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Gupta A, Chandra E, Anand S, Kumar N, Arora R, Rana D, Mrigpuri P. Latent tuberculosis diagnostics: current scenario and review. Monaldi Arch Chest Dis 2024. [PMID: 38700134 DOI: 10.4081/monaldi.2024.2984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 04/03/2024] [Indexed: 05/05/2024] Open
Abstract
This review presents a comprehensive examination of the contemporary landscape pertaining to latent tuberculosis infection (LTBI) diagnostics, with a particular emphasis on the global ramifications and the intricacies surrounding LTBI diagnosis and treatment. It accentuates the imperative of bolstering diagnostic, preventive, and treatment modalities for tuberculosis (TB) to fulfill the ambitious targets set forth by the World Health Organization aimed at reducing TB-related mortalities and the incidence of new TB cases. The document underscores the significance of addressing LTBI as a means of averting the progression to active TB, particularly in regions burdened with high TB prevalence, such as India. An in-depth analysis of the spectrum delineating latent and active TB disease is provided, elucidating the risk factors predisposing individuals with LTBI to progress towards active TB, including compromised immune functionality, concurrent HIV infection, and other immunosuppressive states. Furthermore, the challenges associated with LTBI diagnosis are elucidated, encompassing the absence of a definitive diagnostic assay, and the merits and demerits of tuberculin skin testing (TST) and interferon-γ release assays (IGRAs) are expounded upon. The document underscores the necessity of confronting these challenges and furnishes a meticulous examination of the advantages and limitations of TST and IGRAs, along with the intricacies involved in interpreting their outcomes across diverse demographics and settings. Additionally, attention is drawn towards the heritability of the interferon-γ response to mycobacterial antigens and the potential utility of antibodies in LTBI diagnosis.
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Affiliation(s)
- Amitesh Gupta
- Department of Pulmonary Medicine, Maulana Azad Medical College and associated Lok Nayak Hospital, New Delhi.
| | - Eshutosh Chandra
- Department of Pulmonary Medicine, Maulana Azad Medical College and associated Lok Nayak Hospital, New Delhi.
| | - Shipra Anand
- Department of Pulmonary Medicine, Maulana Azad Medical College and associated Lok Nayak Hospital, New Delhi.
| | - Naresh Kumar
- Department of Pulmonary Medicine, Maulana Azad Medical College and associated Lok Nayak Hospital, New Delhi.
| | - Richa Arora
- Department of Pulmonary Medicine, Maulana Azad Medical College and associated Lok Nayak Hospital, New Delhi.
| | - Divyanshi Rana
- Department of Pulmonary Medicine, Maulana Azad Medical College and associated Lok Nayak Hospital, New Delhi.
| | - Parul Mrigpuri
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi.
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Petersen E, Al-Abri S, Al-Jardani A, Memish ZA, Aklillu E, Ntoumi F, Mwaba P, Wejse C, Zumla A, Al-Yaquobi F. Screening for latent tuberculosis in migrants-status quo and future challenges. Int J Infect Dis 2024; 141S:107002. [PMID: 38479577 DOI: 10.1016/j.ijid.2024.107002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/05/2024] [Accepted: 03/05/2024] [Indexed: 03/25/2024] Open
Abstract
OBJECTIVES To review the evidence that migrants from tuberculosis (TB) high-incidence countries migrating to TB low-incidence countries significantly contribute to active TB cases in the counties of destination, primarily through reactivation of latent TB. METHODS This is a narrative review. The different screening programs in the countries of destination are reviewed either based on screening and preventive treatment of latent TB pre or more commonly - post arrival. RESULTS Screening can be performed using interferon-gamma release assays (IGRA) or tuberculin skin tests (TST). Preventive treatment of latent TB is using either monotherapy with isoniazid, or in combination with rifampicin or rifapentine. We discuss the ethical issues of preventive treatment in asymptomatic individuals and how these are addressed in different screening programs. CONCLUSION Screening migrants from TB high endemic countries to TB low endemic countries is beneficial. There is a lack of standardization and agreement on screening protocols, follow up and treatment.
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Affiliation(s)
- Eskild Petersen
- PandemiX Center of Excellence, Roskilde University, Roskilde, Denmark; European Society for Clinical Microbiology and Infectious Diseases Task Force for Emerging Infections, Basel, Switzerland; International Society for Infectious Diseases, Boston, MA, USA
| | - Seif Al-Abri
- Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman.
| | - Amina Al-Jardani
- Central Public Health Laboratory, Ministry of Health, Muscat, Oman
| | - Ziad A Memish
- Research and Innovation Center, King Saud Medical City, Ministry of Health & College of Medicine, Al Faisal University, Riyadh, Saudi Arabia; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Eleni Aklillu
- Department of Global Public Health, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Francine Ntoumi
- Fondation Congolaise pour la Recherche Médicale, Brazzaville, People's Republic of Congo; Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Peter Mwaba
- UNZA-UCLMS Research and Training Program, UTH, Lusaka, Zambia; Lusaka Apex Medical University, Faculty of Medicine, Lusaka, Zambia
| | - Christian Wejse
- Department of Public Health, Faculty of Health Science, Aarhus University, Aarhus, Denmark
| | - Alimuddin Zumla
- Department of Infection, Centre for Clinical Microbiology, Division of Infection and Immunity, University College London, London, United Kingdom; NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, United Kingdom
| | - Fatma Al-Yaquobi
- Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman
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Delarbre D, Junca-Laplace C, Otto MP, Antoine C, Defuentes G. Disseminated tuberculosis after anti-TNF alpha treatment: Do not blindly trust the IGRA test. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2024; 42:98-101. [PMID: 37919203 DOI: 10.1016/j.eimce.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 06/03/2023] [Indexed: 11/04/2023]
Abstract
INTRODUCTION Interferon gamma release assay (IGRA) is used to detect latent tuberculosis prior to biological treatments in the context of suspected inflammatory rheumatism. METHODS We report the case of a 50-year-old woman with negative IGRA test before adalimumab introduction for presumed axial spondyloarthritis. RESULTS The worsening of symptoms under treatment led to further investigations and the diagnostic of disseminated tuberculosis (TB) was later established with miliary and multiple bone locations such as spondylitis and sacroilitis. The patient's history revealed past exposure to tuberculosis. This observation illustrates the limitations of IGRA in such situation due to its variable performance for active TB diagnosis. CONCLUSION Misdiagnosis is frequent in bone tuberculosis due to non-specific signs. We draw the attention to the importance of a global risk assessment prior to the introduction of biological treatment for suspected chronic inflammatory rheumatism and recall the risk factors for false-negative IGRA. An extended treatment course may be necessary after exposure to anti-TNF-alpha.
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Affiliation(s)
- David Delarbre
- Division of Internal Medicine, Military Teaching Hospital Sainte-Anne, 2, Boulevard Sainte-Anne, Toulon Cedex 9, France.
| | - Camille Junca-Laplace
- Radiology Department, Military Teaching Hospital Sainte-Anne, 2, Boulevard Sainte-Anne, Toulon Cedex 9, France
| | - Marie-Pierre Otto
- Microbiology Department, Military Teaching Hospital Sainte-Anne, 2, Boulevard Sainte-Anne, Toulon Cedex 9, France
| | - Carole Antoine
- Division of Internal Medicine, Military Teaching Hospital Sainte-Anne, 2, Boulevard Sainte-Anne, Toulon Cedex 9, France
| | - Gilles Defuentes
- Division of Internal Medicine, Military Teaching Hospital Sainte-Anne, 2, Boulevard Sainte-Anne, Toulon Cedex 9, France
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Komukai J, Matsumoto K, Fukushima W, Kudoh S. Pulmonary Tuberculosis Incidence among Interferon-Gamma Release Assay-Positive Individuals with Latent Tuberculosis Infection and Fibrotic Lesions in a Vulnerable Urban Population in Osaka City, Japan, 2015-2021. Jpn J Infect Dis 2024; 77:21-24. [PMID: 37779028 DOI: 10.7883/yoken.jjid.2023.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Latent tuberculosis infection (LTBI) with fibrotic lesions (FL) can progress to active tuberculosis (TB). Most previous studies have used tuberculin skin tests, which have lower specificity than interferon-gamma release assays (IGRAs), for LTBI diagnosis. This study evaluated the incidence of active TB among individuals with LTBI (diagnosed using IGRAs) and FL in Nishinari District, Osaka City. In total, 54 men (mean age: 68.7 years) were enrolled, of whom 10 (18.5%) were homeless, and 36 (66.7%) were welfare recipients. The median observation period was 1,084 days (range: 64-2,907 days). The incidence rate of active TB among individuals with LTBI and FL was 1.18 (95% confidence interval: 0.32-4.29) cases per 100 person-years. Among the 19 participants who had not been treated with anti-TB therapy, one (5.3%) progressed to active TB, and among the 30 participants who had completed anti-TB treatment, one (3.3%) progressed to active TB. The other 5 participants did not have TB. This study revealed the incidence of active TB among individuals with LTBI, diagnosed using IGRAs, and FL in a vulnerable urban population. The higher incidence than that reported in previous studies reinforces the importance of improved LTBI management strategies, including chest radiography screening, and LTBI treatment.
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Affiliation(s)
- Jun Komukai
- Nishinari District Public Health Office, Japan
- Department of Infectious Disease Control, Osaka City Public Health Office, Japan
| | | | - Wakaba Fukushima
- Department of Public Health, Research Center for Infectious Disease Sciences, Osaka Metropolitan University Graduate School of Medicine, Japan
| | - Shinzoh Kudoh
- Department of Internal Medicine, Osaka Social Medical Center, Japan
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Li H, Ren W, Liang Q, Zhang X, Li Q, Shang Y, Ma L, Li S, Pang Y. A novel chemokine biomarker to distinguish active tuberculosis from latent tuberculosis: a cohort study. QJM 2023; 116:1002-1009. [PMID: 37740371 PMCID: PMC10753411 DOI: 10.1093/qjmed/hcad214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/12/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Interferon-γ release assays (IGRAs), which are widely used to diagnose tuberculosis (TB), cannot effectively discriminate latent TB infection (LTBI) from active TB (ATB). This study aimed to identify potential antigen-specific biomarkers for differentiating LTBI cases from ATB cases. METHODS Ongoing recruitment was conducted of individuals meeting study inclusion criteria at Beijing Chest Hospital from May 2020 to April 2022; 208 participants were enrolled and assigned to three groups: HC (60 healthy controls), LTBI (52 subjects with LTBI) and ATB (96 ATB patients). After participants were assigned to the discovery cohort (20 or 21 subjects/group), all others were assigned to the verification cohort. Discovery cohort blood levels of 40 chemokines were measured using Luminex assays to identify chemokines that could be used to discriminate LTBI cases from ATB cases; candidate biomarkers were verified using enzyme-linked immunosorbent assay-based testing of validation cohort samples. RESULTS Luminex results revealed highest ATB group levels of numerous cytokines, growth factors and chemokines. Receiving operating characteristic curve-based analysis of 40 biomarkers revealed CCL8 (AUC = 0.890) and CXCL9 (AUC = 0.883) effectively discriminated between LTBI and TB cases; greatest diagnostic efficiency was obtained using both markers together (AUC = 0.929). Interpretation of CCL8 and CXCL9 levels for validation cohort IGRA-positive subjects (based on a 0.658-ng/ml cutoff) revealed ATB group CCL8-based sensitivity and specificity rates approaching 90.79% and 100.00%, respectively. CONCLUSION TB-specific chemokines hold promise as ATB diagnostic biomarkers. Additional laboratory confirmation is needed to establish whether CCL8-based assays can differentiate between ATB and LTBI cases, especially for bacteriologically unconfirmed TB cases.
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Affiliation(s)
- H Li
- Department of Bacteriology and Immunology, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Postal No. 9, Beiguan Street, Tongzhou District, Beijing 101149, People’s Republic of China
| | - W Ren
- Department of Bacteriology and Immunology, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Postal No. 9, Beiguan Street, Tongzhou District, Beijing 101149, People’s Republic of China
| | - Q Liang
- Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, People’s Republic of China
| | - X Zhang
- Department of Bacteriology and Immunology, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Postal No. 9, Beiguan Street, Tongzhou District, Beijing 101149, People’s Republic of China
| | - Q Li
- Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, People’s Republic of China
| | - Y Shang
- Department of Bacteriology and Immunology, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Postal No. 9, Beiguan Street, Tongzhou District, Beijing 101149, People’s Republic of China
| | - L Ma
- Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, People’s Republic of China
| | - S Li
- Department of Bacteriology and Immunology, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Postal No. 9, Beiguan Street, Tongzhou District, Beijing 101149, People’s Republic of China
| | - Y Pang
- Department of Bacteriology and Immunology, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Postal No. 9, Beiguan Street, Tongzhou District, Beijing 101149, People’s Republic of China
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Witte P, Arvand M, Barth S, Diel R, Friesen I, Gastmeier P, Häcker B, Hauer B, Kuhns M, Nienhaus A, Otto-Knapp R, Richter E, Wischnewski N, Ziegler R, Bauer T. [Tuberculosis Infection Control & Hygiene - Recommendations of the DZK]. Pneumologie 2023; 77:983-1000. [PMID: 37832577 DOI: 10.1055/a-2172-9575] [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: 10/15/2023]
Abstract
Preventing the spread of the disease is an essential goal in the care and treatment of tuberculosis. In addition to early diagnosis and effective therapies, isolation of infectious patients and adequate hygiene measures are of particular importance for infection prevention. The present recommendations replace the previous recommendations "tuberculosis infection control" from 2012 and take into account the current national and international recommendations and as well as new scientific findings. After a description of the infection and the transmission pathways, the necessary prevention and hygiene measures in health care facilities are comprehensively presented. Since the last revision of the recommendations on infection prevention, international recommendations and the KRINKO recommendation on ending isolation have been changed. In accordance with this, under certain conditions in the case of sensitive tuberculosis, de-isolation in health care facilities can take place after 14 days without taking the sputum findings into account. The second part of the recommendations explains in detail the measures to be taken in special situations and areas, such as general practitioners, ambulance services and care facilities. Here, the recommendations on respiratory protection have been simplified; for staff, an FFP2 mask is now generally considered sufficient.
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Affiliation(s)
- Peter Witte
- Institut für Krankenhaushygiene, Universitätsklinikum JWK Minden, Minden
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose e. V. (DZK), Berlin
| | | | - Stefanie Barth
- Friedrich-Loeffler-Institut - Bundesforschungsinstitut für Tiergesundheit (FLI), Institut für molekulare Pathogenese, Jena
| | - Roland Diel
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose e. V. (DZK), Berlin
- Institut für Epidemiologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
- Deutsches Zentrum für Lungenforschung, Airway Research Center North (ARCN), LungenClinic Großhansdorf, Großhansdorf
| | - Inna Friesen
- Nationales Referenzzentrum für Mykobakterien, Forschungszentrum Borstel, Leibniz Lungenzentrum, Borstel
| | - Petra Gastmeier
- Institut für Hygiene und Umweltmedizin, Charité - Universitätsmedizin Berlin, Berlin
| | - Brit Häcker
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose e. V. (DZK), Berlin
| | | | - Martin Kuhns
- Nationales Referenzzentrum für Mykobakterien, Forschungszentrum Borstel, Leibniz Lungenzentrum, Borstel
| | - Albert Nienhaus
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg Eppendorf (UKE), Hamburg
| | - Ralf Otto-Knapp
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose e. V. (DZK), Berlin
| | | | | | - Renate Ziegler
- Institut für Klinikhygiene, Medizinische Mikrobiologie und Klinische Infektiologie, Universitätsinstitut der Paracelsus Medizinischen Privatuniversität, Klinikum Nürnberg, Nürnberg
| | - Torsten Bauer
- Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose e. V. (DZK), Berlin
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Kaufmann SHE. Vaccine development against tuberculosis before and after Covid-19. Front Immunol 2023; 14:1273938. [PMID: 38035095 PMCID: PMC10684952 DOI: 10.3389/fimmu.2023.1273938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/16/2023] [Indexed: 12/02/2023] Open
Abstract
Coronavirus disease (Covid-19) has not only shaped awareness of the impact of infectious diseases on global health. It has also provided instructive lessons for better prevention strategies against new and current infectious diseases of major importance. Tuberculosis (TB) is a major current health threat caused by Mycobacterium tuberculosis (Mtb) which has claimed more lives than any other pathogen over the last few centuries. Hence, better intervention measures, notably novel vaccines, are urgently needed to accomplish the goal of the World Health Organization to end TB by 2030. This article describes how the research and development of TB vaccines can benefit from recent developments in the Covid-19 vaccine pipeline from research to clinical development and outlines how the field of TB research can pursue its own approaches. It begins with a brief discussion of major vaccine platforms in general terms followed by a short description of the most widely applied Covid-19 vaccines. Next, different vaccination regimes and particular hurdles for TB vaccine research and development are described. This specifically considers the complex immune mechanisms underlying protection and pathology in TB which involve innate as well as acquired immune mechanisms and strongly depend on fine tuning the response. A brief description of the TB vaccine candidates that have entered clinical trials follows. Finally, it discusses how experiences from Covid-19 vaccine research, development, and rollout can and have been applied to the TB vaccine pipeline, emphasizing similarities and dissimilarities.
