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Njagi LN, Kaguthi G, Mecha JO, Hawn TR, Nduba V. Attenuated tuberculin skin test responses associated with Mycobacterium intracellulare sputum colonization in an adolescent TB prevalence survey in Western Kenya. Tuberculosis (Edinb) 2024; 147:102514. [PMID: 38723342 PMCID: PMC11168861 DOI: 10.1016/j.tube.2024.102514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 04/16/2024] [Accepted: 05/03/2024] [Indexed: 05/26/2024]
Abstract
INTRODUCTION Exposure to Non-tuberculous Mycobacteria (NTM) varies regionally and may partly explain the disparate outcomes of BCG vaccination and tuberculosis (TB) susceptibility. METHODS We examined NTM sputum colonization, associations with clinical characteristics, and tuberculin skin test (TST) responses in an adolescent TB prevalence survey. RESULTS Among 5004 adolescents screened, 2281 (45.5 %) were evaluated further. TB and NTM prevalence rates were 0.3 % and 8.0 %, respectively. Among 418 NTM isolates, 103 were unidentifiable, and 315 (75 %) comprised 15 species, the most frequent being M. intracellulare (MAC) (108, 26 %), M. scrofulaceum (96, 23 %) and M. fortuitum (51, 12 %). "NTM colonized" adolescents had less frequent chronic cough and night sweats (adjusted odds ratio [aOR] 0.62, 95 % confidence interval [CI] 0.44-0.87and aOR 0.61, CI 0.42-0.89 respectively), and lower TST induration (median 11 mm (interquartile range [IQR] 0-16) vs 13 mm (IQR 6-17; p = 0.006)) when compared to "NTM not colonized" participants. MAC, but not M. scrofulaceum or M. fortuitum, was associated with decreased TST induration (median 7.5 mm (IQR 0-15) vs 13 mm (IQR 6-17) among "MAC colonized" vs "not colonized", p = 0.001). CONCLUSION We observed high NTM prevalence rates with species-specific associations with TST induration, consistent with a model of species-dependent heterologous immunity among mycobacteria.
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Affiliation(s)
- Lilian N Njagi
- Kenya Medical Research Institute, Centre for Respiratory Diseases Research (CRDR), PO Box 47855-00100, Nairobi, Kenya.
| | - Grace Kaguthi
- Kenya Medical Research Institute, Centre for Respiratory Diseases Research (CRDR), PO Box 47855-00100, Nairobi, Kenya.
| | - Jared O Mecha
- Department of Clinical Medicine and Therapeutics, Faculty of Health Sciences, University of Nairobi School of Medicine, PO Box 19676 - 00202, Nairobi, Kenya.
| | - Thomas R Hawn
- Department of Medicine, University of Washington, Seattle, WA, 98195, United States.
| | - Videlis Nduba
- Kenya Medical Research Institute, Centre for Respiratory Diseases Research (CRDR), PO Box 47855-00100, Nairobi, Kenya.
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Njagi LN, Nduba V, Mureithi MW, Mecha JO. Prevalence and predictors of tuberculosis infection among people living with HIV in a high tuberculosis burden context. BMJ Open Respir Res 2023; 10:10/1/e001581. [PMID: 37197794 DOI: 10.1136/bmjresp-2022-001581] [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: 12/06/2022] [Accepted: 04/28/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) disease is the leading cause of mortality among people living with HIV (PLHIV). Interferon-gamma release assays (IGRAs) are approved for TB infection ascertainment. However, current IGRA data on the prevalence of TB infection in the context of near-universal access to antiretroviral therapy (ART) and TB preventive therapy (TPT) are lacking. We estimated the prevalence and determinants of TB infection among PLHIV within a high TB and HIV burden context. METHODS This cross-sectional study included data from adult PLHIV age ≥18 years in whom QuantiFERON-TB Gold Plus (QFT-Plus) assay, an IGRA, was performed. TB infection was defined as a positive or indeterminate QFT-Plus test. Participants with TB and those who had previously used TPT were excluded. Regression analysis was performed to identify independent predictors of TB infection. RESULTS Of 121 PLHIV with QFT-Plus test results, females were 74.4% (90/121), and the mean age was 38.4 (SD 10.8) years. Overall, 47.9% (58/121) were classified as TB infection (QFT-Plus test positive and indeterminate results were 39.7% (48/121) and 8.3% (10/121), respectively). Being obese/overweight (body mass index ≥25 kg/m2; p=0.013, adjusted OR (aOR) 2.90, 95% CI 1.25 to 6.74) and ART usage for >3 years (p=0.013, aOR 3.99, 95% CI 1.55 to 10.28) were independently associated with TB infection. CONCLUSION There was a high TB infection prevalence among PLHIV. A longer period of ART and obesity were independently associated with TB infection. The relationship between obesity/overweight and TB infection may be related to ART use and immune reconstitution and requires further investigation. Given the known benefit of test-directed TPT among PLHIV never exposed to TPT, its clinical and cost implications for low and middle-income countries should be explored further.
