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Nyawo G, Naidoo C, Wu BG, Kwok B, Clemente JC, Li Y, Minnies S, Reeve B, Moodley S, John TJ, Karamchand S, Singh S, Pecararo A, Doubell A, Kyriakakis C, Warren R, Segal LN, Theron G. Bad company? The pericardium microbiome in people investigated for tuberculosis pericarditis in an HIV-prevalent setting. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.26.24306431. [PMID: 38712063 PMCID: PMC11071582 DOI: 10.1101/2024.04.26.24306431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Background The microbiome likely plays a role in tuberculosis (TB) pathogenesis. We evaluated the site-of-disease microbiome and predicted metagenome in people with presumptive tuberculous pericarditis, a major cause of mortality, and explored for the first time, the interaction between its association with C-reactive protein (CRP), a potential diagnostic biomarker and the site-of-disease microbiome in extrapulmonary TB. Methods People with effusions requiring diagnostic pericardiocentesis (n=139) provided background sampling controls and pericardial fluid (PF) for 16S rRNA gene sequencing analysed using QIIME2 and PICRUSt2. Blood was collected to measure CRP. Results PF from people with definite (dTB, n=91), probable (pTB, n=25), and non- (nTB, n=23) tuberculous pericarditis differed in β-diversity. dTBs were, vs. nTBs, Mycobacterium-, Lacticigenium-, and Kocuria- enriched. Within dTBs, HIV-positives were Mycobacterium-, Bifidobacterium- , Methylobacterium- , and Leptothrix -enriched vs. HIV-negatives and HIV-positive dTBs on ART were Mycobacterium - and Bifidobacterium -depleted vs. those not on ART. Compared to nTBs, dTBs exhibited short-chain fatty acid (SCFA) and mycobacterial metabolism microbial pathway enrichment. People with additional non-pericardial involvement had differentially PF taxa (e.g., Mycobacterium -enrichment and Streptococcus -depletion associated with pulmonary infiltrates). Mycobacterium reads were in 34% (31/91), 8% (2/25) and 17% (4/23) of dTBs, pTBs, and nTBs, respectively. β-diversity differed between patients with CRP above vs. below the median value ( Pseudomonas -depleted). There was no correlation between enriched taxa in dTBs and CRP. Conclusions PF is compositionally distinct based on TB status, HIV (and ART) status and dTBs are enriched in SCFA-associated taxa. The clinical significance of these findings, including mycobacterial reads in nTBs and pTBs, requires evaluation.
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Derendinger B, Mochizuki TK, Marcelo D, Shankar D, Mangeni W, Nguyen H, Yerikaya S, Worodria W, Yu C, Nguyen NV, Christopher DJ, Theron G, Phillips PP, Nahid P, Denkinger CM, Cattamanchi A, Yoon C. C-reactive protein-based tuberculosis triage testing: a multi-country diagnostic accuracy study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.23.24305228. [PMID: 38712173 PMCID: PMC11071588 DOI: 10.1101/2024.04.23.24305228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Rationale C-reactive protein (CRP)-based tuberculosis (TB) screening is recommended for people with HIV (PWH). However, its performance among people without HIV and in diverse settings is unknown. Objectives In a multi-country study, we aimed to determine whether CRP meets the minimum accuracy targets (sensitivity ≥90%, specificity ≥70%) for an effective TB triage test. Methods/Measurements Consecutive outpatient adults with cough ≥2 weeks from five TB endemic countries in Africa and Asia had baseline blood collected for point-of-care CRP testing and HIV and diabetes screening. Sputum samples were collected for Xpert MTB/RIF Ultra (Xpert) testing and culture. CRP sensitivity and specificity (5 mg/L cut-point) was determined in reference to sputum test results and compared by country, sex, and HIV and diabetes status. Variables affecting CRP performance were identified using a multivariate receiver operating characteristic (ROC) regression model. Results Among 2904 participants, of whom 613 (21%) had microbiologically-confirmed TB, CRP sensitivity was 84% (95% CI: 81-87%) and specificity was 61% (95% CI: 59-63%). CRP accuracy varied geographically, with higher sensitivity in African countries (≥91%) than Asian countries (64-82%). Sensitivity was higher among men than women (87% vs. 79%, difference +8%, 95% CI: 1-15%) and specificity was higher among people without HIV than PWH (64% vs. 45%, difference +19%, 95% CI: 13-25%). ROC regression identified country and measures of TB disease severity as predictors of CRP performance. Conclusions Overall, CRP did not achieve the minimum accuracy targets and its performance varied by setting and in some sub-groups, likely reflecting population differences in mycobacterial load.
