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Seo YJ, Oh I, Nam M, Shin S, Roh EY, Song EY. Comparison of Four T-cell Assays and Two Binding Antibody Assays in SARS-CoV-2 Vaccinees With or Without Omicron Breakthrough Infection. Ann Lab Med 2023; 43:596-604. [PMID: 37387492 DOI: 10.3343/alm.2023.43.6.596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 04/05/2023] [Accepted: 06/09/2023] [Indexed: 07/01/2023] Open
Abstract
Background Several T-cell response assays for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are available; however, their comparability and correlations with antibody responses remain unclear. We compared four SARS-CoV-2 T-cell response assays and two anti-SARS-CoV-2 spike antibody assays. Methods We enrolled 89 participants who had received a booster dose of the BNT162b2 vaccine after two doses of the ChAdOx1 or BNT162b2 vaccine. Fifty-six participants without breakthrough infection (BI) (ChAdOx1/BNT162b2 group: N=27; BNT162b2 group: N=29) and 33 with BI were included. We evaluated two whole-blood interferon-gamma release assays (IGRAs) (QuantiFERON and Euroimmun), T-SPOT.COVID, an in-house enzyme-linked immunospot (ELISPOT) assay (targeting the spike and nucleocapsid peptides of wild-type and Omicron SARS-CoV-2), Abbott IgG II Quant, and Elecsys Anti-S, using Mann-Whitney U, Wilcoxon signed-rank, and Spearman's correlation tests. Results The correlations between the IGRAs and between the ELISPOT assays (ρ=0.60-0.70) were stronger than those between the IGRAs and ELISPOT assays (ρ=0.33-0.57). T-SPOT.COVID showed a strong correlation with Omicron ELISPOT (ρ=0.70). The anti-spike antibody assays showed moderate correlations with T-SPOT.COVID, Euroimmun IGRA, and ELISPOT (ρ=0.43-0.62). Correlations tended to be higher in the BI than in the noninfected group, indicating that infection induces a stronger immune response. Conclusions T-cell response assays show moderate to strong correlations, particularly when using the same platform. T-SPOT.COVID exhibits potential for estimating immune responses to the Omicron variant. To accurately define SARS-CoV-2 immune status, both T-cell and B-cell response measurements are necessary.
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Affiliation(s)
- Yeon Ju Seo
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Laboratory Medicine, College of Medicine, Seoul National University, Seoul, Korea
| | - Inseong Oh
- Department of Laboratory Medicine, College of Medicine, Seoul National University, Seoul, Korea
| | - Minjeong Nam
- Department of Laboratory Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Sue Shin
- Department of Laboratory Medicine, College of Medicine, Seoul National University, Seoul, Korea
- Department of Laboratory Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Eun Youn Roh
- Department of Laboratory Medicine, College of Medicine, Seoul National University, Seoul, Korea
- Department of Laboratory Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Eun Young Song
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Laboratory Medicine, College of Medicine, Seoul National University, Seoul, Korea
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Saad Albichr I, Mzougui S, Devresse A, Georgery H, Goffin E, Kanaan N, Yombi JC, Belkhir L, De Greef J, Scohy A, Rodriguez-Villalobos H, Kabamba-Mukadi B. Evaluation of a commercial interferon-γ release assay for the detection of SARS-CoV-2 T-cell response after vaccination. Heliyon 2023; 9:e17186. [PMID: 37325456 PMCID: PMC10256590 DOI: 10.1016/j.heliyon.2023.e17186] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 06/17/2023] Open
Abstract
Objective Evidence regarding the role of cellular immunity in protecting against COVID-19 is emerging. To better assess immune status, simple and robust assays measuring specific T-cell responses associated with humoral responses are needed. We aimed to evaluate the Quan-T-Cell SARS-CoV-2 test for measuring cellular immune responses in vaccinated healthy and immunosuppressed subjects. Methods T-cell responses were assessed in healthy vaccinated and unvaccinated and unexposed healthcare workers to determine the sensitivity and specificity of the EUROIMMUN SARS-CoV-2 Quan-T-Cell IGRA test performed on vaccinated kidney transplant recipients (KTRs). Results The EUROIMMUN SARS-CoV-2 Quan-T-Cell IGRA test showed good sensitivity (87.2%) and specificity (92.3%) at the calculated 147 mIU/mL cutoff, with an 88.33% accuracy. In KTRs, specific cellular immunity was lower than the antibody response; however, those with a positive IGRA result produced as much IFN-γ as healthy individuals. Conclusions The EUROIMMUN SARS-CoV-2 Quan-T-Cell IGRA test showed good sensitivity and specificity for the detection of specific T-cell responses against the SARS-CoV-2 spike protein. These results present an additional tool for better management of COVID-19, especially in vulnerable populations.
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Affiliation(s)
- Imane Saad Albichr
- Department of Microbiology, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - Samy Mzougui
- Department of Microbiology, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - Arnaud Devresse
- Department of Nephrology, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
- Institut de Recherche Clinique et Expérimentale, Université Catholique de Louvain, Brussels, Belgium
| | - Hélène Georgery
- Department of Nephrology, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - Eric Goffin
- Department of Nephrology, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - Nada Kanaan
- Department of Nephrology, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - Jean Cyr Yombi
- Department of Internal Medicine and Infectious Disease, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - Leila Belkhir
- Department of Internal Medicine and Infectious Disease, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - Julien De Greef
- Department of Internal Medicine and Infectious Disease, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - Anaïs Scohy
- Department of Microbiology, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | | | - Benoît Kabamba-Mukadi
- Department of Microbiology, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
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Castro-Lima VAC, Santos APT, Musqueira PT, Maluf NZ, Ramos JF, Mariano L, Rocha V, Costa SF. Prevalence of latent Mycobacterium tuberculosis infection in hematopoietic stem cell transplantation comparing tuberculin skin test and interferon-gamma release assay. Eur J Clin Microbiol Infect Dis 2023:10.1007/s10096-023-04613-w. [PMID: 37126131 DOI: 10.1007/s10096-023-04613-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 04/25/2023] [Indexed: 05/02/2023]
Abstract
The aim of this study was to evaluate the prevalence of latent Mycobacterium tuberculosis infection in hematopoietic stem cell transplantation candidates, using tuberculin skin test and QuantiFERON-TB Gold-Plus, in a high-burden tuberculosis country. Adult candidates for hematopoietic stem cell transplantation performed both tests before and those submitted to transplantation were followed up for 12 months. The prevalence of latent Mycobacterium tuberculosis infection was 17.1% and a moderate agreement between QuantiFERON-TB Gold-Plus and tuberculin skin test was observed in this population. Previous tuberculosis exposure was a risk factor for latent Mycobacterium tuberculosis infection. No cases of tuberculosis were diagnosed during follow-up period.
