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1.
Medicine (Baltimore) ; 99(2): e18367, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914015

RESUMO

Little is known about the decay kinetics of interferon (IFN)-γ response and its influencing factors in tuberculous pleurisy. We enrolled thirty-two patients with tuberculous pleurisy prospectively and followed up at month 0, 6, and 9, at which time peripheral venous blood was drawn for interferon gamma release assay (IGRA) by means of QuantiFERON-TB Gold In-Tube (QFT-GIT). Demographic and clinical data were captured. To identify significant predictive factors influencing the IFN-γ response, multiple linear regression analyses were performed. Percentage of CD4+, CD8+, Vγ2Vδ2 T cells and Treg cells were measured by flow cytometry. The percentage of QFT-GIT-positive patients at baseline, month 6 and month 9 were 96.9% (30/32), 90.6% (29/32) and 84.4% (27/32), respectively. Quantitative IFN-γ response at baseline were significantly correlated with symptom duration (P = .003, R = 0.261) and age (P = .041, R = 0.132). Besides, the decreases of the IFN-γ response at month 6 and month 9 were positively correlated with the IFN-γ level at baseline. The dynamic tendency of the percentages of Treg cells was similar to the IFN-γ responses at each time-point. Quantitative IFN-γ response could be influenced by host immune status, instead of disease burden and anti-tuberculosis treatment. IGRA is probably not a useful biomarker of treatment efficacy in tuberculous pleurisy.


Assuntos
Testes de Liberação de Interferon-gama/métodos , Interferon gama/imunologia , Tuberculose Pleural/sangue , Adulto , Antituberculosos/administração & dosagem , Antituberculosos/uso terapêutico , Linfócitos T CD4-Positivos/imunologia , Feminino , Citometria de Fluxo/métodos , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Linfócitos T/imunologia , Tuberculose Pleural/diagnóstico , Tuberculose Pleural/tratamento farmacológico , Tuberculose Pleural/metabolismo
2.
Ann Lab Med ; 40(1): 33-39, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31432637

RESUMO

BACKGROUND: The interferon-gamma (IFN-γ) releasing assay (IGRA) is widely used for latent tuberculosis infection (LTBI) diagnosis. We evaluated the analytical performance of a new automated chemiluminescent immunoanalyzer-based IGRA (CLIA-IGRA), AdvanSure I3 (LG Life Sciences, Seoul, Korea) and compared it with that of the QuantiFERON-TB Gold In-Tube (QFT-GIT) assay. METHODS: Repeatability and reproducibility were evaluated at four levels. Detection capability, including limit of blank (LoB), limit of detection (LoD), and limit of quantification (LoQ), was evaluated using IFN-γ standard material (National Institute for Biological Standards and Control code: 87/586). Agreement between the results of two assays was evaluated using 341 blood samples from healthcare workers and patients at a tertiary care hospital. To determine the cut-off value of CLIA-IGRA for diagnosing LTBI, the ROC curve was analyzed. RESULTS: Repeatability and reproducibility were 4.86-7.00% and 6.36-7.88% CV, respectively. LoB, LoD, and LoQ were 0.022, 0.077, and 0.249 IU/mL, respectively. IFN-γ values between CLIA-IGRA and QFT-GIT showed a strong correlation within the analytical measurable range of both assays, especially when the value was low. Qualitative comparison of the two assays yielded a 99.1% overall agreement (kappa coefficient=0.98). A cut-off value of 0.35 IU/mL was appropriate for diagnosing LTBI. CONCLUSIONS: CLIA-IGRA is a reliable assay for LTBI diagnosis, with performance similar to that of QFT-GIT.


Assuntos
Testes de Liberação de Interferon-gama/métodos , Interferon gama/sangue , Área Sob a Curva , Automação , Humanos , Imunoensaio , Tuberculose Latente/diagnóstico , Limite de Detecção , Medições Luminescentes , Curva ROC , Kit de Reagentes para Diagnóstico , Reprodutibilidade dos Testes , República da Coreia , Centros de Atenção Terciária
3.
Artigo em Inglês | MEDLINE | ID: mdl-31581622

RESUMO

Risk prediction and response measures may differ in tuberculosis (TB) patients with low sputum smear positivity for acid-fast bacillus (AFB) compared to those who are smear negative. However, previous studies using the tuberculin skin test (TST) did not show that differences in measures are important. This study compared results of interferon-gamma release assays (IGRA) between contacts of pulmonary TB patients with AFB smear positivity and those with smear negativity using QuantiFERON®-TB Gold In-Tube (QFT) assays. Close contacts of TB patients with culture-confirmed infections between April 2010 and December 2012 in Ibaraki, Japan, were enrolled, and 439 Japanese contacts of 129 index TB patients were examined. Adjusted odds ratios of QFT in contacts were 0.68 (95% confidence interval: 0.17-2.8) for AFB scanty patients, 1.12 (0.45-2.8) for AFB 1+, 1.20 (0.48-3.0) for AFB 2+, and 4.96 (1.9-12.9) for AFB 3+, compared to those who were smear negative. Differences in IGRA positivity were not significant between close contacts of TB patients with low positive and negative smears.


