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Pérez-Isidro A, Xipell M, Llobell A, De Moner N, Lledó GM, Cervera R, Prieto-González S, Quintana LF, Espinosa G, García-Ormaechea M, Ruiz-Ortiz E, Viñas O. Anti-dsDNA B-Cell ELISpot as a Monitoring and Flare Prediction Tool in SLE Patients. J Clin Med 2023; 12:1295. [PMID: 36835833 PMCID: PMC9958982 DOI: 10.3390/jcm12041295] [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: 01/03/2023] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 02/10/2023] Open
Abstract
Anti-dsDNA autoantibodies quantification and complement levels are widely used to monitor disease activity in systemic lupus erythematosus (SLE). However, better biomarkers are still needed. We hypothesised whether the dsDNA antibody-secreting B-cells could be a complementary biomarker in disease activity and prognosis of SLE patients. Fifty-two SLE patients were enrolled and followed for up to 12 months. Additionally, 39 controls were included. An activity cut-off (comparing active and non-active patients according to clinical SLEDAI-2K) was established for SLE-ELISpot, chemiluminescence and Crithidia luciliae indirect immunofluorescence tests (≥11.24, ≥374.1 and ≥1, respectively). Assays performances together with complement status were compared regarding major organ involvement at the inclusion and flare-up risk prediction after follow-up. SLE-ELISpot showed the best performance in identifying active patients. High SLE-ELISpot results were associated with haematological involvement and, after follow-up, with an increased hazard ratio for disease flare-up (3.4) and especially renal flare (6.5). Additionally, the combination of hypocomplementemia and high SLE-ELISpot results increased those risks up to 5.2 and 32.9, respectively. SLE-ELISpot offers complementary information to anti-dsDNA autoantibodies to evaluate the risk of a flare-up in the following year. In some cases, adding SLE-ELISpot to the current follow-up protocol for SLE patients can improve clinicians' personalised care decisions.
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Affiliation(s)
- Albert Pérez-Isidro
- Department of Immunology, Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic, 08036 Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Marc Xipell
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Department of Nephrology and Renal Transplantation, Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain
- Reference Centre for Complex Glomerular Disease (CSUR) of the Spanish Health System, 08036 Barcelona, Spain
| | - Arturo Llobell
- Department of Immunology, Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic, 08036 Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Noemí De Moner
- Department of Immunology, Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic, 08036 Barcelona, Spain
| | - Gema M. Lledó
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain
- Reference Centre for Systemic Autoimmune Diseases (CSUR) of the Spanish Health System, 08036 Barcelona, Spain
| | - Ricard Cervera
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain
- Reference Centre for Systemic Autoimmune Diseases (CSUR) of the Spanish Health System, 08036 Barcelona, Spain
| | - Sergio Prieto-González
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain
- Reference Centre for Systemic Autoimmune Diseases (CSUR) of the Spanish Health System, 08036 Barcelona, Spain
| | - Luis F. Quintana
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Department of Nephrology and Renal Transplantation, Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain
- Reference Centre for Complex Glomerular Disease (CSUR) of the Spanish Health System, 08036 Barcelona, Spain
| | - Gerard Espinosa
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain
- Reference Centre for Systemic Autoimmune Diseases (CSUR) of the Spanish Health System, 08036 Barcelona, Spain
| | - Mila García-Ormaechea
- Department of Immunology, Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic, 08036 Barcelona, Spain
- Lime Tree Surgery NHS, Worthing BN14 0DL, UK
| | - Estíbaliz Ruiz-Ortiz
- Department of Immunology, Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic, 08036 Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Odette Viñas
- Department of Immunology, Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic, 08036 Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
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Velasco-Arnaiz E, Batllori M, Monsonís M, Valls A, Ríos-Barnes M, Simó-Nebot S, Gamell A, Fortuny C, Tebruegge M, Noguera-Julian A. Host, technical, and environmental factors affecting QuantiFERON-TB Gold In-Tube performance in children below 5 years of age. Sci Rep 2022; 12:19908. [PMID: 36402803 PMCID: PMC9675832 DOI: 10.1038/s41598-022-24433-w] [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: 05/24/2022] [Accepted: 11/15/2022] [Indexed: 11/21/2022] Open
Abstract
Interferon-gamma release assays performance can be impaired by host-related, technical and environmental factors, but data in young children are limited. We performed a cross-sectional study of children < 5 years-of-age at risk of tuberculosis (TB), using QuantiFERON-TB Gold In-Tube (QFT-GIT) assays. The impact of the following was evaluated: (i) host-related [age; hematological parameters; erythrocyte sedimentation rate (ESR); C-reactive protein (CRP); and tobacco smoke exposure (TSE) based on serum cotinine concentrations], (ii) technical (pre-analytical delay) and (iii) environmental factors (annual season; monthly temperatures). Of 204 children, 35 (17.2%) were diagnosed with latent TB infection or TB disease. QFT-GIT results were indeterminate in 14 (6.9%) patients. In multivariate analysis, younger age and higher ESR were associated with lower positive control responses (beta: 0.247, p = 0.002 and - 0.204, p = 0.007, respectively), and increasing age was associated with lower rates of indeterminate QFT-GIT results [OR (95% CI) 0.948 (0.903-0.996) per month, p = 0.035]. In children with positive QFT-GIT results, average monthly temperatures correlated with antigen responses (r = 0.453, p = 0.020); also, antigen responses were lower in winter than in other seasons (p = 0.027). Serum cotinine concentrations determined in a subgroup of patients (n = 41) indicated TSE in 36 (88%), positive control responses being lower in children with TSE (p = 0.034). In children < 5 years-of-age, young age, elevated ESR, temperature, annual season and TSE can affect the performance of QFT-GIT assays.
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Affiliation(s)
- Eneritz Velasco-Arnaiz
- grid.411160.30000 0001 0663 8628Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria; Servei d’Infectologia Pediàtrica, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Marta Batllori
- grid.411160.30000 0001 0663 8628Laboratori de Bioquímica, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Manuel Monsonís
- grid.411160.30000 0001 0663 8628Servei de Microbiologia. Hospital Sant Joan de Déu, Barcelona, Spain
| | - Anna Valls
- grid.411160.30000 0001 0663 8628Laboratori de Bioquímica, Hospital Sant Joan de Déu, Barcelona, Spain
| | - María Ríos-Barnes
- grid.411160.30000 0001 0663 8628Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria; Servei d’Infectologia Pediàtrica, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Sílvia Simó-Nebot
- grid.411160.30000 0001 0663 8628Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria; Servei d’Infectologia Pediàtrica, Institut de Recerca Sant Joan de Déu, Barcelona, Spain ,grid.466571.70000 0004 1756 6246CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Anna Gamell
- grid.411160.30000 0001 0663 8628Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria; Servei d’Infectologia Pediàtrica, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Clàudia Fortuny
- grid.411160.30000 0001 0663 8628Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria; Servei d’Infectologia Pediàtrica, Institut de Recerca Sant Joan de Déu, Barcelona, Spain ,grid.466571.70000 0004 1756 6246CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain ,grid.5841.80000 0004 1937 0247Departament de Cirurgia i Especialitats Medicoquirúrgiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain ,Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain
| | - Marc Tebruegge
- grid.83440.3b0000000121901201Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, UK ,grid.1008.90000 0001 2179 088XDepartment of Pediatrics, University of Melbourne, Parkville, Australia ,Department of Paediatrics, Klinik Ottakring, Wiener Gesundheitsverbund, Vienna, Austria
| | - Antoni Noguera-Julian
- grid.411160.30000 0001 0663 8628Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria; Servei d’Infectologia Pediàtrica, Institut de Recerca Sant Joan de Déu, Barcelona, Spain ,grid.466571.70000 0004 1756 6246CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain ,grid.5841.80000 0004 1937 0247Departament de Cirurgia i Especialitats Medicoquirúrgiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain ,Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain ,grid.411160.30000 0001 0663 8628Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, Esplugues de Llobregat, 08950 Barcelona, Spain
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Starke JR, Erkens C, Ritz N, Kitai I. Strengthening Tuberculosis Services for Children and Adolescents in Low Endemic Settings. Pathogens 2022; 11:158. [PMID: 35215101 PMCID: PMC8877840 DOI: 10.3390/pathogens11020158] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/21/2022] [Accepted: 01/23/2022] [Indexed: 01/22/2023] Open
Abstract
In low tuberculosis-burden countries, children and adolescents with the highest incidence of tuberculosis (TB) infection or disease are usually those who have immigrated from high-burden countries. It is, therefore, essential that low-burden countries provide healthcare services to immigrant and refugee families, to assure that their children can receive proper testing, evaluation, and treatment for TB. Active case-finding through contact tracing is a critical element of TB prevention in children and in finding TB disease at an early, easily treated stage. Passive case-finding by evaluating an ill child is often delayed, as other, more common infections and conditions are suspected initially. While high-quality laboratory services to detect Mycobacterium tuberculosis are generally available, they are often underutilized in the diagnosis of childhood TB, further delaying diagnosis in some cases. Performing research on TB disease is difficult because of the low number of cases that are spread over many locales, but critical research on the evaluation and treatment of TB infection has been an important legacy of low-burden countries. The continued education of medical providers and the involvement of educational, professional, and non-governmental organizations is a key element of maintaining awareness of the presence of TB. This article provides the perspective from North America and Western Europe but is relevant to many low-endemic settings. TB in children and adolescents will persist in low-burden countries as long as it persists throughout the rest of the world, and these wealthy countries must increase their financial commitment to end TB everywhere.
