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Wang L, Ruan JX, Chen W, Wang XQ, Yu Y. Exploration and improvement of QuantiFERON-TB assay in patients with indeterminate results in clinical practice: A head-to-head study. Clin Chim Acta 2023; 549:117559. [PMID: 37709113 DOI: 10.1016/j.cca.2023.117559] [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: 06/01/2023] [Revised: 08/13/2023] [Accepted: 09/11/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND We implemented the QuantiFERON-TB Gold In-Tube (QFT-GIT) based on peripheral blood mononuclear cells (QFT-PBMCs) and QFT Gold Plus (QFT-Plus) in patients with indeterminate results, and use Mit-Nil value to identify false negatives and impaired cellular immunity. METHODS One hundred seventy-one out of 2480 patients who had a QFT-GIT test were prospectively recruited and classified as high Nil (n = 35), low Mit (n = 75) and control (n = 61) cohorts. Head-to-head comparisons, i.e., QFT-PBMCs vs. QFT-GIT in high Nil cohort, QFT-Plus vs. QFT-GIT in low Mit cohort, and QFT-PBMCs vs. QFT-GIT in controls, were performed. Lymphocyte subsets counts were conducted in low Mit and control cohorts. RESULTS A significant reduction of positive rate only occurred in Mit-Nil < 6 IU/ml (p < 0.001). QFT-PBMCs yielded 100 % valid results and had a significant Nil decline in high Nil cohort (0.98 ± 1.06 vs. 9.55 ± 0.64 IU/ml, p < 0.0001), while correlated well with QFT-GIT for qualitative (Cohen's k = 0.93) and quantitative (TB-Ag [R2 = 0.91] and Mit [R2 = 0.94]) analyses. QFT-Plus produced 61.3 % valid results and had a significant Mit increase in low Mit cohort (0.82 ± 0.95 vs. 0.17 ± 0.11 IU/ml, p < 0.0001). Mit-Nil value significantly correlated with lymphocyte subsets counts (R:0.49-0.56, p < 0.0001), separately corresponding to thresholds of 4.26, 5.33, 5.55 and 5.81 IU/ml for predicting decreased total lymphocyte, T lymphocyte, CD4+ and CD8+ cells. CONCLUSIONS QFT that replacing whole blood with PBMCs should be recommended to handle high Nil samples, and QFT-Plus can declined the frequency of low Mit results. In addition, Mit-Nil < 6 and 5.81 IU/ml are potential thresholds to identify the risk of false negatives and impaired cellular immunity, respectively.
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Affiliation(s)
- Linchuan Wang
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Jin-Xiong Ruan
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Wei Chen
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Xiao-Qin Wang
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Yan Yu
- Hong-Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi Province, China.
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2
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Kobashi Y. Current status and future landscape of diagnosing tuberculosis infection. Respir Investig 2023; 61:563-578. [PMID: 37406419 DOI: 10.1016/j.resinv.2023.04.010] [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: 02/08/2023] [Revised: 03/29/2023] [Accepted: 04/10/2023] [Indexed: 07/07/2023]
Abstract
Interferon-γ release assays (IGRAs), such as QuantiFERON-TB Gold (QFT) or T-SPOT.TB, are frequently used as tools for the diagnosis of tuberculosis (TB) infection in the 21st century. QFT-Plus recently emerged as the fourth generation of QFT assays and has replaced QFT In-Tube. However, IGRAs have several problems regarding the identification of active, latent, and cured TB infection, and the time-consuming diagnosis of TB infection because of the overnight incubation of clinical specimens or complexity of measuring the level of interferon (IFN)-γ. To easily diagnose TB infection and quickly compare it with conventional IGRAs, many in vitro tests are developed based on assays other than enzyme-linked immunosorbent assay or enzyme-linked immunospot, such as the fluorescent lateral flow assay that requires less manual operation and a shorter time. Simplified versions of IGRAs are emerging, including QIAreach QuantiFERON-TB. On the other hand, to distinguish active TB from latent or cured TB infection, new immunodiagnostic biomarkers beyond IFN-γ are evaluated using QFT supernatants. While IFN-γ or IFN-γ-related chemokine such as IFN-γ induced protein 10 is a potential biomarker in patients with active TB, interleukin-2 or latency-associated antigen such as heparin-binding hemagglutinin may be useful to distinguish active TB from latent or cured TB infection. There are no potential biomarkers to fully distinguish the time-phase of TB infection at present. It is necessary to discover new immunodiagnostic biomarkers to facilitate decisions on treatment selection for active or latent TB infection.
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Affiliation(s)
- Yoshihiro Kobashi
- Department of Respiratory Medicine, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, Japan.
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3
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Zhou G, Luo Q, Luo S, Chen H, Cai S, Guo X, He J, Xia Y, Li H, Zhou Y, Zhang Y, Song C. Indeterminate results of interferon gamma release assays in the screening of latent tuberculosis infection: a systematic review and meta-analysis. Front Immunol 2023; 14:1170579. [PMID: 37256138 PMCID: PMC10225525 DOI: 10.3389/fimmu.2023.1170579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 04/19/2023] [Indexed: 06/01/2023] Open
Abstract
Objectives We aimed to evaluate the indeterminate rate of interferon gamma release assays (IGRAs) in the detection of latent tuberculosis infection (LTBI). Methods On 15 November 2022, we searched the PubMed® (National Library of Medicine, Bethesda, MD, USA), Embase® (Elsevier, Amsterdam, the Netherlands), and Cochrane Library databases in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two investigators independently extracted the study data and assessed their quality using a modified quality assessment of diagnostic accuracy studies (i.e., QUADAS-2) tool. A random-effects model was used to calculate pooled results. Results We included 403 studies involving 486,886 individuals and found that the pooled indeterminate rate was 3.9% (95% CI 3.5%-4.2%). The pooled indeterminate rate for QuantiFERON®-TB (QFT) was similar to that for T-SPOT®.TB (T-SPOT) [odds ratio (OR) = 0.88, 95% CI 0.59-1.32]; however, the indeterminate rate for a new generation of QFT (QFT-plus) was lower than that of T-SPOT (OR = 0.24, 95% CI 0.16-0.35). The indeterminate rate in the immunocompromised population was significantly higher than that in healthy controls (OR = 3.51, 95% CI 2.11-5.82), and it increased with the reduction of CD4+ cell count in HIV-positive patients. Children's pooled indeterminate rates (OR = 2.56, 95% CI 1.79-3.57) were significantly higher than those of adults, and the rates increased as the children's age decreased. Conclusion On average, 1 in 26 tests yields indeterminate IGRA results in LTBI screening. The use of advanced versions of the QuantiFERON-TB assay (QFT-plus), may potentially reduce the occurrence of an indeterminate result. Our study emphasizes the high risk of immunosuppression and young age in relation to indeterminate IGRA, which should receive more attention in the management of LTBI. Systematic review registration PROSPERO https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020211363, CRD42020211363.