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Affiliation(s)
- Lilian Nkirote Njagi
- Center for Respiratory Disease Research, Kenya Medical Research Institute, Nairobi, Kenya
- Department of Medical Microbiology & Immunology, University of Nairobi Faculty of Health Sciences, Nairobi, Kenya
| | - Videlis Nduba
- Center for Respiratory Disease Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Marianne Wanjiru Mureithi
- Department of Medical Microbiology & Immunology, University of Nairobi Faculty of Health Sciences, Nairobi, Kenya
| | - Jared Ongechi Mecha
- Department of Clinical Medicine and Therapeutics, University of Nairobi Faculty of Health Sciences, Nairobi, Kenya
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Aladesanmi AO, Ojuawo OB, Aladesanmi OO, Fawibe AE, Desalu OO, Ojuawo AB, Opeyemi CM, Adio MO, Oluwaloniola V, Salami AK. Diagnosis of latent tuberculosis among HIV infected patients in Ilorin, Nigeria using tuberculin skin test and interferon gamma release assay. Pan Afr Med J 2021; 38:24. [PMID: 33777292 PMCID: PMC7955607 DOI: 10.11604/pamj.2021.38.24.24039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/20/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction Latent Tuberculosis Infection (LTBI) screening is recommended for individuals with a known risk factor for progression to active disease especially in the setting of HIV infection. This will ensure early diagnosis and prompt treatment. The purpose of our study was to compare tuberculin skin test (TST) with Interferon Gamma Release Assay (IGRA) in the diagnosis of LTBI among patients with known HIV infection at University of Ilorin Teaching Hospital (UITH), Ilorin. Methods this was a hospital based cross-sectional study at the Highly Active Antiretroviral therapy (HAART) Clinic and medical wards of the University of Ilorin Teaching Hospital, Ilorin, Nigeria. A total of 282 consenting patients with HIV infection were recruited. Sociodemographic and clinical information was obtained using a well-structured questionnaire. The screening for LTBI was done using Tuberculin skin test (TST) and Interferon Gamma release assay (IGRA). Results the prevalence of LTBI among HIV infected patients was 40.6% and 53.1% using TST and QFT-IT respectively, while the overall prevalence considering positivity to either of the test was 66%. There was mild agreement (κ: 0.218) between TST and QFT-IT in the diagnosis of LTBI among patients with HIV infection. The association between CD4 count and TST was not statistically significant (p value = 0.388) but there was strong association between CD4 cell count and QFT results (p = 0.001). Conclusion the prevalence of LTBI is quite high among patients with HIV infection in our locality. There is a need to encourage screening of at-risk individuals to forestall the morbidity and mortality associated with TB in this population.