Assuntos
Testes de Liberação de Interferon-gama/métodos , Escarro/química , Escarro/microbiologia , Teste Tuberculínico/métodos , Tuberculose Pulmonar/diagnóstico , Adolescente , Adulto , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Japão , Masculino , Pessoa de Meia-Idade , Razão de Chances , Adulto Jovem
4.
J Dtsch Dermatol Ges ; 17(9): 889-893, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31475786

RESUMO

The diagnosis of cutaneous mycobacterial infections may be challenging. Owing to the broad spectrum of their clinical presentations, mycobacterioses have to be considered as differential diagnoses to many inflammatory dermatoses. Diagnostic measures comprise histology including special staining, cultures and molecular microbiological examinations as well as the detection of cellular immune reactions of the patient by means of interferon-γ release assays and skin testing. Clinicians should know the appropriate use and combination of procedures to diagnose mycobacterioses quickly and correctly and to avoid costs and delays caused by unnecessary examinations. This mini review summarizes advantages, limitations, and pitfalls of diagnostic methods for mycobacterial skin infections.


Assuntos
Infecções por Mycobacterium/diagnóstico , Dermatopatias Bacterianas/diagnóstico , Técnicas Bacteriológicas , Diagnóstico Diferencial , Humanos , Testes de Liberação de Interferon-gama/métodos , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Exame Físico , Reação em Cadeia da Polimerase/métodos , Teste Tuberculínico/métodos
5.
Artigo em Inglês | MEDLINE | ID: mdl-31416206

RESUMO

BACKGROUND: Given the lack of a gold standard for latent tuberculosis infection (LTBI) and paucity of performance data from endemic settings, we compared test performance of the tuberculin skin test (TST) and two interferon-gamma-release assays (IGRAs) among health-care workers (HCWs) using latent class analysis. The study was conducted in Cape Town, South Africa, a tuberculosis and human immunodeficiency virus (HIV) endemic setting Methods: 505 HCWs were screened for LTBI using TST, QuantiFERON-gold-in-tube (QFT-GIT) and T-SPOT.TB. A latent class model utilizing prior information on test characteristics was used to estimate test performance. RESULTS: LTBI prevalence (95% credible interval) was 81% (71-88%). TST (10 mm cut-point) had highest sensitivity (93% (90-96%)) but lowest specificity (57%, (43-71%)). QFT-GIT sensitivity was 80% (74-91%) and specificity 96% (94-98%), and for TSPOT.TB, 74% (67-84%) and 96% (89-99%) respectively. Positive predictive values were high for IGRAs (90%) and TST (99%). All tests displayed low negative predictive values (range 47-66%). A composite rule using both TST and QFT-GIT greatly improved negative predictive value to 90% (range 80-97%). CONCLUSION: In an endemic setting a positive TST or IGRA was highly predictive of LTBI, while a combination of TST and IGRA had high rule-out value. These data inform the utility of LTBI-related immunodiagnostic tests in TB and HIV endemic settings.


Assuntos
Infecções por HIV/diagnóstico , Pessoal de Saúde/estatística & dados numéricos , Testes de Liberação de Interferon-gama/métodos , Análise de Classes Latentes , Tuberculose Latente/diagnóstico , Teste Tuberculínico/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Infecções por HIV/epidemiologia , Humanos , Tuberculose Latente/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Sensibilidade e Especificidade , África do Sul/epidemiologia
6.
Clin Lab ; 65(8)2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31414740

