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Kim JW, Nazareth J, Lee J, Patel H, Woltmann G, Verma R, O'Garra A, Haldar P. Interferon-gamma release assay conversion after Mycobacterium tuberculosis exposure specifically associates with greater risk of progression to tuberculosis: A prospective cohort study in Leicester, UK. Int J Infect Dis 2024; 141:106982. [PMID: 38408518 DOI: 10.1016/j.ijid.2024.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/12/2024] [Accepted: 02/21/2024] [Indexed: 02/28/2024] Open
Abstract
OBJECTIVES We investigated whether quantifying the serial QuantiFERON-TB Gold (QFT) response improves tuberculosis (TB) risk stratification in pulmonary TB (PTB) contacts. METHODS A total of 297 untreated adult household PTB contacts, QFT tested at baseline and 3 months after index notification, were prospectively observed (median 1460 days). Normal variance of serial QFT responses was established in 46 extrapulmonary TB contacts. This informed categorisation of the response in QFT-positive PTB contacts as converters, persistently QFT-positive with significant increase (PPincrease), and without significant increase (PPno-increase). RESULTS In total, eight co-prevalent TB (disease ≤3 months after index notification) and 12 incident TB (>3 months after index notification) cases were diagnosed. Genetic linkage to the index strain was confirmed in all culture-positive progressors. The cumulative 2-year incident TB risk in QFT-positive contacts was 8.4% (95% confidence interval, 3.0-13.6%); stratifying by serial QFT response, significantly higher risk was observed in QFT converters (28%), compared with PPno-increase (4.8%) and PPincrease (3.7%). Converters were characterised by exposure to index cases with a shorter interval from symptom onset to diagnosis (median reduction 50.0 days, P = 0.013). CONCLUSIONS QFT conversion, rather than quantitative changes of a persistently positive serial QFT response, is associated with greater TB risk and exposure to rapidly progressive TB.
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Affiliation(s)
- Jee Whang Kim
- NIHR Leicester Biomedical Research Centre, Department of Respiratory Sciences, University of Leicester, Leicester, UK; Department of Respiratory Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK.
| | - Joshua Nazareth
- NIHR Leicester Biomedical Research Centre, Department of Respiratory Sciences, University of Leicester, Leicester, UK; Department of Respiratory Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Joanne Lee
- NIHR Leicester Biomedical Research Centre, Department of Respiratory Sciences, University of Leicester, Leicester, UK; Department of Respiratory Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Hemu Patel
- Department of Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Gerrit Woltmann
- NIHR Leicester Biomedical Research Centre, Department of Respiratory Sciences, University of Leicester, Leicester, UK; Department of Respiratory Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Raman Verma
- NIHR Leicester Biomedical Research Centre, Department of Respiratory Sciences, University of Leicester, Leicester, UK; Department of Respiratory Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Anne O'Garra
- Laboratory of Immunoregulation and Infection, Francis Crick Institute, London, UK; National Heart and Lung Institute, Imperial College, London, UK
| | - Pranabashis Haldar
- NIHR Leicester Biomedical Research Centre, Department of Respiratory Sciences, University of Leicester, Leicester, UK; Department of Respiratory Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
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Salindri AD, Auld SC, Gujral UP, Urbina EM, Andrews JR, Huaman MA, Magee MJ. Tuberculosis infection and hypertension: prevalence estimates from the US National Health and Nutrition Examination Survey. BMJ Open 2024; 14:e075176. [PMID: 38479740 PMCID: PMC10936476 DOI: 10.1136/bmjopen-2023-075176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 12/20/2023] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVES Tuberculosis infection (TBI) is marked by dynamic host-pathogen interactions with persistent low-grade inflammation and is associated with increased risk of cardiovascular diseases (CVD) including acute coronary syndrome, myocardial infarction and stroke. However, few studies assess the relationship between TBI and hypertension, an intermediate of CVD. We sought to determine the association between TBI and hypertension using data representative of the adult US population. METHODS We performed cross-sectional analyses using data from the 2011-2012 US National Health and Nutrition Examination Survey (NHANES). Eligible participants included adults with valid QuantiFERON-TB Gold In-Tube (QFT-GIT) test results who also had blood pressure measures and no history of TB disease. TBI was defined by a positive QFT-GIT. We defined hypertension by either elevated measured blood pressure levels (ie, systolic ≥130 mm Hg or diastolic ≥80 mm Hg) or known hypertension indications (ie, self-reported previous diagnosis or use of antihypertensive medications). Analyses were performed using robust quasi-Poisson regressions and accounted for the stratified probability sampling design of NHANES. RESULTS The overall prevalence of TBI was 5.7% (95% CI 4.7% to 6.7%) and hypertension was present among 48.9% (95% CI 45.2% to 52.7%) of participants. The prevalence of hypertension was higher among those with TBI (58.5%, 95% CI 52.4% to 64.5%) than those without TBI (48.3%, 95% CI 44.5% to 52.1%) (prevalence ratio (PR) 1.2, 95% CI 1.1 to 1.3). However, after adjusting for confounders, the prevalence of hypertension was similar for those with and without TBI (adjusted PR 1.0, 95% CI 1.0 to 1.1). The unadjusted prevalence of hypertension was higher among those with TBI versus no TBI, especially among individuals without CVD risk factors including those with normal body mass index (PR 1.6, 95% CI 1.2 to 2.0), euglycaemia (PR 1.3, 95% CI 1.1 to 1.5) or non-smokers (PR 1.2, 95% CI 1.1 to 1.4). CONCLUSIONS More than half of adults with TBI in the USA had hypertension. Importantly, we observed a relationship between TBI and hypertension among those without established CVD risk factors. SUMMARY The prevalence of hypertension was high (59%) among adults with TBI in the USA. In addition, we found that the prevalence of hypertension was significantly higher among adults with positive QFT without established hypertension risk factors.
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Affiliation(s)
- Argita D Salindri
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Sara C Auld
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Unjali P Gujral
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Elaine M Urbina
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Moises A Huaman
- Division of Infectious Diseases, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Matthew J Magee
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
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Gasser N, Fritschi N, Egger JM, Ritz N, Schoch OD, Zellweger JP. Tuberculosis Case Detection and Guideline Adherence among Child Contacts in Switzerland: A Retrospective Observational Study. Respiration 2023; 102:934-943. [PMID: 37899038 PMCID: PMC10664337 DOI: 10.1159/000534362] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 09/18/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND Children exposed to a tuberculosis (TB) index case are at risk of TB infection and disease. OBJECTIVES The aim of this study was to describe the proportion of child contacts who developed TB infection or disease after exposure and to assess the diagnostic pathways and adherence to current guidelines. METHODS Retrospective observational study including children ≤16 years of age who had contact to a TB index case between January 2019 and July 2021. Analysis was stratified by age groups 0-4, 5-11, and 12-16 years. RESULTS Of 401 TB-exposed children, data were available for 380 (95%). Of those, 7 (2%) were diagnosed with TB disease and 35 (9%) with TB infection. We identified several deviations in the management compared to recommendations in national Swiss guidelines: In the children aged 0-4 years, only 82% were examined with an immunodiagnostic test or a chest radiography within 2 weeks after last contact. Recommended prophylactic treatment was prescribed in 66% of the children only. In the children aged 5-11 years, 64% were tested with an immunodiagnostic test in a first examination and 75% in a second examination, 2 weeks and 2 months after last contact, respectively. CONCLUSIONS Contact investigations of children exposed to a TB index case identified a significant proportion of children with TB infection and disease in a low TB incidence setting. We observed significant deviations from the guidelines in the contact investigations suggesting the need for improved implementation.
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Affiliation(s)
- Nathalie Gasser
- TB Competence Center, Swiss Lung Association, Bern, Switzerland
| | - Nora Fritschi
- Mycobacterial and Migrant Health Research Group, University of Basel Children’s Hospital Basel and Department of Clinical Research, University of Basel, Basel, Switzerland
- University of Basel Children’s Hospital Basel, Basel, Switzerland
| | | | - Nicole Ritz
- Mycobacterial and Migrant Health Research Group, University of Basel Children’s Hospital Basel and Department of Clinical Research, University of Basel, Basel, Switzerland
- University of Basel Children’s Hospital Basel, Basel, Switzerland
- Department of Pediatrics and Pediatric Infectious Diseases, Children’s Hospital Lucerne and Faculty of Health Science and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Otto D. Schoch
- TB Competence Center, Swiss Lung Association, Bern, Switzerland
- Department of Pneumology and Sleep Medicine, St. Gallen Hospital, St. Gallen, Switzerland
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Salindri AD, Auld SC, Gujral UP, Urbina EM, Andrews JR, Huaman MA, Magee MJ. Tuberculosis infection and hypertension: Prevalence estimates from the US National Health and Nutrition Examination Survey. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.05.12.23289899. [PMID: 37325781 PMCID: PMC10262262 DOI: 10.1101/2023.05.12.23289899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Objectives Latent Tuberculosis infection (LTBI) is marked by dynamic host-pathogen interactions with persistent low-grade inflammation and is associated with increased risk of cardiovascular diseases (CVD) including acute coronary syndrome, myocardial infarction, and stroke. However, few studies assess the relationship between LTBI and hypertension, an intermediate of CVD. We sought to determine the association between LTBI and hypertension using data representative of the adult US population. Methods We performed cross-sectional analyses using data from the 2011-2012 US National Health and Nutrition Examination Survey (NHANES). Eligible participants included adults with valid QuantiFERON-TB Gold In-Tube (QFT-GIT) test results who also had blood pressure measures and no history of TB disease. LTBI was defined by a positive QFT-GIT. We defined hypertension by either elevated measured blood pressure levels (i.e., systolic ≥130mmHg or diastolic ≥80mmHg) or known hypertension indications (i.e., self-reported previous diagnosis or use of antihypertensive medications). Analyses were performed using robust quasi-Poisson regressions and accounted for the stratified probability sampling design of NHANES. Results The overall prevalence of LTBI was 5.7% (95%CI 4.7-6.7) and hypertension was present among 48.9% (95%CI 45.2-52.7) of participants. The prevalence of hypertension was higher among those with LTBI (58.5%, 95%CI 52.4-64.5) than those without LTBI (48.3%, 95%CI 44.5-52.1) (prevalence ratio [PR]=1.2, 95%CI 1.1-1.3). However, after adjusting for confounders, the prevalence of hypertension was similar for those with and without LTBI (adjusted PR=1.0, 95%CI 0.9 -1.1). Among individuals without CVD risk factors of elevated BMI (PRnormal BMI=1.6, 95%CI 1.2-2.0), hyperglycemia (PReuglycemia=1.3, 95%CI 1.1-1.5), or cigarette smoking (PRnon-smokers=1.2, 95%CI 1.1-1.4), the unadjusted prevalence of hypertension was higher among those with LTBI vs. no LTBI. Conclusions More than half of adults with LTBI in the US had hypertension. Importantly, we observed a relationship between LTBI and hypertension among those without established CVD risk factors.
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Affiliation(s)
- Argita D Salindri
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Sara C Auld
- Division of Pulmonary and Critical Care Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Unjali P Gujral
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Elaine M Urbina
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Moises A Huaman
- Department of Internal Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Matthew J Magee
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, USA
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-Hidayah N, -Djaharuddin I, -Ahmad A, -Pambudi S, -Halik H, -Subair S, -Tenriola A, -Mumang AA, -Lihawa N, -Massi MN. Plasma Macrophage Migration Inhibitory Factor Concentration at Each Spectrum of Tuberculosis. J Interferon Cytokine Res 2023; 43:98-103. [PMID: 36516121 DOI: 10.1089/jir.2022.0197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Macrophage migration inhibitory factor (MIF) is an inflammatory mediator in several diseases, including tuberculosis (TB). However, the role of MIF in each stage of TB remains to be further elucidated. Thus, this study aimed to analyze the differences in plasma MIF protein levels in patients with active pulmonary TB, positive and negative interferon-gamma release assay (IGRA) household contacts (HHCs), and healthy controls (HCs). Plasma MIF concentration was significantly higher in patients with active-new pulmonary tuberculosis (ATB) and HHCs compared with HCs (mean ± standard deviation: 17.32 ± 16.85, 16.29 ± 14.21, and 7.29 ± 5.39 ng/mL, respectively; P = 0.002). The plasma MIF concentration was not statistically different when compared between patients with ATB, IGRA-positive HHCs (17.44 ± 16.6 ng/mL), and IGRA-negative HHCs (14.34 ± 8.7 ng/mL) (P = 0.897). In conclusion, ATB patients, IGRA-positive HHCs, and IGRA-negative HHCs have a higher MIF concentration than HCs. This shows the involvement of MIF in each stage of TB, starting from TB exposure and infection, but not symptomatic, to the active stage.
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Affiliation(s)
- Najdah -Hidayah
- Research Center for Vaccine and Drugs, National Research and Innovation Agency (BRIN), Tangerang Selatan, Indonesia
| | - Irawaty -Djaharuddin
- Department of Pulmonology and Respiratory Diseases, Faculty of Medicine, Universitas Hasanuddin, Makassar, Indonesia.,Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia
| | - Ahyar -Ahmad
- Department of Chemistry, Mathematics and Natural Science Faculty, Universitas Hasanuddin, Makassar, Indonesia
| | - Sabar -Pambudi
- Research Center for Vaccine and Drugs, National Research and Innovation Agency (BRIN), Tangerang Selatan, Indonesia
| | | | | | - Andi -Tenriola
- Department of Nursing, Sekolah Tinggi Ilmu Kesehatan Panrita Husada, Bulukumba, Indonesia
| | - Andi Agus -Mumang
- Research, Community Service, and International Unit, Faculty of Public Health, Universitas Hasanuddin, Makassar, Indonesia
| | - Nurjannah -Lihawa
- Department of Pulmonology and Respiratory Diseases, Faculty of Medicine, Universitas Hasanuddin, Makassar, Indonesia.,Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia
| | - Muhammad Nasrum -Massi
- Department of Clinical Microbiology, Faculty of Medicine, Universitas Hasanuddin, Makassar, Indonesia
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Liang M, Fan Y, Zhang D, Yang L, Wang X, Wang S, Xu J, Zhang J. Metagenomic next-generation sequencing for accurate diagnosis and management of lower respiratory tract infections. Int J Infect Dis 2022; 122:921-929. [PMID: 35908723 DOI: 10.1016/j.ijid.2022.07.060] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/07/2022] [Accepted: 07/23/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES This study aimed to evaluate the clinical value of metagenomic next-generation sequencing (mNGS) in patients with suspected lower respiratory tract infections (LRTIs). METHODS This retrospective study reviewed patients with suspected LRTIs in Wuhan Union Hospital. Data including demographic, laboratory, and radiological profiles; treatment; and outcomes were recorded and analyzed. RESULTS mNGS identified pathogenic microbes in 100/140 (71.4%) patients, although 135 (96.4%) had received empiric antibiotic treatment before the mNGS tests. Single bacterial infection (35/100, 35%) was the most common type of infection in patients with positive mNGS results, followed by single fungal infection (14/100, 14%), bacterial-viral co-infection (14/100, 14%), single viral infection (12/100, 12%), bacterial-fungal co-infection (9/100, 9%), fungal-viral co-infection (9/100, 9%), and bacterial-fungal-viral co-infection (7/100, 7%). Moreover, compared with culture test, mNGS showed higher sensitivity (63/85, 74.1% vs. 22/85, 25.9% P=0.001) and lower processing time (24 h vs 48 h). Antibiotic treatment was adjusted or confirmed based on the mNGS results in 123 (87.9%) patients, including 5 (3.6%), 33 (23.6%) and 85 (60.7%) patients in whom treatment was downgraded, upgraded and unchanged, respectively, and almost all patients, regardless of escalation, de-escalation, or no change in treatment, showed significant improvement in clinical symptoms and inflammatory indicators. Additionally, 17 (12.1%) patients were referred to Wuhan Pulmonary Hospital for further treatment because of confirmed or suspected tuberculosis. CONCLUSIONS mNGS could be a promising technique for microbiological diagnosis and antibiotic management, potentially improving outcomes of patients.