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Affiliation(s)
- Brigitta Derendinger
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Tessa K. Mochizuki
- Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, USA
- UCSF Center for Tuberculosis, University of California San Francisco, San Francisco, USA
| | - Danaida Marcelo
- De La Salle Medical Health Sciences Institute, Dasmariñas City, Philippines
| | - Deepa Shankar
- Department of Pulmonary Medicine, Christian Medical College, Vellore, India
| | - Wilson Mangeni
- Walimu and Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Seda Yerikaya
- Department of Infectious Disease and Tropical Medicine, Center for Infectious Diseases, Heidelberg University Hospital; German Center for Infection Research, partner site, Heidelberg, Germany
| | - William Worodria
- Walimu and Makerere University College of Health Sciences, Kampala, Uganda
| | - Charles Yu
- De La Salle Medical Health Sciences Institute, Dasmariñas City, Philippines
| | | | | | - Grant Theron
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Patrick P.J. Phillips
- Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, USA
- UCSF Center for Tuberculosis, University of California San Francisco, San Francisco, USA
| | - Payam Nahid
- Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, USA
- UCSF Center for Tuberculosis, University of California San Francisco, San Francisco, USA
| | - Claudia M. Denkinger
- Department of Infectious Disease and Tropical Medicine, Center for Infectious Diseases, Heidelberg University Hospital; German Center for Infection Research, partner site, Heidelberg, Germany
| | - Adithya Cattamanchi
- UCSF Center for Tuberculosis, University of California San Francisco, San Francisco, USA
- Division of Pulmonary Diseases and Critical Care Medicine, University of California Irvine, Irvine, CA
| | - Christina Yoon
- Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, USA
- UCSF Center for Tuberculosis, University of California San Francisco, San Francisco, USA
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Sineque A, Catalao C, Ceffa S, Fonseca AM, Parruque F, Guidotti G, Massango C, Carrilho C, Bicho C, Rangeiro R, Orlando S, Marazzi MC, Lorenzoni C, Ciccacci F. Screening approaches for cervical cancer in Mozambique in HIV positive and negative women. Eur J Cancer Prev 2023; 32:431-437. [PMID: 37144587 DOI: 10.1097/cej.0000000000000802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVE Cervical cancer (CC) is a global health issue, in Mozambique, 5300 new cases and 3800 deaths are reported each year. The WHO recommends the introduction of HPV molecular testing for CC screening, but Mozambique uses an approach based on visual inspection with acetic acid (VIA). This study aims to evaluate the feasibility of high-risk HPV (hrHPV) testing compared to actual approaches in Mozambique. METHODS An observational study was carried out in the DREAM center in Zimpeto, Mozambique. Women aged 30-55 were included. HPV testing was performed with the Cobas HPV test. They were then screened with the current national recommendations based on VIA. Cryotherapy was performed on-site or referred for colposcopy if necessary. RESULTS In the period, 1207 women were enrolled, 47.8% HIV+; 124 (10.3%) VIA+, and HPV DNA test was positive in 325 (26.9%) women. HPV positivity rates were higher in HIV-infected women. In the sample, 52.8% of the 124 VIA+ women were HPV uninfected and underwent unnecessary cryotherapy or colposcopy. Meanwhile, 24.7% of the 1083 VIA- women were actually HPV infected. In comparison, a screen, triage and treat approach based on hrHPV testing would only test and treat the 325 HPV-infected women. CONCLUSION The study found high rates of hrHPV infection, particularly in HIV-positive women, with many concurrent or multiple infections. The current screening method misses important hrHPV infections and results in many unnecessary treatments. These results support the use of HPV molecular testing as the initial screening test for CC.