RESUMO

BACKGROUND: To explore the application value of IGRA-ELISA in the diagnosis of tuberculosis. METHODS: A total of 68 tuberculosis and 58 other pulmonary disease case samples were obtained. All the samples were tested by IGRA-ELISA and T-SPOT.TB assay in parallel. The consistency of IGRA-ELISA and T-SPOT.TB in the diagnosis of TB was analyzed. Five different methods for the diagnosis of TB were assayed: IGRA-ELISA, T-SPOT.TB, AFB staining, TB-Ab, and PPD. For the different PPD positive degrees, IGRA-ELISA and T-SPOT.TB positive rates were calculated. AFB staining positive and negative samples were analyzed by IGRA-ELISA, T-SPOT.TB, TB-Ab, and PPD. Positive rates, sensitivity, specificity, PPV, NPV and accuracy values of the five different detection methods were compared. RESULTS: There was good consistency between IGRA-ELISA and T-SPOT.TB in the diagnosis of TB and other pulmonary diseases. Compared with T-SPOT.TB, there was a significant correlation between the absorbance value of IGRA-ELISA and the number of ESAT-6 or CFP-10-specific SFCs (r = 0.902, p < 0.001; r = 0.901, p < 0.001). There was a significant difference in the positive rates among the above five different detection methods in the TB group and non-TB group (p < 0.001). For the different PPD positive degrees, there were highly significant differences in the positive rates of IGRA-ELISA and T-SPOT.TB in non-TB group; no similar trend was observed in the TB group. No significant differences in sensitivity, specificity, PPV, NPV, accuracy, LR+ and LR- were observed between IGRA-ELISA and T-SPOT.TB. The positive rates of IGRA-ELISA and T-SPOT.TB in the TB group were significantly higher than that of AFB staining, TB-Ab, and PPD (p < 0.05). IGRA-ELISA and T-SPOT.TB combined with AFB staining could further improve the sensitivity of tuberculosis detection without reducing its specificity. The AUC of IGRA-ELISA, ESAT-6, CFP-10, and T-SPOT.TB were 0.923, 0.893, 0.937, and 0.919, respectively. CONCLUSIONS: There was good correlation and consistency between the IGRA-ELISA and T-SPOT.TB in the diagnosis of TB. The sensitivity and accuracy of IGRA-ELISA were significantly better than those of AFB staining, TB-Ab, and PPD. IGRA-ELISA combined with AFB staining could further improve the diagnosis of tuberculosis.


Assuntos
Antígenos de Bactérias/imunologia , Pneumopatias/diagnóstico , Mycobacterium tuberculosis/imunologia , Tuberculose/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Testes de Liberação de Interferon-gama/métodos , Pneumopatias/microbiologia , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis/fisiologia , Sensibilidade e Especificidade , Tuberculose/imunologia , Tuberculose/microbiologia , Adulto Jovem
8.
Wien Klin Wochenschr ; 131(15-16): 356-361, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31123816

RESUMO

BACKGROUND: Tuberculosis (TB) has become a rare disease in developed countries. Austria is a low incidence country for TB with an incidence rate of 7.2/100,000 in 2016. The incidence of TB has shown a constant decline in Austria from 2008 (9.8/100,000) to 2015 (6.7/100,000) but recently stagnated in 2016 (7.2/100,000). In recent years migration to Austria from countries with high TB incidence rates has increased. Therefore, this study aimed to describe the recent epidemiology of childhood TB in Vienna. METHODS: Data of pediatric patients with active TB infections, who were hospitalized for further investigations or isolation precautions between 2010 and 2016 at the Wilhelminenspital, Austria's reference center for childhood tuberculosis, were retrospectively analyzed. Demographic and clinical data (symptoms, microbiology, radiology, immunology) were collected, compared and evaluated. RESULTS: A total of 127 patients with active tuberculosis were included in the study. The number of admissions varied between n = 7 in 2010 and n = 26 in 2016. There were two age peaks of infected children (0-5 years: n = 41 and 15-18 years: n = 45). In 35% of the cases one parent had active TB and was suspected to be the index case. In 36% the source of infection remained unknown. Compared to young children (<5 years), adolescents (15-18 years) showed proportionally more TB-related symptoms, such as cough (41% vs. 24%), fever (15% vs. 14%) and weight loss (22% vs. 0%). At the time of admission 51% of the young children and 33% of the adolescents were free of symptoms. Intrathoracic disease was found in 80.8%, extrathoracic disease in 19.2% and 11% of the cases were tuberculous lymphadenitis. Of the patients with intrathoracic TB 54% (n = 64) had a positive microbiological result (auramine staining, bacteriological culture, PCR). In young children hilar lymphadenopathy was the most frequent radiological finding (50%), whereas in adolescents lung infiltrates were most common (36%). The sensitivity of interferon-gamma release assays (IGRA) was 0.94 compared to 0.88 of the tuberculin skin test (TST). Both test methods showed moderate concordance (ϕ-coefficient = 0.48). CONCLUSION: A high number of asymptomatic children and adolescents with active TB were observed, which underlines the importance of efficient screening measures. Thorough history taking in all patients with TB is essential to maximize the effect of contact tracing. Overall, infection rates remained consistently low during the observation period.