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Affiliation(s)
- Stefan H. E. Kaufmann
- Max Planck Institute for Infection Biology, Berlin, Germany
- Systems Immunology, Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany
- Hagler Institute for Advanced Study, Texas A&M University, College Station, TX, United States
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Diel R, Breuer C, Bös L, Geerdes-Fenge H, Günther A, Häcker B, Hannemann J, Nienhaus A, Priwitzer M, Witte P, Bauer T. [Recommendations for Contact Tracing for Tuberculosis - Update 2023]. DAS GESUNDHEITSWESEN 2023; 85:1076-1098. [PMID: 37972583 DOI: 10.1055/a-2148-7769] [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: 11/19/2023]
Abstract
The aim of contact tracing for tuberculosis is in addition to active case finding the detection of chains of infection and the prevention of the further spread of the disease. In this context, a careful selection of contact persons is necessary, depending on the type and duration of contact, to identify persons who are recently infected and therefore to increase the benefit of a preventive therapy and to avoid unnecessary testing of persons who are not at risk of infection. Since the last update of the recommendations on contact tracing, data on the use of interferon-y release assays (IGRAs) in children has been improved markedly. These are the preferred test in contact tracing of adults. For children, both IGRAs and the tuberculin skin test can be used equivalently. Rifampicin for 4 months, rifampicin and isoniazid for 3 months, or isoniazid for 9 months are recommended as preventive therapy in cases of confirmed infection.The implementation of the contact tracing in different age groups as well as legal framework conditions and socio-medical aspects and challenges are dealt with in detail. In addition, special cases, such as environmental screening in day-care centers, schools, or other community facilities, are discussed separately.
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Affiliation(s)
- Roland Diel
- Universitätsklinikum Schleswig-Holstein, Campus Kiel
- Deutsches Zentrum für Lungenforschung, Airway Research Center North (ARCN), LungenClinic Grosshansdorf, Großhansdorf
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose, Berlin
| | - Cornelia Breuer
- Amt für Gesundheit und Prävention der Landeshauptstadt Dresden
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose, Berlin
| | | | | | | | - Brit Häcker
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose, Berlin
| | | | - Albert Nienhaus
- Berufsgenossenschaft für Gesundheits- und Wohlfahrtspflege, Hamburg
- Universitätskrankenhaus Eppendorf, Hamburg
| | | | - Peter Witte
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose, Berlin
- Institut für Krankenhaushygiene, Universitätsklinikum JWK, Minden
| | - Torsten Bauer
- Helios-Klinikum Emil von Behring, Berlin
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose, Berlin
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Islam R, Islam SS, Rumi TB, Mia Z, Rahim Z. Enhancing bovine tuberculosis screening at Dhaka city in Bangladesh: Integrating gamma interferon blood test as ancillary testing with tuberculin skin test. Vet Immunol Immunopathol 2023; 264:110659. [PMID: 37801841 DOI: 10.1016/j.vetimm.2023.110659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/15/2023] [Accepted: 09/27/2023] [Indexed: 10/08/2023]
Abstract
Tuberculin skin test (TST) is the standard method for screening of bovine tuberculosis (bTB). However, gamma interferon blood test has been introduced in the bTB control program as an ancillary testing with TST in many countries of the world. The objective of this study was to recommend this screening test as an ancillary testing with TST for field application in Bangladesh. In this study 577 cattle of different age, sex and breeds from twenty nine (29) cattle herds were examined to determine skin response against bTB through single intradermal comparative tuberculin test (SICTT) that comprised of positive (n = 81), inconclusive (n = 44) and negative (n = 452) animals. Of which 74 animals that included positive (n = 63), inconclusive (n = 8) and negative (n = 3) animals were taken under this study. Blood samples were collected in heparinized tube and stimulated overnight with bovine and avian purified protein derivatives (PPDs) for the secretion of gamma interferon, and measured via sandwich ELISA. Cohen's kappa statistics was performed for the evaluation of agreement between the two tests. The agreement obtained between two tests was fair (Kappa agreement, K = 24.0%, 95% CI = 16.9-30.5%, P = 0.037). Of positive (n = 63), inconclusive (n = 8) and negative (n = 3) status of animals at SICTT, 82.54% (n = 52), 62.50% (n = 5), and 33.33% (n = 1) were found to be bTB positive respectively through this ancillary test. This test notably corroborates to TST result. A considerable number of inconclusive TB status animals were found to be positive through this gamma interferon assay. Therefore, this test could be used as an ancillary test with TST to maximize the proportion of bTB estimation in the infected cattle herd for early detection of zoonotic tuberculosis in Bangladesh before transmission at the animal-human interface.
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Affiliation(s)
- Robiul Islam
- Department of Microbiology, Jagannath University, Dhaka 1100, Bangladesh.
| | - Sk Shaheenur Islam
- Department of Livestock Services, Krishi Khamar Sarak, Farmgate, Dhaka 1215, Bangladesh; Department of Microbiology and Hygiene, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Tanzida Begum Rumi
- International Centre for Diarrhoeal Disease and Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1215, Bangladesh
| | - Zakaria Mia
- Department of Microbiology, Jagannath University, Dhaka 1100, Bangladesh
| | - Zeaur Rahim
- International Centre for Diarrhoeal Disease and Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1215, Bangladesh
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Diel R, Breuer C, Bös L, Geerdes-Fenge H, Günther A, Häcker B, Hannemann J, Nienhaus A, Priwitzer M, Witte P, Bauer T. [Recommendations for contact tracing for tuberculosis - update 2023]. Pneumologie 2023; 77:607-631. [PMID: 37536363 DOI: 10.1055/a-2107-2147] [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: 08/05/2023]
Abstract
The aim of contact tracing for tuberculosis is in addition to active case finding the detection of chains of infection and the prevention of the further spread of the disease. In this context, a careful selection of contact persons is necessary, depending on the type and duration of contact, to identify persons who are recently infected and therefore to increase the benefit of a preventive therapy and to avoid unnecessary testing of persons who are not at risk of infection. Since the last update of the recommendations on contact tracing, data on the use of interferon-y release assays (IGRAs) in children has been improved markedly. These are the preferred test in contact tracing of adults. For children, both IGRAs and the tuberculin skin test can be used equivalently. Rifampicin for 4 months, rifampicin and isoniazid for 3 months, or isoniazid for 9 months are recommended as preventive therapy in cases of confirmed infection.The implementation of the contact tracing in different age groups as well as legal framework conditions and socio-medical aspects and challenges are dealt with in detail. In addition, special cases, such as environmental screening in day-care centers, schools, or other community facilities, are discussed separately.
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Affiliation(s)
- Roland Diel
- Universitätsklinikum Schleswig-Holstein, Campus Kiel
- Deutsches Zentrum für Lungenforschung, Airway Research Center North (ARCN), LungenClinic Grosshansdorf, Großhansdorf
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose, Berlin
| | - Cornelia Breuer
- Amt für Gesundheit und Prävention der Landeshauptstadt Dresden
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose, Berlin
| | | | | | | | - Brit Häcker
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose, Berlin
| | | | - Albert Nienhaus
- Berufsgenossenschaft für Gesundheits- und Wohlfahrtspflege, Hamburg
- Universitätskrankenhaus Eppendorf, Hamburg
| | | | - Peter Witte
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose, Berlin
- Institut für Krankenhaushygiene, Universitätsklinikum JWK, Minden
| | - Torsten Bauer
- Helios-Klinikum Emil von Behring, Berlin
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose, Berlin
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Wallace H, Nelson C, Crikis S. Tuberculosis screening practices and outcomes in an australian dialysis unit. BMC Nephrol 2023; 24:249. [PMID: 37612629 PMCID: PMC10464025 DOI: 10.1186/s12882-023-03304-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 08/20/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND The World Health Organisation (WHO) recommends all dialysis patients undertake routine screening for latent tuberculosis infection (LTBI) in high income countries such as Australia. However, we employ a targeted screening approach in our Australian dialysis unit in line with local and some international guidelines. We analysed our practices to assess the validity of our approach. METHODS A retrospective review of new dialysis patients during the period 2012-2018 was undertaken. Patient records were reviewed for basic demographic data, comorbidities, LTBI screening using Quantiferon Gold (QFG), and outcomes, including episodes of active TB, to June 2020. RESULTS 472 patients were included. WHO high risk country of origin patients accounted for 22% (n = 103). 229 patients (48.5%) were screened using QFG. The single main indication for screening was transplantation waitlisting. 34 patients had a positive QFG result. Active tuberculosis developed in two patients during the observation period. Both occurred in the screened cohort, the cases having previously tested negative via QFG at 11 and 16 months, prior to the development of active tuberculosis. No patients in the unscreened cohort developed active tuberculosis during the observation period. WHO high risk country of origin was associated with positive QFG status, odds ratio 10.4 (95% CI 3.3-31.2). CONCLUSION The data failed to show a benefit from widening of the screening program within our dialysis unit. However, a much larger sample size will be required to confidently assess the impact of the current approach on patient outcomes. Analysis of current screening practices and outcomes across all Australian dialysis services is warranted to assess the risks and benefits of widening the screening practices to include all dialysis patients as recommended by the WHO.
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Affiliation(s)
- Hannah Wallace
- Department of Nephrology, Western Health, 176 Furlong Road St Albans, St Albans, VIC, 3021, Australia.
| | - Craig Nelson
- Department of Nephrology, Western Health, 176 Furlong Road St Albans, St Albans, VIC, 3021, Australia
- Department of Medicine, Western Health, University of Melbourne, Melbourne, VIC, 3021, Australia
- Western Health Chronic Disease Alliance, Western Health, St Albans, VIC, 3021, Australia
- Deakin University, Victoria, Australia
| | - Sandra Crikis
- Department of Nephrology, Western Health, 176 Furlong Road St Albans, St Albans, VIC, 3021, Australia
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Yahav D, Gitman MR, Margalit I, Avni T, Leeflang MMG, Husain S. Screening for Latent Tuberculosis Infection in Solid Organ Transplant Recipients to Predict Active Disease: A Systematic Review and Meta-Analysis of Diagnostic Studies. Open Forum Infect Dis 2023; 10:ofad324. [PMID: 37559757 PMCID: PMC10407303 DOI: 10.1093/ofid/ofad324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/26/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND This is a systematic review and meta-analysis of diagnostic test accuracy studies to assess the predictive value of both tuberculin skin test (TST) and interferon-gamma release assays (IGRA) for active tuberculosis (TB) among solid organ transplantation (SOT) recipients. METHODS Medline, Embase, and the CENTRAL databases were searched from 1946 until June 30, 2022. Two independent assessors extracted data from studies. Sensitivity analyses were performed to investigate the effect of studies with high or low risk of bias. Methodological quality of each publication was assessed using QUADAS-2. RESULTS A total of 43 studies (36 403 patients) with patients who were screened for latent TB infection (LTBI) and who underwent SOT were included: 18 were comparative and 25 noncomparative (19 TST, 6 QuantiFERON-TB Gold In-Tube [QFT-GIT]). For IGRA tests taken together, positive predictive value (PPV) and negative predictive value (NPV) were 1.2% and 99.6%, respectively. For TST, PPV was 2.13% and NPV was 95.5%. Overall, PPV is higher when TB burden is higher, regardless of test type, although still low in absolute terms. Incidence of active TB was similar between studies using LTBI prophylaxis (mean incidence 1.22%; 95% confidence interval [CI], .2179-2.221) and those not using prophylaxis (mean incidence 1.045%; 95% CI, 0.2731-1.817; P = .7717). Strengths of this study include the large number of studies available from multiple different countries; limitations include absence of gold standard for diagnosis of latent TB and low incidence of active TB. CONCLUSIONS We found both TST and IGRA had a low PPV and high NPV for the development of active TB posttransplant. Further studies are needed to better understand how to prevent active TB in the SOT population.
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Affiliation(s)
- Dafna Yahav
- Infectious Diseases Unit, Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Melissa R Gitman
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ili Margalit
- Infectious Diseases Unit, Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Tomer Avni
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Medicine A, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Mariska M G Leeflang
- Department of Epidemiology and Data Science, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Shahid Husain
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada
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13
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Båtshake Y, Walles J, Winqvist N, Björkman P. Tuberculosis Infection and Disease Among Pregnant People Living in Sweden With Origin in Tuberculosis-Endemic Countries. Open Forum Infect Dis 2023; 10:ofad353. [PMID: 37520421 PMCID: PMC10372857 DOI: 10.1093/ofid/ofad353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/09/2023] [Indexed: 08/01/2023] Open
Abstract
Background Pregnancy has been associated with elevated incidence of tuberculosis (TB) disease. Since 2014, people living in Sweden with origin in TB-endemic countries have been offered screening for TB infection in antenatal care (ANC) using Quantiferon-TB assays. We assessed factors associated with TB infection in this population and determined the incidence of TB disease during pregnancy and postpartum periods with regard to ANC Quantiferon-TB results. Methods Quantiferon-TB results obtained during ANC in Sweden, 2014-2018, were linked to data from national registers (Pregnancy Register, Patient Register and Tuberculosis Register). Factors associated with TB infection (defined as Quantiferon-TB ≥0.35 IU/mL) were identified using logistic regression analysis. Incidence of TB disease was determined with regard to pregnancy, postpartum and subsequent periods, and ANC Quantiferon-TB results. Results Among 7638 screened individuals, 1424 (18.6%) had TB infection. Tuberculosis infection was independently associated with higher age at immigration (adjusted odds ratio, 1.04 [95% confidence interval, 1.03-1.05]; P < .001), and was more common among people originating from Africa compared to other world regions (845/3088 [27.4%] vs 579/4550 [12.7%]; P < .001). In total, 16 participants were diagnosed with TB disease (10 during pregnancy, 4 at <6 months after delivery, 2 at >6 months after delivery); among these, all diagnosed during pregnancy/postpartum had positive ANC Quantiferon-TB results (constituting 14/1424 [1%] of people with TB infection). Conclusions Among pregnant people screened in Swedish ANC, TB infection was associated with higher age and African origin. All cases of TB disease reported in persons with TB infection at ANC screening occurred during pregnancy or postpartum.