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Affiliation(s)
- Mengyuan Liang
- Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical Collage, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei Province, 430022, China
| | - Yamin Fan
- Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical Collage, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei Province, 430022, China
| | - Dongmei Zhang
- Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical Collage, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei Province, 430022, China
| | - Lian Yang
- Department of Radiology, Union Hospital, Tongji Medical Collage, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei Province, 430022, China
| | - Xiaorong Wang
- Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical Collage, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei Province, 430022, China
| | - Sufei Wang
- Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical Collage, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei Province, 430022, China
| | - Juanjuan Xu
- Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical Collage, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei Province, 430022, China.
| | - Jianchu Zhang
- Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical Collage, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei Province, 430022, China.
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Das A, Mead P, Mala HR. Abdominal tuberculosis masquerading as ovarian carcinoma in a Caucasian woman: a diagnostic challenge. BMJ Case Rep 2022; 15:e244015. [PMID: 35217547 PMCID: PMC8883184 DOI: 10.1136/bcr-2021-244015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2022] [Indexed: 11/04/2022] Open
Abstract
We present a case of a 37-year-old Caucasian woman with abdominal distension and loss of weight. She was initially presumed to be a case of ovarian malignancy due to an elevated serum cancer antigen 125 (CA 125) level and imaging of abdomen and pelvis that showed ascites and bulky ovaries. However, histological examination of biopsy later revealed it to be a case of abdominal tuberculosis (AbT). Ascitic fluid was also found to be positive for Mycobacterium tuberculosis by whole genome sequencing. The patient was started on antituberculosis treatment following which she showed a significant improvement in her symptoms.
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Affiliation(s)
- Ananya Das
- Medicine, West Cumberland Hospital, Whitehaven, Cumbria, UK
| | - Paul Mead
- Nephrology, West Cumberland Hospital, Whitehaven, Cumbria, UK
| | - Hilal Razvi Mala
- General Medicine, West Cumberland Hospital, Whitehaven, Cumbria, UK
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韩 思. Clinical value of metagenomic next-generation sequencing in complicated infectious diseases. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2022; 24:210-215. [PMID: 35209988 PMCID: PMC8884048 DOI: 10.7499/j.issn.1008-8830.2110064] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 11/26/2021] [Indexed: 11/21/2022]
Abstract
Infectious diseases are commonly seen in clinical practice, and pathogen diagnosis is the key link in diagnosis and treatment; however, conventional pathogen detection methods cannot meet clinical needs due to time-consuming operation and low positive rate. As a new pathogen detection method, metagenomic next-generation sequencing (mNGS) has a wide detection range and can detect bacteria, viruses, fungi, parasites, rare pathogens, and even unknown pathogens. The technique of mNGS is unbiased and can rapidly, efficiently, and accurately obtain all nucleic acid information in test samples, analyze pathogens, and guide clinical diagnosis and treatment, thereby playing an important role in complicated infectious diseases. This article reviews the diagnostic advantages and clinical value of mNGS in bacterial, fungal, viral, and parasitic infections.
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Ho CS, Feng PJI, Narita M, Stout JE, Chen M, Pascopella L, Garfein R, Reves R, Katz DJ. Comparison of three tests for latent tuberculosis infection in high-risk people in the USA: an observational cohort study. THE LANCET. INFECTIOUS DISEASES 2022; 22:85-96. [PMID: 34499863 PMCID: PMC8712384 DOI: 10.1016/s1473-3099(21)00145-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 01/30/2021] [Accepted: 03/03/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Treatment of latent tuberculosis infection is an important strategy to prevent tuberculosis disease. In the USA, three tests are used to identify latent tuberculosis infection: the tuberculin skin test (TST) and two IFN-γ release assays (T-SPOT.TB and QuantiFERON). To our knowledge, few large studies have compared all three tests among people at high risk of latent tuberculosis infection or progression to tuberculosis disease. We aimed to assess test agreement between IFN-γ release assays and TST to provide guidance on their use in important risk groups. METHODS In this observational cohort study, we enrolled participants at high risk of latent tuberculosis infection or progression to tuberculosis disease at ten US sites with 18 affiliated clinics, including close contacts of infectious tuberculosis cases, people born in countries whose populations in the USA have high (≥100 cases per 100 000 people) or moderate (10-99 cases per 100 000 people) tuberculosis incidence, and people with HIV. Participants were interviewed about demographics and medical risk factors, and all three tests were administered to each participant. The primary endpoints for this study were the proportions of positive test results by test type stratified by risk group and test concordance by risk group for participants with valid results for all three test types. The study is registered at ClinicalTrials.gov, NCT01622140. FINDINGS Between July 12, 2012, and May 5, 2017, 26 292 people were approached and 22 131 (84·2%) were enrolled in the study. Data from 21 846 (98·7%) participants were available for analysis, including 3790 (17·3%) born in the USA and 18 023 (82·5%) born outside the USA. Among non-US-born participants overall, the RR comparing the proportions of TST-positive results (7476 [43·2%] of 17 306 participants) to QuantiFERON-positive results (4732 [26·5%] of 17 882 participants) was 1·6 (95% CI 1·6-1·7). The risk ratio (RR) for the comparison with the proportion of T-SPOT.TB-positive results (3693 [21·6%] of 17 118 participants) was 2·0 (95% CI 1·9-2·1). US-born participants had less variation in the proportions of positive results across all tests. The RRs for the proportion of TST-positive results (391 [10·9%] of 3575 participants) compared with the proportion of QuantiFERON-positive results (445 [12·0%] of 3693 participants) and T-SPOT.TB-positive results (295 [8·1%] of 3638 participants) were 0·9 (95% CI 0·8-1·0) and 1·3 (1·2-1·6), respectively. 20 149 (91·0%) of 21 846 participants had results for all three tests, including 16 712 (76%) non-US-born participants. Discordance between TST and IFN-γ release assay results varied by age among non-US-born participants and was greatest among the 848 non-US-born children younger than 5 years. 204 (87·2%) of 234 non-US-born children younger than 5 years with at least one positive test were TST-positive and IFN-γ release assay-negative. The proportion of non-US-born participants who were TST-negative but IFN-γ release assay-positive ranged from one (0·5%) of 199 children younger than 2 years to 86 (14·5%) of 594 participants aged 65 years and older (ptrend<0·0001). Test agreement was higher between the two IFN-γ release assays than between TST and either IFN-γ release assay, regardless of birthplace. κ agreement was particularly low between TST and IFN-γ release assays in non-US-born children younger than 5 years. INTERPRETATION Our findings support the preferential use of IFN-γ release assays for the diagnosis of latent tuberculosis in high-risk populations, especially in very young and older people born outside the USA. FUNDING US Centers for Disease Control and Prevention.
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Affiliation(s)
- Christine S Ho
- Division of Tuberculosis Elimination, US Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Pei-Jean I Feng
- Division of Tuberculosis Elimination, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Masahiro Narita
- TB Control Program, Public Health-Seattle and King County, Seattle, WA, USA
| | - Jason E Stout
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Michael Chen
- Division of Tuberculosis Elimination, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lisa Pascopella
- Tuberculosis Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Richmond, CA, USA
| | - Richard Garfein
- Division of Global Public Health, School of Medicine, University of California, San Diego, CA, USA
| | - Randall Reves
- Denver Health and Hospital Authority, Denver, CO, USA
| | - Dolly J Katz
- Division of Tuberculosis Elimination, US Centers for Disease Control and Prevention, Atlanta, GA, USA
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Identification of Recent Tuberculosis Exposure Using QuantiFERON-TB Gold Plus, a Multicenter Study. Microbiol Spectr 2021; 9:e0097221. [PMID: 34756079 PMCID: PMC8579846 DOI: 10.1128/spectrum.00972-21] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We investigated whether the difference of antigen tube 2 (TB2) minus antigen tube 1 (TB1) (TB2-TB1) of the QuantiFERON-TB gold plus test, which has been postulated as a surrogate for the CD8+ T-cell response, could be useful in identifying recent tuberculosis (TB) exposure. We looked at the interferon gamma (IFN-γ) responses and differences in TB2 and TB1 tubes for 686 adults with QFT-plus positive test results. These results were compared among groups with high (368 TB contacts), low (229 patients with immune-mediated inflammatory diseases [IMID]), and indeterminate (89 asylum seekers or people from abroad [ASPFA]) risks of recent TB exposure. A TB2-TB1 value >0.6 IU·ml-1 was deemed to indicate a true difference between tubes. In the whole cohort, 13.6%, 10.9%, and 11.2% of cases had a TB2>TB1 result in the contact, IMID, and ASPFA groups, respectively (P = 0.591). The adjusted odds ratios (aORs) for an association between a TB2-TB1 result of >0.6 IU·ml-1 and risk of recent exposure versus contacts were 0.71 (95% confidence interval [CI], 0.31 to 1.61) for the IMID group and 0.86 (95% CI, 0.49 to 1.52) for the ASPFA group. In TB contact subgroups, 11.4%, 15.4%, and 17.7% with close, frequent, and sporadic contact had a TB2>TB1 result (P = 0.362). The aORs versus the close subgroup were 1.29 (95% CI, 0.63 to 2.62) for the frequent subgroup and 1.55 (95% CI, 0.67 to 3.60) for the sporadic subgroup. A TB2-TB1 difference of >0.6 IU·ml-1 was not associated with increased risk of recent TB exposure, which puts into question the clinical potential as a proxy marker for recently acquired TB infection. IMPORTANCE Contact tuberculosis tracing is essential to identify recently infected people, who therefore merit preventive treatment. However, there are no diagnostic tests that can determine whether the infection is a result of a recent exposure or not. It has been suggested that by using the QuantiFERON-TB gold plus, an interferon gamma (IFN-γ) release assay, a difference in IFN-γ production between the two antigen tubes (TB2 minus TB1) of >0.6 IU·ml-1 could serve as a proxy marker for recent infection. In this large multinational study, infected individuals could not be classified according to the risk of recent exposure based on differences in IFN-γ in TB1 and TB2 tubes that were higher than 0.6 IU·ml-1. QuantiFERON-TB gold plus is not able to distinguish between recent and remotely acquired tuberculosis infection, and it should not be used for that purpose in contact tuberculosis tracing.
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11
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Carranza C, Herrera MT, Guzmán-Beltrán S, Salgado-Cantú MG, Salido-Guadarrama I, Santiago E, Chávez-Galán L, Gutiérrez-González LH, González Y. A Dual Marker for Monitoring MDR-TB Treatment: Host-Derived miRNAs and M. tuberculosis-Derived RNA Sequences in Serum. Front Immunol 2021; 12:760468. [PMID: 34804048 PMCID: PMC8600136 DOI: 10.3389/fimmu.2021.760468] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 10/18/2021] [Indexed: 12/18/2022] Open
Abstract
Background In the absence of a late marker of treatment failure or relapse in MDR-TB patients, biomarkers based on host-miRNAs coupled with M. tuberculosis-RNAs evaluated in extracellular vesicles (EVs) are an alternative follow-up for MDR-TB disease. Characterization of EVs cargo to identify differentially expressed miRNAs before and after treatment, and to identify M. tuberculosis-derived RNA in serum EVs from resistant TB patients. Methods EVs were isolated from serum of 26 drug-resistant TB (DR-TB) patients and 16 healthy subjects. Differential expression of miRNAs in pooled exosomes from both untreated and treated patients was assessed and individually validated at different time points during treatment. In addition, M. tuberculosis RNA was amplified in the same samples by qPCR. Results A multivariate analysis using miR-let-7e-5p, -197-3p and -223-3p were found to be a more sensitive discriminator between healthy individuals and those with TB for both DR-TB (AUC= 0.96, 95%, CI=0.907-1) and MDR-TB groups (AUC= 0.95, 95%, CI= 0.89-1). Upregulation of miR-let-7e-5p were observed at the time of M. tuberculosis negative culture T(3-5) for MDR-TB group or for long-term T(9-15) for MDR-TB group without diabetes (T2DM). A second pathogen-based marker based on 30kDa and 5KST sequences was detected in 33% of the MDR-TB patients after the intensive phase of treatment. The miR-let7e-5p is a candidate biomarker for long-term monitoring of treatment for the group of MDR-TB without T2DM. A dual marker of host-derived miR-let7e-5p and M. tuberculosis-derived RNA for monitoring-TB treatment based in serum EVs. Conclusion A dual marker consisting of host-derived miR-let7e-5p and M. tuberculosis-derived RNA, could be an indicator of treatment failure or relapse time after treatment was completed.
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Affiliation(s)
- Claudia Carranza
- Laboratorio de Inmunobiología de la Tuberculosis, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico, Mexico
| | - María Teresa Herrera
- Department of Microbiology, National Institute for Respiratory Diseases Ismael Cosío Villegas, Mexico, Mexico
| | - Silvia Guzmán-Beltrán
- Department of Microbiology, National Institute for Respiratory Diseases Ismael Cosío Villegas, Mexico, Mexico
| | | | - Ivan Salido-Guadarrama
- Department of Microbiology, National Institute for Respiratory Diseases Ismael Cosío Villegas, Mexico, Mexico
| | - Elizabeth Santiago
- Laboratorio de Biología Computacional, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico, Mexico
| | - Leslie Chávez-Galán
- Laboratory of Integrative Immunology, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico, Mexico
| | | | - Yolanda González
- Department of Microbiology, National Institute for Respiratory Diseases Ismael Cosío Villegas, Mexico, Mexico
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12
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Handayani I, Massi MN, Leman Y, Natzir R, Patellongi I, Subair S, Hidayah N, Wulandari AA, Halik H. Composite Bacterial Infection Index and Serum Amyloid A Protein in Pulmonary Tuberculosis Patients and their Household Contacts in Makassar. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Early diagnosis of tuberculosis (TB) cases in limited resource remains challenging. It is urgent to identify the new diagnostic tools which can control the spread of disease with accurate and rapid test.
AIM: This study aimed to investigate the levels of infection markers: Composite bacterial infection index (CBII) and serum amyloid A (SAA) protein in pulmonary TB (PTB), and their healthy household contacts, as the alternative diagnostic markers for TB.
METHODS: CBII and SAA were measured from 44 new PTB patients, and 31 household contact serum samples. The value of CBII was calculated from neutrophils, lymphocytes, monocytes, erythrocyte sedimentation rate, and high-sensitivity C-reactive protein (hs-CRP) level. hs-CRP and SAA levels were quantified from their serum samples using ELISA. QuantiFERON-TB Gold Plus (interferon gamma release assay [IGRA]) was used to screen latent TB infection among household contacts.
RESULTS: Among 31 household contacts, there were 24 positive IGRA results and the rest (n = 7) had negative results. PTB patients exhibited significantly higher level CBII in the serum specimens, than those in household contact (p < 0.0001). There was no significant difference in the SAA level between TB cases and household contacts (p = 0.679).
CONCLUSIONS: CBII can be used as one of the biomarkers for the identification of PTB from the serum specimens.
