1
|
Weary TE, Pappas T, Tusiime P, Tuhaise S, Ross E, Gern JE, Goldberg TL. High frequencies of nonviral colds and respiratory bacteria colonization among children in rural Western Uganda. Front Pediatr 2024; 12:1379131. [PMID: 38756971 PMCID: PMC11096560 DOI: 10.3389/fped.2024.1379131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/19/2024] [Indexed: 05/18/2024] Open
Abstract
Introduction Respiratory illness is the most common childhood disease globally, especially in developing countries. Previous studies have detected viruses in approximately 70-80% of respiratory illnesses. Methods In a prospective cohort study of 234 young children (ages 3-11 years) and 30 adults (ages 22-51 years) in rural Western Uganda sampled monthly from May 2019 to August 2021, only 24.2% of nasopharyngeal swabs collected during symptomatic disease had viruses detectable by multiplex PCR diagnostics and metagenomic sequencing. In the remaining 75.8% of swabs from symptomatic participants, we measured detection rates of respiratory bacteria Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae by quantitative PCR. Results 100% of children tested positive for at least one bacterial species. Detection rates were 87.2%, 96.8%, and 77.6% in children and 10.0%, 36.7%, and 13.3% for adults for H. influenzae, M. catarrhalis, and S. pneumoniae, respectively. In children, 20.8% and 70.4% were coinfected with two and three pathogens, respectively, and in adults 6.7% were coinfected with three pathogens but none were coinfected with two. Detection of any of the three pathogens was not associated with season or respiratory symptoms severity, although parsing detection status by symptoms was challenged by children experiencing symptoms in 80.3% of monthly samplings, whereas adults only reported symptoms 26.6% of the time. Pathobiont colonization in children in Western Uganda was significantly more frequent than in children living in high-income countries, including in a study of age-matched US children that utilized identical diagnostic methods. Detection rates were, however, comparable to rates in children living in other Sub-Saharan African countries. Discussion Overall, our results demonstrate that nonviral colds contribute significantly to respiratory disease burden among children in rural Uganda and that high rates of respiratory pathobiont colonization may play a role. These conclusions have implications for respiratory health interventions in the area, such as increasing childhood immunization rates and decreasing air pollutant exposure.
Collapse
Affiliation(s)
- Taylor E. Weary
- Department of Pathobiological Sciences, University of Wisconsin School of Veterinary Medicine, Madison, WI, United States
| | - Tressa Pappas
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | | | | | | | - James E. Gern
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Tony L. Goldberg
- Department of Pathobiological Sciences, University of Wisconsin School of Veterinary Medicine, Madison, WI, United States
| |
Collapse
|
2
|
Xia Y, Fan Q, Zhang J, Jiang L, Huang X, Xiong Z, Xiong Z. Risk factors and prognosis for latent tuberculosis infection in dialysis patients: A retrospective cohort study at a single tertiary care center. Semin Dial 2024; 37:59-64. [PMID: 36823755 DOI: 10.1111/sdi.13150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 02/13/2023] [Indexed: 02/25/2023]
Abstract
INTRODUCTION Recent studies report that latent tuberculosis infection (LTBI) may lead to an increased risk of cardiovascular disease (CVD) that led us to hypothesize that LTBI may play an important role in major adverse cardiovascular events (MACE) in dialysis patients. METHODS A single-center retrospective cohort study was conducted. A total of 270 patients undergoing hemodialysis or peritoneal dialysis more than 3 months were included. The interferon enzyme-linked immunospot (IFN-γ ELISPOT) assay was used for the diagnosis of LTBI. Primary endpoints were MACE, including all-cause death and acute coronary syndrome (ACS). The association between LTBI and MACE was examined using multivariate Cox proportional hazards regression after adjusting for covariates and Kaplan-Meier survival analysis. RESULTS In our study, the patients were classified into LTBI (n = 47) or non-LTBI (n = 223) groups. Independent risk factors for LTBI in dialysis population were prior tuberculosis (TB) history (odds ratio [OR] 4.817 [1.064-22.306]), tobacco use (OR 2.903 [1.155-7.299]), and older age (OR 1.027 [1.002-1.053]). After a median follow-up of 39 months, the incidence of active TB was 6.4% versus 0% in dialysis patients with and without LTBI, respectively (p = 0.005). Multivariate Cox analysis showed that LTBI was significantly associated with MACE (hazard ratio [HR] 2.540 [1.490-4.350]) after adjustment for potential confounders. CONCLUSIONS Prior TB history, tobacco use, and the elderly can be used to select cost-effective LTBI screening target groups in dialysis patients. LTBI is not only closely related to active TB but also an independent risk factor for higher incidence of MACE in dialysis population.
Collapse
Affiliation(s)
- Yun Xia
- Renal Division, Peking University Shenzhen Hospital, Shenzhen, China
- Renal Division, Shenzhen Luohu District Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Qiuxia Fan
- Renal Division, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Jieyun Zhang
- Guangdong Key Laboratory for Diagnosis & Treatment of Emerging Infectious Diseases, The Affiliated Shenzhen Third Hospital, Shenzhen, China
| | - Li Jiang
- Department of Statistics and Data Science, Southern University of Science and Technology, Shenzhen, China
| | - Xiaoyan Huang
- Renal Division, Peking University Shenzhen Hospital, Shenzhen, China
| | - Zuying Xiong
- Renal Division, Peking University Shenzhen Hospital, Shenzhen, China
| | - Zibo Xiong
- Renal Division, Peking University Shenzhen Hospital, Shenzhen, China
| |
Collapse
|
3
|
Mayito J, Martineau AR, Tiwari D, Nakiyingi L, Kateete DP, Reece ST, Biraro IA. Determinants of QuantiFERON Plus-diagnosed tuberculosis infection in adult Ugandan TB contacts: A cross-sectional study. PLoS One 2023; 18:e0281559. [PMID: 36972254 PMCID: PMC10042355 DOI: 10.1371/journal.pone.0281559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 01/26/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND The tuberculin skin test is commonly used to diagnose latent tuberculosis infection (LTBI) in resource-limited settings, but its specificity is limited by factors including cross-reactivity with BCG vaccine and environmental mycobacteria. Interferon-gamma release assays (IGRA) overcome this problem by detecting M. tuberculosis complex-specific responses, but studies to determine risk factors for IGRA-positivity in high TB burden settings are lacking. METHODS We conducted a cross-sectional study to determine factors associated with a positive IGRA by employing the QuantiFERON-TB® Gold-plus (QFT Plus) assay in a cohort of asymptomatic adult TB contacts in Kampala, Uganda. Multivariate logistic regression analysis with forward stepwise logit function was employed to identify independent correlates of QFT Plus-positivity. RESULTS Of the 202 participants enrolled, 129/202 (64%) were female, 173/202 (86%) had a BCG scar, and 67/202 (33%) were HIV-infected. Overall, 105/192 (54%, 95% CI 0.48-0.62) participants had a positive QFT Plus result. Increased risk of QFT-Plus positivity was independently associated with casual employment/unemployment vs. non-casual employment (adjusted odds ratio (aOR) 2.18, 95% CI 1.01-4.72), a family vs. non-family relation to the index patient (aOR 2.87, 95% CI 1.33-6.18), living in the same vs. a different house as the index (aOR 3.05, 95% CI 1.28-7.29), a higher body mass index (BMI) (aOR per additional kg/m2 1.09, 95% CI 1.00-1.18) and tobacco smoking vs. not (aOR 2.94, 95% CI 1.00-8.60). HIV infection was not associated with QFT-Plus positivity (aOR 0.91, 95% CI 0.42-1.96). CONCLUSION Interferon Gamma Release Assay positivity in this study population was lower than previously estimated. Tobacco smoking and BMI were determinants of IGRA positivity that were previously unappreciated.
Collapse
Affiliation(s)
- Jonathan Mayito
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Adrian R Martineau
- Centre for Immunobiology, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Divya Tiwari
- Centre for Immunobiology, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Lydia Nakiyingi
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
- Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - David P Kateete
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Stephen T Reece
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Irene Andia Biraro
- Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
| |
Collapse
|
4
|
Santos JM, Fachi MM, Beraldi-Magalhães F, Böger B, Junker AM, Domingos EL, Imazu P, Fernandez-Llimos F, Tonin FS, Pontarolo R. Systematic review with network meta-analysis on the treatments for latent tuberculosis infection in children and adolescents. J Infect Chemother 2022; 28:1645-1653. [PMID: 36075488 DOI: 10.1016/j.jiac.2022.08.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 06/15/2022] [Accepted: 08/26/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND We aimed to synthesize the evidence on the efficacy and safety of different treatment regimens for latent tuberculosis infection (LTBI) in children and adolescents. METHODS A systematic review with network meta-analysis was performed (CRD142933). Searches were conducted in Pubmed and Scopus (Nov-2021). Randomized controlled trials comparing treatments for LTBI (patients up to 15 years), and reporting data on the incidence of the disease, death or adverse events were included. Networks using the Bayesian framework were built for each outcome of interest. Results were reported as odds ratio (OR) with 95% credibility intervals (CrI). Rank probabilities were calculated via the surface under the cumulative ranking analysis (SUCRA) (Addis-v.1.16.8). GRADE approach was used to rate evidence's certainty. RESULTS Seven trials (n = 8696 patients) were included. Placebo was significantly associated with a higher incidence of tuberculosis compared to all active therapies. Combinations of isoniazid (15-25 mg/kg/week) plus rifapentine (300-900 mg/week), followed by isoniazid plus rifampicin (10 mg/kg/day) were ranked as best approaches with lower probabilities of disease incidence (10% and 19.5%, respectively in SUCRA) and death (20%). Higher doses of isoniazid monotherapy were significantly associated to more deaths (OR 18.28, 95% ICr [1.02, 48.60] of 4-6 mg/kg/day vs. 10 mg/kg/3x per week). CONCLUSIONS Combined therapies of isoniazid plus rifapentine or rifampicin for short-term periods should be used as the first-line approach for treating LTBI in children and adolescents. The use of long-term isoniazid as monotherapy and at higher doses should be avoided for this population.