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Affiliation(s)
- Ylva Båtshake
- Correspondence: Ylva Båtshake, MD, MSc, Clinical Infection Medicine, Department of Translational Medicine, Lund University, Ruth Lundskogs gata 3, 214 28, Malmö, Sweden (); Per Björkman, MD, PhD, Clinical Infection Medicine, Department of Translational Medicine, Lund University, Ruth Lundskogs gata 3, 214 28, Malmö, Sweden ()
| | - John Walles
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
- Clinical Microbiology, Infection Prevention and Control, Office for Medical Services, Region Skåne, Lund, Sweden
- Department of Infectious Diseases, Central Hospital, Kristianstad, Sweden
| | - Niclas Winqvist
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
- Skåne Regional Office for Infectious Disease Control and Prevention, Malmö, Sweden
| | - Per Björkman
- Correspondence: Ylva Båtshake, MD, MSc, Clinical Infection Medicine, Department of Translational Medicine, Lund University, Ruth Lundskogs gata 3, 214 28, Malmö, Sweden (); Per Björkman, MD, PhD, Clinical Infection Medicine, Department of Translational Medicine, Lund University, Ruth Lundskogs gata 3, 214 28, Malmö, Sweden ()
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14
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Zhang L, Ma Y, Jiang N, Zou X, Zhang Y, Zhang F, Zeng X, Zhao Y, Liu S, Zuo X, Wu H, Wu L, Li H, Zhang Z, Chen S, Zhu P, Zhang M, Qi W, Liu Y, Liu H, Shi X, Liu X. Latent Tuberculosis Infection and Associated Factors in Patients with Systemic Lupus Erythematosus: a Multicenter, Cross-Sectional Study. Microbiol Spectr 2023; 11:e0084823. [PMID: 37158726 PMCID: PMC10269486 DOI: 10.1128/spectrum.00848-23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/13/2023] [Indexed: 05/10/2023] Open
Abstract
The objectives of this study were to screen for latent tuberculosis infection (LTBI) among patients with systemic lupus erythematosus (SLE) using the T-SPOT.TB assay and to identify factors affecting the assay results. SLE patients were enrolled from 13 tertiary hospitals in eastern, central, and western China from September 2014 to March 2016 and were screened using the T-SPOT.TB assay to detect LTBI. Basic information about the subjects was collected, including gender, age, body mass index (BMI), course of disease, evidence of previous tuberculosis, Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) score, and the use of glucocorticoids and immunosuppressants. Univariate analysis and multivariable logistic regression were performed to identify factors affecting the results of the T-SPOT.TB assay. In all, 2,229 SLE patients were screened using the T-SPOT.TB assay, of whom 334 patients tested positive, yielding a positivity rate of 15% (95% confidence interval [CI], 13.5% to 16.5%). The positivity rate was higher in male than female patients and had an increasing trend with age. Multivariable logistic regression analysis showed that patients over 40 (odds ratio [OR], 1.65; 95% CI, 1.29 to 2.10) and with evidence of previous tuberculosis (OR, 4.43; 95% CI, 2.81 to 6.99) were more likely to have positive T-SPOT.TB results, while patients with a SLEDAI-2K score of ≥10 (OR, 0.61; 95% CI, 0.43 to 0.88), a glucocorticoid dose of ≥60 mg/d (OR, 0.62; 95% CI, 0.39 to 0.98), leflunomide (LEF) treatment (OR, 0.51; 95% CI, 0.29 to 0.88), or tacrolimus (FK506) treatment (OR, 0.40; 95% CI, 0.16 to 1.00) were more likely to have negative T-SPOT.TB results. The frequencies of CFP-10-specific gamma interferon (IFN-γ)-secreting T cells were significantly lower in SLE patients with severe disease activity or high-dose glucocorticoids (P < 0.05). The positivity rate of the T-SPOT.TB assay was 15% among SLE patients. Severe, active SLE disease and the use of high-dose glucocorticoids and some types of immunosuppressants are likely to result in negative T-SPOT.TB results. For SLE patients with the above conditions, diagnosing LTBI based on a positive T-SPOT.TB result may lead to underestimation of the prevalence. IMPORTANCE The burden of tuberculosis and systemic lupus erythematosus in China ranks among the top three in the world. Therefore, active screening for LTBI and preventive intervention in SLE patients are of great significance in China. In view of the lack of relevant data in a large sample, we conducted a multicenter, cross-sectional study using T-SPOT.TB as a screening method for LTBI, to investigate the prevalence of LTBI and analyze the factors affecting the results of the T-SPOT.TB assay in SLE patients. Our study showed that the overall positivity rate of the T-SPOT.TB assay in SLE patients was 15.0%, which was lower than the estimated LTBI prevalence in the general population in China (~20%). For SLE patients with severe, active disease, high-dose glucocorticoids, and some types of immunosuppressants, a diagnosis of LTBI based on only positive T-SPOT.TB results may lead to underestimation of the prevalence.
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Affiliation(s)
- Lifan Zhang
- Division of Infectious Diseases, Department of Internal Medicine, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
- Centre for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
- Clinical Epidemiology Unit, International Epidemiology Network, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Yanan Ma
- Division of Infectious Diseases, Department of Internal Medicine, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Nan Jiang
- Division of Infectious Diseases, Department of Internal Medicine, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
- 4+4 Medical Doctor Program, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Xiaoqing Zou
- Division of Infectious Diseases, Department of Internal Medicine, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Yueqiu Zhang
- Division of Infectious Diseases, Department of Internal Medicine, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Fengchun Zhang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, People’s Republic of China
| | - Xiaofeng Zeng
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, People’s Republic of China
| | - Yan Zhao
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, People’s Republic of China
| | - Shengyun Liu
- Department of Rheumatology and Immunology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Xiaoxia Zuo
- Department of Rheumatology and Immunology, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Huaxiang Wu
- Department of Rheumatology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Lijun Wu
- Department of Rheumatology, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumchi, People’s Republic of China
| | - Hongbin Li
- Department of Rheumatology and Immunology, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, People’s Republic of China
| | - Zhiyi Zhang
- Department of Rheumatology and Immunology, First Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
| | - Sheng Chen
- Department of Rheumatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
| | - Ping Zhu
- Department of Clinical Immunology, Xijing Hospital, Fourth Military Medical University, Xi’an, People’s Republic of China
| | - Miaojia Zhang
- Department of Rheumatology, First Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China
| | - Wencheng Qi
- Department of Rheumatology, Tianjin First Central Hospital, Tianjin, People’s Republic of China
| | - Yi Liu
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Huaxiang Liu
- Department of Rheumatology, Qilu Hospital of Shandong University, Ji’nan, People’s Republic of China
| | - Xiaochun Shi
- Division of Infectious Diseases, Department of Internal Medicine, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
- Centre for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Xiaoqing Liu
- Division of Infectious Diseases, Department of Internal Medicine, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
- Centre for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
- Clinical Epidemiology Unit, International Epidemiology Network, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
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15
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Liu L, Wu G, Wang J, Peng L, Xu X, Cai L. Smoking is a Factor in Discordance Between QuantiFERONTB Gold Assay and Tuberculosis Etiology: Especially in Older Patients. Infect Drug Resist 2023; 16:3443-3451. [PMID: 37283941 PMCID: PMC10241176 DOI: 10.2147/idr.s412473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/25/2023] [Indexed: 06/08/2023] Open
Abstract
Purpose Exploring whether smoking is an influencing factor for the inconsistency between QuantiFERONTB Gold assay (QFT-GIT) and tuberculosis etiology. Patients and Methods The clinical data of patients who were confirmed positive for Mycobacterium tuberculosis (MTB) after undergoing QFT-GIT testing from September 2017 to August 2021 were retrospectively analyzed. Chi-square and rank-sum tests were used to compare the differences in characteristics between smokers and non-smokers. Logistic regression was used to adjust for confounding factors affecting smoking. Propensity score matching (PSM) was used to verify the above conclusions again. Results Positive results of tuberculosis etiology were adopted as the standard, the incidence of inconsistent results between QFT-GIT and tuberculosis etiology was 8.90% (108/1213), of which the false negative rate was 6.27% (76/1213) and the indeterminate rate was 2.64% (32/1213). In the overall population, the smokers had a lower level of basal IFN-γ (Z=-2.079, P=0.038). Among 382 elderly (≥65 years old) patients, the smokers had lower levels of antigen-stimulated IFN-γ (Z=-2.838, P=0.005). After performing BOX-COX transformation on all non-normally distributed data, logistic stepwise regression was used to adjust confounding factors. The results showed that smoking was an influencing factor for the inconsistency between QFT-GIT and tuberculosis etiology results (OR=1.69, P=0.020). Using PSM for 1:2 matching, the results showed that smoking was still an independent risk factor for the inconsistent results of QFT-GIT and tuberculosis etiology (OR= 1.95, P=0.019). Age-stratified analysis showed that smoking was an independent risk factor in discordance between QFT-GIT and tuberculosis etiology in patients aged ≥65 years (OR=2.40, P=0.005), but not in patients aged <65 years (P > 0.05). Conclusion Smoking can reduce the body's IFN-γ release ability, and smoking (especially the elderly) is an influencing factor for the inconsistency between QFT-GIT and tuberculosis etiological results.
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Affiliation(s)
- Libin Liu
- Centre of Laboratory Medicine, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
- Centre of Laboratory Medicine, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang, People’s Republic of China
| | - Guihua Wu
- Centre of Laboratory Medicine, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
- Centre of Laboratory Medicine, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang, People’s Republic of China
| | - Jing Wang
- Centre of Laboratory Medicine, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
- Centre of Laboratory Medicine, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang, People’s Republic of China
| | - Lijun Peng
- Centre of Laboratory Medicine, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
- Centre of Laboratory Medicine, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang, People’s Republic of China
| | - Xiaoqun Xu
- Centre of Laboratory Medicine, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
- Centre of Laboratory Medicine, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang, People’s Republic of China
| | - Long Cai
- Centre of Laboratory Medicine, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
- Centre of Laboratory Medicine, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang, People’s Republic of China
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16
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Jonas DE, Riley SR, Lee LC, Coffey CP, Wang SH, Asher GN, Berry AM, Williams N, Balio C, Voisin CE, Kahwati LC. Screening for Latent Tuberculosis Infection in Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2023; 329:1495-1509. [PMID: 37129650 DOI: 10.1001/jama.2023.3954] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Importance Latent tuberculosis infection (LTBI) can progress to active tuberculosis disease, causing morbidity and mortality. Objective To review the evidence on benefits and harms of screening for and treatment of LTBI in adults to inform the US Preventive Services Task Force (USPSTF). Data Sources PubMed/MEDLINE, Cochrane Library, and trial registries through December 3, 2021; references; experts; literature surveillance through January 20, 2023. Study Selection English-language studies of LTBI screening, LTBI treatment, or accuracy of the tuberculin skin test (TST) or interferon-gamma release assays (IGRAs). Studies of LTBI screening and treatment for public health surveillance or disease management were excluded. Data Extraction and Synthesis Dual review of abstracts, full-text articles, and study quality; qualitative synthesis of findings; meta-analyses conducted when a sufficient number of similar studies were available. Main Outcomes and Measures Screening test accuracy; development of active tuberculosis disease, transmission, quality of life, mortality, and harms. Results A total of 113 publications were included (112 studies; N = 69 009). No studies directly evaluated the benefits and harms of screening. Pooled estimates for sensitivity of the TST were 0.80 (95% CI, 0.74-0.87) at the 5-mm induration threshold, 0.81 (95% CI, 0.76-0.87) at the 10-mm threshold, and 0.60 (95% CI, 0.46-0.74) at the 15-mm threshold. Pooled estimates for sensitivity of IGRA tests ranged from 0.81 (95% CI, 0.79-0.84) to 0.90 (95% CI, 0.87-0.92). Pooled estimates for specificity of screening tests ranged from 0.95 to 0.99. For treatment of LTBI, a large (n = 27 830), good-quality randomized clinical trial found a relative risk (RR) for progression to active tuberculosis at 5 years of 0.35 (95% CI, 0.24-0.52) for 24 weeks of isoniazid compared with placebo (number needed to treat, 112) and an increase in hepatotoxicity (RR, 4.59 [95% CI, 2.03-10.39]; number needed to harm, 279). A previously published meta-analysis reported that multiple regimens were efficacious compared with placebo or no treatment. Meta-analysis found greater risk for hepatotoxicity with isoniazid than with rifampin (pooled RR, 4.22 [95% CI, 2.21-8.06]; n = 7339). Conclusions and Relevance No studies directly evaluated the benefits and harms of screening for LTBI compared with no screening. TST and IGRAs were moderately sensitive and highly specific. Treatment of LTBI with recommended regimens reduced the risk of progression to active tuberculosis. Isoniazid was associated with higher rates of hepatotoxicity than placebo or rifampin.
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Affiliation(s)
- Daniel E Jonas
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center, Research Triangle Park
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus
| | - Sean R Riley
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center, Research Triangle Park
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus
| | - Lindsey C Lee
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus
| | - Cory P Coffey
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus
| | - Shu-Hua Wang
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus
- Global One Health Initiative, The Ohio State University, Columbus
| | - Gary N Asher
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center, Research Triangle Park
- Department of Family Medicine, University of North Carolina at Chapel Hill
| | - Anne M Berry
- Department of Family Medicine, University of North Carolina at Chapel Hill
- Department of Family Medicine and Community Health, Duke University, Durham, North Carolina
| | - Niketa Williams
- Department of Family Medicine, University of North Carolina at Chapel Hill
- North Carolina Department of Health and Human Services, Division of Public Health, Raleigh
| | - Casey Balio
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center, Research Triangle Park
- Center for Rural Health Research, East Tennessee State University, Johnson City
| | - Christiane E Voisin
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center, Research Triangle Park
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus
| | - Leila C Kahwati
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center, Research Triangle Park
- RTI International, Research Triangle Park, North Carolina
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The Interferon-Gamma Release Assay versus the Tuberculin Skin Test in the Diagnosis of Mycobacterium tuberculosis Infection in BCG-Vaccinated Children and Adolescents Exposed or Not Exposed to Contagious TB. Vaccines (Basel) 2023; 11:vaccines11020387. [PMID: 36851265 PMCID: PMC9961142 DOI: 10.3390/vaccines11020387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/02/2023] [Accepted: 02/05/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Children have an increased risk of developing active tuberculosis (TB) after exposure to Mycobacterium tuberculosis (M.tb), and they are more likely to develop the most severe forms of TB. Rapid diagnosis and treatment of latent M.tb infection (LTBI) is essential to lessen the devastating consequences of TB in children. OBJECTIVE The aim of the study was to evaluate TST (tuberculin skin test) and IGRA (interferon-gamma release assay) utility in identifying LTBI in a cohort of Bacille Calmette-Guérin (BCG)-vaccinated Polish children and adolescents exposed or not exposed to contagious TB. In addition, we asked whether quantitative assessment of IGRA results could be valuable in predicting active TB disease. RESULTS Of the 235 recruited volunteers, 89 (38%) were TST-positive (TST+), 74 (32%) were IGRA-positive (IGRA+), and 62 (26%) were both TST+ and IGRA+. The frequency of TST positivity was significantly higher in the group with (59%) than without TB contact (18%). The percentage of TST+ subjects increased with age from 36% in the youngest children (<2 years) to 47% in the oldest group (>10 years). All positive IGRA results were found solely in the group of children with TB contact. There was a significant increase in the rate of positive IGRA results with age, from 9% in the youngest to 48% in the oldest group. The 10 mm TST cutoff showed good sensitivity and specificity in both TB exposed and nonexposed children and was associated with excellent negative predictive value, especially among nonexposed volunteers. Mean IFN-γ concentrations in IGRA cultures were significantly higher in the group of LTBI compared to the children with active TB disease, both TST+ and TST-. CONCLUSIONS Both TST and IGRA can be used as screening tests for BCG-vaccinated children and adolescents exposed to contagious TB.
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Riasanti M, Putera I, Jessica P, Waliyuddin MZ, Tagar FA, Karlina CH A, Aziza Y, Susiyanti M, Edwar L, Sitompul R, La Distia Nora R. Interferon-gamma release assay and chest X-ray to classify intraocular tuberculosis among clinically undifferentiated uveitis. MEDICAL JOURNAL OF INDONESIA 2023. [DOI: 10.13181/mji.oa.226324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) is a common cause of intraocular inflammation in Indonesia. As no accurate biomarker can confirm the diagnosis, ophthalmologists often rely on systemic findings, such as tuberculin skin test, interferon-gamma release assay (IGRA), and chest X-ray (CXR) for TB suspicion. This study aimed to evaluate IGRA and CXR in classifying intraocular TB among patients with a clinically undifferentiated cause of uveitis.
METHODS This cross-sectional study included 116 patients (a total of 163 affected eyes) with a clinically undifferentiated cause of uveitis. IGRA and CXR were performed as part of the workup. Data on visual acuity, anterior chamber inflammation grade, and anatomical classification of uveitis were recorded. As there were no confirmed ocular tuberculosis (OTB) in our cases, eyes were classified into probable OTB, possible OTB, and unclassified.
RESULTS Overall, 93 patients (80.2%) with a clinically undifferentiated cause of uveitis had positive IGRA, whereas 10 (8.6%) had CXR results suggestive of TB. More than one-third of the patients were blind (visual acuity <3/60), and panuveitis was the commonest anatomical classification. A trend was identified in patients with panuveitis, who often showed ≥2+ cell anterior chamber inflammation (p for trend = 0.023), according to OTB criteria (probable OTB = 3/4, 75.0%; possible OTB = 44/67, 65.7%; unclassified = 2/9, 22.2%). Furthermore, the clinically undifferentiated uveitis cases were eligible to be stratified into probable (8.6%) and possible (75.0%) OTB categories after IGRA and CXR examinations.