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Affiliation(s)
- Guozhong Zhou
- Department of Science and Research, Anning First People’s Hospital Affiliated to Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Qingyi Luo
- Department of Medical Imaging, Yanan Hospital Affiliated to Kunming Medical University, Kunming, Yunnan, China
| | - Shiqi Luo
- Department of Immunology, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China
| | - Hongbo Chen
- Department of Pulmonary and Critical Care Medicine, Anning First People’s Hospital Affiliated to Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Shunli Cai
- School of Basic Medical Sciences, Kunming Medical University, Kunming, Yunnan, China
| | - Xin Guo
- School of Basic Medical Sciences, Kunming Medical University, Kunming, Yunnan, China
| | - Jian He
- Department of Immunology, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China
| | - Yuan Xia
- School of Basic Medical Sciences, Kunming Medical University, Kunming, Yunnan, China
| | - Hanse Li
- School of Basic Medical Sciences, Kunming Medical University, Kunming, Yunnan, China
| | - Yingchen Zhou
- The School of Medicine, Kunming University, Kunming, China
| | - Yazhou Zhang
- Department of Gerontology 2, The Second People’s Hospital of Kunming, Kunming, China
| | - Chao Song
- Department of Medical Imaging, Anning First People’s Hospital Affiliated to Kunming University of Science and Technology, Kunming, Yunnan, China
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4
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Lim YK, Kweon OJ, Choi Y, Kim TH, Lee MK. Evaluation of ichroma™ COVID-19 interferon gamma release assay for detection of vaccine-induced immunity in healthcare workers. Clin Chem Lab Med 2023; 61:503-509. [PMID: 36476381 DOI: 10.1515/cclm-2022-0914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES We compared the performance of a new interferon gamma release assay (IGRA) format assay, the ichroma™ COVID-19 IGRA (IGRA-SARS), with that of the widely used QuantiFERON SARS-CoV-2 ELISA kit (QFN-SARS) in vaccinated healthcare workers (HCWs). Additionally, we analyzed the long-term changes in IGRA results after the final vaccine dose. METHODS A total of 383 specimens from 281 HCWs were enrolled in this study, and the results of SARS-IGRA and QFN-SARS assays were compared. In addition, we performed the receive operator curve analysis to estimate the optimal cut-off value for IGRA-SARS. RESULTS For all specimens, IGRA-SARS and QFN-SARS showed 75.7% and 64.2% of the positive results, respectively. The absolute agreement between IGRA-SARS and QFN-SARS was 80.0%, and the Fleiss' κ value was 0.525, indicating moderate agreement. ROC curve analysis of the IGRA-SARS results showed a cut-off value of >0.254 IU/mL, which was consistent with the manufacturer's specifications. The positive rates of both IGRA assays decreased significantly after a postvaccination period of 6 months. CONCLUSIONS IGRA-SARS showed acceptable performance in the detection of vaccine-induced immunity against COVID-19; however, harmonization of IGRA assays has not yet been achieved. Additionally, the significant decline of positive rates of IGRA after the last vaccination would support the necessity of booster vaccination after a postvaccination period of 6 months.
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Affiliation(s)
- Yong Kwan Lim
- Department of Laboratory Medicine, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Oh Joo Kweon
- Department of Laboratory Medicine, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Yoojeong Choi
- Department of Laboratory Medicine, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Tae-Hyoung Kim
- Department of Urology, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Mi-Kyung Lee
- Department of Laboratory Medicine, Chung-Ang University College of Medicine, Seoul, South Korea
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5
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Chin KL, Anibarro L, Sarmiento ME, Acosta A. Challenges and the Way forward in Diagnosis and Treatment of Tuberculosis Infection. Trop Med Infect Dis 2023; 8:tropicalmed8020089. [PMID: 36828505 PMCID: PMC9960903 DOI: 10.3390/tropicalmed8020089] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 02/03/2023] Open
Abstract
Globally, it is estimated that one-quarter of the world's population is latently infected with Mycobacterium tuberculosis (Mtb), also known as latent tuberculosis infection (LTBI). Recently, this condition has been referred to as tuberculosis infection (TBI), considering the dynamic spectrum of the infection, as 5-10% of the latently infected population will develop active TB (ATB). The chances of TBI development increase due to close contact with index TB patients. The emergence of multidrug-resistant TB (MDR-TB) and the risk of development of latent MDR-TB has further complicated the situation. Detection of TBI is challenging as the infected individual does not present symptoms. Currently, there is no gold standard for TBI diagnosis, and the only screening tests are tuberculin skin test (TST) and interferon gamma release assays (IGRAs). However, these tests have several limitations, including the inability to differentiate between ATB and TBI, false-positive results in BCG-vaccinated individuals (only for TST), false-negative results in children, elderly, and immunocompromised patients, and the inability to predict the progression to ATB, among others. Thus, new host markers and Mtb-specific antigens are being tested to develop new diagnostic methods. Besides screening, TBI therapy is a key intervention for TB control. However, the long-course treatment and associated side effects result in non-adherence to the treatment. Additionally, the latent MDR strains are not susceptible to the current TBI treatments, which add an additional challenge. This review discusses the current situation of TBI, as well as the challenges and efforts involved in its control.
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Affiliation(s)
- Kai Ling Chin
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu 88400, Malaysia
- Borneo Medical and Health Research Centre, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu 88400, Malaysia
- Correspondence: (K.L.C.); (L.A.); (A.A.)
| | - Luis Anibarro
- Tuberculosis Unit, Infectious Diseases and Internal Medicine Department, Complexo Hospitalario Universitario de Pontevedra, 36071 Pontevedra, Spain
- Immunology Research Group, Galicia Sur Health Research Institute (IIS-GS), 36312 Vigo, Spain
- Correspondence: (K.L.C.); (L.A.); (A.A.)
| | - Maria E. Sarmiento
- School of Health Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Malaysia
| | - Armando Acosta
- School of Health Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Malaysia
- Correspondence: (K.L.C.); (L.A.); (A.A.)
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6
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Sierra CJ, Downs CA. Screening and testing for latent tuberculosis infection among patients who are immunocompromised. Nurse Pract 2022; 47:32-39. [PMID: 36287735 DOI: 10.1097/01.npr.0000884860.99026.ee] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
ABSTRACT It is critical to detect latent tuberculosis infection through screening and testing individuals at high risk of progression to active tuberculosis, including patients who are immunocompromised. NPs should be familiar with available testing for accurate diagnosis in order to expedite treatment.
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7
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Fehily SR, Al-Ani AH, Abdelmalak J, Rentch C, Zhang E, Denholm JT, Johnson D, Ng SC, Sharma V, Rubin DT, Gibson PR, Christensen B. Review article: latent tuberculosis in patients with inflammatory bowel diseases receiving immunosuppression-risks, screening, diagnosis and management. Aliment Pharmacol Ther 2022; 56:6-27. [PMID: 35596242 PMCID: PMC9325436 DOI: 10.1111/apt.16952] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 04/14/2022] [Accepted: 04/18/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND One quarter of the world's population has latent tuberculosis infection (LTBI). Systemic immunosuppression is a risk factor for LTBI reactivation and the development of active tuberculosis. Such reactivation carries a risk of significant morbidity and mortality. Despite the increasing global incidence of inflammatory bowel disease (IBD) and the use of immune-based therapies, current guidelines on the testing and treatment of LTBI in patients with IBD are haphazard with a paucity of evidence. AIM To review the screening, diagnostic practices and medical management of LTBI in patients with IBD. METHODS Published literature was reviewed, and recommendations for testing and treatment were synthesised by experts in both infectious diseases and IBD. RESULTS Screening for LTBI should be performed proactively and includes assessment of risk factors, an interferon-gamma releasing assay or tuberculin skin test and chest X-ray. LTBI treatment in patients with IBD is scenario-dependent, related to geographical endemicity, travel and other factors. Ideally, LTBI therapy should be used prior to immune suppression but can be applied concurrently where urgent IBD medical treatment is required. Management is best directed by a multidisciplinary team involving gastroenterologists, infectious diseases specialists and pharmacists. Ongoing surveillance is recommended during therapy. Newer LTBI therapies show promise, but medication interactions need to be considered. There are major gaps in evidence, particularly with specific newer therapeutic approaches to IBD. CONCLUSIONS Proactive screening for LTBI is essential in patients with IBD undergoing immune-suppressing therapy and several therapeutic strategies are available. Reporting of real-world experience is essential to refining current management recommendations.
