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Herai Y, Yahaba M, Taniguchi T, Murata S, Chiba H, Igari H. Factors Influencing the Indeterminate Results in a T-SPOT.TB test: A Matched Case-control Study. Intern Med 2023; 62:3321-3326. [PMID: 37005270 DOI: 10.2169/internalmedicine.1006-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Objective A T-SPOT.TB can yield indeterminate results under two test observation conditions: a high response to the nil in negative control wells (high nil-control) or a low response to the mitogen in positive control wells (low mitogen-control). The most strongly influential factors for these indeterminate results, however, have yet to be identified. Methods From June 1, 2015, to June 30, 2021, we conducted a 1:1 matched case-control, retrospective study. Patients Patients who underwent a T-SPOT.TB test at Chiba University Hospital. Results The study included 5,956 participants. Indeterminate results were found in 63 participants (1.1%), including high nil-control in 37 and low mitogen-control in 26. Human T-cell leukemia virus type 1 (HTLV-1) positivity was the only influencing factor associated with high nil-control (adjusted odds ratio=98.5, 95% confidence interval: 6.59-1,480). Conclusion Regarding the indeterminate results, all HTLV-1 positive participants had a high nil response and no low mitogen response. It was suspected that abnormally produced interferon γ caused a nonspecific reaction to the negative control well, resulting in a high nil response. Low mitogen-control, conversely, did not appear to have any statistically significant influential factors.
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Affiliation(s)
- Yoriko Herai
- Division of Infection Control, Chiba University, Japan
| | - Misuzu Yahaba
- Division of Infection Control, Chiba University, Japan
| | | | - Shota Murata
- Division of Laboratory Medicine, Chiba University Hospital, Japan
| | - Hitoshi Chiba
- Division of Infection Control, Chiba University, Japan
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Lu P, Ding X, Sun J, Wang R, Liu J, Liu Q, Zhu L, Lu W. Selection of the cutoff value of the tuberculin skin test for diagnosing students who need preventive treatment: A school-based cross-sectional study. Front Cell Infect Microbiol 2022; 12:972484. [PMID: 36310867 PMCID: PMC9606456 DOI: 10.3389/fcimb.2022.972484] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 09/08/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Tuberculosis outbreaks in schools are common in China. This study aimed to introduce and evaluate a new screening process to help control outbreaks. Methods Screening information of students in three schools with tuberculosis outbreaks was collected. QuantiFERON-TB gold in-tube (QFT) results were used as the reference standard to determine the cutoff value of the tuberculin skin test (TST) for diagnosing students who need to have preventive medication. Results A total of 1,232 students and teachers from three different schools that all had more than three student patients with tuberculosis were included in this study. In total, 308 (25.0%) students had an induration diameter ≥10 mm; among students in a class different from the index case, the infection rate was 24.4% (264/1,084), which was lower than the rate among students in the same class (29.7%) (P = 0.157). Students in the same class as the index tuberculosis case had a much higher QFT positivity compared to those in a different class (58.1% vs. 7.7%, P < 0.0001). Diagnostic agreement between TST ≥10 mm and QFT was 36.6%. The diagnostic value reached the highest when the induration diameter of TST was ≥9 mm, with a sensitivity and specificity of 94.1% (95% CI: 89.4%–97.1%) and 27.6% (95% CI: 24.9%–30.4%), respectively. The area under the curve (AUC) was 0.664 (95% CI: 0.637–0.690, P < 0.0001). Conclusion In tuberculosis outbreaks in schools, if there are three or more cases of students with tuberculosis in a class or if the moderate or strong TST positivity rate is much higher than the normal range in the region, attention should be paid to those with moderately positive TST results. Interferon-gamma release assays (IGRAs) are recommended to be conducted following TST on the day of reading the results, especially among students sharing the same class with the index case. In resource-poor areas lacking IGRAs, the induration diameter of TST can be appropriately reduced from 15 to 9 mm to enhance the sensitivity of TST.
