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Meregildo-Rodriguez ED, Yuptón-Chávez V, Asmat-Rubio MG, Vásquez-Tirado GA. Latent tuberculosis infection (LTBI) in health-care workers: a cross-sectional study at a northern Peruvian hospital. Front Med (Lausanne) 2023; 10:1295299. [PMID: 38098842 PMCID: PMC10720426 DOI: 10.3389/fmed.2023.1295299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 11/13/2023] [Indexed: 12/17/2023] Open
Abstract
Background Healthcare workers (HCWs) have a higher risk of latent tuberculosis infection (LTBI) and active tuberculosis than the general population. In HCWs, the risk of tuberculosis infection depends on the local tuberculosis prevalence, HCWs' characteristics, the healthcare facility, and prevention and control measures. We aimed to estimate the prevalence and risk factors for LTBI in HCWs at a northern Peruvian hospital. Methods This study had two phases: (1) a cross-sectional phase involving recruitment, history taking, and sampling for the Interferon-Gamma Release Assays (IGRA test), and (2) a prospective follow-up of IGRA-positive participants. We enrolled direct and non-direct patient caregivers among HCWs. We defined an LTBI case if the IGRA test was positive and clinical, laboratory, and radiological evaluations for active tuberculosis were negative. Results We recruited 308 participants between November 2022 and May 2023. The mean age was 38.6 ± 8.3 years. Over 75% of the participants were female. The most common job category was technicians (30.5%), physicians (22.7%), nurses (20.5%), and other HCWs groups (17.5%). Most participants worked in hospital wards (28.2%), diagnostics departments (16.9%), and critical care departments (15.6%). The LTBI prevalence among HCWs was 17.86% (95% CI 13.84-22.70). In multivariate analysis, after adjusting for age, time working in our hospital, and family history of tuberculosis, males had a higher risk of LTBI (aPR 1.69, 95% CI 1.01-2.77) than females. Working for more than 10 years increased the risk of LBTI (aPR 2.4, 95% CI 1.44-3.97) compared to working for ≤10 years. Even further, participants who had worked for more than 20 years had an aPR of 4.31 (95% CI 1.09-13.65) compared to those with ≤10 years. Similarly, occupational exposure increased the risk of LTBI (aPR 2.21, 95% CI 1.27-4.08) compared to those HCWs not occupationally exposed. Conclusion The LTBI prevalence in HCWs at a northern Peruvian hospital was lower compared to other Peruvian cities. Males, more experienced, and occupational exposed HCWs are at higher risk of LTBI. LTBI prevalence in Peruvian HCWs is still high. More studies are needed to address some aspects this study has not examined.
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Duthie MS, Reed SG. Skin tests for the detection of Mycobacterial infections: achievements, current perspectives, and implications for other diseases. Appl Microbiol Biotechnol 2021; 105:503-508. [PMID: 33394146 PMCID: PMC7780083 DOI: 10.1007/s00253-020-11062-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/09/2020] [Accepted: 12/15/2020] [Indexed: 01/28/2023]
Abstract
Immunological and molecular advances have modernized diagnostic testing for many diseases. Although interferon gamma-release and polymerase chain reaction assays have been developed to detect Mycobacterium tuberculosis (Mtb) infection, purified protein derivative (PPD)-based tuberculin skin testing (TST) remains the most widely used method. Indeed, the TST is a simple and cost-effective tool that can be easily applied for widespread screening for Mtb infection. However, the lack of specificity has been a limitation of these tests, and, more recently, supply issues have arisen. Building upon the skin tests that historically have been used within TB and leprosy control programs, we discuss recent developments using modern technologies for improving mycobacterial skin testing as well as practical advantages inherent to the technique. Furthermore, we outline how this knowledge could be applied to develop similar tests that could benefit diagnostic strategies for other infections. KEY POINTS: • Skin testing provides a significantly cheaper alternative to most modern technologies. • Skin tests provide a lab-independent diagnostic strategy that can be widely administered. • Diseases for which T cell responses are more robust or durable than antibody responses are accessible for skin testing.