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Affiliation(s)
- Alberto Sineque
- DREAM Program, Community of Sant'Egidio
- Department of Biological Sciences, Eduardo Mondlane University, Maputo, Mozambique
| | | | - Susanna Ceffa
- DREAM Program, Community of Sant'Egidio, Rome, Italy
| | | | | | | | | | - Carla Carrilho
- Maputo Central Hospital
- Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Clara Bicho
- Institute for Preventive Medicine and Public Health, Institute of Environmental Health (ISAMB), Faculty of Medicine, University of Lisboa, Portugal
| | | | - Stefano Orlando
- Department of Biomedicine and Prevention, Torvergata University of Rome
| | | | | | - Fausto Ciccacci
- Unicamillus Saint Camillus International University of Health and Medical Sciences, Rome, Italy
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Yu Q, Guo J, Gong F. Construction and Validation of a Diagnostic Scoring System for Predicting Active Pulmonary Tuberculosis in Patients with Positive T-SPOT Based on Indicators Associated with Coagulation and Inflammation: A Retrospective Cross-Sectional Study. Infect Drug Resist 2023; 16:5755-5764. [PMID: 37670979 PMCID: PMC10476653 DOI: 10.2147/idr.s410923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 07/20/2023] [Indexed: 09/07/2023] Open
Abstract
Introduction Tuberculosis (TB) is a life-threatening single infectious disease, which remains a major global public health concern. This study was to establish and validate a clinically practical diagnostic scoring system for predicting active pulmonary tuberculosis (APTB) in patients with positive tuberculosis T cell spot test [T-SPOT] using indicators associated with coagulation and inflammation. Methods A single-center retrospective cross-sectional study was performed to include patients with positive T-SOPT registered and hospitalized at Wuhan Jinyintan Hospital between January 2017 and December 2019. All patients were separated into the active pulmonary tuberculosis (APTB) group and the inactive pulmonary tuberculosis (IPTB) group, according to the diagnostic criteria from China's Expert Consensus for APTB and IPTB. Subsequently, the patients were randomized into a training set and a validation set at a ratio of 2:1. Indicators associated with coagulation and inflammation, including prothrombin time activity (PTA), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen concentration (Fbg-C), C-reactive protein/albumin ratio (CAR), C-reactive protein/prealbumin ratio (CPR), neutrophils count/lymphocyte count ratio (NLR), platelet count/lymphocyte count ratio (PLR), monocyte count/lymphocyte count ratio (MLR), and erythrocyte sedimentation rate (ESR) were obtained from electronic medical record system (EMRS). Stepwise logistic regression was performed in the training set to build a diagnostic model for predicting APTB, which was transformed into an easily applicable scoring system via nomogram. Receiver operating characteristic (ROC) analysis, calibration curve (CC), and decision curve analysis (DCA) were conducted to evaluate the predictive performance of the established diagnostic scoring system. Results A total of 508 patients [training set (211 cases of APTB and 116 cases of IPTB) and validation set (103 cases of APTB and 78 cases of IPTB)] with positive T-SPOT were recruited in the study. Stepwise logistic regression showed that CPR, MLR, ESR, APTT and Fbg-C were independent predictors for APTB. The scoring system was subsequently formulated based on the abovementioned predictors, which correspond to scores of 10, 6, 7, 5, and 5, respectively. In addition, patients are more likely to be diagnosed as APTB when the cut-off score was ≥16 scores, while patients with <16 scores are more likely to be diagnosed as IPTB. The scoring system showed good predictive efficacy in both the training set [area under the curve (AUC): 0.887] and the validation set (AUC: 0.898). Furthermore, both CC and DCA confirmed the clinical utility of the scoring system. Conclusion The data suggest that the combination of indicators associated with coagulation and inflammation could serve as biomarkers to identify APTB in patients with positive T-SPOT. In addition, patients with positive T-SPOT were more prone to be diagnosed with APTB when having a combined total of scores ≥16 in the scoring system.
