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Rosero C, Baldeón L, Alulema V, Rueda A, Vaca L, Galarza D, Prócel C. Cutaneous tuberculosis, different clinical spectrum of the same disease: the importance of pre-test probability. Dermatol Reports 2024; 16:9770. [PMID: 38957638 PMCID: PMC11216143 DOI: 10.4081/dr.2024.9770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 07/16/2023] [Indexed: 07/04/2024] Open
Abstract
This report presents three cases of cutaneous tuberculosis that were identified at the Calderon Hospital in Quito, Ecuador. The first case involved a 44-year-old man who had tuberculosis verrucosa cutis, characterized by circinate erythematous areas, ulcerated nodules, and verruciform plaques extending from the right lower limb to the hip. In the second case a 50-year-old woman with a 1-year history of pruritic dermatosis in the left ciliary area was diagnosed with lupus vulgaris. In the third case, a 23-year-old man with erythematous nodules draining caseous material at the neck, thorax, and axillary region was diagnosed with scrofuloderma. It was discovered that nearly every laboratory test that was accessible had drawbacks as a diagnostic technique. Correlating clinical and epidemiological features with the pretest probability is crucial for optimizing indicators and confirming or ruling out the diagnosis in immunocompromised and high-risk individuals with atypical lesions.
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Affiliation(s)
- Carla Rosero
- Dermatology Postgraduate, Faculty of Medical Sciences, Central University of Ecuador, Quito
- Department of Dermatology, Calderón General Hospital, Quito
| | - Lucy Baldeón
- Biomedicine Research Institute, Central University of Ecuador, Quito
- Faculty of Medical Sciences, Central University of Ecuador, Quito
| | - Valeria Alulema
- Biomedicine Research Institute, Central University of Ecuador, Quito
| | - Adriana Rueda
- Biomedicine Research Institute, Central University of Ecuador, Quito
| | - Lorena Vaca
- Department of Dermatology, Calderón General Hospital, Quito
| | | | - Cesar Prócel
- Internal Medicine Department, Metropolitan Hospital, Quito, Ecuador
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Sierra CJ, Downs CA. Screening and testing for latent tuberculosis infection among patients who are immunocompromised. Nurse Pract 2022; 47:32-39. [PMID: 36287735 DOI: 10.1097/01.npr.0000884860.99026.ee] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
ABSTRACT It is critical to detect latent tuberculosis infection through screening and testing individuals at high risk of progression to active tuberculosis, including patients who are immunocompromised. NPs should be familiar with available testing for accurate diagnosis in order to expedite treatment.
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MARTINI M, BESOZZI G, BARBERIS I. The never-ending story of the fight against tuberculosis: from Koch's bacillus to global control programs. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2018; 59:E241-E247. [PMID: 30397682 PMCID: PMC6196368 DOI: 10.15167/2421-4248/jpmh2018.59.3.1051] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 08/29/2018] [Indexed: 11/24/2022]
Abstract
Tuberculosis (TB) is one of the oldest diseases known to affect humanity, and is still a major public health problem. It is caused by the bacillus Mycobacterium tuberculosis (MT), isolated in 1882 by Robert Koch. Until the 1950s, X rays were used as a cheap method of diagnostic screening together with the tuberculin skin sensitivity test. In the diagnosis and treatment of TB, an important role was also played by surgery. The late Nineteenth century saw the introduction of the tuberculosis sanatorium, which proved to be one of the first useful measures against TB. Subsequently, Albert Calmette and Camille Guérin used a non-virulent MT strain to produce a live attenuated vaccine. In the 1980s and 1990s, the incidence of tuberculosis surged as a major opportunistic infection in people with HIV infection and AIDS; for this reason, a combined strategy based on improving drug treatment, diagnostic instruments and prevention was needed.
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Affiliation(s)
- M. MARTINI
- University of Genoa, Department of Health Sciences, Section of Medical History and Ethics, Genoa, Italy
- UNESCO CHAIR Anthropology of Health - Biosphere and Healing System, University of Genoa, Italy
| | - G. BESOZZI
- Centro di Formazione TB Italia Onlus
- Istituto Villa Marelli, Milano
| | - I. BARBERIS
- University of Genoa, Department of Health Sciences, Section of Medical History and Ethics, Genoa, Italy
- * Correspondence: Ilaria Barberis, University of Genoa, Department of Health Sciences, Section of Medical History and Ethics, largo R. Benzi 10 Pad 3, 16132 Genoa, Italy - Tel./Fax +39 010 353 85 02 - E-mail:
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Brown J, Kumar K, Reading J, Harvey J, Murthy S, Capocci S, Hopkins S, Seneviratne S, Cropley I, Lipman M. Frequency and significance of indeterminate and borderline Quantiferon Gold TB IGRA results. Eur Respir J 2017; 50:50/4/1701267. [DOI: 10.1183/13993003.01267-2017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 08/07/2017] [Indexed: 12/31/2022]
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Han SH. Immunological Prediction of Cytomegalovirus (CMV) Replication Risk in Solid Organ Transplantation Recipients: Approaches for Regulating the Targeted Anti-CMV Prevention Strategies. Infect Chemother 2017; 49:161-175. [PMID: 29027383 PMCID: PMC5620383 DOI: 10.3947/ic.2017.49.3.161] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The current cytomegalovirus (CMV) prevention strategies in solid organ transplantation (SOT) recipients have contributed towards overcoming the detrimental effects caused by CMV lytic infection, and improving the long-term success rate of graft survival. Although the quantification of CMV in peripheral blood is the standard method, and an excellent end-point for diagnosing CMV replication and modulating the anti-CMV prevention strategies in SOT recipients, a novel biomarker mimicking the CMV control mechanism is required. CMV-specific immune monitoring can be employed as a basic tool predicting CMV infection or disease after SOT, since uncontrolled CMV replication mostly originates from the impairment of immune responses against CMV under immunosuppressive conditions in SOT recipients. Several studies conducted during the past few decades have indicated the possibility of measuring the CMV-specific cell-mediated immune response in clinical situations. Among several analytical assays, the most advancing standardized tool is the QuantiFERON®-CMV assay. The T-Track® CMV kit that uses the standardized enzyme-linked immunospot assay is also widely employed. In addition to these assays, immunophenotyping and intracellular cytokine analysis using flow cytometry (with fluorescence-labeled monoclonal antibodies or peptide-major histocompatibility complex multimers) needs to be adequately standardized and validated for potential clinical applications.
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Affiliation(s)
- Sang Hoon Han
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
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6
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Liang Y, Wang Y, Li H, Yang Y, Liu J, Yu T, Wu X. Evaluation of a whole-blood chemiluminescent immunoassay of IFN-γ, IP-10, and MCP-1 for diagnosis of active pulmonary tuberculosis and tuberculous pleurisy patients. APMIS 2016; 124:856-64. [PMID: 27523388 DOI: 10.1111/apm.12583] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 06/19/2016] [Indexed: 02/02/2023]
Affiliation(s)
- Yan Liang
- Army Tuberculosis Prevention and Control Key Laboratory; Beijing Key Laboratory of New Techniques of Tuberculosis Diagnosis and Treatment; Institute of Tuberculosis Research; the 309th Hospital of PLA; Beijing China
| | - Ying Wang
- Army Tuberculosis Prevention and Control Key Laboratory; Beijing Key Laboratory of New Techniques of Tuberculosis Diagnosis and Treatment; Institute of Tuberculosis Research; the 309th Hospital of PLA; Beijing China
- The Second Hospital of Jilin University; Changchun China
| | - Hang Li
- The Tumor Hospital of Jilin Province; Changchun China
| | - Yourong Yang
- Army Tuberculosis Prevention and Control Key Laboratory; Beijing Key Laboratory of New Techniques of Tuberculosis Diagnosis and Treatment; Institute of Tuberculosis Research; the 309th Hospital of PLA; Beijing China
| | - Jianyang Liu
- The Tumor Hospital of Jilin Province; Changchun China
| | - Ting Yu
- The Second Hospital of Jilin University; Changchun China
| | - Xueqiong Wu
- Army Tuberculosis Prevention and Control Key Laboratory; Beijing Key Laboratory of New Techniques of Tuberculosis Diagnosis and Treatment; Institute of Tuberculosis Research; the 309th Hospital of PLA; Beijing China
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7
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Fry DE. Extra-Pulmonary Tuberculosis and Its Surgical Treatment. Surg Infect (Larchmt) 2016; 17:394-401. [DOI: 10.1089/sur.2016.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Donald E. Fry
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, and the Department of Surgery, University of New Mexico School of Medicine, Albuquerque, New Mexico
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Dizdar S, Dzinovic A, Gojak R, Bakalovic G, Selimovic A. Descriptive review of the patients suffering from tuberculosis in the past 10 years treated at pediatric clinic of clinical center of sarajevo university. Med Arch 2014; 68:317-8. [PMID: 25568562 PMCID: PMC4269533 DOI: 10.5455/medarh.2014.68.317-318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 09/15/2014] [Indexed: 12/02/2022] Open
Abstract
Introduction: Due to the geographical position of Bosnia and Herzegovina and its socio economic momentum even though the standard vaccination program is carried out, the child population continues to suffer from pulmonary tuberculosis in significant percentage. Material and methods: The study was retrospective and included patients who were in the period from January 1, 2004 to December 31, 2013 (or the 10 years period) hospitalized at the Department of Pulmonology Pediatric Clinic dually diagnosed with lung TB and start treatment. Data were adopted from available medical records (history of disease). Goal: The aim of the study was to determine the epidemiological and clinical characteristics of tuberculosis of the lungs in children who were hospitalized at the Pediatric Clinic. Results: In the period from January 1, 2004 to December 31, 2013 there were hospitalized a total of 50 children with a proven active infection with MBT, where it was initiated treatment with a specific therapy. From this number 44% of patients were aged from 5 to 10 years, 22% of patients were aged younger than 5 years. Peak incidence was in 2009. About 66% of patients had a positive history of sick close relative, while 10% of them had a history of contact with other sick person. From baseline 28% of patients were referred to the Department with suspicion of a specific process. From the total 70% of respondents were regularly vaccinated, and 29% of them had a visible BCG scar. In 55% of cases there was anamnestic information - decresed body weight, in 82% of cases the presence of cough, of which 52% of the occurrence of expectoration. In 78% of cases we had positive auscultatory findings of the lungs. In 14% of cases on X-ray of the lungs was noticed changes in terms of the primary complex positive. In this material we had one cavernous and one miliary TB of the lungs. Sputum or gastric lavage was positive in 62% of cases, and Quantiferon because of the lack of the same (in the past) was positive in 34% of cases. All subjects at the time of discharge were classified as recovered. In that period we had proven resistant TB. Conclusion: Bosnia and Herzegovina belongs to the group of countries with still present and evident TB. In the investigated period of ten years from the pediatric pulmonary TB, usually have suffered small children and adolescents. At moment of discharge, all patients were classified as recovered. In the teste material we did not have proven resistant TB.