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Affiliation(s)
- Sasha R Fehily
- Gastroenterology Department, St Vincent's Hospital, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Aysha H Al-Ani
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia.,Gastroenterology Department, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Jonathan Abdelmalak
- Gastroenterology Department, Alfred Hospital, Melbourne, Victoria, Australia
| | - Clarissa Rentch
- Gastroenterology Department, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Eva Zhang
- Gastroenterology Department, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Justin T Denholm
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia.,Infectious Diseases Department, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Victorian Tuberculosis Program, Melbourne, Victoria, Australia.,Department of Infectious Diseases, Doherty Institute, Parkville, Victoria, Australia
| | - Douglas Johnson
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia.,Infectious Diseases Department, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Siew C Ng
- Department of Medicine and Therapeutics, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - David T Rubin
- University of Chicago Medicine Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, Illinois, USA
| | - Peter R Gibson
- Department of Gastroenterology, Monash University and Alfred Health, Melbourne, Victoria, Australia
| | - Britt Christensen
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia.,Gastroenterology Department, Royal Melbourne Hospital, Parkville, Victoria, Australia
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8
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Jacquier M, Binquet C, Manoha C, Audia S, Simonet-Lamm AL, Casenaz A, Sow AK, Piroth L, Blot M. Beyond QuantiFERON-TB Results, the Added Value of a Weak Mitogen Response. Front Med (Lausanne) 2022; 9:876864. [PMID: 35712107 PMCID: PMC9197320 DOI: 10.3389/fmed.2022.876864] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/10/2022] [Indexed: 12/26/2022] Open
Abstract
Introduction While QuantiFERON-TB gold (QFT) is frequently used, little attention is paid to the mitogen response. How it could be impacted and associated with outcomes is poorly known. Methods Retrospective, case-control study in hospitalized patients who underwent QFT testing in two hospitals between 2016 and 2019. We defined two groups of cases with either negative [interferon (IFN)-γ ≤ 0.5 IU/ml, official threshold] or weak (0.5–2 IU/ml) mitogen response, and one group of controls with normal (>2 IU/ml) mitogen response. Results A total of 872 patients were included. An ongoing infection was independently associated with both a negative (RR = 4.34; 95% CI = 2.94–6.41) and a weak mitogen response (RR = 2.44; 95% CI = 1.66–3.58). Among tuberculosis patients, a weak mitogen response was associated with a false-negative QFT result (75%) compared to a normal response (20%). Decreasing mitogen response (normal, weak and negative, respectively) was associated with increasing length of hospital stay [median (interquartile range) 5 (3–13), 11 (5–21) and 15 (10–30) days; p < 0.001] and increasing hospital mortality (3, 7, and 15%; p < 0.001). Conclusion Clinicians should take notice of the mitogen response since IFN-γ concentrations lower than <2 IU/ml were associated with false-negative QFT results in tuberculosis patients, independently associated with ongoing infections, and could be associated with worse prognosis.
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Affiliation(s)
- Marine Jacquier
- Department of Infectious Diseases, Dijon-Bourgogne University Hospital, Dijon, France.,Department of Intensive Care, Dijon-Bourgogne University Hospital, Dijon, France.,Lipness Team, INSERM Research Centre LNC-UMR1231 and LabEx LipSTIC, University of Burgundy, Dijon, France
| | - Christine Binquet
- CHU Dijon-Bourgogne, INSERM, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, Dijon, France
| | - Catherine Manoha
- Department of Virology, Dijon-Bourgogne University Hospital, Dijon, France
| | - Sylvain Audia
- Department of Internal Medicine and Clinical Immunology, Dijon-Bourgogne University Hospital, Dijon, France
| | | | - Alice Casenaz
- Department of Virology, Dijon-Bourgogne University Hospital, Dijon, France
| | - Amadou-Khalilou Sow
- CHU Dijon-Bourgogne, INSERM, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, Dijon, France
| | - Lionel Piroth
- Department of Infectious Diseases, Dijon-Bourgogne University Hospital, Dijon, France.,CHU Dijon-Bourgogne, INSERM, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, Dijon, France
| | - Mathieu Blot
- Department of Infectious Diseases, Dijon-Bourgogne University Hospital, Dijon, France.,Lipness Team, INSERM Research Centre LNC-UMR1231 and LabEx LipSTIC, University of Burgundy, Dijon, France.,CHU Dijon-Bourgogne, INSERM, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, Dijon, France
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9
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Imeneo A, Alessio G, Di Lorenzo A, Campogiani L, Lodi A, Barreca F, Zordan M, Barchi V, Massa B, Tedde S, Crea A, Vitale P, Spalliera I, Compagno M, Coppola L, Dori L, Malagnino V, Teti E, Andreoni M, Sarmati L, Iannetta M. In Patients with Severe COVID-19, the Profound Decrease in the Peripheral Blood T-Cell Subsets Is Correlated with an Increase of QuantiFERON-TB Gold Plus Indeterminate Rates and Reflecting a Reduced Interferon-Gamma Production. Life (Basel) 2022; 12:life12020244. [PMID: 35207531 PMCID: PMC8880410 DOI: 10.3390/life12020244] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/03/2022] [Accepted: 02/05/2022] [Indexed: 12/15/2022] Open
Abstract
Increased rates of indeterminate QuantiFERON-TB Gold Plus Assay (QFT-Plus) were demonstrated in patients hospitalized with Coronavirus Disease (COVID)-19. We aimed to define the prevalence and characteristics of hospitalized COVID-19 patients with indeterminate QFT-Plus. A retrospective study was performed including hospitalized COVID-19 patients, stratified in survivors and non-survivors, non-severe and severe according to the maximal oxygen supply required. Statistical analysis was performed using JASP ver0.14.1 and GraphPad Prism ver8.2.1. A total of 420 patients were included, median age: 65 years, males: 66.4%. The QFT-Plus was indeterminate in 22.1% of patients. Increased rate of indeterminate QFT-Plus was found in non-survivors (p = 0.013) and in severe COVID-19 patients (p < 0.001). Considering the Mitogen-Nil condition of the QFT-Plus, an impaired production of interferon-gamma (IFN-γ) was found in non-survivors (p < 0.001) and in severe COVID-19 patients (p < 0.001). A positive correlation between IFN-γ levels in the Mitogen-Nil condition and the absolute counts of CD3+ (p < 0.001), CD4+ (p < 0.001), and CD8+ (p < 0.001) T-lymphocytes was found. At the multivariable analysis, CD3+ T-cell absolute counts and CD4/CD8 ratio were confirmed as independent predictors of indeterminate results at the QFT-Plus. Our study confirmed the increased rate of indeterminate QFT-Plus in COVID-19 patients, mainly depending on the peripheral blood T-lymphocyte depletion found in the most severe cases.