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Affiliation(s)
- Victor A C Castro-Lima
- Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, São Paulo, SP, 470, Brazil.
| | - Ana Paula T Santos
- Divisão de Laboratório Central, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Priscila T Musqueira
- Serviço de Hematologia, Hemoterapia e Terapia Celular, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Natalya Z Maluf
- Divisão de Laboratório Central, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Jéssica F Ramos
- Serviço de Hematologia, Hemoterapia e Terapia Celular, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Lívia Mariano
- Serviço de Hematologia, Hemoterapia e Terapia Celular, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Vanderson Rocha
- Serviço de Hematologia, Hemoterapia e Terapia Celular, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Silvia F Costa
- Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, São Paulo, SP, 470, Brazil
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Shlomi D, Galor I, More A, Oberman B, Fireman L. Latent tuberculosis infection prevalence in second generation immigrants from high to low TB burden countries. Pulmonology 2023; 29:124-129. [PMID: 33408042 DOI: 10.1016/j.pulmoe.2020.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 11/14/2020] [Accepted: 12/09/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Latent tuberculosis infection (LTBI) diagnosis in a country with a low tuberculosis burden is complicated. Since the prevalence of LTBI in second generation immigrants has not been well recognized, we conducted a cross-sectional study which aimed to explore the differences in LTBI prevalence between offspring of immigrants from high tuberculosis (TB) burden countries and those whose parents were born in countries with a low TB burden. METHODS Between May 2014 and April 2018 young native Israelis who were required to perform pre-occupational tuberculin skin tests (TST) (medical and paramedical personnel or teaching assistants of immigrants from high TB burden countries) and who had a TST result of 10mm and above were tested for QuantiFERON-TB In Tube (QFT-GIT). Statistical comparisons were made between second generation immigrants and those with both parents from a low TB burden country. RESULTS Of 102 patients, 71 were born to parents both of whom were from low-risk countries, 14 to one parent from a high-risk country and 17 to parents both of whom were from a high-risk country. The odds ratio for LTBI was 4.5 (95% CI, 1.2...17.2; p=0.03) if both parents were born in a high-risk country compared to both parents being from a low-risk country and 4.01 (95% CI, 1.12...14.3; p=0.03) higher compared to persons for whom at least one parent was born in a low-risk country. CONCLUSION The risk for latent TB is significantly higher in second generation immigrants if both parents were born in a high-risk country. IGRA should be considered before treatment to patients with a positive TST if at least one parent was born in a low-risk country in order to confirm LTBI.
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Affiliation(s)
- D Shlomi
- Adelson School of Medicine, Ariel University, Ariel, Israel; Clalit Health Services, Dan- Petah-Tiqwa District, Israel.
| | - I Galor
- Israel Defense Forces Medical Corps, Israel
| | - A More
- The Obstetric and Gynecology Division, Delivery Room Department, Assaf Harofeh Medical Center, Israel
| | - B Oberman
- The Gertner Institute for Epidemiology and Health Policy Research, Tel-HaShomer, Israel
| | - L Fireman
- The Laboratory of Pulmonary and Allergic Diseases,Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
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Sachdeva K, Kumar P, Kante B, Vuyyuru SK, Mohta S, Ranjan MK, Singh MK, Verma M, Makharia G, Kedia S, Ahuja V. Interferon-gamma release assay has poor diagnostic accuracy in differentiating intestinal tuberculosis from Crohn's disease in tuberculosis endemic areas. Intest Res 2022; 21:226-234. [PMID: 35686294 PMCID: PMC10169514 DOI: 10.5217/ir.2022.00010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/27/2022] [Indexed: 11/05/2022] Open
Abstract
Background/Aims Intestinal tuberculosis (ITB) and Crohn's disease (CD) frequently present with a diagnostic dilemma because of similar presentation. Interferon-gamma release assay (IGRA) has been used in differentiating ITB from CD, but with sparse reports on its diagnostic accuracy in tuberculosis endemic regions and this study evaluated the same. Methods Patients with definitive diagnosis of ITB (n=59) or CD (n=49) who underwent IGRA testing (n=307) were retrospectively included at All India Institute of Medical Sciences, New Delhi (July 2014 to September 2021). CD or ITB was diagnosed as per standard criteria. IGRA was considered positive at >0.35 IU/mL. Relevant data was collected and IGRA results were compared between ITB and CD to determine its accuracy. Results Among 59 ITB patients (mean age, 32.6±13.1 years; median disease duration, 1 year; male, 59.3%), 24 were positive and 35 tested negative for IGRA. Among 49 CD patients (mean age, 37.8±14.0; median disease duration, 4 years; male, 61.2%), 12 were positive and 37 tested negative for IGRA. Hence, for diagnosing ITB, IGRA showed a sensitivity, specificity, positive and negative predictive values of 40.68%, 75.51%, 66.67%, and 51.39%, respectively. The area under the curve of IGRA for ITB diagnosis was 0.66 (95% confidence interval, 0.55-0.75). In a subset (n=64), tuberculin skin test (TST) showed sensitivity, specificity, positive and negative predictive values of 64.7%, 73.3%, 73.3%, and 64.71%, respectively. IGRA and TST were concordant in 38 (59.4%) patients with κ=0.17. Conclusions In a tuberculosis endemic region, IGRA had poor diagnostic accuracy for differentiating ITB from CD, suggesting a limited value of IGRA in this setting.
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Affiliation(s)
- Karan Sachdeva
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Peeyush Kumar
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Bhaskar Kante
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Sudheer K Vuyyuru
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Srikant Mohta
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Mukesh K Ranjan
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Mukesh K Singh
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Mahak Verma
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Govind Makharia
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Kedia
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Vineet Ahuja
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
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İlgen U, Karadağ Ö, Emmungil H, Küçükşahin O, Koca SS, Erden A, Bes C, Alpay Kanıtez N, Dalkılıç E, Akar S, Mercan R, Çınar M, Kaşifoğlu T, Gönüllü E, Kimyon G, Ersözlü D, Atagündüz P, Kılıç L, Ertenli İ, Yazısız V, Ateş A, Kiraz S, Kalyoncu U. Tuberculin skin test before biologic and targeted therapies: does the same rule apply for all? Rheumatol Int 2022. [PMID: 35486197 DOI: 10.1007/s00296-022-05134-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 04/05/2022] [Indexed: 10/18/2022]
Abstract
This study aimed to compare Tuberculin Skin Test (TST) and QuantiFERON®-TB Gold In-Tube (QFT-GIT) test in rheumatoid arthritis (RA) and spondyloarthritis (SpA) patients scheduled for biological and targeted synthetic disease modifying anti-rheumatic drugs (DMARDs) in a Bacillus Calmette-Guérin-vaccinated population. Adult RA (n = 206) and SpA (n = 392) patients from the TReasure database who had both TST and QFT-GIT prior to initiation of biological and targeted synthetic DMARDs were included in the study. Demographic and disease characteristics along with pre-biologic DMARD and steroid use were recorded. The distribution of TST and performance with respect to QFT-GIT were compared between RA and SpA groups. Pre-biologic conventional DMARD and steroid use was higher in the RA group. TST positivity rates were 44.2% in RA and 69.1% in SpA for a 5 mm cutoff (p < 0.001). Only 8.9% and 15% of the patients with RA and SpA, respectively, tested positive by QFT-GIT. The two tests poorly agreed in both groups at a TST cutoff of 5 mm and increasing the TST cutoff only slightly increased the agreement. Among age, sex, education and smoking status, pre-biologic steroid and conventional DMARD use, disease group, and QFT-GIT positivity, which were associated with a 5 mm or higher TST, only disease group (SpA) and QFT-GIT positivity remained significant in multiple logistic regression. TST positivity was more pronounced in SpA compared to that in RA and this was not explainable by pre-biologic DMARD and steroid use. The agreement of TST with QFT-GIT was poor in both groups. Using a 5 mm TST cutoff for both diseases could result in overestimating LTBI in SpA.