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Affiliation(s)
- Selma Dizdar
- Pediatric clinic, Clinical center of University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Amra Dzinovic
- Pediatric clinic, Clinical center of University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Refet Gojak
- Clinic for Infectious Diseases, Clinical center of University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Ganimeta Bakalovic
- Pediatric clinic, Clinical center of University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Amina Selimovic
- Pediatric clinic, Clinical center of University of Sarajevo, Sarajevo, Bosnia and Herzegovina
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Duthie MS, Saunderson P, Reed SG. The potential for vaccination in leprosy elimination: new tools for targeted interventions. Mem Inst Oswaldo Cruz 2013; 107 Suppl 1:190-6. [PMID: 23283471 DOI: 10.1590/s0074-02762012000900027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 07/17/2012] [Indexed: 05/27/2023] Open
Abstract
Despite the huge effort and massive advances toward the elimination of leprosy over the last two decades, the disease has proven stubborn; new case detection rates have stabilised over the last few years and leprosy remains endemic in a number of localised regions. The American Leprosy Missions and Infectious Disease Research Institute have undertaken a large research effort aimed at developing new tools and a vaccine to continue the push for leprosy elimination. In this paper, we outline our strategy for the integration of rapid diagnostic tests and lab-based assays to facilitate the detection of early or asymptomatic leprosy cases, as well as the efficient and focused implementation of chemoprophylaxis and immunisation to intervene in leprosy development and transmission.
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von Baehr V, Doebis C, Volk HD, von Baehr R. The lymphocyte transformation test for borrelia detects active lyme borreliosis and verifies effective antibiotic treatment. Open Neurol J 2012; 6:104-12. [PMID: 23091571 PMCID: PMC3474945 DOI: 10.2174/1874205x01206010104] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Revised: 06/22/2012] [Accepted: 07/02/2012] [Indexed: 11/24/2022] Open
Abstract
Borrelia-specific antibodies are not detectable until several weeks after infection and even if they are present, they are no proof of an active infection. Since the sensitivity of culture and PCR for the diagnosis or exclusion of borreliosis is too low, a method is required that detects an active Borrelia infection as early as possible. For this purpose, a lymphocyte transformation test (LTT) using lysate antigens of Borrelia burgdorferi sensu stricto, Borrelia afzelii and Borrelia garinii and recombinant OspC was developed and validated through investigations of seronegative and seropositive healthy individuals as well as of seropositive patients with clinically manifested borreliosis. The sensitivity of the LTT in clinical borreliosis before antibiotic treatment was determined as 89,4% while the specificity was 98,7%. In 1480 patients with clinically suspected borreliosis, results from serology and LTT were comparable in 79.8% of cases. 18% were serologically positive and LTT-negative. These were mainly patients with borreliosis after antibiotic therapy. 2.2% showed a negative serology and a positive LTT result. Half of them had an early erythema migrans. Following antibiotic treatment, the LTT became negative or borderline in patients with early manifestations of borreliosis, whereas in patients with late symptoms, it showed a regression while still remaining positive. Therefore, we propose the follow-up monitoring of dis-seminated Borrelia infections as the main indication for the Borrelia-LTT.
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Affiliation(s)
- Volker von Baehr
- Institute for Medical Diagnostics, Immunology Department, Nicolaistrasse 22, 12247 Berlin
| | - Cornelia Doebis
- Institute for Medical Diagnostics, Immunology Department, Nicolaistrasse 22, 12247 Berlin
| | - Hans-Dieter Volk
- Institute for Medical Immunology, Charité University Medicine Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin
| | - Rüdiger von Baehr
- Institute for Medical Diagnostics, Immunology Department, Nicolaistrasse 22, 12247 Berlin
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11
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Ahmed RK, Rohava Z, Balaji KN, Hoffner SE, Gaines H, Magalhaes I, Zumla A, Skrahina A, Maeurer MJ. Pattern recognition and cellular immune responses to novel Mycobacterium tuberculosis-antigens in individuals from Belarus. BMC Infect Dis 2012; 12:41. [PMID: 22336002 PMCID: PMC3305616 DOI: 10.1186/1471-2334-12-41] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2011] [Accepted: 02/15/2012] [Indexed: 11/23/2022] Open
Abstract
Background Tuberculosis (TB) is an enduring health problem worldwide and the emerging threat of multidrug resistant (MDR) TB and extensively drug resistant (XDR) TB is of particular concern. A better understanding of biomarkers associated with TB will aid to guide the development of better targets for TB diagnosis and for the development of improved TB vaccines. Methods Recombinant proteins (n = 7) and peptide pools (n = 14) from M. tuberculosis (M.tb) antigens associated with M.tb pathogenicity, modification of cell lipids or cellular metabolism, were used to compare T cell immune responses defined by IFN-γ production using a whole blood assay (WBA) from i) patients with TB, ii) individuals recovered from TB and iii) individuals exposed to TB without evidence of clinical TB infection from Minsk, Belarus. Results We identified differences in M.tb target peptide recognition between the test groups, i.e. a frequent recognition of antigens associated with lipid metabolism, e.g. cyclopropane fatty acyl phospholipid synthase. The pattern of peptide recognition was broader in blood from healthy individuals and those recovered from TB as compared to individuals suffering from pulmonary TB. Detection of biologically relevant M.tb targets was confirmed by staining for intracellular cytokines (IL-2, TNF-α and IFN-γ) in T cells from non-human primates (NHPs) after BCG vaccination. Conclusions PBMCs from healthy individuals and those recovered from TB recognized a broader spectrum of M.tb antigens as compared to patients with TB. The nature of the pattern recognition of a broad panel of M.tb antigens will devise better strategies to identify improved diagnostics gauging previous exposure to M.tb; it may also guide the development of improved TB-vaccines.