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13
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Ledesma JR, Ma J, Zheng P, Ross JM, Vos T, Kyu HH. Interferon-gamma release assay levels and risk of progression to active tuberculosis: a systematic review and dose-response meta-regression analysis. BMC Infect Dis 2021; 21:467. [PMID: 34022827 PMCID: PMC8141158 DOI: 10.1186/s12879-021-06141-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 05/05/2021] [Indexed: 12/26/2022] Open
Abstract
Background Identifying and treating individuals with high risk of progression from latent tuberculosis infection to active tuberculosis (TB) disease is critical for eliminating the disease. We aimed to conduct a systematic review and meta-regression analysis to quantify the dose-response relationship between interferon-gamma release assay (IGRA) levels and the risk of progression to active TB. Methods We searched PubMed and Embase from 1 January 2001 to 10 May 2020 for longitudinal studies that reported the risk of progression from latent to active TB as a function of baseline IGRA values. We used a novel Bayesian meta-regression method to pool effect sizes from included studies and generate a continuous dose-response risk curve. Our modeling framework enabled us to incorporate random effects across studies, and include data with different IGRA ranges across studies. The quality of included studies were assessed using the Newcastle-Ottawa scale (NOS). Results We included 34 studies representing 581,956 person-years of follow-up with a total of 788 incident cases of TB in the meta-regression analysis. Higher levels of interferon-gamma were associated with increased risk of progression to active tuberculosis. In the dose-response curve, the risk increased sharply between interferon-gamma levels 0 and 5 IU/ml, after which the risk continued to increase moderately but at a slower pace until reaching about 15 IU/ml where the risk levels off. Compared to 0 IU/ml, the relative risk of progression to active TB among those with interferon-gamma levels of 0.35, 1, 5, 10, 15, and 20 IU/ml were: 1.64 (1.28–2.08), 2.90 (2.02–3.88), 11.38 (6.64–16.38), 19.00 (13.08–26.90), 21.82 (14.65–32.57), and 22.31 (15.43–33.00), respectively. The dose-response relationship remains consistent when limiting the analysis to studies that scored highest in the NOS. Conclusion The current practice of dichotomizing IGRA test results simplifies the TB infection disease continuum. Evaluating IGRA test results over a continuous scale could enable the identification of individuals at greatest risk of progression to active TB. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06141-4.
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Affiliation(s)
- Jorge R Ledesma
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA, 98195, USA
| | - Jianing Ma
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA, 98195, USA
| | - Peng Zheng
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA, 98195, USA.,Department of Health Metrics Sciences, University of Washington, 3980 15th Ave. NE, Seattle, WA, 98195, USA
| | - Jennifer M Ross
- Department of Global Health, University of Washington, 325 9th Avenue, Box 359931, Seattle, WA, 98104, USA.,Department of Medicine, University of Washington, 1959 NE Pacific Street, Box 356420, Seattle, WA, 98195, USA
| | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA, 98195, USA.,Department of Health Metrics Sciences, University of Washington, 3980 15th Ave. NE, Seattle, WA, 98195, USA
| | - Hmwe H Kyu
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA, 98195, USA. .,Department of Health Metrics Sciences, University of Washington, 3980 15th Ave. NE, Seattle, WA, 98195, USA.
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14
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Dwenger LV, Funke N, Stephany P, Suarez I, Wiesmüller GA, Neuhann F. [Frequency Distribution and Risk Factors for Latent Tuberculosis in Contact Persons: Cologne 2012-2016]. Pneumologie 2021; 75:567-576. [PMID: 33971674 DOI: 10.1055/a-1479-0168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND As part of tuberculosis control and the WHO end-TB strategy, contact persons of tuberculosis patients in Germany are examined for a possible infection with latent tuberculosis (LTBI). Activation of LTBI contributes a considerable proportion of newly reported tuberculosis cases in low-incidence countries such as Germany. Therefore, the aim is to detect cases of LTBI and, through chemopreventive treatment of these cases, prevent future, post-primary, active tuberculosis.In Germany, the rate of LTBI among contact persons of people diagnosed with active tuberculosis is not systematically recorded. The aim of the present work was to close this data gap for Cologne, a major city in Germany with a TB incidence of around 9/100,000 in the past years. The study further aimed to describe risk factors for LTBI and to reevaluate the standard inclusion criteria for contact investigation for tuberculosis under routine conditions in Germany. MATERIAL AND METHODS For the period 07/2012 to 12/2016, the retrospective cohort study examined the rate of LTBI diagnoses among contact persons of those with pulmonary tuberculosis notified at the Cologne public health department, as well as factors that increase the LTBI infection risk of contact persons. The diagnosis of latent tuberculosis was made when the interferon-gamma release assay (IGRA) was positive and there were no signs of active tuberculosis. The study included contact persons who cumulatively had a previously defined minimum total contact time with a tuberculosis patient, who were at least 5 years old at the time of the study and who were registered in Cologne. Statistical evaluation was carried out descriptively as absolute and relative frequency with a significance level of p ≤ 0.05. The analytical evaluation was carried out with univariate and multivariate logistic regression. RESULTS Of a total of 3862 IGRA examinations among contact persons, 2834 cases met the inclusion criteria. A median of seven contact persons per index patient was reported. 12.5 % of the study group tested positive for LTBI. In contact persons of microscopically open index patients, the positivity rate was 11.4 %, in culturally open but microscopically negative index patients, it was 14.3 %. Factors associated with a higher risk of LTBI included male sex (OR = 1.95), age ≥ 50 years (OR = 1.8) and household exposure (OR = 2.37). CONCLUSION Using the German standard criteria, the positivity rate of IGRA testing and the diagnosis of LTBI among contacts in the present study was 12.5 %, which is lower than in other similar studies. Factors identified in the cohort for an increased risk of LTBI confirm known constellations. The significantly higher positivity rate among contact persons of microscopically negative but culturally positive index patients (p = 0.033) underscores the need to conduct a detailed contact examination of individuals of this group as well.
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Affiliation(s)
- L V Dwenger
- Gesundheitsamt der Stadt Köln, Abteilung Infektions- und Umwelthygiene, Tuberkulose-Beratungsstelle.,Institut für Arbeits-, Sozial- und Umweltmedizin, Universitätsklinik, RWTH Aachen
| | - N Funke
- Gesundheitsamt der Stadt Köln, Abteilung Infektions- und Umwelthygiene, Tuberkulose-Beratungsstelle
| | - P Stephany
- Gesundheitsamt der Stadt Köln, Abteilung Infektions- und Umwelthygiene, Tuberkulose-Beratungsstelle
| | - I Suarez
- Medizinische Klinik 1, Infektionsambulanz, Universitätsklinikum Köln
| | - G A Wiesmüller
- Gesundheitsamt der Stadt Köln, Abteilung Infektions- und Umwelthygiene, Tuberkulose-Beratungsstelle.,Institut für Arbeits-, Sozial- und Umweltmedizin, Universitätsklinik, RWTH Aachen
| | - F Neuhann
- Gesundheitsamt der Stadt Köln, Abteilung Infektions- und Umwelthygiene, Tuberkulose-Beratungsstelle.,Heidelberger Institut für Global Health, Universitätsklinikum Heidelberg.,School of Medicine and Clinical Sciences, Levy Mwanawasa Medical University, Lusaka, Zambia
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15
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Deng J, Liu L, Yang Q, Wei C, Zhang H, Xin H, Pan S, Liu Z, Wang D, Liu B, Gao L, Liu R, Pang Y, Chen X, Zheng J, Jin Q. Urinary metabolomic analysis to identify potential markers for the diagnosis of tuberculosis and latent tuberculosis. Arch Biochem Biophys 2021; 704:108876. [PMID: 33864753 DOI: 10.1016/j.abb.2021.108876] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 11/24/2022]
Abstract
Tuberculosis (TB) is a serious infectious disease with high infection and mortality rates. 5%-10% of the latent tuberculosis infections (LTBI) are likely to develop into active TB, and there are currently no clinical biomarkers that can distinguish between LTBI, active TB and other non-tuberculosis populations. Therefore, it is necessary to develop rapid diagnostic methods for active TB and LTBI. In this study, urinary metabolome of 30 active TB samples and the same number of LTBI and non-TB control samples were identified and analyzed by UPLC-Q Exactive MS. In total, 3744 metabolite components were obtained in ESI- mode and 4086 in ESI + mode. Orthogonal partial least square discriminant analysis (OPLS-DA) and hierarchical cluster analysis (HCA) showed that there were significant differences among LTBI, active TB and non-TB. Six differential metabolites were screened in positive and negative mode, 3-hexenoic acid, glutathione (GSH), glycochenodeoxycholate-3-sulfate, N-[4'-hydroxy-(E)-cinnamoyl]-l-aspartic acid, deoxyribose 5-phosphate and histamine. The overlapping pathways differential metabolites involved were mainly related to immune regulation and urea cycle. The results showed that the urine metabolism of TB patients was disordered and many metabolic pathways changed. Multivariate statistical analysis revealed that GSH and histamine were selected as potential molecular markers, with area under curve of receiver operating characteristic curve over 0.75. Among the multiple differential metabolites, GSH and histamine changed to varying degrees in active TB, LTBI and the non-TB control group. The levels of GSH and histamine in 48 urinary samples were measured by ELISA in validation phase, and the result in our study provided the potential for non-invasive biomarkers of TB.
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Affiliation(s)
- Jiaheng Deng
- 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, 100730, China
| | - Liguo Liu
- 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, 100730, China
| | - Qianting Yang
- National Clinical Research Center for Infectious Diseases, Guangdong Key Lab for Diagnosis & Treatment of Emerging Infectious Diseases, Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen, 518112, China
| | - Candong Wei
- 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, 100730, China
| | - Haoran 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, 100730, China
| | - Henan 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, 100730, China
| | - Shouguo Pan
- Center for Diseases Control and Prevention of Zhongmu County, Zhongmu, 451450, China
| | - Zisen Liu
- Center for Diseases Control and Prevention of Zhongmu County, Zhongmu, 451450, China
| | - Dakuan Wang
- Center for Diseases Control and Prevention of Zhongmu County, Zhongmu, 451450, China
| | - Bo Liu
- 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, 100730, China
| | - Lei 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, 100730, China
| | - Rongmei Liu
- Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, No 97, Machang, Tongzhou District, Beijing, 101149, China
| | - Yu Pang
- Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, No 97, Machang, Tongzhou District, Beijing, 101149, China
| | - Xinchun Chen
- Department of Pathogen Biology, Shenzhen University School of Medicine, Shenzhen, 518060, China
| | - Jianhua Zheng
- 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, 100730, China.
| | - Qi 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, 100730, China.
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16
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Evaluation of QuantiFERON-TB Gold Plus for Predicting Incident Tuberculosis among Recent Contacts: A Prospective Cohort Study. Ann Am Thorac Soc 2021; 17:646-650. [PMID: 32083944 PMCID: PMC7193805 DOI: 10.1513/annalsats.201905-407rl] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
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17
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Wejse C. Transcriptomic signatures have a place in short-term prediction of incident tuberculosis. THE LANCET. INFECTIOUS DISEASES 2021; 21:299-300. [PMID: 33508223 DOI: 10.1016/s1473-3099(20)30980-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 12/08/2020] [Indexed: 06/12/2023]
Affiliation(s)
- Christian Wejse
- Center for Global Health AU, Department of Public Health, Aarhus University, Aarhus, Denmark; Bandim Health Project, INDEPTH network, Bissau, Guinea-Bissau.
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18
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Verrall AJ, Schneider M, Alisjahbana B, Apriani L, van Laarhoven A, Koeken VACM, van Dorp S, Diadani E, Utama F, Hannaway RF, Indrati A, Netea MG, Sharples K, Hill PC, Ussher JE, van Crevel R. Early Clearance of Mycobacterium tuberculosis Is Associated With Increased Innate Immune Responses. J Infect Dis 2021; 221:1342-1350. [PMID: 30958547 DOI: 10.1093/infdis/jiz147] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 04/02/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND A proportion of tuberculosis (TB) case contacts do not become infected, even when heavily exposed. We studied the innate immune responses of TB case contacts to understand their role in protection against infection with Mycobacterium tuberculosis, termed "early clearance." METHODS Indonesian household contacts of TB cases were tested for interferon-γ release assay (IGRA) conversion between baseline and 14 weeks post recruitment. Blood cell populations and ex vivo innate whole blood cytokine responses were measured at baseline and, in a subgroup, flow cytometry was performed at weeks 2 and 14. Immunological characteristics were measured for early clearers, defined as a persistently negative IGRA at 3 months, and converters, whose IGRA converted from negative to positive. RESULTS Among 1347 case contacts, 317 were early clearers and 116 were converters. Flow cytometry showed a resolving innate cellular response from 2 to 14 weeks in persistently IGRA-negative contacts but not converters. There were no differences in cytokine responses to mycobacterial stimuli, but compared to converters, persistently IGRA-negative contacts produced more proinflammatory cytokines following heterologous stimulation with Escherichia coli and Streptococcus pneumoniae. CONCLUSIONS Early clearance of M. tuberculosis is associated with enhanced heterologous innate immune responses similar to those activated during induction of trained immunity.
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Affiliation(s)
- Ayesha J Verrall
- Department of Pathology and Molecular Medicine, University of Otago, Wellington, New Zealand
| | - Marion Schneider
- Department of Microbiology and Immunology, University of Otago, Dunedin, New Zealand
| | - Bachti Alisjahbana
- TB-HIV Research Center, Faculty of Medicine, Universitas Padjadjaran, Nijmegen, The Netherlands.,Department of Internal Medicine, Faculty of Medicine, Universitas Padajdaran, Hasan Sadikin Hospital, Nijmegen, The Netherlands
| | - Lika Apriani
- TB-HIV Research Center, Faculty of Medicine, Universitas Padjadjaran, Nijmegen, The Netherlands.,Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Arjan van Laarhoven
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Nijmegen, The Netherlands
| | - Valerie A C M Koeken
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Nijmegen, The Netherlands
| | - Suszanne van Dorp
- Department of Haematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Emira Diadani
- TB-HIV Research Center, Faculty of Medicine, Universitas Padjadjaran, Nijmegen, The Netherlands
| | - Fitri Utama
- TB-HIV Research Center, Faculty of Medicine, Universitas Padjadjaran, Nijmegen, The Netherlands
| | - Rachel F Hannaway
- Department of Microbiology and Immunology, University of Otago, Dunedin, New Zealand
| | - Agnes Indrati
- Department of Clinical Pathology, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin Hospital, Bandung, Indonesia
| | - Mihai G Netea
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Nijmegen, The Netherlands.,Human Genomics Laboratory, Craiova University of Medicine and Pharmacy, Romania
| | - Katrina Sharples
- Department of Mathematics and Statistics, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Philip C Hill
- Centre for International Health, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - James E Ussher
- Department of Microbiology and Immunology, University of Otago, Dunedin, New Zealand
| | - Reinout van Crevel
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Nijmegen, The Netherlands
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19
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Roe J, Venturini C, Gupta RK, Gurry C, Chain BM, Sun Y, Southern J, Jackson C, Lipman MC, Miller RF, Martineau AR, Abubakar I, Noursadeghi M. Blood Transcriptomic Stratification of Short-term Risk in Contacts of Tuberculosis. Clin Infect Dis 2021; 70:731-737. [PMID: 30919880 DOI: 10.1093/cid/ciz252] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 03/20/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The highest risk of tuberculosis arises in the first few months after exposure. We reasoned that this risk reflects incipient disease among tuberculosis contacts. Blood transcriptional biomarkers of tuberculosis may predate clinical diagnosis, suggesting they offer improved sensitivity to detect subclinical incipient disease. Therefore, we sought to test the hypothesis that refined blood transcriptional biomarkers of active tuberculosis will improve stratification of short-term disease risk in tuberculosis contacts. METHODS We combined analysis of previously published blood transcriptomic data with new data from a prospective human immunodeficiency virus (HIV)-negative UK cohort of 333 tuberculosis contacts. We used stability selection as an alternative computational approach to identify an optimal signature for short-term risk of active tuberculosis and evaluated its predictive value in independent cohorts. RESULTS In a previously published HIV-negative South African case-control study of patients with asymptomatic Mycobacterium tuberculosis infection, a novel 3-gene transcriptional signature comprising BATF2, GBP5, and SCARF1 achieved a positive predictive value (PPV) of 23% for progression to active tuberculosis within 90 days. In a new UK cohort of 333 HIV-negative tuberculosis contacts with a median follow-up of 346 days, this signature achieved a PPV of 50% (95% confidence interval [CI], 15.7-84.3) and negative predictive value of 99.3% (95% CI, 97.5-99.9). By comparison, peripheral blood interferon gamma release assays in the same cohort achieved a PPV of 5.6% (95% CI, 2.1-11.8). CONCLUSIONS This blood transcriptional signature provides unprecedented opportunities to target therapy among tuberculosis contacts with greatest risk of incident disease.