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Affiliation(s)
- Peng Lu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, China
| | - Xiaoyan Ding
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, China
| | - Jiansheng Sun
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Zhouxu City, Nanjing, China
| | - Rong Wang
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Nanjing City, Nanjing, China
| | - Jiasong Liu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Huaian City, Huaian, China
| | - Qiao Liu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, China
| | - Limei Zhu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, China
| | - Wei Lu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, China,*Correspondence: Wei Lu,
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Lu P, Lu F, Liu Q, Tang L, Ding X, Kong W, Lu W, Zhu L. High rate of transmission in a pulmonary tuberculosis outbreak in a junior high school in China, 2020. IJID REGIONS 2021; 1:117-123. [PMID: 35757819 PMCID: PMC9216330 DOI: 10.1016/j.ijregi.2021.10.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/22/2021] [Accepted: 10/27/2021] [Indexed: 11/26/2022]
Abstract
School tuberculosis outbreaks are common in China Students with PPD ≥ 15 mm are recommended to have prophylactic treatment More attention should be paid to students with PPD ≥ 10 mm and < 15 mm in school TB outbreaks
Background School tuberculosis outbreaks are common in China. This study aimed to introduce a new screening process to help control outbreaks. Methods An epidemiological investigation into a school-based tuberculosis outbreak was conducted in order to identify the origin of the infection, and how it was transmitted. Results In total, 10 confirmed active tuberculosis cases were diagnosed among student contacts in the index case's class, giving an incidence rate of 19.2% (10/52). Three were found through a proactive visit and seven through screening. Of the nine secondary cases, two had purified protein derivation of tuberculin (PPD) ≥ 15 mm or blister (confirmed by computed tomography (CT) scan before preventive therapy), five had TST ≥ 10 mm and < 15 mm (two with abnormal chest radiography scan and three with positive T-SPOT tests, confirmed by CT) and two with PPD ≥ 5 mm and < 10 mm (confirmed by CT scan through proactive visit). Conclusion Further to our results based on this school outbreak, a new screening process is recommended that involves conducting interferon gamma release assays on those students with PPD ≥ 5 mm and < 15 mm if there are three or more active tuberculosis patients in the class with an epidemiological link. Furthermore, a CT scan is recommended for students who have had a recent tuberculosis infection before they have preventive therapy.
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Attiku Y, Rishi P. Miliary tuberculosis presenting as bilateral pseudo-retinoblastoma. GMS OPHTHALMOLOGY CASES 2021; 11:Doc12. [PMID: 34540524 PMCID: PMC8422939 DOI: 10.3205/oc000185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective: To describe an interesting case of miliary tuberculosis mimicking retinoblastoma. Method: A retrospective case report. Result: The twin brother of a known case of retinobastoma presented with headache. On fundus examination, multiple yellowish-white lesions were noted in both eyes. Magnetic resonance imaging of the brain showed multiple enhancing lesions. A diagnosis of miliary tuberculosis was made and anti-tubercular therapy was started. Conclusion: Ocular tuberculosis can mimic retinoblastoma and lead to diagnostic dilemma especially in cases with family history of retinoblastoma.
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Affiliation(s)
- Yamini Attiku
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Pukhraj Rishi
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India,*To whom correspondence should be addressed: Pukhraj Rishi, Shri Bhagwan Mahavir Vitreo-Retinal Services, Sankara Nethralaya, Medical Research Foundation, 18 College Road, Chennai 600006, Tamilnadu, India, Phone: +91 4428271616; Fax: +91 4428254180, E-mail:
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Immunological Characterization of Proteins Expressed by Genes Located in Mycobacterium tuberculosis-Specific Genomic Regions Encoding the ESAT6-like Proteins. Vaccines (Basel) 2021; 9:vaccines9010027. [PMID: 33430286 PMCID: PMC7825740 DOI: 10.3390/vaccines9010027] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 12/23/2020] [Accepted: 01/04/2021] [Indexed: 12/14/2022] Open
Abstract
The 6 kDa early secreted antigen target (ESAT6) is a low molecular weight and highly immunogenic protein of Mycobacterium tuberculosis with relevance in the diagnosis of tuberculosis and subunit vaccine development. The gene encoding the ESAT6 protein is located in the M. tuberculosis-specific genomic region known as the region of difference (RD)1. There are 11 M. tuberculosis-specific RDs absent in all of the vaccine strains of BCG, and three of them (RD1, RD7, and RD9) encode immunodominant proteins. Each of these RDs has genes for a pair of ESAT6-like proteins. The immunological characterizations of all the possible proteins encoded by genes in RD1, RD7 and RD9 have shown that, besides ESAT-6 like proteins, several other proteins are major antigens useful for the development of subunit vaccines to substitute or supplement BCG. Furthermore, some of these proteins may replace the purified protein derivative of M. tuberculosis in the specific diagnosis of tuberculosis by using interferon-gamma release assays and/or tuberculin-type skin tests. At least three subunit vaccine candidates containing ESAT6-like proteins as antigen components of multimeric proteins have shown efficacy in phase 1 and phase II clinical trials in humans.
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Mastrolia MV, Sollai S, Totaro C, Putignano P, de Martino M, Galli L, Chiappini E. Utility of tuberculin skin test and IGRA for tuberculosis screening in internationally adopted children: Retrospective analysis from a single center in Florence, Italy. Travel Med Infect Dis 2019; 28:64-67. [DOI: 10.1016/j.tmaid.2018.07.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 06/08/2018] [Accepted: 07/20/2018] [Indexed: 10/28/2022]
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Llibre A, Duffy D. Immune response biomarkers in human and veterinary research. Comp Immunol Microbiol Infect Dis 2018; 59:57-62. [PMID: 30290889 PMCID: PMC7172169 DOI: 10.1016/j.cimid.2018.09.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 05/22/2018] [Accepted: 09/17/2018] [Indexed: 11/30/2022]
Abstract
Biomarkers are increasingly utilised in biological research and clinical practice for diagnosis of disease, monitoring of therapeutic prognosis, or as end points in clinical studies. Cytokines are small molecules that orchestrate immune responses and as such have great potential as biomarkers for both human and veterinary fields. Given the ease of sampling in the blood, and their high prevalence in clinical applications we will focus on protein detection as an area for biomarker discovery. This is facilitated by new technological developments such as digital ELISA that have led to significant increases in sensitivity. Two highly relevant examples include type I interferons, namely IFNα, that is now directly quantifiable by digital ELISA from biological samples. The application of this approach to the study of the unique bat interferon response may reveal novel findings with applications in both human and veterinary research. As a second example we will describe the use of CXCL10 as a disease biomarker in Tuberculosis, highlighting findings from human and mouse studies that should be considered in veterinary research. In summary, we describe how cytokines may be applied as novel biomarkers and illustrate two key examples where human and veterinary research may complement each other in line with the One Health objectives.