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Affiliation(s)
| | - Olutobi Babatope Ojuawo
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
| | | | - Ademola Emmanuel Fawibe
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
| | | | | | | | | | - Victoria Oluwaloniola
- Department of Medical Microbiology and Parasitology, University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
| | - Alakija Kazeem Salami
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
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Affiliation(s)
- Jessica L Coleman
- 1 University of Queensland School of Medicine, Herston, Queensland, Australia.,2 Ochsner Clinical School, Ochsner Children's Health Center, New Orleans, LA, USA
| | - Barley R Halton
- 1 University of Queensland School of Medicine, Herston, Queensland, Australia.,2 Ochsner Clinical School, Ochsner Children's Health Center, New Orleans, LA, USA
| | - Russell W Steele
- 1 University of Queensland School of Medicine, Herston, Queensland, Australia.,2 Ochsner Clinical School, Ochsner Children's Health Center, New Orleans, LA, USA.,3 Tulane University School of Medicine, New Orleans, LA, USA
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Lin AWC, Lau SKP, Woo PCY. Screening and treatment of latent tuberculosis infection among HIV-infected patients in resource-rich settings. Expert Rev Anti Infect Ther 2016; 14:489-500. [PMID: 26999724 DOI: 10.1586/14787210.2016.1168693] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Current international guidelines recommend screening and treatment of latent tuberculosis (TB) infection in HIV-infected patients in all settings. The main factors affecting the risk of TB in HIV-infected patients include the level of immunosuppression, coverage of antiretroviral therapy and local TB burden. In resource-rich settings where antiretroviral therapy is more accessible and HIV-infected patients are expected to be diagnosed at an earlier stage, local TB burden remains a key factor on their risk of TB. This article reviewed the epidemiology of latent TB infection among the adult HIV-infected patients, and the use and benefit of screening and treatment of latent TB infection in resource-rich settings in the past decade. While such practice should be continued in countries with medium or high TB burden, targeted screening and treatment only for HIV-infected patients with additional risk factors for TB might be a more practical option in resource-rich countries with low TB burden.
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Affiliation(s)
- Ada W C Lin
- a Department of Microbiology , The University of Hong Kong , Hong Kong , China
| | - Susanna K P Lau
- a Department of Microbiology , The University of Hong Kong , Hong Kong , China.,b State Key Laboratory of Emerging Infectious Diseases , The University of Hong Kong , Hong Kong , China.,c Research Centre of Infection and Immunology , The University of Hong Kong , Hong Kong , China.,d Carol Yu Centre for Infection , The University of Hong Kong , Hong Kong , China
| | - Patrick C Y Woo
- a Department of Microbiology , The University of Hong Kong , Hong Kong , China.,b State Key Laboratory of Emerging Infectious Diseases , The University of Hong Kong , Hong Kong , China.,c Research Centre of Infection and Immunology , The University of Hong Kong , Hong Kong , China.,d Carol Yu Centre for Infection , The University of Hong Kong , Hong Kong , China
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Abstract
PURPOSE OF REVIEW The detection of latent tuberculosis infection (LTBI) in different categories of compromised patients is reviewed with focus on the role of strategies incorporating immunodiagnostic tests and analysis of epidemiological and clinical risk factors. RECENT FINDINGS The development of active tuberculosis (TB) is increased in compromised patients and is closely related to determinants for disease reactivation or newly acquired TB infection. A targeted detection of LTBI in these high-risk groups should be performed especially if preventive treatment is planned. The performance of immunodiagnostic tests is highly variable among different groups of immunocompromised individuals. Findings of cross-sectional studies indicate a better diagnostic accuracy of interferon-γ release assays over the tuberculin skin test. The critical issue is that in low-incidence countries, the positive and negative predictive values of any of immunodiagnostic tests were very poor. A targeted testing process involving analysis of TB risk factors increases the predictive positive values of immunodiagnostic tests and may improve LTBI detection. SUMMARY The LTBI detection in immunocompromised patients is a challenge. The development of new immunological biomarkers and integrated clinical and epidemiological strategies are needed to identify LTBI in compromised individuals and to plan preventive chemotherapies in those at risk of developing active TB.
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Kussen GMB, Dalla-Costa LM, Rossoni A, Raboni SM. Interferon-gamma release assay versus tuberculin skin test for latent tuberculosis infection among HIV patients in Brazil. Braz J Infect Dis 2015; 20:69-75. [PMID: 26706018 PMCID: PMC9425390 DOI: 10.1016/j.bjid.2015.10.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 10/04/2015] [Accepted: 10/25/2015] [Indexed: 12/03/2022] Open
Abstract
Setting Patients HIV+ attending in a reference clinic, Southern Brazil. Objective To compare the interferon-gamma-release assay (IGRA – QuantiFERON® TB Gold In-Tube) with the tuberculin skin test (TST – PPD-Rt 23) for latent tuberculosis infection (LTBI) in patients with HIV. Design Cohort study. Patients were simultaneously submitted to the TST and blood collection for the IGRA. Results A total of 140 subjects were included. Nine (6.4%) were IGRA+/TST+, 12 (8.6%) were IGRA+/TST−, 4 (3%) were IGRA−/TST+, and 115 (82%) IGRA−/TST−. There was poor agreement between tests (kappa = 0.2), and no correlation between these results and CD4+ T lymphocyte counts. During follow-up, one patient with negative results on both tests died from sepsis, and another with discordant results (IGRA+/TST−) exhibited TST seroconversion. Compared to the TST, IGRA showed a sensitivity and specificity of 69% and 90%, respectively. The IGRA detected 8% more positive results than the TST. All patients were followed up for 2 years. Conclusion The higher accuracy of the IGRA would result in LTBI treatments being administered to patients who would have otherwise been overlooked, decreasing the number of active tuberculosis cases. The long-term survival of HIV carriers requires further evaluation.