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Affiliation(s)
- Jeffrey R. Starke
- Department of Pediatrics, Division of Infectious Diseases, Baylor College of Medicine, Houston, TX 77030, USA
| | - Connie Erkens
- KNCV Tuberculosis Foundation, 2516 AB The Hague, The Netherlands;
| | - Nicole Ritz
- Department of Paediatrics and Paediatric Infectious Diseases, Children’s Hospital, Lucerne Cantonal Hospital, 6000 Lucerne, Switzerland;
- Mycobacterial and Migrant Health Research Group, Department of Clinical Research, University of Basel Children’s Hospital, University of Basel, 4031 Basel, Switzerland
| | - Ian Kitai
- Department of Pediatrics, Division of Infectious Diseases, Hospital for Sick Children, University of Toronto, Toronto, ON M5G 1X8, Canada;
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4
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Soler-Garcia A, Gamell A, Pérez-Porcuna T, Soriano-Arandes A, Santiago B, Tórtola T, Ruiz-Serrano MJ, Korta Murua JJ, Bustillo-Alonso M, Garrote-Llanos MI, Rodríguez-Molino P, Piqueras AI, Tagarro A, Monsonís M, Tebruegge M, Noguera-Julian A. Performance of QuantiFERON- TB Gold Plus assays in children and adolescents at risk of tuberculosis: a cross-sectional multicentre study. Thorax 2021; 77:1193-1201. [PMID: 34876500 DOI: 10.1136/thoraxjnl-2021-217592] [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: 05/06/2021] [Accepted: 11/06/2021] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The QuantiFERON-TB Gold Plus (QFT-Plus) assay, which features two antigen-stimulated tubes (TB1 and TB2) instead of a single tube used in previous-generation interferon-gamma release assays (IGRAs), was launched in 2016. Despite this, data regarding the assay's performance in the paediatric setting remain scarce. This study aimed to determine the performance of QFT-Plus in a large cohort of children and adolescents at risk of tuberculosis (TB) in a low-burden setting. METHODS Cross-sectional, multicentre study at healthcare institutions participating in the Spanish Paediatric TB Research Network, including patients <18 years who had a QFT-Plus performed between September 2016 and June 2020. RESULTS Of 1726 patients (52.8% male, median age: 8.4 years), 260 (15.1%) underwent testing during contact tracing, 288 (16.7%) on clinical/radiological suspicion of tuberculosis disease (TBD), 649 (37.6%) during new-entrant migrant screening and 529 (30.6%) prior to initiation of immunosuppressive treatment. Overall, the sensitivity of QFT-Plus for TBD (n=189) and for latent tuberculosis infection (LTBI, n=195) was 83.6% and 68.2%, respectively. The agreement between QFT-Plus TB1 and TB2 antigen tubes was excellent (98.9%, κ=0.961). Only five (2.5%) patients with TBD had discordance between TB1 and TB2 results (TB1+/TB2-, n=2; TB1-/TB2+, n=3). Indeterminate assay results (n=54, 3.1%) were associated with young age, lymphopenia and elevated C reactive protein concentrations. CONCLUSIONS Our non-comparative study indicates that QFT-Plus does not have greater sensitivity than previous-generation IGRAs in children in both TBD and LTBI. In TBD, the addition of the second antigen tube, TB2, does not enhance the assay's performance substantially.
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Affiliation(s)
- Aleix Soler-Garcia
- Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria, Unitat d'Infeccions, Servei de Pediatria, Institut de Recerca Pediàtrica, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Anna Gamell
- Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria, Unitat d'Infeccions, Servei de Pediatria, Institut de Recerca Pediàtrica, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Tomàs Pérez-Porcuna
- Atenció Primària, Fundació Assistencial Mútua de Terrassa, Terrassa, Spain.,Unitat de Salut Internacional, Departament de Pediatria, Fundació Recerca Hospital Universitari Mútua de Terassa, Universitat de Barcelona, Terrassa, Spain
| | - Antonio Soriano-Arandes
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Vall d'Hebron, Barcelona, Spain
| | - Begoña Santiago
- Paediatric Infectious Diseases Unit, Gregorio Marañón Mother and Child Hospital, Madrid, Spain
| | - Teresa Tórtola
- Unitat de Micobactèries, Laboratori Supranacional de Referència de l'OMS per a la Tuberculosi, Hospital Vall d'Hebron, Barcelona, Spain
| | - María Jesús Ruiz-Serrano
- Clinical Microbiology and Infectious Diseases Department, Gregorio Marañón Mother and Child Hospital, Madrid, Spain
| | - José Javier Korta Murua
- Servicio de Pediatría, Hospital Universitario Donostia-Instituto BioDonostia, Donostia Ospitalea, San Sebastian, Spain.,Departamento de Pediatría, Facultad de Medicina, EHU-UPV, Donostia University Hospital Gipuzkoa Building, San Sebastian, Spain
| | | | | | - Paula Rodríguez-Molino
- Pediatric Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Madrid, Spain
| | - Ana Isabel Piqueras
- Pediatric Infectious Diseases Unit, Hospital Universitario y Politécnico La Fe, Hospital La Fe, Valencia, Spain
| | - Alfredo Tagarro
- Servicio de Pediatría, Hospital Universitario Infanta Sofía, San Sebastian de los Reyes, Spain.,Fundación para la Investigación Biomédica del Hospital 12 de Octubre, Universidad Europea de Madrid, Hospital Universitario 12 de Octubre, Madrid, Spain.,Red de Investigación Translacional en Infectología Pediátrica, RITIP, Madrid, Spain
| | - Manuel Monsonís
- Servei de Microbiologia, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Marc Tebruegge
- Department of Pediatrics, University of Melbourne, Parkville, Victoria, Australia.,Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Antoni Noguera-Julian
- Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria, Unitat d'Infeccions, Servei de Pediatria, Institut de Recerca Pediàtrica, Hospital Sant Joan de Déu, Barcelona, Spain .,Red de Investigación Translacional en Infectología Pediátrica, RITIP, Madrid, Spain.,CIBERESP, Madrid, Spain.,Departament de Pediatria, Universitat de Barcelona Facultat de Medicina, Barcelona, Spain
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5
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Soler-Garcia A, Gamell A, Santiago B, Monsonís M, Cobo-Vázquez E, Bustillo-Alonso M, Tagarro A, Pérez-Gorricho B, Espiau M, Piqueras AI, Korta-Murua JJ, Rodríguez-Molino P, Lobato Z, Pérez-Porcuna T, Tebruegge M, Noguera-Julian A. QuantiFERON-TB Gold Plus Assay Specificity in Children and Adolescents With Suspected Tuberculosis-A Multicenter Cross-sectional Study in Spain. Pediatr Infect Dis J 2021; 40:e348-e351. [PMID: 34310504 DOI: 10.1097/inf.0000000000003173] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In this cross-sectional study of 284 children and adolescents with clinically or radiologically suspected tuberculosis in a low-endemic country, the QuantiFERON-TB Gold Plus assay specificity, sensitivity, positive predictive value and negative predictive value were 91.5%, 87.3%, 86.4%, and 91.2%, respectively. The specificity was higher than that observed in tuberculin skin tests performed simultaneously, but similar to previous-generation interferon-gamma release assays.
