RESUMEN
PURPOSE: To assess the performance of interferon-gamma release assay (IGRA) associated with tuberculosis skin test (TST) for ocular tuberculosis (OTB) diagnosis and therapeutic decision making. METHOD: One hundred and ninety-one patients with ocular inflammation were prospectively followed-up. Patients with clinical signs highly suspected of OTB, TST≥10 mm, and/or IGRA≥0.35 IU/mL received antitubercular therapy (ATT). Sensitivity (Se), specificity (Sp), and area under the curve (AUC) were assessed. RESULTS: Seventy-two (37.7%) patients received ATT for presumed OTB. Combining TST and IGRA had Se=89.6%, Sp=99.2%, and AUC (0.98) significantly higher compared to TST (0.85, Z=6.3, p<.001) or IGRA (0.95, Z=2.5, p=.01). Prior history of corticosteroids or immunosuppressant with concomitantly oral prednisone and baseline IGRA> 2.0 IU/mL was associated significantly with more recurrences in ATT patients (p=.01) . CONCLUSION: Considering TST and IGRA together was more effective in assessing OTB diagnosis. The real value of the IGRA test to predict recurrences needs further studies.
Asunto(s)
Tuberculosis Latente , Tuberculosis Ocular , Tuberculosis , Humanos , Ensayos de Liberación de Interferón gamma , Tuberculosis Ocular/diagnóstico , Tuberculosis Ocular/tratamiento farmacológico , Tuberculosis Ocular/complicaciones , Estudios de Seguimiento , Prueba de Tuberculina , Tuberculosis/complicaciones , Antituberculosos/uso terapéutico , Recurrencia , Tuberculosis Latente/diagnósticoRESUMEN
CD(4)(+) and CD(8)(+) T lymphocyte counts, naive and memory/effector CD(4)(+) T subpopulations, and the expression of CD(38) on CD(8)(+) T lymphocytes were evaluated in four groups: AIDS patients with tuberculosis (HIV/TB, n=14), HIV-1 infected patients (HIV, n=10), HIV-1 negative patients with tuberculosis (TB, n=20) and healthy controls (CTL, n=17). TB and HIV had fewer +CD(4)(+) T cells than CTL, with the lowest values observed in TB/HIV (p<0.001). No difference between groups was observed in the percentage of naive and memory/effector subpopulations in +CD(4)(+) T lymphocytes. TB (355 cells/ micro L) and HIV (517 cells/ micro L) had diverging effects on +CD(8)(+) T cell counts, with a marked depletion observed in HIV/TB (196 cells/ micro L). TB and HIV up-regulated CD(38) expression on CD(8)(+) T cells, a finding also present in TB/HIV. While the decrease of +CD(4)(+) T cell counts in HIV/TB may be attributed to HIV and tuberculosis, the decrease of +CD(8)(+) T cell counts is likely to be due to tuberculosis.