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Affiliation(s)
- Alessandra Imeneo
- Department of System Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (A.I.); (G.A.); (A.D.L.); (A.L.); (F.B.); (M.Z.); (V.B.); (B.M.); (S.T.); (A.C.); (V.M.); (M.A.); (L.S.)
| | - Grazia Alessio
- Department of System Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (A.I.); (G.A.); (A.D.L.); (A.L.); (F.B.); (M.Z.); (V.B.); (B.M.); (S.T.); (A.C.); (V.M.); (M.A.); (L.S.)
| | - Andrea Di Lorenzo
- Department of System Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (A.I.); (G.A.); (A.D.L.); (A.L.); (F.B.); (M.Z.); (V.B.); (B.M.); (S.T.); (A.C.); (V.M.); (M.A.); (L.S.)
| | - Laura Campogiani
- Infectious Disease Clinic, Policlinico Tor Vergata, Viale Oxford 81, 00133 Rome, Italy; (L.C.); (P.V.); (I.S.); (M.C.); (L.C.); (L.D.); (E.T.)
| | - Alessandra Lodi
- Department of System Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (A.I.); (G.A.); (A.D.L.); (A.L.); (F.B.); (M.Z.); (V.B.); (B.M.); (S.T.); (A.C.); (V.M.); (M.A.); (L.S.)
| | - Filippo Barreca
- Department of System Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (A.I.); (G.A.); (A.D.L.); (A.L.); (F.B.); (M.Z.); (V.B.); (B.M.); (S.T.); (A.C.); (V.M.); (M.A.); (L.S.)
| | - Marta Zordan
- Department of System Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (A.I.); (G.A.); (A.D.L.); (A.L.); (F.B.); (M.Z.); (V.B.); (B.M.); (S.T.); (A.C.); (V.M.); (M.A.); (L.S.)
| | - Virginia Barchi
- Department of System Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (A.I.); (G.A.); (A.D.L.); (A.L.); (F.B.); (M.Z.); (V.B.); (B.M.); (S.T.); (A.C.); (V.M.); (M.A.); (L.S.)
| | - Barbara Massa
- Department of System Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (A.I.); (G.A.); (A.D.L.); (A.L.); (F.B.); (M.Z.); (V.B.); (B.M.); (S.T.); (A.C.); (V.M.); (M.A.); (L.S.)
| | - Simona Tedde
- Department of System Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (A.I.); (G.A.); (A.D.L.); (A.L.); (F.B.); (M.Z.); (V.B.); (B.M.); (S.T.); (A.C.); (V.M.); (M.A.); (L.S.)
| | - Angela Crea
- Department of System Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (A.I.); (G.A.); (A.D.L.); (A.L.); (F.B.); (M.Z.); (V.B.); (B.M.); (S.T.); (A.C.); (V.M.); (M.A.); (L.S.)
| | - Pietro Vitale
- Infectious Disease Clinic, Policlinico Tor Vergata, Viale Oxford 81, 00133 Rome, Italy; (L.C.); (P.V.); (I.S.); (M.C.); (L.C.); (L.D.); (E.T.)
| | - Ilaria Spalliera
- Infectious Disease Clinic, Policlinico Tor Vergata, Viale Oxford 81, 00133 Rome, Italy; (L.C.); (P.V.); (I.S.); (M.C.); (L.C.); (L.D.); (E.T.)
| | - Mirko Compagno
- Infectious Disease Clinic, Policlinico Tor Vergata, Viale Oxford 81, 00133 Rome, Italy; (L.C.); (P.V.); (I.S.); (M.C.); (L.C.); (L.D.); (E.T.)
| | - Luigi Coppola
- Infectious Disease Clinic, Policlinico Tor Vergata, Viale Oxford 81, 00133 Rome, Italy; (L.C.); (P.V.); (I.S.); (M.C.); (L.C.); (L.D.); (E.T.)
| | - Luca Dori
- Infectious Disease Clinic, Policlinico Tor Vergata, Viale Oxford 81, 00133 Rome, Italy; (L.C.); (P.V.); (I.S.); (M.C.); (L.C.); (L.D.); (E.T.)
| | - Vincenzo Malagnino
- Department of System Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (A.I.); (G.A.); (A.D.L.); (A.L.); (F.B.); (M.Z.); (V.B.); (B.M.); (S.T.); (A.C.); (V.M.); (M.A.); (L.S.)
- Infectious Disease Clinic, Policlinico Tor Vergata, Viale Oxford 81, 00133 Rome, Italy; (L.C.); (P.V.); (I.S.); (M.C.); (L.C.); (L.D.); (E.T.)
| | - Elisabetta Teti
- Infectious Disease Clinic, Policlinico Tor Vergata, Viale Oxford 81, 00133 Rome, Italy; (L.C.); (P.V.); (I.S.); (M.C.); (L.C.); (L.D.); (E.T.)
| | - Massimo Andreoni
- Department of System Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (A.I.); (G.A.); (A.D.L.); (A.L.); (F.B.); (M.Z.); (V.B.); (B.M.); (S.T.); (A.C.); (V.M.); (M.A.); (L.S.)
- Infectious Disease Clinic, Policlinico Tor Vergata, Viale Oxford 81, 00133 Rome, Italy; (L.C.); (P.V.); (I.S.); (M.C.); (L.C.); (L.D.); (E.T.)
| | - Loredana Sarmati
- Department of System Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (A.I.); (G.A.); (A.D.L.); (A.L.); (F.B.); (M.Z.); (V.B.); (B.M.); (S.T.); (A.C.); (V.M.); (M.A.); (L.S.)
- Infectious Disease Clinic, Policlinico Tor Vergata, Viale Oxford 81, 00133 Rome, Italy; (L.C.); (P.V.); (I.S.); (M.C.); (L.C.); (L.D.); (E.T.)
| | - Marco Iannetta
- Department of System Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (A.I.); (G.A.); (A.D.L.); (A.L.); (F.B.); (M.Z.); (V.B.); (B.M.); (S.T.); (A.C.); (V.M.); (M.A.); (L.S.)
- Infectious Disease Clinic, Policlinico Tor Vergata, Viale Oxford 81, 00133 Rome, Italy; (L.C.); (P.V.); (I.S.); (M.C.); (L.C.); (L.D.); (E.T.)
- Correspondence:
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Kumar K, Kon OM. Personalised Medicine for Tuberculosis and Non-Tuberculous Mycobacterial Pulmonary Disease. Microorganisms 2021; 9:2220. [PMID: 34835346 PMCID: PMC8624359 DOI: 10.3390/microorganisms9112220] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/25/2021] [Accepted: 10/25/2021] [Indexed: 12/29/2022] Open
Abstract
Personalised medicine, in which clinical management is individualised to the genotypic and phenotypic data of patients, offers a promising means by which to enhance outcomes in the management of mycobacterial pulmonary infections. In this review, we provide an overview of how personalised medicine approaches may be utilised to identify patients at risk of developing tuberculosis (TB) or non-tuberculous mycobacterial pulmonary disease (NTM-PD), diagnose these conditions and guide effective treatment strategies. Despite recent technological and therapeutic advances, TB and NTM-PD remain challenging conditions to diagnose and treat. Studies have identified a range of genetic and immune factors that predispose patients to pulmonary mycobacterial infections. Molecular tests such as nucleic acid amplification assays and next generation sequencing provide a rapid means by which to identify mycobacterial isolates and their antibiotic resistance profiles, thus guiding selection of appropriate antimicrobials. Host-directed therapies and therapeutic drug monitoring offer ways of tailoring management to the clinical needs of patients at an individualised level. Biomarkers may hold promise in differentiating between latent and active TB, as well as in predicting mycobacterial disease progression and response to treatment.