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Affiliation(s)
- Aleix Soler-Garcia
- From the Infectious Diseases and Systemic Inflammatory Response in Pediatrics, Infectious Diseases Unit, Department of Pediatrics, Hospital Sant Joan de Déu Research Foundation, Barcelona, Spain
| | - Anna Gamell
- From the Infectious Diseases and Systemic Inflammatory Response in Pediatrics, Infectious Diseases Unit, Department of Pediatrics, Hospital Sant Joan de Déu Research Foundation, Barcelona, Spain
| | - Begoña Santiago
- Pediatric Infectious Diseases Unit, Gregorio Marañón Hospital, Madrid, Spain
- Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain
| | - Manuel Monsonís
- Unidad de Enfermedades Infecciosas, Servicio de Pediatría, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Elvira Cobo-Vázquez
- Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain
| | - Matilde Bustillo-Alonso
- Servicio de Pediatría, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | - Alfredo Tagarro
- Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain
- Servicio de Pediatría, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
- Fundación Para la Investigación Biomédica del Hospital 12 de Octubre, Universidad Europea de Madrid, Madrid, Spain
| | - Beatriz Pérez-Gorricho
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - María Espiau
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Ana Isabel Piqueras
- Pediatric Infectious Diseases Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - José Javier Korta-Murua
- Servicio de Pediatría, Hospital Universitario Donostia-Instituto BioDonostia, San Sebastián, Spain
- Departamento de Pediatría, Facultad de Medicina, EHU-UPV, San Sebastián, Spain
| | | | - Zulema Lobato
- Servei de Pediatria, Hospital Sant Joan de Déu, Fundació Althaia, Manresa, Spain
| | - Tomàs Pérez-Porcuna
- Atenció Primària-Unitat de Salut Internacional, Fundació Assistencial Mútua Terrassa, Fundació Recerca Mútua Terrassa, Hospital Universitari Mútua de Terrassa, Terrassa, Spain
| | - Marc Tebruegge
- Department of Pediatric Infectious Diseases & Immunology, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
- Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
- Department of Pediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Antoni Noguera-Julian
- From the Infectious Diseases and Systemic Inflammatory Response in Pediatrics, Infectious Diseases Unit, Department of Pediatrics, Hospital Sant Joan de Déu Research Foundation, Barcelona, Spain
- Pediatric Infectious Diseases Unit, Gregorio Marañón Hospital, Madrid, Spain
- Departament de Pediatria, Universitat de Barcelona, Barcelona, Spain
- CIBER de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
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6
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Noguera-Julian A, Calzada-Hernández J, Brinkmann F, Basu Roy R, Bilogortseva O, Buettcher M, Carvalho I, Chechenyeva V, Falcón L, Goetzinger F, Guerrero-Laleona C, Hoffmann P, Jelusic M, Niehues T, Ozere I, Shackley F, Suciliene E, Welch SB, Schölvinck EH, Ritz N, Tebruegge M. Tuberculosis Disease in Children and Adolescents on Therapy With Antitumor Necrosis Factor-ɑ Agents: A Collaborative, Multicenter Paediatric Tuberculosis Network European Trials Group (ptbnet) Study. Clin Infect Dis 2021; 71:2561-2569. [PMID: 31796965 DOI: 10.1093/cid/ciz1138] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 11/19/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In adults, anti-tumor necrosis factor-α (TNF-α) therapy is associated with progression of latent tuberculosis (TB) infection (LTBI) to TB disease, but pediatric data are limited. METHODS Retrospective multicenter study within the Paediatric Tuberculosis Network European Trials Group, capturing patients <18 years who developed TB disease during anti-TNF-α therapy. RESULTS Sixty-six tertiary healthcare institutions providing care for children with TB participated. Nineteen cases were identified: Crohn's disease (n = 8; 42%) and juvenile idiopathic arthritis (n = 6; 32%) were the commonest underlying conditions. Immune-based TB screening (tuberculin skin test and/or interferon-γ release assay) was performed in 15 patients before commencing anti-TNF-α therapy but only identified 1 LTBI case; 13 patients were already receiving immunosuppressants at the time of screening. The median interval between starting anti-TNF-α therapy and TB diagnosis was 13.1 (IQR, 7.1-20.3) months. All cases presented with severe disease, predominantly miliary TB (n = 14; 78%). One case was diagnosed postmortem. TB was microbiologically confirmed in 15 cases (79%). The median duration of anti-TB treatment was 50 (IQR, 46-66) weeks. Five of 15 (33%) cases who had completed TB treatment had long-term sequelae. CONCLUSIONS LTBI screening is frequently false-negative in this patient population, likely due to immunosuppressants impairing test performance. Therefore, patients with immune-mediated diseases should be screened for LTBI at the point of diagnosis, before commencing immunosuppressive medication. Children on anti-TNF-α therapy are prone to severe TB disease and significant long-term morbidity. Those observations underscore the need for robust LTBI screening programs in this high-risk patient population, even in low-TB-prevalence settings.
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Affiliation(s)
- Antoni Noguera-Julian
- Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria, Unitat d´Infeccions, Servei de Pediatria, Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain.,Departament de Pediatria, Universitat de Barcelona, Barcelona, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Red de Investigación Translacional en Infectología Pediátrica (RITIP), Madrid, Spain
| | - Joan Calzada-Hernández
- Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria, Unitat d´Infeccions, Servei de Pediatria, Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain
| | - Folke Brinkmann
- Department of Pulmonology, University Children's Hospital, Ruhr University, Bochum, Germany
| | - Robindra Basu Roy
- Department of Paediatrics, Oxford University, Oxford, United Kingdom.,Children's Hospital, John Radcliffe Hospital, Oxford, United Kingdom
| | - Olga Bilogortseva
- Department of Child Phthisiology, National Institute of Phthisiology and Pulmonology, National Academy of Medical Sciences of Ukraine, Kiev, Ukraine
| | - Michael Buettcher
- Lucerne Children's Hospital, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Isabel Carvalho
- Department of Pediatrics, Vila Nova de Gaia Hospital Centre, Vila Nova de Gaia, Portugal
| | - Vira Chechenyeva
- Department of Child Phthisiology, National Institute of Phthisiology and Pulmonology, National Academy of Medical Sciences of Ukraine, Kiev, Ukraine.,Center of Infectious Diseases, "Clinic for Children With HIV/AIDS", National Specialized Children's Hospital (Okhmatdyt), Kiev, Ukraine
| | - Lola Falcón
- Department of Paediatric Infectious Diseases, Rheumatology and Immunodeficiency, Hospital Virgen del Rocío, Seville, Spain
| | - Florian Goetzinger
- Department of Pediatrics and Adolescent Medicine, Wilhelminenspital, Vienna, Austria
| | - Carmelo Guerrero-Laleona
- Infectious Diseases Unit, Pediatric Department, Miguel Servet University Hospital-University of Zaragoza, Zaragoza, Spain
| | - Peter Hoffmann
- Department of Internal Medicine, Gastroenterology, and Diabetology, Evang. Kliniken Essen-Mitte, Essen, Germany
| | - Marija Jelusic
- Department of Pediatrics, University of Zagreb, School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Tim Niehues
- Immunodeficiency and Rheumatology Center, Helios Klinikum Krefeld, Krefeld, Germany
| | - Iveta Ozere
- Department of Infectious Diseases and Dermatology, Riga Stradinš University, Riga, Latvia.,Center of Tuberculosis and Lung Diseases, Riga East University Hospital, Riga, Latvia
| | - Fiona Shackley
- Department of Paediatrics, Sheffield Children's National Health Service Foundation Trust, Sheffield, United Kingdom
| | - Elena Suciliene
- Children Hospital, Affiliate of Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Steven B Welch
- Birmingham Chest Clinic and Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Elisabeth H Schölvinck
- University of Groningen, University Medical Center Groningen/Beatrix Children's Hospital, Groningen, the Netherlands
| | - Nicole Ritz
- Paediatric Infectious Diseases and Vaccinology Unit, University of Basel Children's Hospital, Basel, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland.,Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Marc Tebruegge
- Department of Paediatrics, University of Melbourne, Parkville, Australia.,Department of Paediatric Infectious Diseases and Immunology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.,Department of Infection, Immunity, and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
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7
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Götzinger F, Santiago-García B, Noguera-Julián A, Lanaspa M, Lancella L, Calò Carducci FI, Gabrovska N, Velizarova S, Prunk P, Osterman V, Krivec U, Lo Vecchio A, Shingadia D, Soriano-Arandes A, Melendo S, Lanari M, Pierantoni L, Wagner N, L'Huillier AG, Heininger U, Ritz N, Bandi S, Krajcar N, Roglić S, Santos M, Christiaens C, Creuven M, Buonsenso D, Welch SB, Bogyi M, Brinkmann F, Tebruegge M. COVID-19 in children and adolescents in Europe: a multinational, multicentre cohort study. THE LANCET. CHILD & ADOLESCENT HEALTH 2020; 4:653-661. [PMID: 32593339 PMCID: PMC7316447 DOI: 10.1016/s2352-4642(20)30177-2] [Citation(s) in RCA: 808] [Impact Index Per Article: 202.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND To date, few data on paediatric COVID-19 have been published, and most reports originate from China. This study aimed to capture key data on children and adolescents with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection across Europe to inform physicians and health-care service planning during the ongoing pandemic. METHODS This multicentre cohort study involved 82 participating health-care institutions across 25 European countries, using a well established research network-the Paediatric Tuberculosis Network European Trials Group (ptbnet)-that mainly comprises paediatric infectious diseases specialists and paediatric pulmonologists. We included all individuals aged 18 years or younger with confirmed SARS-CoV-2 infection, detected at any anatomical site by RT-PCR, between April 1 and April 24, 2020, during the initial peak of the European COVID-19 pandemic. We explored factors associated with need for intensive care unit (ICU) admission and initiation of drug treatment for COVID-19 using univariable analysis, and applied multivariable logistic regression with backwards stepwise analysis to further explore those factors significantly associated with ICU admission. FINDINGS 582 individuals with PCR-confirmed SARS-CoV-2 infection were included, with a median age of 5·0 years (IQR 0·5-12·0) and a sex ratio of 1·15 males per female. 145 (25%) had pre-existing medical conditions. 363 (62%) individuals were admitted to hospital. 48 (8%) individuals required ICU admission, 25 (4%) mechanical ventilation (median duration 7 days, IQR 2-11, range 1-34), 19 (3%) inotropic support, and one (<1%) extracorporeal membrane oxygenation. Significant risk factors for requiring ICU admission in multivariable analyses were being younger than 1 month (odds ratio 5·06, 95% CI 1·72-14·87; p=0·0035), male sex (2·12, 1·06-4·21; p=0·033), pre-existing medical conditions (3·27, 1·67-6·42; p=0·0015), and presence of lower respiratory tract infection signs or symptoms at presentation (10·46, 5·16-21·23; p<0·0001). The most frequently used drug with antiviral activity was hydroxychloroquine (40 [7%] patients), followed by remdesivir (17 [3%] patients), lopinavir-ritonavir (six [1%] patients), and oseltamivir (three [1%] patients). Immunomodulatory medication used included corticosteroids (22 [4%] patients), intravenous immunoglobulin (seven [1%] patients), tocilizumab (four [1%] patients), anakinra (three [1%] patients), and siltuximab (one [<1%] patient). Four children died (case-fatality rate 0·69%, 95% CI 0·20-1·82); at study end, the remaining 578 were alive and only 25 (4%) were still symptomatic or requiring respiratory support. INTERPRETATION COVID-19 is generally a mild disease in children, including infants. However, a small proportion develop severe disease requiring ICU admission and prolonged ventilation, although fatal outcome is overall rare. The data also reflect the current uncertainties regarding specific treatment options, highlighting that additional data on antiviral and immunomodulatory drugs are urgently needed. FUNDING ptbnet is supported by Deutsche Gesellschaft für Internationale Zusammenarbeit.