Collapse
Affiliation(s)
- Josiane M Santos
- Pharmaceutical Sciences Postgraduate Research Program, Federal University of Paraná, Curitiba, Brazil.
| | - Mariana M Fachi
- Pharmaceutical Sciences Postgraduate Research Program, Federal University of Paraná, Curitiba, Brazil.
| | | | - Beatriz Böger
- Pharmaceutical Sciences Postgraduate Research Program, Federal University of Paraná, Curitiba, Brazil.
| | - Allan M Junker
- Pharmaceutical Sciences Postgraduate Research Program, Federal University of Paraná, Curitiba, Brazil.
| | - Eric L Domingos
- Pharmaceutical Sciences Postgraduate Research Program, Federal University of Paraná, Curitiba, Brazil.
| | - Priscila Imazu
- Pharmaceutical Sciences Postgraduate Research Program, Federal University of Paraná, Curitiba, Brazil.
| | - Fernando Fernandez-Llimos
- Laboratory of Pharmacology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal.
| | - Fernanda S Tonin
- Pharmaceutical Sciences Postgraduate Research Program, Federal University of Paraná, Curitiba, Brazil; H&TRC- Health & Technology Research Center, ESTeSL- Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal.
| | - Roberto Pontarolo
- Department of Pharmacy, Federal University of Paraná, Curitiba, Brazil.
| |
Collapse
|
5
|
Exploring alternative cytokines as potential biomarkers for latent tuberculosis infection in pregnant women. PLoS One 2022; 17:e0270552. [PMID: 35802700 PMCID: PMC9269918 DOI: 10.1371/journal.pone.0270552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/13/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Interferon gamma release assays (IGRAs) are widely used to determine latent tuberculosis infection status. However, its pregnancy-affected performance and cost-expensive nature warrants for different alternatives for pregnant women. This study aims to evaluate the diagnostic performance of several alternative cytokines, including interleukin 2 (IL-2), interleukin 10 (IL-10), and interferon gamma-induced protein 10 (IP-10) to identify latent tuberculosis status in pregnant women.
Materials and methods
123 pregnant womens were recruited for this study. The IGRA status was determined by using QuantiFERON Gold In-Tube. Meanwhile, we measured the level IL-2, IL-10, and IP-10 by using sandwich-microELISA method. We performed normality and comparison test by SPSS. In addition, receiver-operator characteristic (ROC) analyses and the optimal cutoff scores were identified using the EasyROC webtool.
Results
We showed that IL-2, IL-10, and IP-10 were able to discriminate between IGRA-negative and IGRA-positive pregnant women. Moreover, IP-10 showed the highest discriminatory and diagnostic performance when compared to IL-2 and IL-10 with area under the curve (AUC) of 0.96 and cutoff point of 649.65 pg/mL.
Conclusions
Our study showed that IP-10 can be considered as a promising alternative biomarker for IGRAs to diagnose LTBI in pregnant women.
Collapse
|
6
|
Carrère-Kremer S, Kolia-Diafouka P, Pisoni A, Bolloré K, Peries M, Godreuil S, Bourdin A, Van de Perre P, Tuaillon E. QuantiFERON-TB Gold Plus Assay in Patients With Latent vs. Active Tuberculosis in a Low Incidence Setting: Level of IFN-γ, CD4/CD8 Responses, and Release of IL-2, IP-10, and MIG. Front Microbiol 2022; 13:825021. [PMID: 35464936 PMCID: PMC9026190 DOI: 10.3389/fmicb.2022.825021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesWe analyzed the results of the QuantiFERON Glod Plus assay (QFT) and cytokine patterns associated with active tuberculosis (ATB) among patients with positive QFT.MethodsA total of 195 patients are QFT-positive, among which 24 had an ATB and 171 had a latent tuberculosis infection (LTBI). Interferon-gamma (IFN-γ) secretion was analyzed relative to interleukin-2 (IL-2), IFN-γ inducible protein or CXCL-10 (IP-10), and monokine induced by IFN-γ or CXCL-9 (MIG) secretion, and then compared between two sets of peptide antigens [tube 1 - cluster of differentiation 4 (CD4+) T cell stimulation; tube 2 - CD4+/CD8+ T cell response].ResultsHigher IFN-γ responses were measured in the ATB group (p = 0.0089). The results showed that there was a lower ratio of tube 1/tube 2 IFN-γ concentrations in the ATB group (p = 0.0009), and a median [interquartile ranges (IQR)] difference between the two sets at −0.82 IU/ml (−1.67 to 0.18) vs. −0.07 IU/ml (−0.035 to 0.11, p < 0.0001) in the ATB group compared to the LTBI group, respectively. In addition, patients with low ratios of IL-2/IFN-γ, IP-10/IFN-γ, and MIG/IFN-γ were much more likely to have ATB.ConclusionHigh levels of IFN-γ secretion, preferential IFN-γ response in tube 2, and lower secretion of IL-2, IP-10, and MIG release relative to IFN-γ secretion were more likely observed in subjects with ATB. These features of T cell response may be helpful in low prevalence settings to suspect ATB in patients tested positive for IFN-γ release assays (IGRA).
Collapse
Affiliation(s)
- Séverine Carrère-Kremer
- Pathogenesis and Control of Chronic and Emerging Infections, University of Montpellier, INSERM U1058, EFS, Antilles University, Montpellier University Hospital, Montpellier, France
| | - Pratt Kolia-Diafouka
- Pathogenesis and Control of Chronic and Emerging Infections, University of Montpellier, INSERM U1058, EFS, Antilles University, Montpellier University Hospital, Montpellier, France
| | - Amandine Pisoni
- Pathogenesis and Control of Chronic and Emerging Infections, University of Montpellier, INSERM U1058, EFS, Antilles University, Montpellier University Hospital, Montpellier, France
| | - Karine Bolloré
- Pathogenesis and Control of Chronic and Emerging Infections, University of Montpellier, INSERM U1058, EFS, Antilles University, Montpellier University Hospital, Montpellier, France
| | - Marianne Peries
- Pathogenesis and Control of Chronic and Emerging Infections, University of Montpellier, INSERM U1058, EFS, Antilles University, Montpellier University Hospital, Montpellier, France
| | - Sylvain Godreuil
- UMR MIVEGEC IRD-Centre National pour la Recherche Scientifique (CNRS), University of Montpellier, Montpellier University Hospital, Montpellier, France
| | - Arnaud Bourdin
- PhyMedExp, INSERM U1046, Centre National pour la Recherche Scientifique (CNRS) UMR 9214, University of Montpellier, Montpellier University Hospital, Montpellier, France
| | - Philippe Van de Perre
- Pathogenesis and Control of Chronic and Emerging Infections, University of Montpellier, INSERM U1058, EFS, Antilles University, Montpellier University Hospital, Montpellier, France
| | - Edouard Tuaillon
- Pathogenesis and Control of Chronic and Emerging Infections, University of Montpellier, INSERM U1058, EFS, Antilles University, Montpellier University Hospital, Montpellier, France
- *Correspondence: Edouard Tuaillon,
| |
Collapse
|
7
|
Muchuro S, Makabayi-Mugabe R, Musaazi J, Mayito J, Zawedde-Muyanja S, Nakawooya M, Tugumisirize D, Semanda P, Wandiga S, Nabada-Ndidde S, Nkolo A, Turyahabwe S. Integrating interferon-gamma release assay testing into provision of tuberculosis preventive therapy is feasible in a tuberculosis high burden resource-limited setting: A mixed methods study. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000197. [PMID: 36962307 PMCID: PMC10022101 DOI: 10.1371/journal.pgph.0000197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 06/01/2022] [Indexed: 11/19/2022]
Abstract
The World Health Organization recommends the scale-up of tuberculosis preventive therapy (TPT) for persons at risk of developing active tuberculosis (TB) as a key component to end the global TB epidemic. We sought to determine the feasibility of integrating testing for latent TB infection (LTBI) using interferon-gamma release assays (IGRAs) into the provision of TPT in a resource-limited high TB burden setting. We conducted a parallel convergent mixed methods study at four tertiary referral hospitals. We abstracted details of patients with bacteriologically confirmed pulmonary tuberculosis (PBC TB). We line-listed household contacts (HHCs) of these patients and carried out home visits where we collected demographic data from HHCs, and tested them for both HIV and LTBI. We performed multi-level Poisson regression with robust standard errors to determine the associations between the presence of LTBI and characteristics of HHCs. Qualitative data was collected from health workers and analyzed using inductive thematic analysis. From February to December 2020 we identified 355 HHCs of 86 index TB patients. Among these HHCs, uptake for the IGRA test was 352/355 (99%) while acceptability was 337/352 (95.7%). Of the 352 HHCs that were tested with IGRA, the median age was 18 years (IQR 10-32), 191 (54%) were female and 11 (3%) were HIV positive. A total of 115/352 (32.7%) had a positive IGRA result. Among HHCs who tested negative on IGRA at the initial visit, 146 were retested after 9 months and 5 (3.4%) of these tested positive for LTBI. At multivariable analysis, being aged ≥ 45 years [PR 2.28 (95% CI 1.02, 5.08)], being employed as a casual labourer [PR 1.38 (95% CI 1.19, 1.61)], spending time with the index TB patient every day [PR 2.14 (95% CI 1.51, 3.04)], being a parent/sibling to the index TB patients [PR 1.39 (95% CI 1.21, 1.60)] and sharing the same room with the index TB patients [PR 1.98 (95% CI 1.52, 2.58)] were associated with LTBI. Implementation challenges included high levels of TB stigma and difficulties in following strict protocols for blood sample storage and transportation. Integrating home-based IGRA testing for LTBI into provision of TB preventive therapy in routine care settings was feasible and resulted in high uptake and acceptability of IGRA tests.