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Bommart S, Charriot J, Nagot N, Vernhet-Kovacsik H, Revel MP, Boissin C, Bourdin A, Tuaillon E. Differentiating between active and latent tuberculosis with chest computed tomography. Diagn Interv Imaging 2021; 102:605-610. [PMID: 34183300 DOI: 10.1016/j.diii.2021.05.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/08/2021] [Accepted: 05/28/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the capabilities of chest computed tomography (CT) in distinguishing between active and latent tuberculosis in patients positive for interferon-gamma release assay (IGRA) testing, and to compare the performance of CT with that of quantitative IGRA testing in a low incidence setting. MATERIALS AND METHODS Patients with latent or active tuberculosis define by an IGRA positive test were retrospectively recruited. Sensitivity, specificity and accuracy were determined for CT variables and quantitative IGRA results. Final diagnosis of active tuberculosis was based on clinical data and microbiological culture. Univariable and multivariable analyses were performed using logistic regression model to identify CT variables associated with the diagnosis of active tuberculosis. RESULTS A total of 92 patients with positive IGRA results who underwent CT examination were included. There were 54 men and 38 women with a mean age of 53.5±18 (SD) years (range: 40-68 years). Of them, 22 patients (24%) had positive Mycobacterium tuberculosis culture and 70 (76%) had latent tuberculosis. Among CT variables, consolidation had the greatest sensitivity (77%; 95%CI: 60-95%) and "tree-in-bud" the greatest specificity (97%; 95% CI: 93-100%) for the diagnosis of active tuberculosis. At univariable analysis "tree-in-bud", splenic calcification and non-calcified lung nodules were the significant variables independently associated with active tuberculosis. At multivariable analysis, the adjusted odds ratio of "tree-in-bud" was 42.91 (95% CI: 5.62-327.42). Using an optimal threshold of 51 spots, quantitative IGRA yielded 64% sensitivity (95% CI: 44-84%) and 61% specificity (95% CI: 50-73%) for the diagnosis of active tuberculosis. CONCLUSIONS In a low incidence setting, chest CT, especially when "tree-in-bud" pattern is present, is superior to quantitative IGRA testing to identify patients with active tuberculosis among those with positive IGRA testing.
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Affiliation(s)
- Sébastien Bommart
- Department of Radiology, CHU Montpellier, avenue Doyen Gaston Giraud, 34000 Montpellier, France; PhyMedExp Inserm U1046, UMR9214 CNRS, 34000 Montpellier, France.
| | - Jeremy Charriot
- PhyMedExp Inserm U1046, UMR9214 CNRS, 34000 Montpellier, France; Department of Respiratory Diseases, CHU Montpellier, 34000 Montpellier, France
| | - Nicolas Nagot
- Department of Biostatistics, CHU Montpellier, 34000 Montpellier, France
| | - Hélène Vernhet-Kovacsik
- Department of Radiology, CHU Montpellier, avenue Doyen Gaston Giraud, 34000 Montpellier, France
| | - Marie P Revel
- Department of Radiology, Cochin Hospital, Assistance Publique-Hopitaux de Paris, 75014 Paris, France; Université de Paris, Faculté de Médecine, 75006 Paris, France
| | - Clément Boissin
- Department of Respiratory Diseases, CHU Montpellier, 34000 Montpellier, France
| | - Arnaud Bourdin
- PhyMedExp Inserm U1046, UMR9214 CNRS, 34000 Montpellier, France; Department of Respiratory Diseases, CHU Montpellier, 34000 Montpellier, France
| | - Edouard Tuaillon
- UMR1058 Inserm, 34000 Montpellier, France; Department of Bacteriology-Virology, CHU Montpellier, 34000 Montpellier, France
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Lee HH, Choi DH, Kim JR, Kim YG, Jo KW, Shim TS. Evaluation of a lateral flow assay-based IFN-γ release assay as a point-of-care test for the diagnosis of latent tuberculosis infection. Clin Rheumatol 2021; 40:3773-3781. [PMID: 33666781 DOI: 10.1007/s10067-021-05663-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/16/2021] [Accepted: 02/18/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION We compared the performance of a fluorescence lateral flow assay (ichroma™ IGRA-TB) with the QuantiFERON-TB Gold PLUS (QFT-PLUS) for the diagnosis of latent tuberculosis infection (LTBI) in patients with immune-mediated inflammatory diseases (IMID) prior to receiving biologics therapy. METHOD The comparability of the ichroma™ IGRA-TB assay with the QFT-PLUS assay for the diagnosis of LTBI was determined in prospectively enrolled patients with IMID prior to receiving biologics between August 2018 and October 2019. To determine the best cut-off value of the ichroma™ IGRA-TB, an ROC curve analysis was performed. RESULTS Patients with IMID (n = 145) had inflammatory bowel disease (n = 83; 57.2%), rheumatoid arthritis (n = 44; 30.3%), or spondyloarthropathy (n = 18; 12.4%). The median age was 40.5 (interquartile range: 27.0-56.0), 72 (49.7%) were men, and 140 (96.6%) received BCG vaccination. With the manufacturer-recommended cut-off values, 11 (7.6%) and 20 (13.8%) patients showed positive results with the ichroma™ IGRA-TB and QFT-PLUS tests, respectively. The overall agreement between the two tests was 91.0% with a Cohen's kappa value of 0.535 (95% confidence interval: 0.317-0.754). ROC curve analysis of the QFT-PLUS results showed that a cut-off value of > 0.21 IU/mL would improve the performance of the ichroma™ IGRA-TB. Using the new cut-off value, the concordance rate was improved to 93.1% with a Cohen's kappa value of 0.668 (95% confidence interval: 0.478-0.858). CONCLUSIONS The ichroma™ IGRA-TB could be used as a point-of-care test for LTBI screening in IMID patients before starting biologics, especially in resource-limited settings. Key Points • The ichroma™ IGRA-TB is an automated fluorescence lateral flow assay-based IGRA. • The test has advantages like short turn-around time, low-cost, and ease of use. • The ichroma™ IGRA-TB showed high agreement with the QuantiFERON-TB Gold In-Tube in patients with chronic immune-mediated inflammatory diseases before starting biologics.