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Affiliation(s)
- Jennifer Roe
- Division of Infection & Immunity, University College London
| | | | - Rishi K Gupta
- Institute for Global Health, University College London
| | - Celine Gurry
- Division of Infection & Immunity, University College London
| | | | - Yuxin Sun
- Department of Computer Science, University College London
| | - Jo Southern
- Institute for Global Health, University College London
| | | | - Marc C Lipman
- University College London Respiratory Medicine, University College London.,Department of Respiratory Medicine, Royal Free London National Health Service Trust
| | | | | | | | - Mahdad Noursadeghi
- Division of Infection & Immunity, University College London.,National Institute for Health Research University College London Hospitals Biomedical Research Centre, United Kingdom
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Gupta RK, Calderwood CJ, Yavlinsky A, Krutikov M, Quartagno M, Aichelburg MC, Altet N, Diel R, Dobler CC, Dominguez J, Doyle JS, Erkens C, Geis S, Haldar P, Hauri AM, Hermansen T, Johnston JC, Lange C, Lange B, van Leth F, Muñoz L, Roder C, Romanowski K, Roth D, Sester M, Sloot R, Sotgiu G, Woltmann G, Yoshiyama T, Zellweger JP, Zenner D, Aldridge RW, Copas A, Rangaka MX, Lipman M, Noursadeghi M, Abubakar I. Discovery and validation of a personalized risk predictor for incident tuberculosis in low transmission settings. Nat Med 2020; 26:1941-1949. [PMID: 33077958 PMCID: PMC7614810 DOI: 10.1038/s41591-020-1076-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 08/26/2020] [Indexed: 12/12/2022]
Abstract
The risk of tuberculosis (TB) is variable among individuals with latent Mycobacterium tuberculosis infection (LTBI), but validated estimates of personalized risk are lacking. In pooled data from 18 systematically identified cohort studies from 20 countries, including 80,468 individuals tested for LTBI, 5-year cumulative incident TB risk among people with untreated LTBI was 15.6% (95% confidence interval (CI), 8.0-29.2%) among child contacts, 4.8% (95% CI, 3.0-7.7%) among adult contacts, 5.0% (95% CI, 1.6-14.5%) among migrants and 4.8% (95% CI, 1.5-14.3%) among immunocompromised groups. We confirmed highly variable estimates within risk groups, necessitating an individualized approach to risk stratification. Therefore, we developed a personalized risk predictor for incident TB (PERISKOPE-TB) that combines a quantitative measure of T cell sensitization and clinical covariates. Internal-external cross-validation of the model demonstrated a random effects meta-analysis C-statistic of 0.88 (95% CI, 0.82-0.93) for incident TB. In decision curve analysis, the model demonstrated clinical utility for targeting preventative treatment, compared to treating all, or no, people with LTBI. We challenge the current crude approach to TB risk estimation among people with LTBI in favor of our evidence-based and patient-centered method, in settings aiming for pre-elimination worldwide.
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Affiliation(s)
- Rishi K Gupta
- Institute for Global Health, University College London, London, UK
| | | | - Alexei Yavlinsky
- Institute of Health Informatics, University College London, London, UK
| | - Maria Krutikov
- Institute for Global Health, University College London, London, UK
| | - Matteo Quartagno
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | | | - Neus Altet
- Unitat de Tuberculosis, Hospital Universitari Vall d'Hebron-Drassanes, Barcelona, Spain
- Unitat de TDO de la Tuberculosis 'Servicios Clínicos', Barcelona, Spain
| | - Roland Diel
- Institute for Epidemiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
- Lung Clinic Grosshansdorf, Airway Research Center North (ARCN), Großhansdorf, Germany
| | - Claudia C Dobler
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
- Department of Respiratory Medicine, Liverpool Hospital, Sydney, Australia
| | - Jose Dominguez
- Institut d'Investigació Germans Trias i Pujol, Badalona, Barcelona, Spain
- CIBER Enfermedades Respiratorias, Badalona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - Joseph S Doyle
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Australia
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
| | - Connie Erkens
- KNCV Tuberculosis Foundation, The Hague, The Netherlands
| | - Steffen Geis
- Institute for Medical Microbiology and Hospital Hygiene, Philipps University of Marburg, Marburg, Germany
| | - Pranabashis Haldar
- Respiratory Biomedical Research Centre, Institute for Lung Health, Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | | | - Thomas Hermansen
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark
| | - James C Johnston
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Christoph Lange
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany
- German Center for Infection Research (DZIF), Clinical Tuberculosis Center, Borstel, Germany
- Tuberculosis Network European Trials Group (TBnet), Borstel, Germany
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Berit Lange
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Frank van Leth
- Tuberculosis Network European Trials Group (TBnet), Borstel, Germany
- Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands
- Department of Global Health, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - Laura Muñoz
- Department of Clinical Sciences, University of Barcelona, Barcelona, Spain
| | - Christine Roder
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Australia
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
| | - Kamila Romanowski
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - David Roth
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Martina Sester
- Tuberculosis Network European Trials Group (TBnet), Borstel, Germany
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
| | - Rosa Sloot
- Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Giovanni Sotgiu
- Tuberculosis Network European Trials Group (TBnet), Borstel, Germany
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, Uniiversity of Sassari, Sassari, Italy
| | - Gerrit Woltmann
- Respiratory Biomedical Research Centre, Institute for Lung Health, Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | | | - Jean-Pierre Zellweger
- Tuberculosis Network European Trials Group (TBnet), Borstel, Germany
- Swiss Lung Association, Berne, Switzerland
| | - Dominik Zenner
- Institute for Global Health, University College London, London, UK
| | - Robert W Aldridge
- Institute of Health Informatics, University College London, London, UK
| | - Andrew Copas
- Institute for Global Health, University College London, London, UK
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Molebogeng X Rangaka
- Institute for Global Health, University College London, London, UK
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Marc Lipman
- UCL-TB and UCL Respiratory, University College London, London, UK
- Royal Free London NHS Foundation Trust, London, UK
| | | | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK.
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21
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Sloot R, Shanaube K, Claassens M, Telisinghe L, Schaap A, Godfrey-Faussett P, Ayles H, Floyd S. Interpretation of serial interferon-gamma test results to measure new tuberculosis infection among household contacts in Zambia and South Africa. BMC Infect Dis 2020; 20:760. [PMID: 33059620 PMCID: PMC7559914 DOI: 10.1186/s12879-020-05483-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 10/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A more stringent QuantiFERON-TB Gold In-Tube (QFT) conversion (from negative to positive) definition has been proposed to allow more definite detection of recent tuberculosis (TB) infection. We explored alternative conversion definitions to assist the interpretation of serial QFT results and estimate incidence of TB infection in a large cohort study. METHODS We used QFT serial results from TB household contacts aged ≥15 years, collected at baseline and during two follow-up visits (2006-2011) as part of a cohort study in 24 communities in Zambia and South Africa (SA). Conversion rates using the manufacturers' definition (interferon-gamma (IFN-g) < 0.35 to ≥0.35, 'def1') were compared with stricter definitions (IFN-g < 0.2 to ≥0.7 IU/ml, 'def2'; IFN-g < 0.2 to ≥1.05 IU/ml, 'def3'; IFN-g < 0.2 to ≥1.4 IU/ml, 'def4'). Poisson regression was used for analysis. RESULTS One thousand three hundred sixty-five individuals in Zambia and 822 in SA had QFT results available. Among HIV-negative individuals, the QFT conversion rate was 27.4 per 100 person-years (CI:22.9-32.6) using def1, 19.0 using def2 (CI:15.2-23.7), 14.7 using def3 (CI:11.5-18.8), and 12.0 using def4 (CI:9.2-15.7). Relative differences across def1-def4 were similar in Zambia and SA. Using def1, conversion was less likely if HIV positive not on antiretroviral treatment compared to HIV negative (aRR = 0.7, 95%CI = 0.4-0.9), in analysis including both countries. The same direction of associations were found using def 2-4. CONCLUSION High conversion rates were found even with the strictest definition, indicating high incidence of TB infection among household contacts of TB patients in these communities. The trade-off between sensitivity and specificity using different thresholds of QFT conversion remains unknown due to the absence of a reference standard. However, we identified boundaries within which an appropriate definition might fall, and our strictest definition plausibly has high specificity.
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Affiliation(s)
- Rosa Sloot
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Kwame Shanaube
- Zambart, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Mareli Claassens
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Lily Telisinghe
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Ab Schaap
- Zambart, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Peter Godfrey-Faussett
- UNAIDS, Geneva, Switzerland.,Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Helen Ayles
- Zambart, School of Medicine, University of Zambia, Lusaka, Zambia.,Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Sian Floyd
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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22
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Shi CL, Han P, Tang PJ, Chen MM, Ye ZJ, Wu MY, Shen J, Wu HY, Tan ZQ, Yu X, Rao GH, Zhang JP. Clinical metagenomic sequencing for diagnosis of pulmonary tuberculosis. J Infect 2020; 81:567-574. [PMID: 32768450 DOI: 10.1016/j.jinf.2020.08.004] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 07/29/2020] [Accepted: 08/02/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVES The aim of this study is to investigate the clinical usefulness of metagenomic Next-generation sequencing (mNGS) on bronchoalveolar lavage fluid (BALF) samples to discriminate pulmonary tuberculosis (PTB) from Non-TB community-acquired pneumonia (CAP) in PTB suspects. METHODS We investigate the performance of mNGS on BALF samples from 110 PTB suspects, in comparison with conventional microbiological testing (solid media culture, acid-fast bacilli staining (AFS), Xpert) of BALF or sputum samples and final clinical diagnosis. RESULTS We finally clinically diagnosed 48 cases of pulmonary tuberculosis patients and 62 cases of non-tuberculosis patients. Comparing to the final clinical diagnosis, mNGS produced a sensitivity of 47.92%, which was similar to that of Xpert (45.83%) and culture (46.81%), but much higher than that of AFS (29.17%) for TB diagnosis in BALF samples. Apart from detecting Mycobacterium tuberculosis, mNGS also identified mixed infections in PTB patients, including 3 fungal cases and 1 bacteria case. Meanwhile, mNGS efficiently identified 14 of 22 (63.63%) cases of non-tuberculous mycobacteria (NTM), 7 cases of fungi, 1 case of viral infection, and other common bacterial pathogens in Non-PTB group. Finally, mNGS identified 67.23% infection cases within 3 days, while the conventional methods identified 49.58% infection cases for over 90 days. CONCLUSION Our data show that mNGS of BALF represents a potentially effective tool for the rapid diagnosis of PTB suspects.
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Affiliation(s)
- Cui-Lin Shi
- The Affiliated Infectious Hospital of Soochow University, 10 Guangqian Road, Suzhou, Suzhou, Jiangsu 215131, China; The Fifth People's Hospital of Suzhou, Suzhou, China
| | - Peng Han
- Genskey Medical Technology Co., Ltd, Beijing, China
| | - Pei-Jun Tang
- The Affiliated Infectious Hospital of Soochow University, 10 Guangqian Road, Suzhou, Suzhou, Jiangsu 215131, China; The Fifth People's Hospital of Suzhou, Suzhou, China
| | | | - Zhi-Jian Ye
- The Affiliated Infectious Hospital of Soochow University, 10 Guangqian Road, Suzhou, Suzhou, Jiangsu 215131, China; The Fifth People's Hospital of Suzhou, Suzhou, China
| | - Mei-Ying Wu
- The Affiliated Infectious Hospital of Soochow University, 10 Guangqian Road, Suzhou, Suzhou, Jiangsu 215131, China; The Fifth People's Hospital of Suzhou, Suzhou, China
| | - Jie Shen
- The Affiliated Infectious Hospital of Soochow University, 10 Guangqian Road, Suzhou, Suzhou, Jiangsu 215131, China; The Fifth People's Hospital of Suzhou, Suzhou, China
| | - Hai-Yan Wu
- The Affiliated Infectious Hospital of Soochow University, 10 Guangqian Road, Suzhou, Suzhou, Jiangsu 215131, China; The Fifth People's Hospital of Suzhou, Suzhou, China
| | - Zhu-Qing Tan
- The Affiliated Infectious Hospital of Soochow University, 10 Guangqian Road, Suzhou, Suzhou, Jiangsu 215131, China; The Fifth People's Hospital of Suzhou, Suzhou, China
| | - Xin Yu
- The Affiliated Infectious Hospital of Soochow University, 10 Guangqian Road, Suzhou, Suzhou, Jiangsu 215131, China; The Fifth People's Hospital of Suzhou, Suzhou, China.
| | - Guan-Hua Rao
- Genskey Medical Technology Co., Ltd, Beijing, China.
| | - Jian-Ping Zhang
- The Affiliated Infectious Hospital of Soochow University, 10 Guangqian Road, Suzhou, Suzhou, Jiangsu 215131, China; The Fifth People's Hospital of Suzhou, Suzhou, China.
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23
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Zhou G, Luo Q, Luo S, Teng Z, Ji Z, Yang J, Wang F, Wen S, Ding Z, Li L, Chen T, Abi ME, Jian M, Luo L, Liu A, Bao F. Interferon-γ release assays or tuberculin skin test for detection and management of latent tuberculosis infection: a systematic review and meta-analysis. THE LANCET. INFECTIOUS DISEASES 2020; 20:1457-1469. [PMID: 32673595 DOI: 10.1016/s1473-3099(20)30276-0] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 03/20/2020] [Accepted: 03/27/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Use of an interferon-γ (IFN-γ) release assay or tuberculin skin test for detection and management of latent tuberculosis infection is controversial. For both types of test, we assessed their predictive value for the progression of latent infection to active tuberculosis disease, the targeting value of preventive treatment, and the necessity of dual testing. METHODS In this systematic review and meta-analysis, we searched PubMed, Embase, Web of Science, and the Cochrane Library, with no start date or language restrictions, on Oct 18, 2019, using the keywords ("latent tuberculosis" OR "latent tuberculosis infection" OR "LTBI") AND ("interferon gamma release assays" OR "Interferon-gamma Release Test" OR "IGRA" OR "QuantiFERON®-TB in tube" OR "QFT" OR "T-SPOT.TB") AND ("tuberculin skin test" OR "tuberculin test" OR "Mantoux test" OR "TST"). We included articles that used a cohort study design; included information that individuals with latent tuberculosis infection detected by IFN-γ release assay, tuberculin skin test, or both, progressed to active tuberculosis; reported information about treatment; and were limited to high-risk populations. We excluded studies that included patients with active or suspected tuberculosis at baseline, evaluated a non-commercial IFN-γ release assay, and had follow-up of less than 1 year. We extracted study details (study design, population investigated, tests used, follow-up period) and the number of individuals observed at baseline, who progressed to active tuberculosis, and who were treated. We then calculated the pooled risk ratio (RR) for disease progression, positive predictive value (PPV), and negative predictive value (NPV) of IFN-γ release assay versus tuberculin skin test. FINDINGS We identified 1823 potentially eligible studies after exclusion of duplicates, of which 256 were eligible for full-text screening. From this screening, 40 studies (50 592 individuals in 41 cohorts) were identified as eligible and included in our meta-analysis. Pooled RR for the rate of disease progression in untreated individuals who were positive by IFN-γ release assay versus those were negative was 9·35 (95% CI 6·48-13·49) compared with 4·24 (3·30-5·46) for tuberculin skin test. Pooled PPV for IFN-γ release assay was 4·5% (95% CI 3·3-5·8) compared with 2·3% (1·5-3·1) for tuberculin skin test. Pooled NPV for IFN-γ release assay was 99·7% (99·5-99·8) compared with 99·3% (99·0-99·5) for tuberculin skin test. Pooled RR for rates of disease progression in individuals positive by IFN-γ release assay who were untreated versus those who were treated was 3·09 (95% CI 2·08-4·60) compared with 1·11 (0·69-1·79) for the same populations who were positive by tuberculin skin test. Pooled proportion of disease progression for individuals who were positive by IFN-γ release assay and tuberculin skin test was 6·1 (95% CI 2·3-11·5). Pooled RR for rates of disease progression in individuals who were positive by IFN-γ release assay and tuberculin skin test who were untreated versus those who were treated was 7·84 (95% CI 4·44-13·83). INTERPRETATION IFN-γ release assays have a better predictive ability than tuberculin skin tests. Individuals who are positive by IFN-γ release assay might benefit from preventive treatment, but those who are positive by tuberculin skin test probably will not. Dual testing might improve detection, but further confirmation is needed. FUNDING National Natural Science Foundation of China and Natural Foundation of Yunnan Province.