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Affiliation(s)
- Raija K Ahmed
- Department of Microbiology, Tumor and Cell Biology (MTC), Karolinska Institutet, Nobelsväg 16, SE 17182 Solna, Sweden
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12
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Evaluation of various cytokines elicited during antigen-specific recall as potential risk indicators for the differential development of leprosy. Eur J Clin Microbiol Infect Dis 2011; 31:1443-51. [DOI: 10.1007/s10096-011-1462-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Accepted: 10/11/2011] [Indexed: 10/15/2022]
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13
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Evaluation of cell-mediated immune responses to two BCG vaccination regimes in young children in South Korea. Vaccine 2011; 29:6564-71. [PMID: 21763746 DOI: 10.1016/j.vaccine.2011.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Revised: 07/01/2011] [Accepted: 07/01/2011] [Indexed: 12/21/2022]
Abstract
Children in South Korea are vaccinated with either BCG Pasteur vaccine intradermally (ID), or with BCG Tokyo vaccine given by multipuncture device (MP). Data from a recent national survey indicated that in children under 6 years old, 31.1% had received the ID vaccine and 64.5% the MP vaccine. To compare the T cell responses induced by the two vaccines, children aged 3-7 were recruited and tested for tuberculin skin test reactivity and for in vitro IFN-γ responses to mycobacterial antigens. DTH responses were not significantly different in children vaccinated by either the ID or MP vaccines. PPD-induced IFN-γ was measured in supernatants of 6-day diluted whole blood cultures. IFN-γ production to PPD was not significantly different in the two vaccine groups, although there is a trend that the MP group gives a higher proportion of IFN-γ positivity than the ID group. In addition, when IFN-γ responses to the antigens ESAT-6 and CFP-10 were assessed in the 6-7 year old group, there was no significant difference between the two vaccine groups. Thus, there was no evidence that the increasing use of MP vaccination has reduced protection against M. tuberculosis in young children in South Korea, based on immunogenicity as assessed by DTH and IFN-γ responses to PPD, and also equivalent frequency of responses to ESAT-6 and CFP-10.
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Lee YJ, Lee J, Kim YY, Won DI, Cha SI, Park JY, Jung TH, Kim CH. Performance of whole-blood interferon-gamma release assay in patients admitted to the emergency department with pulmonary infiltrates. BMC Infect Dis 2011; 11:107. [PMID: 21513568 PMCID: PMC3107174 DOI: 10.1186/1471-2334-11-107] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2011] [Accepted: 04/24/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study was conducted to evaluate the performance of a whole-blood interferon-gamma release assay in inpatients who were admitted to the emergency department (ED) with pulmonary infiltrates who required a differential diagnosis with pulmonary tuberculosis (TB). METHODS The patients with pulmonary infiltrates who received a QuantiFERON (QFT) test in the ED were included as an inpatient group and were divided into TB and non-TB group based on the final diagnosis. Patients with pulmonary TB who were tested in the outpatient department served as a control group. RESULTS In total, 377 QFT tests were analyzed. Of the 284 inpatient QFT tests, 29.6% had an indeterminate result (35.2% in the 196 patients with non-TB and 17.0% in the 88 patients with TB). In contrast, only 1.1% of the 93 outpatients with TB returned an indeterminate result (p<0.001). The indeterminate QFT results in the inpatient group were independently associated with lymphocytopenia, hypoalbuminemia, and high C-reactive protein levels. Non-positive QFT results in inpatients with TB were associated with lymphocytopenia and hypoalbuminemia, while non-positive QFT results in outpatients with TB were associated with high erythrocyte sedimentation rates and radiographically more severe diseases. CONCLUSIONS QFT tests in ED-based inpatients with pulmonary infiltrate return indeterminate results relatively frequently. In addition, inpatients and outpatients with pulmonary TB may differ in terms of the risk factors on non-positive QFT results.
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Affiliation(s)
- Yoon Jee Lee
- Department of Internal Medicine, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
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Zar HJ, Connell TG, Nicol M. Diagnosis of pulmonary tuberculosis in children: new advances. Expert Rev Anti Infect Ther 2010; 8:277-88. [PMID: 20192682 DOI: 10.1586/eri.10.9] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The global burden of childhood pulmonary TB has been underappreciated, in part due to difficulties in obtaining microbiological confirmation of disease. Most HIV-uninfected children can be diagnosed using a combination of clinical and epidemiological features, tuberculin skin testing and chest radiography, as represented in different scoring systems. However, accurate microbiologic diagnosis has become increasingly important for timely use of effective treatment. Mycobacterial culture confirms the diagnosis of TB and provides drug susceptibility data but is not available in most areas with a high TB prevalence. Moreover, culture has poor sensitivity in children who usually have paucibacillary disease. The HIV epidemic has made definitive diagnosis even more challenging due to nonspecific clinical and radiological signs. In high HIV-prevalence areas, scoring systems have been especially variable, lacking sensitivity and specificity. Newer methods for diagnosis are aimed either at detecting the organism or a specific host immune response. Methods for organism detection have focused on collection of better samples, improved culture techniques, molecular methods or antigen detection. Recent advances include the use of sputum induction for obtaining a more reliable specimen, faster and more sensitive culture methods, and rapid detection of the organism and drug resistance based on nucleic acid amplification. Improved methods for detecting a specific host response have largely focused on the use of IFN-g release assays. Even with newer methods, accurately diagnosing childhood TB may be challenging. Greater efforts to obtain a microbiologic diagnosis should be made in children, even in primary care settings. Further research to develop a more accurate, cost-effective and simple diagnostic test for childhood TB is urgently needed.
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Affiliation(s)
- Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa.
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16
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del Corral H, París SC, Marín ND, Marín DM, López L, Henao HM, Martínez T, Villa L, Barrera LF, Ortiz BL, Ramírez ME, Montes CJ, Oquendo MC, Arango LM, Riaño F, Aguirre C, Bustamante A, Belisle JT, Dobos K, Mejía GI, Giraldo MR, Brennan PJ, Robledo J, Arbeláez MP, Rojas CA, García LF. IFNgamma response to Mycobacterium tuberculosis, risk of infection and disease in household contacts of tuberculosis patients in Colombia. PLoS One 2009; 4:e8257. [PMID: 20011589 PMCID: PMC2788133 DOI: 10.1371/journal.pone.0008257] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2009] [Accepted: 10/26/2009] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Household contacts (HHCs) of pulmonary tuberculosis patients are at high risk of Mycobacterium tuberculosis infection and early disease development. Identification of individuals at risk of tuberculosis disease is a desirable goal for tuberculosis control. Interferon-gamma release assays (IGRAs) using specific M. tuberculosis antigens provide an alternative to tuberculin skin testing (TST) for infection detection. Additionally, the levels of IFNgamma produced in response to these antigens may have prognostic value. We estimated the prevalence of M. tuberculosis infection by IGRA and TST in HHCs and their source population (SP), and assessed whether IFNgamma levels in HHCs correlate with tuberculosis development. METHODS A cohort of 2060 HHCs was followed for 2-3 years after exposure to a tuberculosis case. Besides TST, IFNgamma responses to mycobacterial antigens: CFP, CFP-10, HspX and Ag85A were assessed in 7-days whole blood cultures and compared to 766 individuals from the SP in Medellín, Colombia. Isoniazid prophylaxis was not offered to child contacts because Colombian tuberculosis regulations consider it only in children under 5 years, TST positive without BCG vaccination. RESULTS Using TST 65.9% of HHCs and 42.7% subjects from the SP were positive (OR 2.60, p<0.0001). IFNgamma response to CFP-10, a biomarker of M. tuberculosis infection, tested positive in 66.3% HHCs and 24.3% from the SP (OR = 6.07, p<0.0001). Tuberculosis incidence rate was 7.0/1000 person years. Children <5 years accounted for 21.6% of incident cases. No significant difference was found between positive and negative IFNgamma responders to CFP-10 (HR 1.82 95% CI 0.79-4.20 p = 0.16). However, a significant trend for tuberculosis development amongst high HHC IFNgamma producers was observed (trend Log rank p = 0.007). DISCUSSION CFP-10-induced IFNgamma production is useful to establish tuberculosis infection prevalence amongst HHC and identify those at highest risk of disease. The high tuberculosis incidence amongst children supports administration of chemoprophylaxis to child contacts regardless of BCG vaccination.
