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Herai Y, Yahaba M, Taniguchi T, Murata S, Chiba H, Igari H. Factors Influencing the Indeterminate Results in a T-SPOT.TB test: A Matched Case-control Study. Intern Med 2023; 62:3321-3326. [PMID: 37005270 DOI: 10.2169/internalmedicine.1006-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Objective A T-SPOT.TB can yield indeterminate results under two test observation conditions: a high response to the nil in negative control wells (high nil-control) or a low response to the mitogen in positive control wells (low mitogen-control). The most strongly influential factors for these indeterminate results, however, have yet to be identified. Methods From June 1, 2015, to June 30, 2021, we conducted a 1:1 matched case-control, retrospective study. Patients Patients who underwent a T-SPOT.TB test at Chiba University Hospital. Results The study included 5,956 participants. Indeterminate results were found in 63 participants (1.1%), including high nil-control in 37 and low mitogen-control in 26. Human T-cell leukemia virus type 1 (HTLV-1) positivity was the only influencing factor associated with high nil-control (adjusted odds ratio=98.5, 95% confidence interval: 6.59-1,480). Conclusion Regarding the indeterminate results, all HTLV-1 positive participants had a high nil response and no low mitogen response. It was suspected that abnormally produced interferon γ caused a nonspecific reaction to the negative control well, resulting in a high nil response. Low mitogen-control, conversely, did not appear to have any statistically significant influential factors.
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Affiliation(s)
- Yoriko Herai
- Division of Infection Control, Chiba University, Japan
| | - Misuzu Yahaba
- Division of Infection Control, Chiba University, Japan
| | | | - Shota Murata
- Division of Laboratory Medicine, Chiba University Hospital, Japan
| | - Hitoshi Chiba
- Division of Infection Control, Chiba University, Japan
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Kim KJ, Ryu SE, Lee HN, Oh SH, Chang CL. Evaluation of a New Chemiluminescent Immunoassay-Based Interferon-Gamma Release Assay for Detection of Latent Tuberculosis Infection. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1734. [PMID: 37893452 PMCID: PMC10608617 DOI: 10.3390/medicina59101734] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/20/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: This study aimed to evaluate the performance of a new chemiluminescent immunoassay-based tuberculosis (TB) interferon-gamma release assay (IGRA), AdvanSureI3 TB-IGRA (LG Chem Ltd., Seoul, Republic of Korea), for detecting latent tuberculosis infection in comparison with T-SPOT.TB (Oxford Immunotec, Oxford, UK). Materials and Methods: Between June 2021 and December 2021, 125 non-duplicate blood specimens were collected from adult volunteers; each subject received both tests concurrently. Total agreement and Cohen's kappa coefficient (κ) were used to calculate concordance. The Jonckheere-Terpstra test was used to examine the correlation between interferon-gamma (IFN-γ) levels in AdvanSureI3 TB-IGRA and spot counts in T-SPOT.TB. Results: The IGRA findings of the two assays revealed 90.8% (95% confidence interval [CI] = 84.2-94.8) total agreement with κ of 0.740 (95% CI = 0.595-0.885), showing substantial agreement between the two tests. Additionally, the amount of IFN-γ in AdvanSureI3 TB-IGRA increased with the spot counts in T-SPOT.TB (p < 0.001). Conclusions: Our research revealed that the results of the AdvanSureI3 TB-IGRA were comparable to those of T-SPOT.TB.