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Affiliation(s)
- Kartik Kumar
- National Heart and Lung Institute, Imperial College London, Dovehouse Street, London SW3 6LY, UK;
- Department of Respiratory Medicine, St Mary’s Hospital, Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, UK
| | - Onn Min Kon
- National Heart and Lung Institute, Imperial College London, Dovehouse Street, London SW3 6LY, UK;
- Department of Respiratory Medicine, St Mary’s Hospital, Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, UK
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11
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The Relationship between Pre-Pandemic Interferon Gamma Release Assay Test Results and COVID-19 Infection: Potential Prognostic Value of Indeterminate IFN- γ Release Assay Results. ACTA ACUST UNITED AC 2021; 2021:1989277. [PMID: 34367385 PMCID: PMC8342180 DOI: 10.1155/2021/1989277] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 07/23/2021] [Indexed: 12/23/2022]
Abstract
Objective To reveal the relationship between interferon-gamma release assay (IGRA) test (Standard ETB-Feron ELISA (TBF)) results performed within 12 months before the COVID-19 pandemic and the frequency of COVID-19 infections and the severity of COVID-19. Methods The retrospective TBF test results and contact information of 684 patients aged over 18 years who underwent TBF testing between March 11th, 2019, and March 10th, 2020, were obtained. Of the 684 patients contacted by phone, 365 agreed to participate in the study and were enrolled. The patients were divided into three groups (TBF test positive, negative, and indeterminate). The data obtained from the questionnaire were compared statistically. Results According to the TBF test results, positive (n = 51, 14%), negative (n = 286, 78.3%), and indeterminate (n = 28, 7.7%) groups were compared. The frequency of COVID-19 infections in the indeterminate group was found significantly higher than that in the positive and negative groups (p=0.005). When the group with COVID-19 (n = 46, 12.6%) was compared with the group without (n = 319, 87.4%), no difference was found in terms of age, sex, body mass index, smoking history and number of cigarettes smoked, TB history, diabetes mellitus, hypertension, coronary artery disease, and biologic and corticosteroid therapy use. Only the frequency of obstructive pulmonary disease was significantly higher in the group without COVID-19 (p=0.033). Conclusion The frequency of COVID-19 infection was increased in patients with indeterminate TBF test results. Indeterminate TBF test results may be a guide in terms of risk stratification in groups at risk for COVID-19.
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12
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Evaluation of the Fully Automated Chemiluminescence Analyzer Liaison XL for the Performance of the QuantiFERON-TB Gold Plus Assay in an Area with a Low Incidence of Tuberculosis. J Clin Microbiol 2021; 59:e0060321. [PMID: 34076474 DOI: 10.1128/jcm.00603-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Diagnosis of latent tuberculosis infection (LTBI) is considered key in the control of tuberculosis. Interferon gamma (IFN-γ) release assays, such as the QuantiFERON-TB Gold Plus test (QFT-Plus), are now widely implemented for the in vitro diagnosis of LTBI. To date, the detection and quantification of IFN-γ has been mostly performed with semiautomated enzyme-linked immunosorbent assays (ELISAs), but several limitations currently exist. The study aims to evaluate the chemiluminescence immunoassay (CLIA) analyzer Liaison XL compared to ELISA for the performance of the QFT-Plus test. Between February and April 2020, 333 heparin blood samples from 323 adult patients were collected at a tertiary teaching hospital in Barcelona, Spain. Overall, the CLIA analyzer Liaison XL performed well for the detection of IFN-γ compared to the ELISA method, demonstrating substantial agreement (κ, 0.872) and great correlation between assays (r, >0.950). CLIA produced significantly higher values of IFN-γ IU per milliliter than the ELISA (P = 0.004 for the TB1 tube and P = 0.010 for the TB2 tube). Many discrepant cases (8/15, 53.3%) corresponded to indeterminate results with ELISA (NIL-corrected mitogen value of <0.5 IU/ml), which, when analyzed with the CLIA analyzer Liaison XL, reverted to interpretable results. In conclusion, this analysis suggests that CLIA presents a greater sensitivity for the identification of LTBI, especially among immunocompromised patients. Furthermore, the analytical variability reported between both ELISA and CLIA methods, especially around the standardized 0.35-IU/ml positivity threshold, suggests the need to refine the interpretative algorithm.
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13
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Lu P, Liu Q, Zhou Y, Martinez L, Kong W, Ding X, Peng H, Zhu T, Zhu L, Lu W. Predictors of Discordant Tuberculin Skin Test and QuantiFERON-TB Gold In-tube Results in Eastern China: A Population-based, Cohort Study. Clin Infect Dis 2021; 72:2006-2015. [PMID: 32369577 DOI: 10.1093/cid/ciaa519] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 04/29/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Discordance between the QuantiFERON-TB Gold In-tube (QFT) and tuberculin skin test (TST) is not well understood. We aimed to identify the factors that determine discordance between the TST and QFT when compared to either TST+QFT+ or TST-QFT- results in a medium tuberculosis (TB) burden setting. METHODS We conducted a population-based study in Eastern China and administered TSTs and QFTs to participants. We calculated kappa values while constructing multivariable logistic regression models to evaluate predictors of test discordance. We analyzed the predictive value of discordant and concordant test results for progression to TB over 6 years of follow-up. RESULTS Overall, 5405 participants were enrolled; 2043 (37.8%) and 1104 (20.4%) were TST and QFT positive, respectively. There was fair agreement between the TST and the QFT (kappa values between 0.30-0.39 at different TST cutoffs). Agreement was lower among participants vaccinated with Bacillus Calmette-Guerin (BCG; κ, 0.17 versus 0.47 in nonvaccinated participants). TST+QFT- results were associated with decreasing age, smoking, undiagnosed diabetes, and BCG vaccination (adjusted odds ratio, 1.45; 95% confidence interval [CI], 1.11-1.90). TST-QFT+ results were associated with increasing age, male sex, smoking, and diagnosed diabetes. Compared to participants with TST-QFT- results, QFT+ and TST+QFT+ participants were 6.3 (95% CI, 1.9-20.4) and 7.5 (95%CI, 2.3-25.1) times more likely to progress to TB, respectively. CONCLUSIONS In this population-based study of over 5000 participants from a medium TB burden region, the test agreement between QFT and TST was fair overall and we found multiple novel predictors of discordant QFT/TST results. QFT provides a substantial improvement to the TST among these populations and was multi-fold better at predicting progression to TB.