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Affiliation(s)
- Helena del Corral
- Grupo de Epidemiología, Universidad de Antioquia, Medellín, Colombia
- Escuela de Microbiología, Universidad de Antioquia, Medellín, Colombia
- Centro Colombiano de Investigación en Tuberculosis, Medellín, Colombia
| | - Sara C. París
- Grupo de Inmunología Celular e Inmunogenética, Universidad de Antioquia, Medellín, Colombia
- Centro Colombiano de Investigación en Tuberculosis, Medellín, Colombia
| | - Nancy D. Marín
- Grupo de Inmunología Celular e Inmunogenética, Universidad de Antioquia, Medellín, Colombia
| | - Diana M. Marín
- Grupo de Epidemiología, Universidad de Antioquia, Medellín, Colombia
- Centro Colombiano de Investigación en Tuberculosis, Medellín, Colombia
| | - Lucelly López
- Grupo de Epidemiología, Universidad de Antioquia, Medellín, Colombia
- Centro Colombiano de Investigación en Tuberculosis, Medellín, Colombia
| | - Hanna M. Henao
- Grupo de Inmunología Celular e Inmunogenética, Universidad de Antioquia, Medellín, Colombia
- Centro Colombiano de Investigación en Tuberculosis, Medellín, Colombia
| | - Teresita Martínez
- Grupo de Epidemiología, Universidad de Antioquia, Medellín, Colombia
- Centro Colombiano de Investigación en Tuberculosis, Medellín, Colombia
| | - Liliana Villa
- Grupo de Epidemiología, Universidad de Antioquia, Medellín, Colombia
- Grupo de Inmunología Celular e Inmunogenética, Universidad de Antioquia, Medellín, Colombia
| | - Luis F. Barrera
- Grupo de Inmunología Celular e Inmunogenética, Universidad de Antioquia, Medellín, Colombia
- Centro Colombiano de Investigación en Tuberculosis, Medellín, Colombia
| | - Blanca L. Ortiz
- Grupo de Inmunología Celular e Inmunogenética, Universidad de Antioquia, Medellín, Colombia
- Centro Colombiano de Investigación en Tuberculosis, Medellín, Colombia
| | - María E. Ramírez
- Grupo de Inmunología Celular e Inmunogenética, Universidad de Antioquia, Medellín, Colombia
| | - Carlos J. Montes
- Grupo de Inmunología Celular e Inmunogenética, Universidad de Antioquia, Medellín, Colombia
| | - María C. Oquendo
- Grupo de Inmunología Celular e Inmunogenética, Universidad de Antioquia, Medellín, Colombia
- Centro Colombiano de Investigación en Tuberculosis, Medellín, Colombia
| | - Lisandra M. Arango
- Grupo de Inmunología Celular e Inmunogenética, Universidad de Antioquia, Medellín, Colombia
- Centro Colombiano de Investigación en Tuberculosis, Medellín, Colombia
| | - Felipe Riaño
- Grupo de Inmunología Celular e Inmunogenética, Universidad de Antioquia, Medellín, Colombia
| | - Carlos Aguirre
- Departamento de Pediatría, Universidad de Antioquia, Medellín, Colombia
| | | | - John T. Belisle
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, United States of America
| | - Karen Dobos
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, United States of America
| | - Gloria I. Mejía
- Centro Colombiano de Investigación en Tuberculosis, Medellín, Colombia
- Corporación para Investigaciones Biológicas, Medellín, Colombia
| | | | - Patrick J. Brennan
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, United States of America
| | - Jaime Robledo
- Centro Colombiano de Investigación en Tuberculosis, Medellín, Colombia
- Corporación para Investigaciones Biológicas, Medellín, Colombia
| | - María P. Arbeláez
- Grupo de Epidemiología, Universidad de Antioquia, Medellín, Colombia
- Centro Colombiano de Investigación en Tuberculosis, Medellín, Colombia
| | - Carlos A. Rojas
- Grupo de Epidemiología, Universidad de Antioquia, Medellín, Colombia
- Centro Colombiano de Investigación en Tuberculosis, Medellín, Colombia
| | - Luis F. García
- Grupo de Inmunología Celular e Inmunogenética, Universidad de Antioquia, Medellín, Colombia
- Centro Colombiano de Investigación en Tuberculosis, Medellín, Colombia
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17
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Jiang W, Shao L, Zhang Y, Zhang S, Meng C, Xu Y, Huang L, Wang Y, Wang Y, Weng X, Zhang W. High-sensitive and rapid detection of Mycobacterium tuberculosis infection by IFN-gamma release assay among HIV-infected individuals in BCG-vaccinated area. BMC Immunol 2009; 10:31. [PMID: 19476627 PMCID: PMC2700818 DOI: 10.1186/1471-2172-10-31] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2008] [Accepted: 05/28/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An accurate test for Mycobacterium tuberculosis infection is urgently needed in immunosuppressed populations. The aim of this study was to investigate the diagnostic power of enzyme-linked immunospot (ELISPOT)-based IFN-gamma release assay in detecting active and latent tuberculosis in HIV-infected population in bacillus Calmette-Guerin (BCG)-vaccinated area. A total of 100 HIV-infected individuals including 32 active tuberculosis patients were recruited. An ELISPOT-based IFN-gamma release assay, T-SPOT.TB, was used to evaluate the M. tuberculosis ESAT-6 and CFP-10 specific IFN-gamma response. Tuberculin skin test (TST) was performed for all recruited subjects. RESULTS The subjects were divided into group HIV+ATB (HIV-infected individuals with active tuberculosis, n = 32), group HIV+LTB (HIV-infected individuals with positive results of T-SPOT.TB assay, n = 46) and group HIV only (HIV-infected individuals with negative results of T-SPOT.TB assay and without evidence of tuberculosis infection, n = 22). In group HIV+ATB and HIV+LTB, T-SPOT.TB positive rate in subjects with TST <5 mm were 50% (16/32) and 41.3% (19/46), respectively. Individuals in group HIV+ATB and HIV+LTB with CD4+ T cells <500/microl, T-SPOT.TB showed a higher sensitivity than TST (64.5% vs. 22.6% and 62.2% vs. 29.7%, respectively, both P < 0.0001). In addition, the sensitivity of T-SPOT.TB assay in group HIV+ATB increased to >85% in patients with TB treatment for less than 1 month and CD4+ T cells > or = 200/microl, while for patients treated for more than 3 months and CD4+ T cells <200/microl, the sensitivity was decreased to only 33.3%. Furthermore, the results could be generated by T-SPOT.TB assay within 24 hours, which was more rapid than TST with 48-72 hours. CONCLUSION ELISPOT-based IFN-gamma release assay is more sensitive and rapid for the diagnosis of TB infection in Chinese HIV-infected individuals with history of BCG vaccination, and could be an effective tool for guiding preventive treatment with isoniazid in latently infected people and for TB control in China.
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Affiliation(s)
- Weimin Jiang
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai 200040, PR China.
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18
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Chegou NN, Black GF, Kidd M, van Helden PD, Walzl G. Host markers in QuantiFERON supernatants differentiate active TB from latent TB infection: preliminary report. BMC Pulm Med 2009; 9:21. [PMID: 19445695 PMCID: PMC2696407 DOI: 10.1186/1471-2466-9-21] [Citation(s) in RCA: 131] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2008] [Accepted: 05/16/2009] [Indexed: 11/10/2022] Open
Abstract
Background Interferon gamma release assays, including the QuantiFERON® TB Gold In Tube (QFT) have been shown to be accurate in diagnosing Mycobacterium tuberculosis infection. These assays however, do not discriminate between latent TB infection (LTBI) and active TB disease. Methods We recruited twenty-three pulmonary TB patients and 34 household contacts from Cape Town, South Africa and performed the QFT test. To investigate the ability of new host markers to differentiate between LTBI and active TB, levels of 29 biomarkers in QFT supernatants were evaluated using a Luminex multiplex cytokine assay. Results Eight out of 29 biomarkers distinguished active TB from LTBI in a pilot study. Baseline levels of epidermal growth factor (EGF) soluble CD40 ligand (sCD40L), antigen stimulated levels of EGF, and the background corrected antigen stimulated levels of EGF and macrophage inflammatory protein (MIP)-1β were the most informative single markers for differentiation between TB disease and LTBI, with AUCs of 0.88, 0.84, 0.87, 0.90 and 0.79 respectively. The combination of EGF and MIP-1β predicted 96% of active TB cases and 92% of LTBIs. Combinations between EGF, sCD40L, VEGF, TGF-α and IL-1α also showed potential to differentiate between TB infection states. EGF, VEGF, TGF-α and sCD40L levels were higher in TB patients. Conclusion These preliminary data suggest that active TB may be accurately differentiated from LTBI utilizing adaptations of the commercial QFT test that includes measurement of EGF, sCD40L, MIP-1β, VEGF, TGF-α or IL-1α in supernatants from QFT assays. This approach holds promise for development as a rapid diagnostic test for active TB.
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Affiliation(s)
- Novel N Chegou
- Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Health Sciences, University of Stellenbosch, Cape Town, Western Cape Province, Tygerberg 7505, South Africa.