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Affiliation(s)
- Alba Llibre
- Immunobiology of Dendritic Cells, Institut Pasteur, Paris, France; INSERM U1223, Paris, France
| | - Darragh Duffy
- Immunobiology of Dendritic Cells, Institut Pasteur, Paris, France; INSERM U1223, Paris, France.
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Lombardi G, Petrucci R, Corsini I, Bacchi Reggiani ML, Visciotti F, Bernardi F, Landini MP, Cazzato S, Dal Monte P. Quantitative Analysis of Gamma Interferon Release Assay Response in Children with Latent and Active Tuberculosis. J Clin Microbiol 2018; 56:e01360-17. [PMID: 29142046 PMCID: PMC5786731 DOI: 10.1128/jcm.01360-17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 11/08/2017] [Indexed: 12/22/2022] Open
Abstract
The use of interferon gamma (IFN-γ) release assays (IGRAs) for the diagnosis of tuberculosis (TB) infection in children is still under debate because of concerns about the immature immune response in children. The aim of this study was to investigate quantitative values of the QuantiFERON-TB Gold In-Tube (QFT-IT) test, a commercially available IGRA, in a large cohort of children screened for TB infection. A retrospective analysis was conducted on samples from 517 children aged 0 to 14 years old at the Pediatric Unit of S. Orsola-Malpighi University Hospital of Bologna (Italy); quantitative responses to QFT-IT stimuli were analyzed according to diagnosis and age. Elevated IFN-γ values in the QFT-IT nil (background) tube were statistically associated with diagnosis of active TB. Quantitative IFN-γ response to Mycobacterium tuberculosis-specific antigens (TB Ag) was not significantly different in children with active TB compared to those with latent TB infection (LTBI), even though the median values were higher in the first group. When children were grouped by age, those less than 5 years old produced significantly higher levels of IFN-γ in response to TB Ag if they had active TB (median 10 IU/ml) than those with LTBI (median 1.96 IU/ml). IFN-γ response to mitogen increased with age. The overall rate of indeterminate results was low (3.9%), and no indeterminate QFT-IT values were observed in active or latent TB patients. In conclusion, quantitative QFT-IT values could provide further information to clinicians to manage TB in children, and these observations could be transferred to the new version of the test, QuantiFERON-TB Gold Plus, which to date lacks data from the pediatric population.
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Affiliation(s)
- Giulia Lombardi
- Department of Experimental, Diagnostic and Specialty Medicine-Microbiology Unit, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Roberta Petrucci
- Paediatric Unit, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Ilaria Corsini
- Unit of Pediatric Emergency, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Maria Letizia Bacchi Reggiani
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | | | - Filippo Bernardi
- Unit of Pediatric Emergency, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Maria Paola Landini
- Department of Experimental, Diagnostic and Specialty Medicine-Microbiology Unit, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Salvatore Cazzato
- Paediatric Unit, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Paola Dal Monte
- Department of Experimental, Diagnostic and Specialty Medicine-Microbiology Unit, S. Orsola-Malpighi University Hospital, Bologna, Italy
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Liu QY, Han F, Pan LP, Jia HY, Li Q, Zhang ZD. Inflammation responses in patients with pulmonary tuberculosis in an intensive care unit. Exp Ther Med 2018; 15:2719-2726. [PMID: 29456674 PMCID: PMC5795479 DOI: 10.3892/etm.2018.5775] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 08/18/2017] [Indexed: 01/05/2023] Open
Abstract
Pulmonary tuberculosis caused by Mycobacterium tuberculosis remains a global problem. Inflammatory responses are the primary characteristics of patients with pulmonary tuberculosis in intensive care units (ICU). The aim of the present study was to investigate the clinical importance of inflammatory cells and factors for patients with pulmonary tuberculosis in ICU. A total of 124 patients with pulmonary tuberculosis in ICU were recruited for the present study. The inflammatory responses in patients with pulmonary tuberculosis in ICU were examined by changes in inflammatory cells and factors in the serum. The results indicated that serum levels of lymphocytes, plasma cells, granulocytes and monocytes were increased in patients with pulmonary tuberculosis in ICU compared with healthy controls. The serum levels of inflammatory factors interleukin (IL)-1, IL-6, IL-10, IL-12, and IL-4 were upregulated in patients with pulmonary tuberculosis in ICU. Lower plasma concentrations of IL-2, IL-15 and interferon-γ were detected in patients with pulmonary tuberculosis compared with healthy controls. It was demonstrated that high mobility group box-1 protein expression levels were higher in the serum of patients with pulmonary tuberculosis compared with healthy controls. Notably, an imbalance of T-helper cell (Th)1/Th2 cytokines was observed in patients with pulmonary tuberculosis. Pulmonary tuberculosis caused by M. tuberculosis also upregulated expression of matrix metalloproteinase (MMP)-1 and MMP-9 in hPMCs. In conclusion, these outcomes demonstrated that inflammatory responses and inflammatory factors are associated with the progression of pulmonary tuberculosis, suggesting that inhibition of inflammatory responses and inflammatory factors may be beneficial for the treatment of patients with pulmonary tuberculosis in ICU.