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Affiliation(s)
- Keun Ju Kim
- Department of Laboratory Medicine, Korea University College of Medicine, Seoul 02841, Republic of Korea;
- Department of Laboratory Medicine, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea;
| | - Seong-Eun Ryu
- Department of Laboratory Medicine, Pusan National University Hospital, Busan 49241, Republic of Korea;
| | - Ha-Na Lee
- Department of Laboratory Medicine, School of Medicine, Pusan National University, Yangsan 50612, Republic of Korea;
| | - Seung-Hwan Oh
- Department of Laboratory Medicine, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea;
- Department of Laboratory Medicine, School of Medicine, Pusan National University, Yangsan 50612, Republic of Korea;
| | - Chulhun L. Chang
- Department of Laboratory Medicine, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea;
- Department of Laboratory Medicine, School of Medicine, Pusan National University, Yangsan 50612, Republic of Korea;
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A Fatal Case of Concurrent Disseminated Tuberculosis, Pneumocystis Pneumonia, and Bacterial Septic Shock in a Patient with Rheumatoid Arthritis Receiving Methotrexate, Glucocorticoid, and Tocilizumab: An Autopsy Report. Case Rep Rheumatol 2021; 2021:7842049. [PMID: 34532148 PMCID: PMC8440108 DOI: 10.1155/2021/7842049] [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: 05/17/2021] [Accepted: 08/30/2021] [Indexed: 12/02/2022] Open
Abstract
Recently, treatment for rheumatoid arthritis has dramatically improved but increases the risk of bacterial and opportunistic infections. Herein, we report a fatal case of concurrent disseminated tuberculosis, pneumocystis pneumonia, and septic shock due to pyelonephritis caused by extended-spectrum β-lactamase-producing Escherichia coli in a patient with rheumatoid arthritis who received methotrexate, glucocorticoid, and tocilizumab. Despite undergoing intensive treatment, the patient developed respiratory failure and died after 7 days of admission. An autopsy indicated that pulmonary tuberculosis were the ultimate causes of death, while pyelonephritis was controlled.
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Scordo JM, Aguillón-Durán GP, Ayala D, Quirino-Cerrillo AP, Rodríguez-Reyna E, Joya-Ayala M, Mora-Guzmán F, Ledezma-Campos E, Villafañez A, Schlesinger LS, Torrelles JB, Turner J, Restrepo BI. Interferon Gamma Release Assays for Detection of Latent Mycobacterium tuberculosis in Elderly Hispanics. Int J Infect Dis 2021; 111:85-91. [PMID: 34389503 PMCID: PMC8540394 DOI: 10.1016/j.ijid.2021.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 11/28/2022] Open
Abstract
Background: Interferon gamma release assays (IGRAs) are used to detect latent Mycobacterium tuberculosis (M.tb) infection (LTBI) in adults, but their performance in older people is not well-established. We evaluated IGRAs for LTBI detection in older Hispanic recent TB contacts (ReC) or community controls (CoC). Methods: Cross-sectional assessment of LTBI with T-SPOT.TB and/or QuantiFERON-Gold in-tube or –Plus assay in older (≥60 years) and adult (18–50 years) Hispanic people. Results: We enrolled 193 CoC (119 adults, 74 older persons) and 459 ReC (361 adults, 98 older persons). LTBI positivity increased with age in CoC (19%–59%, P<0.001), but was similar in ReC (59%–69%, P=0.329). Older people had lower concordance between IGRAs (kappa 0.465 vs 0.688 in adults) and more inconclusive results (indeterminate/borderline 11.6% vs 5.8% in adults, P=0.012). With simultaneous IGRAs, inconclusive results were resolved as positive or negative with the other IGRA. The magnitude of response to M.tb peptides in IGRAs was similar among age groups, but responsiveness to mitogens was lower in older people. Conclusions: IGRAs are suitable for LTBI detection in older people. Discordant and inconclusive findings are more prevalent in older people, but results are resolved when IGRA is repeated with a different IGRA test.