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19
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Davies MA, Connell T, Johannisen C, Wood K, Pienaar S, Wilkinson KA, Wilkinson RJ, Zar HJ, Eley B, Beatty D, Curtis N, Nicol MP. Detection of tuberculosis in HIV-infected children using an enzyme-linked immunospot assay. AIDS 2009; 23:961-969. [PMID: 19287300 PMCID: PMC4849554 DOI: 10.1097/qad.0b013e32832956ad] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate an enzyme-linked immunospot assay (ELISPOT) for the diagnosis of tuberculosis (TB) in HIV-infected children with suspected TB and to compare the performance of ELISPOT with the tuberculin skin test (TST). METHODS Interferon-gamma responses to Mycobacterium tuberculosis-specific antigens were measured by ELISPOT in HIV-infected children with suspected TB. HIV-infected and HIV-uninfected children without TB were taken for comparison. RESULTS Results were available for 188 children, of whom 139 (74%) were HIV-infected. Of these, 22 were classified as having definite TB: 24 probable TB, 14 possible TB and 128 not having TB. The median (range) age of patients was 20 (10-54.1) months. Median interferon-gamma responses to early-secreted antigenic target-6 and culture filtrate protein-10 were higher in children with definite or probable TB compared with children without TB (P < 0.002). In HIV-infected children with an interpretable ELISPOT result, the ELISPOT was positive in 14/21 (66%) with definite TB. A significantly higher proportion of HIV-infected children with definite or probable TB had a positive ELISPOT compared with a positive TST [25/39 (64%) vs. 10/34 (29%), P = 0.005]. In contrast to TST, results from ELISPOT were not affected by young age or severe immunosuppression. In HIV-infected children without active TB disease, 27% had a positive ELISPOT, suggesting latent TB infection. CONCLUSION ELISPOT is more sensitive than TST for the detection of active TB in HIV-infected children. However, the sensitivity of current ELISPOT assays is not sufficiently high to be used as a rule out test for TB.
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Affiliation(s)
- Mary-Ann Davies
- Red Cross Children’s Hospital and School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
- School of Public Health and Family Medicine, University of Cape Town, South Africa
| | - Tom Connell
- Department of Paediatrics, University of Melbourne; Infectious Diseases Unit, Department of General Medicine; and Murdoch Children’s Research Institute; Royal Children’s Hospital Melbourne, Parkville, Australia
- Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, South Africa
| | - Christine Johannisen
- Red Cross Children’s Hospital and School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Kathryn Wood
- Red Cross Children’s Hospital and School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
- Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, South Africa
| | - Sandy Pienaar
- Red Cross Children’s Hospital and School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Katalin A Wilkinson
- Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, South Africa
- National Institute for Medical Research, Mill Hill, London NW7 1AA, UK
| | - Robert J Wilkinson
- Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, South Africa
- National Institute for Medical Research, Mill Hill, London NW7 1AA, UK
- Division of Medicine, Imperial College London, W2 1PG, UK
| | - Heather J Zar
- Red Cross Children’s Hospital and School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Brian Eley
- Red Cross Children’s Hospital and School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - David Beatty
- Red Cross Children’s Hospital and School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Nigel Curtis
- Department of Paediatrics, University of Melbourne; Infectious Diseases Unit, Department of General Medicine; and Murdoch Children’s Research Institute; Royal Children’s Hospital Melbourne, Parkville, Australia
| | - Mark P. Nicol
- Red Cross Children’s Hospital and School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
- Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, South Africa
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20
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Contact investigation in a primary school using a whole blood interferon-gamma assay. J Infect 2009; 58:352-7. [PMID: 19342102 DOI: 10.1016/j.jinf.2009.02.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2008] [Revised: 02/06/2009] [Accepted: 02/25/2009] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To evaluate the usefulness of QuantiFERON-TB Gold (QFT-G) for children. METHODS Students in a primary school exposed to a tuberculosis patient were investigated using the tuberculin skin test (TST), chest X-ray examination and sequential QFT-G tests. RESULTS The first QFT-G test was conducted one month after the end of exposure for 308 of the 313 children, with 6 (1.9%) positive. TST results were obtained from 306 of the students at 2 months after exposure, and 200 (65.4%) had induration > or =5mm. A second QFT-G test, a further month later, and a third QFT-G test, six months after exposure, found an additional 2 positive and one weakly positive, respectively. Overall, the rate of QFT-G positivity was 9.8% (4/41) for close contact children (> or =90h exposure), significantly higher than for casual contacts (< or =18h exposure; 1.8%, 5/272; p=0.020), whereas there was no significant difference in TST positive rates (p=0.078). CONCLUSIONS These data suggest that QFT-G has the same performance characteristics in BCG vaccinated children as it does in adults. The observation that none of the 297 students who were QFT-G negative had developed active TB after 3 years of follow-up suggests that QFT-G has a very high negative predictive value.
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21
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Antigen-specific T-cell responses of leprosy patients. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2008; 15:1659-65. [PMID: 18784342 DOI: 10.1128/cvi.00234-08] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The identification of human T-cell antigens of Mycobacterium leprae could improve treatment and help to disrupt the transmission of leprosy by directing diagnosis and vaccine programs. This study screened a panel of M. leprae recombinant proteins for T-cell recall responses, measured by gamma interferon (IFN-gamma) production, among leprosy patients. After initial studies using peripheral blood mononuclear cells from leprosy patients, we transitioned our studies to simple whole-blood assays (WBA), which are more applicable in field or clinical settings. T-cell responses generated in WBA using blood from individuals in Goiânia, Brazil, demonstrated that several M. leprae antigens (ML0276, ML0840, ML1623, ML2044, and 46f) elicited >0.5 IU/ml IFN-gamma, and these proteins were classified as immunogenic and leprosy specific. Several of these individual antigens were recognized by cells from >60% of Brazilian paucibacillary (PB) leprosy patients, and ML0276, ML0840, ML1623, and 46f complemented each other such that 82% of PB patients had strong (>1.25 IU/ml IFN-gamma) responses to at least one of these proteins. These proteins were also recognized by cells from a significant proportion of the household contacts of multibacillary leprosy patients, but in contrast, few responses were observed in active tuberculosis patients or healthy control groups from areas of endemicity. Our results indicate several potential candidate antigens which may be useful for either leprosy diagnosis or vaccination and demonstrate the utility of leprosy WBA that can be applied broadly in clinical or field settings.
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22
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Ruhwald M, Petersen J, Kofoed K, Nakaoka H, Cuevas LE, Lawson L, Squire SB, Eugen-Olsen J, Ravn P. Improving T-cell assays for the diagnosis of latent TB infection: potential of a diagnostic test based on IP-10. PLoS One 2008; 3:e2858. [PMID: 18682747 PMCID: PMC2483344 DOI: 10.1371/journal.pone.0002858] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2008] [Accepted: 07/08/2008] [Indexed: 12/31/2022] Open
Abstract
Background There is a need for simple tools such as the M.tuberculosis specific IFN-γ release assays (IGRA) to improve diagnosis of M.tuberculosis-infection in children. The aim of the study was to evaluate the performance of an IP-10 and IL-2 based tests for the diagnosis of M.tuberculosis-infection in recently exposed children from Nigeria. Methodology and Principal Findings Samples were obtained from 59 children at high risk of infection with M.tuberculosis (contacts of adults with smear and culture-positive tuberculosis) and 61 at low risk (contacts of smear-negative/culture-positive tuberculosis or community controls). IP-10 and IL-2 was measured in plasma after stimulation of whole-blood with M.tuberculosis specific antigens and mitogen. Previously developed criteria for positive IP-10 and IL-2 tests were used and the diagnostic performances of the IP-10 and IL-2 tests were compared with the Quantiferon In-Tube (QFT-IT) and the Tuberculin Skin Tests (TST). In response to M.tuberculosis specific antigens, the high-risk children expressed significantly higher levels of IP-10 (1358 pg/ml[IQR 278–2535 pg/ml]) and IL-2 (164 pg/ml[11–590 pg/ml]) than low risk groups 149 pg/ml(25–497 pg/ml), and 0 pg/ml(0–3 pg/ml), respectively. There was excellent agreement (>89%,k>0.80) between IP-10, IL-2 tests and QFT-IT, better than with TST (>74%,k>0.49). The IP-10 and IL-2 responses were strongly associated with M.tuberculosis exposure and with grade of infectiousness of the index cases (p<0.0001). IP-10, IL-2, and TST but not QFT-IT was associated with age of the child in the low risk groups (p<0.02). Conclusions/Significance IP-10 is expressed in high levels and results of the IP-10 test were comparable to the QFT-IT. IL-2 was released in low amounts in response to the antigens and not in response to the mitogen therefore IL-2 seems a less useful marker. We have demonstrated that IP-10 and possibly IL-2 could be alternative or adjunct markers to IFN-γ in the diagnosis infection with M.tuberculosis.
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Affiliation(s)
- Morten Ruhwald
- Department of Infectious Diseases 144, Copenhagen University, Hvidovre Hospital, Hvidovre, Denmark.
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23
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Young DB, Perkins MD, Duncan K, Barry CE. Confronting the scientific obstacles to global control of tuberculosis. J Clin Invest 2008; 118:1255-65. [PMID: 18382738 DOI: 10.1172/jci34614] [Citation(s) in RCA: 237] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Tuberculosis (TB) is a major threat to global health, recently exacerbated by the emergence of highly drug-resistant forms of the disease-causing pathogen and synergy with HIV/AIDS. In 2006, the Stop TB Partnership published "The global plan to stop TB: 2006--2015," which set out a vision of halving the prevalence of and mortality caused by the disease by 2015, followed by eliminating the disease as a public health problem by 2050. This vision depends on the development of improved diagnostics, simpler treatment, and more effective vaccination. Recently, active translational research pipelines directed toward each of these goals have been established, but improved understanding of the fundamental biology of this complex disease will prove to be the key to radical advances in TB control.