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Affiliation(s)
- Qiu-Yue Liu
- Department of Tuberculosis, Beijing Chest Hospital, Beijing Tuberculosis and Thoracic Tumor Research Institute, Capital Medical University, Beijing 101149, P.R. China
| | - Fen Han
- Intensive Care Unit, Beijing Chest Hospital, Beijing Tuberculosis and Thoracic Tumor Research Institute, Capital Medical University, Beijing 101149, P.R. China
| | - Li-Ping Pan
- Beijing Key Laboratory of Drug Resistance Tuberculosis Research, Beijing Chest Hospital, Beijing Tuberculosis and Thoracic Tumor Research Institute, Capital Medical University, Beijing 101149, P.R. China
| | - Hong-Yan Jia
- Beijing Key Laboratory of Drug Resistance Tuberculosis Research, Beijing Chest Hospital, Beijing Tuberculosis and Thoracic Tumor Research Institute, Capital Medical University, Beijing 101149, P.R. China
| | - Qi Li
- Department of Tuberculosis, Beijing Chest Hospital, Beijing Tuberculosis and Thoracic Tumor Research Institute, Capital Medical University, Beijing 101149, P.R. China
| | - Zong-De Zhang
- Beijing Key Laboratory of Drug Resistance Tuberculosis Research, Beijing Chest Hospital, Beijing Tuberculosis and Thoracic Tumor Research Institute, Capital Medical University, Beijing 101149, P.R. China
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Abstract
BACKGROUND The diagnostic accuracy of Quantiferon-TB Gold In-Tube (QFT-IT) is uncertain in the pediatric population, while tuberculin skin test (TST) is still conventionally used despite its limitations. The aim of this study was to compare the performance of QFT-IT with TST in a large cohort of children screened for tuberculosis (TB) infection because of contact tracing, suspected TB, arrival from endemic country or immunosuppressive therapy. METHODS A retrospective analysis was conducted on 517 children 0-14 years of age evaluated at the pediatric unit of the S. Orsola-Malpighi University Hospital of Bologna, Italy; 366 of them were also tested with TST. Results were analyzed for Calmette-Guérin bacillus vaccination, country of origin, reason for testing, diagnosis and age. RESULTS The overall agreement between the 2 tests was 89.9%, but it was highly affected by Calmette-Guérin bacillus vaccination (P < .0001). According to diagnosis and age, QFT-IT detected latent tuberculous infection cases better than TST in all age groups. Sensitivity for diagnosing active TB in symptomatic children was higher for QFT-IT than TST (93.3% vs. 86.5%), especially in children younger than 2 years, while specificity was high for both tests (99.3% and 98.8%, respectively). Low rate of indeterminate QFT-IT results (3.9%) was not differently distributed among age groups, but was associated with diagnosis of TB exclusion (P < 0.0001), mainly pneumonia (35%), and to Italian children (P = 0.0024). CONCLUSIONS Despite the concern about the use of QFT-IT in children because of their immature immune system, our results suggest the preferential use of QFT-IT as a support tool for diagnosis and management of TB, even in infants.