Assuntos
Testes de Liberação de Interferon-gama , Teste Tuberculínico , Tuberculose/epidemiologia , Adolescente , Áustria/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Testes de Liberação de Interferon-gama/métodos , Masculino , Estudos Retrospectivos , Teste Tuberculínico/métodos , Tuberculose/diagnóstico
9.
Int J Tuberc Lung Dis ; 23(4): 482-490, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-31064628

RESUMO

SETTING Accurate testing and treatment for latent tuberculous infection is necessary for tuberculosis elimination. Certain parasite infections are associated with increased tuberculin skin test positivity; species-specific effects on QuantiFERON®-TB Gold In-Tube (QGIT) have not been described. OBJECTIVE To determine whether infection with helminths or protozoa affects QGIT results. DESIGN We retrospectively analyzed QGIT and parasite testing results for immigrants screened in Boston, MA, USA, from 2012 to 2017. We also prospectively measured cytokines in QGIT supernatants for a subset (n = 68) with 1) helminths, 2) Blastocystis hominis, 3) other protozoa, and 4) no parasites. RESULTS Of 527 immigrants screened, 141 (26.8%) were QGIT-positive and 229 (43.4%) had parasites detected: 27/527 (5.1%) had helminths and 202/527 (38.3%) protozoa. Cytokine analysis revealed increased interleukin-10 concentrations with protozoa (P = 0.04), and non-significantly higher T-helper 2 concentrations with helminths compared with no parasites. No significant differences emerged in QGIT positivity or interferon-gamma concentrations in any group. CONCLUSION Study results support the use of QGIT in parasite-endemic settings. .


Assuntos
Emigrantes e Imigrantes , Testes de Liberação de Interferon-gama/métodos , Programas de Rastreamento/métodos , Doenças Parasitárias/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Boston , Criança , Pré-Escolar , Citocinas/metabolismo , Feminino , Humanos , Tuberculose Latente/diagnóstico , Masculino , Pessoa de Meia-Idade , Doenças Parasitárias/parasitologia , Estudos Prospectivos , Reprodutibilidade dos Testes , Estudos Retrospectivos , Teste Tuberculínico , Adulto Jovem
10.
Tuberculosis (Edinb) ; 116S: S2-S10, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31060960

RESUMO

BACKGROUND: The new QuantiFERON Gold Plus (QFT+) assay is used for diagnosing tuberculosis (TB) infection and has 2 phlebotomy methods: direct (QFT + D) and single tube transfer (QFT + T). Little data is available on how the TB incidence in the country of birth (COB) of healthcare workers (HCWs) can impact the assay results. METHODS: QuantiFERON Gold In-Tube (QFT-G), QFT + D and QFT + T assays were obtained from a single blood draw and compared for HCWs annually tested for TB infection. HCWs COB was ranked as: high (≥150 per 100,000), medium (20-149), and low TB incidence (<20 TB cases). RESULTS: In 265 HCWs, QFT-G/+D/+T results from medium TB incidence COB (15.6%, 16.9% and 22.1%) were more likely to be positive than high (9.7%, 11.8% and 16.1%) or low incidence COB (6.3%, 8.4% and 10.5%). Agreement between assay results for high, medium and low TB incidence COB were: 95.7%, 83.1%, and 95.8% between QFT-G/QFT + D (p = 0.003), 91.4%, 88.3% and 95.8% between QFT-G/QFT + T (p = 0.187), and 91.4%, 76.6%, and 91.6% between QFT + D/QFT + T (p = 0.005). CONCLUSION: Lower agreement and a higher proportion of positivity were found in QFT-G/+D/+T results in individuals from medium TB incidence COB. QFT + may be more sensitive than QFT-G in HCWs from medium TB incidence COB.


