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Apriani L, McAllister S, Sharples K, Alisjahbana B, Ruslami R, Hill PC, Menzies D. Latent tuberculosis infection in healthcare workers in low- and middle-income countries: an updated systematic review. Eur Respir J 2019; 53:13993003.01789-2018. [PMID: 30792341 DOI: 10.1183/13993003.01789-2018] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 01/17/2019] [Indexed: 12/13/2022]
Abstract
Healthcare workers (HCWs) are at increased risk of latent tuberculosis (TB) infection (LTBI) and TB disease.We conducted an updated systematic review of the prevalence and incidence of LTBI in HCWs in low- and middle-income countries (LMICs), associated factors, and infection control practices. We searched MEDLINE, Embase and Web of Science (January 1, 2005-June 20, 2017) for studies published in any language. We obtained pooled estimates using random effects methods and investigated heterogeneity using meta-regression.85 studies (32 630 subjects) were included from 26 LMICs. Prevalence of a positive tuberculin skin test (TST) was 14-98% (mean 49%); prevalence of a positive interferon-γ release assay (IGRA) was 9-86% (mean 39%). Countries with TB incidence ≥300 per 100 000 had the highest prevalence (TST: pooled estimate 55%, 95% CI 41-69%; IGRA: pooled estimate 56%, 95% CI 39-73%). Annual incidence estimated from the TST was 1-38% (mean 17%); annual incidence estimated from the IGRA was 10-30% (mean 18%). The prevalence and incidence of a positive test was associated with years of work, work location, TB contact and job category. Only 15 studies reported on infection control measures in healthcare facilities, with limited implementation.HCWs in LMICs in high TB incidence settings remain at increased risk of acquiring LTBI. There is an urgent need for robust implementation of infection control measures.
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Affiliation(s)
- Lika Apriani
- TB-HIV Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia .,Dept of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.,Centre for International Health, Dept of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Susan McAllister
- Centre for International Health, Dept of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Katrina Sharples
- Centre for International Health, Dept of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand.,Dept of Mathematics and Statistics, University of Otago, Dunedin, New Zealand
| | - Bachti Alisjahbana
- TB-HIV Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.,Dept of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Rovina Ruslami
- TB-HIV Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.,Dept of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Philip C Hill
- Centre for International Health, Dept of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Dick Menzies
- Montreal Chest Institute, McGill University Montreal, Montreal, QC, Canada
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Lamberti M, Muoio MR, Westermann C, Nienhaus A, Arnese A, Ribeiro Sobrinho AP, Di Giuseppe G, Garzillo EM, Crispino V, Coppola N, De Rosa A. Prevalence and associated risk factors of latent tuberculosis infection among undergraduate and postgraduate dental students: A retrospective study. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2017; 72:99-105. [PMID: 27018614 DOI: 10.1080/19338244.2016.1167006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 03/12/2016] [Indexed: 06/05/2023]
Abstract
To estimate the prevalence of latent tuberculosis (TB) infection (LTBI) in Italian dental students exposed to the same occupational risks as dental health care personnel and to evaluate potential risk factors, a cross-sectional study was conducted on undergraduate and postgraduate students. After clinical evaluation, students were given a tuberculin skin test; in those found positive, an interferon-γ release assay (IGRA) was conducted. Of the 281 students enrolled, 10 were only TST positive; 8 were TST or/and IGRA positive. We found that participants testing positive at TST and/or IGRA, a group in which the risk of false LTBI positives is minimal, were older and had been studying longer. Although the prevalence of LTBI among dental students in our study was low, a risk of acquiring a work-related infection exists even in a country with a low incidence of TB. Thus, dental students should be screened to catch LTBI early on.