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Yun KW, Kim YK, Kim HR, Lee MK, Lim IS. Usefulness of interferon-γ release assay for the diagnosis of latent tuberculosis infection in young children. KOREAN JOURNAL OF PEDIATRICS 2016; 59:256-61. [PMID: 27462354 PMCID: PMC4958703 DOI: 10.3345/kjp.2016.59.6.256] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 02/27/2016] [Accepted: 03/13/2016] [Indexed: 11/27/2022]
Abstract
Purpose Latent tuberculosis infection (LTBI) in young children may progress to severe active tuberculosis (TB) disease and serve as a reservoir for future transmission of TB disease. There are limited data on interferon-γ release assay (IGRA) performance in young children, which our research aims to address by investigating the usefulness of IGRA for the diagnosis of LTBI. Methods We performed a tuberculin skin test (TST) and IGRA on children who were younger than 18 years and were admitted to Chung-Ang University Hospital during May 2011–June 2015. Blood samples for IGRA were collected, processed, and interpreted according to manufacturer protocol. Results Among 149 children, 31 (20.8%) and 10 (6.7%) were diagnosed with LTBI and active pulmonary TB, respectively. In subjects lacking contact history with active TB patients, TST and IGRA results were positive in 41.4% (29 of 70) and 12.9% (9 of 70) subjects, respectively. The agreement (kappa) of TST and IGRA was 0.123. The control group, consisting of non-TB-infected subjects, showed no correlation between age and changes in interferon-γ concentration after nil antigen, TB-specific antigen, or mitogen stimulation in IGRAs (P=0.384, P=0.176, and P=0.077, respectively). In serial IGRAs, interferon-γ response to TB antigen increased in IGRA-positive LTBI subjects, but did not change considerably in initially IGRA-negative LTBI or control subjects. Conclusion The lack of decrease in interferon-γ response in young children indicates that IGRA could be considered for this age group. Serial IGRA tests might accurately diagnose LTBI in children lacking contact history with active TB patients.
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Affiliation(s)
- Ki Wook Yun
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.; Department of Pediatrics, Chung-Ang University College of Medicine, Seoul, Korea
| | - Young Kwang Kim
- Department of Pediatrics, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hae Ryun Kim
- Department of Laboratory Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Mi Kyung Lee
- Department of Laboratory Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - In Seok Lim
- Department of Pediatrics, Chung-Ang University College of Medicine, Seoul, Korea
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Nejat S, Bennet R. Interferon-gamma release assays can effectively screen migrants for the tuberculosis infection, but urgent, active cases need clinical recognition. Acta Paediatr 2016; 105:671-5. [PMID: 26936211 DOI: 10.1111/apa.13386] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Revised: 12/20/2015] [Accepted: 02/29/2016] [Indexed: 11/28/2022]
Abstract
AIM Increasing numbers of migrants to Sweden are screened for tuberculosis (TB), and a rational approach to screening is required. We evaluated positive tuberculin skin tests (TSTs) and interferon-gamma release assays (IGRAs) on paediatric migrants in relation to the TB incidence in the corresponding foreign-born populations in Stockholm. METHODS This study examined the characteristics of migrants under the age of 18 who were referred to a paediatric TB clinic at Karolinska University Hospital from 2008 to 2014 by primary care centres in Stockholm County. RESULTS We saw 943 TST-positive children with a median age of 14 years at the TB clinic and performed IGRAs on 557. IGRA positivity ranged from 64% in migrants from Somalia to 20% in those from the former Soviet Union and eastern Europe, with an estimated population level prevalence of 18.8% and 4.2%, respectively. These were significantly correlated to TB incidence in foreign-born Stockholm children. We diagnosed active TB in 20 screened migrants, and advanced, symptomatic TB was diagnosed in 10 recently arrived migrants without screening. CONCLUSION IGRAs showed higher specificity than TST in identifying tuberculosis. TB screening should focus on migrants from high-incidence countries, but this may be inadequate to detect advanced TB cases.
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Affiliation(s)
- Sahar Nejat
- Astrid Lindgren Children's Hospital; Karolinska University Hospital; Stockholm Sweden
| | - Rutger Bennet
- Astrid Lindgren Children's Hospital; Karolinska University Hospital; Stockholm Sweden
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Validity of antibodies in lymphocyte supernatant in diagnosing tuberculosis in severely malnourished children presenting with pneumonia. PLoS One 2015; 10:e0126863. [PMID: 26020966 PMCID: PMC4447255 DOI: 10.1371/journal.pone.0126863] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 04/08/2015] [Indexed: 11/25/2022] Open
Abstract
Background The diagnosis of tuberculosis (TB) in young children can be challenging, especially in severely malnourished children. There is a critical need for improved diagnostics for children. Thus, we sought to evaluate the performance of a technique that measures antibodies in lymphocyte supernatant (ALS) for the diagnosis of TB in severely malnourished children presenting with suspected pneumonia. Methods Children less than 5 years with severe acute malnutrition and radiological features of pneumonia admitted to the Dhaka Hospital of International Centre for Diarrhoeal Disease Research, Bangladesh, were enrolled consecutively following informed written consent. In addition to clinical and radiological assessment, samples taken for TB diagnosis included gastric lavage fluid and induced sputum for microbiological confirmation. ALS was measured from venous blood, and results were evaluated in children classified as “confirmed”, “non-confirmed TB” or “not TB”. Results Among 224 children who had ALS analysis, 12 (5.4%) children had microbiologically “confirmed TB”, a further 41 (18%) had clinically diagnosed “non-confirmed TB” and the remaining 168 (75%) were considered not to have TB. ALS was positive in 89 (40%) and negative in 85 (39%) of children, with a large number (47 or 21%) reported as “borderline”. These proportions were similar between the three diagnostic groups. The sensitivity and specificity of ALS when comparing “Confirmed TB” to “Not TB” was only 67% (95% CI: 31–91%) and 51% (95% CI: 42–60%), respectively. Conclusions and Significance Our data suggest that ALS is not sufficiently accurate to improve the diagnosis of TB in children with severe malnutrition.