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Affiliation(s)
| | - Steven G Reed
- HDT Bio Corp, 1616 Eastlake Ave E, Seattle, WA, 98102, USA
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Badaro R, Machado BAS, Duthie MS, Araujo-Neto CA, Pedral-Sampaio D, Nakatani M, Reed SG. The single recombinant M. tuberculosis protein DPPD provides enhanced performance of skin testing among HIV-infected tuberculosis patients. AMB Express 2020; 10:133. [PMID: 32737693 PMCID: PMC7394993 DOI: 10.1186/s13568-020-01068-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/18/2020] [Indexed: 11/10/2022] Open
Abstract
Diagnostic testing for M. tuberculosis infection has advanced with QuantiFERON and GeneXpert, but simple cost-effective alternatives for widespread TB screening has remained elusive and purified protein derivative (PPD)-based tuberculin skin testing (TST) remains the most widely used method. PPD-based tests have reduced performance, however, in BCG vaccinees and in individuals with immune deficiencies. We compared the performance of skin testing with the recombinant DPPD protein against that of a standard PPD-based skin test. Our data indicates similar performance of DPPD and PPD (r2 = 0.7689) among HIV-negative, active TB patients, all of whom presented greater than 10 mm induration following administration. In contrast to results demonstrating that PPD induced indurations greater than 5 mm (i.e., the recommended threshold for positive results in this population) in only half (19 of 38) of the HIV positive TB patients, 89.5% (34 of 38) of these participants developed indurations greater than 5 mm when challenged with DPPD. Importantly, none of the patients that were positive following PPD administration were negative following DPPD administration, indicating markedly improved sensitivity of DPPD among HIV-infected individuals. Our data indicate that DPPD has superior performance in skin testing than the current TST standard.
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Gaps in Study Design for Immune Parameter Research for Latent Tuberculosis Infection: A Systematic Review. J Immunol Res 2020; 2020:8074183. [PMID: 32377537 PMCID: PMC7191376 DOI: 10.1155/2020/8074183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 03/16/2020] [Indexed: 01/09/2023] Open
Abstract
Background Immune parameters (IP) have been extensively studied to distinguish between latent tuberculosis (LTBI) and active tuberculosis (TB). Objective To determine the IP associated with LTBI, compared to active TB and individuals not infected by M. tuberculosis published in literature. Methods We conducted a systematic search using Google Scholar and PubMed databases, combining the MeSH terms latent tuberculosis, Mycobacterium tuberculosis, cytokines, and biological markers, with the free terms, biomarkers and cytokines. Spanish, English, and Portuguese articles comparing the concentration of IP associated with LTBI, either in plasma/serum or in vitro, in adults and nonimmunocompromised versus individuals with TB or without M. tuberculosis infection between 2006 July and 2018 July were included. Two blinded reviewers carried out the searches, read the abstracts, and selected the articles for analysis. Participants' information, diagnostic criteria, IP, detection methods, and biases were collected. Results We analyzed 36 articles (of 637 abstracts) with 93 different biomarkers in different samples. We found 24 parameters that were increased only in active TB (TGF-α, CSF3, CSF2, CCL1 [I-309], IL-7, TGF-β1, CCL3 [MIP-1α], sIL-2R, TNF-β, CCL7 [MCP-3], IFN-α, fractalkine, I-TAG, CCL8 [MCP-2], CCL21 [6Ckine], PDGF, IL-22, VEGF-A, LXA4, PGE2, PGF2α, sCD163, sCD14, and 15-Epi-LXA4), five were elevated in LTBI (IL-5, IL-17F, IL-1, CCL20 [MIP-3α], and ICAM-1), and two substances were increased among uninfected individuals (IL-23 and basic FGF). We found high heterogeneity between studies including failure to account for the time/illness of the individuals studied; varied samples and protocols; different clinical classification of TB; different laboratory methods for IP detection, which in turn leads to variable units of measurement and assay sensitivities; and selection bias regarding TST and booster effect. None of the studies adjusted the analysis for the effect of ethnicity. Conclusions It is mandatory to harmonize the study of immune parameters for LTBI diagnosis. This systematic review is registered with PROSPERO CRD42017073289.
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Salas-Coronas J, Rogado-González MC, Lozano-Serrano AB, Cabezas-Fernández MT. [Tuberculosis and immigration]. Enferm Infecc Microbiol Clin 2016; 34:261-9. [PMID: 26851978 DOI: 10.1016/j.eimc.2015.12.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 12/31/2015] [Indexed: 11/19/2022]
Abstract
The incidence of tuberculosis worldwide is declining. However, in Western countries this decline is slower due to the impact of immigration. Tuberculosis in the immigrant population is related to health status in the country of origin and with overcrowding and poverty conditions in the host country. Immigrants with tuberculosis are younger, have a higher prevalence of extrapulmonary forms, greater proportion of drug resistance and higher treatment default rates than those of natives. New molecular techniques not only reduce diagnostic delay time but also allow the rapid identification of resistances and improve knowledge of transmission patterns. It is necessary to implement measures to improve treatment compliance in this population group like facilitating access to health card, the use of fixed-dose combination drugs, the participation of cultural mediators and community health workers and gratuity of drugs.
