Defining the Role of Cellular Immune Signatures in Diagnostic Evaluation of Suspected Tuberculosis.
J Infect Dis
; 225(9): 1632-1641, 2022 05 04.
Article
en En
| MEDLINE
| ID: mdl-34331451
ABSTRACT
BACKGROUND:
Diagnosis of paucibacillary tuberculosis (TB) including extrapulmonary TB is a significant challenge, particularly in high-income, low-incidence settings. Measurement of Mycobacterium tuberculosis (Mtb)-specific cellular immune signatures by flow cytometry discriminates active TB from latent TB infection (LTBI) in case-control studies; however, their diagnostic accuracy and clinical utility in routine clinical practice is unknown.METHODS:
Using a nested case-control study design within a prospective multicenter cohort of patients presenting with suspected TB in England, we assessed diagnostic accuracy of signatures in 134 patients who tested interferon-gamma release assay (IGRA)-positive and had final diagnoses of TB or non-TB diseases with coincident LTBI. Cellular signatures were measured using flow cytometry.RESULTS:
All signatures performed less well than previously reported. Only signatures incorporating measurement of phenotypic markers on functional Mtb-specific CD4 T cells discriminated active TB from non-TB diseases with LTBI. The signatures measuring HLA-DR+IFNγâ+ CD4 T cells and CD45RA-CCR7-CD127- IFNγâ-IL-2-TNFαâ+ CD4 T cells performed best with 95% positive predictive value (95% confidence interval, 90-97) in the clinically challenging subpopulation of IGRA-positive but acid-fast bacillus (AFB) smear-negative TB suspects.CONCLUSIONS:
Two cellular immune signatures could improve and accelerate diagnosis in the challenging group of patients who are IGRA-positive, AFB smear-negative, and have paucibacillary TB.Palabras clave
Texto completo:
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Base de datos:
MEDLINE
Asunto principal:
Tuberculosis
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Tuberculosis Latente
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Mycobacterium tuberculosis
Tipo de estudio:
Clinical_trials
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Diagnostic_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Idioma:
En
Revista:
J Infect Dis
Año:
2022
Tipo del documento:
Article