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Affiliation(s)
- Qi Yu
- Department of Infectious Diseases, Wuhan Jinyintan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430023, People’s Republic of China
| | - Jinqiang Guo
- Department of Rheumatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People’s Republic of China
| | - Fengyun Gong
- Department of Infectious Diseases, Wuhan Jinyintan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430023, People’s Republic of China
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Sales ACDS, Lopes LA, Vale MCDS, Costa MF, Lima JVDS, Silva JGMD, Ferreira BSDC, Nascimento VAD, Flor SEDS, Sousa ELCD, Paz BKB, Garcia RADS, Sousa EMD, Santos AFD, Silva LCND, Zagmignan A. Clinical Features, Biochemical Parameters, and Treatment Adherence of Individuals Who Started the Treatment for Active Pulmonary Tuberculosis during the Pandemic Period. J Clin Med 2023; 12:4843. [PMID: 37510958 PMCID: PMC10381187 DOI: 10.3390/jcm12144843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 07/30/2023] Open
Abstract
This descriptive prospective study investigated the clinical features and treatment adherence of individuals who started the treatment for Pulmonary tuberculosis (TB) during the COVID-19 pandemic in São Luís. Thirty-six TB patients and thirty-five age/sex-matched individuals were recruited between January 2021 and January 2022. The clinical features, sociodemographic information, and serum were obtained at the diagnosis time. Adherence to treatment and adverse reactions were investigated monthly. The most common symptoms in TB patients were cough (91.6%) and fever (83.3%). All TB patients had elevated pre-therapy levels of CRP and reduced HDL: 88.9% presented hypocalcemia and 47.2% showed elevated ALP and GGT. TB patients showed higher levels of ALT, AST, ALP, GGT, CRP, amylase, and triglycerides than the comparison group (p < 0.05), while the calcium levels were reduced (p < 0.0001). TB patients with anti-SARS-CoV-2-IgG antibodies (seroprevalence of 66.7%) presented higher values of amylase and lower CRP levels (p < 0.05). Most patients (~70%) reported at least one adverse drug reaction, mainly pruritus and nausea. The treatment abandonment rate was 19.2%. In conclusion, TB patients showed elevated pre-therapy levels of CRP, low levels of HDL, and hypocalcemia. Liver and pancreatic functions were also compromised in several patients before the therapy. The treatment non-adherence rate observed was similar to other studies performed before the pandemic period.