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Affiliation(s)
- Joaquín Salas-Coronas
- Unidad de Medicina Tropical, Hospital de Poniente, El Ejido, Almería, España; Centro de Estudio de las Migraciones y Relaciones Interculturales (CEMyRI). Universidad de Almería, Almería, España.
| | | | | | - M Teresa Cabezas-Fernández
- Unidad de Medicina Tropical, Hospital de Poniente, El Ejido, Almería, España; Centro de Estudio de las Migraciones y Relaciones Interculturales (CEMyRI). Universidad de Almería, Almería, España
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Martinez Lacasa X, Canals Font R, Jaen Manzanera A, Cuchi Burgos E, Lite Lite J. [Comparative study of concordance and costs between tuberculin skin test and QuantiFERON(®)-TB Gold In-Tube in the diagnosis of latent tuberculosis infection among contacts of patients with pulmonary tuberculosis]. Med Clin (Barc) 2015; 145:427-32. [PMID: 25794770 DOI: 10.1016/j.medcli.2014.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 11/11/2014] [Accepted: 11/20/2014] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Recently diagnosis of latent tuberculosis infection (LTBI) can be made using the tuberculin skin test (TST) or by techniques known as interferon-γ release assays (IGRAS), being QuantiFERON(®)-TB Gold In-Tube (QF-G-IT) the most used. The IGRAS avoid some drawbacks of the TST, especially cross-reaction with bacillus Calmette-Guérin (BCG) vaccine, but also present some problems such as those arising from cost and the need of having an adequate infrastructure and experience. There is no clear consensus on which technique should be preferentially used for the diagnosis of LTBI. METHODS This is a comparative study between the TST and QT-G-IT in a cohort of contacts of patients with pulmonary tuberculosis during the study period. An analysis of global agreement and groups was performed according to whether the contacts were vaccinated with BCG or not. A study of costs of both techniques and diagnostic strategies based on these techniques was performed. RESULTS The agreement between TST and QF-G-IT was acceptable in the whole sample yet it was very good in the unvaccinated group. Few cases of indeterminate values were recorded. The cost study showed that TST was cheaper than QF-G-IT; however when we analyzed the cost of the strategies according to each technique, the QF-G-IT showed a better cost-benefit. CONCLUSION We suggest considering QF-G-IT as the only preferred technique for the diagnosis of LTBI in household contacts, based on good overall agreement between the 2 techniques (even if we eliminate the effect of the vaccine) and a cost analysis favorable to QF-G-IT.
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Affiliation(s)
- Xavier Martinez Lacasa
- Unitat de Control de Tuberculosis, Servei de Medicina Interna, Hospital Universitari Mútua Terrassa, Terrassa, Barcelona, España.
| | - Roser Canals Font
- Unitat de Control de Tuberculosis, Servei de Medicina Interna, Hospital Universitari Mútua Terrassa, Terrassa, Barcelona, España
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Recomendaciones del Grupo Español de Trabajo en Enfermedad de Crohn y Colitis Ulcerosa (GETECCU) sobre el cribado y tratamiento de la tuberculosis latente en pacientes con enfermedad inflamatoria intestinal. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.eii.2015.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Dias MFRG, Bernardes Filho F, Quaresma MV, Nascimento LVD, Nery JADC, Azulay DR. Update on cutaneous tuberculosis. An Bras Dermatol 2015; 89:925-38. [PMID: 25387498 PMCID: PMC4230662 DOI: 10.1590/abd1806-4841.20142998] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Accepted: 09/26/2013] [Indexed: 01/10/2023] Open
Abstract
Tuberculosis continues to draw special attention from health care professionals and
society in general. Cutaneous tuberculosis is an infection caused by M. tuberculosis
complex, M. bovis and bacillus Calmette-Guérin. Depending on individual immunity,
environmental factors and the type of inoculum, it may present varied clinical and
evolutionary aspects. Patients with HIV and those using immunobiological drugs are
more prone to infection, which is a great concern in centers where the disease is
considered endemic. This paper aims to review the current situation of cutaneous
tuberculosis in light of this new scenario, highlighting the emergence of new and
more specific methods of diagnosis, and the molecular and cellular mechanisms that
regulate the parasite-host interaction.