Collapse
Affiliation(s)
- Simon Muchuro
- USAID-Defeat TB Project, University Research Co. LLC, Kampala, Uganda
- Ministry of Health-National TB and Leprosy Division, Kampala, Uganda
| | - Rita Makabayi-Mugabe
- USAID-Defeat TB Project, University Research Co. LLC, Kampala, Uganda
- Ministry of Health-National TB and Leprosy Division, Kampala, Uganda
| | - Joseph Musaazi
- The Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Jonathan Mayito
- The Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Stella Zawedde-Muyanja
- USAID-Defeat TB Project, University Research Co. LLC, Kampala, Uganda
- The Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Mabel Nakawooya
- Ministry of Health-National TB and Leprosy Division, Kampala, Uganda
| | | | - Patrick Semanda
- Ministry of Health-Central Public Health Laboratories, Kampala, Uganda
| | | | | | - Abel Nkolo
- The Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Stavia Turyahabwe
- Ministry of Health-National TB and Leprosy Division, Kampala, Uganda
| |
Collapse
|
8
|
Can S, Sahin A, Dalgic N, Aygün D. The Diagnostic Value of Blood and Urine IP-10 Test in Children Having Active Tuberculosis or Latent Tuberculosis Infection. J PEDIAT INF DIS-GER 2021. [DOI: 10.1055/s-0041-1731039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Abstract
Objective This study aimed to investigate interferon-gamma-inducible protein-10 (IP-10) values in serum and urine in pediatric patients in the diagnosis of active tuberculosis (TB) or latent TB infection (LTBI). It also aimed to investigate whether it can be used as a biomarker to distinguish between active TB and LTBI.
Methods Our study comprised active TB (25 patients), LTBI (25 patients), and the “infected” group (50 patients) formed by combining the two groups. As the control group, 37 healthy children were included in the study. TB skin test, plasma IP-10, and urine IP-10 measurements were performed in all patients included in the study. An additional QuantiFERON-TB Gold In-Tube (QFT-GIT) test was performed on patients evaluated as active TB or LTBI.
Results Plasma IP-10 levels of the patients in the active TB, LTBI, and the “infected” groups were significantly higher than the control group (p = 0.022, p = 0.028, and p = 0.007, respectively). Urine IP-10 was successful in distinguishing the active TB and “infected” groups from the control group (p = 0.007 and p = 0.047, respectively). Also, in the combined use of the tests, when QFT-GIT and urine IP-10 were positive together, active TB and LTBI could be distinguished (p = 0.044). Urine IP-10 levels were found to be significantly higher in those with pulmonary TB than those with extrapulmonary TB (p = 0.012).
Conclusion Our findings suggest that IP-10 can be used as a useful biomarker in the diagnosis of active TB in children.
Collapse
Affiliation(s)
- Salim Can
- Department of Pediatric Infectious Diseases, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Ayse Sahin
- Department of Pediatric Infectious Diseases, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Nazan Dalgic
- Department of Pediatric Infectious Diseases, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Deniz Aygün
- Department of Pediatric Infectious Diseases, Kanuni Sultan Suleyman Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| |
Collapse
|
9
|
Pedersen JL, Barry SE, Bokil NJ, Ellis M, Yang Y, Guan G, Wang X, Faiz A, Britton WJ, Saunders BM. High sensitivity and specificity of a 5-analyte protein and microRNA biosignature for identification of active tuberculosis. Clin Transl Immunology 2021; 10:e1298. [PMID: 34188917 PMCID: PMC8219900 DOI: 10.1002/cti2.1298] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/19/2021] [Accepted: 05/24/2021] [Indexed: 02/02/2023] Open
Abstract
Objectives Non‐sputum‐based tests to accurately identify active tuberculosis (TB) disease and monitor response to therapy are urgently needed. This study examined the biomarker capacity of a panel of plasma proteins alone, and in conjunction with a previously identified miRNA signature, to identify active TB disease. Methods The expression of nine proteins (IP‐10, MCP‐1, sTNFR1, RANTES, VEGF, IL‐6, IL‐10, TNF and Eotaxin) was measured in the plasma of 100 control subjects and 100 TB patients, at diagnosis (treatment naïve) and over the course of treatment (1‐, 2‐ and 6‐month intervals). The diagnostic performance of the nine proteins alone, and with the miRNA, was assessed. Results Six proteins were significantly up‐regulated in the plasma of TB patients at diagnosis compared to controls. Receiver operator characteristic curve analysis demonstrated that IP‐10 with an AUC = 0.874, sensitivity of 75% and specificity of 87% was the best single biomarker candidate to distinguish TB patients from controls. IP‐10 and IL‐6 levels fell significantly within one month of commencing treatment and may have potential as indicators of a positive response to therapy. The combined protein and miRNA panel gave an AUC of 1.00. A smaller panel of only five analytes (IP‐10, miR‐29a, miR‐146a, miR‐99b and miR‐221) showed an AUC = 0.995, sensitivity of 96% and specificity of 97%. Conclusions A novel combination of miRNA and proteins significantly improves the sensitivity and specificity as a biosignature over single biomarker candidates and may be useful for the development of a non‐sputum test to aid the diagnosis of active TB disease.
Collapse
Affiliation(s)
- Jessica L Pedersen
- School of Life Sciences, Faculty of Science University of Technology Sydney Sydney NSW Australia
| | - Simone E Barry
- Centenary Institute The University of Sydney Sydney NSW Australia.,South Australian Tuberculosis Services Royal Adelaide Hospital. Adelaide Australia
| | - Nilesh J Bokil
- School of Life Sciences, Faculty of Science University of Technology Sydney Sydney NSW Australia
| | - Magda Ellis
- Centenary Institute The University of Sydney Sydney NSW Australia
| | - YuRong Yang
- Pathogen Biology and Medical Immunological Department Ningxia Medical University Yinchuan China
| | - Guangyu Guan
- Infectious Disease Hospital of Ningxia Yinchuan China
| | - Xiaolin Wang
- Pathogen Biology and Medical Immunological Department Ningxia Medical University Yinchuan China
| | - Alen Faiz
- School of Life Sciences, Faculty of Science University of Technology Sydney Sydney NSW Australia
| | | | - Bernadette M Saunders
- School of Life Sciences, Faculty of Science University of Technology Sydney Sydney NSW Australia.,Centenary Institute The University of Sydney Sydney NSW Australia
| |
Collapse
|
10
|
Ghanaie RM, Karimi A, Azimi L, James S, Nasehi M, Mishkar AP, Sheikhi M, Fallah F, Tabatabaei SR, Hoseini-Alfatemi SM. Diagnosis of latent tuberculosis infection among pediatric household contacts of Iranian tuberculosis cases using tuberculin skin test, IFN- γ release assay and IFN-γ-induced protein-10. BMC Pediatr 2021; 21:76. [PMID: 33573613 PMCID: PMC7877026 DOI: 10.1186/s12887-021-02524-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 01/26/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Although the World Health Organization has recommended the diagnosis and prophylactic treatment of latent tuberculous infection (LTBI) in child household contacts of tuberculosis (TB) cases, the national programs in high-burden TB regions rarely implement adequate screening of this high-risk group, mainly because of resource limitations. We aimed to evaluate the prevalence of LTBI among pediatric household contacts of TB cases in two high-burden provinces in Iran. METHODS We conducted a cohort study in children who had been in household contact with a TB index. All subjects were assessed for active TB disease. For LTBI diagnosis, tuberculin skin test (TST) and QuantiFERON®-TB Gold Plus (QFT-Plus) were performed at the time of the index TB case diagnosis, as well as, 3, 12, and 18 months, if the first results were negative. In addition, interferon-γ-induced protein-10(IP-10) concentrations were measured for all participants. RESULTS A total of 230 children were enrolled, who had contact with an index TB case. Three contacts were diagnosed with active TB. According to the TST/QFT-Plus results, 104 (45.2%) children were identified with LTBI during our study. Significantly increased IP-10 levels were found in LTBI patients compared to healthy contacts. Accordingly, more than 50% of LTBI contacts and about 10% of healthy contacts were considered as IP-10-positive. CONCLUSION This study alarmingly illustrates a high prevalence of LTBI among Iranian children exposed to TB cases. We, therefore, emphasize that the children living in close contact with an infectious TB case should be screened effectively and receive prophylactic therapy.