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Affiliation(s)
- Gislene Maria Botão Kussen
- Internal Medicine and Health Science, Universidade Federal do Paraná, Curitiba, PR, Brazil; Bacteriology Laboratory, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | - Libera Maria Dalla-Costa
- Bacteriology Laboratory, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil; Faculdades e Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba, PR, Brazil
| | - Andrea Rossoni
- Department of Pediatrics, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | - Sonia Mara Raboni
- Internal Medicine and Health Science, Universidade Federal do Paraná, Curitiba, PR, Brazil; Infectious Diseases Division, Universidade Federal do Paraná, Curitiba, PR, Brazil.
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Lin WC, Lin HH, Lee SSJ, Sy CL, Wu KS, Chen JK, Tsai HC, Chen YS. Prevalence of latent tuberculosis infection in persons with and without human immunodeficiency virus infection using two interferon-gamma release assays and tuberculin skin test in a low human immunodeficiency virus prevalence, intermediate tuberculosis-burden country. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2014; 49:729-736. [PMID: 25442858 DOI: 10.1016/j.jmii.2014.08.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 08/08/2014] [Accepted: 08/26/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND The risk of tuberculosis (TB) is higher in human immunodeficiency virus (HIV)-infected patients and intravenous drug users (IDUs). We determined the prevalence and risk factors of latent TB infection (LTBI) in individuals with or without HIV infection, including IDUs, in a country with a low HIV prevalence, an intermediate TB burden, and a high Bacillus Calmette-Guérin (BCG) vaccine coverage using two interferon-gamma release assays (IGRAs) and the tuberculin skin test (TST). METHODS For this prospective, cross-sectional study, HIV-infected and -uninfected patients from a regional hospital and medical center in Taiwan were enrolled. Results of the two IGRAs [QuantiFERON-TB Gold (QFT-G) and QuantiFERON-TB Gold In-Tube (QFT-GIT)] and the TST were compared. Risk factors for positivity were analyzed. RESULTS We recruited 233 patients [198 (85%) men; mean age, 39.4 years]. Most patients (74%) were BCG vaccinated. The prevalence of LTBI was estimated to be 22.8% by TST, 15.9% by QFT-G, and 20.6% by QFT-GIT. HIV-infected individuals had fewer positive QFT-GIT [7.0% vs. 28.6%, p < 0.001, adjusted odds ratio (aOR) = 0.28, p = 0.05] and TST results, and more indeterminate QFT-G responses (9.3% vs. 0.7%, p = 0.002). Concordance between IGRAs and TST was very poor in HIV-infected patients (κ < 0.05). Independent risk factors for IGRA positivity were increasing age (QFT-G: aOR = 1.98, p = 0.03; QFT-GIT: aOR = 2.00, p = 0.01) and IDUs (aOR = 4.33, p = 0.05 by QFT-G). CONCLUSION HIV-infected persons had a significantly lower response to both IGRAs and TST. High discordance was found between the two generations of IGRAs and between IGRAs and TST. Increasing age, a known risk factor for LTBI, was significantly associated with IGRAs, but not with TST.
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Affiliation(s)
- Wei-Cheng Lin
- Section of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Hsi-Hsun Lin
- Department of Internal Medicine and Infection Control, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
| | - Susan Shin-Jung Lee
- Section of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Cheng-Len Sy
- Section of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Kuan-Sheng Wu
- Section of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jui-Kuang Chen
- Section of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hung-Chin Tsai
- Section of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yao-Shen Chen
- Section of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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