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Clifford V, Zufferey C, Germano S, Ryan N, Leslie D, Street A, Denholm J, Tebruegge M, Curtis N. The impact of anti-tuberculous antibiotics and corticosteroids on cytokine production in QuantiFERON-TB Gold In Tube assays. Tuberculosis (Edinb) 2015; 95:343-9. [PMID: 25837441 DOI: 10.1016/j.tube.2015.02.039] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 02/02/2015] [Accepted: 02/07/2015] [Indexed: 01/03/2023]
Abstract
INTRODUCTION The ability to monitor and confirm adequate treatment of latent TB infection (LTBI) would be a major advance. The potential immunomodulatory effects of anti-tuberculous drugs and steroids need to be considered in assessing the utility of cytokine-based assays for this purpose. METHODS We determined whether anti-tuberculous antibiotics or dexamethasone affect the production of IFN-γ and other potential cytokine biomarkers (TNF-α, IL-1ra, IL-2, IL-10, IL-13, IP-10, MIP-1β) in the QuantiFERON-TB Gold In-Tube (QFT-IT) assay. Blood from ten adults with LTBI was added to one standard set of QFT-IT tubes and five further sets containing therapeutic concentrations of either isoniazid, rifampicin, isoniazid and rifampicin, ciprofloxacin or dexamethasone. Resulting supernatants were analysed by ELISA (QFT-IT assay IFN-γ) and xMAP-Luminex assays (all cytokines). RESULTS Anti-tuberculous antibiotics had only a limited effect on categorical QFT-IT assay results and the production of cytokines. In contrast, dexamethasone resulted in a change in categorical results from positive to negative in four of ten patients, and caused a marked reduction in IL-13 and IL-1ra responses. CONCLUSION Substantial changes in TB-antigen-induced IFN-γ and other cytokine responses during treatment likely primarily reflect host immunological changes rather than immunomodulatory effects of anti-tuberculous antibiotics. Results from cytokine-based assays in patients on corticosteroids should be interpreted with caution.
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Affiliation(s)
- Vanessa Clifford
- Department of Paediatrics, The University of Melbourne and Murdoch Children's Research Institute, Royal Children's Hospital Melbourne, Parkville, VIC, Australia
| | - Christel Zufferey
- Department of Paediatrics, The University of Melbourne and Murdoch Children's Research Institute, Royal Children's Hospital Melbourne, Parkville, VIC, Australia
| | - Susie Germano
- Department of Paediatrics, The University of Melbourne and Murdoch Children's Research Institute, Royal Children's Hospital Melbourne, Parkville, VIC, Australia
| | - Norbert Ryan
- Victorian Infectious Diseases Reference Laboratory, Parkville, VIC, Australia
| | - David Leslie
- Victorian Infectious Diseases Reference Laboratory, Parkville, VIC, Australia
| | - Alan Street
- Victorian Infectious Diseases Unit, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Justin Denholm
- Victorian Infectious Diseases Unit, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Marc Tebruegge
- Department of Paediatrics, The University of Melbourne and Murdoch Children's Research Institute, Royal Children's Hospital Melbourne, Parkville, VIC, Australia; Academic Unit of Clinical and Experimental Medicine, Faculty of Medicine & National Institute for Health Research Southampton Respiratory Biomedical Research Unit & Institute for Life Sciences, University of Southampton, United Kingdom
| | - Nigel Curtis
- Department of Paediatrics, The University of Melbourne and Murdoch Children's Research Institute, Royal Children's Hospital Melbourne, Parkville, VIC, Australia.
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15
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Bamford A, Turkova A, Lyall H, Foster C, Klein N, Bastiaans D, Burger D, Bernadi S, Butler K, Chiappini E, Clayden P, Della Negra M, Giacomet V, Giaquinto C, Gibb D, Galli L, Hainaut M, Koros M, Marques L, Nastouli E, Niehues T, Noguera-Julian A, Rojo P, Rudin C, Scherpbier HJ, Tudor-Williams G, Welch SB. Paediatric European Network for Treatment of AIDS (PENTA) guidelines for treatment of paediatric HIV-1 infection 2015: optimizing health in preparation for adult life. HIV Med 2015; 19:e1-e42. [PMID: 25649230 PMCID: PMC5724658 DOI: 10.1111/hiv.12217] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2014] [Indexed: 02/06/2023]
Abstract
The 2015 Paediatric European Network for Treatment of AIDS (PENTA) guidelines provide practical recommendations on the management of HIV‐1 infection in children in Europe and are an update to those published in 2009. Aims of treatment have progressed significantly over the last decade, moving far beyond limitation of short‐term morbidity and mortality to optimizing health status for adult life and minimizing the impact of chronic HIV infection on immune system development and health in general. Additionally, there is a greater need for increased awareness and minimization of long‐term drug toxicity. The main updates to the previous guidelines include: an increase in the number of indications for antiretroviral therapy (ART) at all ages (higher CD4 thresholds for consideration of ART initiation and additional clinical indications), revised guidance on first‐ and second‐line ART recommendations, including more recently available drug classes, expanded guidance on management of coinfections (including tuberculosis, hepatitis B and hepatitis C) and additional emphasis on the needs of adolescents as they approach transition to adult services. There is a new section on the current ART ‘pipeline’ of drug development, a comprehensive summary table of currently recommended ART with dosing recommendations. Differences between PENTA and current US and World Health Organization guidelines are highlighted and explained.