CONCLUSIONS The combination of IGRA and CXR is valuable for classifying and diagnosing TB-related uveitis. A multidisciplinary approach is essential when the cause of uveitis is unknown.
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Rodriguez-Moncayo R, Garcia-Cordero JL. Secretion Function Analysis of Ex Vivo Immune Cells in an Integrated Microfluidic Device. Methods Mol Biol 2023; 2679:269-285. [PMID: 37300623 DOI: 10.1007/978-1-0716-3271-0_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Immune cells play a major role in the development of cancer, from being able to inhibit it by secreting pro-inflammatory mediators, to assist in its development by secreting growth factors, immunosuppressive mediators, and ECM-modifying enzymes. Therefore, the ex vivo analysis of the secretion function of immune cells can be employed as a reliable prognostic biomarker in cancer. However, one limiting factor in current approaches to probe the ex vivo secretion function of cells is their low throughput and the consumption of large quantities of sample. Microfluidics provides a unique advantage, by being able to integrate different components, such as cell culture and biosensors in a monolithic microdevice; it can increase the analytical throughput and leverage it with its intrinsic low sample requirement. Furthermore, the integration of fluid control elements also allows this analysis to be highly automatable, leading to increases in consistency in the results. Here, we describe an approach to analyze the ex vivo secretion function of immune cells using a highly integrated microfluidic device.
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Affiliation(s)
- Roberto Rodriguez-Moncayo
- Laboratory of Microtechnologies Applied to Biomedicine, Centro de Investigación y Estudios Avanzados del Instituto Politécnico Nacional (Cinvestav), Monterrey, NL, Mexico
- Research Laboratory of Electronics, Massachusetts Institute of Technology (MIT), Cambridge, MA, USA
| | - Jose L Garcia-Cordero
- Laboratory of Microtechnologies Applied to Biomedicine, Centro de Investigación y Estudios Avanzados del Instituto Politécnico Nacional (Cinvestav), Monterrey, NL, Mexico.
- Institute of Human Biology (IHB), Roche Pharma Research and Early Development, Roche Innovation Center, Basel, Switzerland.
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20
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Arinola GO, Abdullahi I, Rahamon SK, Fasasi ZB, Adedeji OO, Kehinde A, Bakare AA. Activities of plasma indoleamine-2, 3-dioxygenase (IDO) enzyme in Nigerian patients with lung diseases: basis for tryptophan supplementation or IDO inhibitor use. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2023; 17:2. [PMCID: PMC9828369 DOI: 10.1186/s43168-022-00174-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background Clinical trial of IDO inhibitor or uses of micro-nutrient supplements during management of diseases is commonly done without having adequate basis for the practise. Tryptophan (Trp) is an essential amino acid needed for T-lymphocyte function, and indoleamine-2,3-dioxygenase (IDO) is a potent immunoregulatory molecule that catalyses the rate-limiting step of Trp degradation in the kynurenine (Kyn) pathway. Materials and methods Human IDO in the plasma samples was measured using ELISA in patients with non-infectious (asthma) and infectious diseases (pulmonary tuberculosis and COVID-19) compared with corresponding un-infected controls. Results Mean IDO activity in COVID-19 patients was significantly higher compared with corresponding control (p = 0.001) while mean IDO activity in pulmonary tuberculosis patients was non-significantly higher compared with corresponding control (p = 0.520), and mean IDO activity in asthma patients was non-significantly lower compared with corresponding control (p = 0.102). Conclusion Our data suggest that IDO activity as an innate immune factor is increased in infectious lung diseases (COVID-19 and pulmonary tuberculosis) but reduced in non-infectious disease (asthma) and that use of tryptophan supplementation or IDO inhibitor may not be necessary in all lung diseases.
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Affiliation(s)
- Ganiyu Olatunbosun Arinola
- grid.9582.60000 0004 1794 5983Department of Immunology, University of Ibadan and University College Hospital, Ibadan, Nigeria
| | - Issa Abdullahi
- grid.9582.60000 0004 1794 5983Department of Zoology, University of Ibadan, Ibadan, Nigeria
| | - Sheu Kadiri Rahamon
- grid.9582.60000 0004 1794 5983Department of Immunology, University of Ibadan and University College Hospital, Ibadan, Nigeria
| | - Zainab Bolanle Fasasi
- grid.9582.60000 0004 1794 5983Department of Zoology, University of Ibadan, Ibadan, Nigeria
| | | | - Adigun Kehinde
- grid.412438.80000 0004 1764 5403Department of Family Medicine, University College Hospital, Ibadan, Nigeria
| | - Adekunle Akeem Bakare
- grid.9582.60000 0004 1794 5983Department of Zoology, University of Ibadan, Ibadan, Nigeria
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Mahon J, Beale S, Holmes H, Arber M, Nikolayevskyy V, Alagna R, Manissero D, Dowdy D, Migliori GB, Sotgiu G, Duarte R. A systematic review of cost-utility analyses of screening methods in latent tuberculosis infection in high-risk populations. BMC Pulm Med 2022; 22:375. [PMID: 36199061 PMCID: PMC9533619 DOI: 10.1186/s12890-022-02149-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 09/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background The World Health Organisation (WHO) recommends that testing and treatment for latent tuberculosis infection (LTBI) should be undertaken in high-risk groups using either interferon gamma release assays (IGRAs) or a tuberculin skin test (TST). As IGRAs are more expensive than TST, an assessment of the cost-effectiveness of IGRAs can guide decision makers on the most appropriate choice of test for different high-risk populations. This current review aimed to provide the most up to date evidence on the cost-effectiveness evidence on LTBI testing in high-risk groups—specifically evidence reporting the costs per QALY of different testing strategies.
Methods A comprehensive search of databases including MEDLINE, EMBASE and NHS-EED was undertaken from 2011 up to March 2021. Studies were screened and extracted by two independent reviewers. The study quality was assessed using the Bias in Economic Evaluation Checklist (ECOBIAS). A narrative synthesis of the included studies was undertaken. Results Thirty-two studies reported in thirty-three documents were included in this review. Quality of included studies was generally high, although there was a weakness across all studies referencing sources correctly and/or justifying choices of parameter values chosen or assumptions where parameter values were not available. Inclusions of IGRAs in testing strategies was consistently found across studies to be cost-effective but this result was sensitive to underlying LTBI prevalence rates. Conclusion While some concerns remain about uncertainty in parameter values used across included studies, the evidence base since 2010 has grown with modelling approaches addressing the weakness pointed out in previous reviews but still reaching the same conclusion that IGRAs are likely to be cost-effective in high-income countries for high-risk populations. Evidence is also required on the cost-effectiveness of different strategies in low to middle income countries and countries with high TB burden.
Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-02149-x.
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Affiliation(s)
- James Mahon
- York Health Economics Consortium, University of York, York, UK.
| | - Sophie Beale
- York Health Economics Consortium, University of York, York, UK
| | - Hayden Holmes
- York Health Economics Consortium, University of York, York, UK
| | - Mick Arber
- York Health Economics Consortium, University of York, York, UK
| | | | | | | | - David Dowdy
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Giovanni Battista Migliori
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
| | - Giovanni Sotgiu
- Scinze Mediche Chirurgiche E Sperimentali, Universita' degli Studi di Sassari, Sassari, Italy
| | - Raquel Duarte
- EPI Unit, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal.,Unidade de Investigação Clínica da Administração Regional de Saúde do Norte, Porto, Portugal.,Departamento de Ciências de Saúde Pública, Ciências Forenses e Educação Médica, Universidade do Porto, Porto, Portugal.,Serviço de Pneumologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
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22
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Ren C, Tang J, Xia L. Interferon gamma release assays for diagnosis of osteoarticular tuberculosis: A systematic review and meta-analysis. PLoS One 2022; 17:e0269234. [PMID: 35771875 PMCID: PMC9246147 DOI: 10.1371/journal.pone.0269234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 05/17/2022] [Indexed: 11/18/2022] Open
Abstract
Background Although the Interferon Gamma Release Assays (IGRA) is often used to identify latent tuberculosis, it also plays a crucial role in diagnosing active extrapulmonary tuberculosis. Some studies have assessed the use of IGRA as a biomarker for osteoarticular tuberculosis (OATB), which is elevated following TB infection. Still, conclusive results about its effectiveness have not been reported. Method We searched PubMed, Embase, and Cochran databases. We obtained literature related to the diagnosis of OATB by IGRA, and the retrieval period was from the establishment of the database to June 2021. The bivariate random effect model was used to summarize the sensitivity, specificity, and accuracy of other indicators in diagnosing OATB by IGRA, and the forest plot and receiver operating characteristic (ROC) curve were used for testing. Results We included seven studies involving 643 subjects in diagnosing OATB by IGRA. The comprehensive sensitivity and specificity were 0.84 (95% CI, 0.70–0.92) and 0.78 (95% CI, 0.66–0.87), respectively. The area under the curve (AUC) was 0.87. Conclusion In blood samples, the diagnostic accuracy of IGRAS is poor in patients with suspected OAT. We conclude that IGRA may not be appropriate for patients with OATB.
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Affiliation(s)
- Chunnian Ren
- Department of Cardiothoracic Surgery, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jie Tang
- Department of Biostatistics and Epidemiology, School of Public Health, Shenyang Medical College, Shenyang, China
- * E-mail: (LX); (JT)
| | - Liangfeng Xia
- Department of Cardiothoracic Surgery, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- * E-mail: (LX); (JT)
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23
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Interferon-Inducible Protein-10 as a Marker to Detect Latent Tuberculosis Infection in Patients with Inflammatory Rheumatic Diseases. J Pers Med 2022; 12:jpm12071027. [PMID: 35887523 PMCID: PMC9318865 DOI: 10.3390/jpm12071027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/17/2022] [Accepted: 06/20/2022] [Indexed: 11/17/2022] Open
Abstract
It is important to identify cases of latent tuberculosis infection (LTBI) who are at risk for tuberculosis (TB) reactivation. We aimed to evaluate the performance of interferon (IFN)-gamma-inducible protein 10 (IP-10) as a marker to detect LTBI in patients with inflammatory rheumatic diseases (IRD). This study comprised 76 consecutive subjects with IRD. Patients with a history of TB or having active TB were excluded. In all patients, IP-10 level was measured and tuberculin skin test (TST) and QuantiFERON-TB Gold In-Tube test (QFT-GIT) were performed. Seventy patients with complete test results were analyzed. Twenty-one (30%) QFT-GIT-positive patients were defined as having LTBI. IP-10 yielded 2197 pg/mL cut-off point. At this cut-off point, IP-10 showed 89% specificity with a sensitivity of 91% (AUC: 0.950, 95% CI 0.906–0.994). TST, QFT-GIT, and IP-10 were positive in 77.1%, 30%, and 44.3% of the patients, respectively. Concordance among the results of TST, QFT-GIT, and IP-10 tests was evaluated. Agreement was poor between IP-10 and TST (58.6%, κ = 0.19), whereas it was good between QFT-GIT and IP-10 (84.3%, κ = 0.65). The results of the present study demonstrated that sensitivity and specificity of released IP-10 were as high as those of QFT-GIT in indicating LTBI in IRD patient group.
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24
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Malinvaud D, Shenouda K, Laccourreye L, Guiquerro S, Rubin F, Laccourreye O. Aural tuberculosis at the start of the 21st century. Literature review according to SWiM guidelines. Part 1: Clinical and diagnostic data. Eur Ann Otorhinolaryngol Head Neck Dis 2022; 139:343-349. [PMID: 35701295 DOI: 10.1016/j.anorl.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Review of the scientific literature dedicated to clinical data and diagnosis modalities for aural tuberculosis published since the start of the 21st century. MATERIAL AND METHODS Search of the Medline, Cochrane and Embase databases for the period 2000-2020. Selection of articles in English, French and Spanish devoted to clinical cases and series documenting clinical data and diagnosis for aural tuberculosis of articles by two authors. Analysis performed according to SWiM guidelines. Extraction of data on pre-established files documenting clinical and diagnostic data. RESULTS In total, 173 articles: 163 case reports (228 patients) and 10 cohorts (177 patients) from 49 countries were analyzed. Female/male sex ratio was 1.05, with ages ranging from less than 1 month to 87 years. Tuberculosis involved another site in 35.1% of cases. Aural involvement was bilateral in 19.7% of cases. Clinical presentation corresponded to otitis media (prior antibiotic treatment and auricular surgery in 41.4% and 10.1% of cases, respectively) without any pathognomonic symptoms or signs. Associated severe locoregional complications were seen in 32% of cases, with 23.2% and 13% incidence of peripheral facial palsy and severe intracranial complications, respectively. Time to diagnosis ranged from less than 1 month to 384 months, and was longer than 12 months in 26.5% of case reports, without significant correlation (P=0.29) with severe revelatory locoregional complications. Incidence of Mycobacterium tuberculosis detection ranged from 33.4% of documented cases in auricular secretions to 64.6% in polyps, granulomas, and/or biopsies. In the case reports, diagnosis with certainty was done in 58.3% of cases, while it was based on involvement of another site and on indirect criteria or positive clinical progression after treatment in the other 10.1% and 31.6%, respectively. CONCLUSION Aural tuberculous must always be considered in case of unfavorable progression of otitis. Definitive diagnosis is based on multiple auricular sample sites, polymerase chain reaction, and γ interferon blood assay.
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Affiliation(s)
- D Malinvaud
- Service d'otorhinolaryngologie et de chirurgie cervico-faciale, HEGP, université Paris Cité, AP-HP, 20, rue Leblanc, 75015 Paris, France
| | - K Shenouda
- Service d'otorhinolaryngologie et de chirurgie cervico-faciale, HEGP, université Paris Cité, AP-HP, 20, rue Leblanc, 75015 Paris, France
| | - L Laccourreye
- Service d'otorhinolaryngologie et de chirurgie cervico-faciale, institut Arthur-Vernes, 36, rue d'Assas, 75006 Paris, France
| | - S Guiquerro
- Bibliothèque universitaire Necker, université Paris Cité, 160, rue de Vaugirard, 75015 Paris, France
| | - F Rubin
- Clinique Saint-Vincent, 8, rue de Paris, CS 71027, 97404 Saint-Denis cedex, France
| | - O Laccourreye
- Service d'otorhinolaryngologie et de chirurgie cervico-faciale, HEGP, université Paris Cité, AP-HP, 20, rue Leblanc, 75015 Paris, France.
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25
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Diagnostic accuracy of interferon-gamma release assays for diagnosis of smear-negative pulmonary tuberculosis: a systematic review and meta-analysis. BMC Pulm Med 2022; 22:219. [PMID: 35668411 PMCID: PMC9169405 DOI: 10.1186/s12890-022-02013-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/31/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction
The diagnosis of smear-negative pulmonary tuberculosis (SNPTB) is challenging. Interferon gamma-release assays (IGRAs) may be helpful in early diagnosis among these patients resulting in prompt treatment and favorable outcomes.
Methods
We performed a comprehensive search from each databases’ inception to April 5, 2021. The studies that provided sufficient data regarding the sensitivity and specificity of IGRAs included QuantiFERON-TB Gold In-Tube (QFT-GIT), T-SPOT.TB, or QuantiFERON-TB Gold Plus for diagnosis of SNPTB were included.
Results
Of 1,312 studies screened, 16 studies were included; 11 QFT-GIT, 2 T-SPOT.TB, and 3 QFT-GIT and T-SPOT.TB. For diagnosis of SNPTB, QFT-GIT had sensitivity of 0.77 (95% CI 0.71–0.82), specificity of 0.70 (95% CI 0.58–0.80), diagnostic odds ratio (DOR) of 8.03 (95% CI 4.51–14.31), positive likelihood ratio (LR) of 2.61 (95% CI 1.80–3.80), negative LR of 0.33 (95% CI 0.25–0.42), and area under receiver operating characteristic (AUROC) of 0.81 (95% CI 0.77–0.84). T-SPOT.TB had sensitivity of 0.74 (95% CI 0.71–0.78), specificity of 0.71 (95% CI 0.49–0.86), DOR of 6.96 (95% CI 2.31–20.98), positive LR of 2.53 (95% CI 1.26–5.07), negative LR of 0.36 (95% CI 0.24–0.55), and AUROC of 0.77 (95% CI 0.73–0.80). The specificity seemed lower in the subgroup analyses of studies from high tuberculosis burden counties compared to the studies from low tuberculosis burden.