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Affiliation(s)
- Hoon Hee Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | | | - Jeong-Ran Kim
- Department of Research and Development, The Korean Institute of Tuberculosis, Cheongju, South Korea
| | | | - Kyung-Wook Jo
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Tae Sun Shim
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
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Tang I, So H, Luk L, Wong V, Pang S, Lao V, Yip R. Comparison of single and dual latent tuberculosis screening strategies before biologic and targeted therapy in patients with rheumatic diseases: a retrospective cohort study. Hong Kong Med J 2020; 26:111-119. [PMID: 32245912 DOI: 10.12809/hkmj198165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
PURPOSE Before biologic and targeted synthetic disease-modifying antirheumatic drug (b/tsDMARD) treatment, latent tuberculosis infection (LTBI) screening by tuberculin skin test (TST) or interferon gamma release assay (IGRA) is recommended. However, both tests have reduced reliability in immunosuppressed patients. We investigated whether dual LTBI screening with both tests could reduce the incidence of tuberculosis. METHODS Consecutive patients receiving b/tsDMARDs for rheumatic diseases in a regional hospital were recruited. All patients underwent either TST/IGRA or both. They were categorised into a single or dual testing group and were followed up for at least 6 months. Isoniazid was prescribed if any one test was positive. RESULTS In total, 217 patients were included in this study; 121 underwent single LTBI testing and 96 underwent dual testing. Tuberculosis occurred in nine patients in the single testing group and one patient in the dual testing group (7.4% vs 1.0%, P=0.045). However, the difference was not statistically significant when follow-up duration was considered (log rank test). In total, 71 patients tested positive for LTBI with isoniazid treatment (28.9% in the single testing group and 45.8% in the dual testing group, P=0.007). Agreement between the IGRA and TST was 74.4% (Cohen's kappa=0.413); agreement was lower in patients receiving prednisolone. Infliximab use was independently associated with tuberculosis (P=0.032). Mild isoniazid-related side-effects occurred in seven patients. CONCLUSIONS Dual LTBI testing with both TST and IGRA is effective and safe. It might be useful for patients receiving prednisolone at the time of LTBI screening, or if infliximab therapy is anticipated.
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Affiliation(s)
- I Tang
- Department of Medicine and Geriatrics, Kwong Wah Hospital, Yaumatei, Hong Kong
| | - H So
- Department of Medicine and Geriatrics, Kwong Wah Hospital, Yaumatei, Hong Kong
| | - L Luk
- Department of Medicine and Geriatrics, Kwong Wah Hospital, Yaumatei, Hong Kong
| | - V Wong
- Department of Medicine and Geriatrics, Kwong Wah Hospital, Yaumatei, Hong Kong
| | - S Pang
- Department of Medicine and Geriatrics, Kwong Wah Hospital, Yaumatei, Hong Kong
| | - V Lao
- Department of Medicine and Geriatrics, Kwong Wah Hospital, Yaumatei, Hong Kong
| | - R Yip
- Tung Wah Group Hospitals Integrated Diagnostic and Medical Centre, Yaumatei, Hong Kong
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Kim SH, Jo KW, Shim TS. QuantiFERON-TB Gold PLUS versus QuantiFERON- TB Gold In-Tube test for diagnosing tuberculosis infection. Korean J Intern Med 2020; 35:383-391. [PMID: 31875668 PMCID: PMC7061006 DOI: 10.3904/kjim.2019.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 03/11/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND/AIMS QuantiFERON-TB Gold PLUS (QFT-PLUS) was developed as a new version of the interferon-γ (IFN-γ) release assay that contains an extra antigen tube to elicit a CD8+ T-cell response in addition to a CD4+ T-cell response. This study aimed to evaluate the performances of QFT-PLUS versus QuantiFERON-TB Gold In-Tube (QFT-GIT) for detecting tuberculosis (TB) infection. METHODS Between October, 2016 and May, 2018, 137 participants were prospectively recruited and subjected to QFT-GIT and QFT-PLUS testing. The concordance between tests and performance based on different immune states and/or TB infection risk were evaluated. RESULTS The 137 participants were classified as follows: active TB (n = 14), TB contact (n = 14), screening before biologic therapy (n = 85) and other disease (n = 24). The positive results for either test were 100% (n = 14/14), 42.9% (n = 6/14), 15.3% (n = 13/85), and 62.5% (n = 15/24) in each four groups, respectively. The QFT-GIT and QFT-PLUS test results showed good concordance with 91.2% agreement and a Cohen's κ of 0.807. The good concordance between two tests was also observed in 64 immunocompromised subjects (agreement of 90.6% and a Cohen's κ of 0.711). The intra-class correlation coefficient for each antigen tube of the QFT-PLUS showed a good correlation with the IFN-γ release of the QFT-GIT (TB1 = 0.912, p < 0.001; TB2 = 0.918, p < 0.001). CONCLUSION QFT-PLUS showed highly comparable results to those of QFT-GIT for diagnosing TB infection in South Korea as well as in immunocompromised subjects.
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Affiliation(s)
- Soo Han Kim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung-Wook Jo
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Sun Shim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Correspondence to Tae Sun Shim, M.D. Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea Tel: +82-2-3010-3892 Fax: +82-2-3010-6968 E-mail:
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11
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Kim T, Lee HJ, Kim SM, Jung JH, Shin S, Kim YH, Sung H, Chong YP, Lee SO, Choi SH, Kim YS, Woo JH, Kim SH, Han DJ. Diagnostic usefulness of the cytomegalovirus (CMV)-specific T cell-based assay for predicting CMV infection after kidney transplant. Korean J Intern Med 2020; 35:438-448. [PMID: 29865778 PMCID: PMC7061014 DOI: 10.3904/kjim.2017.318] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 01/29/2018] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND/AIMS We evaluated the usefulness in kidney transplant (KT) candidates of cytomegalovirus (CMV)-specific enzyme-linked immunospot (ELISPOT) assays for predicting the development of post-transplant CMV infections. METHODS All adult recipients admitted for living-donor KT between March 2014 and March 2015 were prospectively enrolled except donor CMV-seropositive and recipient seronegative (D+/R-) recipients. All the enrolled patients underwent CMV-specific ELISPOT assays before transplant, and a researcher blinded to the results of these assays examined the patients for CMV infection at least 6 months post-transplant. RESULTS Of 133 KT recipients, 44 (33%) developed CMV infections. When we used the cut-off determined by receiver operator characteristic curve, 16 of the 34 patients (47%) with negative pp65-specific ELISPOT results (< 11 spots/200,000 cells) developed CMV infections, whereas 28 of the 99 patients (39%) with positive pp65-specific ELISPOT results at baseline (≥ 11 spots/200,000 cells) developed CMV infections after KT (p = 0.02). Based on the multivariable Cox regression model, negative pp65-specific ELISPOT assay results was an independent risk factor for CMV infection (adjusted hazard ratio [AHR], 1.87; 95% confidence interval [CI], 1.01 to 3.46; p = 0.047) as well as age (AHR, 1.05; 95% CI, 1.01 to 1.08; p = 0.007). CONCLUSION Pre-transplant CMV-specific ELISPOT assay appears to predict the development of CMV infections after KT in recipients at moderate risk such as CMV-seropositive recipients (Clinical Trial Registration Number NCT02025335).