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Affiliation(s)
- Guozhong Zhou
- Department of Microbiology and Immunology, Kunming Medical University, Kunming, Yunnan Province, China
| | - Qingyi Luo
- School of Basic Medical Sciences, Department of Medical Imaging, Affiliated Yanan Hospital, Kunming Medical University, Kunming, Yunnan Province, China
| | - Shiqi Luo
- Department of Microbiology and Immunology, Kunming Medical University, Kunming, Yunnan Province, China
| | - Zhaowei Teng
- Department of Orthopedic Surgery, The 6th Affiliated Hospital, Kunming Medical University, Kunming, Yunnan Province, China
| | - Zhenhua Ji
- Department of Microbiology and Immunology, Kunming Medical University, Kunming, Yunnan Province, China
| | - Jiaru Yang
- Department of Microbiology and Immunology, Kunming Medical University, Kunming, Yunnan Province, China
| | - Feng Wang
- Department of Microbiology and Immunology, Kunming Medical University, Kunming, Yunnan Province, China
| | - Shiyuan Wen
- Department of Microbiology and Immunology, Kunming Medical University, Kunming, Yunnan Province, China
| | - Zhe Ding
- Department of Microbiology and Immunology, Kunming Medical University, Kunming, Yunnan Province, China
| | - Lianbao Li
- Department of Microbiology and Immunology, Kunming Medical University, Kunming, Yunnan Province, China
| | - Taigui Chen
- Department of Microbiology and Immunology, Kunming Medical University, Kunming, Yunnan Province, China
| | - Manzama-Esso Abi
- Department of Microbiology and Immunology, Kunming Medical University, Kunming, Yunnan Province, China
| | - Miaomiao Jian
- Department of Biochemistry and Molecular Biology, Kunming Medical University, Kunming, Yunnan Province, China
| | - Lisha Luo
- Department of Biochemistry and Molecular Biology, Kunming Medical University, Kunming, Yunnan Province, China
| | - Aihua Liu
- Department of Biochemistry and Molecular Biology, Kunming Medical University, Kunming, Yunnan Province, China; Yunnan Province Key Laboratory for Tropical Infectious Diseases in Universities, Kunming Medical University, Kunming, Yunnan Province, China; The Institute for Tropical Medicine, Kunming Medical University, Kunming, Yunnan Province, China.
| | - Fukai Bao
- Department of Microbiology and Immunology, Kunming Medical University, Kunming, Yunnan Province, China; Yunnan Province Key Laboratory for Tropical Infectious Diseases in Universities, Kunming Medical University, Kunming, Yunnan Province, China; The Institute for Tropical Medicine, Kunming Medical University, Kunming, Yunnan Province, China.
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24
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Gupta RK, Lipman M, Jackson C, Sitch AJ, Southern J, Drobniewski F, Deeks JJ, Tsou CY, Griffiths C, Davidson J, Campbell C, Stirrup O, Noursadeghi M, Kunst H, Haldar P, Lalvani A, Abubakar I. Quantitative IFN-γ Release Assay and Tuberculin Skin Test Results to Predict Incident Tuberculosis. A Prospective Cohort Study. Am J Respir Crit Care Med 2020; 201:984-991. [PMID: 31825645 DOI: 10.1164/rccm.201905-0969oc] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rationale: Development of diagnostic tools with improved predictive value for tuberculosis (TB) is a global research priority.Objectives: We evaluated whether implementing higher diagnostic thresholds than currently recommended for QuantiFERON Gold-in-Tube (QFT-GIT), T-SPOT.TB, and the tuberculin skin test (TST) might improve prediction of incident TB.Methods: Follow-up of a UK cohort of 9,610 adult TB contacts and recent migrants was extended by relinkage to national TB surveillance records (median follow-up 4.7 yr). Incidence rates and rate ratios, sensitivities, specificities, and predictive values for incident TB were calculated according to ordinal strata for quantitative results of QFT-GIT, T-SPOT.TB, and TST (with adjustment for prior bacillus Calmette-Guérin [BCG] vaccination).Measurements and Main Results: For all tests, incidence rates and rate ratios increased with the magnitude of the test result (P < 0.0001). Over 3 years' follow-up, there was a modest increase in positive predictive value with the higher thresholds (3.0% for QFT-GIT ≥0.35 IU/ml vs. 3.6% for ≥4.00 IU/ml; 3.4% for T-SPOT.TB ≥5 spots vs. 5.0% for ≥50 spots; and 3.1% for BCG-adjusted TST ≥5 mm vs. 4.3% for ≥15 mm). As thresholds increased, sensitivity to detect incident TB waned for all tests (61.0% for QFT-GIT ≥0.35 IU/ml vs. 23.2% for ≥4.00 IU/ml; 65.4% for T-SPOT.TB ≥5 spots vs. 27.2% for ≥50 spots; 69.7% for BCG-adjusted TST ≥5 mm vs. 28.1% for ≥15 mm).Conclusions: Implementation of higher thresholds for QFT-GIT, T-SPOT.TB, and TST modestly increases positive predictive value for incident TB, but markedly reduces sensitivity. Novel biomarkers or validated multivariable risk algorithms are required to improve prediction of incident TB.
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Affiliation(s)
| | - Marc Lipman
- UCL-TB.,UCL Respiratory, and.,Royal Free London National Health Service (NHS) Foundation Trust, London, United Kingdom
| | | | - Alice J Sitch
- National Institute for Health Research Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, United Kingdom.,Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Jo Southern
- Tuberculosis Unit, Public Health England, Colindale, London, United Kingdom
| | | | - Jonathan J Deeks
- National Institute for Health Research Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, United Kingdom.,Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Chuen-Yan Tsou
- Tuberculosis Unit, Public Health England, Colindale, London, United Kingdom
| | | | - Jennifer Davidson
- Tuberculosis Unit, Public Health England, Colindale, London, United Kingdom
| | - Colin Campbell
- Tuberculosis Unit, Public Health England, Colindale, London, United Kingdom
| | | | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Heinke Kunst
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.,Department of Respiratory Medicine, Barts Health NHS Trust, London, United Kingdom; and
| | - Pranab Haldar
- Respiratory Biomedical Research Centre, Institute for Lung Health, Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, United Kingdom
| | - Ajit Lalvani
- Tuberculosis Research Centre, National Heart and Lung Institute, Imperial College, London, United Kingdom
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25
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Zhang H, Cao X, Xin H, Liu J, Pan S, Guan L, Shen F, Liu Z, Wang D, Guan X, Yan J, Feng B, Li N, Jin Q, Gao L. Serum level of IL-1ra was associated with the treatment of latent tuberculosis infection in a Chinese population. BMC Infect Dis 2020; 20:330. [PMID: 32384874 PMCID: PMC7206663 DOI: 10.1186/s12879-020-05047-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 04/21/2020] [Indexed: 02/01/2023] Open
Abstract
Background Dynamically changed levels of serum cytokines might predict the development of active TB from latent tuberculosis infection (LTBI) and monitor preventive treatment effectiveness. The aim of the study was to identify potential serum cytokines associated with LTBI treatment which might predict active disease development in a Chinese population. Methods Based on a randomized controlled trial aiming to explore short-course regimens for LTBI treatment, the dynamic changes of serum cytokines determined by bead-based multiplex assays were investigated for the participants who developed active TB during follow-up and age and gender matched controls stayed healthy. Results Totally, 21 patients diagnosed with active tuberculosis (TB) during the 2-year follow-up (12 from treated groups and 9 from untreated controls) and 42 age and gender matched healthy controls (24 from treated groups and 18 from untreated controls) were included in the study. Before treatment, serum IL-1ra was statistically higher among those who developed active disease during follow-up as compared with those stayed healthy. As for treated participants, the levels of IL-1ra were significantly lower after treatment in comparison with those before treatment both in active TB group (p = 0.002) and non-TB group (p = 0.009). For untreated participants, the levels of IL-1ra were not statistically different between different time points both in active TB group (p = 0.078) and non-TB group (p = 0.265). Conclusion Our results suggested that declined serum level of IL-1ra was associated with LTBI treatment. Further studies are needed to verify whether it could be used to evaluate LTBI treatment and to predict active disease development.
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Affiliation(s)
- Haoran 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, No. 9 Dong Dan San Tiao, Dongcheng District, Beijing, 100730, China
| | - Xuefang 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, No. 9 Dong Dan San Tiao, Dongcheng District, Beijing, 100730, China
| | - Henan 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, No. 9 Dong Dan San Tiao, Dongcheng District, Beijing, 100730, China
| | - Jianmin Liu
- The Sixth People's Hospital of Zhengzhou, Zhengzhou, 450061, China
| | - Shouguo Pan
- The Center for Disease Prevention and Control of Zhongmu County, Zhengzhou, 451470, China
| | - Ling Guan
- The Sixth People's Hospital of Zhengzhou, Zhengzhou, 450061, China
| | - Fei Shen
- The Sixth People's Hospital of Zhengzhou, Zhengzhou, 450061, China
| | - Zisen Liu
- The Center for Disease Prevention and Control of Zhongmu County, Zhengzhou, 451470, China
| | - Dakuan Wang
- The Center for Disease Prevention and Control of Zhongmu County, Zhengzhou, 451470, China
| | - Xueling Guan
- The Sixth People's Hospital of Zhengzhou, Zhengzhou, 450061, China
| | - Jiaoxia Yan
- The Center for Disease Prevention and Control of Zhongmu County, Zhengzhou, 451470, China
| | - Boxuan 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, No. 9 Dong Dan San Tiao, Dongcheng District, Beijing, 100730, China
| | - Na Li
- Gastroenterology Department, PLA Rocket Force Characteristic Medical Center, Beijing, 100088, China
| | - Qi 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, No. 9 Dong Dan San Tiao, Dongcheng District, Beijing, 100730, China
| | - Lei 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, No. 9 Dong Dan San Tiao, Dongcheng District, Beijing, 100730, China.
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Dheda K, Davids M. Latent Tuberculosis Infection–associated Immunodiagnostic Test Responses as Biomarkers of Incipient Tuberculosis: Fruitful or Futile? Am J Respir Crit Care Med 2020; 201:895-898. [PMID: 31951482 PMCID: PMC7159435 DOI: 10.1164/rccm.201912-2425ed] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Keertan Dheda
- Centre for Lung Infection and ImmunityUCT Lung InstituteCape Town, South Africa
- Faculty of Infectious and Tropical DiseasesLondon School of Hygiene and Tropical MedicineLondon, United Kingdomand
- South African MRC/UCT Centre for the Study of Antimicrobial ResistanceUniversity of Cape TownCape Town, South Africa
| | - Malika Davids
- Centre for Lung Infection and ImmunityUCT Lung InstituteCape Town, South Africa
- Faculty of Infectious and Tropical DiseasesLondon School of Hygiene and Tropical MedicineLondon, United Kingdomand
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Gupta RK, Turner CT, Venturini C, Esmail H, Rangaka MX, Copas A, Lipman M, Abubakar I, Noursadeghi M. Concise whole blood transcriptional signatures for incipient tuberculosis: a systematic review and patient-level pooled meta-analysis. THE LANCET. RESPIRATORY MEDICINE 2020; 8:395-406. [PMID: 31958400 PMCID: PMC7113839 DOI: 10.1016/s2213-2600(19)30282-6] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/15/2019] [Accepted: 08/16/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Multiple blood transcriptional signatures have been proposed for identification of active and incipient tuberculosis. We aimed to compare the performance of systematically identified candidate signatures for incipient tuberculosis and to benchmark these against WHO targets. METHODS We did a systematic review and individual participant data meta-analysis. We searched Medline and Embase for candidate whole blood mRNA signatures discovered with the primary objective of diagnosis of active or incipient tuberculosis, compared with controls who were healthy or had latent tuberculosis infection. We tested the performance of eligible signatures in whole blood transcriptomic datasets, in which sampling before tuberculosis diagnosis was done and time to disease was available. Culture-confirmed and clinically or radiologically diagnosed pulmonary or extrapulmonary tuberculosis cases were included. Non-progressor (individuals who remained tuberculosis-free during follow-up) samples with less than 6 months of follow-up from the date of sample collection were excluded, as were participants with prevalent tuberculosis and those who received preventive therapy. Scores were calculated for candidate signatures for each participant in the pooled dataset. Receiver operating characteristic curves, sensitivities, and specificities were examined using prespecified intervals to tuberculosis (<3 months, <6 months, <1 year, and <2 years) from sample collection. This study is registered with PROSPERO, number CRD42019135618. RESULTS We tested 17 candidate mRNA signatures in a pooled dataset from four eligible studies comprising 1126 samples. This dataset included 183 samples from 127 incipient tuberculosis cases in South Africa, Ethiopia, The Gambia, and the UK. Eight signatures (comprising 1-25 transcripts) that predominantly reflect interferon and tumour necrosis factor-inducible gene expression, had equivalent diagnostic accuracy for incipient tuberculosis over a 2-year period with areas under the receiver operating characteristic curves ranging from 0·70 (95% CI 0·64-0·76) to 0·77 (0·71-0·82). The sensitivity of all eight signatures declined with increasing disease-free time interval. Using a threshold derived from two SDs above the mean of uninfected controls to prioritise specificity and positive-predictive value, the eight signatures achieved sensitivities of 24·7-39·9% over 24 months and of 47·1-81·0% over 3 months, with corresponding specificities of more than 90%. Based on pre-test probability of 2%, the eight signatures achieved positive-predictive values ranging from 6·8-9·4% over 24 months and 11·2-14·4% over 3 months. When using biomarker thresholds maximising sensitivity and specificity with equal weighting to both, no signature met the minimum WHO target product profile parameters for incipient tuberculosis biomarkers over a 2-year period. INTERPRETATION Blood transcriptional biomarkers reflect short-term risk of tuberculosis and only exceed WHO benchmarks if applied to 3-6-month intervals. Serial testing among carefully selected target groups might be required for optimal implementation of these biomarkers. FUNDING Wellcome Trust and National Institute for Health Research.