Conclusion
IGRAs do have insufficient diagnostic performance for SNPTB. However, the tests are still helpful to exclude tuberculosis among patients with low pre-test probability.
Registry: PROSPERO: CRD42021274653.
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Fisher KL, Moodley D, Rajkumar-Bhugeloo K, Baiyegunhi OO, Karim F, Ndlovu H, Ndung’u T, Marakalala MJ. Elevated IP-10 at the Protein and Gene Level Associates With Pulmonary TB. Front Cell Infect Microbiol 2022; 12:908144. [PMID: 35694534 PMCID: PMC9184682 DOI: 10.3389/fcimb.2022.908144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/02/2022] [Indexed: 11/21/2022] Open
Abstract
There is an urgent need for accurate and sensitive diagnostic tools that can overcome the current challenge to distinguish individuals with latent tuberculosis infection (LTBI) from individuals with active tuberculosis (TB). Recent literature has suggested that a group of cytokines may serve as biomarkers of TB disease progression. Using a multiplex ELISA, we quantified 27 circulatory markers present within the unstimulated plasma of individuals in Durban, South Africa who were healthy (n=20), LTBI (n=13), or had active TB (n=30). RT-qPCR was performed to measure gene expression of the cytokines of interest, using RNA isolated from healthy (n=20), LTBI (n=20), or active TB (n=30). We found that at the protein level, IL-1RA, IL-6, and IP-10 were significantly more abundant in participants with active TB (p< 0.05) compared to those with LTBI individuals. IP-10 also showed the strongest association with active TB compared to healthy and LTBI at mRNA level. Our data shows that these proteins may serve as biomarkers of TB at both the protein and gene level.
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Affiliation(s)
- Kimone L. Fisher
- Africa Health Research Institute, Nelson R. Mandela School of Medicine, University KwaZulu-Natal, Durban, South Africa
| | - Denelle Moodley
- Africa Health Research Institute, Nelson R. Mandela School of Medicine, University KwaZulu-Natal, Durban, South Africa
| | - Kerishka Rajkumar-Bhugeloo
- Africa Health Research Institute, Nelson R. Mandela School of Medicine, University KwaZulu-Natal, Durban, South Africa
| | - Omolara O. Baiyegunhi
- Africa Health Research Institute, Nelson R. Mandela School of Medicine, University KwaZulu-Natal, Durban, South Africa
- Human Immunodeficiency Virus (HIV) Pathogenesis Programme, Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Farina Karim
- Africa Health Research Institute, Nelson R. Mandela School of Medicine, University KwaZulu-Natal, Durban, South Africa
| | - Hlumani Ndlovu
- Department of Integrative Biomedical Sciences, Division of Chemical and Systems Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Thumbi Ndung’u
- Africa Health Research Institute, Nelson R. Mandela School of Medicine, University KwaZulu-Natal, Durban, South Africa
- Human Immunodeficiency Virus (HIV) Pathogenesis Programme, Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Mohlopheni J. Marakalala
- Africa Health Research Institute, Nelson R. Mandela School of Medicine, University KwaZulu-Natal, Durban, South Africa
- Human Immunodeficiency Virus (HIV) Pathogenesis Programme, Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- Division of Infection and Immunity, University College London, London, United Kingdom
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Tuberculin skin test before biologic and targeted therapies: does the same rule apply for all? Rheumatol Int 2022; 42:1797-1806. [PMID: 35486197 DOI: 10.1007/s00296-022-05134-z] [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: 01/09/2022] [Accepted: 04/05/2022] [Indexed: 10/18/2022]
Abstract
This study aimed to compare Tuberculin Skin Test (TST) and QuantiFERON®-TB Gold In-Tube (QFT-GIT) test in rheumatoid arthritis (RA) and spondyloarthritis (SpA) patients scheduled for biological and targeted synthetic disease modifying anti-rheumatic drugs (DMARDs) in a Bacillus Calmette-Guérin-vaccinated population. Adult RA (n = 206) and SpA (n = 392) patients from the TReasure database who had both TST and QFT-GIT prior to initiation of biological and targeted synthetic DMARDs were included in the study. Demographic and disease characteristics along with pre-biologic DMARD and steroid use were recorded. The distribution of TST and performance with respect to QFT-GIT were compared between RA and SpA groups. Pre-biologic conventional DMARD and steroid use was higher in the RA group. TST positivity rates were 44.2% in RA and 69.1% in SpA for a 5 mm cutoff (p < 0.001). Only 8.9% and 15% of the patients with RA and SpA, respectively, tested positive by QFT-GIT. The two tests poorly agreed in both groups at a TST cutoff of 5 mm and increasing the TST cutoff only slightly increased the agreement. Among age, sex, education and smoking status, pre-biologic steroid and conventional DMARD use, disease group, and QFT-GIT positivity, which were associated with a 5 mm or higher TST, only disease group (SpA) and QFT-GIT positivity remained significant in multiple logistic regression. TST positivity was more pronounced in SpA compared to that in RA and this was not explainable by pre-biologic DMARD and steroid use. The agreement of TST with QFT-GIT was poor in both groups. Using a 5 mm TST cutoff for both diseases could result in overestimating LTBI in SpA.
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Varpuluoma O, Sinikumpu SP, Jackson P, Tasanen K, Huilaja L. Ulcerative Tuberculosis in a Patient Treated with Adalimumab. Acta Derm Venereol 2022; 102:adv00700. [DOI: 10.2340/actadv.v102.1616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract is missing (Short Communication)
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Bigdon E, Steinhorst NA, Weissleder S, Durchkiv V, Stübiger N. Treatment in Latent Tuberculosis Uveitis-Is Immunosuppression Effective or Is Conventional 3- or 4-Drug Antituberculosis Therapy Mandatory? J Clin Med 2022; 11:2419. [PMID: 35566544 PMCID: PMC9105017 DOI: 10.3390/jcm11092419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 04/03/2022] [Accepted: 04/11/2022] [Indexed: 11/29/2022] Open
Abstract
Background/Aims: Controversy exists regarding 3- or 4 drug antituberculosis therapy (conventional ATT) in uveitis patients having latent tuberculosis (LTB), especially while initiating therapy with corticosteroids and/or other immunosuppressants. Methods: We performed a monocentral retrospective analysis of posterior uveitis patients with latent TB. Latent TB was diagnosed, in case of a positive QuantiFERON®-TB-Gold test and normal chest imaging, after ruling out other causes of infectious and noninfectious uveitis. Patients with active TB were excluded. From 2016 to 2020 we included 17 patients. Ophthalmological evaluation consisted of Best corrected visual acuity (BCVA), slit lamp examination, fundoscopy, OCT, and fluorescein- and indocyaningreen- angiography before and at months 3, 6, 12, 24, and the last follow-up after treatment. Results: Initially, all patients had active posterior uveitis with occlusive (n = 5 patients) and nonocclusive retinal vasculitis (n = 12 patients). Mean follow up was 28 ± 15 months. Therapy was started with systemic corticosteroids (mean prednisolone equivalent 71.3 mg/d) and already after 3 months it could be tapered to a mean maintenance dosage of 8.63 mg/d. Additional immunosuppressive treatment with cs- or bDMARDs was initiated in 14 patients (82%) due to recurrences of uveitis while tapering the corticosteroids <10 mg per/day or because of severe inflammation at the initial visit. While being on immunosuppression, best corrected visual acuity increased from 0.56 logMAR to 0.32 logMAR during follow-up and only three patients had one uveitis relapse, which was followed by switch of immunosuppressive treatment. As recommended, TB prophylaxis with 300 mg/d isoniazid was administered in 11 patients for at least 9 months while being on TNF-alpha-blocking agents. No patient developed active tuberculosis during immunosuppressive therapy. Conclusion: Mainly conventional ATT is strongly recommended—as monotherapy or in combination with immunosuppressives—for effective treatment in patients with uveitis due to latent TB. Although in our patient group no conventional ATT was initiated, immunosuppression alone occurred as an efficient treatment. Nevertheless, due to possible activation of TB, isoniazid prophylaxis is mandatory in latent TB patients while being on TNF-alpha blocking agents.
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Affiliation(s)
- Eileen Bigdon
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany; (N.A.S.); (S.W.); (V.D.); (N.S.)
- Augenzentrum Schleswig-Holstein, Peter-Ox-Straße 7, 25917 Leck, Germany
| | - Nils Alexander Steinhorst
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany; (N.A.S.); (S.W.); (V.D.); (N.S.)
- Augenärzte Ingelheim, 55218 Ingelheim am Rhein, Germany
| | - Stephanie Weissleder
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany; (N.A.S.); (S.W.); (V.D.); (N.S.)
- Augenärzte Ingelheim, 55218 Ingelheim am Rhein, Germany
| | - Vasyl Durchkiv
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany; (N.A.S.); (S.W.); (V.D.); (N.S.)
| | - Nicole Stübiger
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany; (N.A.S.); (S.W.); (V.D.); (N.S.)
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30
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Pan L, Huang M, Jia H, Deng G, Chen Y, Wei R, Zhang M, Li X, Sun Q, Fang M, Ren P, Xing A, Chen Q, Li X, Du B, Chen T, Gao M, Zhang Z. Diagnostic Performance of a Novel CXCL10 mRNA Release Assay for Mycobacterium tuberculosis Infection. Front Microbiol 2022; 13:825413. [PMID: 35432271 PMCID: PMC9005954 DOI: 10.3389/fmicb.2022.825413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
One-fourth of the world’s population has been infected with Mycobacterium tuberculosis (M.tb). Although interferon-gamma release assays (IGRAs) have been shown to be valid methods for identifying M.tb infection and auxiliary methods for diagnosis of active tuberculosis (TB), lower sensitivity and higher indeterminate rate were often detected among immunosuppressed patients. IP-10 was an alternative biomarker due to the higher expression level after M.tb antigen stimulation, but whether CXCL10 mRNA (the gene that transcribes for the IP-10 protein) can be used as a target for M.tb infection diagnosis was limited. Therefore, we aimed to evaluate the performance of a novel M.tb-specific CXCL10 mRNA release assay in diagnosis of M.tb infection. Suspected TB patients and healthy controls were prospectively recruited between March 2018 and November 2019 from three hospitals in China. CXCL10 mRNA release assay and traditional interferon-gamma release assay (T-SPOT.TB) were simultaneously performed on peripheral blood. Of the 1,479 participants enrolled in the study, 352 patients with definite TB and 153 healthy controls were analyzed. CXCL10 mRNA release assay provided a sensitivity of 93.9% (95% CI = 90.8–96.2%) and a specificity of 98.0% (95% CI = 94.3–99.6%) in the diagnosis of M.tb infection, respectively, while T-SPOT.TB gave a sensitivity of 94.5% (95% CI = 91.5–96.6%) and a specificity of 100% (95% CI = 97.6–100.0%) in the diagnosis of M.tb infection, respectively. The diagnostic performance of CXCL10 mRNA release assay was consistent with T-SPOT.TB, with a total coincidence rate of 95.0% (95% CI = 93.0–96.9%) and a Cohen’s kappa value of 0.89 (0.84–0.93, p < 0.001). However, among TB patients with HIV co-infection (n = 14), CXCL10 mRNA release assay presented significantly higher positive rate [92.9% (66.1–99.8%) vs. 61.5% (31.6–86.1%), p = 0.029] than those of T-SPOT.TB. These results suggested that M.tb-specific CXCL10 mRNA was a novel and useful target in the diagnosis of M.tb infection.
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Affiliation(s)
- Liping Pan
- Beijing Chest Hospital, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Capital Medical University, Beijing, China
| | - Mailing Huang
- Department of Tuberculosis, Beijing Chest Hospital, Beijing Tuberculosis and Thoracic Tumor Research Institute, Capital Medical University, Beijing, China
| | - Hongyan Jia
- Beijing Chest Hospital, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Capital Medical University, Beijing, China
| | - Guofang Deng
- Department of Pulmonary Medicine, The Third People's Hospital of Shenzhen, Shenzhen, China
| | - Yu Chen
- Department of Tuberculosis, Henan Provincial Infectious Disease Hospital, Zhengzhou, China
| | - Rongrong Wei
- Beijing Chest Hospital, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Capital Medical University, Beijing, China
| | - Mingxia Zhang
- Laboratory Medical Center, The Third People's Hospital of Shenzhen, Guangdong Key Lab of Emerging Infectious Diseases, Shenzhen, China
| | - Xin Li
- Laboratory Medical Center, Henan Provincial Infectious Disease Hospital, Zhengzhou, China
| | - Qi Sun
- Beijing Chest Hospital, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Capital Medical University, Beijing, China
| | - Mutong Fang
- Department of Pulmonary Medicine, The Third People's Hospital of Shenzhen, Shenzhen, China
| | - Pengfei Ren
- Department of Tuberculosis, Henan Provincial Infectious Disease Hospital, Zhengzhou, China
| | - Aiying Xing
- Beijing Chest Hospital, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Capital Medical University, Beijing, China
| | - Qi Chen
- Laboratory Medical Center, The Third People's Hospital of Shenzhen, Guangdong Key Lab of Emerging Infectious Diseases, Shenzhen, China
| | - Xinxin Li
- Department of Tuberculosis, Henan Provincial Infectious Disease Hospital, Zhengzhou, China
| | - Boping Du
- Beijing Chest Hospital, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Capital Medical University, Beijing, China
| | - Tao Chen
- Department of Pulmonary Medicine, The Third People's Hospital of Shenzhen, Shenzhen, China
| | - Mengqiu Gao
- Department of Tuberculosis, Beijing Chest Hospital, Beijing Tuberculosis and Thoracic Tumor Research Institute, Capital Medical University, Beijing, China
| | - Zongde Zhang
- Beijing Chest Hospital, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Capital Medical University, Beijing, China
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31
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Neß T, Winterhalter S, Stübiger N. Infectious Posterior Uveitis - Toxoplasmosis, Treponema, Tuberculosis (TTT). Klin Monbl Augenheilkd 2022; 239:666-675. [PMID: 35320874 DOI: 10.1055/a-1727-1951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Toxoplasma gondii, Treponema pallidum and Mycobacterium tuberculosis are the most important infectious causes of posterior uveitis. The epidemiology, clinical picture, diagnostic and treatment strategies of these diseases are presented.
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Affiliation(s)
- Thomas Neß
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Albert-Ludwigs-Universität Freiburg, Deutschland.,Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Deutschland
| | | | - Nicole Stübiger
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
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32
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AutoCellANLS: An Automated Analysis System for Mycobacteria-Infected Cells Based on Unstained Micrograph. Biomolecules 2022; 12:biom12020240. [PMID: 35204741 PMCID: PMC8961542 DOI: 10.3390/biom12020240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 01/25/2022] [Accepted: 01/25/2022] [Indexed: 11/17/2022] Open
Abstract
The detection of Mycobacterium tuberculosis (Mtb) infection plays an important role in the control of tuberculosis (TB), one of the leading infectious diseases in the world. Recent advances in artificial intelligence-aided cellular image processing and analytical techniques have shown great promises in automated Mtb detection. However, current cell imaging protocols often involve costly and time-consuming fluorescence staining, which has become a major bottleneck for procedural automation. To solve this problem, we have developed a novel automated system (AutoCellANLS) for cell detection and the recognition of morphological features in the phase-contrast micrographs by using unsupervised machine learning (UML) approaches and deep convolutional neural networks (CNNs). The detection algorithm can adaptively and automatically detect single cells in the cell population by the improved level set segmentation model with the circular Hough transform (CHT). Besides, we have designed a Cell-net by using the transfer learning strategies (TLS) to classify the virulence-specific cellular morphological changes that would otherwise be indistinguishable to the naked eye. The novel system can simultaneously classify and segment microscopic images of the cell populations and achieve an average accuracy of 95.13% for cell detection, 95.94% for morphological classification, 94.87% for sensitivity, and 96.61% for specificity. AutoCellANLS is able to detect significant morphological differences between the infected and uninfected mammalian cells throughout the infection period (2 hpi/12 hpi/24 hpi). Besides, it has overcome the drawback of manual intervention and increased the accuracy by more than 11% compared to our previous work, which used AI-aided imaging analysis to detect mycobacterial infection in macrophages. AutoCellANLS is also efficient and versatile when tailored to different cell lines datasets (RAW264.7 and THP-1 cell). This proof-of concept study provides a novel venue to investigate bacterial pathogenesis at a macroscopic level and offers great promise in the diagnosis of bacterial infections.