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Affiliation(s)
- Florian Götzinger
- Department of Paediatric and Adolescent Medicine, National Reference Centre for Childhood Tuberculosis, Wilhelminenspital, Vienna, Austria
| | - Begoña Santiago-García
- Department of Paediatric Infectious Diseases, University Hospital Gregorio Marañón and Gregorio Marañón Research Institute, Madrid, Spain; Red de Investigación Translacional en Infectología Pediátrica, Madrid, Spain
| | - Antoni Noguera-Julián
- Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria, Unitat d'Infeccions, Servei de Pediatria, Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain; Departament de Pediatria, Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain; Red de Investigación Translacional en Infectología Pediátrica, Madrid, Spain
| | - Miguel Lanaspa
- Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria, Unitat d'Infeccions, Servei de Pediatria, Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain
| | - Laura Lancella
- Academic Department of Paediatrics, Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Natalia Gabrovska
- Children's Clinic, Department of Pulmonary Diseases, MHATLD "St Sofia", Medical University Sofia, Sofia, Bulgaria
| | - Svetlana Velizarova
- Children's Clinic, Department of Pulmonary Diseases, MHATLD "St Sofia", Medical University Sofia, Sofia, Bulgaria
| | - Petra Prunk
- Department of Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Veronika Osterman
- Department of Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Uros Krivec
- Department of Paediatric Pulmonology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Andrea Lo Vecchio
- Section of Paediatrics, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Delane Shingadia
- Department of Paediatric Infectious Diseases, Great Ormond Street Hospital, London, UK; Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Antoni Soriano-Arandes
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Susana Melendo
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Marcello Lanari
- Medical and Surgical Science Department, S Orsola University Hospital, Bologna, Italy
| | - Luca Pierantoni
- Medical and Surgical Science Department, S Orsola University Hospital, Bologna, Italy
| | - Noémie Wagner
- Paediatric Infectious Diseases Unit, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Arnaud G L'Huillier
- Paediatric Infectious Diseases Unit, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Ulrich Heininger
- Department of Paediatric Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland
| | - Nicole Ritz
- Department of Paediatric Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland; Department of Paediatrics, Royal Children's Hospital Melbourne, University of Melbourne, Melbourne, Australia
| | - Srini Bandi
- Department of Paediatrics, Leicester Children's Hospital, Leicester, UK
| | - Nina Krajcar
- Department of Paediatric Infectious Diseases, University Hospital for Infectious Diseases, Zagreb, Croatia
| | - Srđan Roglić
- Department of Paediatric Infectious Diseases, University Hospital for Infectious Diseases, Zagreb, Croatia
| | - Mar Santos
- Department of Paediatric Infectious Diseases, University Hospital Gregorio Marañón and Gregorio Marañón Research Institute, Madrid, Spain; Red de Investigación Translacional en Infectología Pediátrica, Madrid, Spain
| | | | - Marine Creuven
- Department of Paediatric Infectious Diseases, CHC Montlegia, Liège, Belgium
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Steven B Welch
- Birmingham Chest Clinic and Heartlands Hospital, University Hospitals Birmingham, Birmingham, UK
| | - Matthias Bogyi
- Department of Paediatric and Adolescent Medicine, National Reference Centre for Childhood Tuberculosis, Wilhelminenspital, Vienna, Austria
| | - Folke Brinkmann
- Department of Paediatric Pulmonology, Ruhr University Bochum, Bochum, Germany
| | - Marc Tebruegge
- Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, UK; Department of Paediatrics, Royal Children's Hospital Melbourne, University of Melbourne, Melbourne, Australia; Department of Paediatric Infectious Diseases & Immunology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
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Soler-Garcia A, Gamell A, Santiago B, Monsonís M, Calvo C, Cobo E, Colino E, Espiau M, Guerrero-Laleona C, Lobato Z, Martín-Nalda A, Pérez-Gorricho B, Perez-Porcuna TM, Piqueras AI, Rodríguez-Molino P, Ruiz M, Soriano-Arandes A, Valmanya T, Tebruegge M, Noguera-Julian A, Gómez-Pastrana D, Montero M, Peromingo E, Bustillo M, Moliner E, Fenoy M, Velásquez M, Soler MQ, GARCÍA L, Calavia O, Rius N, Pascual MT, Soler-Palacín P, Tórtola T, Lillo M, Dapena M, López-Medina EM, Ruiz M, Santos MDM, Hernández Á, Hernández-Sanpelayo T, Tagarro A, Méndez A, Mellado MJ, Baquero-Artigao F, Sainz T, García-Hortelano M, Álvarez J, Villalobos E, García-García ML, Garrote MI, Korta Murua JJ, Gundín NA, Sánchez-Torrent L, Velasco-Arnaiz E, Fortuny C. Diagnostic Accuracy of QuantiFERON-TB Gold Plus Assays in Children and Adolescents with Tuberculosis Disease. J Pediatr 2020; 223:212-215.e1. [PMID: 32334890 DOI: 10.1016/j.jpeds.2020.02.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/27/2020] [Accepted: 02/12/2020] [Indexed: 10/24/2022]
Abstract
In 2016, a new interferon-gamma release assay, QuantiFERON-TB Gold Plus, was introduced. We conducted a cross-sectional multicenter study, involving 158 children and adolescents with tuberculosis disease. The overall sensitivity of the assay was 82.9% (IQR 77.0%-88.8%), indicating that in children this test does not have higher sensitivity than previous generation interferon-gamma release assays.
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Affiliation(s)
- Aleix Soler-Garcia
- Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria, Unitat d´Infeccions, Servei de Pediatria, Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain
| | - Anna Gamell
- Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria, Unitat d´Infeccions, Servei de Pediatria, Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain
| | - Begoña Santiago
- Pediatric Infectious Diseases Unit, Gregorio Marañón Hospital, Madrid, Spain
| | - Manuel Monsonís
- Servei de Microbiologia, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Cristina Calvo
- Pediatrics Department, Hospital Severo Ochoa, Madrid, Spain; Pediatric Infectious and Tropical Diseases Department, Hospital La Paz, Madrid, Spain; Health Research Institute IdiPAZ, Hospital La Paz, Madrid, Spain; Red de Investigación Translacional en Infectología Pediátrica, RITIP, Madrid, Spain
| | - Elvira Cobo
- Pediatric Infectious Diseases Unit, Gregorio Marañón Hospital, Madrid, Spain
| | - Elena Colino
- Pediatrics Department, Complejo Hospitalario Universitario Insular-Materno Infantil de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - María Espiau
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Carmelo Guerrero-Laleona
- Unidad de Enfermedades Infecciosas, Servicio de Pediatría, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Zulema Lobato
- Servei de Pediatria, Hospital Sant Joan de Déu, Fundació Althaia, Manresa, Spain
| | - Andrea Martín-Nalda
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Beatriz Pérez-Gorricho
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Tomas M Perez-Porcuna
- Atenció Primària, Fundació Assistencial Mútua Terrassa, Terrassa, Spain; Unitat de Salut Internacional, Departament de Pediatria, Fundació Recerca Mútua Terrassa, Atenció Primària, Hospital Universitari Mútua de Terrassa, Universitat de Barcelona, Terrassa, Spain
| | - Ana Isabel Piqueras
- Pediatric Infectious Diseases Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - Marta Ruiz
- Pediatrics Department, Hospital de Getafe, Madrid, Spain
| | - Antoni Soriano-Arandes
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Teresa Valmanya
- Servei de Pediatria, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Marc Tebruegge
- Department of Pediatric Infectious Diseases & Immunology, Evelina London Childrenś Hospital, Guyś and St. Thomaś NHS Foundation Trust, London, United Kingdom; Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom; Department of Pediatrics, University of Melbourne, Parkville, Australia
| | - Antoni Noguera-Julian
- Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria, Unitat d´Infeccions, Servei de Pediatria, Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain; Red de Investigación Translacional en Infectología Pediátrica, RITIP, Madrid, Spain; Departament de Pediatria, Universitat de Barcelona, Barcelona, Spain; CIBER de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.