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Affiliation(s)
- Rishi K Gupta
- Institute for Global Health, University College London, London, UK
| | - Carolin T Turner
- Division of Infection & Immunity, University College London, London, UK
| | | | - Hanif Esmail
- Institute for Global Health, University College London, London, UK; Medical Research Council Clinical Trials Unit, University College London, London, UK; Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Molebogeng X Rangaka
- Institute for Global Health, University College London, London, UK; Medical Research Council Clinical Trials Unit, University College London, London, UK; Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Andrew Copas
- Institute for Global Health, University College London, London, UK; Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Marc Lipman
- UCL-TB and UCL Respiratory, University College London, London, UK; Department of Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK
| | - Mahdad Noursadeghi
- Division of Infection & Immunity, University College London, London, UK.
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28
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Zellweger JP. Is the EU model for contact investigation applicable to high TB burden settings? Int J Infect Dis 2020; 92S:S55-S59. [DOI: 10.1016/j.ijid.2020.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/10/2020] [Accepted: 02/11/2020] [Indexed: 11/16/2022] Open
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Ma Y, Li R, Shen J, He L, Li Y, Zhang N, Wu Q, Zhang J, Zheng J, Wang X. Clinical effect of T-SPOT.TB test for the diagnosis of tuberculosis. BMC Infect Dis 2019; 19:993. [PMID: 31752713 PMCID: PMC6873440 DOI: 10.1186/s12879-019-4597-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 10/25/2019] [Indexed: 11/12/2022] Open
Abstract
Background The goal of this study was to further investigate the clinical effectiveness of the T-SPOT.TB test in diagnosing tuberculosis (TB), including the effects of T-SPOT.TB test on evaluating diverse TB types and locations. Methods We collected 20,332 specimens from patients suspected to have TB. Afterwards, we performed an integrative analysis of T-SPOT.TB results and clinical diagnoses, and evaluated the composition ratio and positive detection rate of the T-SPOT.TB test in various age groups, sample types, and hospital departments. In addition, we compared the spot number and composition rate between latent TB infection (LTBI), active TB infection, and old TB infection groups. The active TB group was then further divided into pulmonary TB (PTB), pulmonary and extrapulmonary TB (PETB), and extrapulmonary TB (EPTB) subgroups, and we evaluated whether there were statistical differences in spot number and composition rate between subgroups. Results Positive results from the T-SPOT.TB test were found across different age groups, specimen types, and hospital departments. Elderly patient groups, pleural effusion samples, and thoracic surgery departments showed the highest rates of positivity. There were no statistically significant differences in spot number of CFP-10 and ESAT-6 wells between disease groups or active TB subgroups. The composition rate, however, was significantly different when ESAT-6 and CFP-10 wells were double-positive. The spot number and composition rate were statistically different between the three disease groups, but showed no significant differences between the three subgroups of active TB. Conclusions The results of T-SPOT. TB test showed differences in LTBI, active TB and old TB. Additionally, a higher spot number level was observed in the active TB group.
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Affiliation(s)
- Yanfen Ma
- Department of Clinical Laboratory, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China
| | - Ruicheng Li
- Department of Clinical Laboratory, The Second Affiliated Hospital of Air Force Medical University, Xi'an, 710038, Shaanxi Province, China
| | - Jinghui Shen
- Department of Clinical Laboratory, Xi'an Central Hospital, Xi'an, 710003, Shaanxi Province, China
| | - Longmei He
- Department of Clinical Laboratory, Shaanxi Provincial Hospital of Traditional Chinese Medicine, Xi'an, 710061, Shaanxi Province, China
| | - Ying Li
- Department of Clinical Laboratory, Shaanxi KangFu Hospital, Xi'an, 710061, Shaanxi Province, China
| | - Ning Zhang
- Department of Clinical Laboratory, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China
| | - Qian Wu
- Department of Clinical Laboratory, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China
| | - Jinling Zhang
- Department of Clinical Laboratory, Xi'an Encephalopathy Hospital, Xi'an, 710061, Shaanxi Province, China
| | - Jie Zheng
- Clinical Research Center, The The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China.
| | - Xiaoqin Wang
- Department of Clinical Laboratory, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China.
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Muñoz L, Santin M, Alcaide F, Ruíz-Serrano MJ, Gijón P, Bermúdez E, Domínguez-Castellano A, Navarro MD, Ramírez E, Pérez-Escolano E, López-Prieto MD, Gutiérrez-Rodriguez J, Anibarro L, Calviño L, Trigo M, Cifuentes C, García-Gasalla M, Payeras A, Gasch O, Espasa M, Agüero R, Ferrer D, Casas X, González-Cuevas A, García-Zamalloa A, Bikuña E, Lecuona M, Galindo R, Ramírez-Lapausa M, Carrillo R. QuantiFERON-TB Gold In-Tube as a Confirmatory Test for Tuberculin Skin Test in Tuberculosis Contact Tracing: A Noninferiority Clinical Trial. Clin Infect Dis 2019; 66:396-403. [PMID: 29020191 DOI: 10.1093/cid/cix745] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 08/15/2017] [Indexed: 12/15/2022] Open
Abstract
Background Screening strategies based on interferon-γ release assays in tuberculosis contact tracing may reduce the need for preventive therapy without increasing subsequent active disease. Methods We conducted an open-label, randomized trial to test the noninferiority of a 2-step strategy with the tuberculin skin test (TST) followed by QuantiFERON-TB Gold In-Tube (QFT-GIT) as a confirmatory test (the TST/QFT arm) to the standard TST-alone strategy (TST arm) for targeting preventive therapy in household contacts of patients with tuberculosis. Participants were followed for 24 months after randomization. The primary endpoint was the development of tuberculosis, with a noninferiority margin of 1.5 percentage points. Results A total of 871 contacts were randomized. Four contacts in the TST arm and 2 in the TST/QFT arm developed tuberculosis. In the modified intention-to-treat analysis, this accounted for 0.99% in the TST arm and 0.51% in the TST/QFT arm (-0.48% difference; 97.5% confidence interval [CI], -1.86% to 0.90%); in the per-protocol analysis, the corresponding rates were 1.67% and 0.82% in the TST and TST/QFT arms, respectively (-0.85% difference; 97.5% CI, -3.14% to 1.43%). Of the 792 contacts analyzed, 65.3% in the TST arm and 42.2% in the TST/QFT arm were diagnosed with tuberculosis infection (23.1% difference; 95% CI, 16.4% to 30.0%). Conclusions In low-incidence settings, screening household contacts with the TST and using QFT-GIT as a confirmatory test is not inferior to TST-alone for preventing active tuberculosis, allowing a safe reduction of preventive treatments. Clinical Trials Registration NCT01223534.
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Affiliation(s)
- Laura Muñoz
- Department of Infectious Diseases, Hospital Universitari de Bellvitge-IDIBELL, Barcelona
| | - Miguel Santin
- Department of Infectious Diseases, Hospital Universitari de Bellvitge-IDIBELL, Barcelona
| | - Fernando Alcaide
- Department of Microbiology, Hospital Universitari de Bellvitge-IDIBELL, Barcelona
| | - Maria Jesús Ruíz-Serrano
- Department of Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid
| | - Paloma Gijón
- Department of Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid
| | - Elena Bermúdez
- Department of Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid
| | - Angel Domínguez-Castellano
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Hospital Virgen Macarena, Sevilla
| | - María Dolores Navarro
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Hospital Virgen Macarena, Sevilla
| | - Encarnación Ramírez
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Hospital Virgen Macarena, Sevilla
| | - Elvira Pérez-Escolano
- Clinical Unit of Infectious Diseases and Microbiology, Hospital Jerez, Jerez de la Frontera Cádiz
| | | | | | - Luis Anibarro
- Infectious Diseases Unit, Complexo Hospitalario de Pontevedra
| | - Laura Calviño
- Infectious Diseases Unit, Complexo Hospitalario de Pontevedra
| | - Matilde Trigo
- Department of Microbiology, Complexo Hospitalario de Pontevedra
| | - Carmen Cifuentes
- Department of Internal Medicine, Hospital Son Llàtzer, Palma de Mallorca
| | | | - Antoni Payeras
- Department of Internal Medicine, Hospital Son Llàtzer, Palma de Mallorca
| | - Oriol Gasch
- Department of Infectious Diseases, Corporació Sanitària Parc Taulí, Sabadell Barcelona
| | - Mateu Espasa
- Department of Microbiology, Corporació Sanitària Parc Taulí, Sabadell Barcelona
| | - Ramon Agüero
- Respiratory Medicine, Hospital Universitario Marqués de Valdecilla, Santander
| | - Diego Ferrer
- Respiratory Medicine, Hospital Universitario Marqués de Valdecilla, Santander
| | - Xavier Casas
- Respiratory Medicine Department, Parc Sanitari Sant Joan de Déu, Sant Boi Barcelona
| | | | | | - Edurne Bikuña
- Department of Internal Medicine, Hospital de Mendaro, Mendaro Gipuzkoa
| | - María Lecuona
- Department of Microbiology, Hospital Universitario de Canarias, La Laguna Tenerife
| | - Rosa Galindo
- Respiratory Medicine, Hospital Universitario de Canarias, La Laguna Tenerife
| | | | - Raquel Carrillo
- Department of Internal Medicine, Hospital de Cantoblanco, Madrid, Spain
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Kampmann B, Seddon JA, Paton J, Nademi Z, Keane D, Williams B, Williams A, Liebeschutz S, Riddell A, Bernatoniene J, Patel S, Martinez N, McMaster P, Basu-Roy R, Welch SB. Evaluating UK National Guidance for Screening of Children for Tuberculosis. A Prospective Multicenter Study. Am J Respir Crit Care Med 2019; 197:1058-1064. [PMID: 29190430 DOI: 10.1164/rccm.201707-1487oc] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE To identify infected contacts of tuberculosis (TB) cases, the UK National Institute for Health and Care Excellence (NICE) recommended the addition of IFN-γ release assays (IGRA) to the tuberculin skin test (TST) in its 2006 TB guidelines. Treatment for TB infection was no longer recommended for children who screened TST-positive but IGRA-negative. OBJECTIVES We performed a cohort study to evaluate the risk of TB disease in this group. METHODS Children exposed to an infectious case of TB in their household were recruited from 11 pediatric TB clinics. TST and IGRA were performed at baseline, with IGRA repeated at 8 weeks and TST repeated if initially negative. Children were treated according to 2006 NICE guidelines and followed for 24 months. MEASUREMENTS AND MAIN RESULTS Of 431 recruited children, 392 completed the study. We diagnosed 48 (12.2%) cases of prevalent TB disease, 105 (26.8%) with TB infection, and 239 (60.9%) without TB infection or disease. Eighteen children aged 2 years and above had a positive TST but persistently negative IGRA. None received TB infection treatment and none developed TB disease. Ninety (26.1%) children qualified for TB infection treatment according to 2006 NICE guidelines. In contrast, 147 (42.7%) children would have qualified under revised NICE guidance, issued in 2016. CONCLUSIONS In this low-prevalence setting we saw no incident cases of TB disease in children who were TST-positive but IGRA-negative and did not receive treatment for TB infection. Following the latest NICE guidance, significantly more children will require medication.
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Affiliation(s)
- Beate Kampmann
- 1 Centre of International Child Health, Department of Academic Paediatrics, Imperial College London, London, United Kingdom.,2 Vaccines & Immunity Theme, Medical Research Council Unit The Gambia, Fajara, Gambia
| | - James A Seddon
- 1 Centre of International Child Health, Department of Academic Paediatrics, Imperial College London, London, United Kingdom
| | - James Paton
- 3 School of Medicine, College of Medical, Veterinary, and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Zohreh Nademi
- 4 Department of Paediatrics, Great North Children Hospital, Newcastle upon Tyne, United Kingdom.,5 Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Denis Keane
- 1 Centre of International Child Health, Department of Academic Paediatrics, Imperial College London, London, United Kingdom
| | - Bhanu Williams
- 6 Department of Paediatrics, London North West Healthcare National Health Service Trust, Northwick Park Hospital, Middlesex, United Kingdom
| | - Amanda Williams
- 6 Department of Paediatrics, London North West Healthcare National Health Service Trust, Northwick Park Hospital, Middlesex, United Kingdom
| | - Sue Liebeschutz
- 7 Department of Paediatrics, Newham University Hospital, and
| | - Anna Riddell
- 8 The Children's Hospital at the Royal London Hospital, Barts Health National Health Service Trust, London, United Kingdom
| | - Jolanta Bernatoniene
- 9 Department of Paediatric Infectious Diseases, Bristol Royal Hospital for Children, Paul O'Gorman Building, Bristol, United Kingdom
| | - Sanjay Patel
- 10 Department of Paediatric Infectious Diseases and Immunology, Southampton Children's Hospital, Southampton, United Kingdom
| | - Nuria Martinez
- 11 Department of Paediatric Infectious Diseases, Evelina Children's Hospital, London, United Kingdom
| | - Paddy McMaster
- 12 Department of Paediatric Infectious Diseases, North Manchester General Hospital, Manchester, United Kingdom; and
| | - Robindra Basu-Roy
- 1 Centre of International Child Health, Department of Academic Paediatrics, Imperial College London, London, United Kingdom
| | - Steven B Welch
- 13 Birmingham Chest Clinic, Heart of England National Health Service Foundation Trust, West Midlands, United Kingdom
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Hamada Y, Glaziou P, Sismanidis C, Getahun H. Prevention of tuberculosis in household members: estimates of children eligible for treatment. Bull World Health Organ 2019; 97:534-547D. [PMID: 31384072 PMCID: PMC6653819 DOI: 10.2471/blt.18.218651] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 04/24/2019] [Accepted: 05/06/2019] [Indexed: 02/08/2023] Open
Abstract
Objective To estimate of the number of children younger than 5 years who were household contacts of people with tuberculosis and were eligible for tuberculosis preventive treatment in 2017. Methods To estimate the number of eligible children, we obtained national values for the number of notified cases of bacteriologically confirmed pulmonary tuberculosis in 2017, the proportion of the population younger than 5 years in 2017 and average household size from published sources. We obtained global values for the number of active tuberculosis cases per household with an index case and for the prevalence of latent tuberculosis infection among children younger than 5 years who were household contacts of a tuberculosis case through systematic reviews, meta-analysis and Poisson regression models. Findings The estimated number of children younger than 5 years eligible for tuberculosis preventive treatment in 2017 globally was 1.27 million (95% uncertainty interval, UI: 1.24–1.31), which corresponded to an estimated global coverage of preventive treatment in children of 23% at best. By country, the estimated number ranged from less than one in the Bahamas, Iceland, Luxembourg and Malta to 350 000 (95% UI: 320 000–380 000) in India. Regionally, the highest estimates were for the World Health Organization (WHO) South-East Asia Region (510 000; 95% UI: 450 000–580 000) and the WHO African Region (470 000; 95% UI: 440 000–490 000). Conclusion Tuberculosis preventive treatment in children was underutilized globally in 2017. Treatment should be scaled up to help eliminate the pool of tuberculosis infection and achieve the End TB Strategy targets.
