID: 25184558 DOI: 10.1128/mmbr.00010-14] [Citation(s) in RCA: 156] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The aim of this review is to present the current state of knowledge on human latent tuberculosis infection (LTBI) based on clinical studies and observations, as well as experimental in vitro and animal models. Several key terms are defined, including "latency," "persistence," "dormancy," and "antibiotic tolerance." Dogmas prevalent in the field are critically examined based on available clinical and experimental data, including the long-held beliefs that infection is either latent or active, that LTBI represents a small population of nonreplicating, "dormant" bacilli, and that caseous granulomas are the haven for LTBI. The role of host factors, such as CD4(+) and CD8(+) T cells, T regulatory cells, tumor necrosis factor alpha (TNF-α), and gamma interferon (IFN-γ), in controlling TB infection is discussed. We also highlight microbial regulatory and metabolic pathways implicated in bacillary growth restriction and antibiotic tolerance under various physiologically relevant conditions. Finally, we pose several clinically important questions, which remain unanswered and will serve to stimulate future research on LTBI.
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Gonzślez-Moreno J, García-Gasalla M, Gállego-Lezaun C, Fernández-Baca V, Mir Viladrich I, Cifuentes-Luna C, Serrano Bujalance A, Salom Vallespir A, Payeras Cifre A. Role of QuantiFERON(®)-TB Gold In-Tube in tuberculosis contact investigation: experience in a tuberculosis unit. Infect Dis (Lond) 2015; 47:244-51. [PMID: 25692351 DOI: 10.3109/00365548.2014.987813] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Interferon-γ release assays (IGRAs) are increasingly used for the diagnosis of latent tuberculosis infection (LTBI). Because of the lack of a gold standard for the diagnosis of LTBI, IGRAs are compared to the tuberculin skin test (TST) and yield conflicting results. We assessed the usefulness of an IGRA test, QuantiFERON(®)-TB Gold In-Tube (QFT-G-IT), for diagnosing LTBI compared with TST in the setting of a contact screening study. METHODS A prospective comparison between the QFT-G-IT and the TST in TB contact subjects in a low TB burden area was conducted sequentially between January 2006 and December 2012. RESULTS A moderate concordance between the two tests (κ = 0.44 for TST cut-off of 5 mm and κ = 0.56 for TST cut-off of 15 mm) was found. A better agreement was shown in younger contacts and in non-vaccinated contacts when using a TST of 15 mm. Independent risk factors for a TST(+)/QFT-G-IT(-) discordance were history of BCG vaccination and age between 31 and 59 years. Discordance was also more frequent using a TST cut-off value of 5 mm. QFT-G-IT(+)/TST(-) was infrequent and was found in older contacts. CONCLUSIONS Based on our data, we cannot recommend the use of QFT-G-IT as the only test to rule out LTBI, especially in older patients.