Collapse
Affiliation(s)
- Roxana Mansour Ghanaie
- Pediatric Infections Research Center (PIRC), Research Institute for Children's Health (RICH), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abdollah Karimi
- Pediatric Infections Research Center (PIRC), Research Institute for Children's Health (RICH), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Leila Azimi
- Pediatric Infections Research Center (PIRC), Research Institute for Children's Health (RICH), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seddon James
- Centre for International Child Health, Department of Paediatrics, Imperial College London, London, UK
| | - Mahshid Nasehi
- Center for Communicable Diseases Control, Ministry of Health and Medical Education, Tehran, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | | | - Mahnaz Sheikhi
- TB Coordinator of Deputy Health, Golestan University of Medical Sciences, Gorgan, Golestan, Iran
| | - Fatemeh Fallah
- Pediatric Infections Research Center (PIRC), Research Institute for Children's Health (RICH), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sedigheh Rafiei Tabatabaei
- Pediatric Infections Research Center (PIRC), Research Institute for Children's Health (RICH), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyedeh Mahsan Hoseini-Alfatemi
- Pediatric Infections Research Center (PIRC), Research Institute for Children's Health (RICH), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
11
|
Mayito J, Meya DB, Rhein J, Sekaggya-Wiltshire C. Utility of the monocyte to lymphocyte ratio in diagnosing latent tuberculosis among HIV-infected individuals with a negative tuberculosis symptom screen. PLoS One 2020; 15:e0241786. [PMID: 33166312 PMCID: PMC7652277 DOI: 10.1371/journal.pone.0241786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/20/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Latent Tuberculosis Infection (LTBI) remains a major driver of the TB epidemic, and individuals with Human Immuno-deficiency Virus (HIV) are particularly at a heightened risk of developing LTBI. However, LTBI screening among HIV-infected individuals in resource limited setting is largely based on a negative symptom screen, which has low specificity. METHODS In a cross sectional diagnostic study, 115 HIV infected participants with a negative symptom screen will be consented and enrolled. They will be requested to donate 5 ml of blood for complete blood count (CBC) and interferon gamma release assay (IGRA) testing. In a nested prospective study, the 115 participants will be initiated on Tuberculosis Preventive Therapy and the CBC testing repeated after 3 months. In the analysis of study finding, the monocyte to lymphocyte ratio (MLR) will be derived from the dividend of the absolute monocyte and lymphocyte counts. The optimal MLR positivity cut-off for elevated or normal MLR will be the highest value of Youden's index, J (sensitivity + specificity-1). The MLR will be cross tabulated with the IGRA status to determine the sensitivity, specificity, negative and positive predictive values of the MLR. The area under the receiver operating characteristic (ROC) curve will be determined to give the overall diagnostic accuracy of MLR. The baseline and 3 month CBC will be used to determine the change in MLR, and a random effect logistic regression will be used to determine factors associated with the change in the MLR. DISCUSSION If positive results are realized from this study, the MLR could become an inexpensive alternative biomarker with potential to improve the specificity of the negative symptom screen in identifying individuals that should be targeted for TB preventive therapy.
Collapse
Affiliation(s)
- Jonathan Mayito
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - David B. Meya
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Joshua Rhein
- Division of Infectious Diseases and International Medicine, University of Minnesota, USA Department of Research, Minneapolis, Minnesota, United States of America
| | | |
Collapse
|
12
|
Nakanjako D, Zalwango F, Wairagala P, Luboga F, Andia Biraro I, Bukirwa VD, Mboowa MG, Cose S, Seeley J, Elliott A. Career development for infection and immunity research in Uganda: a decade of experience from the Makerere University - Uganda Virus Research Institute research and training programme. AAS Open Res 2020; 3:26. [PMID: 32734140 PMCID: PMC7372530 DOI: 10.12688/aasopenres.13066.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2020] [Indexed: 11/23/2022] Open
Abstract
Background: The Makerere University/Uganda Virus Research Institute (UVRI) Centre of Excellence for Infection & Immunity Research and Training (MUII) is a collaborative programme supporting excellence in Infection and Immunity (I&I) research in Uganda. Set up in 2008, MUII aims to produce internationally competitive Ugandan and East African I&I research leaders, and develop human and infrastructural resources to support research and training excellence. We undertook an internal evaluation of MUII’s achievements, challenges and lessons learned between 08-2008 and 12-2019, to inform programmes seeking to build Africa’s health research expertise. Methods: Quantitative data were abstracted from programme annual reports. Qualitative data were obtained in 03-04/2019: a cross-sectional evaluation was undertaken among a purposefully selected representative sample of 27 trainees and two programme staff. Qualitative data was analysed according to pre-determined themes of achievements, challenges, lessons learned and recommendations for improvement. Results: By 12-2019, MUII had supported 68 fellowships at master’s-level and above (50% female: 23 Masters, 27 PhD, 15 post-doctoral, three group-leaders) and over 1,000 internships. Fellows reported career advancement, mentorship by experts, and improved research skills and outputs. Fellows have published over 300 papers, secured grants worth over £20m, established over 40 international collaborations, and taken on research and academic leadership positions in the country. Key lessons were: i) Efficient administration provides a conducive environment for high quality research; ii) Institutions need supportive policies for procurement, including provisions for purchases of specific biological research reagents from international manufacturers; iii) Strong international and multi-disciplinary collaboration provides a critical mass of expertise to mentor researchers in development; and iv) Mentorship catalyses young scientists to progress from graduate trainees to productive academic researchers, relevant to society’s most pressing health challenges. Conclusions: Sustainable academic productivity can be achieved through efficient operational support, global collaboration and mentorship to provide solutions to Africa’s health challenges.
Collapse
Affiliation(s)
- Damalie Nakanjako
- Makerere University-Uganda Virus Research Institute Infection and Immunity (MUII), Uganda Virus Research Institute, Entebbe, Uganda.,Department of Medicine, School of Medicine, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Flavia Zalwango
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit,, Uganda Virus Research Institute, Entebbe, Uganda
| | - Pamela Wairagala
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit,, Uganda Virus Research Institute, Entebbe, Uganda
| | - Fiona Luboga
- Makerere University-Uganda Virus Research Institute Infection and Immunity (MUII), Uganda Virus Research Institute, Entebbe, Uganda
| | - Irene Andia Biraro
- Makerere University-Uganda Virus Research Institute Infection and Immunity (MUII), Uganda Virus Research Institute, Entebbe, Uganda.,Department of Medicine, School of Medicine, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Victoria Diana Bukirwa
- Makerere University-Uganda Virus Research Institute Infection and Immunity (MUII), Uganda Virus Research Institute, Entebbe, Uganda
| | - Mary Gorrethy Mboowa
- Makerere University-Uganda Virus Research Institute Infection and Immunity (MUII), Uganda Virus Research Institute, Entebbe, Uganda
| | - Steve Cose
- Makerere University-Uganda Virus Research Institute Infection and Immunity (MUII), Uganda Virus Research Institute, Entebbe, Uganda.,Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit,, Uganda Virus Research Institute, Entebbe, Uganda
| | - Janet Seeley
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit,, Uganda Virus Research Institute, Entebbe, Uganda.,Global Health and Development Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Alison Elliott
- Makerere University-Uganda Virus Research Institute Infection and Immunity (MUII), Uganda Virus Research Institute, Entebbe, Uganda.,Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit,, Uganda Virus Research Institute, Entebbe, Uganda
| |
Collapse
|
13
|
Tesfaye F, Sturegård E, Walles J, Winqvist N, Balcha TT, Karlson S, Mulleta D, Isberg PE, Jansson M, Björkman P. Alternative biomarkers for classification of latent tuberculosis infection status in pregnant women with borderline Quantiferon plus results. Tuberculosis (Edinb) 2020; 124:101984. [PMID: 32829076 DOI: 10.1016/j.tube.2020.101984] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 07/30/2020] [Accepted: 08/04/2020] [Indexed: 01/29/2023]
Abstract
Borderline interferon-gamma (IFN-γ) results (near the cut-off level 0.35 IU/ml) occur in QuantiFERON (QFT) assays. We investigated the performance of alternative biomarkers for classification of latent tuberculosis infection (LTBI) status in pregnant women with borderline QFT IFN-γ responses. Pregnant women (n = 96) were identified from a cohort study in Ethiopia, based on QFT-Plus IFN-γ results (QFT-low: <0.20 IU/ml, n = 33; QFT-borderline: 0.20-0.70 IU/ml, n = 31; QFT-high: >0.70 IU/ml, n = 32), including 12 HIV-positive individuals in each group and with 20 HIV-negative non-pregnant women from the same cohort with QFT IFN-γ <0.20 IU/ml as controls. Concentrations of 8 markers (IL-1ra, IL-6, IL-8, IP-10, MCP-1, MCP-2, osteopontin and resistin) were measured in whole blood QFT supernatants, stimulated separately with TB1 and TB2 antigens. K-nearest neighbor analysis (KNN) was used to classify participants with regard to likelihood of LTBI. Concentrations of MCP-2, IP-10 and IL-1ra were higher in QFT-borderline compared to QFT-low participants in both antigen stimulations (p < 0.001). KNN classification indicated high likelihood of LTBI in 13/31 (42%) women with QFT-borderline IFN-γ results. MCP-2, IP-10 and IL-1ra expressed in whole blood after TB antigen stimulation may be considered as alternative biomarkers for classification of LTBI status in pregnant women with borderline QFT IFN-γ results.
Collapse
Affiliation(s)
- Fregenet Tesfaye
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden; Armauer Hansen Research Institute, Addis Ababa, Ethiopia.
| | - Erik Sturegård
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden; Clinical Microbiology, Division of Laboratory Medicine, Lund, Sweden
| | - John Walles
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden; Department of Infectious Diseases, Central Hospital, Kristianstad, Sweden
| | - Niclas Winqvist
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Taye Tolera Balcha
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Sara Karlson
- Medical Microbiology, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Daba Mulleta
- Adama Public Health Research and Referral Laboratory Center, Adama, Ethiopia
| | - Per-Erik Isberg
- Department of Statistics, School of Economics and Management, Lund University, Lund, Sweden
| | - Marianne Jansson
- Medical Microbiology, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Per Björkman
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden; Department of Infectious Diseases, Skane University Hospital, Malmö, Sweden
| |
Collapse
|
14
|
Nakanjako D, Zalwango F, Wairagala P, Luboga F, Andia Biraro I, Bukirwa VD, Mboowa MG, Cose S, Seeley J, Elliott A. Career development for infection and immunity research in Uganda: a decade of experience from the Makerere University – Uganda Virus Research Institute research and training programme. AAS Open Res 2020; 3:26. [DOI: 10.12688/aasopenres.13066.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2020] [Indexed: 11/20/2022] Open
Abstract
Background: The Makerere University/Uganda Virus Research Institute (UVRI) Centre of Excellence for Infection & Immunity Research and Training (MUII) is a collaborative programme supporting excellence in Infection and Immunity (I&I) research in Uganda. Set up in 2008, MUII aims to produce internationally competitive Ugandan and East African I&I research leaders, and develop human and infrastructural resources to support research and training excellence. We undertook an internal evaluation of MUII’s achievements, challenges and lessons learned between August 2008 and December 2019, to inform programmes seeking to build Africa’s health research expertise. Methods: Quantitative data were abstracted from programme annual reports. Qualitative data were obtained in March and April 2019: a cross-sectional evaluation was undertaken among a purposefully selected representative sample of 27 trainees and two programme staff. Qualitative data was analysed according to pre-determined themes of achievements, challenges, lessons learned and recommendations for improvement. Results: By December 2019, MUII had supported 68 fellowships at master’s-level and above (50% female: 23 Masters, 27 PhD, 15 post-doctoral, three group-leader fellows) and over 1,000 internships. Fellows reported career advancement, mentorship by experts, and improved research skills and outputs. Fellows have published over 300 papers, secured grants worth over £20m, established over 40 international collaborations, and taken on research and academic leadership positions in the country. Key lessons for success include the following: efficient administration provides an enabling environment; institutions need supportive policies for procurement, including provisions for purchases of specific biological research reagents from international manufacturers; strong international, multi-disciplinary collaboration provides a critical mass of expertise to mentor researchers in development; and mentorship catalyses young scientists to progress from graduate trainees to productive academic researchers, relevant to society’s most pressing health challenges. Conclusions: Sustainable academic productivity can be achieved through efficient operational support, global collaboration and mentorship to provide solutions to Africa’s health challenges.