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Affiliation(s)
- Taeeun Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Division of Infectious Diseases, Department of Internal Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Hyun-Jeong Lee
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sun-Mi Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joo Hee Jung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Shin
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Hoon Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Heungsup Sung
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong Pil Chong
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang-Oh Lee
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang-Ho Choi
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yang Soo Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jun Hee Woo
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung-Han Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Correspondence to Sung-Han Kim, M.D. Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea Tel: +82-2-3010-3305 Fax: +82-2-3010-6970 E-mail:
| | - Duck Jong Han
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Uzorka JW, Duinkerk DL, Kroft LJM, Bakker JA, Ramai RSRS, Ottenhoff THM, Arend SM. Trends in diagnostic methods and treatment of latent tuberculosis infection in a tertiary care center from 2000 to 2017. Eur J Clin Microbiol Infect Dis 2020; 39:1329-37. [PMID: 32076881 DOI: 10.1007/s10096-020-03850-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 02/11/2020] [Indexed: 11/17/2022]
Abstract
Screening for latent tuberculosis infection (LTBI) is indicated before immunosuppressive therapies but is complicated by lack of a gold standard and limited by, e.g., immunosuppression. This study aimed to investigate a series of patients diagnosed with LTBI during screening before immunosuppressive therapy, describing how the use of diagnostic tests and treatment evolved over time. This retrospective cohort study included all individuals diagnosed with LTBI during screening before intended immunosuppressive therapy in a tertiary care hospital between January 2000 and December 2017. Evidence for LTBI, including history, tuberculin skin test (TST), QuantiFERON (QFT) result and suggestive lesions on chest radiography (CXR), and CT scan if available, was analyzed. The study included 295 individuals with LTBI, with median follow-up of 3.8 years (IQR 1.7–7.4 years). During screening, TST, QFT, and CXR were positive in 80.8%, 53.4%, and 22.7%, respectively. Chest CT revealed lesions associated with past tuberculosis infection in around 70%, significantly more frequent than CXR. In patients diagnosed with LTBI, we observed that the use of TST declined over time whereas the use of QFT increased, and that isoniazid was replaced with rifampicin as preferential treatment. Preventive treatment was started in 82.3%, of whom 88.6% completed treatment. During follow-up, no individuals developed active tuberculosis. The diagnosis of LTBI was based on history, TST, QFT, and/or CXR in nearly every possible combination, but mostly on TST and QFT. The most striking trends were the decreased use of TST, increased use of QFT, and the replacement of isoniazid with rifampicin for treatment.
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13
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Bae JM. Proposal to Revise the Screening Test for Latent Tuberculosis Infection in Close Contacts at Elementary Schools in Korea. J Prev Med Public Health 2019; 52:272-275. [PMID: 31390691 PMCID: PMC6686106 DOI: 10.3961/jpmph.19.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 05/08/2019] [Indexed: 11/19/2022] Open
Abstract
The 2018 National Guideline for Tuberculosis Control, which was published by the Korea Centers for Diseases Prevention and Control (KCDC), mandates conducting an epidemiological survey among close contacts of active tuberculosis patients at public institutions such as schools. In the procedure for these surveys, the tuberculin skin test (TST) is mandated as the screening test for latent tuberculosis infection in elementary school students. However, several guidelines recommend using the interferon-gamma releasing assay (IGRA) for contacts aged over 5 years with a Bacillus Calmette-Guérin vaccination history. The main reason for this is that IGRA has a higher specificity and lower false positive rate than TST. In addition, IGRA requires only a single visit to draw blood and the results are available within 24 hours. These advantages could promote cooperation from both parents and students in conducting these surveys. Thus, these findings regarding the benefits of IGRA for surveys of close contacts at elementary schools should be incorporated into the KCDC guideline.
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Affiliation(s)
- Jong-Myon Bae
- Department of Preventive Medicine, Jeju National University School of Medicine, Jeju, Korea
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14
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Pyo J, Cho SK, Kim D, Sung YK. Systemic review: agreement between the latent tuberculosis screening tests among patients with rheumatic diseases. Korean J Intern Med 2018; 33:1241-1251. [PMID: 29277097 PMCID: PMC6234384 DOI: 10.3904/kjim.2016.222] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 11/16/2016] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS To estimate the level of agreement and positivity rates of latent tuberculosis infection (LTBI) tests prior to the use of tumor necrosis factor (TNF) inhibitors in relation to underlying rheumatic diseases and endemic tuberculosis levels. METHODS The Ovid-Medline, Embase, and Cochrane Libraries were searched for articles before October 2013 involving LTBI screening in rheumatic patients, including rheumatoid arthritis (RA), ankylosing spondylitis (AS), juvenile idiopathic arthritis (JIA), and psoriatic arthritis. RESULTS In pooled analyses, 5,224 rheumatic patients had undergone both a tuberculin skin test (TST) and an interferon-gamma release assay (IGRA) before TNF inhibitors use. The positivity of TST, QuantiFERON-TB Gold In Tube (QFT-GIT), and T-SPOT.TB (T-SPOT) tests were estimated to be 29%, 17%, and 18%, respectively. The agreement percentage between the TST and QFT-GIT, and between the TST and T-SPOT were 73% and 75%. Populations from low-to-moderate endemic TB presented with slightly less agreement (71% between TST and QFT-GIT, and 74% between TST and T-SPOT) than patients from high endemic countries (73% between TST and QFT-GIT, and 81% between TST and T-SPOT). By underlying disease stratification, a lower level of agreement between TST and QFT-GIT was found among AS (64%) than among JIA (77%) and RA patients (73%). CONCLUSION We reaffirm the current evidence for accuracy of LTBI test done by TST and IGRA among rheumatic patients is inconsistent. Our stratified analysis suggests different screening strategies might be needed in clinical settings considering the endemic status in the patient's country of origin and the precise nature of underlying diseases.
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Affiliation(s)
- Junhee Pyo
- WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Department of Pharmaceutical Science, Utrecht University, Utrecht, the Netherlands
| | - Soo-Kyung Cho
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Dam Kim
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Yoon-Kyoung Sung
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
- Correspondence to Yoon-Kyoung Sung, M.D. Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, 222-1 Wangsimni-ro, Seongdong-gu, Seoul 04763, Korea Tel: +82-2-2290-9207 Fax: +82-2-2298-8231 E-mail:
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15
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Agarwal A, Kedia S, Jain S, Gupta V, Bopanna S, Yadav DP, Goyal S, Mouli VP, Dhingra R, Makharia G, Ahuja V. High risk of tuberculosis during infliximab therapy despite tuberculosis screening in inflammatory bowel disease patients in India. Intest Res 2018; 16:588-598. [PMID: 30301331 PMCID: PMC6223459 DOI: 10.5217/ir.2018.00023] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 06/25/2018] [Indexed: 02/07/2023] Open
Abstract
Background/Aims The data on the risk of tuberculosis (TB) reactivation with infliximab (IFX) in patients with inflammatory bowel disease (IBD) from TB endemic countries, like India, is limited. The risk of TB reactivation on IFX and its predictors in patients with IBD was assessed. Methods This retrospective review included consecutive patients with IBD who received IFX, and were on follow-up from January 2005 to November 2017. The data was recorded on age/disease duration, indications for IFX, screening for latent tuberculosis (LTB) before IFX, response to IFX, incidence and duration when TB developed after IFX, and type of TB (pulmonary [PTB]/extra-pulmonary [EPTB]/disseminated). Results Of 69 patients (22 ulcerative colitis/47 Crohn's disease; mean age, 35.6±14.5 years; 50.7% males; median follow-up duration after IFX, 19 months [interquartile range, 5.5-48.7 months]), primary non-response at 8 weeks and secondary loss of response at 26 and 52 weeks were seen in 14.5%, 6% and 15% patients respectively. Prior to IFX, all patients were screened for LTB, 8 (11.6%) developed active TB (disseminated, 62.5%; EPTB, 25%; PTB, 12.5%) after a median of 19 weeks (interquartile range, 14.0-84.5 weeks) of IFX. Of these 8 patients' none had LTB, even when 7 of 8 were additionally screened with contrast-enhanced chest tomography. Though not statistically significant, more patients with Crohn's disease than ulcerative colitis (14.9% vs. 4.5%, P=0.21), and those with past history of TB (25% vs. 9.8%, P=0.21), developed TB. Age, gender, disease duration, or extraintestinal manifestations could not predict TB reactivation. Conclusions There is an extremely high rate of TB with IFX in Indian patients with IBD. Current screening techniques are ineffective and it is difficult to predict TB after IFX.