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Affiliation(s)
- Juan Gonzślez-Moreno
- Department of Internal Medicine - Infectious Diseases, Hospital Son Llàtzer , Palma de Mallorca , Spain
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Pullar ND, Steinum H, Bruun JN, Dyrhol-Riise AM. HIV patients with latent tuberculosis living in a low-endemic country do not develop active disease during a 2 year follow-up; a Norwegian prospective multicenter study. BMC Infect Dis 2014; 14:667. [PMID: 25515915 PMCID: PMC4273430 DOI: 10.1186/s12879-014-0667-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 11/26/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Interferon-γ release assays (IGRA) serve as immunodiagnostics of tuberculosis (TB) infection to identify individuals with latent TB infection (LTBI) eligible for preventive anti-TB therapy. In this longitudinal study of HIV-infected LTBI patients we have observed for possible progression to active TB as well as evaluated repeated IGRA testing in a TB low-endemic setting. METHODS QuantiFERON TB-Gold In-tube® assay (QFT), TB-SPOT.TB® (TSPOT) and tuberculin skin test (TST) were performed on 298 HIV-patients recruited from seven out-patient clinics in Norway. Patients with active TB, LTBI and negative IGRA were followed with repeat QFTs and clinical evaluation over a period of 24 months. RESULTS Seven HIV-patients (median CD4 count 270; IQR 50-340) were diagnosed with active TB at inclusion, all IGRA positive. Sixty-four (21%) HIV-patients (median CD4 count 471; IQR 342-638) were diagnosed with LTBI and of these 39 (61%) received TB preventive treatment. Neither treated nor untreated HIV-infected LTBI patients developed active TB during the 24 months. At baseline, the median interferon-γ (INF-γ) level measured by QFT was 3.48 IU/ml (IQR 0.94-8.91 IU/ml) for treated LTBI compared to 1.13 IU/ml (IQR 0.47-4.25 IU/ml) for untreated LTBI patients (p = 0.029). The QFT reversion rates were 75% for active TB, 23% for treated LTBI and 44% for untreated LTBI, whereas the conversion rate for the non-TB group was 7% despite no new TB exposure. There was no significant difference in the trend of INF-γ levels over time between treated and untreated LTBI patients. CONCLUSION The prevalence of LTBI is high among HIV-patients, but the risk of developing active TB seems to be low in patients with high CD4 counts in this TB low-endemic setting. In several patients, especially with baseline IFN-γ levels close to cut-offs, the QFT tests reverted to negative independent of preventive anti-TB treatment indicating possibly false positive tests. This highlights the importance of defining reliable cut-offs for immunodiagnostic tests and deferring preventive therapy in selected patients. Randomized studies with longer follow-up time are needed to identify HIV-patients that would benefit from LTBI treatment in a TB low-endemic setting.
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Affiliation(s)
- Nadine Durema Pullar
- Department of Internal Medicine, Section for Infectious Diseases, University Hospital of Northern Norway, N-9038, Tromsø, Norway. .,Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, N-9037, Tromsø, Norway.
| | - Harald Steinum
- Department of Infectious Diseases, Trondheim University Hospital, N-7004, Trondheim, Norway.
| | - Johan Nikolai Bruun
- Department of Internal Medicine, Section for Infectious Diseases, University Hospital of Northern Norway, N-9038, Tromsø, Norway. .,Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, N-9037, Tromsø, Norway.
| | - Anne Ma Dyrhol-Riise
- Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, N-5021, Bergen, Norway. .,Present address: Department of Infectious Diseases, Oslo University Hospital (Ullevål), pb 4956 Nydalen, 0424, Oslo, Norway. .,Institute of Clinical Medicine, University of Oslo, 0316, Oslo, Norway.
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Innate Resistance to Tuberculosis in Man, Cattle and Laboratory Animal Models: Nipping Disease in the Bud? J Comp Pathol 2014; 151:291-308. [DOI: 10.1016/j.jcpa.2014.08.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 07/29/2014] [Accepted: 08/02/2014] [Indexed: 01/04/2023]