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9
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Basu Roy R, Thee S, Blázquez-Gamero D, Falcón-Neyra L, Neth O, Noguera-Julian A, Lillo C, Galli L, Venturini E, Buonsenso D, Götzinger F, Martinez-Alier N, Velizarova S, Brinkmann F, Welch SB, Tsolia M, Santiago-Garcia B, Krüger R, Tebruegge M. Performance of immune-based and microbiological tests in children with tuberculosis meningitis in Europe: a multicentre Paediatric Tuberculosis Network European Trials Group (ptbnet) study. Eur Respir J 2020; 56:13993003.02004-2019. [PMID: 32299859 PMCID: PMC7330130 DOI: 10.1183/13993003.02004-2019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 03/09/2020] [Indexed: 01/31/2023]
Abstract
Introduction Tuberculous meningitis (TBM) is often diagnostically challenging. Only limited data exist on the performance of interferon-γ release assays (IGRA) and molecular assays in children with TBM in routine clinical practice, particularly in the European setting. Methods Multicentre, retrospective study involving 27 healthcare institutions providing care for children with tuberculosis (TB) in nine European countries. Results Of 118 children included, 54 (45.8%) had definite, 38 (32.2%) probable and 26 (22.0%) possible TBM; 39 (33.1%) had TBM grade 1, 68 (57.6%) grade 2 and 11 (9.3%) grade 3. Of 108 patients who underwent cranial imaging 90 (83.3%) had at least one abnormal finding consistent with TBM. At the 5-mm cut-off the tuberculin skin test had a sensitivity of 61.9% (95% CI 51.2–71.6%) and at the 10-mm cut-off 50.0% (95% CI 40.0–60.0%). The test sensitivities of QuantiFERON-TB and T-SPOT.TB assays were 71.7% (95% CI 58.4–82.1%) and 82.5% (95% CI 58.2–94.6%), respectively (p=0.53). Indeterminate results were common, occurring in 17.0% of QuantiFERON-TB assays performed. Cerebrospinal fluid (CSF) cultures were positive in 50.0% (95% CI 40.1–59.9%) of cases, and CSF PCR in 34.8% (95% CI 22.9–43.7%). In the subgroup of children who underwent tuberculin skin test, IGRA, CSF culture and CSF PCR simultaneously, 84.4% had at least one positive test result (95% CI 67.8%–93.6%). Conclusions Existing immunological and microbiological TB tests have suboptimal sensitivity in children with TBM, with each test producing false-negative results in a substantial proportion of patients. Combining immune-based tests with CSF culture and CSF PCR results in considerably higher positive diagnostic yields, and should therefore be standard clinical practice in high-resource settings. All existing immunological and microbiological TB tests have suboptimal sensitivity in children with TBM. Combining immune-based tests with CSF culture and PCR results in far higher positive diagnostic yields, and should therefore be standard practice.http://bit.ly/2TSAArl
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Affiliation(s)
- Robindra Basu Roy
- Clinical Research Dept, London School of Hygiene and Tropical Medicine, London, UK.,Joint first authors
| | - Stephanie Thee
- Dept of Pediatric Pneumology, Immunology and Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Joint first authors
| | - Daniel Blázquez-Gamero
- Paediatric Infectious Diseases Unit, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Instituto de Investigación Hospital Universitario 12 de Octubre (imas12), RITIP, Madrid, Spain
| | - Lola Falcón-Neyra
- Paediatric Infectious Diseases, Rheumatology and Immunology Unit, Hospital Universitario Virgen del Rocío, Institute of Biomedicine, Seville, Spain
| | - Olaf Neth
- Paediatric Infectious Diseases, Rheumatology and Immunology Unit, Hospital Universitario Virgen del Rocío, Institute of Biomedicine, Seville, Spain
| | - Antoni Noguera-Julian
- Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria, Institut de Recerca Pediàtrica; Hospital Sant Joan de Déu, Barcelona, Spain.,Departament de Pediatria, Universitat de Barcelona, Barcelona, Spain.,CIBER de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.,Red de Investigación Translacional en Infectología Pediátrica, RITIP, Madrid, Spain
| | - Cristina Lillo
- Paediatric Infectious Diseases Unit, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Instituto de Investigación Hospital Universitario 12 de Octubre (imas12), RITIP, Madrid, Spain
| | - Luisa Galli
- Dept of Health Sciences, University of Florence, Florence, Italy.,Paediatric Infectious Disease Unit, Meyer Children's University Hospital, Florence, Italy
| | - Elisabetta Venturini
- Dept of Health Sciences, University of Florence, Florence, Italy.,Paediatric Infectious Disease Unit, Meyer Children's University Hospital, Florence, Italy
| | - Danilo Buonsenso
- Dept of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Florian Götzinger
- Dept of Paediatrics and Adolescent Medicine, Wilhelminenspital, Vienna, Austria
| | - Nuria Martinez-Alier
- Dept of Paediatric Infectious Diseases and Immunology, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Svetlana Velizarova
- Dept of Pulmonary Diseases, Medical University, Hospital for Lung Diseases 'St. Sofia', Sofia, Bulgaria
| | - Folke Brinkmann
- Dept of Paediatric Pulmonology, Ruhr University Bochum, Bochum, Germany
| | - Steven B Welch
- Birmingham Chest Clinic and Heartlands Hospital, University Hospitals Birmingham, Birmingham, UK
| | - Maria Tsolia
- Second Dept of Paediatrics, National and Kapodistrian University of Athens, School of Medicine, P. and A. Kyriakou Children's Hospital, Athens, Greece
| | - Begoña Santiago-Garcia
- Dept of Paediatric Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Renate Krüger
- Dept of Pediatric Pneumology, Immunology and Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Marc Tebruegge
- Dept of Paediatric Infectious Diseases and Immunology, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK .,Dept of Paediatrics, Royal Children's Hospital Melbourne, University of Melbourne, Melbourne, Australia.,Dept of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
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10
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Sartoris G, Seddon JA, Rabie H, Nel ED, Schaaf HS. Abdominal Tuberculosis in Children: Challenges, Uncertainty, and Confusion. J Pediatric Infect Dis Soc 2020; 9:218-227. [PMID: 31909804 DOI: 10.1093/jpids/piz093] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 12/06/2019] [Indexed: 02/06/2023]
Abstract
The diagnosis of abdominal tuberculosis (TB) is challenging, and the prevalence of abdominal TB in children is likely underestimated. It may present with nonspecific abdominal symptoms and signs, but children who present with pulmonary TB may have additional abdominal subclinical involvement. Diagnosis is specifically challenging because none of the available diagnostic tools provide adequate sensitivity and specificity. In this review, we summarize the best available evidence on abdominal TB in children, covering the epidemiology, pathogenesis, clinical presentation, diagnosis, and treatment. We propose a diagnostic approach that could be followed for symptomatic children. We believe that a combination of investigations could be useful to both aid diagnosis and define the extent of the disease, and we propose that abdominal ultrasound should be used more frequently in children with possible TB and any abdominal symptoms. This neglected disease has received little attention to date, and further research is warranted.
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Affiliation(s)
- Giulia Sartoris
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.,Department of Pediatric Sciences, Giannina Gaslini Institute, University of Genoa, Italy
| | - James A Seddon
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.,Department of Paediatrics, Imperial College London, London, United Kingdom
| | - Helena Rabie
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Etienne D Nel
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - H Simon Schaaf
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
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11
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Barton E, Gao Y, Ball D, Fidler K, Klein N, Curtis N, Clifford V, Marshall BG, Chancellor A, Mansour S, Elkington P, Tebruegge M. Calcineurin Inhibitors and Variation in the Performance of Interferon-γ Release Assays Used to Detect Tuberculosis Infection. Ann Am Thorac Soc 2019; 16:771-775. [PMID: 30811214 PMCID: PMC6543466 DOI: 10.1513/annalsats.201811-784rl] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- Edward Barton
- University of SouthamptonSouthampton, United Kingdom
| | | | - Darran Ball
- University Hospital Southampton NHS Foundation TrustSouthampton, United Kingdom
| | - Katy Fidler
- Brighton and Sussex Medical SchoolBrighton, United Kingdom
| | - Nigel Klein
- University College LondonLondon, United Kingdom
| | | | | | | | | | - Salah Mansour
- University of SouthamptonSouthampton, United Kingdom
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12
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Agonafir M, Assefa Y, Girmachew F, Jerene D. Factors affecting the utilization of Xpert MTB/RIF assay among TB clinic health workers in Addis Ababa. J Clin Tuberc Other Mycobact Dis 2018; 12:48-53. [PMID: 31720399 PMCID: PMC6830159 DOI: 10.1016/j.jctube.2018.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 06/21/2018] [Accepted: 06/29/2018] [Indexed: 11/23/2022] Open
Abstract
Introduction The diagnostic accuracy of Xpert MTB/RIF is well documented but underutilization is a major challenge in most high burden countries. This appears to be linked with insufficient knowledge of health professionals of using the tool. However, this has not been well studied. Objective Our objective was to assess the knowledge of health professionals on Xpert MTB/RIF assay and associated factors in detecting TB/TB drug resistance. Methods An institution based cross–sectional study was conducted from April 4 to June 5, 2015, in Addis Ababa that involved 209 healthcare providers working in TB clinics. Structured questionnaire through self-administered interview technique was used to collect the data. We asked them about Xpert on whether they are aware of its place in TB diagnosis, when and for whom it shall be used, its role in treatment monitoring, result interpretation and patient's registration that are diagnosed by Xpert MTB/RIF. We used binary logistic regression analysis to identify associated factors. Odds ratio with 95% CI was computed to assess the strength of the associations. Results Of the 209 participants interviewed, the majority 151 (72.2%) were nurses. More than a half of the respondents 114 (54.6%) had poor knowledge. Health professionals with age above 35 years (AOR = 6.253, 95% CI (1.1995, 19.604)) and those who read the Xpert guideline (AOR = 4.231, 95% CI (2.011, 8.900)) were more likely to have good knowledge on Xpert. Conclusion and recommendation This study revealed that the overall magnitude of knowledge status was found to be low. Health workers above 35 years and those who read the guideline on Xpert had higher knowledge status on Xpert. Distribution of national guideline on Xpert and assigning experienced clinicians in TB DOTs clinics are recommended.