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Affiliation(s)
- Douglas B Young
- Division of Medicine, Faculty of Medicine, Imperial College London, London, United Kingdom
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24
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McPherson ME, Kelly H, Patel MS, Leslie D. Persistent risk of tuberculosis in migrants a decade after arrival in Australia. Med J Aust 2008; 188:528-31. [DOI: 10.5694/j.1326-5377.2008.tb01768.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2007] [Accepted: 01/31/2008] [Indexed: 11/17/2022]
Affiliation(s)
- Michelle E McPherson
- Communicable Disease Control, Department of Human Services, Melbourne, VIC
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT
| | - Heath Kelly
- Victorian Infectious Diseases Reference Laboratory, Melbourne, VIC
| | - Mahomed S Patel
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT
| | - David Leslie
- Victorian Infectious Diseases Reference Laboratory, Melbourne, VIC
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25
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Jacobsen M, Mattow J, Repsilber D, Kaufmann SH. Novel strategies to identify biomarkers in tuberculosis. Biol Chem 2008; 389:487-95. [DOI: 10.1515/bc.2008.053] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
The more we learn about the immune response against tuberculosis (TB) and particularly about the features which distinguish protective immunity, disease susceptibility and pathology, the better we can define biomarkers which correlate with these different stages of infection. The most widely used biomarker in TB, which without a doubt is an important component of protective immunity, is IFNγ secreted by antigen-specific CD4 T-cells. However, the complexity of the immune response against TB makes it more than likely that additional biomarkers are required for a reliable correlate of protection. As a corollary, we assume that a set of biomarkers will be required, termed a biosignature.
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26
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Dye C, Bassili A, Bierrenbach AL, Broekmans JF, Chadha VK, Glaziou P, Gopi PG, Hosseini M, Kim SJ, Manissero D, Onozaki I, Rieder HL, Scheele S, van Leth F, van der Werf M, Williams BG. Measuring tuberculosis burden, trends, and the impact of control programmes. THE LANCET. INFECTIOUS DISEASES 2008; 8:233-43. [PMID: 18201929 DOI: 10.1016/s1473-3099(07)70291-8] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The targets for tuberculosis control, framed within the United Nations' Millennium Development Goals, are to ensure that the incidence per head of tuberculosis is falling by 2015, and that the 1990 prevalence and mortality per head are halved by 2015. In monitoring progress in tuberculosis control, the ultimate aim for all countries is to count tuberculosis cases (incidence) accurately through routine surveillance. Disease prevalence surveys are costly and laborious, but give unbiased measures of tuberculosis burden and trends, and are justified in high-burden countries where many cases and deaths are missed by surveillance systems. Most countries in which tuberculosis is highly endemic do not yet have reliable death registration systems. Verbal autopsy, used in cause-of-death surveys, is an alternative, interim method of assessing tuberculosis mortality, but needs further validation. Although several new assays for Mycobacterium tuberculosis infection have recently been devised, the tuberculin skin test remains the only practical method of measuring infection in populations. However, this test typically has low specificity and is therefore best used comparatively to assess geographical and temporal variation in risk of infection. By 2015, every country should be able to assess progress in tuberculosis control by estimating the time trend in incidence, and the magnitude of reductions in either prevalence or deaths.
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Affiliation(s)
- C Dye
- HIV/AIDS, Tuberculosis, Malaria and Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland.
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27
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Madge SN, Prabhakaran VC, Shome D, Kim U, Honavar S, Selva D. Orbital tuberculosis: a review of the literature. Orbit 2008; 27:267-277. [PMID: 18716964 DOI: 10.1080/01676830802225152] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE To provide an up-to-date review of the clinical presentations, investigations, and management of orbital tuberculosis (OTB). METHODS Systematic review of the literature concerning OTB, limiting the results to English-language peer-reviewed journals. RESULTS Seventy-nine patients from 39 publications were identified as cases of OTB. The condition presents in one of five forms: classical periostitis; orbital soft tissue tuberculoma or cold abscess, with no bony involvement; OTB with bony involvement; spread from the paranasal sinuses; and tuberculous dacryoadenitis. The ocular adnexa, including the nasolacrimal system and overlying skin, may also be involved. CONCLUSIONS Diagnosis can be difficult and may necessitate an orbital biopsy, in which acid-fast bacilli (AFB) and characteristic histopathology may be seen. Growth of Mycobacterium tuberculosis (mTB) from such a specimen remains the gold standard for diagnosis. Ancillary investigations include tuberculin skin tests and chest radiography, but more recently alternatives such as whole blood interferon-gamma immunological tests and PCR-based tests of pathological specimens have proven useful. The management of OTB is complex, requiring a stringent public health strategy and high levels of patient adherence, combined with long courses of multiple anti-tuberculous medications. The interaction of the human immunodeficiency virus (HIV) with TB may further complicate management.
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Affiliation(s)
- Simon N Madge
- Oculoplastic & Orbital Division, Discipline of Ophthalmology and Visual Sciences, Level 8, Royal Adelaide Hospital, North Terrace, Adelaide 500, Australia.
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28
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A Blood Test for Tuberculosis. Obstet Gynecol 2008. [DOI: 10.1097/01.aog.0000299136.09836.4c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Tuberculosis is still a leading cause of death in low-income and middle-income countries, especially those of sub-Saharan Africa where tuberculosis is an epidemic because of the increased susceptibility conferred by HIV infection. The effectiveness of the Bacille Calmette Guérin (BCG) vaccine is partial, and that of treatment of latent tuberculosis is unclear in high-incidence settings. The routine diagnostic methods that are used in many parts of the world are still very similar to those used 100 years ago. Multidrug treatment, within the context of structured, directly observed therapy, is a cost-effective control strategy. Nevertheless, the duration of treatment needed reduces its effectiveness, as does the emergence of multidrug-resistant and extensively drug-resistant disease; the latter has recently become widespread. The rapid expansion of basic, clinical, and operational research, in addition to increasing knowledge of tuberculosis, is providing new diagnostic, treatment, and preventive measures. The challenge is to apply these advances to the populations most at risk. The development of a comprehensive worldwide plan to stop tuberculosis might facilitate this process by coordinating the work of health agencies. However, massive effort, political will, and resources are needed for this plan to succeed.
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Affiliation(s)
- Gary Maartens
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Health Sciences, University of Cape Town Medical School, Cape Town, South Africa.
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30
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Mofenson LM, Laughon BE. Human Immunodeficiency Virus, Mycobacterium Tuberculosis, and Pregnancy: A Deadly Combination. Clin Infect Dis 2007; 45:250-3. [PMID: 17578787 DOI: 10.1086/518975] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2007] [Accepted: 04/02/2007] [Indexed: 11/03/2022] Open
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31
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Martineau AR, Newton SM, Wilkinson KA, Kampmann B, Hall BM, Nawroly N, Packe GE, Davidson RN, Griffiths CJ, Wilkinson RJ. Neutrophil-mediated innate immune resistance to mycobacteria. J Clin Invest 2007; 117:1988-94. [PMID: 17607367 PMCID: PMC1904316 DOI: 10.1172/jci31097] [Citation(s) in RCA: 279] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2006] [Accepted: 04/02/2007] [Indexed: 12/31/2022] Open
Abstract
Neutrophils contain antimicrobial peptides with antituberculous activity, but their contribution to immune resistance to tuberculosis (TB) infection has not been previously investigated to our knowledge. We determined differential white cell counts in peripheral blood of 189 adults who had come into contact with patients diagnosed with active TB in London, United Kingdom, and evaluated them for evidence of TB infection and capacity to restrict mycobacterial growth in whole-blood assays. Risk of TB infection was inversely and independently associated with peripheral blood neutrophil count in contacts of patients diagnosed with pulmonary TB. The ability of whole blood to restrict growth of Mycobacterium bovis bacille Calmette Guérin and Mycobacterium tuberculosis was impaired 7.3- and 3.1-fold, respectively, by neutrophil depletion. In microbiological media, human neutrophil peptides (HNPs) 1-3 killed M. tuberculosis. The neutrophil peptides cathelicidin LL-37 and lipocalin 2 restricted growth of the organism, the latter in an iron-dependent manner. Black African participants had lower neutrophil counts and lower circulating concentrations of HNP1-3 and lipocalin 2 than south Asian and white participants. Neutrophils contribute substantially to innate resistance to TB infection, an activity associated with their antimicrobial peptides. Elucidation of the regulation of neutrophil antimicrobial peptides could facilitate prevention and treatment of TB.