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Affiliation(s)
- Ashish Agarwal
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Kedia
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Saransh Jain
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Vipin Gupta
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Sawan Bopanna
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Dawesh P Yadav
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Goyal
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Venigalla Pratap Mouli
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Rajan Dhingra
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Govind Makharia
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Vineet Ahuja
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
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Abstract
The incidence and mortality rates of tuberculosis (TB) in the Republic of Korea are 77 and 5.2 per 100,000 people, respectively (2016), which are the highest among the member countries of the Organization for Economic Cooperation and Development. Recently, the incidence of TB among teens and individuals in their 20s in the Republic of Korea decreased significantly. The decrease is largely attributed to the TB screening and contact investigation efforts targeting schools over the past few years. However, the incidence of TB among elderly individuals remains high, and it is even increasing compared to that in the past 10 years. Older individuals account for 42% of all TB cases and 82% of TB-related deaths. The success rate of TB treatment in the Republic of Korea has gradually increased due to various programs, such as control of non-compliance, insurance coverage for TB diagnosis and treatment, and TB public-private mix models. This study suggests that policy makers should focus their efforts on policies that prioritize a significant reduction in the incidence of TB based on the 2nd National Strategic Plan for Tuberculosis Control (2018-2022).
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Affiliation(s)
- Kyung Sook Cho
- Division of Social Services Projects, Office of Social Welfare Policy, Ministry of Health and Welfare, Sejong, Korea
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17
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Uzorka JW, Bossink AWJ, Franken WPJ, Thijsen SFT, Leyten EMS, van Haeften AC, Doornenbal G, Boonstra P, Ottenhoff THM, Arend SM. Borderline QuantiFERON results and the distinction between specific responses and test variability. Tuberculosis (Edinb) 2018; 111:102-108. [PMID: 30029893 DOI: 10.1016/j.tube.2018.06.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 05/29/2018] [Accepted: 06/04/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND QuantiFERON (QFT) results near the cut-off are subject to debate. We aimed to investigate which borderline QFT results were due to Mycobacterium tuberculosis (Mtb)-specific responses or to test variability. METHODS In a contact investigation, tuberculin skin test (TST), QFT and T-SPOT.TB (T-SPOT) were performed in 785 BCG-unvaccinated contacts. Contacts with a low-negative (<0.15), borderline (0.15-0.35), low-positive (0.35-0.70) or high-positive QFT (≥0.70 IU/mL) were compared with respect to exposure, TST and T-SPOT results. Development of active tuberculosis was assessed. RESULTS Borderline QFT results occurred in threefold excess over test variability (p = 0.0027). In contacts with low-negative, borderline or positive QFT results, a positive TST occurred in 24.9%, 62.1% and 91.4% (p < 0.0001) and a positive T-SPOT result in 6.3%, 41.3% and 86.4%, respectively (p < 0.0001). Two-third (20/29) of contacts with a borderline and 14/16 (88%) with a low-positive QFT had a positive TST and/or T-SPOT, indicating probable Mtb-infection. During 12 years of follow-up, seven patients were diagnosed with active tuberculosis, two of whom after a low-positive QFT. CONCLUSIONS In this study, most borderline and low-positive QFT results were Mtb-specific, showing the biological significance of a borderline QFT. The clinical relevance, however, will be most distinct in patients who are or will be immunocompromised.
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Affiliation(s)
- Jonathan W Uzorka
- Department of Infectious Diseases, Leiden University Medical Center, Room C5P-40, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Ailko W J Bossink
- Department of Pulmonology, Hospital Diakonessenhuis, Jagersingel 1, 3707 JA, Zeist, Utrecht/Zeist, The Netherlands
| | - Willeke P J Franken
- Department of Clinical Chemistry, Certe Location Medical Center Leeuwarden, Borniastraat 34, 8934 AD, Leeuwarden, The Netherlands
| | - Steven F T Thijsen
- Department of Medical Microbiology, Hospital Diakonessenhuis, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands
| | - Eliane M S Leyten
- Department of Internal Medicine, Haaglanden Medical Center, Lijnbaan 32, 2512 VA, Den Haag, The Netherlands
| | - Alida C van Haeften
- Department of Infectious Diseases, Municipal Health Service of Utrecht (GGD), Stadsplateau 1, 3521 AZ, Utrecht, The Netherlands
| | - Gert Doornenbal
- Department of Infectious Diseases, Municipal Health Service of Utrecht (GGD), Stadsplateau 1, 3521 AZ, Utrecht, The Netherlands
| | - Peter Boonstra
- Department of Infectious Diseases, Municipal Health Service of Utrecht (GGD), Stadsplateau 1, 3521 AZ, Utrecht, The Netherlands
| | - Tom H M Ottenhoff
- Department of Infectious Diseases, Leiden University Medical Center, Room C5P-40, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Sandra M Arend
- Department of Infectious Diseases, Leiden University Medical Center, Room C5P-40, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
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Lee HW, Lee YJ, Kim SJ, Park JS, Cho YJ, Yoon HI, Lee CT, Lee JH. Comparing tuberculin skin test and interferon γ release assay (T-SPOT.TB) to diagnose latent tuberculosis infection in household contacts. Korean J Intern Med 2017; 32:486-496. [PMID: 28111432 PMCID: PMC5432797 DOI: 10.3904/kjim.2015.344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 05/08/2016] [Accepted: 07/12/2016] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND/AIMS The tuberculin skin test (TST) and interferon γ release assay are currently used as diagnostic tools to detect latent tuberculosis (TB) infection; however, there are inconsistencies about the degree of agreement between the tests. We aimed to evaluate the concordance rate between the two tests in household contacts of a country with intermediate TB burden, where most people were vaccinated. METHODS We recruited household contacts who spent > 8 hours daily with patients with microbiologically confirmed active pulmonary TB, and received both TST and T-SPOT.TB (Oxford Immunotec) simultaneously. The degree of agreement was analysed according to TST cutoff and Bacille Calmette-Guerin (BCG) vaccination status. Relevant factors were analysed to establish the association with TST or T-SPOT.TB. RESULTS Among 298 household contacts, 122 (40.9%) were spouses, and 250 (83.9%) had received BCG vaccination. In the contact sources, 117 (39.3%) showed a positive result for acid-fast bacillus (AFB) sputum smear and 109 (36.6%) had cavities. The highest agreement rate of 69.5% and κ value of 0.378 were found with a 10 mm cutoff. Spouse, time interval from TB diagnosis to test, and AFB sputum smear positivity were significantly associated with a positive result for T-SPOT.TB. Sex, BCG vaccination, and cavity on chest computed tomography were related to TST positivity. CONCLUSIONS The present study suggested it was not possible for TST and T-SPOT.TB to replace each other because of considerable discrepancy between the two tests in household contacts in a country with intermediate TB prevalence.