Assuntos
Ensaio de Imunoadsorção Enzimática , Pessoal Profissional Estrangeiro , Pessoal de Saúde , Testes de Liberação de Interferon-gama/métodos , Características de Residência , Tuberculose/diagnóstico , Adulto , Idoso , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Saúde do Trabalhador , Flebotomia , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Tuberculose/sangue , Tuberculose/etnologia , Tuberculose/microbiologia
11.
Am J Public Health ; 109(7): 1028-1033, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31095412

RESUMO

Objectives. To characterize the cascade of care for latent tuberculosis infection (LTBI) in persons experiencing homelessness (PEH) and evaluate the effect of screening by QuantiFERON-TB Gold (QFT) versus tuberculin skin test (TST). Methods. We performed a retrospective cohort study of all PEH screened for LTBI by QFT and TST from May 2015 to April 2017 in Fulton County, Georgia. Results. There were 3504 PEH screened by QFT and 5509 by TST, with 2925 TSTs administered on site at community shelters and 2584 at the health department. More valid test results were obtained in those screened by QFT (99.0% vs 69.0%; P < .001) because of low return rates for reading in both TST arms. For tests administered on site, testing by QFT versus TST improved retention in care with significantly more estimated LTBI cases following up for a medical examination (67.8% vs 51.0%; P < .001) and starting LTBI treatment (58.4% vs 39.8%; P < .001). Conclusions. A QFT-based screening strategy in PEH improved diagnosis and retention in care for new LTBI cases compared with TST and may be an effective strategy to limit progression to active tuberculosis.


Assuntos
Pessoas em Situação de Rua/estatística & dados numéricos , Testes de Liberação de Interferon-gama/métodos , Tuberculose Latente/diagnóstico , Programas de Rastreamento/métodos , Teste Tuberculínico/métodos , Adulto , Feminino , Georgia , Humanos , Tuberculose Latente/imunologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
12.
BMC Infect Dis ; 19(1): 323, 2019 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-30987605

RESUMO

BACKGROUND: To investigate the diagnostic value of the interferon-γ release assay (IGRA) for detecting tuberculosis (TB) infection in patients with Behçet's disease (BD). METHODS: We retrospective analyzed the data collected from 173 BD patients hospitalized between 2010 and 2015. Ninety-nine healthy volunteers were enrolled as a control group. IGRA was performed using T-SPOT.TB. The diagnosis of active TB (ATB) was based on clinical, radiological, microbiological, histopathological information and the response to anti-TB therapy. Latent TB (LTB) infection was defined as asymptomatic patients with positive T-SPOT.TB. RESULTS: TB infection was documented in 59 BD patients (34.1%). The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio of T-SPOT.TB for the diagnosis of ATB were 88.9%, 74.8%, 29.1%, 98.3%, 3.53 and 0.15, respectively. The receiver-operating-characteristic curve demonstrated that spot-forming cells (SFCs) of 70/106 PBMC was the optimal cutoff for diagnosing ATB, with an area under the curve of 0.891. Furthermore, the median SFCs in ATB group was significantly higher than those in LTB infection (466/106 PBMC vs. 68/106 PBMC, p = 0.007) or previous TB infection (466/106 PBMC vs. 96/106 PBMC, p = 0.018). A significant discrepancy between T-SPOT.TB and tuberculin skin test was noted (kappa coefficient = 0.391, p = 0.002). CONCLUSIONS: T-SPOT.TB, an IGRA, may assist in the diagnosis of ATB in BD patients, and the higher SFCs suggest ATB in BD patients.


Assuntos
Síndrome de Behçet/microbiologia , Testes de Liberação de Interferon-gama/métodos , Tuberculose/diagnóstico , Adulto , Síndrome de Behçet/complicações , Feminino , Humanos , Tuberculose Latente/diagnóstico , Leucócitos Mononucleares , Masculino , Pessoa de Meia-Idade , Curva ROC , Estudos Retrospectivos , Sensibilidade e Especificidade , Teste Tuberculínico
13.
Yonsei Med J ; 60(4): 375-380, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30900424

RESUMO

PURPOSE: This study aimed to evaluate ichroma™ IGRA-TB, a novel point-of-care platform for assaying IFN-γ release, and to compare it with QuantiFERON-TB Gold In-Tube (QFT-GIT) for identifying Mycobacterium tuberculosis (M. tb) infection. MATERIALS AND METHODS: We recruited 60 healthy subjects, and blood samples were obtained in QFT-GIT blood collection tubes. The blood collection tubes were incubated at 37°C, and culture supernatant was harvested after 18-24 hours. IFN-γ responses were assessed by the ichroma™ IGRA-TB cartridge and the QFT-GIT IFN-γ enzyme-linked immunosorbent assay. Three active TB patients were recruited as a positive control for M. tb infection. RESULTS: The area under the receiver operating characteristic curve of the ichroma™ IGRA-TB test for differentiating between infected and non-infected individuals was 0.9706 (p<0.001). Inconsistent positivity between the two tests was found in three participants who showed weak positive IFN-γ responses (<1.0 IU/mL) with QFT-GIT. However, the two tests had excellent agreement (95.2%, κ=0.91, p<0.001), and a very strong positive correlation was observed between the IFN-γ values of both tests (r=0.91, p<0.001). CONCLUSION: The diagnostic accuracy demonstrated in this study indicates that the ichroma™ IGRA-TB test could be used as a rapid diagnostic method for detecting latent TB infection. It may be particularly beneficial in resource-limited places that require cost-effective laboratory diagnostics.