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Scurr MJ, Zelek WM, Lippiatt G, Somerville M, Burnell SEA, Capitani L, Davies K, Lawton H, Tozer T, Rees T, Roberts K, Evans M, Jackson A, Young C, Fairclough L, Tighe P, Wills M, Westwell AD, Morgan BP, Gallimore A, Godkin A. Whole blood-based measurement of SARS-CoV-2-specific T cells reveals asymptomatic infection and vaccine immunogenicity in healthy subjects and patients with solid-organ cancers. Immunology 2022; 165:250-259. [PMID: 34775604 PMCID: PMC8653009 DOI: 10.1111/imm.13433] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/05/2021] [Accepted: 11/03/2021] [Indexed: 12/23/2022] Open
Abstract
Accurate assessment of SARS-CoV-2 immunity is critical in evaluating vaccine efficacy and devising public health policies. Whilst the exact nature of effective immunity remains incompletely defined, SARS-CoV-2-specific T-cell responses are a critical feature that will likely form a key correlate of protection against COVID-19. Here, we developed and optimized a high-throughput whole blood-based assay to determine the T-cell response associated with prior SARS-CoV-2 infection and/or vaccination amongst 231 healthy donors and 68 cancer patients. Following overnight in vitro stimulation with SARS-CoV-2-specific peptides, blood plasma samples were analysed for TH 1-type cytokines. Highly significant differential IFN-γ+ /IL-2+ SARS-CoV-2-specific T-cell responses were seen amongst previously infected COVID-19-positive healthy donors in comparison with unknown / naïve individuals (p < 0·0001). IFN-γ production was more effective at identifying asymptomatic donors, demonstrating higher sensitivity (96·0% vs. 83·3%) but lower specificity (84·4% vs. 92·5%) than measurement of IL-2. A single COVID-19 vaccine dose induced IFN-γ and/or IL-2 SARS-CoV-2-specific T-cell responses in 116 of 128 (90·6%) healthy donors, reducing significantly to 27 of 56 (48·2%) when measured in cancer patients (p < 0·0001). A second dose was sufficient to boost T-cell responses in the majority (90·6%) of cancer patients, albeit IFN-γ+ responses were still significantly lower overall than those induced in healthy donors (p = 0·034). Three-month post-vaccination T-cell responses also declined at a faster rate in cancer patients. Overall, this cost-effective standardizable test ensures accurate and comparable assessments of SARS-CoV-2-specific T-cell responses amenable to widespread population immunity testing, and identifies individuals at greater need of booster vaccinations.
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Affiliation(s)
- Martin J. Scurr
- Division of Infection & ImmunitySchool of MedicineCardiff UniversityCardiffUK
- ImmunoServ LtdCardiffUK
| | - Wioleta M. Zelek
- School of MedicineSystems Immunity University Research InstituteCardiff UniversityCardiffUK
- UK Dementia Research Institute CardiffCardiff UniversityCardiffUK
| | | | - Michelle Somerville
- Division of Infection & ImmunitySchool of MedicineCardiff UniversityCardiffUK
| | | | - Lorenzo Capitani
- Division of Infection & ImmunitySchool of MedicineCardiff UniversityCardiffUK
| | | | | | - Thomas Tozer
- Department of Gastroenterology & HepatologyUniversity Hospital of WalesCardiffUK
| | - Tara Rees
- Department of Gastroenterology & HepatologyUniversity Hospital of WalesCardiffUK
| | - Kerry Roberts
- Department of Gastroenterology & HepatologyUniversity Hospital of WalesCardiffUK
| | | | | | | | | | - Paddy Tighe
- School of Life SciencesUniversity of NottinghamNottinghamUK
| | - Mark Wills
- Department of MedicineAddenbrooke’s HospitalUniversity of CambridgeCambridgeUK
| | - Andrew D. Westwell
- School of Pharmacy and Pharmaceutical SciencesCardiff UniversityCardiffUK
| | - B. Paul Morgan
- School of MedicineSystems Immunity University Research InstituteCardiff UniversityCardiffUK
- UK Dementia Research Institute CardiffCardiff UniversityCardiffUK
| | - Awen Gallimore
- Division of Infection & ImmunitySchool of MedicineCardiff UniversityCardiffUK
- School of MedicineSystems Immunity University Research InstituteCardiff UniversityCardiffUK
| | - Andrew Godkin
- Division of Infection & ImmunitySchool of MedicineCardiff UniversityCardiffUK
- School of MedicineSystems Immunity University Research InstituteCardiff UniversityCardiffUK
- Department of Gastroenterology & HepatologyUniversity Hospital of WalesCardiffUK
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Jia J, Chen D, Liu L, Siddiqui MJ, Yang F, Zhu Y, Liao Q, Luo S, Shu M, Wen Y, Gao L, Li X, Long L, Peng X, Li W, Liu Y, Xu W, Han Q, Wu H, Guo J, Du X, Guo Q, Wan C. Prevalence of Latent Tuberculosis Infection Among Healthy Young Children and Adolescents and a Two-step Approach for the Diagnosis of Tuberculosis Infection in Chengdu, China. Pediatr Infect Dis J 2022; 41:6-11. [PMID: 34508026 PMCID: PMC8658967 DOI: 10.1097/inf.0000000000003338] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/17/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND China has a high burden of tuberculosis and latent tuberculosis infection (LTBI). The aim of this study was to estimate the prevalence of LTBI among healthy young children and adolescents and test a 2-step approach to explore the threshold for the diagnosis of tuberculosis infection in Chengdu, China. METHODS Healthy preschool children and school-going children in Chengdu, Sichuan Province, were screened for LTBI using the tuberculin skin test (TST). Preschool children with TST ≥ 5 mm also underwent interferon-γ release assay (IGRA) to explore the threshold of this 2-step approach. RESULTS In total, 5667 healthy young children and adolescents completed TST test between July 2020 and January 2021 and were included in the present analysis. The age of the participants ranged from 2.4 to 18 years (median 7.25 ± 4.514 years), of which 2093 (36.9%) were younger than 5 years. The overall prevalence of LTBI was 6.37% and 6.64% in children younger than 5 years old. Fourteen of the 341 preschool children with TST ≥5 mm were interferon-γ release assay positive, of which 4 showed a TST result of 5-10 mm, and 6 preschool children received preventive treatment for LTBI. CONCLUSIONS Healthy young children and adolescents should also be considered as important target populations for LTBI screening. TST can be recommended for first-line screening as part of a 2-step approach for LTBI screening using a positive threshold of 5 mm.
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Affiliation(s)
- Jihang Jia
- From the Department of Pediatrics, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education
| | - Dapeng Chen
- From the Department of Pediatrics, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education
- Chengdu Chenghua District Maternal and Child Health Hospital
| | - Li Liu
- Department of Pediatrics, Chengdu Second People’s Hospital
| | - Mohd Jaish Siddiqui
- From the Department of Pediatrics, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education
| | - Fan Yang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education
- Chengdu Chenghua District Maternal and Child Health Hospital
- Department of Ultrasound, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yu Zhu
- From the Department of Pediatrics, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education
| | - Qiong Liao
- From the Department of Pediatrics, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education
| | - Shuanghong Luo
- From the Department of Pediatrics, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education
| | - Min Shu
- From the Department of Pediatrics, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education
| | - Yang Wen
- From the Department of Pediatrics, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education
| | - Lihong Gao
- From the Department of Pediatrics, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education
| | - Xu Li
- From the Department of Pediatrics, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education
| | - Lilin Long
- From the Department of Pediatrics, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education
| | - Xiaoshan Peng
- From the Department of Pediatrics, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education
| | - Weiran Li
- From the Department of Pediatrics, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education
| | - Yang Liu
- From the Department of Pediatrics, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education
| | - Wanting Xu
- Department of Pediatrics, Chengdu Second People’s Hospital
| | - Qian Han
- Department of Pediatrics, Chengdu Second People’s Hospital
| | - Huaiyong Wu
- Chengdu Chenghua District Maternal and Child Health Hospital
| | - Jiarong Guo
- Chengdu Chenghua District Maternal and Child Health Hospital
| | - Xi Du
- Chengdu Chenghua District Maternal and Child Health Hospital
| | - Qin Guo
- From the Department of Pediatrics, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education
| | - Chaomin Wan
- From the Department of Pediatrics, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education
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36
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Heireman L, Bruynseels P, Camps K, Geysels D, Huyghe E, André E, Van Gasse N. Comparison of the QuantiFERON-TB® Gold Plus on LIAISON® XL and T-SPOT.TB for the diagnosis of latent Mycobacterium tuberculosis infection in a low tuberculosis incidence population. Diagn Microbiol Infect Dis 2021; 102:115613. [PMID: 34954453 DOI: 10.1016/j.diagmicrobio.2021.115613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/25/2021] [Accepted: 11/26/2021] [Indexed: 11/17/2022]
Abstract
The current study compared the QuantiFERON-TB® Gold Plus on LIAISON® XL to the T-SPOT.TB for the diagnosis of latent Mycobacterium tuberculosis infection on 125 patient samples. A high agreement of qualitative results (90%) was observed between both methods with 3% major discrepancies, half of which were false negative results with the T-SPOT.TB.
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Affiliation(s)
- Laura Heireman
- Department of Laboratory Medicine, Hospital Network Antwerp, Antwerp, Belgium.
| | - Peggy Bruynseels
- Department of Laboratory Medicine, Hospital Network Antwerp, Antwerp, Belgium
| | - Kim Camps
- Department of Laboratory Medicine, Hospital Network Antwerp, Antwerp, Belgium
| | - Dieter Geysels
- Department of Laboratory Medicine, Hospital Network Antwerp, Antwerp, Belgium
| | - Evelyne Huyghe
- Department of Laboratory Medicine, Hospital Network Antwerp, Antwerp, Belgium
| | - Emmanuel André
- Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Natasja Van Gasse
- Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
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Gomes CMF, Terreri MT, Moraes-Pinto MI, Pinheiro MM. Performance of 4 methods for screening of latent tuberculosis infection in patients with chronic inflammatory arthritis under TNFα inhibitors: a 24-month prospective study. Adv Rheumatol 2021; 61:71. [PMID: 34838126 DOI: 10.1186/s42358-021-00226-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The reactivation rate of tuberculosis in patients with chronic inflammatory arthritis (CIA) on TNFα inhibitors (TNFi) and baseline negative screening for latent tuberculosis infection (LTBI) is higher than in the general population. AIM To compare the performance of tuberculin skin test (TST), TST-Booster, ELISPOT (T-SPOT.TB) and QuantiFERON-TB Gold in tube (QFT-IT) to detect LTBI in patients with CIA on TNFi. PATIENTS AND METHODS A total of 102 patients with CIA [rheumatoid arthritis (RA), n = 40; ankylosing spondylitis (AS), n = 35; psoriatic arthritis (PsA), n = 7; and juvenile idiopathic arthritis (JIA), n = 20] were prospectively followed-up for 24 months to identify incident LTBI cases. Epidemiologic data, TST, T-SPOT.TB, QFT-IT and a chest X-ray were performed at baseline and after 6 months of LTBI treatment. RESULTS Thirty six percent (37/102) of patients had positive TST or Interferon Gamma Release Assays (IGRAs) tests. Agreement among TST and IGRAs was moderate (k = 0.475; p = 0.001), but high between T-SPOT.TB and QFT-IT (k = 0.785; p < 0.001). During the 24-Month follow-up, 15 (18.5%) incident cases of LTBI were identified. In comparison to TST, the IGRAs increased the LTBI diagnosis power in 8.5% (95% CI 3.16-17.49). TST-Booster did not add any value in patients with negative TST at baseline. After 6-Month isoniazid therapy, IGRAs results did not change significantly. CONCLUSIONS Almost 20% of CIA patients had some evidence of LTBI, suggesting higher conversion rate after exposition to TNFi. TST was effective in identifying new cases of LTBI, but IGRAs added diagnostic power in this scenario. Our findings did not support the repetition of IGRAs after 6-Month isoniazid therapy and this approach was effective to mitigate active TB in 2 years of follow-up.
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Affiliation(s)
- Carina M F Gomes
- Rheumatology Division, Universidade Federal de Sao Paulo (Unifesp/EPM), São Paulo, Brazil
| | - Maria Teresa Terreri
- Pediatric Rheumatology Unit, Department of Pediatrics, Universidade Federal de Sao Paulo (Unifesp/EPM), São Paulo, Brazil
| | - Maria Isabel Moraes-Pinto
- Pediatric Infectious Diseases Division, Department of Pediatrics, Universidade Federal de Sao Paulo (Unifesp/EPM), São Paulo, Brazil
| | - Marcelo M Pinheiro
- Head of the Spondyloarthritis and Immunobiological Therapy Section, Rheumatology Division, Universidade Federal de Sao Paulo (Unifesp/EPM), Rua Leandro Dupré, 204, Conj. 74, Vila Clementino, São Paulo, SP, CEP 04025-010, Brazil.
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Marx FM, Hauer B, Menzies NA, Haas W, Perumal N. Targeting screening and treatment for latent tuberculosis infection towards asylum seekers from high-incidence countries - a model-based cost-effectiveness analysis. BMC Public Health 2021; 21:2172. [PMID: 34836526 PMCID: PMC8622109 DOI: 10.1186/s12889-021-12142-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 11/01/2021] [Indexed: 11/26/2022] Open
Abstract
Background Enhancing tuberculosis (TB) prevention and care in a post-COVID-19-pandemic phase will be essential to ensure progress towards global TB elimination. In low-burden countries, asylum seekers constitute an important high-risk group. TB frequently arises post-immigration due to the reactivation of latent TB infection (LTBI). Upon-entry screening for LTBI and TB preventive treatment (TPT) are considered worthwhile if targeted to asylum seekers from high-incidence countries who usually present with higher rates of LTBI. However, there is insufficient knowledge about optimal incidence thresholds above which introduction could be cost-effective. We aimed to estimate, among asylum seekers in Germany, the health impact and costs of upon-entry LTBI screening/TPT introduced at different thresholds of country-of-origin TB incidence. Methods We sampled hypothetical cohorts of 30–45 thousand asylum seekers aged 15 to 34 years expected to arrive in Germany in 2022 from cohorts of first-time applicants observed in 2017–2019. We modelled LTBI prevalence as a function of country-of-origin TB incidence fitted to data from observational studies. We then used a probabilistic decision-analytic model to estimate health-system costs and quality-adjusted life years (QALYs) under interferon gamma release assay (IGRA)-based screening for LTBI and rifampicin-based TPT (daily, 4 months). Incremental cost-effectiveness ratios (ICERs) were calculated for scenarios of introducing LTBI screening/TPT at different incidence thresholds. Results We estimated that among 15- to 34-year-old asylum seekers arriving in Germany in 2022, 17.5% (95% uncertainty interval: 14.2–21.6%) will be latently infected. Introducing LTBI screening/TPT above 250 per 100,000 country-of-origin TB incidence would gain 7.3 (2.7–14.8) QALYs at a cost of €51,000 (€18,000–€114,100) per QALY. Lowering the threshold to ≥200 would cost an incremental €53,300 (€19,100–€122,500) per additional QALY gained relative to the ≥250 threshold scenario; ICERs for the ≥150 and ≥ 100 thresholds were €55,900 (€20,200–€128,200) and €62,000 (€23,200–€142,000), respectively, using the next higher threshold as a reference, and considerably higher at thresholds below 100. Conclusions LTBI screening and TPT among 15- to 34-year-old asylum seekers arriving in Germany could produce health benefits at reasonable additional cost (with respect to international benchmarks) if introduced at incidence thresholds ≥100. Empirical trials are needed to investigate the feasibility and effectiveness of this approach.
