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Ruiz-Tagle C, Naves R, García P, Günther A, Schneiderhan-Marra N, Balcells ME. Differential levels of anti- Mycobacterium tuberculosis-specific IgAs in saliva of household contacts with latent tuberculosis infection. Front Med (Lausanne) 2023; 10:1267670. [PMID: 37869168 PMCID: PMC10587581 DOI: 10.3389/fmed.2023.1267670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
Introduction Mucosal immunity is strongly elicited in early stages of many respiratory and enteric infections; however, its role in tuberculosis pathogenesis has been scarcely explored. We aimed to investigate Mycobacterium tuberculosis (Mtb) specific IgA levels in saliva in different stages of latent Tuberculosis Infection (TBI). Methodology A multiplex bead-based Luminex immunoassay was developed to detect specific IgA against 12 highly immunogenic Mtb antigens. A prospective cohort of household contacts (>14 years) of pulmonary TB cases was established in Santiago, Chile. Contacts were classified as Mtb-infected or not depending on serial interferon-γ release assay results. Saliva samples were collected and tested at baseline and at a 12-week follow-up. Results Mtb-specific IgA was detectable at all visits in all participants (n = 168), including the "non-Mtb infected" (n = 64). Significantly higher median levels of IgA were found in the "Mtb infected" compared to the uninfected for anti-lipoarabinomannan (LAM) (110 vs. 84.8 arbitrary units (AU), p < 0.001), anti-PstS1 (117 vs. 83 AU, p < 0.001), anti-Cell Membrane Fraction (CMF) (140 vs. 103 AU, p < 0.001) and anti-Culture Filtrate Proteins (CFP) (median 125 vs. 96 AU, p < 0.001), respectively. Nonetheless, the discriminatory performance of these specific mucosal IgA for TBI diagnosis was low. Conclusion Saliva holds Mtb-specific IgA against several antigens with increased levels for anti-LAM, anti-PstS1, anti-CMF and anti-CFP found in household contacts with an established TBI. The role of these mucosal antibodies in TB pathogenesis, and their kinetics in different stages of Mtb infection merits further exploring.
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Affiliation(s)
- Cinthya Ruiz-Tagle
- Departamento de Enfermedades Infecciosas del Adulto, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rodrigo Naves
- Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Patricia García
- Laboratorio de Microbiología, Departamento de Laboratorios Clínicos, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Anna Günther
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | | | - María Elvira Balcells
- Departamento de Enfermedades Infecciosas del Adulto, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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Du Y, He Y, Zhang H, Shen F, Guan L, Xin H, He Y, Cao X, Feng B, Quan Z, Liu J, Gao L. Declining incidence rate of tuberculosis among close contacts in five years post-exposure: a systematic review and meta-analysis. BMC Infect Dis 2023; 23:373. [PMID: 37270474 DOI: 10.1186/s12879-023-08348-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 05/24/2023] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND Individuals in close contact with active pulmonary tuberculosis (TB) patients showed a high risk of recent infection and, once infected, higher risk of developing active TB in the following years post-exposure. But the peak time of active disease onset is unclear. This study aims to estimate post exposure TB incidence risk among close contacts to provide reference for clinical and public health strategies. METHODS We searched PubMed, Web of Science, and EMBASE for articles published until December 1, 2022. The incidence rates were quantitatively summarized by means of meta-analysis using the random-effect model. RESULTS Of the 5616 studies, 31 studies included in our analysis. For baseline close contacts results, the summarized prevalence of Mycobacterium tuberculosis (MTB) infection and active TB was found to be 46.30% (95% CI: 37.18%-55.41%) and 2.68% (95% CI: 2.02%-3.35%), respectively. During the follow-up, the 1-year, 2-year and 5-year cumulative incidence of TB in close contacts were 2.15% (95% CI: 1.51%-2.80%), 1.21% (95% CI: 0.93%-1.49%) and 1.11% (95% CI: 0.64%-1.58%), respectively. Individuals with a positive result of MTB infection testing at baseline showed significantly higher cumulative TB incidence as compared to those negatives (3.80% vs. 0.82%, p < 0.001). CONCLUSIONS Individuals with close contact to active pulmonary TB patients are bearing significant risk of developing active TB, particularly within the first-year post-exposure. Population with recent infections should be an important priority for active case finding and preventive intervention worldwide.
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Affiliation(s)
- Ying Du
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, 100069, China
| | - Yijun He
- 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, No 9 Dong Dan San Tiao, Beijing, 100730, China
| | - 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, No 9 Dong Dan San Tiao, Beijing, 100730, China
| | - Fei Shen
- The Sixth People's Hospital of Zhengzhou, Zhengzhou, 400060, China
| | - Ling Guan
- The Sixth People's Hospital of Zhengzhou, Zhengzhou, 400060, China
| | - 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, No 9 Dong Dan San Tiao, Beijing, 100730, China
| | - Yongpeng He
- 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, No 9 Dong Dan San Tiao, Beijing, 100730, 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, No 9 Dong Dan San Tiao, Beijing, 100730, China
| | - 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, No 9 Dong Dan San Tiao, Beijing, 100730, China
| | - Zhusheng Quan
- 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, No 9 Dong Dan San Tiao, Beijing, 100730, China
| | - Jianmin Liu
- The Sixth People's Hospital of Zhengzhou, Zhengzhou, 400060, China
| | - 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, No 9 Dong Dan San Tiao, Beijing, 100730, China.