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Affiliation(s)
- Yohhei Hamada
- Global Tuberculosis Programme, World Health Organization, 20 avenue Appia, 1211 Geneva 27, Switzerland
| | - Philippe Glaziou
- Global Tuberculosis Programme, World Health Organization, 20 avenue Appia, 1211 Geneva 27, Switzerland
| | - Charalambos Sismanidis
- Global Tuberculosis Programme, World Health Organization, 20 avenue Appia, 1211 Geneva 27, Switzerland
| | - Haileyesus Getahun
- Global Tuberculosis Programme, World Health Organization, 20 avenue Appia, 1211 Geneva 27, Switzerland
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Abubakar I, Lalvani A, Southern J, Sitch A, Jackson C, Onyimadu O, Lipman M, Deeks JJ, Griffiths C, Bothamley G, Kon OM, Hayward A, Lord J, Drobniewski F. Two interferon gamma release assays for predicting active tuberculosis: the UK PREDICT TB prognostic test study. Health Technol Assess 2019; 22:1-96. [PMID: 30334521 DOI: 10.3310/hta22560] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Despite a recent decline in the annual incidence of tuberculosis (TB) in the UK, rates remain higher than in most Western European countries. The detection and treatment of latent TB infection (LTBI) is an essential component of the UK TB control programme. OBJECTIVES To assess the prognostic value and cost-effectiveness of the current two interferon gamma release assays (IGRAs) compared with the standard tuberculin skin test (TST) for predicting active TB among untreated individuals at increased risk of TB: (1) contacts of active TB cases and (2) new entrants to the UK from high-TB-burden countries. DESIGN A prospective cohort study and economic analysis. PARTICIPANTS AND SETTING Participants were recruited in TB clinics, general practices and community settings. Contacts of active TB cases and migrants who were born in high-TB-burden countries arriving in the UK were eligible to take part if they were aged ≥ 16 years. MAIN OUTCOME MEASURES Outcomes include incidence rate ratios comparing the incidence of active TB in those participants with a positive test result and those with a negative test result for each assay, and combination of tests and the cost per quality-adjusted life-year (QALY) for each screening strategy. RESULTS A total of 10,045 participants were recruited between May 2010 and July 2015. Among 9610 evaluable participants, 97 (1.0%) developed active TB. For the primary analysis, all test data were available for 6380 participants, with 77 participants developing active TB. A positive result for TSTa (positive if induration is ≥ 5 mm) was a significantly poorer predictor of progression to active TB than a positive result for any of the other tests. Compared with TSTb [positive if induration is ≥ 6 mm without prior bacillus Calmette-Guérin (BCG) alone, T-SPOT®.TB (Oxford Immunotec Ltd, Oxford, UK), TSTa + T-SPOT.TB, TSTa + IGRA and the three combination strategies including TSTb were significantly superior predictors of progression. Compared with the T-SPOT.TB test alone, TSTa + T-SPOT.TB, TSTb + QuantiFERON® TB Gold In-Tube (QFT-GIT; QIAGEN GmbH, Hilden, Germany) and TSTb + IGRA were significantly superior predictors of progression and, compared with QFT-GIT alone, T-SPOT.TB, TSTa + T-SPOT.TB, TSTa + QFT-GIT, TSTa + IGRA, TSTb + T-SPOT.TB, TSTb + QFT-GIT and TSTb + IGRA were significantly superior predictors of progression. When evaluating the negative predictive performance of tests and strategies, negative results for TSTa + QFT-GIT were significantly poorer predictors of non-progression than negative results for TSTa, T-SPOT.TB and TSTa + IGRA. The most cost-effective LTBI testing strategies are the dual-testing strategies. The cost and QALY differences between the LTBI testing strategies were small; in particular, QFT-GIT, TSTb + T-SPOT.TB and TSTb + QFT-GIT had very similar incremental net benefit estimates. CONCLUSION This study found modest differences between tests, or combinations of tests, in identifying individuals who would go on to develop active TB. However, a two-step approach that combined TSTb with an IGRA was the most cost-effective testing option. IMPLICATIONS FOR PRACTICE AND FUTURE RESEARCH The two-step TSTb strategy, which stratified the TST by prior BCG vaccination followed by an IGRA, was the most cost-effective approach. The limited ability of current tests to predict who will progress limits the clinical utility of tests. The implications of these results for the NHS England/Public Health England national TB screening programme for migrants should be investigated. STUDY REGISTRATION This study is registered as NCT01162265. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK
| | - Ajit Lalvani
- Tuberculosis Research Centre, National Heart and Lung Institute, Imperial College London, London, UK
| | - Jo Southern
- National Infection Service, Public Health England, London, UK
| | - Alice Sitch
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Oluchukwu Onyimadu
- Southampton Health Technology Assessment Centre, University of Southampton, Southampton, UK
| | - Marc Lipman
- Respiratory Medicine, University College London, London, UK
| | - Jonathan J Deeks
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Chris Griffiths
- Blizard Institute, Queen Mary University of London, London, UK
| | | | - Onn Min Kon
- Imperial College Healthcare NHS Trust, London, UK
| | - Andrew Hayward
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Joanne Lord
- Southampton Health Technology Assessment Centre, University of Southampton, Southampton, UK
| | - Francis Drobniewski
- Tuberculosis Research Centre, National Heart and Lung Institute, Imperial College London, London, UK
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Bennet R, Nejat S, Eriksson M. Effective Tuberculosis Contact Investigation Using Interferon-Gamma Release Assays. Pediatr Infect Dis J 2019; 38:e76-e78. [PMID: 30882747 DOI: 10.1097/inf.0000000000002272] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
During 2000 to 2018, 1831 children were screened as part of tuberculosis contact investigation at the Stockholm Northern Clinic. The risk of a child having a positive tuberculin skin test was 33% and positive interferon-gamma release assay 12%. The risk of tuberculosis disease was 6.1% (tuberculin skin test) and 13% (interferon-gamma release assay) in positive-testing children.
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Affiliation(s)
- Rutger Bennet
- From the Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
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Villar-Hernández R, Latorre I, De Souza-Galvão ML, Jiménez MA, Ruiz-Manzano J, Pilarte J, García-García E, Muriel-Moreno B, Cantos A, Altet N, Millet JP, González-Díaz Y, Molina-Pinargote I, Prat C, Ruhwald M, Domínguez J. Use of IP-10 detection in dried plasma spots for latent tuberculosis infection diagnosis in contacts via mail. Sci Rep 2019; 9:3943. [PMID: 30850687 PMCID: PMC6408503 DOI: 10.1038/s41598-019-40778-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 02/22/2019] [Indexed: 02/07/2023] Open
Abstract
The aim of this study was to test the use of IP-10 detection in dried plasma from contact studies individuals (contacts of smear positive patients), by comparing it with IP-10 and IFN-γ detection in direct plasma, to establish IP-10 detection in DPS as a useful assay for LTBI diagnosis. Whole blood samples were collected from 80 subjects: 12 with active tuberculosis (TB), and 68 from contact studies. The amount of IFN-γ produced by sensitized T cells was determined in direct plasma by QuantiFERON Gold In-Tube test. IP-10 levels were determined in direct and dried plasma by an in-house ELISA. For dried plasma IP-10 determination, two 25 µl plasma drops were dried in Whatman903 filter paper and sent by mail to the laboratory. Regarding TB patients, 100.0%, 91.7% and 75.0% were positive for IFN-γ detection and IP-10 detection in direct and dried plasma, respectively. In contacts, 69.1%, 60.3% and 48.5% had positive results after IFN-γ and IP-10 in direct and dried plasma, respectively. The agreement among in vitro tests was substantial and IP-10 levels in direct and dried plasma were strongly correlated (r = 0.897). In conclusion, IP-10 detection in dried plasma is a simple and safe method that would help improve LTBI management.
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Affiliation(s)
- R Villar-Hernández
- Servei de Microbiología, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol, Carretera del Canyet, 08916 Badalona, Barcelona, Spain.,CIBER Enfermedades Respiratorias, CIBERES, Instituto de Salud Carlos III, Carretera del Canyet, 08916 Badalona, Barcelona, Spain.,Universitat Autònoma de Barcelona, Carretera del Canyet, 08916 Badalona, Barcelona, Spain
| | - I Latorre
- Servei de Microbiología, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol, Carretera del Canyet, 08916 Badalona, Barcelona, Spain.,CIBER Enfermedades Respiratorias, CIBERES, Instituto de Salud Carlos III, Carretera del Canyet, 08916 Badalona, Barcelona, Spain.,Universitat Autònoma de Barcelona, Carretera del Canyet, 08916 Badalona, Barcelona, Spain
| | - M L De Souza-Galvão
- Unitat de Tuberculosi de Drassanes, Hospital Universitari Vall d'Hebron. Av. de les Drassanes, 17, 08001 Barcelona, Barcelona, Spain
| | - M A Jiménez
- Unitat de Tuberculosi de Drassanes, Hospital Universitari Vall d'Hebron. Av. de les Drassanes, 17, 08001 Barcelona, Barcelona, Spain
| | - J Ruiz-Manzano
- CIBER Enfermedades Respiratorias, CIBERES, Instituto de Salud Carlos III, Carretera del Canyet, 08916 Badalona, Barcelona, Spain.,Universitat Autònoma de Barcelona, Carretera del Canyet, 08916 Badalona, Barcelona, Spain.,Servei de Pneumologia, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet, 08916 Badalona, Barcelona, Spain
| | - J Pilarte
- Unitat de Tuberculosi de Drassanes, Hospital Universitari Vall d'Hebron. Av. de les Drassanes, 17, 08001 Barcelona, Barcelona, Spain
| | - E García-García
- Servei de Microbiología, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol, Carretera del Canyet, 08916 Badalona, Barcelona, Spain.,CIBER Enfermedades Respiratorias, CIBERES, Instituto de Salud Carlos III, Carretera del Canyet, 08916 Badalona, Barcelona, Spain.,Universitat Autònoma de Barcelona, Carretera del Canyet, 08916 Badalona, Barcelona, Spain
| | - B Muriel-Moreno
- Servei de Microbiología, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol, Carretera del Canyet, 08916 Badalona, Barcelona, Spain.,CIBER Enfermedades Respiratorias, CIBERES, Instituto de Salud Carlos III, Carretera del Canyet, 08916 Badalona, Barcelona, Spain.,Universitat Autònoma de Barcelona, Carretera del Canyet, 08916 Badalona, Barcelona, Spain
| | - A Cantos
- Unitat de Tuberculosi de Drassanes, Hospital Universitari Vall d'Hebron. Av. de les Drassanes, 17, 08001 Barcelona, Barcelona, Spain
| | - N Altet
- Unitat de Tuberculosi de Drassanes, Hospital Universitari Vall d'Hebron. Av. de les Drassanes, 17, 08001 Barcelona, Barcelona, Spain.,Unidad Clínica de Tratamiento Directamente Observado "Serveis Clinics", Carrer de García Mariño, 4, 08022, Barcelona, Spain.,CIBER de Epidemiología y Salud Pública, CIBEREESP, Instituto de Salud Carlos III, Carretera del Canyet, 08916 Badalona, Barcelona, Spain
| | - J P Millet
- Unidad Clínica de Tratamiento Directamente Observado "Serveis Clinics", Carrer de García Mariño, 4, 08022, Barcelona, Spain.,CIBER de Epidemiología y Salud Pública, CIBEREESP, Instituto de Salud Carlos III, Carretera del Canyet, 08916 Badalona, Barcelona, Spain
| | - Y González-Díaz
- Unidad Clínica de Tratamiento Directamente Observado "Serveis Clinics", Carrer de García Mariño, 4, 08022, Barcelona, Spain
| | - I Molina-Pinargote
- Unidad Clínica de Tratamiento Directamente Observado "Serveis Clinics", Carrer de García Mariño, 4, 08022, Barcelona, Spain
| | - C Prat
- Servei de Microbiología, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol, Carretera del Canyet, 08916 Badalona, Barcelona, Spain.,CIBER Enfermedades Respiratorias, CIBERES, Instituto de Salud Carlos III, Carretera del Canyet, 08916 Badalona, Barcelona, Spain.,Universitat Autònoma de Barcelona, Carretera del Canyet, 08916 Badalona, Barcelona, Spain
| | - M Ruhwald
- Department of Infectious Disease Immunology Statens Serum Institut, Copenhagen, Denmark - Artillerivej 5, 2300, Copenhagen, Denmark
| | - J Domínguez
- Servei de Microbiología, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol, Carretera del Canyet, 08916 Badalona, Barcelona, Spain. .,CIBER Enfermedades Respiratorias, CIBERES, Instituto de Salud Carlos III, Carretera del Canyet, 08916 Badalona, Barcelona, Spain. .,Universitat Autònoma de Barcelona, Carretera del Canyet, 08916 Badalona, Barcelona, Spain.
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36
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Basu Roy R, Whittaker E, Seddon JA, Kampmann B. Tuberculosis susceptibility and protection in children. THE LANCET. INFECTIOUS DISEASES 2019; 19:e96-e108. [PMID: 30322790 PMCID: PMC6464092 DOI: 10.1016/s1473-3099(18)30157-9] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 01/27/2018] [Accepted: 02/09/2018] [Indexed: 12/14/2022]
Abstract
Children represent both a clinically important population susceptible to tuberculosis and a key group in whom to study intrinsic and vaccine-induced mechanisms of protection. After exposure to Mycobacterium tuberculosis, children aged under 5 years are at high risk of progressing first to tuberculosis infection, then to tuberculosis disease and possibly disseminated forms of tuberculosis, with accompanying high risks of morbidity and mortality. Children aged 5-10 years are somewhat protected, until risk increases again in adolescence. Furthermore, neonatal BCG programmes show the clearest proven benefit of vaccination against tuberculosis. Case-control comparisons from key cohorts, which recruited more than 15 000 children and adolescents in total, have identified that the ratio of monocytes to lymphocytes, activated CD4 T cell count, and a blood RNA signature could be correlates of risk for developing tuberculosis. Further studies of protected and susceptible populations are necessary to guide development of novel tuberculosis vaccines that could facilitate the achievement of WHO's goal to eliminate deaths from tuberculosis in childhood.
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Affiliation(s)
- Robindra Basu Roy
- Centre for International Child Health, Department of Paediatrics, Imperial College London, London, UK; Vaccines and Immunity Theme MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Elizabeth Whittaker
- Centre for International Child Health, Department of Paediatrics, Imperial College London, London, UK
| | - James A Seddon
- Centre for International Child Health, Department of Paediatrics, Imperial College London, London, UK
| | - Beate Kampmann
- Centre for International Child Health, Department of Paediatrics, Imperial College London, London, UK; Vaccines and Immunity Theme MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia.
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37
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Towards better management of latent tuberculosis infection in children and young adults in the Maghreb. Conclusions of an expert meeting, Paris, 16 March 2018. Arch Pediatr 2019; 26:126-129. [DOI: 10.1016/j.arcped.2018.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 11/05/2018] [Accepted: 12/02/2018] [Indexed: 11/16/2022]
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38
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Bothamley G. What next? Basic research, new treatments and a patient-centred approach in controlling tuberculosis. Tuberculosis (Edinb) 2018. [DOI: 10.1183/2312508x.10026118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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39
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Rendon A, Goletti D, Matteelli A. Diagnosis and treatment of latent tuberculosis infection. Tuberculosis (Edinb) 2018. [DOI: 10.1183/2312508x.10022617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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40
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Marimani M, Ahmad A, Duse A. The role of epigenetics, bacterial and host factors in progression of Mycobacterium tuberculosis infection. Tuberculosis (Edinb) 2018; 113:200-214. [PMID: 30514504 DOI: 10.1016/j.tube.2018.10.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 08/21/2018] [Accepted: 10/23/2018] [Indexed: 12/29/2022]
Abstract
Tuberculosis (TB) infection caused by Mycobacterium tuberculosis (Mtb) is still a persistent global health problem, particularly in developing countries. The World Health Organization (WHO) reported a mortality rate of about 1.8 million worldwide due to TB complications in 2015. The Bacillus Calmette-Guérin (BCG) vaccine was introduced in 1921 and is still widely used to prevent TB development. This vaccine offers up to 80% protection against various forms of TB; however its efficacy against lung infection varies among different geographical settings. Devastatingly, the development of various forms of drug-resistant TB strains has significantly impaired the discovery of effective and safe anti-bacterial agents. Consequently, this necessitated discovery of new drug targets and novel anti-TB therapeutics to counter infection caused by various Mtb strains. Importantly, various factors that contribute to TB development have been identified and include bacterial resuscitation factors, host factors, environmental factors and genetics. Furthermore, Mtb-induced epigenetic changes also play a crucial role in evading the host immune response and leads to bacterial persistence and dissemination. Recently, the application of GeneXpert MTB/RIF® to rapidly diagnose and identify drug-resistant strains and discovery of different molecular markers that distinguish between latent and active TB infection has motivated and energised TB research. Therefore, this review article will briefly discuss the current TB state, highlight various mechanisms employed by Mtb to evade the host immune response as well as to discuss some modern molecular techniques that may potentially target and inhibit Mtb replication.