Collapse
|
15
|
Mamishi S, Pourakbari B, Sadeghi RH, Marjani M, Mahmoudi S. Diagnostic Accuracy of Monocyte Chemotactic Protein (MCP)-2 as Biomarker in Response to PE35/PPE68 Proteins: A Promising Diagnostic Method for the Discrimination of Active and Latent Tuberculosis. Protein Pept Lett 2019; 26:281-286. [PMID: 30663558 DOI: 10.2174/0929866526666190119165805] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 01/03/2019] [Accepted: 01/03/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Several studies have been conducted to find new biomarkers for the discrimination of Latent Tuberculosis Infection (LTBI) from active TB (ATB); however, their findings are inconsistent. The aim of the current study was to evaluate the potential of in vitro antigenspecific expression of Monocyte Chemotactic Protein (MCP)-2 for discrimination of ATB and LTBI after stimulation of whole blood with PE35 and PPE68 recombinant proteins. MATERIALS AND METHODS The recombinant PE35 and PPE68 proteins were evaluated at a final concentration of 5 µg/ml by a 3-day whole blood assay. Secreted MCP-2 from the culture supernatants were measured by commercially available Human MCP2 ELISA Kit. The diagnostic performance of MCP-2 was ascertained by Receiver Operator Characteristic (ROC) curve and measuring the Area Under the Curve (AUC) and their 95% Confidence Intervals (CI). Cut-offs was estimated at various sensitivities and specificities and at the maximum Youden's index (YI), i.e. sensitivity specificity-1. RESULTS The median MCP-2 response to both PE35 and PPE68 in those with LTBI was significantly higher than patients with ATB. The discrimination performance of MCP-2 response following stimulation of PE35 (assessed by AUC) between LTBI and patients with ATB was 0.98 (95%CI: 0.94-1.00). Maximum discrimination was reached at a cut-off of 86pg/mL with 100% sensitivity and 97% specificity. The highest sensitivity and specificity was obtained using cut off 58 pg/mL following stimulation with PPE68 (100% and 90%, respectively; AUC: 0.94, 95%CI: 0.85- 1.00). CONCLUSION MCP-2 induced by PE35 and PPE68 shows good discriminatory power for discrimination of ATB and LTBI. Additional studies with a larger sample size are needed to confirm the advantage of this marker, alone or combined with other markers; however, these findings present a promising method, which can discriminate between ATB and LTBI.
Collapse
Affiliation(s)
- Setareh Mamishi
- Pediatric Infectious Disease Research Center, Children Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Department of Infectious Diseases, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Babak Pourakbari
- Pediatric Infectious Disease Research Center, Children Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Reihaneh Hosseinpour Sadeghi
- Pediatric Infectious Disease Research Center, Children Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Majid Marjani
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shima Mahmoudi
- Pediatric Infectious Disease Research Center, Children Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
16
|
Accumulate evidence for IP-10 in diagnosing pulmonary tuberculosis. BMC Infect Dis 2019; 19:924. [PMID: 31666025 PMCID: PMC6822474 DOI: 10.1186/s12879-019-4466-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 09/12/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUNDS Pulmonary tuberculosis (PTB) is a major health and economic burden. Accurate PTB detection is an important step to eliminating TB globally. Interferon gamma-induced protein 10 (IP-10) has been reported as a potential diagnostic marker for PTB since 2007. In this study, a meta-analysis approach was used to assess diagnostic value of IP-10 for PTB. METHODS Web of Science, PubMed, the Cochrane Library, and Embase databases were searched for studies published in English up to February 2019. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), the area under the curve (AUC) and hierarchical summary receiver operating characteristic (HSROC) curve were estimated by the HSROC model and random effect model. RESULTS Eighteen studies including 2836 total participants met our inclusion criteria. The pooled sensitivity, specificity, PLR, and NLR of IP-10 for PTB detection were 86, 88%, 7.00, and 0.16, respectively. The pooled DOR was 43.01, indicating a very powerful discriminatory ability of IP-10. The AUC was 0.93 (95% CI: 0.91-0.95), showed the accuracy of IP-10 was good. Meta-regression showed that there was no heterogeneity with respect to TB burden, study design type, age, IP-10 assay method, IP-10 condition and HIV-infection status. CONCLUSIONS Our results showed that IP-10 is a promising marker for differentiating PTB from non-TB.
Collapse
|
17
|
Benachinmardi KK, Sangeetha S, Rao M, Prema R. Validation and Clinical Application of Interferon-Gamma Release Assay for Diagnosis of Latent Tuberculosis Infection in Children. Int J Appl Basic Med Res 2019; 9:241-245. [PMID: 31681551 PMCID: PMC6822318 DOI: 10.4103/ijabmr.ijabmr_86_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/12/2019] [Accepted: 08/16/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND India has the highest tuberculosis (TB) burden, accounting for one-fifth of the global incidence and two-third of the cases in Southeast Asia with an estimated 1.9 million new cases every year. Identifying and treating latent TB infection (LTBI) can reduce the risk of development of active disease by up to 90%, thereby decreasing a major burden to the prevalence of the disease, and thus reducing potential sources in future. AIM Early diagnosis of LTBI by tuberculin skin test (TST) and a newer interferon-gamma release assay (IGRA). MATERIALS AND METHODS Seventy-seven clinically asymptomatic household contacts (≤18 years) of confirmed pulmonary TB patients were enrolled to compare the performance of TST and IGRA to diagnose LTBI. At baseline, all participants underwent testing for IGRA and TST. RESULTS TST showed positivity of 22%, while IGRA demonstrated positivity of 40% in the diagnosis of latent TB. Kappa value at 95% confidence interval was 0.4753, indicates a moderate agreement between the two tests. This indicates that IGRA is a better predictor of latent TB. Maximum positive percentage was in the age group of 16-18 years in both the tests followed by 1-5 years. AIM Early diagnosis of LTBI by tuberculin skin test (TST) and a newer interferon-gamma release assay (IGRA).
Collapse
Affiliation(s)
| | - S Sangeetha
- Department of Microbiology, Rajarajeswari Medical College and Hospital, Bengaluru, Karnataka, India
| | - Mohan Rao
- Department of Tuberculosis and Chest Diseases, Rajarajeswari Medical College and Hospital, Bengaluru, Karnataka, India
| | - R Prema
- Department of Paediatrics, Rajarajeswari Medical College and Hospital, Bengaluru, Karnataka, India
| |
Collapse
|
18
|
Mamishi S, Mahmoudi S, Banar M, Hosseinpour Sadeghi R, Marjani M, Pourakbari B. Diagnostic accuracy of interferon (IFN)-γ inducible protein 10 (IP-10) as a biomarker for the discrimination of active and latent tuberculosis. Mol Biol Rep 2019; 46:6263-6269. [PMID: 31564016 DOI: 10.1007/s11033-019-05067-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 09/10/2019] [Indexed: 01/28/2023]
Abstract
To assess the potency of Interferon (IFN)-γ inducible protein 10 (IP-10) stimulated by recombinant PE35 and PPE68 as a biomarker in differentiating between active and latent tuberculosis. Patients with active pulmonary TB (PTB) (n = 30), latent TB infection (LTBI) (n = 29), and BCG-vaccinated healthy controls (HCs) (n = 30) were enrolled and blood samples were taken from them. The diagnostic performance of IP-10 was evaluated by the Receiver operator characteristic (ROC) curve and the area under the curve (AUC) and their 95% confidence intervals (CI) were calculated. The median IP-10 concentrations following stimulation with recombinant PE35 and PPE68 were significantly higher in TB-infected group (both PTB and LTBI) compared with HCs (P < 0.05). It was also significantly higher in PTB patients compared with individuals with LTBI (P < 0.05). The discriminatory performance of IP-10 following stimulation with recombinant PE35 and PPE68 (assessed by AUC) between TB patients and HCs were similar (AUC: 0.79 [95% CI 0.68-0.89] and 0.79 [95% CI 0.69-0.89], respectively). AUCs of IP-10 following stimulation with recombinant PE35 and PPE68 for distinguishing between PTB and LTBI groups were 0.63 (95% CI 0.47-0.79) and 0.61 (0.45-0.77), respectively. Under the selected cut-off values, the sensitivity and specificity of IP-10 for distinguishing of TB-infected and HCs after stimulation with recombinant PE35 was 74.5% and 73%, respectively and after stimulation with recombinant PPE68 were 76.5% and 63%, respectively. Moreover, the sensitivity and specificity of IP-10 for differentiating of PTB and LTBI following stimulation with recombinant PE35 and PPE68 were 770 pg/ml (sensitivity: 63%; specificity: 62%) and 502 pg/ml (sensitivity: 80%; specificity: 52%), respectively. IP-10 stimulated by recombinant PE35 and PPE68 is a promising biomarker for TB diagnosis. However, it doesn't have desirable sensitivity and specificity in distinguishing between PTB and LTBI.