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Affiliation(s)
- Florian M Marx
- Department for Infectious Disease Epidemiology, Respiratory Infections Unit, Robert Koch Institute, Berlin, Germany. .,Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa. .,DSI-NRF South African Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa.
| | - Barbara Hauer
- Department for Infectious Disease Epidemiology, Respiratory Infections Unit, Robert Koch Institute, Berlin, Germany
| | - Nicolas A Menzies
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Walter Haas
- Department for Infectious Disease Epidemiology, Respiratory Infections Unit, Robert Koch Institute, Berlin, Germany
| | - Nita Perumal
- Department for Infectious Disease Epidemiology, Respiratory Infections Unit, Robert Koch Institute, Berlin, Germany.,Immunization Unit, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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Malsam R, Nienhaus A. Occupational Infections among Dental Health Workers in Germany-14-Year Time Trends. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910128. [PMID: 34639430 PMCID: PMC8508029 DOI: 10.3390/ijerph181910128] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/22/2021] [Accepted: 09/24/2021] [Indexed: 12/25/2022]
Abstract
Dental health workers (DHW) are at increased risk of acquiring occupational infections. Due to various protective measures, it can be assumed that infections have decreased over the past 14 years. Secondary data from a German accident insurance company was analyzed in terms of reported and confirmed occupational diseases (OD) in DHW from 2006 to 2019. A total of 271 claims were reported, of which 112 were confirmed as OD, representing an average of eight per year. However, the number of claims and confirmed ODs has decreased by 65.6% and 85.7%, respectively. The decrease was most evident for hepatitis B (HBV) and C (HCV) infections, while tuberculosis (TB) infections were stable. A total of 44 HCV, 33 HBV, 6 TB and 24 latent TB infections were confirmed as ODs. For DHW, 0.05, and for hospital workers, 0.48 claims per 1000 full-time equivalents (FTE) were registered in 2019. In a separate documentation system, between March 2020 and February 2021, 155 COVID-19 claims were registered, and 47 cases were confirmed as ODs. For DHW, 0.7, and for hospital workers, 47.3 COVID-19 claims per 1000 FTE were registered since 2020. Occupational infectious diseases rarely occur among DHW. Nevertheless, new infectious diseases such as COVID-19 pose a major challenge for DHW. Continued attention should be paid to infectious disease prevention.
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Affiliation(s)
- Rebecca Malsam
- Competence Center for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany;
| | - Albert Nienhaus
- Competence Center for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany;
- Department for Occupational Medicine, Hazardous Substances and Health Sciences (AGG), Institution for Statutory Accident Insurance in the Health and Welfare Services (BGW), 22089 Hamburg, Germany
- Correspondence: ; Tel.: +49-(0)40-20207-3220
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40
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Tan Y, Tan Y, Li J, Hu P, Guan P, Kuang H, Liang Q, Yu Y, Chen Z, Wang Q, Yang Z, AiKeReMu D, Pang Y, Liu J. Combined IFN-γ and IL-2 release assay for detect active pulmonary tuberculosis: a prospective multicentre diagnostic study in China. J Transl Med 2021; 19:289. [PMID: 34217302 PMCID: PMC8254998 DOI: 10.1186/s12967-021-02970-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 06/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We performed a prospective multicentre diagnostic study to evaluate the combined interferon-γ (IFN-γ) and interleukin-2 (IL-2) release assay for detect active pulmonary tuberculosis (TB) in China. METHODS Adult patients presenting symptoms suggestive of pulmonary TB were consecutively enrolled in three TB-specialized hospitals. Sputum specimens and blood sample and were collected from each participant at enrolment. The levels of Mycobacterium tuberculosis (MTB)-specific antigen-stimulated IFN-γ and IL-2 were determined using enzyme-linked immunosorbent assay (ELISA). RESULTS Between July 2017 and December 2018, a total of 3245 patients with symptoms suggestive of pulmonary TB were included in final analysis. Of 3245 patients, 2536 were diagnosed as active TB, consisting of 1092 definite TB and 1444 clinically diagnosed TB. The overall sensitivity and specificity of IFN-γ were 83.8% and 81.5%, respectively. In addition, compared with IFN-γ, the specificity of IL-2 increased to 94.3%, while the sensitivity decreased to 72.6%. In addition, the highest sensitivity was achieved with parallel combination of IFN-γ/IL-2, with a sensitivity of 87.9%, and its overall specificity was 79.8%. The sensitivity of series combination test was 68.5%. Notably, the sensitivity of series combination test in definite TB (72.1%) was significantly higher than that in clinically diagnosed TB (65.8%). CONCLUSION In conclusion, we develop a new immunological method that can differentiate between active TB and other pulmonary diseases. Our data demonstrates that the various IFN-γ/IL-2 combinations provides promising alternatives for diagnosing active TB cases in different settings. Additionally, the diagnostic accuracy of series combination correlates with severity of disease in our cohort.
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Affiliation(s)
- Yaoju Tan
- Clinical Laboratory, Guangzhou Chest Hospital, Guangzhou/State Key Laboratory of Respiratory Diseases, Guangzhou, China
| | - Yunhong Tan
- Clinical Laboratory, Hunan Chest Hospital, Changsha, China
| | - Junlian Li
- Clinical Laboratory, Chest Hospital of Xinjiang Uygur Autonomous Region, Ürümqi, China
| | - Pengnan Hu
- School of Life Science & Technology, LingNan Normal University, Zhanjiang, China
| | - Ping Guan
- Clinical Laboratory, Guangzhou Chest Hospital, Guangzhou/State Key Laboratory of Respiratory Diseases, Guangzhou, China
| | - Haobin Kuang
- Clinical Laboratory, Guangzhou Chest Hospital, Guangzhou/State Key Laboratory of Respiratory Diseases, Guangzhou, China
| | - Qide Liang
- Clinical Laboratory, Guangzhou Chest Hospital, Guangzhou/State Key Laboratory of Respiratory Diseases, Guangzhou, China
| | - Yanyan Yu
- Clinical Laboratory, Hunan Chest Hospital, Changsha, China
| | - Zhongnan Chen
- Clinical Laboratory, Hunan Chest Hospital, Changsha, China
| | - Quan Wang
- Clinical Laboratory, Chest Hospital of Xinjiang Uygur Autonomous Region, Ürümqi, China
| | - Zhenping Yang
- Clinical Laboratory, Chest Hospital of Xinjiang Uygur Autonomous Region, Ürümqi, China
| | - DiLiNaZi AiKeReMu
- Clinical Laboratory, Chest Hospital of Xinjiang Uygur Autonomous Region, Ürümqi, China
| | - Yu Pang
- Department of Bacteriology and Immunology, Beijing Key Laboratory on Drug-Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis & Thoracic Tumor Research Institute, Beijing, China.
| | - Jianxiong Liu
- Clinical Laboratory, Guangzhou Chest Hospital, Guangzhou/State Key Laboratory of Respiratory Diseases, Guangzhou, China.
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Kucharzik T, Ellul P, Greuter T, Rahier JF, Verstockt B, Abreu C, Albuquerque A, Allocca M, Esteve M, Farraye FA, Gordon H, Karmiris K, Kopylov U, Kirchgesner J, MacMahon E, Magro F, Maaser C, de Ridder L, Taxonera C, Toruner M, Tremblay L, Scharl M, Viget N, Zabana Y, Vavricka S. ECCO Guidelines on the Prevention, Diagnosis, and Management of Infections in Inflammatory Bowel Disease. J Crohns Colitis 2021; 15:879-913. [PMID: 33730753 DOI: 10.1093/ecco-jcc/jjab052] [Citation(s) in RCA: 151] [Impact Index Per Article: 50.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- T Kucharzik
- Department of Gastroenterology, Klinikum Lüneburg, University of Hamburg, Lüneburg, Germany
| | - P Ellul
- Department of Medicine, Division of Gastroenterology, Mater Dei Hospital, Msida, Malta
| | - T Greuter
- University Hospital Zürich, Department of Gastroenterology and Hepatology, Zürich, Switzerland, and Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois CHUV, University Hospital Lausanne, Lausanne, Switzerland
| | - J F Rahier
- Department of Gastroenterology and Hepatology, CHU UCL Namur, Yvoir, Belgium
| | - B Verstockt
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium, and Department of Chronic Diseases, Metabolism and Ageing, TARGID-IBD, KU Leuven, Leuven, Belgium
| | - C Abreu
- Infectious Diseases Service, Centro Hospitalar Universitário São João, Porto, Portugal.,Instituto de Inovação e Investigação em Saúde [I3s], Faculty of Medicine, Department of Medicine, University of Porto, Portugal
| | - A Albuquerque
- Gastroenterology Department, St James University Hospital, Leeds, UK
| | - M Allocca
- Humanitas Clinical and Research Center - IRCCS -, Rozzano [Mi], Italy.,Humanitas University, Department of Biomedical Sciences, Milan, Italy
| | - M Esteve
- Hospital Universitari Mútua Terrassa, Digestive Diseases Department, Terrassa, Catalonia, and Centro de Investigación Biomédica en red de Enfermedades Hepáticas y Digestivas CIBERehd, Madrid, Spain
| | - F A Farraye
- Inflammatory Bowel Disease Center, Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | - H Gordon
- Department of Gastroenterology, Barts Health NHS Trust, Royal London Hospital, London, UK
| | - K Karmiris
- Department of Gastroenterology, Venizeleio General Hospital, Heraklion, Greece
| | - U Kopylov
- Department of Gastroenterology, Sheba Medical Center, Ramat Gan, Israel, and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - J Kirchgesner
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Saint-Antoine, Department of Gastroenterology, Paris, France
| | - E MacMahon
- Department of Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - F Magro
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal.,Institute of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Portugal
| | - C Maaser
- Outpatient Department of Gastroenterology, Department of Geriatrics, Klinikum Lüneburg, University of Hamburg, Lüneburg, Germany
| | - L de Ridder
- Department of Paediatric Gastroenterology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - C Taxonera
- IBD Unit, Department of Gastroenterology, Hospital Clínico San Carlos and Instituto de Investigación del Hospital Clínico San Carlos [IdISSC], Madrid, Spain
| | - M Toruner
- Ankara University School of Medicine, Department of Gastroenterology, Ankara, Turkey
| | - L Tremblay
- Centre Hospitalier de l'Université de Montréal [CHUM] Pharmacy Department and Faculty of Pharmacy, Université de Montréal, Montréal, QC, Canada
| | - M Scharl
- University Hospital Zürich, Department of Gastroenterology and Hepatology, Zürich, Switzerland
| | - N Viget
- Department of Infectious Diseases, Tourcoing Hospital, Tourcoing, France
| | - Y Zabana
- Hospital Universitari Mútua Terrassa, Digestive Diseases Department, Terrassa, Catalonia, and Centro de Investigación Biomédica en red de Enfermedades Hepáticas y Digestivas CIBERehd, Madrid, Spain
| | - S Vavricka
- University Hospital Zürich, Department of Gastroenterology and Hepatology, Zürich, Switzerland
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42
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Tuberculosis Screening, Testing, and Treatment of US Health Care Personnel: ACOEM and NTCA Joint Task Force on Implementation of the 2019 MMWR Recommendations. J Occup Environ Med 2021; 62:e355-e369. [PMID: 32730040 DOI: 10.1097/jom.0000000000001904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
: On May 17, 2019, the US Centers for Disease Control and Prevention and National Tuberculosis Controllers Association issued new Recommendations for Tuberculosis Screening, Testing, and Treatment of Health Care Personnel, United States, 2019, updating the health care personnel-related sections of the Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005. This companion document offers the collective effort and experience of occupational health, infectious disease, and public health experts from major academic and public health institutions across the United States and expands on each section of the 2019 recommendations to provide clarifications, explanations, and considerations that go beyond the 2019 recommendations to answer questions that may arise and to offer strategies for implementation.
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43
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HaileMariam M, Yu Y, Singh H, Teklu T, Wondale B, Worku A, Zewude A, Mounaud S, Tsitrin T, Legesse M, Gobena A, Pieper R. Protein and Microbial Biomarkers in Sputum Discern Acute and Latent Tuberculosis in Investigation of Pastoral Ethiopian Cohort. Front Cell Infect Microbiol 2021; 11:595554. [PMID: 34150670 PMCID: PMC8212885 DOI: 10.3389/fcimb.2021.595554] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 03/22/2021] [Indexed: 01/01/2023] Open
Abstract
Differential diagnosis of tuberculosis (TB) and latent TB infection (LTBI) remains a public health priority in high TB burden countries. Pulmonary TB is diagnosed by sputum smear microscopy, chest X-rays, and PCR tests for distinct Mycobacterium tuberculosis (Mtb) genes. Clinical tests to diagnose LTBI rely on immune cell stimulation in blood plasma with TB-specific antigens followed by measurements of interferon-γ concentrations. The latter is an important cytokine for cellular immune responses against Mtb in infected lung tissues. Sputum smear microscopy and chest X-rays are not sufficiently sensitive while both PCR and interferon-γ release assays are expensive. Alternative biomarkers for the development of diagnostic tests to discern TB disease states are desirable. This study's objective was to discover sputum diagnostic biomarker candidates from the analysis of samples from 161 human subjects including TB patients, individuals with LTBI, negative community controls (NCC) from the province South Omo, a pastoral region in Ethiopia. We analyzed 16S rRNA gene-based bacterial taxonomies and proteomic profiles. The sputum microbiota did not reveal statistically significant differences in α-diversity comparing the cohorts. The genus Mycobacterium, representing Mtb, was only identified for the TB group which also featured reduced abundance of the genus Rothia in comparison with the LTBI and NCC groups. Rothia is a respiratory tract commensal and may be sensitive to the inflammatory milieu generated by infection with Mtb. Proteomic data supported innate immune responses against the pathogen in subjects with pulmonary TB. Ferritin, an iron storage protein released by damaged host cells, was markedly increased in abundance in TB sputum compared to the LTBI and NCC groups, along with the α-1-acid glycoproteins ORM1 and ORM2. These proteins are acute phase reactants and inhibit excessive neutrophil activation. Proteomic data highlight the effector roles of neutrophils in the anti-Mtb response which was not observed for LTBI cases. Less abundant in the sputum of the LTBI group, compared to the NCC group, were two immunomodulatory proteins, mitochondrial TSPO and the extracellular ribonuclease T2. If validated, these proteins are of interest as new biomarkers for diagnosis of LTBI.
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Affiliation(s)
- Milkessa HaileMariam
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yanbao Yu
- J. Craig Venter Institute, Rockville, MD, United States
| | - Harinder Singh
- J. Craig Venter Institute, Rockville, MD, United States
| | - Takele Teklu
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Immunology and Molecular Biology, University of Gondar, Gondar, Ethiopia
| | - Biniam Wondale
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Biology, Arba Minch University, Arba Minch, Ethiopia
| | - Adane Worku
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Aboma Zewude
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Tamara Tsitrin
- J. Craig Venter Institute, Rockville, MD, United States
| | - Mengistu Legesse
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ameni Gobena
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Rembert Pieper
- J. Craig Venter Institute, Rockville, MD, United States
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44
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Sousa S, Rocha D, Silva JC, Ribeiro AI, Gonçalves G, Almeida Á, Correia AM, Duarte R, Carvalho C. Comparing the cost-effectiveness of two screening strategies for latent tuberculosis infection in Portugal. Pulmonology 2021; 27:493-499. [PMID: 34053903 DOI: 10.1016/j.pulmoe.2021.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Screening for latent tuberculosis infection (LTBI) in close contacts of infectious TB cases might include Tuberculin Skin Test (TST) and Interferon-Gamma Release Assays (IGRA), in combination or as single-tests. In Portugal, the screening strategy changed from TST followed by IGRA to IGRA-only testing in 2016. Our objective was to compare the cost-effectiveness of two-step TST/IGRA with the current IGRA-only screening strategy in immunocompetent individuals exposed to individuals with respiratory TB. MATERIALS AND METHODS We reviewed clinical records of individuals exposed to infectious TB cases diagnosed in 2015 and 2016, in two TB outpatient centers in the district of Porto. We estimated medical, non-medical and indirect costs for each screening strategy, taking into account costs of tests and health care personnel, travel distance from place of residence to screening site and employment status. We calculated the incremental cost-effectiveness ratio (ICER) as the cost difference between the two screening strategies with the difference number of LTBI diagnosis as a measure of cost-effectiveness, assuming that treating LTBI is a cost-effective intervention. We also calculated adjusted odds-ratios to test the association between diagnosis of LTBI and screening strategy and estimated the total cost for averting a potential TB case. RESULTS We compared 499 contacts TST/IGRA screened with 547 IGRA-only. IGRA-only strategy yielded a higher screening effectiveness for diagnosing latent tuberculosis infection (aOR 2.12, 95%CI: 1.53 - 2.94). ICER was €106 per LTBI diagnosis, representing increased effectiveness with a slightly increased cost of IGRA-only screening strategy. CONCLUSIONS Our data suggests that in Portugal LTBI screening with IGRA-only is more cost-effective than the two-step TST/IGRA testing strategy, preventing a higher number of cases of TB cases.