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Affiliation(s)
- Musa Marimani
- Clinical Microbiology and Infectious Diseases, School of Pathology, Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Aijaz Ahmad
- Clinical Microbiology and Infectious Diseases, School of Pathology, Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Infection Control, Charlotte Maxeke Johannesburg Academic Hospital, National Health Laboratory Service, South Africa.
| | - Adriano Duse
- Clinical Microbiology and Infectious Diseases, School of Pathology, Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Infection Control, Charlotte Maxeke Johannesburg Academic Hospital, National Health Laboratory Service, South Africa
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41
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Zellweger JP. Predicting tuberculosis: the blood, the skin, or the Sibyl? THE LANCET. INFECTIOUS DISEASES 2018; 18:1048-1049. [DOI: 10.1016/s1473-3099(18)30398-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 06/11/2018] [Indexed: 01/20/2023]
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42
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Delacourt C, Guerin S, Pommelet V. [Interferon gamma release assay tests in children less than 15 years old]. Rev Mal Respir 2018; 35:875-878. [PMID: 30224212 DOI: 10.1016/j.rmr.2018.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 03/21/2018] [Indexed: 11/15/2022]
Affiliation(s)
- C Delacourt
- Hôpital Necker-Enfants-Malades, AP-HP, 75015 Paris, France.
| | - S Guerin
- Hôpital Necker-Enfants-Malades, AP-HP, 75015 Paris, France
| | - V Pommelet
- Service de pédiatrie générale, hôpital Robert-Debré, AP-HP, 75019 Paris, France
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43
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[Tuberculosis contact tracing]. Rev Mal Respir 2018; 35:866-871. [PMID: 30224213 DOI: 10.1016/j.rmr.2018.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 03/21/2018] [Indexed: 11/20/2022]
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44
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Fraisse P. [Latent tuberculosis infection, from diagnosis to prognosis]. Rev Mal Respir 2018; 35:785-787. [PMID: 30217572 DOI: 10.1016/j.rmr.2018.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 07/30/2018] [Indexed: 11/18/2022]
Affiliation(s)
- P Fraisse
- Service de pneumologie, Nouvel Hôpital Civil, 67091 Strasbourg cedex, France; Groupe pour la recherche et l'enseignement en pneumo-infectiologie (GREPI) de la SPLF, 66, boulevard Saint-Michel, 75006 Paris, France.
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45
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Faust L, McCarthy A, Schreiber Y. Recommendations for the screening of paediatric latent tuberculosis infection in indigenous communities: a systematic review of screening strategies among high-risk groups in low-incidence countries. BMC Public Health 2018; 18:979. [PMID: 30081879 PMCID: PMC6090746 DOI: 10.1186/s12889-018-5886-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 07/25/2018] [Indexed: 11/13/2022] Open
Abstract
Background Tuberculosis (TB) continues to be a global public health concern. Due to the presence of multiple risk factors such as poor housing conditions and food insecurity in Canadian Indigenous communities, this population is at particularly high risk of TB infection. Given the challenges of screening for latent TB infection (LTBI) in remote communities, a synthesis of the existing literature regarding current screening strategies among high-risk groups in low-incidence countries is warranted, in order to provide an evidence base for the optimization of paediatric LTBI screening practices in the Canadian Indigenous context. Methods A literature search of the Embase and Medline databases was conducted, and studies pertaining the evaluation of screening strategies or screening tools for LTBI in paediatric high-risk groups in low-incidence countries were included. Studies focusing on LTBI screening in Indigenous communities were also included, regardless of whether they focused on a paediatric population. Their results were summarized and discussed in the context of their relevance to screening strategies suitable to the Canadian Indigenous setting. Grey literature sources such as government reports or policy briefs were also consulted. Results The initial literature search returned 327 studies, with 266 being excluded after abstract screening, and 36 studies being included in the final review (original research studies: n = 25, review papers or policy recommendations: n = 11). In the examined studies, case identification and cost-effectiveness of universal screening were low in low-incidence countries. Therefore, studies generally recommended targeted screening of high-risk groups in low-incidence countries, however, there remains a lack of consensus regarding cut-offs for the incidence-based screening of high-risk communities, as well as regarding the utility and prioritization of individual risk-factor-based screening of high-risk groups. The utility of the TST compared to IGRAs for LTBI detection in the pediatric population also remains contested. Conclusions Relevant strategies for targeted screening in the Canadian Indigenous context include community-level incidence-based screening (screening based on geographic location within high-incidence communities), as well as individual risk-factor-based screening, taking into account pertinent risk factors in Indigenous settings, such as poor housing conditions, malnutrition, contact with an active case, or the presence of relevant co-morbidities, such as renal disease.
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Affiliation(s)
- Lena Faust
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Anne McCarthy
- Department of Medicine, University of Ottawa, Ottawa, Canada.,Ottawa Hospital Research Institute, Ottawa, Canada
| | - Yoko Schreiber
- Department of Medicine, University of Ottawa, Ottawa, Canada. .,Ottawa Hospital Research Institute, Ottawa, Canada.
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Stout JE, Wu Y, Ho CS, Pettit AC, Feng PJ, Katz DJ, Ghosh S, Venkatappa T, Luo R. Evaluating latent tuberculosis infection diagnostics using latent class analysis. Thorax 2018; 73:1062-1070. [PMID: 29982223 DOI: 10.1136/thoraxjnl-2018-211715] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 05/07/2018] [Accepted: 06/04/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND Lack of a gold standard for latent TB infection has precluded direct measurement of test characteristics of the tuberculin skin test and interferon-γ release assays (QuantiFERON Gold In-Tube and T-SPOT.TB). OBJECTIVE We estimated test sensitivity/specificity and latent TB infection prevalence in a prospective, US-based cohort of 10 740 participants at high risk for latent infection. METHODS Bayesian latent class analysis was used to estimate test sensitivity/specificity and latent TB infection prevalence among subgroups based on age, foreign birth outside the USA and HIV infection. RESULTS Latent TB infection prevalence varied from 4.0% among foreign-born, HIV-seronegative persons aged <5 years to 34.0% among foreign-born, HIV-seronegative persons aged ≥5 years. Test sensitivity ranged from 45.8% for the T-SPOT.TB among foreign-born, HIV-seropositive persons aged ≥5 years to 80.7% for the tuberculin skin test among foreign-born, HIV-seronegative persons aged ≥5 years. The skin test was less specific than either interferon-γ release assay, particularly among foreign-born populations (eg, the skin test had 70.0% specificity among foreign-born, HIV-seronegative persons aged ≥5 years vs 98.5% and 99.3% specificity for the QuantiFERON and T-SPOT.TB, respectively). The tuberculin skin test's positive predictive value ranged from 10.0% among foreign-born children aged <5 years to 69.2% among foreign-born, HIV-seropositive persons aged ≥5 years; the positive predictive values of the QuantiFERON (41.4%) and T-SPOT.TB (77.5%) were also low among US-born, HIV-seropositive persons aged ≥5 years. CONCLUSIONS These data reinforce guidelines preferring interferon-γ release assays for foreign-born populations and recommending against screening populations at low risk for latent TB infection. TRIAL REGISTRATION NUMBER NCT01622140.
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Affiliation(s)
- Jason E Stout
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Yanjue Wu
- Northrop Grumman, McLean, Virginia, USA
| | - Christine S Ho
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - April C Pettit
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Pei-Jean Feng
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Dolly J Katz
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Smita Ghosh
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Thara Venkatappa
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ruiyan Luo
- Department of Epidemiology and Biostatistics, Georgia State University, School of Public Health, Atlanta, Georgia, USA
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Goletti D, Petrone L, Ippolito G, Niccoli L, Nannini C, Cantini F. Preventive therapy for tuberculosis in rheumatological patients undergoing therapy with biological drugs. Expert Rev Anti Infect Ther 2018; 16:501-512. [PMID: 29848120 DOI: 10.1080/14787210.2018.1483238] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Latent tuberculosis infection (LTBI) accounts for almost a quarter of the world population, and, in 5-10% of the subjects with impaired immune-response against M. tuberculosis growth, it may progress to active tuberculosis (TB). In this review, we focus on the need to propose a screening for LTBI including preventive therapy offer in rheumatic patients undergoing therapy with biological drugs. Areas covered: We report on evidence that biologics are associated with an increased risk of active TB reactivation. This effect seems to be mainly limited to treatment with anti-tumor necrosis factor (TNF) agents, while non-anti-TNF-targeted biologics are not likely associated to any increased risk. We introduce the concept that the patients' coexisting host-related risk factors, such as comorbidities, are crucial to identify those at higher risk to reactivate TB. We report that preventive TB therapy is well tolerated in patients treated with biological drugs. Expert commentary: Availability of non-anti-TNF targeted biologics, that are not associated with an increased risk of TB reactivation, offers a great opportunity to tailor a therapeutic intervention at low/absent TB risk. After proper LTBI screening investigations, preventive TB therapy has been demonstrated to be effective and well-tolerated to reduce the risk of TB reactivation in rheumatic patients requiring biological drugs.
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Affiliation(s)
- Delia Goletti
- a Translational Research Unit, Department of Epidemiology and Preclinical Research , "L. Spallanzani" National Institute for Infectious Diseases (INMI), IRCCS , Rome , Italy
| | - Linda Petrone
- a Translational Research Unit, Department of Epidemiology and Preclinical Research , "L. Spallanzani" National Institute for Infectious Diseases (INMI), IRCCS , Rome , Italy
| | - Giuseppe Ippolito
- b Scientific Direction, "L. Spallanzani" National Institute for Infectious Diseases (INMI), IRCCS , Rome , Italy
| | - Laura Niccoli
- c Department of Rheumatology , Hospital of Prato , Prato , Italy
| | - Carlotta Nannini
- c Department of Rheumatology , Hospital of Prato , Prato , Italy
| | - Fabrizio Cantini
- c Department of Rheumatology , Hospital of Prato , Prato , Italy
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48
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Meermeier EW, Lewinsohn DM. Early clearance versus control: what is the meaning of a negative tuberculin skin test or interferon-gamma release assay following exposure to Mycobacterium tuberculosis? F1000Res 2018; 7. [PMID: 29904578 PMCID: PMC5974584 DOI: 10.12688/f1000research.13224.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/22/2018] [Indexed: 01/01/2023] Open
Abstract
The elimination of tuberculosis (TB) cannot reasonably be achieved by treatment of individual cases and will require an improved vaccine or immunotherapy. A challenge in developing an improved TB vaccine has been the lack of understanding what is needed to generate sterilizing immunity against
Mycobacterium tuberculosis (Mtb) infection. Several epidemiological observations support the hypothesis that humans can eradicate Mtb following exposure. This has been termed early clearance and is defined as elimination of Mtb infection prior to the development of an adaptive immune response, as measured by a tuberculin skin test or interferon-gamma release assay. Here, we examine research into the likelihood of and possible mechanisms responsible for early clearance in household contacts of patients with active TB. We explore both innate and adaptive immune responses in the lung. Enhanced understanding of these mechanisms could be harnessed for the development of a preventative vaccine or immunotherapy.
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Affiliation(s)
- Erin W Meermeier
- Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health and Science University, Portland, USA
| | - David M Lewinsohn
- Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health and Science University, Portland, USA.,Department of Medicine, VA Portland Health Care System, Portland, OR, USA
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49
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Winje BA, White R, Syre H, Skutlaberg DH, Oftung F, Mengshoel AT, Blix HS, Brantsæter AB, Holter EK, Handal N, Simonsen GS, Afset JE, Bakken Kran AM. Stratification by interferon-γ release assay level predicts risk of incident TB. Thorax 2018; 73:thoraxjnl-2017-211147. [PMID: 29622693 DOI: 10.1136/thoraxjnl-2017-211147] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 01/02/2018] [Accepted: 03/12/2018] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Targeted testing and treatment of latent TB infection (LTBI) are priorities on the global health agenda, but LTBI management remains challenging. We aimed to evaluate the prognostic value of the QuantiFERON TB-Gold (QFT) test for incident TB, focusing on the interferon (IFN)-γ level, when applied in routine practice in a low TB incidence setting. METHODS In this large population-based prospective cohort, we linked QFT results in Norway (1 January 2009-30 June 2014) with national registry data (Norwegian Surveillance System for Infectious Diseases, Norwegian Prescription Database, Norwegian Patient Registry and Statistics Norway) to assess the prognostic value of QFT for incident TB. Participants were followed until 30 June 2016. We used restricted cubic splines to model non-linear relationships between IFN-γ levels and TB, and applied these findings to a competing risk model. RESULTS The prospective analyses included 50 389 QFT results from 44 875 individuals, of whom 257 developed TB. Overall, 22% (n=9878) of QFT results were positive. TB risk increased with the IFN-γ level until a plateau level, above which further increase was not associated with additional prognostic information. The HRs for TB were 8.8 (95% CI 4.7 to 16.5), 19.2 (95% CI 11.6 to 31.6) and 31.3 (95% CI 19.8 to 49.5) times higher with IFN-γ levels of 0.35 to <1.00, 1.00 to <4.00 and >4.00 IU/mL, respectively, compared with negative tests (<0.35 IU/mL). CONCLUSIONS Consistently, QFT demonstrates increased risk of incident TB with rising IFN-γ concentrations, indicating that IFN-γ levels may be used to guide targeted treatment of LTBI.
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Affiliation(s)
- Brita Askeland Winje
- Department of Vaccine Preventable Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Richard White
- Department of Infectious Disease Epidemiology and Modelling, Norwegian Institute of Public Health, Oslo, Norway
| | - Heidi Syre
- Department of Medical Microbiology, Stavanger University Hospital, Stavanger, Norway
| | - Dag Harald Skutlaberg
- Department of Microbiology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Fredrik Oftung
- Department of Infectious Disease Immunology, Norwegian Institute of Public Health, Oslo, Norway
| | - Anne Torunn Mengshoel
- Department of Tuberculosis, Blood Borne and Sexually Transmitted Infections, Norwegian Institute for Public Health, Oslo, Norway
| | - Hege Salvesen Blix
- Department of Pharmacoepidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Arne Broch Brantsæter
- Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
- Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Nina Handal
- Department of Microbiology and Infection control, Akershus University Hospital, Lørenskog, Norway
| | - Gunnar Skov Simonsen
- Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
- Research Group for Host-Microbe Interaction, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromso, Norway
| | - Jan Egil Afset
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Medical Microbiology, St Olavs University Hospital, Trondheim, Norway
| | - Anne Marte Bakken Kran
- Department of Microbiology, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Fraisse P. Lutte antituberculeuse : la courbe des décideurs. Rev Mal Respir 2018; 35:1-5. [DOI: 10.1016/j.rmr.2017.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 09/19/2017] [Indexed: 11/15/2022]
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