Assuntos
Doenças da Coroide , Neovascularização de Coroide , Pólipos , Ásia/epidemiologia , Corioide , Doenças da Coroide/diagnóstico por imagem , Neovascularização de Coroide/diagnóstico por imagem , Corantes , Visualização de Dados , Angiofluoresceinografia/métodos , Humanos , Verde de Indocianina , Pólipos/diagnóstico , Estudos Retrospectivos , Tomografia de Coerência Óptica/métodosAssuntos
Doenças da Coroide , Neovascularização de Coroide , Fotoquimioterapia , Pólipos , Corioide , Doenças da Coroide/diagnóstico , Doenças da Coroide/tratamento farmacológico , Neovascularização de Coroide/tratamento farmacológico , Visualização de Dados , Angiofluoresceinografia , Humanos , Ranibizumab/uso terapêutico , Tomografia de Coerência ÓpticaAssuntos
Planetas , Pólipos , Inibidores da Angiogênese/uso terapêutico , Corioide , Visualização de Dados , Angiofluoresceinografia , Humanos , Injeções Intravítreas , Pólipos/diagnóstico , Pólipos/tratamento farmacológico , Receptores de Fatores de Crescimento do Endotélio Vascular/uso terapêutico , Proteínas Recombinantes de Fusão/uso terapêutico , Tomografia de Coerência ÓpticaRESUMO
The majority of individuals infected with Mycobacterium tuberculosis achieve lifelong immune containment of the bacillus. What constitutes this effective host immune response is poorly understood. We compared the frequencies of gamma interferon (IFN-gamma)-secreting T cells specific for five region of difference 1 (RD1)-encoded antigens and one DosR-encoded antigen in 205 individuals either with active disease (n = 167), whose immune responses had failed to contain the bacillus, or with remotely acquired latent infection (n = 38), who had successfully achieved immune control, and a further 149 individuals with recently acquired asymptomatic infection. When subjects with an IFN-gamma enzyme-linked immunospot (ELISpot) assay response to one or more RD1-encoded antigens were analyzed, T cells from subjects with active disease recognized more pools of peptides from these antigens than T cells from subjects with nonrecent latent infection (P = 0.002). The T-cell frequencies for peptide pools were greater for subjects with active infection than for subjects with nonrecent latent infection for summed RD1 peptide pools (P Assuntos
Antígenos de Bactérias
, Proteínas de Bactérias
, Interferon gama/metabolismo
, Mycobacterium tuberculosis/imunologia
, Linfócitos T/imunologia
, Tuberculose/diagnóstico
, Tuberculose/imunologia
, Adolescente
, Adulto
, Antígenos de Bactérias/imunologia
, Proteínas de Bactérias/imunologia
, Criança
, Feminino
, Humanos
, Técnicas Imunoenzimáticas/métodos
, Masculino
, Pessoa de Meia-Idade
, Adulto Jovem
RESUMO
BACKGROUND: The role of new T-cell-based blood tests for tuberculosis in the diagnosis of active tuberculosis is unclear. OBJECTIVE: To compare the performance of 2 interferon-gamma assays and tuberculin skin testing in adults with suspected tuberculosis. DESIGN: Prospective study conducted in routine practice. SETTING: 2 urban hospitals in the United Kingdom. PATIENTS: 389 adults, predominantly of South Asian and black ethnicity, with moderate to high clinical suspicion of active tuberculosis. INTERVENTION: Tuberculin skin testing, the enzyme-linked immunospot assay (ELISpot) incorporating early secretory antigenic target-6 and culture filtrate protein-10 (standard ELISpot), and ELISpot incorporating a novel antigen, Rv3879c (ELISpot(PLUS)) were performed during diagnostic assessment by independent persons who were blinded to results of the other test. MEASUREMENTS: Sensitivity, specificity, predictive values, and likelihood ratios. RESULTS: 194 patients had a final diagnosis of active tuberculosis, of which 79% were culture-confirmed. Sensitivity for culture confirmed and highly probable tuberculosis was 89% (95% CI, 84% to 93%) with ELISpot(PLUS), 85% (CI, 79% to 90%) with standard ELISpot, 79% (CI, 72% to 85%) with 15-mm threshold tuberculin skin testing, and 83% (CI, 77% to 89%) with stratified thresholds of 15 and 10 mm in vaccinated and unvaccinated patients, respectively. The ELISpot(PLUS) assay was more sensitive than tuberculin skin testing with 15-mm cutoff points (P = 0.01) but not with stratified cutoff points (P = 0.10). The ELISpot(PLUS) assay had 4% higher diagnostic sensitivity than standard ELISpot (P = 0.02). Combined sensitivity of ELISpot(PLUS) and tuberculin skin testing was 99% (CI, 95% to 100%), conferring a negative likelihood ratio of 0.02 (CI, 0 to 0.06) when both test results were negative. LIMITATIONS: Local standards for tuberculin skin testing differed from others used internationally. The study sample included few immunosuppressed patients. CONCLUSION: The ELISpot(PLUS) assay is more sensitive than standard ELISpot and, when used in combination with tuberculin skin testing, enables rapid exclusion of active infection in patients with moderate to high pretest probability of tuberculosis.