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Variability in distribution and use of tuberculosis diagnostic tests in Kenya: a cross-sectional survey. BMC Infect Dis 2018; 18:328. [PMID: 30012092 PMCID: PMC6048895 DOI: 10.1186/s12879-018-3237-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 07/04/2018] [Indexed: 11/14/2022] Open
Abstract
Background Globally, 40% of all tuberculosis (TB) cases, 65% paediatric cases and 75% multi-drug resistant TB (MDR-TB) cases are missed due to underreporting and/or under diagnosis. A recent Kenyan TB prevalence survey found that a significant number of TB cases are being missed here. Understanding spatial distribution and patterns of use of TB diagnostic tests as per the guidelines could potentially help improve TB case detection by identifying diagnostic gaps. Methods We used 2015 Kenya National TB programme data to map TB case notification rates (CNR) in different counties, linked with their capacity to perform diagnostic tests (chest x-rays, smear microscopy, Xpert MTB/RIF®, culture and line probe assay). We then ran hierarchical regression models for adults and children to specifically establish determinants of use of Xpert® (as per Kenyan guidelines) with county and facility as random effects. Results In 2015, 82,313 TB cases were notified and 7.8% were children. The median CNR/100,000 amongst 0-14yr olds was 37.2 (IQR 20.6, 41.0) and 267.4 (IQR 202.6, 338.1) for ≥15yr olds respectively. 4.8% of child TB cases and 12.2% of adult TB cases had an Xpert® test done, with gaps in guideline adherence. There were 2,072 microscopy sites (mean microscopy density 4.46/100,000); 129 Xpert® sites (mean 0.31/100,000); two TB culture laboratories and 304 chest X-ray facilities (mean 0.74/100,000) with variability in spatial distribution across the 47 counties. Retreatment cases (i.e. failures, relapses/recurrences, defaulters) had the highest odds of getting an Xpert® test compared to new/transfer-in patients (AOR 7.81, 95% CI 7.33-8.33). Children had reduced odds of getting an Xpert® (AOR 0.41, CI 0.36-0.47). HIV-positive individuals had nearly twice the odds of getting an Xpert® test (AOR 1.82, CI 1.73-1.92). Private sector and higher-level hospitals had a tendency towards lower odds of use of Xpert®. Conclusions We noted under-use and gaps in guideline adherence for Xpert® especially in children. The under-use despite considerable investment undermines cost-effectiveness of Xpert®. Further research is needed to develop strategies enhancing use of diagnostics, including innovations to improve access (e.g. specimen referral) and overcoming local barriers to adoption of guidelines and technologies. Electronic supplementary material The online version of this article (10.1186/s12879-018-3237-z) contains supplementary material, which is available to authorized users.
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14
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Villanueva P, Neth O, Ritz N, Tebruegge M. Use of Xpert MTB/RIF Ultra assays among paediatric tuberculosis experts in Europe. Eur Respir J 2018; 51:51/5/1800346. [PMID: 29773607 DOI: 10.1183/13993003.00346-2018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 04/18/2018] [Indexed: 11/05/2022]
Affiliation(s)
- Paola Villanueva
- Dept of Paediatric Infectious Diseases and Immunology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Olaf Neth
- Paediatric Infectious Diseases, Rheumatology and Immunology Unit, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain
| | - Nicole Ritz
- University of Basel Children's Hospital, Paediatric Infectious Disease and Vaccinology, Paediatric Pharmacology and Pharmacometrics, and Migrant Health Service, Basel, Switzerland.,Dept of Paediatrics, Royal Children's Hospital Melbourne, University of Melbourne, Melbourne, Australia
| | - Marc Tebruegge
- Dept of Paediatric Infectious Diseases and Immunology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Dept of Paediatrics, Royal Children's Hospital Melbourne, University of Melbourne, Melbourne, Australia.,Dept of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
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15
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Jafari C, Olaru ID, Daduna F, Ernst M, Heyckendorf J, Lange C, Kalsdorf B. Rapid diagnosis of pulmonary tuberculosis by combined molecular and immunological methods. Eur Respir J 2018; 51:13993003.02189-2017. [PMID: 29599184 DOI: 10.1183/13993003.02189-2017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 03/14/2018] [Indexed: 11/05/2022]
Abstract
Diagnosing pulmonary tuberculosis (TB) may be delayed until culture results become available.We ascertained the accuracy of a stepwise diagnostic algorithm for the rapid diagnosis of pulmonary TB by GeneXpert from sputum and/or bronchoalveolar lavage (BAL) followed by a Mycobacterium tuberculosis-specific BAL ELISPOT assay in patients with a suspected diagnosis of pulmonary TB at a clinical referral centre in Germany.Among 166 patients with a presumptive diagnosis of pulmonary TB, 81 cases were confirmed by M. tuberculosis culture from sputum and/or BAL. In 66 out of 81 (81.5%) cases, patients initially had M. tuberculosis detected by GeneXpert from sputum; in addition, six out of 81 (7.4%) cases were diagnosed by GeneXpert on BAL fluid (together 72 out of 81 (88.9%) patients). Out of the remaining nine patients with negative GeneXpert results from sputum and BAL, BAL ELISPOT identified eight patients with culture-confirmed TB correctly (median time to culture positivity 26 days). At a cut-off of >4000 early secretory antigenic target-6- or culture filtrate protein-10-specific interferon-γ-producing lymphocytes per 1 000 0000 lymphocytes, the specificity of the BAL ELISPOT for active TB was 97%.In low TB incidence countries, nearly all patients with active pulmonary TB can be identified within the first few days of clinical presentation using a stepwise strategy with GeneXpert and BAL ELISPOT.
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Affiliation(s)
- Claudia Jafari
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany.,Both authors contributed equally
| | - Ioana D Olaru
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany.,Biomedical Research and Training Institute, Harare, Zimbabwe.,Both authors contributed equally
| | - Franziska Daduna
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany
| | - Martin Ernst
- Division of Immune Cell Analytics, Research Center Borstel, Borstel, Germany
| | - Jan Heyckendorf
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany.,International Health/Infectious Diseases, University of Lübeck, German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel, Lübeck, Germany
| | - Christoph Lange
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany.,International Health/Infectious Diseases, University of Lübeck, German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel, Lübeck, Germany.,Dept of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Barbara Kalsdorf
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany.,International Health/Infectious Diseases, University of Lübeck, German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel, Lübeck, Germany
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16
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Tebruegge M, Curtis N, Clifford V, Fernandez-Turienzo C, Klein N, Fidler K, Mansour S, Elkington P, Morris-Jones S. Seasonal variation in the performance of QuantiFERON-TB Gold In-Tube assays used for the diagnosis of tuberculosis infection. Tuberculosis (Edinb) 2018; 110:26-29. [PMID: 29779769 DOI: 10.1016/j.tube.2018.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 03/04/2018] [Accepted: 03/07/2018] [Indexed: 11/20/2022]
Abstract
This study aimed to determine whether there are seasonal changes in the performance of QuantiFERON-TB Gold In-Tube (QFT-GIT) assays, an interferon-gamma release assay widely used for the diagnosis of tuberculosis infection. Results of 31,932 QFT-GIT assays performed at a large independent, accredited diagnostic service provider in London, UK over a 4.5-year-period were analysed. The proportion of positive results was significantly lower in autumn (14.8%) than in spring (16.0%; p = 0.0366) and summer (17.5%; p < 0.0001), but similar to winter (15.2%; p = 0.4711). The proportion of indeterminate results was significantly higher in autumn (8.2%) than in spring (6.2%; p < 0.0001), summer (4.8%; p < 0.0001), and winter (6.2%; p < 0.0001). The highest proportions of indeterminate results were observed in October (8.4%) and November (8.8%), the lowest in June (4.5%). Our data show that significant seasonal variation occurs in the performance of QFT-GIT assays in a temperate climate setting. Potential underlying mechanisms, including host and environmental factors, are discussed.