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Affiliation(s)
- Monica Lamberti
- a Department of Experimental Medicine , Section of Hygiene, Occupational Medicine and Forensic Medicine, Second University of Naples , Naples , Italy
| | - Maria Rosaria Muoio
- a Department of Experimental Medicine , Section of Hygiene, Occupational Medicine and Forensic Medicine, Second University of Naples , Naples , Italy
| | - Claudia Westermann
- b Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Albert Nienhaus
- b Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Antonio Arnese
- a Department of Experimental Medicine , Section of Hygiene, Occupational Medicine and Forensic Medicine, Second University of Naples , Naples , Italy
| | - Antônio Paulino Ribeiro Sobrinho
- c Department of Operative Dentistry , Dental School, Universidade Federal de Minas Gerais (UFMG) , Belo Horizonte , Minas Gerais , Brazil
| | - Gabriella Di Giuseppe
- a Department of Experimental Medicine , Section of Hygiene, Occupational Medicine and Forensic Medicine, Second University of Naples , Naples , Italy
| | - Elpidio Maria Garzillo
- a Department of Experimental Medicine , Section of Hygiene, Occupational Medicine and Forensic Medicine, Second University of Naples , Naples , Italy
| | - Vincenzo Crispino
- a Department of Experimental Medicine , Section of Hygiene, Occupational Medicine and Forensic Medicine, Second University of Naples , Naples , Italy
| | - Nicola Coppola
- d Department of Mental Health and Public Medicine , Section of Infectious Diseases, Second University of Naples , Naples , Italy
| | - Alfredo De Rosa
- e Department of Orthodontics , Second University of Naples , Naples , Italy
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Durando P, Alicino C, Orsi A, Barberis I, Paganino C, Dini G, Mazzarello G, Del Bono V, Viscoli C, Copello F, Sossai D, Orengo G, Sticchi L, Ansaldi F, Icardi G. Latent tuberculosis infection among a large cohort of medical students at a teaching hospital in Italy. BIOMED RESEARCH INTERNATIONAL 2015; 2015:746895. [PMID: 25705685 PMCID: PMC4331323 DOI: 10.1155/2015/746895] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 11/13/2014] [Indexed: 01/08/2023]
Abstract
The surveillance of latent tuberculosis infection (LTBI) in both healthcare workers and healthcare students is considered fundamental for tuberculosis (TB) prevention. The aim of the present study was to estimate LTBI prevalence and evaluate potential risk-factors associated with this condition in a large cohort of medical students in Italy. In a cross-sectional study, performed between March and December 2012, 1511 eligible subjects attending the Medical School of the University of Genoa, trained at the IRCCS San Martino-IST Teaching Hospital of Genoa, were actively called to undergo the tuberculin skin test (TST). All the TST positive cases were confirmed with an interferon-gamma release assay (IGRA). A standardized questionnaire was collected for multivariate risk analysis. A total of 1302 (86.2%) students underwent TST testing and completed the questionnaire. Eleven subjects (0.8%) resulted TST positive and LTBI diagnosis was confirmed in 2 (0.1%) cases. Professional exposure to active TB patients (OR 21.7, 95% CI 2.9-160.2; P value 0.003) and previous BCG immunization (OR 28.3, 95% CI 3.0-265.1; P value 0.003) are independently associated with TST positivity. Despite the low prevalence of LTBI among Italian medical students, an occupational risk of TB infection still exists in countries with low circulation of Mycobacterium tuberculosis.