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Affiliation(s)
- Sofia Sousa
- Public Health Unit - South Sousa Valley, Northern Regional Health Administration, Paredes, Portugal; Multidisciplinary Unit for Biomedical Research (UMIB), Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal.
| | - Diogo Rocha
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Joelma C Silva
- Pulmonology Department of Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Ana Isabel Ribeiro
- Epidemiology Research Unit (EpiUnit) - Institute of Public Health, University of Porto, Porto, Portugal; Departamento de Ciências de Saúde Pública, Ciências Forenses e Educação Médica, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Guilherme Gonçalves
- Multidisciplinary Unit for Biomedical Research (UMIB), Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
| | - Álvaro Almeida
- CEF.UP - Center for Economics and Finance at the University of Porto and Faculdade de Economia, Universidade do Porto
| | - Ana Maria Correia
- Northern Regional Health Administration, Department of Public Health, Porto, Portugal
| | - Raquel Duarte
- Epidemiology Research Unit (EpiUnit) - Institute of Public Health, University of Porto, Porto, Portugal; Departamento de Ciências de Saúde Pública, Ciências Forenses e Educação Médica, Faculty of Medicine, University of Porto, Porto, Portugal; Serviço de Pneumologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal; National Tuberculosis Program, Directorate-General of Health, Lisbon, Portugal
| | - Carlos Carvalho
- Public Health Unit - South Sousa Valley, Northern Regional Health Administration, Paredes, Portugal; Department of Public Health, Northern Regional Health Administration, Porto, Portugal; Multidisciplinary Unit for Biomedical Research (UMIB), Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
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Meinerz G, Silva CKD, Dorsdt DMB, Adames JB, Andrade JP, Ventura PE, Monteiro ADA, Pasqualotto AC, Garcia VD, Keitel E. Latent tuberculosis screening before kidney transplantation in the South of Brazil. J Bras Nefrol 2021; 43:520-529. [PMID: 33999988 PMCID: PMC8940112 DOI: 10.1590/2175-8239-jbn-2020-0189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 02/25/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Tuberculosis (TB) is a prevalent infection after kidney transplantation (KT) in high-burden countries. Latent tuberculosis infection (LTBI) screening includes previous TB history, chest radiograph findings, and tuberculin test (TST) and/or interferon-gamma release assays (IGRAs) results. We aimed to compare our routine LTBI screening of KT candidates and living donors (LD) with their IGRA results, and evaluate if this would improve isoniazid (INH) treatment referral. Methods: We evaluated adult KT candidates and LD with complete routine LTBI screening and QuantiFERON-TB® Gold In-Tube (QFT) testing. Blood samples were collected from April 4th, 2014 to October 31st, 2018, with follow-up until October 31st, 2019. Results: There were 116 KT recipients, with 30% QFT-positive results. Positive QFT was associated with past TB history (p=0.007), positive TST (p<0.0001), residual radiographic lesions (p=0.003), and diabetes (p=0.035). There were 25 LD, 40% had positive QFT. Positive QFT was associated with a positive TST (p=0.002). Positive QFT results increased INH referral in 80%. Post-transplant TB incidence was 2.6% in a median follow-up of 2 (1-33) months. No variables were associated with post-transplant TB. TB patients had inferior, although non-significant, 5-year graft survival (66.7% vs. 76.5%) (p = 0.402). Conclusion: In the present study, the association of QFT to our routine LTBI screening incremented INH treatment referral, but there was still a high incidence of post-transplant TB, possibly related to other forms of infection, such as new exposure and donor transmission.
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Affiliation(s)
- Gisele Meinerz
- Santa Casa de Misericórdia de Porto Alegre, Departamento de Nefrologia e Transplante de Rim e Pâncreas, Porto Alegre, RS, Brasil.,Universidade Federal de Ciências da Saúde de Porto Alegre, Programa de Pós-Graduação em Patologia, Porto Alegre, RS, Brasil
| | - Cynthia Keitel da Silva
- Santa Casa de Misericórdia de Porto Alegre, Departamento de Nefrologia e Transplante de Rim e Pâncreas, Porto Alegre, RS, Brasil.,Universidade Federal de Ciências da Saúde de Porto Alegre, Programa de Pós-Graduação em Patologia, Porto Alegre, RS, Brasil
| | | | - Julia Bertoni Adames
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brasil
| | | | - Pedro Enrico Ventura
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brasil
| | | | - Alessandro Comarú Pasqualotto
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brasil.,Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brasil
| | - Valter Duro Garcia
- Santa Casa de Misericórdia de Porto Alegre, Departamento de Nefrologia e Transplante de Rim e Pâncreas, Porto Alegre, RS, Brasil
| | - Elizete Keitel
- Santa Casa de Misericórdia de Porto Alegre, Departamento de Nefrologia e Transplante de Rim e Pâncreas, Porto Alegre, RS, Brasil.,Universidade Federal de Ciências da Saúde de Porto Alegre, Programa de Pós-Graduação em Patologia, Porto Alegre, RS, Brasil
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46
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Bongomin F, Ssekamatte P, Nattabi G, Olum R, Ninsiima S, Kyazze AP, Nabakka W, Kukunda R, Cose S, Kibirige D, Batte C, Kaddumukasa M, Kirenga BJ, Nakimuli A, Baluku JB, Andia-Biraro I. Latent Tuberculosis Infection Status of Pregnant Women in Uganda Determined Using QuantiFERON TB Gold-Plus. Open Forum Infect Dis 2021; 8:ofab241. [PMID: 34113689 PMCID: PMC8186242 DOI: 10.1093/ofid/ofab241] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/05/2021] [Indexed: 11/23/2022] Open
Abstract
Background The risk of progression of latent tuberculosis infection (LTBI) to active disease increases with pregnancy. This study determined the prevalence and risk factors associated with LTBI among pregnant women in Uganda. Methods We enrolled 261 pregnant women, irrespective of gestational age. Participants who had known or suspected active tuberculosis (TB) on the basis of clinical evaluation or who had recently received treatment for TB were excluded. LTBI was defined as an interferon-γ concentration ≥0.35 IU/mL (calculated as either TB1 [eliciting CD4+ T-cell responses] or TB2 [eliciting CD8+ T-cell responses] antigen minus nil) using QuantiFERON TB Gold-Plus (QFT-plus) assay. Results LTBI prevalence was 37.9% (n = 99) (95% confidence interval [CI], 32.3–44.0). However, 24 (9.2%) subjects had indeterminate QFT-plus results. Among participants with LTBI, TB1 and TB2 alone were positive in 11 (11.1%) and 18 (18.2%) participants, respectively. In multivariable analysis, human immunodeficiency virus (HIV) infection (adjusted odds ratio [aOR], 4.4 [95% confidence interval {CI}, 1.1–18.0]; P = .04) and age 30–39 years (aOR, 4.0 [95% CI, 1.2–12.7]; P = .02) were independently associated with LTBI. Meanwhile, smoking status, alcohol use, nature of residence, crowding index, and TB contact were not associated with LTBI. Conclusions Our findings are in keeping with the evidence that HIV infection and advancing age are important risk factors for LTBI in pregnancy. In our setting, we recommend routine screening for LTBI and TB preventive therapy among eligible pregnant women.
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Affiliation(s)
- Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda.,Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Phillip Ssekamatte
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Gloria Nattabi
- Department of Medicine, Uganda Martyrs Hospital Lubaga, Kampala, Uganda
| | - Ronald Olum
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Sandra Ninsiima
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Andrew Peter Kyazze
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Winnie Nabakka
- Department of Medicine, Uganda Martyrs Hospital Lubaga, Kampala, Uganda
| | - Rebecca Kukunda
- Department of Medicine, Uganda Martyrs Hospital Lubaga, Kampala, Uganda
| | - Stephen Cose
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Davis Kibirige
- Department of Medicine, Uganda Martyrs Hospital Lubaga, Kampala, Uganda.,Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Charles Batte
- Lung Institute, Makerere University, Kampala, Uganda
| | - Mark Kaddumukasa
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Bruce J Kirenga
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.,Lung Institute, Makerere University, Kampala, Uganda
| | - Annettee Nakimuli
- Department of Obstetrics and Gynecology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Joseph Baruch Baluku
- Division of Pulmonology, Kiruddu National Referral Hospital, Kampala, Uganda.,Directorate of Programs, Mildmay Uganda, Wakiso, Uganda
| | - Irene Andia-Biraro
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.,Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda.,Department of Clinical Research, Faculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London, United Kingdom
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47
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Liu S, Wu M, A E, Wu S, Geng S, Li Z, Li M, Li L, Pang Y, Kang W, Tang S. Factors associated with differential T cell responses to antigens ESAT-6 and CFP-10 in pulmonary tuberculosis patients. Medicine (Baltimore) 2021; 100:e24615. [PMID: 33663071 PMCID: PMC7909155 DOI: 10.1097/md.0000000000024615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 01/07/2021] [Indexed: 01/05/2023] Open
Abstract
The T-SPOT.TB assay detects cellular immune responses to 2 core Mycobacterium tuberculosis antigens, early secreted antigenic target of 6-kDa protein (ESAT-6) and culture filtrate protein-10 (CFP-10). T-SPOT.TB has been recently used for auxiliary diagnosis of active pulmonary tuberculosis (PTB). However, testing can produce inconsistent results due to differential PTB patient immune responses to these antigens, prompting us to identify factors underlying inconsistent results.Data were retrospectively analyzed from 1225 confirmed PTB patients who underwent T-SPOT.TB testing at 5 specialized tuberculosis hospitals in China between December 2012 and November 2015. Numbers of spot-forming cells (SFCs) reflecting T cell responses to ESAT-6 and CFP-10 antigens were recorded then analyzed via multivariable logistic regression to reveal factors underlying discordant T cell responses to these antigens.The agreement rate of 84.98% (82.85%-86.94%) between PTB patient ESAT-6 and CFP-10 responses demonstrated high concordance. Additionally, positivity rates were higher for ESAT-6 than for CFP-10 (84.8% vs 80.7%, P < .001), with ESAT-6 and CFP-10 microwell SFC numbers for each single positive group not differing significantly (P > .99), while spot numbers of the single positive group were lower than numbers for the double positive group (P < .001). Elderly patients (aged ≥66 years) and patients receiving retreatment were most likely to have discordance results.ESAT-6 promoted significantly more positive T-SPOT.TB results than did CFP-10 in PTB patients. Advanced age and retreatment status were correlated with discordant ESAT-6 and CFP-10 results. Assessment of factors underlying discordance may lead to improved PTB diagnosis using T-SPOT.TB.
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Affiliation(s)
- Shengsheng Liu
- Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing
| | | | - Ertai A
- Chest Hospital of Xinjiang Uygur Autonomous Region, Urumqi
| | | | | | | | - Mingwu Li
- Kunming 3rd People's Hospital, Kunming, China
| | - Liang Li
- Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing
| | - Yu Pang
- Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing
| | - Wanli Kang
- Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing
| | - Shenjie Tang
- Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing
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48
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Dhanda AD, Yates E, Schewitz-Bowers LP, Lait PJ, Lee RWJ, Cramp ME. Ex Vivo T Cell Cytokine Expression Predicts Survival in Patients with Severe Alcoholic Hepatitis. Gut Liver 2021; 14:265-268. [PMID: 31158952 PMCID: PMC7096227 DOI: 10.5009/gnl19035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 03/29/2019] [Accepted: 04/15/2019] [Indexed: 12/12/2022] Open
Abstract
Alcoholic hepatitis (AH) is an acute inflammatory liver condition with high early mortality rate. Steroids improve short-term survival but nonresponders have the worst outcomes. There is a clinical need to identify these high-risk individuals at the time of presentation. T cells are implicated in AH and steroid responsiveness. We measured ex vivo T cell cytokine expression as a candidate biomarker of outcomes in patients with AH. Consecutive patients (bilirubin >80 µmol/L and ratio of aspartate aminotransferase to alanine aminotransferase >1.5 who were heavy alcohol consumers with discriminant function [DF] ≥32), were recruited from University Hospitals Plymouth NHS Trust. T cells were obtained and stimulated ex vivo. Cytokine expression levels were determined by flow cytometry and protein multiplex analysis. Twenty-three patients were recruited (10 male; median age 51 years; baseline DF 67; 30% 90-day mortality). Compared to T cells from nonsurvivors at day 90, T cells from survivors had higher baseline baseline intracellular interleukin (IL)-10:IL-17A ratio (0.43 vs 1.20, p=0.02). Multiplex protein analysis identified interferon γ (IFNγ) and tumor necrosis factor-α (TNF-α) as independent predictors of 90-day mortality (p=0.04, p=0.01, respectively). The ratio of IFNγ to TNF-α was predictive of 90-day mortality (1.4 vs 0.2, p=0.03). These data demonstrate the potential utility of T cell cytokine release assays performed on pretreatment blood samples as biomarkers of survival in patients with severe AH. Our key findings were that intracellular IL-10:IL-17A and IFNγ:TNF-α in culture supernatants were predictors of 90-day mortality. This offers the promise of developing T cell-based diagnostic tools for risk stratification.
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Affiliation(s)
- Ashwin D Dhanda
- South West Liver Unit, University Hospitals Plymouth NHS Trust, Plymouth, UK.,Hepatology Research Group, University of Plymouth, Plymouth, UK
| | - Euan Yates
- Hepatology Research Group, University of Plymouth, Plymouth, UK
| | | | - Philippa J Lait
- Translational Health Sciences, University of Bristol, Bristol, UK
| | - Richard W J Lee
- Translational Health Sciences, University of Bristol, Bristol, UK
| | - Matthew E Cramp
- South West Liver Unit, University Hospitals Plymouth NHS Trust, Plymouth, UK.,Hepatology Research Group, University of Plymouth, Plymouth, UK
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49
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Betzler BK, Gupta V, Agrawal R. Clinics of ocular tuberculosis: A review. Clin Exp Ophthalmol 2021; 49:146-160. [DOI: 10.1111/ceo.13847] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/16/2020] [Accepted: 08/18/2020] [Indexed: 01/06/2023]
Affiliation(s)
- Bjorn Kaijun Betzler
- Yong Loo Lin School of Medicine National University of Singapore Singapore Singapore
| | - Vishali Gupta
- Advanced Eye Centre Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Rupesh Agrawal
- Yong Loo Lin School of Medicine National University of Singapore Singapore Singapore
- National Healthcare Group Eye Institute Tan Tock Seng Hospital Singapore Singapore
- Moorfields Eye Hospital, National Health Service Foundation Trust London UK
- Singapore Eye Research Institute Singapore Singapore
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50
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Xin H, Zhang H, Yang S, Liu J, Lu W, Bai L, Cao X, Feng B, Jin Q, Gao L. 5-Year Follow-up of Active Tuberculosis Development From Latent Infection in Rural China. Clin Infect Dis 2021; 70:947-950. [PMID: 31253988 DOI: 10.1093/cid/ciz581] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 06/27/2019] [Indexed: 11/14/2022] Open
Abstract
A 5-year follow-up study found declining disease development rates from latent tuberculosis infection. In the latter 3 years, the incidence, per 100 person-years, was 0.26 for interferon-γ release assay positives and 0.19 for tuberculin skin test positives (P = .28). In addition, all round have been checked.
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Affiliation(s)
- Henan Xin
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Haoran Zhang
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Shumin Yang
- Gansu Provincial Center for Diseases Control and Prevention, Lanzhou
| | - Jianmin Liu
- The Sixth People's Hospital of Zhengzhou, Nanjing, China
| | - Wei Lu
- Jiangsu Provincial Center for Diseases Control and Prevention, Nanjing, China
| | - Liqiong Bai
- Hunan Provincial Institute of Tuberculosis Prevention and Control, Changsha, China
| | - Xuefang Cao
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Boxuan Feng
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Qi Jin
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Lei Gao
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
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