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Affiliation(s)
- Julia M Scordo
- Host-Pathogen Interactions and Population Health Programs, Texas Biomedical Research Institute, San Antonio, TX, USA; The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Génesis P Aguillón-Durán
- Secretaria de Salud de Tamaulipas, Reynosa 88630, Matamoros 87370 and Ciudad Victoria 87000, Tamaulipas, México
| | - Doris Ayala
- University of Texas Health Science Center at Houston, School of Public Health, Brownsville campus, Brownsville, TX 78520, USA
| | - Ana Paulina Quirino-Cerrillo
- University of Texas Health Science Center at Houston, School of Public Health, Brownsville campus, Brownsville, TX 78520, USA
| | - Eminé Rodríguez-Reyna
- Secretaria de Salud de Tamaulipas, Reynosa 88630, Matamoros 87370 and Ciudad Victoria 87000, Tamaulipas, México
| | - Mateo Joya-Ayala
- University of Texas Health Science Center at Houston, School of Public Health, Brownsville campus, Brownsville, TX 78520, USA
| | - Francisco Mora-Guzmán
- Secretaria de Salud de Tamaulipas, Reynosa 88630, Matamoros 87370 and Ciudad Victoria 87000, Tamaulipas, México
| | - Eder Ledezma-Campos
- Secretaria de Salud de Tamaulipas, Reynosa 88630, Matamoros 87370 and Ciudad Victoria 87000, Tamaulipas, México
| | - Alejandro Villafañez
- Casa Club del Adulto Mayor, Sistema para el Desarrollo Integral de la Familia, Matamoros, Tamaulipas, Mexico
| | - Larry S Schlesinger
- Host-Pathogen Interactions and Population Health Programs, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - Jordi B Torrelles
- Host-Pathogen Interactions and Population Health Programs, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - Joanne Turner
- Host-Pathogen Interactions and Population Health Programs, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - Blanca I Restrepo
- University of Texas Health Science Center at Houston, School of Public Health, Brownsville campus, Brownsville, TX 78520, USA; School of Medicine, South Texas Diabetes and Obesity Institute, University of Texas Rio Grande Valley, Edinburg, TX 78541, USA.
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Sun X, Wan S, Zhang L, Zhang Y, Liu X. Prevalence and influencing factors of the high nil-control spot count in T-SPOT.TB: A matched case-control study. Clin Chim Acta 2018; 487:96-100. [PMID: 30201370 DOI: 10.1016/j.cca.2018.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 08/16/2018] [Accepted: 09/06/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND T-SPOT.TB may yield indeterminate results, including high nil responses and insufficient mitogen responses. We explored the incidence and risk factors of high nil responses. METHODS A 1:1 matched case-control study of patients who underwent T-SPOT.TB tests in Peking Union Medical College Hospital from Jan 1, 2015 to Apr 30, 2017 was conducted. High nil responses were defined as >10 spots in negative control wells. Cases and controls were matched based on when the tests were performed. Demographic, clinical and laboratory data were obtained from the Medical Record System. RESULTS A total of 644 out of 36,316 (1.76%, 95% CI: 1.63%-1.90%) patients presented with high nil responses (280 cases and 280 controls were enrolled). Multivariate analysis revealed that male (OR = 1.882, 95% CI: 1.222-2.899), Behcet's disease (OR = 7.764, 95% CI: 1.714-35.167), heavy use of corticosteroids within a month (OR = 0.357, 95% CI: 0.138-0.921, for >1000 mg group) and hypoalbuminemia (OR = 0.385, 95% CI: 0.241-0.615) are significantly associated with high nil responses. CONCLUSIONS High nil responses in T-SPOT.TB assays are quite rare. Male gender and Behcet's disease are suggested as independent risk factors, while recent excessive use of corticosteroids and hypoalbuminemia seem to be independent protective factors.
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Affiliation(s)
- Xiaochuan Sun
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shijun Wan
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Lifan Zhang
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; Clinical Epidemiology Unit, International Clinical Epidemiology Network (INCLEN), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; Centre for Tuberculosis Research, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yueqiu Zhang
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiaoqing Liu
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; Clinical Epidemiology Unit, International Clinical Epidemiology Network (INCLEN), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; Centre for Tuberculosis Research, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
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Pan L, Jia H, Liu F, Sun H, Gao M, Du F, Xing A, Du B, Sun Q, Wei R, Gu S, Zhang Z. Risk factors for false-negative T-SPOT.TB assay results in patients with pulmonary and extra-pulmonary TB. J Infect 2015; 70:367-80. [DOI: 10.1016/j.jinf.2014.12.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 11/28/2014] [Accepted: 12/01/2014] [Indexed: 10/24/2022]
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Xie X, Li F, Chen JW, Wang J. Risk of tuberculosis infection in anti-TNF-α biological therapy: from bench to bedside. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2013; 47:268-74. [PMID: 23727394 DOI: 10.1016/j.jmii.2013.03.005] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 01/08/2013] [Accepted: 03/19/2013] [Indexed: 02/08/2023]
Abstract
Anti-tumor necrosis factor-α (TNF-α) biological agents, including soluble TNF-α receptors and anti-TNF-α monoclonal antibodies, bring new hope for treating rheumatic diseases such as rheumatoid arthritis, but also increase the risk of infection, especially tuberculosis (TB) infection. Recent findings have shown that the physiological TNF-mediated signaling was somehow impaired by TNF antagonists, leading to the exacerbation of chronic infection associated with aberrant granuloma formation and maintenance. Although both receptor and antibody agents appear to pose an equally high risk in causing development of new TB infections, monoclonal anti-TNF-α antibody seems more inclined to reactivate latent TB infection. This review is focused on the underlying mechanisms that cause the TB risk in the anti-TNF-α therapy and also the strategies to deal with it, with the aim of reducing the TB incidence during anti-TNF-α biological therapies.