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Affiliation(s)
- Peng Lu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu Province, People's Republic of China
| | - Qiao Liu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu Province, People's Republic of China.,Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu Province, People's Republic of China
| | - Yang Zhou
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu Province, People's Republic of China
| | - Leonardo Martinez
- Division of Infectious Diseases and Geographic Medicine, School of Medicine, Stanford University, Stanford, California, USA
| | - Wen Kong
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu Province, People's Republic of China
| | - Xiaoyan Ding
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu Province, People's Republic of China
| | - Hong Peng
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu Province, People's Republic of China
| | - Tao Zhu
- Center for Disease Control and Prevention of Danyang City, Zhenjiang, Jiangsu Province, People's Republic of China
| | - Limei Zhu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu Province, People's Republic of China
| | - Wei Lu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu Province, People's Republic of China
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14
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Torre A, Aliberti S, Castellotti PF, Cirillo DM, Grisolia A, Mangioni D, Marchetti G, Rossotti R, Santus P, Besozzi G, Villa S, Codecasa LR. Preliminary observations on IGRA testing for TB infection in patients with severe COVID-19 eligible for immunosuppressive therapy. Respir Med 2020; 175:106204. [PMID: 33186846 PMCID: PMC7645275 DOI: 10.1016/j.rmed.2020.106204] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/23/2020] [Accepted: 10/26/2020] [Indexed: 01/05/2023]
Abstract
COVID-19, the novel coronavirus pandemic, has already spread around the globe affecting more than 18 million people. As previously observed with other coronaviruses, SARS-CoV-2 deeply dysregulate the immune system eliciting respiratory failure and a state of systemic hyperinflammation in severely ill individuals. Immunotherapy is often used to downgrade the detrimental effects of the disease sustained by high-level of cytokines. Those treatments, however, are known to undermine patients’ ability to contain tuberculosis (TB) infection. This study aims to describe interferon-γ release assay (IGRA) results in severe COVID-19 patients eligible for immunosuppressive treatment. Aggregate data were gathered from five hospitals in Milan, Italy, from March 1 to May 15, 2020 and retrospectively analyses. Results were summarized using absolute frequencies and percentages and compared using a two-sided Chi-squared test. Overall, 462 COVID-19 patients were eligible for immunosuppressive therapy, among which 335 were tested using IGRA testing. More than one-third of them (122/335; 36.4%) had an indeterminate IGRA result because of insufficient immune response to mitogen control, 19 (5.7%) tested positive and 194 (57.9) negative. The majority of patients with lymphocytopenia (i.e., total lymphocyte count [TLC] below 1000 cells/mm3) had indeterminate IGRAs (81/155; 52.3%). The proportion becomes even higher in patients with severe lymphocytopenia (i.e., TLC<500 cells/mm3) (36/57; 63%). Our results suggest a possible negative impact of COVID-19 related immune dysregulation on TB infection assessment and management. Close monitoring of individuals with or without retesting of individuals with indeterminate IGRAs and further basic science investigations should to be sought to better comprehend their implication on TB epidemiology. So far, no data on the effect of COVID-19 and anti-IL-1/-6 agents in TB progression. IGRA indeterminate was associated to severe lymphocytopenia in COVID-19 patients. Patients with indeterminate IGRA treated with anti-IL-1/-6 were more likely to die. A monitoring program is needed to avoid late diagnosis and poor outcome of TB.
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Affiliation(s)
- Alessandro Torre
- III Department of Infectious Diseases, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Stefano Aliberti
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Milan, Italy
| | - Paola Francesca Castellotti
- Regional TB Reference Centre and Laboratory, Villa Marelli Institute/ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Stop TB Italia ONLUS, Milan, Italy
| | - Daniela Maria Cirillo
- Stop TB Italia ONLUS, Milan, Italy; Emerging Pathogens Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonella Grisolia
- I Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Davide Mangioni
- Infectious Disease Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia Marchetti
- Clinic of Infectious and Tropical Diseases, Department of Health Sciences, ASST Santi Paolo e Carlo, Milan, Italy
| | - Roberto Rossotti
- Department of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Pierachille Santus
- Department of Biomedical and Clinical Sciences (DIBIC), Università Degli Studi di Milano, Milan, Italy; Division of Respiratory Diseases, "L. Sacco" University Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
| | | | - Simone Villa
- Stop TB Italia ONLUS, Milan, Italy; Centre for Multidisciplinary Research in Health Science, Università Degli Studi di Milano, Milan, Italy.
| | - Luigi Ruffo Codecasa
- Regional TB Reference Centre and Laboratory, Villa Marelli Institute/ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Stop TB Italia ONLUS, Milan, Italy
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15
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Moiola L, Barcella V, Benatti S, Capobianco M, Capra R, Cinque P, Comi G, Fasolo MM, Franzetti F, Galli M, Gerevini S, Meroni L, Origoni M, Prosperini L, Puoti M, Scarpazza C, Tortorella C, Zaffaroni M, Riva A. The risk of infection in patients with multiple sclerosis treated with disease-modifying therapies: A Delphi consensus statement. Mult Scler 2020; 27:331-346. [PMID: 32940121 DOI: 10.1177/1352458520952311] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The risk of infection associated with immunomodulatory or immunosuppressive disease-modifying drugs (DMDs) in patients with multiple sclerosis (MS) has been increasingly addressed in recent scientific literature. A modified Delphi consensus process was conducted to develop clinically relevant, evidence-based recommendations to assist physicians with decision-making in relation to the risks of a wide range of infections associated with different DMDs in patients with MS. The current consensus statements, developed by a panel of experts (neurologists, infectious disease specialists, a gynaecologist and a neuroradiologist), address the risk of iatrogenic infections (opportunistic infections, including herpes and cryptococcal infections, candidiasis and listeria; progressive multifocal leukoencephalopathy; human papillomavirus and urinary tract infections; respiratory tract infections and tuberculosis; hepatitis and gastrointestinal infections) in patients with MS treated with different DMDs, as well as prevention strategies and surveillance strategies for the early identification of infections. In the discussion, more recent data emerged in the literature were taken into consideration. Recommended risk reduction and management strategies for infections include screening at diagnosis and before starting a new DMD, prophylaxis where appropriate, monitoring and early diagnosis.
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Affiliation(s)
- Lucia Moiola
- Multiple Sclerosis Center and Neurology Department, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Valeria Barcella
- Department of Neurology and Multiple Sclerosis Center, ASST 'Papa Giovanni XXIII', Bergamo, Italy
| | - Simone Benatti
- Department of Infectious Diseases, ASST 'Papa Giovanni XXIII', Bergamo, Italy
| | - Marco Capobianco
- SCDO Neurology and Regional Reference Multiple Sclerosis Center, A.O.U. San Luigi, Orbassano, Italy
| | - Ruggero Capra
- Multiple Sclerosis Center, Spedali Civili of Brescia, Montichiari, Italy
| | - Paola Cinque
- Division of Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy
| | - Giancarlo Comi
- The Institute of Experimental Neurology and Multiple Sclerosis Center IRCCS, San Raffaele Hospital, Milan
| | - Maria Michela Fasolo
- Division of Infectious Diseases, Department of Infectious Diseases, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy
| | - Fabio Franzetti
- Infectious Diseases Unit, Busto Arsizio Hospital, Busto Arsizio, Italy/Luigi Sacco University Hospital, III Division of Infectious Diseases, Milan and Infectious Diseases Unit, Busto Arsizio, Italy
| | - Massimo Galli
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Department of Biomedical and Clinical Sciences 'L.Sacco', University of Milan, Italy
| | - Simonetta Gerevini
- Division of Neuroradiology, IRCCS San Raffaele Scientific Institute, Milan, Italy/Neuroradiology Department, 'Papa Giovanni XXIII' Hospital, Bergamo, Italy
| | - Luca Meroni
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, University of Milan, Italy
| | - Massimo Origoni
- Department of Gynecology and Obstetrics, Vita Salute San Raffaele University, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Luca Prosperini
- Department of Neuroscience, San Camillo-Forlanini Hospital, Rome, Italy
| | - Massimo Puoti
- SC Infectious Diseases ASST Niguarda Ca Grande Hospital, Milan, Italy
| | - Cristina Scarpazza
- Multiple Sclerosis Center, Spedali Civili of Brescia, Montichiari, Italy/Department of General Psychology, University of Padova, Padova, Italy
| | - Carla Tortorella
- Department of Neuroscience, San Camillo-Forlanini Hospital, Rome, Italy
| | - Mauro Zaffaroni
- Multiple Sclerosis Center, Hospital of Gallarate, ASST della Valle Olona, Gallarate, Italy
| | - Agostino Riva
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
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16
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Riestra S, Taxonera C, Zabana Y, Carpio D, Beltrán B, Mañosa M, Gutiérrez A, Barreiro-de Acosta M. Recommendations of the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU) on screening and treatment of tuberculosis infection in patients with inflammatory bowel disease. GASTROENTEROLOGIA Y HEPATOLOGIA 2020; 44:51-66. [PMID: 32828562 DOI: 10.1016/j.gastrohep.2020.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 04/06/2020] [Indexed: 12/14/2022]
Abstract
There is evidence that following the recommendations on screening and treatment of tuberculosis infection does not completely prevent the onset of tuberculosis in patients with inflammatory bowel disease. This fact, and the increasing use of new biologics and immunomodulators, has led the Spanish Group Working on Crohn's Disease and Ulcerative Colitis to update their recommendations for the prevention of tuberculosis in patients with inflammatory bowel disease. Diagnostic methods for latent tuberculosis infection, different scenarios in which screening is to be performed, strategies to reduce the risk of tuberculosis once biological treatment is initiated and chemoprophylaxis guidelines for latent tuberculosis infection are reviewed, as well as the management of active tuberculosis during biological treatment. Finally, there is a summary of the current recommendations within the paper and in an algorithm.