Collapse
Affiliation(s)
- Setareh Mamishi
- Pediatric Infectious Disease Research Center, Children Medical Center Hospital, Tehran University of Medical Sciences, No.62, Gharib St., Keshavarz Blvd., Tehran, Iran.,Department of Infectious Diseases, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Shima Mahmoudi
- Pediatric Infectious Disease Research Center, Children Medical Center Hospital, Tehran University of Medical Sciences, No.62, Gharib St., Keshavarz Blvd., Tehran, Iran
| | - Maryam Banar
- Pediatric Infectious Disease Research Center, Children Medical Center Hospital, Tehran University of Medical Sciences, No.62, Gharib St., Keshavarz Blvd., Tehran, Iran
| | - Reihaneh Hosseinpour Sadeghi
- Pediatric Infectious Disease Research Center, Children Medical Center Hospital, Tehran University of Medical Sciences, No.62, Gharib St., Keshavarz Blvd., Tehran, Iran
| | - Majid Marjani
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Babak Pourakbari
- Pediatric Infectious Disease Research Center, Children Medical Center Hospital, Tehran University of Medical Sciences, No.62, Gharib St., Keshavarz Blvd., Tehran, Iran.
| |
Collapse
|
19
|
Bisht D, Sharma D, Sharma D, Singh R, Gupta VK. Recent insights intoMycobacterium tuberculosisthrough proteomics and implications for the clinic. Expert Rev Proteomics 2019; 16:443-456. [DOI: 10.1080/14789450.2019.1608185] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Deepa Bisht
- Department of Biochemistry, National JALMA Institute for Leprosy & Other Mycobacterial Diseases (ICMR), Agra, India
| | - Devesh Sharma
- Department of Biochemistry, National JALMA Institute for Leprosy & Other Mycobacterial Diseases (ICMR), Agra, India
| | - Divakar Sharma
- Medical Microbiology and Molecular Biology Laboratory, Interdisciplinary Biotechnology Unit, Aligarh Muslim University, Aligarh, India
| | - Rananjay Singh
- Department of Biochemistry, National JALMA Institute for Leprosy & Other Mycobacterial Diseases (ICMR), Agra, India
| | - Vivek Kumar Gupta
- Department of Biochemistry, National JALMA Institute for Leprosy & Other Mycobacterial Diseases (ICMR), Agra, India
| |
Collapse
|
20
|
Luo J, Zhang M, Yan B, Li F, Guan S, Chang K, Jiang W, Xu H, Yuan T, Chen M, Deng S. Diagnostic performance of plasma cytokine biosignature combination and MCP-1 as individual biomarkers for differentiating stages Mycobacterium tuberculosis infection. J Infect 2019; 78:281-291. [DOI: 10.1016/j.jinf.2018.10.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 10/27/2018] [Accepted: 10/29/2018] [Indexed: 12/20/2022]
|
21
|
Villar-Hernández R, Latorre I, De Souza-Galvão ML, Jiménez MA, Ruiz-Manzano J, Pilarte J, García-García E, Muriel-Moreno B, Cantos A, Altet N, Millet JP, González-Díaz Y, Molina-Pinargote I, Prat C, Ruhwald M, Domínguez J. Use of IP-10 detection in dried plasma spots for latent tuberculosis infection diagnosis in contacts via mail. Sci Rep 2019; 9:3943. [PMID: 30850687 PMCID: PMC6408503 DOI: 10.1038/s41598-019-40778-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 02/22/2019] [Indexed: 02/07/2023] Open
Abstract
The aim of this study was to test the use of IP-10 detection in dried plasma from contact studies individuals (contacts of smear positive patients), by comparing it with IP-10 and IFN-γ detection in direct plasma, to establish IP-10 detection in DPS as a useful assay for LTBI diagnosis. Whole blood samples were collected from 80 subjects: 12 with active tuberculosis (TB), and 68 from contact studies. The amount of IFN-γ produced by sensitized T cells was determined in direct plasma by QuantiFERON Gold In-Tube test. IP-10 levels were determined in direct and dried plasma by an in-house ELISA. For dried plasma IP-10 determination, two 25 µl plasma drops were dried in Whatman903 filter paper and sent by mail to the laboratory. Regarding TB patients, 100.0%, 91.7% and 75.0% were positive for IFN-γ detection and IP-10 detection in direct and dried plasma, respectively. In contacts, 69.1%, 60.3% and 48.5% had positive results after IFN-γ and IP-10 in direct and dried plasma, respectively. The agreement among in vitro tests was substantial and IP-10 levels in direct and dried plasma were strongly correlated (r = 0.897). In conclusion, IP-10 detection in dried plasma is a simple and safe method that would help improve LTBI management.
Collapse
Affiliation(s)
- R Villar-Hernández
- Servei de Microbiología, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol, Carretera del Canyet, 08916 Badalona, Barcelona, Spain.,CIBER Enfermedades Respiratorias, CIBERES, Instituto de Salud Carlos III, Carretera del Canyet, 08916 Badalona, Barcelona, Spain.,Universitat Autònoma de Barcelona, Carretera del Canyet, 08916 Badalona, Barcelona, Spain
| | - I Latorre
- Servei de Microbiología, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol, Carretera del Canyet, 08916 Badalona, Barcelona, Spain.,CIBER Enfermedades Respiratorias, CIBERES, Instituto de Salud Carlos III, Carretera del Canyet, 08916 Badalona, Barcelona, Spain.,Universitat Autònoma de Barcelona, Carretera del Canyet, 08916 Badalona, Barcelona, Spain
| | - M L De Souza-Galvão
- Unitat de Tuberculosi de Drassanes, Hospital Universitari Vall d'Hebron. Av. de les Drassanes, 17, 08001 Barcelona, Barcelona, Spain
| | - M A Jiménez
- Unitat de Tuberculosi de Drassanes, Hospital Universitari Vall d'Hebron. Av. de les Drassanes, 17, 08001 Barcelona, Barcelona, Spain
| | - J Ruiz-Manzano
- CIBER Enfermedades Respiratorias, CIBERES, Instituto de Salud Carlos III, Carretera del Canyet, 08916 Badalona, Barcelona, Spain.,Universitat Autònoma de Barcelona, Carretera del Canyet, 08916 Badalona, Barcelona, Spain.,Servei de Pneumologia, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet, 08916 Badalona, Barcelona, Spain
| | - J Pilarte
- Unitat de Tuberculosi de Drassanes, Hospital Universitari Vall d'Hebron. Av. de les Drassanes, 17, 08001 Barcelona, Barcelona, Spain
| | - E García-García
- Servei de Microbiología, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol, Carretera del Canyet, 08916 Badalona, Barcelona, Spain.,CIBER Enfermedades Respiratorias, CIBERES, Instituto de Salud Carlos III, Carretera del Canyet, 08916 Badalona, Barcelona, Spain.,Universitat Autònoma de Barcelona, Carretera del Canyet, 08916 Badalona, Barcelona, Spain
| | - B Muriel-Moreno
- Servei de Microbiología, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol, Carretera del Canyet, 08916 Badalona, Barcelona, Spain.,CIBER Enfermedades Respiratorias, CIBERES, Instituto de Salud Carlos III, Carretera del Canyet, 08916 Badalona, Barcelona, Spain.,Universitat Autònoma de Barcelona, Carretera del Canyet, 08916 Badalona, Barcelona, Spain
| | - A Cantos
- Unitat de Tuberculosi de Drassanes, Hospital Universitari Vall d'Hebron. Av. de les Drassanes, 17, 08001 Barcelona, Barcelona, Spain
| | - N Altet
- Unitat de Tuberculosi de Drassanes, Hospital Universitari Vall d'Hebron. Av. de les Drassanes, 17, 08001 Barcelona, Barcelona, Spain.,Unidad Clínica de Tratamiento Directamente Observado "Serveis Clinics", Carrer de García Mariño, 4, 08022, Barcelona, Spain.,CIBER de Epidemiología y Salud Pública, CIBEREESP, Instituto de Salud Carlos III, Carretera del Canyet, 08916 Badalona, Barcelona, Spain
| | - J P Millet
- Unidad Clínica de Tratamiento Directamente Observado "Serveis Clinics", Carrer de García Mariño, 4, 08022, Barcelona, Spain.,CIBER de Epidemiología y Salud Pública, CIBEREESP, Instituto de Salud Carlos III, Carretera del Canyet, 08916 Badalona, Barcelona, Spain
| | - Y González-Díaz
- Unidad Clínica de Tratamiento Directamente Observado "Serveis Clinics", Carrer de García Mariño, 4, 08022, Barcelona, Spain
| | - I Molina-Pinargote
- Unidad Clínica de Tratamiento Directamente Observado "Serveis Clinics", Carrer de García Mariño, 4, 08022, Barcelona, Spain
| | - C Prat
- Servei de Microbiología, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol, Carretera del Canyet, 08916 Badalona, Barcelona, Spain.,CIBER Enfermedades Respiratorias, CIBERES, Instituto de Salud Carlos III, Carretera del Canyet, 08916 Badalona, Barcelona, Spain.,Universitat Autònoma de Barcelona, Carretera del Canyet, 08916 Badalona, Barcelona, Spain
| | - M Ruhwald
- Department of Infectious Disease Immunology Statens Serum Institut, Copenhagen, Denmark - Artillerivej 5, 2300, Copenhagen, Denmark
| | - J Domínguez
- Servei de Microbiología, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol, Carretera del Canyet, 08916 Badalona, Barcelona, Spain. .,CIBER Enfermedades Respiratorias, CIBERES, Instituto de Salud Carlos III, Carretera del Canyet, 08916 Badalona, Barcelona, Spain. .,Universitat Autònoma de Barcelona, Carretera del Canyet, 08916 Badalona, Barcelona, Spain.