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Torres M, García-García L, Cruz-Hervert P, Guio H, Carranza C, Ferreyra-Reyes L, Canizales S, Molina S, Ferreira-Guerrero E, Téllez N, Montero-Campos R, Delgado-Sánchez G, Mongua-Rodriguez N, Sifuentes-Osornio J, Ponce-de Leon A, Sada E, Young DB, Wilkinson RJ. Effect of isoniazid on antigen-specific interferon-γ secretion in latent tuberculosis. Eur Respir J 2014; 45:473-82. [PMID: 25359354 PMCID: PMC4318657 DOI: 10.1183/09031936.00123314] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Treatment of persons with latent tuberculosis (TB) infection at greatest risk of reactivation is an important component of TB control and elimination strategies. Biomarkers evaluating the effectiveness of treatment of latent TB infection have not yet been identified. This information would enhance control efforts and assist the evaluation of new treatment regimes. We designed a two-group, two-arm, randomised clinical study of tuberculin skin test-positive participants: 26 with documented contact with TB patients and 34 with non-documented contact. Participants in each group were randomly assigned to the immediate- or deferred-isoniazid treatment arms. Assays of in vitro interferon (IFN)-γ secretion in response to recombinant Rv1737 and overlapping synthetic peptide pools from various groups of immunodominant proteins were performed. During isoniazid therapy, a significant increase from baseline in the proportion of IFN-γ responders to the 10-kDa culture filtrate protein, Rv2031, Rv0849, Rv1986, Rv2659c, Rv2693c and the recombinant Rv1737 protein was observed (p⩽0.05). The peptide pool of Rv0849 and Rv1737 recombinant proteins induced the highest percentage of IFN-γ responders after isoniazid therapy. The in vitro IFN-γ responses to these proteins might represent useful markers to evaluate changes associated with treatment of latent TB infection. Peptide pool of Rv0849 and recombinant protein Rv1737 may be useful to test the efficacy of treatment of latentTBhttp://ow.ly/Catld
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Affiliation(s)
- Martha Torres
- Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | | | | | | | - Claudia Carranza
- Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | | | | | - Susana Molina
- Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | | | - Norma Téllez
- Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | | | | | | | - Jose Sifuentes-Osornio
- Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Alfredo Ponce-de Leon
- Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Eduardo Sada
- Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Douglas B Young
- Dept of Medicine, Imperial College, London, UK MRC National Institute for Medical Research, London, UK
| | - Robert J Wilkinson
- Dept of Medicine, Imperial College, London, UK MRC National Institute for Medical Research, London, UK Clinical Infectious Diseases Research Initiative, Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Essone PN, Kalsdorf B, Chegou NN, Loxton AG, Kriel M, Preyer R, Ernst M, Walzl G, Lange C. Bifunctional T-cell-derived cytokines for the diagnosis of tuberculosis and treatment monitoring. Respiration 2014; 88:251-61. [PMID: 25171202 DOI: 10.1159/000365816] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 07/09/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Diagnosis and treatment monitoring of patients with tuberculosis remain challenging. OBJECTIVE We have evaluated whether Mycobacterium-specific interferon (IFN)-γ and interleukin (IL)-2 bifunctional cytokine immune response assays improve the diagnosis of and correlate to treatment response in pulmonary tuberculosis. METHODS Early secretory antigenic target (ESAT)6/culture filtrate protein 10 (CFP10), microsomal triglyceride transfer protein 65 (MTP65) and the purified protein derivative (PPD) tuberculin-specific immune profiles were investigated in peripheral blood mononuclear cells from 19 patients with culture-confirmed tuberculosis and 23 healthy community controls (HCCs; 82.6% with latent M. tuberculosis infection) using a novel fluorescence-based dual-colour enzyme-linked immunospot (EliSpot) technology (FluoroSpot). RESULTS The frequency of ESAT6/CFP10-induced IFN-γ+IL-2- producing cells was elevated (p < 0.001), whereas the percentages of specific IFN-γ-IL-2+ (p = 0.002) and IFN-γ+IL-2+ double producing cells (p = 0.037) were diminished in tuberculosis patients in comparison to HCCs. A 3-host marker model using a combination of those IFN-γ and IL-2 single-cell responses showed 93.8% sensitivity and 77.8% specificity for tuberculosis. During tuberculosis treatment, the PPD-induced immune responses shifted from an IFN-γ+IL-2- dominated profile towards a balance of IFN-γ-IL-2+ and IFN-γ+IL-2+ double producing cells (all p ≤ 0.05). CONCLUSIONS The addition of antigen-specific IL-2 production to IFN-γ responses by EliSpot in IFN-γ release assays increases diagnostic sensitivity for active tuberculosis.