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Affiliation(s)
- Paolo Durando
- Department of Health Sciences, University of Genoa and Hygiene and Infection Control Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
- Postgraduate School in Occupational Medicine, University of Genoa and Occupational Medicine Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Cristiano Alicino
- Department of Health Sciences, University of Genoa and Hygiene and Infection Control Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Andrea Orsi
- Department of Health Sciences, University of Genoa and Hygiene and Infection Control Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Ilaria Barberis
- Department of Health Sciences, University of Genoa and Hygiene and Infection Control Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Chiara Paganino
- Department of Health Sciences, University of Genoa and Hygiene and Infection Control Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Guglielmo Dini
- Postgraduate School in Occupational Medicine, University of Genoa and Occupational Medicine Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Giovanni Mazzarello
- Department of Health Sciences, University of Genoa and Infectious Diseases Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Valerio Del Bono
- Department of Health Sciences, University of Genoa and Infectious Diseases Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Claudio Viscoli
- Department of Health Sciences, University of Genoa and Infectious Diseases Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Francesco Copello
- Postgraduate School in Occupational Medicine, University of Genoa and Occupational Medicine Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Dimitri Sossai
- Health Safety and Prevention Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Giovanni Orengo
- Quality and Risk Management Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Laura Sticchi
- Department of Health Sciences, University of Genoa and Hygiene and Infection Control Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Filippo Ansaldi
- Department of Health Sciences, University of Genoa and Hygiene and Infection Control Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Giancarlo Icardi
- Department of Health Sciences, University of Genoa and Hygiene and Infection Control Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
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Khawcharoenporn T, Apisarnthanarak A, Phetsuksiri B, Rudeeaneksin J, Srisungngam S, Mundy LM. Tuberculin skin test and QuantiFERON-TB Gold In-tube Test for latent tuberculosis in Thai HIV-infected adults. Respirology 2014; 20:340-7. [PMID: 25428131 DOI: 10.1111/resp.12442] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 09/19/2014] [Accepted: 09/25/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Limited data exist for the performance of QuantiFERON-TB Gold In-tube Test (QFT-IT) in comparison to tuberculin skin test (TST) for detecting latent tuberculosis (LTB) in patients with human immunodeficiency virus (HIV) infection from tuberculosis (TB)-endemic Asia-Pacific countries. METHODS A cohort study of Thai HIV-infected patients without history of TB or LTB treatment was conducted from March 2012 through March 2013. Each patient underwent simultaneous TST and QFT-IT. RESULTS Among the 150 enrolled subjects, the median age was 40 years (range 17-65), 53% were male, and the median CD4 count was 367 cells/μL (range 8-1290). Reactive TST and positive QFT-IT were 16% and 13%, respectively, with low concordance between tests (kappa = 0.26); correlation between TST reaction size and level of interferon-γ was moderate (r = 0.34). Independent factors associated with discordant results were long-term smoking (adjusted odds ratio (aOR) 5.74; P = 0.002) for TST-reactive, QFT-IT-negative subjects, and age greater than 52 years (aOR 5.56; P = 0.02) and female gender (aOR 4.40; P = 0.04) for TST non-reactive, QFT-IT-positive subjects. The level of agreement between both tests improved when using a TST cut-off of ≥ 10 mm (kappa = 0.39). CONCLUSIONS In our setting where QFT-IT is available but has limited use due to cost, TST with a cut-off of 10 mm for reactivity should be the initial LTB test. HIV-infected women and persons older than 52 years with non-reactive TST and long-term smokers with reactive TST may benefit from subsequent QFT-IT.
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Affiliation(s)
- Thana Khawcharoenporn
- Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
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Lamberti M, Muoio M, Monaco MGL, Uccello R, Sannolo N, Mazzarella G, Garzillo EM, Arnese A, La Cerra G, Coppola N. Prevalence of latent tuberculosis infection and associated risk factors among 3,374 healthcare students in Italy. J Occup Med Toxicol 2014; 9:34. [PMID: 25302073 PMCID: PMC4190494 DOI: 10.1186/s12995-014-0034-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 09/23/2014] [Indexed: 12/29/2022] Open
Abstract