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Affiliation(s)
- Hyun Woo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yeon Joo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Se Joong Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jong Sun Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young-Jae Cho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ho Il Yoon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Choon-Taek Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae-Ho Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Correspondence to Jae-Ho Lee, M.D. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beongil, Bundang-gu, Seongnam 13620, Korea Tel: +82-31-787-7058 Fax: +82-31-787-4050 E-mail:
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Park IN, Shim TS. Qualitative and quantitative results of interferon-γ release assays for monitoring the response to anti-tuberculosis treatment. Korean J Intern Med 2017; 32:302-308. [PMID: 27951621 PMCID: PMC5339471 DOI: 10.3904/kjim.2016.199] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 07/29/2016] [Accepted: 10/20/2016] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS The usefulness of interferon-γ release assays (IGRAs) in monitoring to responses to anti-tuberculosis (TB) treatment is controversial. We compared the results of two IGRAs before and after anti-TB treatment in same patients with active TB. METHODS From a retrospective review, we selected patients with active TB who underwent repeated QuantiFERON-TB Gold (QFN-Gold, Cellestis Limited) and T-SPOT.TB (Oxford Immunotec) assays before and after anti-TB treatment with first-line drugs. Both tests were performed prior to the start of anti-TB treatment or within 1 week after the start of anti-TB treatment and after completion of treatment. RESULTS A total of 33 active TB patients were included in the study. On the QFN-Gold test, at baseline, 23 cases (70%) were early secreted antigenic target 6-kDa protein 6 (ESAT-6) or culture filtrate protein 10 (CFP-10) positive. On the T-SPOT. TB test, at baseline, 31 cases (94%) were ESAT-6 or CFP-10 positive. Most of patients remained both test-positive after anti-TB treatment. Although changes in interferon-γ release responses over time were highly variable in both tests, there was a mean decline of 27 and 24 spot-forming counts for ESAT-6 and CFP-10, respectively on the T-SPOT.TB test (p < 0.05 for all). CONCLUSIONS Although limited by the small number of patients and a short-term follow-up, there was significant decline in the quantitative result of the T-SPOT. TB test with treatment. However, both commercial IGRAs may not provide evidence regarding the cure of disease in Korea, a country where the prevalence of TB is within the intermediate range.
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Affiliation(s)
- I-Nae Park
- Department of Internal Medicine, Inje University Seoul Paik Hospital, Seoul, Korea
- Correspondence to I-Nae Park, M.D. Department of Internal Medicine, Inje University Seoul Paik Hospital, 9 Mareunnae-ro, Jung-gu, Seoul 04551, Korea Tel: +82-2-2270-0004 Fax: +82-2-2285-2286 E-mail:
| | - Tae Sun Shim
- Division of Pulmonology and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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So H, Yuen CS, Yip RM. Comparison of a commercial interferon-gamma release assay and tuberculin skin test for the detection of latent tuberculosis infection in Hong Kong arthritis patients who are candidates for biologic agents. Hong Kong Med J 2017; 23:246-50. [PMID: 28126971 DOI: 10.12809/hkmj164880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION It is universally agreed that screening for latent tuberculosis infection prior to biologic therapy is necessary, especially in endemic areas such as Hong Kong. There are still, however, controversies regarding how best to accomplish this task. The tuberculin skin test has been the routine screening tool for latent tuberculosis infection in Hong Kong for the past decade although accuracy is far from perfect, especially in patients who have been vaccinated with Bacillus Calmette-Guérin, who are immunocompromised, or who have atypical mycobacterium infection. The new interferon-gamma release assays have been shown to improve specificity and probably sensitivity. This study aimed to evaluate agreement between the interferon-gamma release assay and the tuberculin skin test in the diagnosis of latent tuberculosis infection in patients with arthritic diseases scheduled to receive biologic agents. METHODS We reviewed 38 patients with rheumatoid arthritis, psoriatic arthritis, or spondyloarthritis at a local hospital in Hong Kong from August 2013 to April 2014. They were all considered candidates for biologic agents. The patients underwent both the interferon-gamma release assay (ASACIR.TB; A.TB) and the tuberculin skin test simultaneously. Concurrent medications were documented. Patients who tested positive for either test (ie A.TB+ or TST+) were prescribed treatment for latent tuberculosis if they were to be given biologic agents. All patients were followed up regularly for 1 year and the development of active tuberculosis infection was evaluated. RESULTS Based on an induration of 10 mm in diameter as the cut-off value, 13 (34.2%) of 38 patients had a positive tuberculin skin test. Of the 38 patients, 11 (28.9%) also had a positive interferon-gamma release assay. The agreement between interferon-gamma release assay and tuberculin skin test was 73.7% (kappa=0.39). Six patients were TST+/A.TB- and four were TST-/A.TB+. When positive tuberculin skin test was defined as an induration of 5-mm diameter, the agreement between the two tests improved with a kappa value of 0.47. In that case, half of the patients had a positive tuberculin skin test; among them, nine were TST+/A.TB-. Only one was TST-/A.TB+. Subgroup analysis showed that the agreement between both tests improved further (kappa=0.69) in patients not taking a concurrent systemic steroid. For patients prescribed systemic steroid, the agreement was only slight with a kappa value of 0.066. Finally, none of the 38 patients, of whom 32 had an exposure to biologic agents, developed active tuberculosis during the 1-year follow-up period. CONCLUSION In a tuberculosis-endemic population, although 10-mm diameter induration is the usual cut-off for a positive tuberculin skin test, the level of agreement between the interferon-gamma release assay and tuberculin skin test improved from fair to moderate when the cut-off was lowered to 5 mm. A dual testing strategy of tuberculin skin test and interferon-gamma release assays appeared to be effective and should be pursued especially in patients who are on systemic steroid therapy. Nonetheless, the issue of potential overtreatment is yet to be evaluated.