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Affiliation(s)
- Maria Fernanda Reis Gavazzoni Dias
- Instituto de Dermatologia Professor Rubem David Azulay, Santa Casa da Misericórdia do Rio de Janeiro (IDPRDA-SCMRJ), Rio de Janeiro, RJ, Brazil
| | - Fred Bernardes Filho
- Instituto de Dermatologia Professor Rubem David Azulay, Santa Casa da Misericórdia do Rio de Janeiro (IDPRDA-SCMRJ), Rio de Janeiro, RJ, Brazil
| | - Maria Victória Quaresma
- Instituto de Dermatologia Professor Rubem David Azulay, Santa Casa da Misericórdia do Rio de Janeiro (IDPRDA-SCMRJ), Rio de Janeiro, RJ, Brazil
| | | | | | - David Rubem Azulay
- Instituto de Dermatologia Professor Rubem David Azulay, Santa Casa da Misericórdia do Rio de Janeiro (IDPRDA-SCMRJ), Rio de Janeiro, RJ, Brazil
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Zhang H, Sun Z, Wei W, Liu Z, Fleming J, Zhang S, Lin N, Wang M, Chen M, Xu Y, Zhou J, Li C, Bi L, Zhou G. Identification of serum microRNA biomarkers for tuberculosis using RNA-seq. PLoS One 2014; 9:e88909. [PMID: 24586438 PMCID: PMC3930592 DOI: 10.1371/journal.pone.0088909] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Accepted: 01/13/2014] [Indexed: 01/02/2023] Open
Abstract
Tuberculosis (TB) remains a significant human health issue. More effective biomarkers for use in tuberculosis prevention, diagnosis, and treatment, including markers that can discriminate between healthy individuals and those with latent infection, are urgently needed. To identify a set of such markers, we used Solexa sequencing to examine microRNA expression in the serum of patients with active disease, healthy individuals with latent TB, and those with or without prior BCG inoculation. We identified 24 microRNAs that are up-regulated (2.85–1285.93 fold) and 6 microRNAs that are down-regulated (0.003–0.11 fold) (P<0.05) in patients with active TB relative to the three groups of healthy controls. In addition, 75 microRNAs were up-regulated (2.05–2454.58 fold) and 11 were down-regulated (0.001–0.42 fold) (P<0.05) in latent-TB infected individuals relative to BCG- inoculated individuals. Of interest, 134 microRNAs were differentially-expressed in BCG-inoculated relative to un-inoculated individuals (18 up-regulated 2.9–499.29 fold, 116 down-regulated 0.0002–0.5 fold), providing insights into the effects of BCG inoculation at the microRNA level. Target prediction of differentially-expressed microRNAs by microRNA-Gene Network analysis and analysis of pathways affected suggest that regulation of the host immune system by microRNAs is likely to be one of the main factors in the pathogenesis of tuberculosis. qRT-PCR validation indicated that hsa-miR-196b and hsa-miR-376c have potential as markers for active TB disease. The microRNA differential-expression profiles generated in this study provide a good foundation for the development of markers for TB diagnosis, and for investigations on the role of microRNAs in BCG-inoculated and latent-infected individuals.
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Affiliation(s)
- Hongtai Zhang
- Department of Space Radiobiology, Key Laboratory of Heavy Ion Radiation Biology and Medicine, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, China
- Key Laboratory of Non-coding RNA, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Zhaogang Sun
- Beijing Key Laboratory of Drug Resistance in Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Wenjing Wei
- Key Laboratory of Non-coding RNA, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
| | | | - Joy Fleming
- Key Laboratory of Non-coding RNA, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
| | - Shuai Zhang
- Key Laboratory of Non-coding RNA, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
| | - Nan Lin
- College of Life Sciences, Fujian Agriculture and Forestry University, Fuzhou, China
| | - Ming Wang
- Key Laboratory of Non-coding RNA, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
| | - Maoshan Chen
- Beijing Genomics Institute, Shenzhen 518083, China
| | - Yuhui Xu
- Beijing Key Laboratory of Drug Resistance in Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Jie Zhou
- The 4th Peoples’ Hospital, Foshan City, Guangdong Province, China
| | - Chuanyou Li
- Beijing Chest Hospital, Capital Medical University, Beijing, China
- * E-mail: (GZ); (LB); (CL)
| | - Lijun Bi
- Key Laboratory of Non-coding RNA, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
- * E-mail: (GZ); (LB); (CL)
| | - Guangming Zhou
- Department of Space Radiobiology, Key Laboratory of Heavy Ion Radiation Biology and Medicine, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, China
- * E-mail: (GZ); (LB); (CL)
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