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Affiliation(s)
- Marc Tebruegge
- Academic Unit of Clinical and Experimental Sciences Faculty of Medicine & Global Health Research Institute, University of Southampton, Tremona Road, Southampton, UK; UCL Great Ormond Street Institute of Child Health, University College London, 30 Guildford Street, London, UK; Department of Paediatric Infectious Diseases & Immunology, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, Lambeth Palace Road, London, UK; Department of Paediatrics, The University of Melbourne, Flemington Road, Parkville, Australia.
| | - Nigel Curtis
- Department of Paediatrics, The University of Melbourne, Flemington Road, Parkville, Australia; Murdoch Children's Research Institute, Royal Children's Hospital Melbourne, Flemington Road, Parkville, Australia
| | - Vanessa Clifford
- Department of Paediatrics, The University of Melbourne, Flemington Road, Parkville, Australia; Murdoch Children's Research Institute, Royal Children's Hospital Melbourne, Flemington Road, Parkville, Australia
| | | | - Nigel Klein
- UCL Great Ormond Street Institute of Child Health, University College London, 30 Guildford Street, London, UK; Department of Paediatric Infectious Diseases, Great Ormond Street Hospital, Great Ormond Street, London, UK
| | - Katy Fidler
- Academic Department of Paediatrics, Brighton and Sussex Medical School, Biology Road, Brighton, UK
| | - Salah Mansour
- Academic Unit of Clinical and Experimental Sciences Faculty of Medicine & Global Health Research Institute, University of Southampton, Tremona Road, Southampton, UK
| | - Paul Elkington
- Academic Unit of Clinical and Experimental Sciences Faculty of Medicine & Global Health Research Institute, University of Southampton, Tremona Road, Southampton, UK; Department of Respiratory Medicine, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK
| | - Stephen Morris-Jones
- Division of Infection and Immunity, University College London, Gower Street, London, UK; Department of Microbiology, University College London Hospitals NHS Trust, Euston Road, London, UK
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17
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Edwards A, Gao Y, Allan RN, Ball D, de Graaf H, Coelho T, Clifford V, Curtis N, Williams A, Faust SN, Mansour S, Marshall B, Elkington P, Tebruegge M. Corticosteroids and infliximab impair the performance of interferon-γ release assays used for diagnosis of latent tuberculosis. Thorax 2017; 72:946-949. [PMID: 28159773 DOI: 10.1136/thoraxjnl-2016-209397] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 12/19/2016] [Accepted: 01/12/2017] [Indexed: 12/20/2022]
Abstract
The impact of immunosuppression on interferon-γ release assays and novel cytokine biomarkers of TB infection, mycobacteria-specific IL-2, IP-10 and TNF-α responses was investigated in an ex vivo model. Cytokine responses in standard QuantiFERON-TB Gold in-Tube (QFT-GIT) assays were compared with duplicate assays containing dexamethasone or infliximab. Dexamethasone converted QFT-GIT results from positive to negative in 30% of participants. Antigen-stimulated interferon-γ, IL-2 and TNF-α responses were markedly reduced, but IP-10 responses were preserved. Infliximab caused QFT-GIT result conversion in up to 30% of participants and substantial reductions in all cytokine responses. Therefore, corticosteroids and anti-TNF-α agents significantly impair interferon-γ release assay performance. IP-10 may be a more robust TB biomarker than interferon-γ in patients receiving corticosteroids.
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Affiliation(s)
- Alexander Edwards
- Academic Unit of Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Yifang Gao
- Academic Unit of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- CRUK NIHR Southampton Experimental Cancer Medicine Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Raymond N Allan
- Academic Unit of Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Darran Ball
- NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Hans de Graaf
- Academic Unit of Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Department of Paediatric Rheumatology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Tracy Coelho
- Academic Unit of Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Department of Paediatric Gastroenterology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Vanessa Clifford
- Department of Paediatrics, The University of Melbourne & Murdoch Children's Research Institute, Parkville, Australia
| | - Nigel Curtis
- Department of Paediatrics, The University of Melbourne & Murdoch Children's Research Institute, Parkville, Australia
| | - Anthony Williams
- Academic Unit of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- CRUK NIHR Southampton Experimental Cancer Medicine Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Department of Immunology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Wessex Investigational Sciences Hub, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Saul N Faust
- Academic Unit of Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- NIHR Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Department of Paediatric Infectious Diseases & Immunology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Salah Mansour
- Academic Unit of Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Ben Marshall
- Academic Unit of Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Department of Respiratory Medicine, University Hospital NHS Foundation Trust, Southampton, UK
| | - Paul Elkington
- Academic Unit of Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Department of Respiratory Medicine, University Hospital NHS Foundation Trust, Southampton, UK
| | - Marc Tebruegge
- Academic Unit of Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Department of Paediatrics, The University of Melbourne & Murdoch Children's Research Institute, Parkville, Australia
- NIHR Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Department of Paediatric Infectious Diseases & Immunology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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18
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Amicosante M, D’Ambrosio L, Munoz M, Mello FCDQ, Tebruegge M, Chegou NN, Seghrouchni F, Centis R, Goletti D, Bothamley G, Migliori GB. Current use and acceptability of novel diagnostic tests for active tuberculosis: a worldwide survey. J Bras Pneumol 2017; 43:380-392. [PMID: 29160384 PMCID: PMC5790656 DOI: 10.1590/s1806-37562017000000219] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 09/03/2017] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To determine the current use and potential acceptance (by tuberculosis experts worldwide) of novel rapid tests for the diagnosis of tuberculosis that are in line with World Health Organization target product profiles. METHODS A multilingual survey was disseminated online between July and November of 2016. RESULTS A total of 723 individuals from 114 countries responded to the survey. Smear microscopy was the most commonly used rapid tuberculosis test (available to 90.9% of the respondents), followed by molecular assays (available to 70.7%). Only a small proportion of the respondents in middle- and low-income countries had access to interferon-gamma-release assays. Serological and lateral flow immunoassays were used by more than a quarter (25.4%) of the respondents. Among the respondents who had access to molecular tests, 46.7% were using the Xpert assay overall, that proportion being higher in lower middle-income countries (55.6%) and low-income countries (76.6%). The data also suggest that there was some alignment of pricing for molecular assays. Respondents stated they would accept novel rapid tuberculosis tests if available, including molecular assays (acceptable to 86.0%) or biomarker-based serological assays (acceptable to 81.7%). Simple biomarker-based assays were more commonly deemed acceptable in middle- and low-income countries. CONCLUSIONS Second-generation molecular assays have become more widely available in high- and low-resource settings. However, the development of novel rapid tuberculosis tests continues to be considered important by tuberculosis experts. Our data also underscore the need for additional training and education of end users.
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Affiliation(s)
- Massimo Amicosante
- . Dipartimento di Biomedicina e Prevenzione, Università degli Studi di Roma “Tor Vergata”, Roma, Italia.Università degli Studi di Roma Tor VergataDipartimento di Biomedicina e PrevenzioneUniversità degli Studi di Roma “Tor Vergata”RomaItaly
- . ProxAgen OOD, Sofia, Bulgaria.ProxAgen OODSofiaBulgaria
| | - Lia D’Ambrosio
- . WHO Collaborating Centre for TB and Lung Diseases, Maugeri Care and Research Institute, Tradate, Italia.World Health OrganizationWHO Collaborating Centre for TB and Lung DiseasesTradateItalia
- . Public Health Consulting Group SAGL, Lugano, Switzerland.Public Health Consulting Group SAGLLuganoSwitzerland
| | - Marcela Munoz
- . Clínica en Tuberculosis y Enfermedades Pleurales, Instituto Nacional de Enfermedades Respiratorias - INER - Ciudad de México, México.Clínica en Tuberculosis y Enfermedades PleuralesInstituto Nacional de Enfermedades RespiratoriasCiudad de MéxicoMéxico
| | - Fernanda Carvalho de Queiroz Mello
- . Instituto de Doenças do Tórax, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro (RJ) Brasil.Instituto de Doenças do TóraxHospital Universitário Clementino Fraga FilhoRio de JaneiroRJBrasil
| | - Marc Tebruegge
- . Faculty of Medicine, University of Southampton, Southampton, United Kingdom.University of SouthamptonFaculty of MedicineUniversity of SouthamptonSouthamptonUnited Kingdom
- . Department of Paediatric Infectious Diseases and Immunology, Evelina London Children’s Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.Department of Paediatric Infectious Diseases and ImmunologyEvelina London Children’s HospitalGuy’s and St. Thomas’ NHS Foundation TrustLondonUnited Kingdom
- . Great Ormond Street Hospital Institute of Child Health, University College London, London, United Kingdom.University College LondonGreat Ormond Street Hospital Institute of Child HealthUniversity College LondonLondonUnited Kingdom
| | - Novel Njweipi Chegou
- . SA MRC Centre for TB Research, DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.Division of Molecular Biology and Human GeneticsFaculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
| | - Fouad Seghrouchni
- . National Institute of Hygiene, Rabat, Morocco.National Institute of HygieneRabatMorocco
| | - Rosella Centis
- . WHO Collaborating Centre for TB and Lung Diseases, Maugeri Care and Research Institute, Tradate, Italia.World Health OrganizationWHO Collaborating Centre for TB and Lung DiseasesTradateItalia
| | - Delia Goletti
- . Unità di Ricerca Translazionale, Dipartimento di Epidemiologia e Ricerca Preclinica, Istituto Nazionale per le Mallatie Infettive - INMI - Lazzaro Spallanzani, Roma, Italia.Unità di Ricerca TranslazionaleDipartimento di Epidemiologia e Ricerca PreclinicaIstituto Nazionale per le Mallatie InfettiveLazzaro SpallanzaniRomaItalia
| | - Graham Bothamley
- . Homerthon University Hospital, London, United Kingdom.Homerthon University HospitalLondonUnited Kingdom
| | - Giovanni Battista Migliori
- . WHO Collaborating Centre for TB and Lung Diseases, Maugeri Care and Research Institute, Tradate, Italia.World Health OrganizationWHO Collaborating Centre for TB and Lung DiseasesTradateItalia
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19
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Kontturi A, Santiago B, Tebruegge M, von Both U, Salo E, Ritz N. The impact of Bacille Calmette-Guérin shortage on immunisation practice and policies in Europe - A Paediatric Tuberculosis Network European Trials Group (ptbnet) survey. Tuberculosis (Edinb) 2016; 101:125-129. [PMID: 27865381 DOI: 10.1016/j.tube.2016.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 08/23/2016] [Accepted: 08/25/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Recent reports indicate an ongoing BCG shortage that may influence immunisation practice. This study aimed to determine current availability of BCG vaccine across Europe, and implications on immunisation practices and policies in Europe. METHODS Web-based survey among Paediatric Tuberculosis Network European Trials Group (ptbnet) members, between May and October 2015. RESULTS Twenty individuals from 13 European countries participated. Ongoing shortages were reported in eight countries routinely using BCG (8/11, 73%). As a consequence of the shortage, BCG was not given as completely unavailable in some countries (2/8, 25%), was given only whenever available (1/8, 13%), or only in certain regions of the country (1/8, 13%). Strategies reported to reduce loss of immunisation were administration to selected high-risk individuals (2/8, 25%), or cohorting vaccinees on specific days to maximise the use of multi-dose vials (3/8, 38%). Authorities in two countries each were considering a change of manufacturer/supplier (2/8, 25%). CONCLUSIONS The BCG shortage in Europe leads to significant changes in immunisation policies including changes of BCG vaccine strain and manufacturer. In addition, infants and children eligible for immunisation are at risk of not receiving BCG. To ensure necessary BCG immunisations, collaboration between national health agencies and vaccine manufacturers is crucial.