Introduction The risk of tuberculosis (TB) in healthcare personnel (HCP) is related to its incidence in the general population. Healthcare students involved in clinical training could be exposed to occupational risks similar to those that HCP face. The prevalence of latent tuberculosis infection (LTBI) among undergraduate healthcare students with different working seniority in Italy was analysed. Methods A cross-sectional study under a screening programme for LTBI among undergraduate and postgraduate students attending Medical School at the Second University of Naples was conducted between January 2012 and December 2013 with clinical evaluations, tuberculin skin testing (TST) and, in positive TST students, Interferon-γ release assays (IGRA). Putative risk factors for LTBI were assessed by means of a standardised questionnaire. Results 3,374 students attending the Medical School of the Second University of Naples were submitted to a screening programme for TBC. 3,331 performed TST as a first-level test and 43 performed a Quantiferon test (QFT). 128 students were TST-positive and continued the diagnostic work with QFT, which was positive in 34 students. Of the 43 subjects who took the QFT as a first-level test only 1 was positive. In 35 students positive to the QFT test we formulated the diagnosis of LTBI by clinical and radiographic results. A correlation was found between age, non-Italian born persons, studying age, post-medical school status and LTBI. Conclusions The prevalence of LTBI among healthcare students in our study was very low. In countries with a low incidence of TB, the screening programmes of healthcare students can be useful for early identification and treatment of sporadic cases of LTBI. Electronic supplementary material The online version of this article (doi:10.1186/s12995-014-0034-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Monica Lamberti
- Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic Medicine, Second University of Naples, Naples, Italy
| | - Mariarosaria Muoio
- Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic Medicine, Second University of Naples, Naples, Italy
| | - Maria Grazia Lourdes Monaco
- Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic Medicine, Second University of Naples, Naples, Italy
| | - Rossella Uccello
- Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic Medicine, Second University of Naples, Naples, Italy
| | - Nicola Sannolo
- Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic Medicine, Second University of Naples, Naples, Italy
| | - Gennaro Mazzarella
- Department of Cardio-Thoracic and Respiratory Science, Second University of Naples, Naples, Italy
| | - Elpidio Maria Garzillo
- Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic Medicine, Second University of Naples, Naples, Italy
| | - Anonio Arnese
- Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic Medicine, Second University of Naples, Naples, Italy
| | - Giuseppe La Cerra
- Department of Cardio-Thoracic and Respiratory Science, Second University of Naples, Naples, Italy
| | - Nicola Coppola
- Department of Mental Health and Public Medicine, Second University of Naples, Naples, Italy
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Durando P, Sotgiu G, Spigno F, Piccinini M, Mazzarello G, Viscoli C, Copello F, Poli A, Ansaldi F, Icardi G. Latent tuberculosis infection and associated risk factors among undergraduate healthcare students in Italy: a cross-sectional study. BMC Infect Dis 2013; 13:443. [PMID: 24059355 PMCID: PMC3848912 DOI: 10.1186/1471-2334-13-443] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 09/18/2013] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The screening of both healthcare workers and students attending teaching hospitals for latent tuberculosis infection (LTBI) is recommended in hospitals of many countries with a low-incidence of TB, including Italy, as a fundamental tool of tuberculosis (TB) control programs. The aim of the study was to estimate the prevalence of LTBI and evaluate the main risk-factors associated with this condition in a cohort of healthcare Italian students. METHODS In a cross-sectional study, performed between January and May 2012, 881 undergraduate students attending the Medical, Nursing, Pediatric Nursing and Midwifery Schools of the University of Genoa, trained at the IRCCS San Martino-IST Teaching Hospital of Genoa, were actively called to undergo the Tuberculin Skin Test (TST). All the TST positive cases were also tested with an Interferon-Gamma Release Assay (IGRA) to confirm the diagnosis of LTBI. A standardized questionnaire was collected for risk-assessment analysis. RESULTS Seven hundred and thirty-three (83.2%) subjects underwent TST testing. The prevalence of TST positives was 1.4%, and in 4 (0.5%) out of 10 TST positive cases LTBI diagnosis was confirmed by IGRA. No difference in the prevalence of subjects who tested positive to TST emerged between pre-clinical (n = 138) and clinical (n = 595) students. No statistically significant association between TST positivity and age, gender, and BCG vaccination was observed. The main independent variable associated with TST positivity was to be born in a country with a high TB incidence (i.e., ≥20 cases per 100,000 population) (adjusted OR 102.80, 95% CI 18.09-584.04, p < 0.001). CONCLUSIONS The prevalence of LTBI among healthcare students resulted very low. The only significant association between TST positivity and potential risk factors was to be born in high TB incidence areas. In countries with a low incidence of TB, the screening programs of healthcare students before clinical training can be useful for the early identification and treatment of the sporadic cases of LTBI.