| |
Collapse
|
22
|
Qiu X, Tang Y, Yue Y, Zeng Y, Li W, Qu Y, Mu D. Accuracy of interferon-γ-induced protein 10 for diagnosing latent tuberculosis infection: a systematic review and meta-analysis. Clin Microbiol Infect 2018; 25:667-672. [PMID: 30553864 DOI: 10.1016/j.cmi.2018.12.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 12/02/2018] [Accepted: 12/05/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Effective diagnostic methods for detecting latent tuberculosis infection (LTBI) are important for its eradication. A number of studies have evaluated the use of interferon-γ-induced protein 10 (IP-10), which is elevated after tuberculosis infection, as a biomarker for LTBI, but conclusive results regarding its effectiveness have not been reported. OBJECTIVES Our objective was to assess the diagnostic value of IP-10 for LTBI. DATA SOURCES We searched the PubMed, Embase, the Cochrane Library and Web of Science databases to find eligible studies. STUDY ELIGIBILITY CRITERIA We included cohort, case-control and cross-sectional studies that evaluated IP-10 in LTBI participants in comparison with tuberculin skin tests (TST) and interferon-γ release assays (IGRA). PARTICIPANTS Individuals with LTBI and uninfected participants. INTERVENTIONS IP-10 (index test) compared with TST and IGRA (reference standard) for diagnosing LTBI. METHODS PubMed, Embase, the Cochrane Library, and Web of Science databases were searched up to June 2018. A hierarchical summary receiver operating characteristic (HSROC) model was used to evaluate the pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and HSROC curve for the diagnostic efficiency of IP-10. RESULTS Twelve studies including 1023 participants and 1122 samples were included. The overall pooled sensitivity was 0.85 (95% CI 0.80-0.88), specificity was 0.89 (95% CI 0.84-0.92), PLR was 7.55 (95% CI 5.20-10.97), NLR was 0.17 (95% CI 0.13-0.22) and DOR was 44.23 (95% CI 28.86-67.79), indicating a high accuracy for diagnosing LTBI. Based on a meta-regression analysis, high-burden countries, study design, IP-10 method, reference standard and the IP-10 cut-off could not explain the heterogeneity (p >0.05). CONCLUSIONS Our results suggested that IP-10 is a promising biomarker for the diagnosis of LTBI.
Collapse
Affiliation(s)
- X Qiu
- Department of Paediatrics, West China Second University Hospital, Sichuan University, Chengdu, China; Key Laboratory of Obstetric & Gynaecological and Paediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, China
| | - Y Tang
- Key Laboratory of Obstetric & Gynaecological and Paediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, China; Department of Ultrasonography, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Y Yue
- Department of Paediatrics, West China Second University Hospital, Sichuan University, Chengdu, China; Key Laboratory of Obstetric & Gynaecological and Paediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, China
| | - Y Zeng
- Department of Paediatrics, West China Second University Hospital, Sichuan University, Chengdu, China; Key Laboratory of Obstetric & Gynaecological and Paediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, China
| | - W Li
- Department of Paediatrics, West China Second University Hospital, Sichuan University, Chengdu, China; Key Laboratory of Obstetric & Gynaecological and Paediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, China
| | - Y Qu
- Department of Paediatrics, West China Second University Hospital, Sichuan University, Chengdu, China; Key Laboratory of Obstetric & Gynaecological and Paediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, China
| | - D Mu
- Department of Paediatrics, West China Second University Hospital, Sichuan University, Chengdu, China; Key Laboratory of Obstetric & Gynaecological and Paediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, China.
| |
Collapse
|
23
|
Farr K, Ravindran R, Strnad L, Chang E, Chaisson LH, Yoon C, Worodria W, Andama A, Ayakaka I, Bbosa Nalwanga P, Byanyima P, Kalema N, Kaswabuli S, Katagira W, Aman KD, Musisi E, Tumwine NW, Sanyu I, Ssebunya R, Davis JL, Huang L, Khan IH, Cattamanchi A. Diagnostic performance of blood inflammatory markers for tuberculosis screening in people living with HIV. PLoS One 2018; 13:e0206119. [PMID: 30352099 PMCID: PMC6198956 DOI: 10.1371/journal.pone.0206119] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 10/08/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Approaches to screening for active tuberculosis (TB) among people living with HIV are inadequate, leading to missed diagnoses and poor implementation of preventive therapy. METHODS Consecutive HIV-infected adults hospitalized at Mulago Hospital (Kampala, Uganda) between June 2011 and July 2013 with a cough ≥ 2 weeks were enrolled. Patients underwent extensive evaluation for pulmonary TB. Concentrations of 43 cytokines/chemokines were measured at the same time point as C-reactive protein (CRP) in banked plasma samples using commercially-available multiplex kits. Advanced classification algorithms were used to rank cytokines/chemokines for their ability to identify TB, and to model the specificity of the top-ranked cytokines/chemokines individually and in combination with sensitivity constrained to ≥ 90% as recommended for TB screening. RESULTS The median plasma level of 5 biomarkers (IL-6, INF-γ, MIG, CRP, IL-18) was significantly different between patients with and without TB. With sensitivity constrained to 90%, all had low specificity with IL-6 showing the highest specificity (44%; 95% CI 37.4-49.5). Biomarker panels were found to be more valuable than any biomarker alone. A panel combining IFN-γ and IL-6 had the highest specificity (50%; 95% CI 46.7-53.3). Sensitivity remained high (>85%) for all panels among sputum smear-negative TB patients. CONCLUSIONS Direct measurement of unstimulated plasma cytokines/chemokines in peripheral blood is a promising approach to TB screening. Cytokine/chemokine panels retained high sensitivity for smear-negative TB and achieved improved specificity compared to individual cytokines/chemokines. These markers should be further evaluated in outpatient settings where most TB screening occurs and where other illnesses associated with systematic inflammation are less common.
Collapse
Affiliation(s)
- Katherine Farr
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco and Zuckerberg San Francisco General Hospital, San Francisco, California, United States of America
- Curry International Tuberculosis Center, University of California San Francisco, San Francisco, California, United States of America
| | - Resmi Ravindran
- Department of Pathology and Laboratory Medicine, University of California at Davis, Sacramento, California, United States of America
| | - Luke Strnad
- Division of Infectious Diseases, Oregon Health & Science University, Portland, Oregon, United States of America
- Epidemiology Programs, Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon, United States of America
| | - Emily Chang
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco and Zuckerberg San Francisco General Hospital, San Francisco, California, United States of America
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco and Zuckerberg San Francisco General Hospital, San Francisco, California, United States of America
| | - Lelia H. Chaisson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Christina Yoon
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco and Zuckerberg San Francisco General Hospital, San Francisco, California, United States of America
| | - William Worodria
- Department of Medicine, School of Medicine, Makerere University, Kampala, Uganda
- Division of Respiratory Medicine, Department of Medicine, Mulago Hospital, Kampala, Uganda
| | - Alfred Andama
- Department of Medicine, Mulago Hospital, Makerere University, Kampala, Uganda
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Irene Ayakaka
- Infectious Diseases Research Collaboration, Kampala, Uganda
- International Multidisciplinary Programme to Address Lung Health and TB in Africa, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | | | - Nelson Kalema
- Infectious Diseases Institute, Department of Research, Makerere College Health Sciences, Makerere University, Kampala, Uganda
| | | | | | | | - Emmanuel Musisi
- Infectious Diseases Research Collaboration, Kampala, Uganda
- Department of Biochemistry, College of Natural Sciences, Makerere University, Kampala, Uganda
| | | | - Ingvar Sanyu
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | - J. Lucian Davis
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Laurence Huang
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco and Zuckerberg San Francisco General Hospital, San Francisco, California, United States of America
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco and Zuckerberg San Francisco General Hospital, San Francisco, California, United States of America
| | - Imran H. Khan
- Department of Pathology and Laboratory Medicine, University of California at Davis, Sacramento, California, United States of America
| | - Adithya Cattamanchi
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco and Zuckerberg San Francisco General Hospital, San Francisco, California, United States of America
- Curry International Tuberculosis Center, University of California San Francisco, San Francisco, California, United States of America
| |
Collapse
|
24
|
Doan TN, Eisen DP, Rose MT, Slack A, Stearnes G, McBryde ES. Interferon-gamma release assay for the diagnosis of latent tuberculosis infection: A latent-class analysis. PLoS One 2017; 12:e0188631. [PMID: 29182688 PMCID: PMC5705142 DOI: 10.1371/journal.pone.0188631] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 11/11/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Accurate diagnosis and subsequent treatment of latent tuberculosis infection (LTBI) is essential for TB elimination. However, the absence of a gold standard test for diagnosing LTBI makes assessment of the true prevalence of LTBI and the accuracy of diagnostic tests challenging. Bayesian latent class models can be used to make inferences about disease prevalence and the sensitivity and specificity of diagnostic tests using data on the concordance between tests. We performed the largest meta-analysis to date aiming to evaluate the performance of tuberculin skin test (TST) and interferon-gamma release assays (IGRAs) for LTBI diagnosis in various patient populations using Bayesian latent class modelling. METHODS Systematic search of PubMeb, Embase and African Index Medicus was conducted without date and language restrictions on September 11, 2017 to identify studies that compared the performance of TST and IGRAs for LTBI diagnosis. Two IGRA methods were considered: QuantiFERON-TB Gold In Tube (QFT-GIT) and T-SPOT.TB. Studies were included if they reported 2x2 agreement data between TST and QFT-GIT or T-SPOT.TB. A Bayesian latent class model was developed to estimate the sensitivity and specificity of TST and IGRAs in various populations, including immune-competent adults, immune-compromised adults and children. A TST cut-off value of 10 mm was used for immune-competent subjects and 5 mm for immune-compromised individuals. FINDINGS A total of 157 studies were included in the analysis. In immune-competent adults, the sensitivity of TST and QFT-GIT were estimated to be 84% (95% credible interval [CrI] 82-85%) and 52% (50-53%), respectively. The specificity of QFT-GIT was 97% (96-97%) in non-BCG-vaccinated and 93% (92-94%) in BCG-vaccinated immune-competent adults. The estimated figures for TST were 100% (99-100%) and 79% (76-82%), respectively. T-SPOT.TB has comparable specificity (97% for both tests) and better sensitivity (68% versus 52%) than QFT-GIT in immune-competent adults. In immune-compromised adults, both TST and QFT-GIT display low sensitivity but high specificity. QFT-GIT and TST are equally specific (98% for both tests) in non-BCG-vaccinated children; however, QFT-GIT is more specific than TST (98% versus 82%) in BCG-vaccinated group. TST is more sensitive than QFT-GIT (82% versus 73%) in children. CONCLUSIONS This study is the first to assess the utility of TST and IGRAs for LTBI diagnosis in different population groups using all available data with Bayesian latent class modelling. Our results challenge the current beliefs about the performance of LTBI screening tests, and have important implications for LTBI screening policy and practice. We estimated that the performance of IGRAs is not as reliable as previously measured in the general population. However, IGRAs are not or minimally affected by BCG and should be the preferred tests in this setting. Adoption of IGRAs in settings where BCG is widely administered will allow for a more accurate identification and treatment of LTBI.