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Affiliation(s)
- Xi Xie
- Department of Rheumatology and Clinical Immunology, The Second Xiangya Hospital of Center South University, Changsha, Hunan 410011, China
| | - Fen Li
- Department of Rheumatology and Clinical Immunology, The Second Xiangya Hospital of Center South University, Changsha, Hunan 410011, China.
| | - Jin-Wei Chen
- Department of Rheumatology and Clinical Immunology, The Second Xiangya Hospital of Center South University, Changsha, Hunan 410011, China
| | - Jia Wang
- Department of Rheumatology and Clinical Immunology, The Second Xiangya Hospital of Center South University, Changsha, Hunan 410011, China
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Delgado Naranjo J, Castells Carrillo C, García Calabuig MÁ, Sáez López I. [Comparative performance of QuantiFERON(®)-TB Gold IT versus tuberculin skin test among contact investigations for latent tuberculosis infection]. Med Clin (Barc) 2011; 137:289-96. [PMID: 21524761 DOI: 10.1016/j.medcli.2010.11.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 11/28/2010] [Accepted: 11/30/2010] [Indexed: 10/17/2022]
Abstract
BACKGROUND AND OBJECTIVE Until recently, the only tool for detection of latent tuberculosis infection (LTI) was the tuberculin skin test (PPD). QuantiFERON(®)-TB Gold In-Tube (QF), as well as other Mycobacterium tuberculosis-specific interferon-γ release assays (IGRAs), appears to be an alternative or adjunct to the PPD. The goal of the study was to compare QF with PPD to evaluate de accuracy of QF for routinely identifying LTI in contact investigations. PATIENTS AND METHOD We performed a descriptive and prospective study with contacts of culture-confirmed tuberculosis source cases in Bizkaia and Araba from May 2007 through February 2008 who underwent QF and PPD. Concordance between both tests was analyzed using the kappa statistic (κ). RESULTS 376 contacts were found: 8 were high-risk children (age < 15), 30 low-medium risk children, 46 high-risk adults (age>14) and 270 low-medium risk adults. PPD was positive in 160 subjects (42.5%) at PPD ≥ 5mm, 141 (37.5%) at PPD ≥ 10mm and 95 (25.3%) at PPD ≥ 15 mm. In QF analysis 94 subjects were positive, 279 negative and 3 indeterminate. Overall agreement between QF and PPD was good at PPD ≥ 10mm (κ=0.53; p<0.0001) but agreement was poor when the index case had positive baciloscopy at PPD ≥ 5mm (κ=0.28; p<0.001) and high-risk contacts at PPD ≥ 15 mm (κ=0.048; p=0.36). CONCLUSIONS IGRAs are an accurate indicator of LTI, providing a more specific way of diagnostic and reducing the number of subjects to be treated. QF appears to be a valuable public health tool with potential advantages over the PPD and improving resources.
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Affiliation(s)
- Jesús Delgado Naranjo
- Servicio de Medicina Preventiva, Hospital de Cruces, Servicio Vasco de Salud OSAKIDETZA, Baracaldo, Bizkaia, España.