Assuntos
Ensaio de Imunoadsorção Enzimática/métodos , Testes de Liberação de Interferon-gama/métodos , Interferon gama/sangue , Tuberculose Latente/diagnóstico , Mycobacterium tuberculosis/isolamento & purificação , Sistemas Automatizados de Assistência Junto ao Leito , Teste Tuberculínico/métodos , Adulto , Área Sob a Curva , Estudos de Casos e Controles , Estudos de Viabilidade , Feminino , Humanos , Interferon gama/análise , Tuberculose Latente/etnologia , Tuberculose Latente/imunologia , Masculino , Mycobacterium tuberculosis/imunologia , Curva ROC , Kit de Reagentes para Diagnóstico , República da Coreia/epidemiologia , Adulto Jovem
14.
PLoS One ; 14(3): e0213304, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30830945

RESUMO

BACKGROUND: Although QuantiFERON-TB Gold Plus (QFT-Plus), a new interferon-gamma release assay, has shown good performance in adults, little data is available in children. METHODS: De-identified data from TB-suspected patients age <18 years with QFT-Plus results, who were admitted or screened at the National Lung Hospital (NLH) in Ha Noi, Vietnam in 2017, were assessed. Logistic regression analyses were performed to determine the characteristics associated with having a positive QFT-Plus result. Sensitivity, both overall and in subgroups of pulmonary TB only (PTB), extra-pulmonary TB (EPTB) only, and both PTB and EPTB were calculated. RESULTS: Of 222 children with available QFT-Plus results, 33 were classified as confirmed TB, of whom 18 had QFT-Plus (+) and 15 had QFT-Plus (-). Multiple logistic regression modeling suggested that age, history of TB, and confirmed TB were significantly associated with having a positive QFT-Plus result with an area under the ROC curve of 0.77. QFT-Plus sensitivity in PTB only, EPTB, and both PTB and EPTB patients was 84.2%, 14.3% and 14.3%, respectively. The overall sensitivity of the QFT-Plus assay (regardless PTB or EPTB) in children was 54.5%. CONCLUSION: Although QFT-Plus had a good sensitivity in children having exclusive PTB, it had poor sensitivity in EPTB.


Assuntos
Bioensaio/métodos , Testes de Liberação de Interferon-gama/métodos , Programas de Rastreamento , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose/diagnóstico , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Prevalência , Curva ROC , Tuberculose/epidemiologia , Tuberculose/microbiologia , Vietnã/epidemiologia
15.
BMC Infect Dis ; 19(1): 131, 2019 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-30736743

RESUMO

BACKGROUND: The tuberculin skin test (TST) and interferon-gamma-release-assays (IGRAs) are utilized in screening programmes for presumed latent tuberculosis infection (LTBI) in health care workers (HCWs). However, inter-test comparison yields high rates of discordance, which is poorly understood. The aim of the study was therefore to identify factors associated with discordance amongst HCWs in a TB and HIV endemic setting. METHODS: 505 HCWs were screened for LTBI in South Africa using the TST and two IGRA assays (QuantiFERON-TB-Gold-In-Tube (QFT-GIT) and TSPOT.TB). Factors associated with discordance were analyzed using a multinomial logistic regression model. RESULTS: TST-IGRA discordance was negatively associated with longer duration of employment for both TSPOT.TB (OR = 0.92; 95% confidence interval (CI) 0.85-0.99) and QFT-GIT (OR = 0.90; 95% CI 0.84-0.96). Marked test discordance occurred in HIV-infected individuals who were more likely to have TSPOT.TB + ve / TST-ve discordance (OR 4.44; 95% CI 1.14-17.27) or TSPOT.TB + ve / QFT-GIT-ve test discordance (OR 5.72; 95% CI 1.95-16.78). Those engaged in home care were less likely to have QFT-GIT + ve/TSPOT.TB -ve / discordance (OR 0.32; 95% CI 0.10-0.95). CONCLUSION: The marked TST-IGRA and IGRA-IGRA discordance in HIV-infected individuals suggest greater sensitivity of TSPOT.TB in immunocompromised persons or potential greater reactivity of TSPOT.TB in this population.


