RESUMO
Interferon (IFN)-gamma release assays (IGRA) have improved tuberculosis contact tracing, but discrimination of recent from remote Mycobacterium tuberculosis contacts is not possible by IGRA alone. We present results of a tuberculosis contact investigation with a new early-secretory-antigenic-target (ESAT)-6 and culture-filtrate-protein (CFP)-10 specific interleukin (IL)-2 ELISpot in addition to ESAT-6 and CFP-10 specific IFN-gamma ELISpot and tuberculin skin testing (TST). Results of the TST, IFN-gamma ELISpot and IL-2 ELISpot were positive in 6/172 (3.4%), 7/167 (4.2%) and 6/196 (3.1%) of contacts, respectively. Close contact (> or =100 hours) to the index case increased the risk of positive results in the IFN-gamma ELISpot, TST, and IL-2 ELISpot by 40.8, 19.3, and 2.5 times, respectively. Individuals with a positive IFN-gamma ELISpot/negative IL-2 ELISpot result had a median (IQR) duration of index case exposure of 568 hours (133_1000) compared to individuals with a positive IFN-gamma ELISpot/positive IL-2 ELISpot result (median = 24 hours; 20_130; p-value = 0.047). Combination of a M. tuberculosis specific IFN-gamma ELISpot with a M. tuberculosis specific IL-2 ELISpot significantly improved the identification of individuals with the highest risk of recent M. tuberculosis infection and is a promising method that should be explored to target tuberculosis preventive chemotherapy.
Assuntos
Imunoensaio/métodos , Interleucina-2/metabolismo , Mycobacterium tuberculosis/imunologia , Tuberculose/diagnóstico , Adolescente , Adulto , Linhagem Celular , Criança , Feminino , Humanos , Interferon gama/metabolismo , Modelos Logísticos , Masculino , Mycobacterium tuberculosis/metabolismo , Testes Cutâneos , Tuberculina/metabolismo , Tuberculose/imunologia , Tuberculose/microbiologia , Adulto JovemAssuntos
Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Antituberculosos/uso terapêutico , Bases de Dados Factuais , Sistema de Registros , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/transmissão , Estudos Transversais , Países em Desenvolvimento , Quimioterapia Combinada , Alemanha , Humanos , Testes de Sensibilidade Microbiana , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Tuberculose Resistente a Múltiplos Medicamentos/transmissãoAssuntos
Acetamidas/administração & dosagem , Acetamidas/uso terapêutico , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Oxazolidinonas/administração & dosagem , Oxazolidinonas/uso terapêutico , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Extensivamente Resistente a Medicamentos/tratamento farmacológico , Humanos , LinezolidaRESUMO
We evaluated risk factors and treatment outcomes associated with multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) in Germany in 2004-2006. In 177 (4%) of 4,557 culture-positive TB cases, Mycobacterium tuberculosis isolates were identified as MDR TB; an additional 7 (0.15%) met criteria for XDR TB. Of these 184 patients, 148 (80%) were born in countries of the former Soviet Union. In patients with XDR TB, hospitalization was longer (mean +/- SD 202 +/- 130 vs. 123 +/- 81 days; p = 0.015) and resistance to all first-line drugs was more frequent (36% vs. 86%; p = 0.013) than in patients with MDR TB. Seventy-four (40%) of these 184 patients received treatment with linezolid. Treatment success rates ranged from 59% for the entire cohort (59% for MDR TB and 57% for XDR TB) to 87% for those with a definitive outcome (n = 125; 89% for MDR TB and 80% for XDR TB). Extensive drug susceptibility testing and availability of second- and third-line drugs under inpatient management conditions permit relatively high treatment success rates in MDR- and XDR TB.