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Lee JN, Ryu DY, Park SH, You HS, Lee BE, Kim DU, Kim TO, Heo J, Kim GH, Song GA, Kim S, Park DY. [The usefulness of in vitro interferon-gamma assay for differential diagnosis between intestinal tuberculosis and Crohns disease]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2010; 55:376-83. [PMID: 20571305 DOI: 10.4166/kjg.2010.55.6.376] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND/AIMS It is difficult to clinically and endoscopically differentiate intestinal tuberculosis (ITB) and Crohns disease (CD). The aim of this study was to evaluate the usefulness of in vitro interferon-gamma (INF-gamma) assay for differential diagnosis between ITB and CD. METHODS Sixty patients for whom differential diagnosis between ITB and CD was difficult were enrolled between January 2007 and January 2009. The INF-gamma-producing T-cell response to early secreted antigenic target 6 and culture filtrate protein 10 were measured by T-SPOT.TB blood test in vitro. We evaluated the usefulness of T-SPOT.TB blood test by comparing its results with the final diagnosis. RESULTS Twenty and forty patients were revealed to be positive and negative in T-SPOT.TB blood test, respectively. Of the 20 patients found to be positive, 12 patients (60%) were finally diagnosed as ITB, 6 patients as CD, and 2 patients as Behcets enterocolitis. Of the 40 patients with negative results, 38 patients (95%) were diagnosed as CD; one as Behcets enterocolitis; one as nonspecific colitis; none as ITB. The sensitivity and specificity of T-SPOT.TB blood test for ITB were 100% and 83.3%, respectively. Positive and negative predictive values of T-SPOT.TB blood test for ITB were 60.0% and 100%, respectively. CONCLUSIONS When differential diagnosis between ITB and CD is difficult, T-SPOT.TB blood test may be a helpful and rapid diagnostic tool to exclude ITB. Prospective large-scaled studies are required for further evaluation of the usefulness of T-SPOT.TB blood test for differential diagnosis between ITB and CD.
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Affiliation(s)
- Jung Nam Lee
- Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea
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Use of a T cell interferon gamma release assay in the investigation for suspected active tuberculosis in a low prevalence area. BMC Infect Dis 2009; 9:105. [PMID: 19575781 PMCID: PMC2713243 DOI: 10.1186/1471-2334-9-105] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2008] [Accepted: 07/03/2009] [Indexed: 11/22/2022] Open
Abstract
Background In settings with low background prevalence of tuberculosis (TB) infection, interferon-γ release assays (IGRA) could be useful for diagnosing active TB. This study aims to evaluate the performance of QuantiFERON®-TB Gold (QFT-G) in the investigation for suspected active TB, with particular attention to patients originating in high-incidence countries. Furthermore, factors associated with QFT-G results in patients with active TB were assessed. Methods From patients investigated for clinically suspected active TB, blood was obtained for QFT-G testing, in addition to routine investigations. Positive (PPV) and negative (NPV) predictive values for QFT-G were calculated, comparing patients with confirmed TB and those with other final diagnoses. QFT-G results in TB patients originating from countries with intermediate or high TB incidence were compared with QFT-G results from a control group of recently arrived asymptomatic immigrants from high-incidence countries. Factors associated with QFT-G outcome in patients with confirmed TB were assessed. Results Among 141 patients, 41/70 (58.6%) with confirmed TB had a positive QFT-G test, compared to 16/71 (22.6%) patients with other final diagnoses, resulting in overall PPV of 71.9% and NPV of 67.6%. For patients with pulmonary disease, PPV and NPV were 61.1% and 67.7%, respectively, and 90.5% and 66.7% for subjects with extrapulmonary manifestations. Comparing patients from high-incidence countries with controls yielded a PPV for active TB of 76.7%, and a NPV of 82.7%. Patients with confirmed TB and positive QFT-G results were characterized by a lower median peripheral white blood cell count (5.9 × 109/L vs. 8.8 × 109/L; P < 0.001) and a higher median body mass index (22.7 vs. 20.7; P = 0.043) as compared to QFT-G-negative TB patients. Conclusion The overall PPV and NPV of QFT-G for identifying active TB were unsatisfactory, especially for pulmonary disease. Thus, the usefulness of QFT-G for this purpose is questionable. However, a high PPV was observed for extrapulmonary TB and QFT-G might be considered in the diagnostic process in this situation. The PPV and NPV for identifying active TB among persons originating from regions with high-and intermediate TB incidence was similar to that observed in subjects originating in the low-incidence region.
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