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Affiliation(s)
- Adrian R. Martineau
- Wellcome Trust Center for Research in Clinical Tropical Medicine, Division of Medicine, Wright Fleming Institute, Imperial College, London, United Kingdom.
Center for Health Sciences, Queen Mary’s School of Medicine and Dentistry, Barts and The London NHS Trust, London, United Kingdom.
Institute of Infectious Diseases and Molecular Medicine and Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Department of Respiratory Medicine, National Heart and Lung Institute, Imperial College, London, United Kingdom.
Newham Chest Clinic, Newham University Hospital NHS Trust, London, United Kingdom.
Tuberculosis Clinic, Northwick Park Hospital, Harrow, United Kingdom
| | - Sandra M. Newton
- Wellcome Trust Center for Research in Clinical Tropical Medicine, Division of Medicine, Wright Fleming Institute, Imperial College, London, United Kingdom.
Center for Health Sciences, Queen Mary’s School of Medicine and Dentistry, Barts and The London NHS Trust, London, United Kingdom.
Institute of Infectious Diseases and Molecular Medicine and Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Department of Respiratory Medicine, National Heart and Lung Institute, Imperial College, London, United Kingdom.
Newham Chest Clinic, Newham University Hospital NHS Trust, London, United Kingdom.
Tuberculosis Clinic, Northwick Park Hospital, Harrow, United Kingdom
| | - Katalin A. Wilkinson
- Wellcome Trust Center for Research in Clinical Tropical Medicine, Division of Medicine, Wright Fleming Institute, Imperial College, London, United Kingdom.
Center for Health Sciences, Queen Mary’s School of Medicine and Dentistry, Barts and The London NHS Trust, London, United Kingdom.
Institute of Infectious Diseases and Molecular Medicine and Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Department of Respiratory Medicine, National Heart and Lung Institute, Imperial College, London, United Kingdom.
Newham Chest Clinic, Newham University Hospital NHS Trust, London, United Kingdom.
Tuberculosis Clinic, Northwick Park Hospital, Harrow, United Kingdom
| | - Beate Kampmann
- Wellcome Trust Center for Research in Clinical Tropical Medicine, Division of Medicine, Wright Fleming Institute, Imperial College, London, United Kingdom.
Center for Health Sciences, Queen Mary’s School of Medicine and Dentistry, Barts and The London NHS Trust, London, United Kingdom.
Institute of Infectious Diseases and Molecular Medicine and Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Department of Respiratory Medicine, National Heart and Lung Institute, Imperial College, London, United Kingdom.
Newham Chest Clinic, Newham University Hospital NHS Trust, London, United Kingdom.
Tuberculosis Clinic, Northwick Park Hospital, Harrow, United Kingdom
| | - Bridget M. Hall
- Wellcome Trust Center for Research in Clinical Tropical Medicine, Division of Medicine, Wright Fleming Institute, Imperial College, London, United Kingdom.
Center for Health Sciences, Queen Mary’s School of Medicine and Dentistry, Barts and The London NHS Trust, London, United Kingdom.
Institute of Infectious Diseases and Molecular Medicine and Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Department of Respiratory Medicine, National Heart and Lung Institute, Imperial College, London, United Kingdom.
Newham Chest Clinic, Newham University Hospital NHS Trust, London, United Kingdom.
Tuberculosis Clinic, Northwick Park Hospital, Harrow, United Kingdom
| | - Niga Nawroly
- Wellcome Trust Center for Research in Clinical Tropical Medicine, Division of Medicine, Wright Fleming Institute, Imperial College, London, United Kingdom.
Center for Health Sciences, Queen Mary’s School of Medicine and Dentistry, Barts and The London NHS Trust, London, United Kingdom.
Institute of Infectious Diseases and Molecular Medicine and Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Department of Respiratory Medicine, National Heart and Lung Institute, Imperial College, London, United Kingdom.
Newham Chest Clinic, Newham University Hospital NHS Trust, London, United Kingdom.
Tuberculosis Clinic, Northwick Park Hospital, Harrow, United Kingdom
| | - Geoffrey E. Packe
- Wellcome Trust Center for Research in Clinical Tropical Medicine, Division of Medicine, Wright Fleming Institute, Imperial College, London, United Kingdom.
Center for Health Sciences, Queen Mary’s School of Medicine and Dentistry, Barts and The London NHS Trust, London, United Kingdom.
Institute of Infectious Diseases and Molecular Medicine and Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Department of Respiratory Medicine, National Heart and Lung Institute, Imperial College, London, United Kingdom.
Newham Chest Clinic, Newham University Hospital NHS Trust, London, United Kingdom.
Tuberculosis Clinic, Northwick Park Hospital, Harrow, United Kingdom
| | - Robert N. Davidson
- Wellcome Trust Center for Research in Clinical Tropical Medicine, Division of Medicine, Wright Fleming Institute, Imperial College, London, United Kingdom.
Center for Health Sciences, Queen Mary’s School of Medicine and Dentistry, Barts and The London NHS Trust, London, United Kingdom.
Institute of Infectious Diseases and Molecular Medicine and Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Department of Respiratory Medicine, National Heart and Lung Institute, Imperial College, London, United Kingdom.
Newham Chest Clinic, Newham University Hospital NHS Trust, London, United Kingdom.
Tuberculosis Clinic, Northwick Park Hospital, Harrow, United Kingdom
| | - Christopher J. Griffiths
- Wellcome Trust Center for Research in Clinical Tropical Medicine, Division of Medicine, Wright Fleming Institute, Imperial College, London, United Kingdom.
Center for Health Sciences, Queen Mary’s School of Medicine and Dentistry, Barts and The London NHS Trust, London, United Kingdom.
Institute of Infectious Diseases and Molecular Medicine and Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Department of Respiratory Medicine, National Heart and Lung Institute, Imperial College, London, United Kingdom.
Newham Chest Clinic, Newham University Hospital NHS Trust, London, United Kingdom.
Tuberculosis Clinic, Northwick Park Hospital, Harrow, United Kingdom
| | - Robert J. Wilkinson
- Wellcome Trust Center for Research in Clinical Tropical Medicine, Division of Medicine, Wright Fleming Institute, Imperial College, London, United Kingdom.
Center for Health Sciences, Queen Mary’s School of Medicine and Dentistry, Barts and The London NHS Trust, London, United Kingdom.
Institute of Infectious Diseases and Molecular Medicine and Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Department of Respiratory Medicine, National Heart and Lung Institute, Imperial College, London, United Kingdom.
Newham Chest Clinic, Newham University Hospital NHS Trust, London, United Kingdom.
Tuberculosis Clinic, Northwick Park Hospital, Harrow, United Kingdom
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Abstract
Laboratory diagnosis of tuberculosis (TB) traditionally relies on smear microscopy and culture of Mycobacterium tuberculosis from clinical samples. With recent advances in technology, there have been numerous efforts to develop new diagnostic tests for TB that overcome the low sensitivity and specificity and long turnover time associated with current diagnostic tests. Molecular biological tests based on nucleic acid amplification have brought an unprecedented opportunity for the rapid and specific detection of M. tuberculosis from clinical specimens. With automated sequencing analysis, species identification of mycobacteria is now easier and more accurate than with conventional methods, and rapid detection of mutations in the genes associated with resistance to TB drugs provides early information on the potential drug resistance for each clinical isolate or for clinical samples. In addition, immunological tests for the detection of M. tuberculosis antigens and antibodies to the antigens have been explored to identify individuals at risk of developing TB or with latent TB infection (LTBI). The recent introduction of commercial IFN-gamma assay kits for the detection of LTBI provides a new approach for TB control even in areas with a high incidence of TB. However, these molecular and immunological tools still require further evaluation using large scale cohort studies before implementation in TB control programs.
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Affiliation(s)
- Sang-Nae Cho
- Department of Microbiology and Institute of Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Korea.
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Pai M, Dheda K, Cunningham J, Scano F, O'Brien R. T-cell assays for the diagnosis of latent tuberculosis infection: moving the research agenda forward. THE LANCET. INFECTIOUS DISEASES 2007; 7:428-38. [PMID: 17521596 DOI: 10.1016/s1473-3099(07)70086-5] [Citation(s) in RCA: 120] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
For nearly a century, the tuberculin skin test was the only tool available for the detection of latent tuberculosis infection. A recent breakthrough has been the development of T-cell-based interferon-gamma release assays. Current evidence suggests interferon-gamma release assays have higher specificity than the tuberculin skin test, better correlation with surrogate markers of exposure to Mycobacterium tuberculosis in low-incidence settings, and less cross-reactivity as a result of BCG vaccination compared with the tuberculin skin test. The body of literature supporting the use of interferon-gamma release assays has rapidly expanded. However, several unresolved and unexplained issues remain. To address these issues, a group of experts met in Geneva, Switzerland, in March, 2006, to discuss the research evidence on T-cell-based assays, their clinical usefulness, limitations, and directions for future research, with a specific focus on resource-limited and high HIV prevalence settings. On the basis of 2 days of discussions, a comprehensive research agenda was generated, which will propel the field forward by stimulating focused high-impact research and encourage the investment of resources needed to tackle priority research questions, especially in resource-limited settings. Ultimately, if adequately financed, the research findings will inform appropriate use of novel latent tuberculosis infection diagnostics in global tuberculosis control.