Assuntos
Pessoal de Saúde/estatística & dados numéricos , Testes de Liberação de Interferon-gama , Tuberculose Latente/diagnóstico , Tuberculose Latente/epidemiologia , Teste Tuberculínico , Adulto , Grupo com Ancestrais do Continente Africano , Idoso , Reações Falso-Positivas , Feminino , Humanos , Testes de Liberação de Interferon-gama/métodos , Tuberculose Latente/complicações , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Sensibilidade e Especificidade , África do Sul/epidemiologia , Teste Tuberculínico/métodos
16.
Artigo em Inglês | MEDLINE | ID: mdl-30761274

RESUMO

The performance of T-SPOT.TB (T-SPOT) assay in diagnosing pleural tuberculosis (plTB) is inconsistent. In this study, we compared the performance of peripheral blood (PB) and pleural fluid (PF) T-SPOT assay in diagnosing plTB. Between July 2017 and March 2018, 218 and 210 suspected plTB patients were prospectively enrolled from Wuhan (training) and Guangzhou (validation) cohort, respectively. PB T-SPOT, PF T-SPOT, and other conventional tests were simultaneously performed. Our data showed the performance of PB T-SPOT in diagnosing plTB was limited, especially with low sensitivity. However, the results of early secreted antigenic target 6 (ESAT-6) and culture filtrate protein 10 (CFP-10) in PF T-SPOT were significantly increased compared with those in PB T-SPOT in plTB patients. If using 76 as the cutoff value of MAX (the larger of ESAT-6 and CFP-10) in Wuhan cohort, the sensitivity and specificity of PF T-SPOT to diagnose plTB were 89.76 and 96.70%, respectively. The diagnostic accuracy of PF T-SPOT was better than other routine tests such as pathogen detection methods and biochemical markers. The diagnostic accuracy of PF T-SPOT in Guangzhou cohort was similar to that in Wuhan cohort, with a sensitivity and specificity of 91.07 and 94.90%, respectively. Furthermore, CD4+ T cells were more activated in PF compared with PB, and the frequency of mycobacterium tuberculosis-specific CD4+ T cells in PF was significantly higher than that in PB in plTB patients. In conclusion, the performance of PF T-SPOT is obviously better than PB T-SPOT or other laboratory tests, which suggests that PF T-SPOT assay has been of great value in the diagnosis of pleural tuberculosis.


Assuntos
Testes Diagnósticos de Rotina/métodos , Testes de Liberação de Interferon-gama/métodos , Derrame Pleural/imunologia , Tuberculose Pleural/diagnóstico , Adulto , Idoso , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sensibilidade e Especificidade
17.
Tuberculosis (Edinb) ; 114: 91-102, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30711163

RESUMO

OBJECTIVE: Accurate and timely diagnosis of tuberculosis (TB) is essential to control the global pandemic. Currently available immunodiagnostic tests cannot discriminate between latent tuberculosis infection (LTBI) and active tuberculosis. This study aimed to determine whether candidate mycobacterial antigen-stimulated cytokine biomarkers can discriminate between TB-uninfected and TB-infected adults, and additionally between LTBI and active TB disease. METHODS: 193 adults were recruited, and categorised into four unambiguous diagnostic groups: microbiologically-proven active TB, LTBI, sick controls (non-TB lower respiratory tract infections) and healthy controls. Whole blood assays were used to determine mycobacterial antigen (CFP-10, ESAT-6, PPD)-stimulated cytokine (IL-1ra, IL-2, IL-10, IL-13, TNF-α, IFN-γ, IP-10 and MIP-1ß) responses, measured by Luminex multiplex immunoassay. RESULTS: The background-corrected mycobacterial antigen-stimulated cytokine responses of all eight cytokines were significantly higher in TB-infected participants compared with TB-uninfected individuals, with IL-2 showing the best performance characteristics. In addition, mycobacterial antigen-stimulated responses with IL-1ra, IL-10 and TNF-α were higher in participants with active TB compared those with LTBI, reaching statistical significance with PPD stimulation, although there was a degree of overlap between the two groups. CONCLUSION: Mycobacterial antigen-stimulated cytokine responses may prove useful in future immunodiagnostic tests to discriminate between tuberculosis-infected and tuberculosis-uninfected individual, and potentially between LTBI and active tuberculosis.