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Affiliation(s)
- Paulin N Essone
- DST/NRF Centre of Excellence for Biomedical Tuberculosis Research and MRC Centre for Molecular and Cellular Biology, Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
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Jenum S, Grewal HMS, Hokey DA, Kenneth J, Vaz M, Doherty TM, Jahnsen FL. The frequencies of IFNγ+IL2+TNFα+ PPD-specific CD4+CD45RO+ T-cells correlate with the magnitude of the QuantiFERON® gold in-tube response in a prospective study of healthy indian adolescents. PLoS One 2014; 9:e101224. [PMID: 24992314 PMCID: PMC4081517 DOI: 10.1371/journal.pone.0101224] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Accepted: 06/04/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND QuantiFERON-TB Gold In-Tube (QFT) is an IFNγ-release assay used in the diagnosis of Mycobacterium tuberculosis (MTB) infection. The risk of TB progression increases with the magnitude of the MTB-specific IFNγ-response. QFT reversion, also associated with low Tuberculin Skin Test responses, may therefore represent a transient immune response with control of M. tuberculosis infection. However, studies at the single cell level have suggested that the quality (polyfunctionality) of the T-cell response is more important than the quantity of cytokines produced. OBJECTIVE To explore the quality and/or magnitude of mycobacteria-specific T-cell responses associated with QFT reversion and persistent QFT-positivity. METHODS Multi-color flowcytometry on prospectively collected peripheral blood mononuclear cells was applied to assess mycobacteria-specific T-cell responses in 42 QFT positive Indian adolescents of whom 21 became QFT negative (reverters) within one year. Ten QFT consistent negatives were also included as controls. RESULTS There was no difference in the qualitative PPD-specific CD4+ T-cell response between QFT consistent positives and reverters. However, compared with QFT consistent positives, reverters displayed lower absolute frequencies of polyfunctional (IFNγ+IL2+TNFα+) CD4+ T-cells at baseline, which were further reduced to the point where they were not different to QFT negative controls one year later. Moreover, absolute frequencies of these cells correlated well with the magnitude of the QFT-response. CONCLUSION Whereas specific polyfunctional CD4+ T-cells have been suggested to protect against TB progression, our data do not support that higher relative or absolute frequencies of PPD-specific polyfunctional CD4+ T-cells in peripheral blood can explain the reduced risk of TB progression observed in QFT reverters. On the contrary, absolute frequencies of these cells correlated with the QFT-response, suggesting that this readout reflects antigenic load.
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Affiliation(s)
- Synne Jenum
- Centre for Immune Regulation and Department of Pathology, Oslo University Hospital - Rikshospitalet and the University of Oslo, Oslo, Norway
- * E-mail:
| | - Harleen M. S. Grewal
- Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Norway, and Department of Microbiology, Haukeland University Hospital, Bergen, Norway
| | | | - John Kenneth
- Division of Infectious Diseases, St. John’s Research Institute, Bangalore, India
| | - Mario Vaz
- Physiology and Health and Humanities, St. John’s Medical College and St. John’s Research Institute, Bangalore, India
| | | | - Frode Lars Jahnsen
- Centre for Immune Regulation and Department of Pathology, Oslo University Hospital - Rikshospitalet and the University of Oslo, Oslo, Norway
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Baumann R, Kaempfer S, Chegou NN, Oehlmann W, Loxton AG, Kaufmann SHE, van Helden PD, Black GF, Singh M, Walzl G. Serologic diagnosis of tuberculosis by combining Ig classes against selected mycobacterial targets. J Infect 2014; 69:581-9. [PMID: 24968240 DOI: 10.1016/j.jinf.2014.05.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 05/14/2014] [Accepted: 05/16/2014] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Accurate, simple and cost-effective diagnostic tests are needed for diagnosis of active tuberculosis (TB). Serodiagnosis is attractive as it can be harnessed for point-of-care tests. METHODS We evaluated, in a blinded fashion, the sensitivity and specificity of serologic immunoglobulin (Ig)G, IgA and/or IgM responses to Apa, heat shock protein (HSP) 16.3, HSP20, PE35, probable thiol peroxidase Tpx and lipoarabinomannan (LAM) in 42 HIV-negative South African pulmonary TB patients and 67 control individuals. The status of latent Mycobacterium tuberculosis infection (LTBI) among controls was defined through the TST and IFN-γ release assays (IGRAs). We evaluated 47 definite LTBI (IGRA(+)/LTBI), 8 putative LTBI (IGRA(-)/TST(+)) and 12 TB-uninfected (non-LTBI) subjects. RESULTS In contrast to anti-PE35 IgA, anti-PE35 IgG and particularly anti-Apa IgA, performances of anti-LAM IgG and selected anti-protein antibodies were less affected by inclusion of LTBI participants into the analysis. Anti-LAM IgG showed with a sensitivity/specificity of 71.4%/86.6% (p < 0.001) the best discrimination between TB and non-TB subjects. Selected five-antibody-combinations (including anti-LAM IgG, anti-LAM IgA and anti-Tpx IgG) further improved this performance to an accuracy exceeding 86%. CONCLUSIONS Antibody responses to some Mycobacterium tuberculosis antigens often also reflect latent infection explaining the poor performance of antibody-based tests for active TB in TB-endemic settings. Our results suggest that rather a combination of serological responses against selected protein and non-protein antigens and different Ig classes should be investigated for TB serodiagnostics.