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Affiliation(s)
- H So
- Department of Medicine and Geriatrics, Kwong Wah Hospital, Yaumatei, Hong Kong
| | - C Sw Yuen
- Department of Medicine and Geriatrics, Kwong Wah Hospital, Yaumatei, Hong Kong
| | - R Ml Yip
- Department of Medicine and Geriatrics, Kwong Wah Hospital, Yaumatei, Hong Kong
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Baquero-Artigao F, Mellado Peña MJ, Del Rosal Rabes T, Noguera Julián A, Goncé Mellgren A, de la Calle Fernández-Miranda M, Navarro Gómez ML. [Spanish Society for Pediatric Infectious Diseases guidelines on tuberculosis in pregnant women and neonates (i): Epidemiology and diagnosis. Congenital tuberculosis]. An Pediatr (Barc) 2015; 83:285.e1-8. [PMID: 25754313 DOI: 10.1016/j.anpedi.2015.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 01/13/2015] [Accepted: 01/15/2015] [Indexed: 12/18/2022] Open
Abstract
Tuberculosis (TB) screening in pregnancy using tuberculin skin test (TST) is recommended in case of symptoms of TB disease, close contact with a patient with infectious TB, or high risk of developing active disease. The new interferon gamma release assay (IGRA) tests are recommended in BCG-vaccinated pregnant women with positive TST and no known risk factors for TB, and in those immunocompromised, with clinical suspicion of TB but negative TST. TB diagnosis is difficult due to the non-specific symptoms, the increased frequency of extrapulmonary disease, the delay in radiological examinations, and the high rate of tuberculin anergy. Neonatal TB can be acquired in utero (congenital TB), or through airborne transmission after delivery (postnatal TB). Congenital TB is extremely rare and does not cause fetal malformations. It may be evident at birth, although it usually presents after the second week of life. In newborns with no family history of TB, the disease should be considered in cases of miliary pneumonia, hepatosplenomegaly with focal lesions, or lymphocytic meningitis with hypoglycorrhachia, especially in those born to immigrants from high TB-burden countries. TST is usually negative, and IGRAs have lower sensitivity than in older children. However, the yield of acid-fast smear and culture is higher, mostly in congenital TB. Molecular diagnosis techniques enable early diagnosis and detection of drug resistance mutations. There is a substantial risk of disseminated disease and death.
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Affiliation(s)
- F Baquero-Artigao
- Grupo de Infección Congénita y Perinatal de la SEIP, Servicio de Pediatría, Enfermedades Infecciosas y Patología Tropical, Hospital Infantil La Paz, Madrid, España.
| | - M J Mellado Peña
- Grupo de Tuberculosis de la SEIP, Servicio de Pediatría, Enfermedades Infecciosas y Patología Tropical, Hospital Infantil La Paz, Madrid, España
| | - T Del Rosal Rabes
- Servicio de Pediatría, Enfermedades Infecciosas y Patología Tropical, Hospital Infantil La Paz, Madrid, España
| | - A Noguera Julián
- Unidad de Infecciones, Servicio de Pediatría, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues de Llobregat, Barcelona, España
| | - A Goncé Mellgren
- Servicio de Medicina Maternofetal, Institut Clínic de Ginecología, Obstetricia i Neonatologia, Hospital Clínic, Barcelona, España
| | | | - M L Navarro Gómez
- Sección de Enfermedades Infecciosas, Servicio de Pediatría, Hospital Gregorio Marañón, Madrid, España
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Ahn SJ, Kim KE, Woo SJ, Park KH. The usefulness of interferon-gamma release assay for diagnosis of tuberculosis-related uveitis in Korea. Korean J Ophthalmol 2014; 28:226-33. [PMID: 24882956 PMCID: PMC4038728 DOI: 10.3341/kjo.2014.28.3.226] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 09/04/2013] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the usefulness of the interferon-gamma release assay (IGRA) for diagnosing tuberculosis (TB)-related uveitis (TRU). Methods Records from 181 patients with ocular signs and symptoms suggestive of TRU and intraocular inflammation of unknown etiology were reviewed. All subjects underwent clinical and laboratory testing, including IGRA, to rule out presence of underlying disease. A diagnosis of presumed TRU was made based on an internist's TB diagnosis and a patient's response to anti-TB therapy. Sensitivity, specificity, and positive predictive values of IGRA for TRU diagnosis were calculated. Clinical characteristics were compared between patients with positive and negative IGRA results. Results The sensitivity and specificity of IGRA for TRU were 100% and 72.0%, respectively. Mean age, percentage of patients with retinal vasculitis, and the anatomic type of uveitis were significantly different between patients with positive and negative IGRA results (all p ≤ 0.001). Positive IGRA rates and false-positive rates were significantly different between age and anatomic type groups (both p = 0.001). The positive predictive value of the IGRA among patients with intraocular inflammation was high (70%) when all of younger age (≤40 years), posterior uveitis, and retinal vasculitis were present. Conclusions The IGRA is useful for diagnosing TRU in the Korean population, especially when it is used as a screening test. Clinical characteristics, including younger age (≤40 years), posterior uveitis, and retinal vasculitis in IGRA-positive patients, increase the likelihood of the patient having TRU.
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Affiliation(s)
- Seong Joon Ahn
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea. ; Department of Ophthalmology, Armed Forces Capital Hospital, Seongnam, Korea
| | - Ko Eun Kim
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea. ; Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Se Joon Woo
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Kyu Hyung Park
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Kim JK, Bang WJ, Oh CY, Yoo C, Cho JS. Feasibility of the Interferon-γ Release Assay for the Diagnosis of Genitourinary Tuberculosis in an Endemic Area. Korean J Urol 2013; 54:123-6. [PMID: 23550219 PMCID: PMC3580302 DOI: 10.4111/kju.2013.54.2.123] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 10/20/2012] [Indexed: 11/18/2022] Open
Abstract
Purpose To evaluate the feasibility of the interferon-gamma release assay (IGRA) as a supplementary diagnostic tool for the diagnosis of genitourinary tuberculosis (GUTB). Materials and Methods Fifty-seven patients who were tested with the IGRA to diagnose GUTB were included. All patients had clinical or radiologic features suspicious for GUTB. Signs and symptoms included chronic dysuria with long-standing sterile pyuria, renal calcification with distorted renal calyces and contracted renal pelvis, and chronic epididymitis. Patients who had a history of tuberculosis in other organs were excluded. Tests including IGRA, urine acid-fast bacilli (AFB) stain and culture, urine tuberculosis polymerase chain reaction (UT-PCR), and radiological examinations were performed to confirm GUTB. The medical records of the patients were reviewed retrospectively. Results The IGRA result was positive in 30 patients (52.6%). The results of the urine AFB stain and culture were positive in 5 patients (8.8%) and 7 patients (12.2%), respectively. The results of UT-PCR were positive in 9 patients (15.8%). The 7 patients who showed positive results in the urine AFB stain and culture also had positive results on the IGRA. A UT-PCR-negative patient was diagnosed with GUTB by positive results on both the IGRA and AFB stain and culture. Conclusions The IGRA might feasibly be used as a supplementary or screening tool for the diagnosis of GUTB in addition to urine AFB stain and culture. Further studies for statistical evaluation of its sensitivity, specificity, and efficacy are needed.
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Affiliation(s)
- Jong Keun Kim
- Department of Urology, Hallym University College of Medicine, Chuncheon, Korea
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