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Affiliation(s)
- A Bamford
- Department of Paediatric Infectious Diseases and Immunology, Great Ormond Street Hospital NHS Trust, London, UK
| | - A Turkova
- Medical Research Council Clinical Trials Unit, London, UK
| | - H Lyall
- Department of Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, UK
| | - C Foster
- Department of Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, UK
| | - N Klein
- Institute of Child Health, University College London, London, UK
| | - D Bastiaans
- Radboud University Medical Center, Nijmegan, The Netherlands
| | - D Burger
- Radboud University Medical Center, Nijmegan, The Netherlands
| | - S Bernadi
- University Department of Immunology and Infectious Disease, Bambino Gesù Children's Hospital, Rome, Italy
| | - K Butler
- Our Lady's Children's Hospital Crumlin & University College Dublin, Dublin, Ireland
| | - E Chiappini
- Meyer University Hospital, Florence University, Florence, Italy
| | | | - M Della Negra
- Emilio Ribas Institute of Infectious Diseases, Sao Paulo, Brazil
| | - V Giacomet
- Paediatric Infectious Disease Unit, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - C Giaquinto
- Department of Paediatrics, University of Padua, Padua, Italy
| | - D Gibb
- Medical Research Council Clinical Trials Unit, London, UK
| | - L Galli
- Department of Health Sciences, Pediatric Unit, University of Florence, Florence, Italy
| | - M Hainaut
- Department of Pediatrics, CHU Saint-Pierre, Free University of Brussels, Brussels, Belgium
| | - M Koros
- Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - L Marques
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Pediatric Department, Porto Central Hospital, Porto, Portugal
| | - E Nastouli
- Department of Clinical Microbiology and Virology, University College London Hospitals, London, UK
| | - T Niehues
- Centre for Pediatric and Adolescent Medicine, HELIOS Hospital Krefeld, Krefeld, Germany
| | - A Noguera-Julian
- Infectious Diseases Unit, Pediatrics Department, Sant Joan de Déu Hospital, University of Barcelona, Barcelona, Spain
| | - P Rojo
- 12th of October Hospital, Madrid, Spain
| | - C Rudin
- University Children's Hospital, Basel, Switzerland
| | - H J Scherpbier
- Department of Paediatric Immunology and Infectious Diseases, Emma Children's Hospital Academic Medical Centre, Amsterdam, The Netherlands
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16
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Howley MM, Painter JA, Katz DJ, Graviss EA, Reves R, Beavers SF, Garrett DO. Evaluation of QuantiFERON-TB gold in-tube and tuberculin skin tests among immigrant children being screened for latent tuberculosis infection. Pediatr Infect Dis J 2015; 34:35-9. [PMID: 25093974 PMCID: PMC5136477 DOI: 10.1097/inf.0000000000000494] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Centers for Disease Control and Prevention requirements for pre-immigration tuberculosis (TB) screening of children 2- to 14-years old permit a tuberculin skin test (TST) or an interferon-gamma release assay (IGRA). Few data are available on the performance of IGRAs versus TSTs in foreign-born children. METHODS We compared the performance of TST and QuantiFERON-TB (QFT) Gold In-Tube in children 2- to 14-years old applying to immigrate to the United States from Mexico, the Philippines and Vietnam, using diagnosis of TB in immigrating family members as a measure of potential exposure. RESULTS We enrolled 2520 children: 664 (26%) were TST+ and 142 (5.6%) were QFT+. One hundred and eleven (4.4%) were TST+/QFT+, 553 (21.9%) were TST+/QFT- and 31 (1.2%) were TST-/QFT+. Agreement between tests was poor (κ = 0.20). Although positive results of both tests were significantly associated with older age (relative risks [RR] TST+, 1.64; 95% confidence interval [CI]: 1.36-1.97; RR QFT+, 3.05; 95% CI: 1.72-5.38) and with the presence of TB in at least 1 immigrating family member (RR TST+, 1.40; 95% CI: 1.12-1.75; RR QFT+ 2.24; 95% CI: 1.18-4.28), QFT+ results were more strongly associated with both predictive variables. CONCLUSIONS The findings support the preferential use of QFT over TST for pre-immigration screening of foreign-born children 2 years of age and older and lend support to the preferential use of IGRAs in testing foreign-born children for latent TB infection.