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Affiliation(s)
- Paolo Durando
- Department of Health Sciences, Associate Professor of Hygiene, Preventive Medicine and Public Health, Hygiene Unit, IRCCS AOU San Martino-IST teaching Hospital, University of Genoa, Via Antonio Pastore 1, 16132, Genoa, Italy
| | - Giovanni Sotgiu
- Department of Biomedical Sciences, Associate Professor of Medical Statistics, Research, Medical Education and Professional Development Unit, AOU Sassari, University of Sassari, Via Padre Manzella 4, 07100, Sassari, Italy
| | - Fabio Spigno
- Department of Health Sciences, Associate Professor of Occupational Health, Chief of the Occupational Health Unit, IRCCS AOU San Martino-IST teaching Hospital, University of Genoa, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - Mauro Piccinini
- Prevention and Protection Service of the University of Genoa, Via Balbi 5, 16126, Genoa, Italy
| | - Giovanni Mazzarello
- Department of Health Sciences, Infectious Diseases Unit, IRCCS AOU San Martino-IST teaching Hospital, University of Genoa, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - Claudio Viscoli
- Department of Health Sciences, Full Professor of Infectious Diseases, Chief of the Infectious Diseases Unit, IRCCS AOU San Martino-IST teaching Hospital, University of Genoa, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - Francesco Copello
- Occupational and Preventive Medicine Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - Alessandro Poli
- Occupational and Preventive Medicine Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - Filippo Ansaldi
- Department of Health Sciences, Associate Professor of Hygiene, Preventive Medicine and Public Health, Hygiene Unit, IRCCS AOU San Martino-IST teaching Hospital, University of Genoa, Via Antonio Pastore 1, 16132, Genoa, Italy
| | - Giancarlo Icardi
- Department of Health Sciences, Full Professor of Hygiene, Preventive Medicine and Public Health, Chief of the Hygiene Unit, IRCCS AOU San Martino-IST teaching Hospital, University of Genoa, Via Antonio Pastore 1, 16132, Genoa, Italy
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Lesho E, Forestiero FJ, Hirata MH, Hirata RD, Cecon L, Melo FF, Paik SH, Murata Y, Ferguson EW, Wang Z, Ooi GT. Transcriptional responses of host peripheral blood cells to tuberculosis infection. Tuberculosis (Edinb) 2011; 91:390-9. [PMID: 21835698 DOI: 10.1016/j.tube.2011.07.002] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Revised: 06/19/2011] [Accepted: 07/07/2011] [Indexed: 12/23/2022]
Abstract
Host responses following exposure to Mycobacterium tuberculosis (TB) are complex and can significantly affect clinical outcome. These responses, which are largely mediated by complex immune mechanisms involving peripheral blood cells (PBCs) such as T-lymphocytes, NK cells and monocyte-derived macrophages, have not been fully characterized. We hypothesize that different clinical outcome following TB exposure will be uniquely reflected in host gene expression profiles, and expression profiling of PBCs can be used to discriminate between different TB infectious outcomes. In this study, microarray analysis was performed on PBCs from three TB groups (BCG-vaccinated, latent TB infection, and active TB infection) and a control healthy group. Supervised learning algorithms were used to identify signature genomic responses that differentiate among group samples. Gene Set Enrichment Analysis was used to determine sets of genes that were co-regulated. Multivariate permutation analysis (p < 0.01) gave 645 genes differentially expressed among the four groups, with both distinct and common patterns of gene expression observed for each group. A 127-probeset, representing 77 known genes, capable of accurately classifying samples into their respective groups was identified. In addition, 13 insulin-sensitive genes were found to be differentially regulated in all three TB infected groups, underscoring the functional association between insulin signaling pathway and TB infection.
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Affiliation(s)
- Emil Lesho
- Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA.
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