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Affiliation(s)
- Sabino Riestra
- Servicio de Aparato Digestivo, Hospital Universitario Central de Asturias e Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, España.
| | - Carlos Taxonera
- Servicio de Aparato Digestivo, Hospital Clínico San Carlos e Instituto de Investigación del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - Yamile Zabana
- Servicio de Aparato Digestivo, Hospital Universitari Mútua Terrassa, Barcelona, España; Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas [CIBEREhd], Madrid, España
| | - Daniel Carpio
- Servicio de Aparato Digestivo, Complexo Hospitalario Universitario de Pontevedra e Instituto de Investigación Biomédica Galicia Sur (IBI), Pontevedra, España
| | - Belén Beltrán
- Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas [CIBEREhd], Madrid, España; Servicio de Aparato Digestivo, Hospital Universitari La Fe, Valencia, España
| | - Míriam Mañosa
- Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas [CIBEREhd], Madrid, España; Servicio de Aparato Digestivo, Hospital Universitari Germans Trias i Pujol, Badalona, España
| | - Ana Gutiérrez
- Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas [CIBEREhd], Madrid, España; Servicio de Aparato Digestivo, Hospital General Universitario de Alicante, Alicante, España
| | - Manuel Barreiro-de Acosta
- Servicio de Aparato Digestivo, Hospital Clínico Universitario de Santiago, Santiago de Compostela, España
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17
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Park JH, Kim N, Park H, Kim TS, Park SW, Roh EY, Yoon JH, Shin S. The use of a borderline zone for the interpretation of interferon-gamma release assay results for serial screening of healthcare workers. PLoS One 2020; 15:e0235254. [PMID: 32603343 PMCID: PMC7326217 DOI: 10.1371/journal.pone.0235254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 06/01/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE An interferon-gamma release assay (IGRA) is used to screen for latent tuberculosis infection (LTBI). Among IGRAs, the QuantiFERON-TB Gold In-Tube (QFT-GIT) results are highly variable, so the borderline zone has been proposed to reduce unnecessary LTBI treatment. The aim of this study was to examine the proportion of the borderline zone of QFT-GIT in healthcare workers' (HCWs) serial IGRA and to retrospectively identify the utility of predicting tuberculosis (TB) in a moderate TB incidence setting. METHODS The participants were HCWs who had undergone serial LTBI screening between June 2013 and June 2018. IGRA-positive HCWs underwent examinations that included low-dose computed tomography (LDCT) and TB culture, if necessary. Applying the borderline zone (0.2-<0.7 IU/mL), the results were classified as definite negative, borderline negative, borderline positive and definite positive. RESULTS Through the follow-up of 477 HCWs, 441 (92.5%) invariant, 30 (6.3%) conversion, 2 (0.4%) reversion and 5 (1.0%) indeterminate results were observed with the manufacturer's cutoff. Applying the borderline zone, 419 (87.8%) invariant, 22 (4.6%) conversion, 1 (0.2%) reversion and 36 (7.5%) decision pending, including 5 (1.0%) indeterminate results, were observed. At the time of screening, five TB cases were identified. Chest X-ray (CXR) identified one TB case, and LDCT identified four additional TB cases. After one year, two TB cases were diagnosed, and their screening QFT-GIT results were definite positive and borderline negative. In the Cochran-Armitage trend test, the greater the maximum difference in the QFT-GIT grade with the borderline zone was, the higher the probability of developing TB (P-value <0.001). CONCLUSION The application of the borderline zone lowered the conversion rate but increased the decision pending rate. Introducing the borderline zone requires a careful approach, and a thorough examination needs to be performed to rule out TB in converters. HCWs with borderline QFT-GIT results also need close observation.
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Affiliation(s)
- Jae Hyeon Park
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, South Korea.,Department of Laboratory Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Namhee Kim
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, South Korea.,Department of Laboratory Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Hyunwoong Park
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, South Korea.,Department of Laboratory Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Taek Soo Kim
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, South Korea.,Department of Laboratory Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Sang-Won Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.,Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Eun Youn Roh
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, South Korea.,Department of Laboratory Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Jong Hyun Yoon
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, South Korea.,Department of Laboratory Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Sue Shin
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, South Korea.,Department of Laboratory Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea
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Evaluation of QuantiFERON-TB Gold Plus on Liaison XL in a Low-Tuberculosis-Incidence Setting. J Clin Microbiol 2020; 58:JCM.00159-20. [PMID: 32024727 DOI: 10.1128/jcm.00159-20] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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19
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Goel N, Torralba K, Downey C, Salto L. Screening for acquired latent tuberculosis in rheumatoid arthritis patients on tumor necrosis factor inhibition therapy in Southern California. Clin Rheumatol 2020; 39:2291-2297. [PMID: 32112272 DOI: 10.1007/s10067-020-04991-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 02/06/2020] [Accepted: 02/14/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND There are no studies assessing the development of latent tuberculosis infection (LTBI) in patients on tumor necrosis factor inhibitors (TNFα-I) in high TB prevalence areas of the USA. Our objective was to assess the rate of LTBI development in rheumatoid arthritis (RA) patients on TNFα-I therapies in San Bernardino and Riverside Counties of California, high TB prevalence areas in the US. METHODS Data were extracted from the electronic health record for 217 adult RA patients across three health centers from January 2010 to January 2017 who have had at least 1 year of TNFα-I use and negative initial QuantiFERON Gold status. Demographics, TNFα-I type, duration of use, TB risk factors, QuantiFERON results, rates of re-screening, TB test seroconversion, and its association with drug use and other factors were assessed. RESULTS Of the 217 patients, 115 (53%) received baseline and annual screening for LTBI. LTBI was diagnosed in 9.4% (10) of patients. Four patients were on infliximab, three on golimumab, two on adalimumab, and one on etanercept. Hispanic patients tended to have a greater than 200% increase in odds of seroconversion compared to non-Hispanic patients. Infliximab and golimumab were associated with a 92% and 400% increase in odds of seroconversion, respectively. CONCLUSION The LTBI developed in 9.4% of the patients. This is higher than what is reported for previous US studies. Screening for LTBI in the US should take into consideration TB prevalence, ethnicity, drug type, and duration of use. For our local population and similar populations, annual screening should be practiced. Key Points • Although patients on TNFα inhibitor (TNFα-I) therapy are at high risk of latent tuberculosis infection (LTBI), few studies report the rate of LTBI in patients living in high prevalence areas of the US. • The rate of LTBI was 9.4% in patients on TNFα-I therapy in Southern California. The risk of seroconversion was higher in patients of Hispanic ethnicity and also higher for those on infliximab and golimumab compared to those on other TNFα-I therapies. • Screening guidelines for LTBI screening on TNFα-I should consider local TB prevalence, drugs used, duration of use and ethnicity for cost efficient, and optimal healthcare.