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Corbett C, Kalmambetova G, Umetalieva N, Ahmedov S, Antonenka U, Myrzaliev B, Sahalchyk E, Vogel M, Kadyrov A, Hoffmann H. QuantiFERON-TB Gold plus testing for the detection of LTBI among health care workers in major TB hospitals of the Northern Kyrgyz Republic. BMC Infect Dis 2022; 22:180. [PMID: 35197008 PMCID: PMC8867784 DOI: 10.1186/s12879-022-07149-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 02/12/2022] [Indexed: 11/24/2022] Open
Abstract
Background Health care workers (HCW) are at increased risk of TB infection due to their close contact with infected patients with active TB. The objectives of the study were (1) to assess the prevalence of LTBI among HCW in the Northern Kyrgyz Republic, and (2) to determine the association of LTBI with job positions or departments. Methods HCWs from four TB hospitals in the Northern Kyrgyz Republic were tested with the interferon-gamma release assay (IGRA) Quantiferon-TB Gold plus (QFT) for the detection of an immune response to TB as marker of TB infection. Age was controlled for as a confounder. Univariate and multivariable analysis were performed using logistic regression to assess the association of the risk factors (job position, and department) with having a QTF positive result. Firth’s penalized-likelihood estimates were used to account for the small-sample size. Pairwise comparisons using the Bonferroni correction (conservative) and comparisons without adjusting for multiple comparisons (unadjusted) were used to identify the categories where differences occurred. Results QFT yielded valid results for 404 HCW, with 189 (46.7%) having a positive test. In the National Tuberculosis Center there was an increased odds to have a positive QFT test for the position of physician (OR = 8.7, 95%, CI = 1.2–60.5, p = 0.03) and laboratory staff (OR = 19.8, 95% CI = 2.9–135.4, p < 0.01) when administration staff was used as the baseline. When comparing departments for all hospitals combined, laboratories (OR 7.65; 95%CI 2.3–24.9; p < 0.001), smear negative TB (OR 5.90; 95%CI 1.6–21.8; p = 0.008), surgery (OR 3.79; 95%CI 1.3–11.4; p = 0.018), and outpatient clinics (OR 3.80; 95%CI 1.1–13.0; p = 0.03) had higher odds of a positive QFT result than the admin department. Fifteen of the 49 HCW with follow-up tests converted from negative to positive at follow-up testing. Conclusions This is the first report on prevalence and risk factors of LTBI for HCW in the Kyrgyz republic, and results indicate there may be an increased risk for LTBI among physicians and laboratory personnel. Further research should investigate gaps of infection control measures particularly for physicians and laboratory staff and lead to further improvement of policies.
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Affiliation(s)
- Caroline Corbett
- Institute of Microbiology and Laboratory Medicine, Department IML Red GmbH, WHO, Supranational Tuberculosis Reference Laboratory, Robert-Koch-Allee 2, Gauting, 82131, Munich, Germany.
| | | | - Nagira Umetalieva
- Institute of Microbiology and Laboratory Medicine, Department IML Red GmbH, WHO, Supranational Tuberculosis Reference Laboratory, Robert-Koch-Allee 2, Gauting, 82131, Munich, Germany.,Republican Tuberculosis Reference Laboratory, Bishkek, Kyrgyzstan
| | - Sevim Ahmedov
- USAID, Bureau for Global Health, TB Division, Washington, DC, USA
| | - Uladzimir Antonenka
- Institute of Microbiology and Laboratory Medicine, Department IML Red GmbH, WHO, Supranational Tuberculosis Reference Laboratory, Robert-Koch-Allee 2, Gauting, 82131, Munich, Germany
| | - Bakyt Myrzaliev
- KNCV Branch Office in the Kyrgyz Republic, Bishkek, Kyrgyzstan
| | - Evgeni Sahalchyk
- Institute of Microbiology and Laboratory Medicine, Department IML Red GmbH, WHO, Supranational Tuberculosis Reference Laboratory, Robert-Koch-Allee 2, Gauting, 82131, Munich, Germany
| | - Monica Vogel
- Institute of Microbiology and Laboratory Medicine, Department IML Red GmbH, WHO, Supranational Tuberculosis Reference Laboratory, Robert-Koch-Allee 2, Gauting, 82131, Munich, Germany
| | - Abdylat Kadyrov
- Republican Tuberculosis Center, National TB Program, Bishkek, Kyrgyzstan
| | - Harald Hoffmann
- Institute of Microbiology and Laboratory Medicine, Department IML Red GmbH, WHO, Supranational Tuberculosis Reference Laboratory, Robert-Koch-Allee 2, Gauting, 82131, Munich, Germany.,SYNLAB Gauting, SYNLAB MVZ Humane Genetics, Munich, Germany