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17
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Performance of interferon-γ release assay for the diagnosis of active or latent tuberculosis in children in the first 2 years of age: a multicenter study of the Italian Society of Pediatric Infectious Diseases. Pediatr Infect Dis J 2014; 33:e226-31. [PMID: 25361032 DOI: 10.1097/inf.0000000000000353] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND The diagnosis of latent or active tuberculosis in children is often challenging. Recently, interferon-γ release assays have been licensed, but their diagnostic accuracy in young children remains questionable as frequent false-negative or indeterminate results have been reported. METHODS We performed a multicenter, retrospective study in children 0-24 months of age who were tested at least once with QuantiFERON-TB Gold-in-tube (QTF-IT) ± tuberculin skin test (TST), to analyze its use and performance in clinical practice. RESULTS Eight-hundred and twenty-three children (449 males, median age 13.5 months) were enrolled. QTF-IT sensitivity and specificity for active tuberculosis were 92.4% and 98.6%, respectively. Indeterminate tests (4.2 %) were not related to age (P = 0.838) or gender (P = 0.223); 32 children (91.4 %) with an indeterminate QTF-IT ultimately resulted uninfected. In the 616 subjects with valid paired results of QTF-IT and TST, sensitivity and specificity were comparable (91.1% vs. 85.1% and 98.1% vs. 97.9%, respectively). Diagnostic concordance between tests was higher in Bacillus Calmétte-Guerin nonvaccinated children (κ = 0.802). A high rate of discordant tests was observed in latent infections. CONCLUSIONS QTF-IT showed good sensitivity and specificity, and a low rate of indeterminate results in the first 2 years of life, supporting its use at this age. However, considering costs and the similar performance between QTF-IT and TST, it is reasonable to suggest the latter as first-line testing in young children. The complementary use of TST and interferon-γ release assays may be considered in selected cases to improve the accuracy of testing.
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18
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Indeterminate QuantiFERON-TB gold in-tube assay results in children: possible association with procedural specimen collection. Pediatr Infect Dis J 2014; 33:220-2. [PMID: 24413410 DOI: 10.1097/inf.0000000000000001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Fifty-six of 182 (31%) children had indeterminate QuantiFERON assays. Indeterminate assays were associated with inpatient status [odds ratios (OR): 11.7, 95% confidence interval 3.9-34.9], but not with age, gender or medical comorbidities. This indicates that indeterminates may be due to specimen handling, and proper procedural training may be necessary to decrease indeterminate QuantiFERON results.
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19
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Blandinières A, de Lauzanne A, Guérin-El Khourouj V, Gourgouillon N, See H, Pédron B, Faye A, Sterkers G. QuantiFERON to diagnose infection by Mycobacterium tuberculosis: performance in infants and older children. J Infect 2013; 67:391-8. [PMID: 23796868 DOI: 10.1016/j.jinf.2013.06.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 05/27/2013] [Accepted: 06/12/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVES QuantiFERON value to diagnose tuberculosis (TB) in young children remains to be clarified. To this aim QF-TB-IT performance was evaluated in a large series of immunocompetent children that were stratified according to age and clinical conditions. METHODS QF-TB-IT reactivity was analyzed in 226 immunocompetent children (0-15 years old): 31 were uninfected despite TB contact; 51 presented TB disease; 39 had Latent TB (LTBI) and 105 had TB disease suspected but an alternative diagnosis (TB excluded). RESULTS QF-TB-IT specificity was 100% in TB excluded. In TB disease, low sensitivity of QF-TB-IT in infants (40%) increased with aging (77% in 1-<5 years and 82% in 5-<15 years old subgroups). In LTBI, agreement between TST and QF-TB-IT was 0% in infants, 40% in 1-<5 years and 57% in children >5 years old. Finally, the incidence of indeterminate results was high (24%) in children <5 years old with TB excluded, especially with non-TB pneumonitis (61%), but was low (0-6%) regardless of age group in TB disease, LTBI and uninfected contact cases. CONCLUSIONS In our low burden country, i) QF-TB-IT specificity was 100%, ii) QF-TB-IT sensitivity was low in infants but commensurable to adult values in older children, and iii) indeterminate results mostly relied on ongoing infections unrelated to TB.
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Affiliation(s)
- Adeline Blandinières
- Laboratory of Immunology, Robert Debré Hospital, 48 Boulevard Sérurier, 75019 Paris, France; Assistance Publique-Hôpitaux de Paris (AP-H), Univ. Paris Diderot, Sorbonne Paris Cité, Paris, France
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Nellore A, Kotton CN. Screening Strategies for Tuberculosis in Children With Kidney Disease: What Is Cost-Effective? Am J Kidney Dis 2013; 61:3-5. [DOI: 10.1053/j.ajkd.2012.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 10/04/2012] [Indexed: 11/11/2022]
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21
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Brouqui P, Delaigue S, Parola P, Drancourt M. Interferon-gamma release assay: use and misuse. Clin Microbiol Infect 2012; 18:1053-4. [DOI: 10.1111/1469-0691.12025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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