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Affiliation(s)
- Noopur Goel
- Division of Rheumatology, Department of Medicine, Loma Linda University Medical Center, 11234 Anderson St, Suite 1503A, Loma Linda, California, 92354, USA
| | - Karina Torralba
- Division of Rheumatology, Department of Medicine, Loma Linda University School of Medicine, 11234 Anderson St, Suite 1503A, Loma Linda, California, 92354, USA
| | - Christina Downey
- Division of Rheumatology, Department of Medicine, Loma Linda University School of Medicine, 11234 Anderson St, Suite 1503A, Loma Linda, California, 92354, USA.
| | - Lorena Salto
- Loma Linda University School of Medicine, 11234 Anderson St, Loma Linda, California, 92354, USA
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Abubakar I, Gupta RK, Rangaka MX, Lipman M. Update in Tuberculosis and Nontuberculous Mycobacteria 2017. Am J Respir Crit Care Med 2019. [PMID: 29537298 DOI: 10.1164/rccm.201801-0106up] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | | | | | - Marc Lipman
- 2 UCL-TB and UCL Respiratory, University College London, London, United Kingdom; and.,3 Royal Free London NHS Foundation Trust, London, United Kingdom
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Carter HL, Connor AW, Hart R, McCabe J, McIntyre AC, McMillan AE, Monks NR, Mullen AK, Ronson TO, Steven A, Tomasi S, Yates SD. Rapid route design of AZD7594. REACT CHEM ENG 2019. [DOI: 10.1039/c9re00118b] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Multidisciplinary collaboration enables the rapid and efficient design and selection of an improved manufacturing route to a new potential medicine for the treatment of asthma.
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Affiliation(s)
- Holly L. Carter
- Pharmaceutical Technology and Development
- AstraZeneca
- Macclesfield
- UK
| | - Amand W. Connor
- Pharmaceutical Technology and Development
- AstraZeneca
- Macclesfield
- UK
| | - Richard Hart
- Pharmaceutical Technology and Development
- AstraZeneca
- Macclesfield
- UK
| | - James McCabe
- Early Product Development
- Pharmaceutical Sciences
- IMED Biotech Unit
- AstraZeneca
- Macclesfield
| | | | | | - Natalie R. Monks
- Pharmaceutical Technology and Development
- AstraZeneca
- Macclesfield
- UK
| | | | - Thomas O. Ronson
- Pharmaceutical Technology and Development
- AstraZeneca
- Macclesfield
- UK
| | - Alan Steven
- Pharmaceutical Technology and Development
- AstraZeneca
- Macclesfield
- UK
| | - Simone Tomasi
- Pharmaceutical Technology and Development
- AstraZeneca
- Macclesfield
- UK
| | - Simon D. Yates
- Pharmaceutical Technology and Development
- AstraZeneca
- Macclesfield
- UK
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Uzorka JW, Bossink AWJ, Franken WPJ, Thijsen SFT, Leyten EMS, van Haeften AC, Doornenbal G, Boonstra P, Ottenhoff THM, Arend SM. Borderline QuantiFERON results and the distinction between specific responses and test variability. Tuberculosis (Edinb) 2018; 111:102-108. [PMID: 30029893 DOI: 10.1016/j.tube.2018.06.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 05/29/2018] [Accepted: 06/04/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND QuantiFERON (QFT) results near the cut-off are subject to debate. We aimed to investigate which borderline QFT results were due to Mycobacterium tuberculosis (Mtb)-specific responses or to test variability. METHODS In a contact investigation, tuberculin skin test (TST), QFT and T-SPOT.TB (T-SPOT) were performed in 785 BCG-unvaccinated contacts. Contacts with a low-negative (<0.15), borderline (0.15-0.35), low-positive (0.35-0.70) or high-positive QFT (≥0.70 IU/mL) were compared with respect to exposure, TST and T-SPOT results. Development of active tuberculosis was assessed. RESULTS Borderline QFT results occurred in threefold excess over test variability (p = 0.0027). In contacts with low-negative, borderline or positive QFT results, a positive TST occurred in 24.9%, 62.1% and 91.4% (p < 0.0001) and a positive T-SPOT result in 6.3%, 41.3% and 86.4%, respectively (p < 0.0001). Two-third (20/29) of contacts with a borderline and 14/16 (88%) with a low-positive QFT had a positive TST and/or T-SPOT, indicating probable Mtb-infection. During 12 years of follow-up, seven patients were diagnosed with active tuberculosis, two of whom after a low-positive QFT. CONCLUSIONS In this study, most borderline and low-positive QFT results were Mtb-specific, showing the biological significance of a borderline QFT. The clinical relevance, however, will be most distinct in patients who are or will be immunocompromised.
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Affiliation(s)
- Jonathan W Uzorka
- Department of Infectious Diseases, Leiden University Medical Center, Room C5P-40, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Ailko W J Bossink
- Department of Pulmonology, Hospital Diakonessenhuis, Jagersingel 1, 3707 JA, Zeist, Utrecht/Zeist, The Netherlands
| | - Willeke P J Franken
- Department of Clinical Chemistry, Certe Location Medical Center Leeuwarden, Borniastraat 34, 8934 AD, Leeuwarden, The Netherlands
| | - Steven F T Thijsen
- Department of Medical Microbiology, Hospital Diakonessenhuis, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands
| | - Eliane M S Leyten
- Department of Internal Medicine, Haaglanden Medical Center, Lijnbaan 32, 2512 VA, Den Haag, The Netherlands
| | - Alida C van Haeften
- Department of Infectious Diseases, Municipal Health Service of Utrecht (GGD), Stadsplateau 1, 3521 AZ, Utrecht, The Netherlands
| | - Gert Doornenbal
- Department of Infectious Diseases, Municipal Health Service of Utrecht (GGD), Stadsplateau 1, 3521 AZ, Utrecht, The Netherlands
| | - Peter Boonstra
- Department of Infectious Diseases, Municipal Health Service of Utrecht (GGD), Stadsplateau 1, 3521 AZ, Utrecht, The Netherlands
| | - Tom H M Ottenhoff
- Department of Infectious Diseases, Leiden University Medical Center, Room C5P-40, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Sandra M Arend
- Department of Infectious Diseases, Leiden University Medical Center, Room C5P-40, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
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Incidence of active tuberculosis in rural China. THE LANCET. INFECTIOUS DISEASES 2018; 18:144-145. [DOI: 10.1016/s1473-3099(18)30021-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 12/05/2017] [Indexed: 11/21/2022]
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