Collapse
Affiliation(s)
- Tan N. Doan
- Department of Medicine at The Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- * E-mail:
| | - Damon P. Eisen
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Morgan T. Rose
- Department of Infectious Diseases, Alfred Health, Melbourne, Victoria, Australia
| | - Andrew Slack
- Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Grace Stearnes
- Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Emma S. McBryde
- Department of Medicine at The Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
| |
Collapse
|
25
|
Nonghanphithak D, Reechaipichitkul W, Namwat W, Naranbhai V, Faksri K. Chemokines additional to IFN-γ can be used to differentiate among Mycobacterium tuberculosis infection possibilities and provide evidence of an early clearance phenotype. Tuberculosis (Edinb) 2017; 105:28-34. [PMID: 28610785 DOI: 10.1016/j.tube.2017.04.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 04/11/2017] [Accepted: 04/17/2017] [Indexed: 02/07/2023]
Abstract
Current diagnostic tests for tuberculosis (TB) remain limited in their ability to discriminate between active TB (ATB) and latent TB infection (LTBI). Early clearance (EC) of TB by individuals exposed to Mycobacterium tuberculosis is a debated phenomenon for which evidence is lacking. We measured and compared secreted chemokines in the plasma fraction from 48 ATB, 38 LTBI, 162 presumed EC and 39 healthy controls (HC) using the QuantiFERON®-TB Gold In-Tube assay. Single chemokine markers were limited in their ability to discriminate between ATB and LTBI: IFN-γ showed 16.7% sensitivity; CCL2 showed moderate sensitivity (70.8%) and specificity (74.4%); CXCL10 showed high sensitivity (87.5%) and specificity (78.9%). Compared to IFN-γ alone, IFN-γ combined with CXCL10 significantly improved (p < 0.001) the sensitivity and specificity to discriminate between ATB and HC (97.9% sensitivity and 94.9% specificity) and between ATB and LTBI (89.6% sensitivity and 71.1% specificity). Levels of CCL2 were very significantly lower (p < 0.0001) in EC compared to HC groups and hence CCL2 is a useful marker for EC. This study demonstrated the potential application of profiling using multiple chemokines for differentiating among the various M. tuberculosis infection possibilities. We also present evidence to support the EC phenomenon based on the decrease of CCL2 levels.
Collapse
Affiliation(s)
| | - Wipa Reechaipichitkul
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; Research and Diagnostic Center for Emerging Infectious Diseases (RCEID), Khon Kaen University, Khon Kaen, Thailand
| | - Wises Namwat
- Department of Microbiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; Research and Diagnostic Center for Emerging Infectious Diseases (RCEID), Khon Kaen University, Khon Kaen, Thailand
| | - Vivek Naranbhai
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom; Centre for the AIDS Program of Research in South Africa, Nelson R Mandela School of Medicine, University of KwaZulu Natal, South Africa
| | - Kiatichai Faksri
- Department of Microbiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; Research and Diagnostic Center for Emerging Infectious Diseases (RCEID), Khon Kaen University, Khon Kaen, Thailand.
| |
Collapse
|
26
|
Antigen-specific secretion of IFNγ and CXCL10 in whole blood assay detects Mycobacterium leprae infection but does not discriminate asymptomatic infection from symptomatic leprosy. Diagn Microbiol Infect Dis 2017; 87:328-334. [DOI: 10.1016/j.diagmicrobio.2017.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 12/20/2016] [Accepted: 01/03/2017] [Indexed: 11/24/2022]
|
27
|
Abstract
Robert Heinrich Herman Koch, a German physician and microbiologist, received Nobel Prize in 1905 for identifying the specific causative agent of tuberculosis (TB). During his time it was believed that TB was an inherited disease. However he was convinced that the disease was caused by a bacterium and was infectious, tested his postulates using guinea pigs, and found the causative agent to be slow growing mycobacterium tuberculosis. TB is the second most common cause of death from infectious diseases after HIV/AIDS. Drug-resistant TB poses serious challenge to effective management of TB worldwide. Multidrug-resistant TB accounted for about half a million new cases and over 200,000 deaths in 2013. Whole-genome sequencing (first done in 1998) technologies have provided new insight into the mechanism of drug resistance. For the first time in 50 y, new anti TB drugs have been developed. The World Health Organization (WHO) has recently revised their treatment guidelines based on 32 studies. In United States, latent TB affects between 10 and 15 million people, 10% of whom may develop active TB disease. QuantiFERON TB Gold and T-SPOT.TB test are used for diagnosis. Further research will look into the importance of newly discovered gene mutations in causing drug resistance.
Collapse
|
28
|
Carrère-Kremer S, Rubbo PA, Pisoni A, Bendriss S, Marin G, Peries M, Bolloré K, Terru D, Godreuil S, Bourdin A, Van de Perre P, Tuaillon E. High IFN-γ Release and Impaired Capacity of Multi-Cytokine Secretion in IGRA Supernatants Are Associated with Active Tuberculosis. PLoS One 2016; 11:e0162137. [PMID: 27603919 PMCID: PMC5014470 DOI: 10.1371/journal.pone.0162137] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 08/17/2016] [Indexed: 12/12/2022] Open
Abstract
Interferon gamma (IFN-γ) release assays (IGRAs) detect Mycobacterium tuberculosis (Mtb) infection regardless of the active (ATB) or latent (LTBI) forms of tuberculosis (TB). In this study, Mtb-specific T cell response against region of deletion 1 (RD1) antigens were explored by a microbead multiplex assay performed in T-SPOT TB assay (T-SPOT) supernatants from 35 patients with ATB and 115 patients with LTBI. T-SPOT is positive when over 7 IFN-γ secreting cells (SC)/250 000 peripheral blood mononuclear cells (PBMC) are enumerated. However, over 100 IFN-γ SC /250 000 PBMC were more frequently observed in the ATB group compared to the LTBI group. By contrast, lower cytokine concentrations and lower cytokine productions relative to IFN-γ secretion were observed for IL 4, IL-12, TNF-α, GM-CSF, Eotaxin and IFN-α when compared to LTBI. Thus, high IFN-γ release and low cytokine secretions in relation with IFN-γ production appeared as signatures of ATB, corroborating that multicytokine Mtb-specific response against RD1 antigens reflects host capacity to contain TB reactivation. In this way, testing cytokine profile in IGRA supernatants would be helpful to improve ATB screening strategy including immunologic tests.
Collapse
Affiliation(s)
- Séverine Carrère-Kremer
- UMR1058 INSERM/University Montpellier/EFS, Montpellier, France.,University Montpellier, Montpellier, France
| | - Pierre-Alain Rubbo
- UMR1058 INSERM/University Montpellier/EFS, Montpellier, France.,University Montpellier, Montpellier, France
| | - Amandine Pisoni
- UMR1058 INSERM/University Montpellier/EFS, Montpellier, France.,CHRU Montpellier, Departments of Bacteriology-Virology, Montpellier, France
| | - Sophie Bendriss
- CHRU Montpellier, Departments of Bacteriology-Virology, Montpellier, France
| | - Grégory Marin
- CHRU Montpellier, Department of Medical Information, Montpellier, France
| | - Marianne Peries
- UMR1058 INSERM/University Montpellier/EFS, Montpellier, France
| | - Karine Bolloré
- UMR1058 INSERM/University Montpellier/EFS, Montpellier, France.,University Montpellier, Montpellier, France
| | - Dominique Terru
- CHRU Montpellier, Departments of Bacteriology-Virology, Montpellier, France
| | - Sylvain Godreuil
- CHRU Montpellier, Departments of Bacteriology-Virology, Montpellier, France
| | - Arnaud Bourdin
- CHRU Montpellier, Department of Pneumology, Montpellier, France
| | - Philippe Van de Perre
- UMR1058 INSERM/University Montpellier/EFS, Montpellier, France.,University Montpellier, Montpellier, France.,CHRU Montpellier, Departments of Bacteriology-Virology, Montpellier, France
| | - Edouard Tuaillon
- UMR1058 INSERM/University Montpellier/EFS, Montpellier, France.,University Montpellier, Montpellier, France.,CHRU Montpellier, Departments of Bacteriology-Virology, Montpellier, France
| |
Collapse
|