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Affiliation(s)
- Amanda Caroline de Souza Sales
- Laboratory of Microbial Pathogenesis, CEUMA University, São Luís 65075-120, MA, Brazil
- Postgraduate Program in Microbial Biology, CEUMA University, São Luís 65075-120, MA, Brazil
- Laboratory of Clinical Analysis (LABORCEUMA), CEUMA University, São Luís 65075-120, MA, Brazil
| | - Larissa Araújo Lopes
- Laboratory of Microbial Pathogenesis, CEUMA University, São Luís 65075-120, MA, Brazil
| | | | - Mayara Ferreira Costa
- Laboratory of Microbial Pathogenesis, CEUMA University, São Luís 65075-120, MA, Brazil
| | - João Victor de Souza Lima
- Laboratory of Microbial Pathogenesis, CEUMA University, São Luís 65075-120, MA, Brazil
- Postgraduate Program in Microbial Biology, CEUMA University, São Luís 65075-120, MA, Brazil
| | | | | | | | | | | | | | | | - Eduardo Martins de Sousa
- Postgraduate Program in Microbial Biology, CEUMA University, São Luís 65075-120, MA, Brazil
- Postgraduate Program in Health and Services Management, CEUMA University, São Luís 65075-120, MA, Brazil
- Laboratory of Immunology and Microbiology of Respiratory Infections, CEUMA University, São Luís 65075-120, MA, Brazil
| | | | - Luís Cláudio Nascimento da Silva
- Laboratory of Microbial Pathogenesis, CEUMA University, São Luís 65075-120, MA, Brazil
- Postgraduate Program in Microbial Biology, CEUMA University, São Luís 65075-120, MA, Brazil
| | - Adrielle Zagmignan
- Laboratory of Microbial Pathogenesis, CEUMA University, São Luís 65075-120, MA, Brazil
- Postgraduate Program in Microbial Biology, CEUMA University, São Luís 65075-120, MA, Brazil
- Postgraduate Program in Health and Services Management, CEUMA University, São Luís 65075-120, MA, Brazil
- Departament of Nutrition, CEUMA University, São Luís 65075-120, MA, Brazil
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Meca AD, Turcu-Stiolica A, Bogdan M, Subtirelu MS, Cocoș R, Ungureanu BS, Mahler B, Pisoschi CG. Screening performance of C-reactive protein for active pulmonary tuberculosis in HIV-positive patients: A systematic review with a meta-analysis. Front Immunol 2022; 13:891201. [PMID: 36090970 PMCID: PMC9453225 DOI: 10.3389/fimmu.2022.891201] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 08/03/2022] [Indexed: 12/01/2022] Open
Abstract
Background Tuberculosis (TB) is the leading infectious cause of mortality worldwide. In the last years, resistant strains of the etiological agent, Mycobacterium tuberculosis, have emerged, thus demanding more triage tests to identify active pulmonary TB (PTB) patients and to evaluate their disease severity. Therefore, acute-phase reaction serum tests are required for monitoring TB patients, among WHO symptom screening recommendations. C-reactive protein (CRP) is a non-specific inflammatory biomarker that has been recently proposed for TB screening and can be quantitatively analyzed through cost-effective point-of-care assays. A previous meta-analysis found CRP to be highly sensitive and moderately specific for active PTB with confirmed HIV infection. Methods We performed a meta-analysis update of diagnostic tests, pooling sensitivities, and specificities in order to assess the accuracy of CRP as a potential test for the screening of HIV-associated PTB in outpatients. We searched MEDLINE, Web of Science, and SCOPUS for eligible articles before 19 October 2021. Results We identified 13 eligible studies with HIV-positive patients with PTB. At a CRP threshold of 10 mg/L, CRP pooled sensitivity was 87% (76%–93%) and pooled specificity was 67% (49%–81%), with an area under the curve (AUC) of 0.858. Using a CRP threshold of 8 mg/L, pooled sensitivity was 82% (72%–89%) and pooled specificity was 82% (67%–92%), with an AUC of 0.879. We found that CRP has a high sensitivity in the screening of PTB in HIV-positive outpatients, consistent with findings reported previously. Conclusions Regardless of pooled specificity, better results were found using the CRP threshold of 8 mg/L as a test screening of PTB, meeting the need of further approaching specific TB diagnostic methods and reducing resource consumption.