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Affiliation(s)
- Madhukar Pai
- McGill University, Department of Epidemiology, Biostatistics and Occupational Health, Montreal, Quebec, Canada
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34
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Connell TG, Shey MS, Seldon R, Rangaka MX, van Cutsem G, Simsova M, Marcekova Z, Sebo P, Curtis N, Diwakar L, Meintjes GA, Leclerc C, Wilkinson RJ, Wilkinson KA. Enhanced ex vivo stimulation of Mycobacterium tuberculosis-specific T cells in human immunodeficiency virus-infected persons via antigen delivery by the Bordetella pertussis adenylate cyclase vector. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2007; 14:847-54. [PMID: 17522328 PMCID: PMC1951068 DOI: 10.1128/cvi.00041-07] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The genetically detoxified Bordetella pertussis adenylate cyclase is a promising delivery system for immunodominant tuberculosis antigens in gamma interferon release assays. This system has not been evaluated in human immunodeficiency virus (HIV)-infected persons in high tuberculosis prevalence areas. A whole-blood gamma interferon release assay with Mycobacterium tuberculosis antigens (early-secreted antigenic target 6, culture filtrate protein 10, alpha-crystallin 2, and TB10.3) delivered by adenylate cyclase in addition to native tuberculosis antigens (without adenylate cyclase delivery) was evaluated in 119 adults in Khayelitsha Township, Cape Town, South Africa. Results were compared to tuberculin skin test results of 41 HIV-positive and 42 HIV-negative asymptomatic persons, in addition to 36 HIV-positive persons with recently diagnosed smear- or culture-positive pulmonary tuberculosis. Delivery of tuberculosis antigens by adenylate cyclase decreased by 10-fold the amount of antigen required to restimulate T cells. Furthermore, the responses of HIV-positive persons with a low response to native tuberculosis antigens were enhanced when these antigens were delivered by adenylate cyclase. When gamma interferon responses to the tuberculosis antigens (with or without delivery by adenylate cyclase) were combined, a significantly higher number of patients were scored positive than by tuberculin skin testing. Ex vivo responses to tuberculosis antigens delivered by adenylate cyclase are maintained in the context of HIV infection. Our findings suggest that the majority of those in this population are infected with tuberculosis, which is of significant public health importance.
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Affiliation(s)
- Tom G Connell
- Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Observatory 7925, South Africa
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35
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Abstract
Children account for a major proportion of the global tuberculosis disease burden, especially in endemic areas. However, the accurate diagnosis of childhood tuberculosis remains a major challenge. This review provides an overview of the most important recent advances in the diagnosis of intrathoracic childhood tuberculosis: (1) symptom-based approaches, including symptom-based screening of exposed children and symptom-based diagnosis of active disease; (2) novel immune-based approaches, including T cell assays and novel antigen-based tests; and (3) bacteriological and molecular methods that are more rapid and/or less expensive than conventional culture techniques for tuberculosis diagnosis and/or drug-resistance testing. Recent advances have improved our ability to diagnose latent infection and active tuberculosis in children, but establishing a diagnosis of either latent infection or active disease in HIV-infected children remains a major challenge, particularly in high-burden settings. Although improved access to diagnosis and treatment is essential, ultimately the burden of childhood tuberculosis is determined by the level of epidemic control achieved in a particular community. Several recent initiatives, in particular the United Nations Millennium Developmental Goals, deal with the problem of poverty and disease in a holistic fashion, but global political commitment is required to support these key initiatives.
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Affiliation(s)
- Ben J Marais
- Ukwanda Centre for Rural Health and the Department of paediatrics and Child Health, Desmond Tutu TB Centre, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa.
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Ruhwald M, Bjerregaard-Andersen M, Rabna P, Kofoed K, Eugen-Olsen J, Ravn P. CXCL10/IP-10 release is induced by incubation of whole blood from tuberculosis patients with ESAT-6, CFP10 and TB7.7. Microbes Infect 2007; 9:806-12. [PMID: 17533146 DOI: 10.1016/j.micinf.2007.02.021] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2006] [Revised: 02/02/2007] [Accepted: 02/26/2007] [Indexed: 12/22/2022]
Abstract
IFN-gamma responses to Mycobacterium tuberculosis specific antigens are used as in vitro diagnostic tests for tuberculosis infection. The tests are sensitive and specific for latent and active tuberculosis disease, but sensitivity may be reduced during immunosuppression. The objective of the study was to explore new ways to improve the diagnosis of tuberculosis infection using CXCL10 and IL-2 as alternative markers to IFN-gamma. CXCL10, IL-2, and IFN-gamma responses to stimulation with ESAT-6/CFP10/TB7.7 were assessed in 12 Quantiferon positive, 8 Quantiferon negative tuberculosis patients and 11 Quantiferon negative controls. CXCL10 and IL-2 were determined by multiplex and IFN-gamma by the Quantiferon ELISA. The median antigen specific CXCL10, IFN-gamma, and IL-2 responses in patients with tuberculosis were 870 pg/ml (range 261-1576 pg/ml), 217 pg/ml (81-1273 pg/ml), 59 pg/ml (14-276 pg/ml) respectively, and the CXCL10 responses were significantly higher than any of the other cytokines measured (p=0.001). In 4/7 individuals with a negative (n=6) or indeterminate (n=1) Quantiferon test, antigen specific CXCL10 responses were detectable at high levels ranging from 196-532 pg/ml. In conclusion CXCL10 was strongly induced after M. tuberculosis specific stimulation and sensitivity appeared superior to the Quantiferon test. Our findings suggest that CXCL10 may serve as an alternative or additional marker for the immunodiagnosis of tuberculosis.
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Affiliation(s)
- Morten Ruhwald
- Department of Infectious Diseases 144, Copenhagen University Hospital, Kettegaards Alle 30, DK-2650 Hvidovre, Denmark.
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37
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Rangaka MX, Wilkinson KA, Seldon R, Van Cutsem G, Meintjes GA, Morroni C, Mouton P, Diwakar L, Connell TG, Maartens G, Wilkinson RJ. Effect of HIV-1 Infection on T-Cell–based and Skin Test Detection of Tuberculosis Infection. Am J Respir Crit Care Med 2007; 175:514-20. [PMID: 17158278 DOI: 10.1164/rccm.200610-1439oc] [Citation(s) in RCA: 149] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Two forms of the IFN-gamma release assay (IFNGRA) to detect tuberculosis infection are available, but neither has been evaluated in comparable HIV-infected and uninfected persons in a high tuberculosis incidence environment. OBJECTIVE To compare the ability of the T-SPOT.TB (Oxford Immunotec, Abingdon, UK), QuantiFERON-TB Gold (Cellestis, Melbourne, Australia), and Mantoux tests to identify latent tuberculosis in HIV-infected and uninfected persons. METHODS A cross-sectional study of 160 healthy adults without active tuberculosis attending a voluntary counseling and testing center for HIV infection in Khayelitsha, a deprived urban South African community with an HIV antenatal seroprevalence of 33% and a tuberculosis incidence of 1,612 per 100,000. MEASUREMENTS AND MAIN RESULTS One hundred and sixty (74 HIV(+) and 86 HIV(-)) persons were enrolled. A lower proportion of Mantoux results was positive in HIV-infected subjects compared with HIV-uninfected subjects (p < 0.01). By contrast, the proportion of positive IFNGRAs was not significantly different in HIV-infected persons for the T-SPOT.TB test (52 vs. 59%; p = 0.41) or the QuantiFERON-TB Gold test (43 and 46%; p = 0.89). Fair agreement between the Mantoux test (5- and 10-mm cutoffs) and the IFNGRA was seen in HIV-infected people (kappa = 0.52-0.6). By contrast, poor agreement between the Mantoux and QuantiFERON-TB Gold tests was observed in the HIV-uninfected group (kappa = 0.07-0.30, depending on the Mantoux cutoff). The pattern was similar for T-SPOT.TB (kappa = 0.18-0.24). INTERPRETATION IFNGRA sensitivity appears relatively unimpaired by moderately advanced HIV infection. However, agreement between the tests and with the Mantoux test varied from poor to fair. This highlights the need for prospective studies to determine which test may predict the subsequent risk of tuberculosis.
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Affiliation(s)
- Molebogeng Xheeda Rangaka
- Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Observatory 7925, Cape Town, South Africa
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