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Affiliation(s)
- Antti Kontturi
- Department of Paediatrics, Children's Hospital, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland; Clinicum, Department of Public Health, Faculty of Medicine, Doctoral Programme in Population Health, University of Helsinki, Finland.
| | - Begoña Santiago
- Sección Enfermedades Infecciosas Pediátricas, Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.
| | - Marc Tebruegge
- Faculty of Medicine & Global Health Research Institute, University of Southampton, Southampton, UK; Department of Paediatric Immunology and Infectious Diseases & NIHR Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Department of Paediatrics, The University of Melbourne, Parkville, Australia.
| | - Ulrich von Both
- Division of Paediatric Infectious Diseases, Dr von Hauner Children's Hospital, LMU, Munich, Germany; German Centre for Infection Research (DZIF), Germany.
| | - Eeva Salo
- Department of Paediatrics, Children's Hospital, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland.
| | - Nicole Ritz
- Department of Paediatrics, The University of Melbourne, Parkville, Australia; University Children's Hospital Basel, Paediatric Infectious Diseases, Vaccinology, and Paediatric Pharmacology, Basel, Switzerland.
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Interferon-gamma Release Assays Should Not Replace Tuberculin Skin Tests in Screening Programs for Children. Pediatr Infect Dis J 2016; 35:929. [PMID: 27416010 DOI: 10.1097/inf.0000000000001195] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Affiliation(s)
- Nicole Ritz
- University of Basel Children's Hospital Basel, Infectious Diseases Unit and Paediatric Pharmacology, Basel, Switzerland
| | - Folke Brinkmann
- Department of Paediatric Pneumology, Children's Hospital, Ruhr University of Bochum, Bochum, Germany
| | - Begoña Santiago Garcia
- Laboratorio de InmunoBiología Molecular, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Marc Tebruegge
- Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine and Global Health Research Institute, University of Southampton, Southampton, UK
| | - Beate Kampmann
- Academic Department of Paediatrics, Faculty of Medicine, Imperial College, London SW7 2AZ, UK.
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Tebruegge M, Ritz N, Curtis N, Shingadia D. Diagnostic Tests for Childhood Tuberculosis: Past Imperfect, Present Tense and Future Perfect? Pediatr Infect Dis J 2015; 34:1014-9. [PMID: 26107342 DOI: 10.1097/inf.0000000000000796] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Marc Tebruegge
- From the *Academic Unit of Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom; †Department of Paediatric Infectious Diseases & Immunology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom; ‡Institute for Life Sciences, University of Southampton, Southampton, United Kingdom; §NIHR Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom; ¶Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia; ‖University Children´s Hospital Basel, Paediatric Infectious Diseases and Pharmacology, University Basel, Basel, Switzerland; **Murdoch Children's Research Institute, Parkville, Victoria, Australia; ††Infectious Diseases Unit, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia; ‡‡Department of Paediatric Infectious Diseases, Great Ormond Street Hospital, London, United Kingdom; and §§University College London Institute of Child Health, London, United Kingdom
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23
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Jarvis J, Gao Y, de Graaf H, Hughes S, Allan RN, Williams A, Marshall B, Elkington P, Faust SN, Tebruegge M. Environmental temperature impacts on the performance of QuantiFERON-TB Gold In-Tube assays. J Infect 2015; 71:276-80. [DOI: 10.1016/j.jinf.2015.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 04/04/2015] [Indexed: 11/29/2022]
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Dierig A, Tebruegge M, Krivec U, Heininger U, Ritz N. Current status of Bacille Calmette Guérin (BCG) immunisation in Europe - A ptbnet survey and review of current guidelines. Vaccine 2015; 33:4994-9. [PMID: 26151543 DOI: 10.1016/j.vaccine.2015.06.097] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 05/29/2015] [Accepted: 06/22/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The incidence of tuberculosis (TB) and the use of Bacille Calmette-Guérin (BCG) vaccines differ significantly worldwide. Information regarding recent changes in BCG use and immunisation policies is difficult to access. Therefore, this study aimed to systematically collect up-to-date data on the use of BCG in Europe. METHODS A web-based survey of members of the Paediatric Tuberculosis Network European Trials group (ptbnet) and Tuberculosis Network European Trials group (TBnet) was conducted between October 2012 and May 2013. RESULTS A total of 89 individuals from 31 European countries participated. Participants from 27/31 (87%) countries reported to have a national BCG immunisation policy/guideline. Reported indications for BCG immunisation were: universally at birth (14/31; 45%), universally at older age (2/31; 6%), at birth for high-risk groups (12/31; 39%), at older age for high-risk groups (6/31; 19%), at older age for Mantoux-negative individuals (6/31;19%), for immigrants (4/31; 13%) and as a travel vaccine (10/31; 32%). Members from 11 (35%) countries reported changes in BCG policies in the previous 5 years: discontinuation of universal immunisation of infants/children (6/11), reintroduction of immunisation of high-risk children (3/11), and change in BCG vaccine strain (2/11). Members from 24/31 (77%) countries reported using BCG Denmark. CONCLUSIONS Immunisation policies regarding BCG vaccine exist in the majority of European countries. Indications for BCG immunisation varied considerably, likely reflecting national TB incidence rates, immigration and other factors influencing TB control strategies. Importantly, the considerable number of recent policy changes highlights the need for regular collection of up-to-date information to inform public health planning.
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Affiliation(s)
- Alexa Dierig
- University of Basel Children's Hospital, Paediatric Infectious Diseases and Vaccinology, Basel, Switzerland
| | - Marc Tebruegge
- Academic Unit of Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton; Department of Paediatric Infectious Diseases and Immunology, University Hospital Southampton NHS Foundation Trust; Institute for Life Sciences, University of Southampton; National Institute for Health Research Southampton Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Department of Paediatrics, The University of Melbourne, Parkville, Australia
| | - Uros Krivec
- Department of Pulmology, University Children's Hospital, Ljubljana, Slovenia
| | - Ulrich Heininger
- University of Basel Children's Hospital, Paediatric Infectious Diseases and Vaccinology, Basel, Switzerland
| | - Nicole Ritz
- University of Basel Children's Hospital, Paediatric Infectious Diseases and Vaccinology, Basel, Switzerland; Department of Paediatrics, The University of Melbourne, Parkville, Australia; University of Basel Children's Hospital, Department of Paediatric Pharmacology, Basel, Switzerland.
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New tuberculosis diagnostics and rollout. Int J Infect Dis 2015; 32:81-6. [DOI: 10.1016/j.ijid.2015.01.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 01/09/2015] [Accepted: 01/14/2015] [Indexed: 11/23/2022] Open
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Mycobacterial DNA extraction for whole-genome sequencing from early positive liquid (MGIT) cultures. J Clin Microbiol 2015; 53:1137-43. [PMID: 25631807 PMCID: PMC4365189 DOI: 10.1128/jcm.03073-14] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We developed a low-cost and reliable method of DNA extraction from as little as 1 ml of early positive mycobacterial growth indicator tube (MGIT) cultures that is suitable for whole-genome sequencing to identify mycobacterial species and predict antibiotic resistance in clinical samples. The DNA extraction method is based on ethanol precipitation supplemented by pretreatment steps with a MolYsis kit or saline wash for the removal of human DNA and a final DNA cleanup step with solid-phase reversible immobilization beads. The protocol yielded ≥0.2 ng/μl of DNA for 90% (MolYsis kit) and 83% (saline wash) of positive MGIT cultures. A total of 144 (94%) of the 154 samples sequenced on the MiSeq platform (Illumina) achieved the target of 1 million reads, with <5% of reads derived from human or nasopharyngeal flora for 88% and 91% of samples, respectively. A total of 59 (98%) of 60 samples that were identified by the national mycobacterial reference laboratory (NMRL) as Mycobacterium tuberculosis were successfully mapped to the H37Rv reference, with >90% coverage achieved. The DNA extraction protocol, therefore, will facilitate fast and accurate identification of mycobacterial species and resistance using a range of bioinformatics tools.
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