Assuntos
Citocinas/sangue , Tuberculose/diagnóstico , Adulto , Antígenos de Bactérias/imunologia , Biomarcadores/sangue , Estudos de Casos e Controles , Citocinas/biossíntese , Diagnóstico Diferencial , Feminino , Humanos , Testes de Liberação de Interferon-gama/métodos , Tuberculose Latente/diagnóstico , Masculino , Pessoa de Meia-Idade , Curva ROC , Teste Tuberculínico/métodos , Adulto Jovem
18.
Med Microbiol Immunol ; 208(2): 171-183, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30623240

RESUMO

The new QuantiFERON-TB Gold Plus employs modified peptides optimized to elicit an IFNγ response from CD8+ cytotoxic T lymphocytes in addition to CD4+ T cells. With a view to improve the difficult identification of TB cases, we assessed the combination of two specific immunological markers comprising IFNγ secretion and T cells co-expression of CD25 and CD134 in response to Mycobacterium tuberculosis-specific antigens. A total of 34 subjects with suspected TB and 10 age-matched HD were prospectively enrolled. Assessing the performance of QFT-Plus in terms of the TB1 and TB2 results, we found that in TB patients, the quantitative IFNγ value in TB2 was similar to that in TB1, and we did not find any differences irrespective of the disease (pulmonary or extra-pulmonary). The flow cytometric CD25/CD134 assay, allowed a more accurate differentiation between M. tuberculosis-infected and uninfected patients, with a better combination of sensitivity and specificity, especially by evaluation of CD4+ T-cell subset. All individuals with negative QFT-Plus results displayed a positive CD25/CD134 response. Overall, a positive correlation was found between T cells co-expressing CD25/CD134 and IFNγ levels in response to both QFT-Plus TB antigen tubes, as well as between the QFT-Plus TB1 and TB2 tubes. We demonstrated that both TB1 and TB2 induce a higher expression of CD25+CD134+ markers on CD4+ T cells among infected TB subjects, compared to the lower degree of CD8+ T cells, mainly induced to TB2 stimulation. We suggest that a combined use of classic QFT-Plus and specific CD25/CD134 response may be a useful means in the diagnostic workup for active TB.


Assuntos
Antígenos de Bactérias/imunologia , Testes de Liberação de Interferon-gama/métodos , Subunidade alfa de Receptor de Interleucina-2/análise , Mycobacterium tuberculosis/imunologia , Receptores OX40/análise , Tuberculose/diagnóstico , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sensibilidade e Especificidade
20.
Int J Tuberc Lung Dis ; 23(1): 38-44, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30572979

RESUMO

SETTING: Seven tuberculosis (TB) clinics in South Africa. OBJECTIVE: As both purified protein derivative (PPD) and a Mycobacterium tuberculosis-specific skin test (C-Tb) contain region of difference 1 (RD1) antigens, we conducted a study to evaluate whether there was any interaction between the two during concomitant and separate administration in patients with newly diagnosed culture-positive TB. DESIGN: Adult patients with active TB (n = 456, 20% human immunodeficiency virus infected) were randomised to receive only C-Tb, only PPD, or concomitant injection of both C-Tb and PPD using the Mantoux technique. Indurations were read after 48-72 h. QuantiFERON®-TB Gold In-Tube (QFT) was performed in tandem. RESULTS: Of the 456 study participants, 154 simultaneously received both C-Tb and PPD, 153 only C-Tb and 149 only PPD. There was no effect of concomitant injection of PPD on the mean C-Tb induration (19 mm, 95%CI 17-22 vs. 18 mm, 95%CI 16-21; P = 0.91). In patients with active TB, C-Tb sensitivity (78%) was similar to PPD (81%) and QFT (84%; excluding 82/429 [19%] indeterminate results). All tests showed reduced sensitivity in participants with CD4 <100 cells/µl. CONCLUSION: In patients with active TB, there was no interaction between C-Tb and PPD during concomitant injection of both agents. Sensitivities were similar for PPD and C-Tb.


Assuntos
Teste Tuberculínico/métodos , Tuberculina/administração & dosagem , Tuberculose/diagnóstico , Adolescente , Adulto , Idoso , Vacina BCG/administração & dosagem , Reações Cruzadas , Método Duplo-Cego , Feminino , Infecções por HIV/complicações , Humanos , Testes de Liberação de Interferon-gama/métodos , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis , Sensibilidade e Especificidade , África do Sul , Tuberculose/complicações , Adulto Jovem
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