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Affiliation(s)
- Ralf Baumann
- DST/NRF Centre of Excellence for Biomedical TB Research and MRC Centre for TB Research, Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 19063, Tygerberg 7505, South Africa; Lionex Diagnostics and Therapeutics, 38126 Braunschweig, Germany
| | - Susanne Kaempfer
- Lionex Diagnostics and Therapeutics, 38126 Braunschweig, Germany
| | - Novel N Chegou
- DST/NRF Centre of Excellence for Biomedical TB Research and MRC Centre for TB Research, Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 19063, Tygerberg 7505, South Africa
| | - Wulf Oehlmann
- Lionex Diagnostics and Therapeutics, 38126 Braunschweig, Germany
| | - André G Loxton
- DST/NRF Centre of Excellence for Biomedical TB Research and MRC Centre for TB Research, Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 19063, Tygerberg 7505, South Africa
| | - Stefan H E Kaufmann
- Department of Immunology, Max Planck Institute for Infection Biology, Charitéplatz 1, 10117 Berlin, Germany
| | - Paul D van Helden
- DST/NRF Centre of Excellence for Biomedical TB Research and MRC Centre for TB Research, Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 19063, Tygerberg 7505, South Africa
| | - Gillian F Black
- DST/NRF Centre of Excellence for Biomedical TB Research and MRC Centre for TB Research, Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 19063, Tygerberg 7505, South Africa
| | - Mahavir Singh
- Lionex Diagnostics and Therapeutics, 38126 Braunschweig, Germany.
| | - Gerhard Walzl
- DST/NRF Centre of Excellence for Biomedical TB Research and MRC Centre for TB Research, Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 19063, Tygerberg 7505, South Africa
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50
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Gamma interferon release assays for detection of Mycobacterium tuberculosis infection. Clin Microbiol Rev 2014; 27:3-20. [PMID: 24396134 DOI: 10.1128/cmr.00034-13] [Citation(s) in RCA: 553] [Impact Index Per Article: 55.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Identification and treatment of latent tuberculosis infection (LTBI) can substantially reduce the risk of developing active disease. However, there is no diagnostic gold standard for LTBI. Two tests are available for identification of LTBI: the tuberculin skin test (TST) and the gamma interferon (IFN-γ) release assay (IGRA). Evidence suggests that both TST and IGRA are acceptable but imperfect tests. They represent indirect markers of Mycobacterium tuberculosis exposure and indicate a cellular immune response to M. tuberculosis. Neither test can accurately differentiate between LTBI and active TB, distinguish reactivation from reinfection, or resolve the various stages within the spectrum of M. tuberculosis infection. Both TST and IGRA have reduced sensitivity in immunocompromised patients and have low predictive value for progression to active TB. To maximize the positive predictive value of existing tests, LTBI screening should be reserved for those who are at sufficiently high risk of progressing to disease. Such high-risk individuals may be identifiable by using multivariable risk prediction models that incorporate test results with risk factors and using serial testing to resolve underlying phenotypes. In the longer term, basic research is necessary to identify highly predictive biomarkers.
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