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Corbett C, Kulzhabaeva A, Toichkina T, Kalmambetova G, Ahmedov S, Antonenka U, Iskakova A, Kosimova D, Migunov D, Myrzaliev B, Sahalchyk E, Umetalieva N, Vogel M, Kadyrov A, Hoffmann H. Implementing contact tracing for tuberculosis in Kyrgyz Republic and risk factors for positivity using QuantiFERON-TB Gold plus. BMC Infect Dis 2020; 20:746. [PMID: 33046016 PMCID: PMC7552456 DOI: 10.1186/s12879-020-05465-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 09/30/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Effective active case finding (ACF) activities are essential for early identification of new cases of active tuberculosis (TB) and latent TB infection (LTBI). Accurate diagnostics as well as the ability to identify contacts at high risk of infection are essential for ACF, and have not been systematically reported from Central Asia. The objective was to implement a pilot ACF program to determine the prevalence and risk factors for LTBI and active TB among contacts of individuals with TB in Kyrgyz Republic using Quantiferon-TB Gold plus (QuantiFERON). METHODS An enhanced ACF project in the Kyrgyz Republic was implemented in which close and household (home) contacts of TB patients from the Issyk-Kul Oblast TB Center were visited at home. QuantiFERON and the tuberculin skin test (TST) alongside clinical and bacteriological examination were used to identify LTBI and active TB cases among contacts. The association for QuantiFERON positivity and risk factors were analysed and compared to TST results. RESULTS Implementation of ACF with QuantiFERON involved close collaboration with the national sanitary and epidemiological services (SES) and laboratories in the Kyrgyz Republic. From 67 index cases, 296 contacts were enrolled of whom 253 had QuantiFERON or TST results; of those 103 contacts had LTBI (positive TST or IGRA), and four (1.4%) active TB cases were detected. Index case smear microscopy (OR 1.76) and high household density (OR 1.97) were significant risk factors for QuantiFERON positivity for all contacts. When stratified by age, association with smear positivity disappeared for children below 15 years. TST was not associated with any risk factor. CONCLUSIONS This is the first time that ACF activities have been reported for Central Asia, and provide insight for implementation of effective ACF in the region. These ACF activities using QuantiFERON led to increase in the detection of LTBI and active cases, prior to patients seeking treatment. Household density should be taken into consideration as an important risk factor for the stratification of future ACF activities.
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Affiliation(s)
- Caroline Corbett
- Departments SYNLAB Gauting & IML red GmbH, WHO - Supranational Tuberculosis Reference Laboratory Munich-Gauting, Institute of Microbiology and Laboratory Medicine, Robert-Koch-Allee 2, D-82131, Gauting, Germany.
| | | | | | | | | | - Uladzimir Antonenka
- Departments SYNLAB Gauting & IML red GmbH, WHO - Supranational Tuberculosis Reference Laboratory Munich-Gauting, Institute of Microbiology and Laboratory Medicine, Robert-Koch-Allee 2, D-82131, Gauting, Germany
| | - Altyn Iskakova
- Republican Tuberculosis Reference Laboratory, Bishkek, Kyrgyz Republic
| | | | | | - Bakyt Myrzaliev
- KNCV Branch Office in the Kyrgyz Republic, Bishkek, Kyrgyz Republic
| | - Evgeni Sahalchyk
- Departments SYNLAB Gauting & IML red GmbH, WHO - Supranational Tuberculosis Reference Laboratory Munich-Gauting, Institute of Microbiology and Laboratory Medicine, Robert-Koch-Allee 2, D-82131, Gauting, Germany
| | - Nagira Umetalieva
- Departments SYNLAB Gauting & IML red GmbH, WHO - Supranational Tuberculosis Reference Laboratory Munich-Gauting, Institute of Microbiology and Laboratory Medicine, Robert-Koch-Allee 2, D-82131, Gauting, Germany
| | - Monica Vogel
- Departments SYNLAB Gauting & IML red GmbH, WHO - Supranational Tuberculosis Reference Laboratory Munich-Gauting, Institute of Microbiology and Laboratory Medicine, Robert-Koch-Allee 2, D-82131, Gauting, Germany
| | - Abdylat Kadyrov
- Republican Tuberculosis Center, National TB Program, Bishkek, Kyrgyz Republic
| | - Harald Hoffmann
- Departments SYNLAB Gauting & IML red GmbH, WHO - Supranational Tuberculosis Reference Laboratory Munich-Gauting, Institute of Microbiology and Laboratory Medicine, Robert-Koch-Allee 2, D-82131, Gauting, Germany.,SYNLAB Gauting, SYNLAB Human Genetics, Munich, Germany
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Domínguez J, Latorre I, Santin M. Diagnóstico y abordaje terapéutico de la infección tuberculosa latente. Enferm Infecc Microbiol Clin 2018; 36:302-311. [DOI: 10.1016/j.eimc.2017.11.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 11/14/2017] [Accepted: 11/18/2017] [Indexed: 10/18/2022]
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Domínguez J, Latorre I, Santin M. Diagnosis and therapeutic approach of latent tuberculosis infection. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.eimce.2017.11.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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