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Affiliation(s)
- Andreea-Daniela Meca
- Department of Pharmacology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Adina Turcu-Stiolica
- Department of Pharmacoeconomics, University of Medicine and Pharmacy of Craiova, Craiova, Romania
- *Correspondence: Adina Turcu-Stiolica,
| | - Maria Bogdan
- Department of Pharmacology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Mihaela-Simona Subtirelu
- Department of Pharmacoeconomics, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Relu Cocoș
- Department of Medical Genetics, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
- Marius Nasta Institute of Pneumology, Bucharest, Romania
| | - Bogdan Silviu Ungureanu
- Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Beatrice Mahler
- Marius Nasta Institute of Pneumology, Bucharest, Romania
- Pneumology Department (II), University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
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KOÇ İ, GULLU YT. C-reactive protein Lymphocyte Ratio in the Diagnosis of Pulmonary Tuberculosis. TURKISH JOURNAL OF INTERNAL MEDICINE 2022. [DOI: 10.46310/tjim.1072714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Tuberculosis (TB) is still a severe problem in underdeveloped and developing countries. Diagnostic tests are unavailable in every health institution, and TB culture can take up to 45 days. Therefore, there is a need for cheaper, faster, and easily accessible diagnostic methods that can guide the diagnosis. This study aimed to determine whether red blood cell distribution width (RDW), C-reactive protein (CRP)-lymphocyte ratio (CLR), platelet-lymphocyte ratio (PLR), and lymphocyte-monocyte ratio (LMR) can be used as biomarkers in the diagnosis of pulmonary TB in patients with no comorbidities.
Material and Methods: Files of microbiologically confirmed 122 patients with pulmonary TB and 153 patients in whom pulmonary TB was excluded were retrospectively reviewed. Out of them, patients with comorbidities were excluded from the study. Eighty-one patients with TB and 100 controls were included in the study.
Results: The lymphocyte, eosinophil, and LMR levels remained significantly lower in the TB group, while neutrophil, monocyte, RDW, platelet, and PLR levels were higher in the same group.
Conclusion: In those patients suspicious of pulmonary TB, higher levels of RDW, PLR, and CLR, whereas lower levels of eosinophil, PDW, and LMR may predict the diagnosis of pulmonary TB in previously healthy individuals.
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Wykowski JH, Phillips C, Ngo T, Drain PK. A systematic review of potential screening biomarkers for active TB disease. J Clin Tuberc Other Mycobact Dis 2021; 25:100284. [PMID: 34805557 PMCID: PMC8590066 DOI: 10.1016/j.jctube.2021.100284] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The standard TB Four Symptom Screen does not meet the World Health Organization (WHO) ideal screening criteria for having greater than 90% sensitivity to identify active TB disease, regardless of HIV status. To identify novel screening biomarkers for active TB, we performed a systematic review of any cohort or case-control study reporting associations between screening biomarkers and active TB disease. METHODS We searched PubMed and Embase for articles published before October 10, 2021. We included studies from high or medium tuberculosis burden countries. We excluded articles focusing on C-reactive protein and lipoarabinomannan. For all included biomarkers, we calculated sensitivity, specificity and 95% confidence intervals, and assessed study quality using a tool adapted from the QUADAS-2 risk of bias. RESULTS From 8,062 abstracts screened, we included 79 articles. The articles described 302 unique biomarkers, including host antibodies, host proteins, TB antigens, microRNAs, whole blood gene PCRs, and combinations of biomarkers. Of these, 23 biomarkers had sensitivity greater than 90% and specificity greater than 70%, meeting WHO criteria for an ideal screening test. Among the eleven biomarkers described in people living with HIV, only one had a sensitivity greater than 90% and specificity greater than 70% for active TB. CONCLUSION Further evaluation of biomarkers of active TB should be pursued to accelerate identification of TB disease.
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Affiliation(s)
- James H. Wykowski
- Department of Medicine, 925 9 Ave Seattle, WA 98104, University of Washington, Seattle, USA
| | - Chris Phillips
- Department of Global Health, 925 9 Ave Seattle, WA 98104, University of Washington, Seattle, USA
| | - Thao Ngo
- Department of Global Health, 925 9 Ave Seattle, WA 98104, University of Washington, Seattle, USA
| | - Paul K. Drain
- Department of Medicine, 925 9 Ave Seattle, WA 98104, University of Washington, Seattle, USA
- Department of Global Health, 925 9 Ave Seattle, WA 98104, University of Washington, Seattle, USA
- Department of Epidemiology, 925 9 Ave Seattle, WA 98104, University of Washington, Seattle, USA
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