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@#Abstract: Objective To explore the early diagnostic value of peripheral blood peroxisome proliferator-activated receptor γ (PPARγ) combined with γ-interferon (IFN-γ) release assay (IGRA) in the diagnosis of pulmonary tuberculosis in patients with end-stage renal disease (ESRD), and to provide reference for clinical diagnosis and treatment. Methods From January 2019 to December 2021, 70 ESRD patients with suspicious symptoms of pulmonary tuberculosis were treated at Hebei Chest Hospital were selected as the research objects. According to the examination results, they were divided into ESRD group (40 cases) and ESRD complicated by pulmonary tuberculosis (40 cases, comorbidity group). In addition, 40 cases with pulmonary tuberculosis were used as the PTB group. All three groups of patients underwent IGRA test, and the peripheral blood PPARγ level was detected by enzyme-linked immunosorbent assay, and the diagnostic value of PPARγ combined with IGRA test for ESRD patients with pulmonary tuberculosis was explored. Results The expression level of PPARγ and IFN-γ content in the PTB group and the comorbidity group were obviously higher than those in the ESRD group (P<0.05), while the differences in PPARγ expression level and IFN-γ content between the PTB and comorbidity groups were not statistically significant (P>0.05). The ROC curve showed that the areas under the curve (AUC) of PPARγ and IGRA in the diagnosis of end-stage renal disease combined with tuberculosis were 0.823 (95%CI: 0.722-0.925) and 0.773 (95%CI: 0.662-0.883), respectively, and the AUC of combined detection was 0.928 (95%CI: 0.871-0.984), which was better than that of PPARγ and IGRA alone (Z/P=2.057/0.039, 2.843/0.005). The Kappa values of serum PPARγ and IGRA test compared with the clinical gold standard results in the diagnosis of ESRD complicated with pulmonary tuberculosis were 0.557 and 0.444 (P<0.05). The combined screening of ESRD with pulmonary tuberculosis was consistent with the clinical gold standard (Kappa=0.661, P<0.05). Among the 30 ESRD patients complicated with pulmonary tuberculosis, the sensitivity of PPARγ combined with IGRA test in diagnosis of ESRD complicated with pulmonary tuberculosis was 93.33% (28/30), which was higher than 70.00% (21/30) of PPARγ and 66.67% (20/30) of IGRA test alone (P<0.05). Conclusions Peripheral blood PPARγ and IGRA tests have certain diagnostic value for ESRD complicated with tuberculosis, and the combined detection of the two can improve the sensitivity and reduce the rate of missed diagnosis, which is worthy of clinical promotion.
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Objective:To evaluate the influencing factors of inconsistency between γ-interferon release test QFT-GIT and etiological results in tuberculosis patients.Methods:The clinical data of 1 398 patients with positive Mycobacterium tuberculosis infection confirmed by pathogen culture after QFT-GIT test who were admitted to Hangzhou Chest Hospital Affiliated to Zhejiang University School of Medicine from September 2017 to August 2021 were retrospectively analyzed. There were 1 242 cases in whom both the pathogenic culture and QFT-GIT results were positive(consistent result group) and 156 cases in whom the QFT-GIT test results were negative or indeterminate(inconsistent result group). Logistic regression was used to analyze the influencing factors of inconsistent results between QFT-GIT and tuberculosis pathogenic tests. SPSS 25.0 software was used to analyze the data. Results:The overall incidence of inconsistency between QFT-GIT and tuberculosis etiological results was 11.16% (156/1 398). The incidence of inconsistency was 0, 7.09% (63/889) and 19.58% (93/475) in patients aged <18, 18-<65 and ≥65 years old, respectively; the incidence of inconsistency in age group ≥65 was higher than that in age groups <18 and 18-<65 ( χ2=6.584 and 36.762, P<0.01). Multivariate Logistic regression analysis showed that age ( OR=1.026, 95% CI 1.016-1.037), smoking ( OR=1.649, 95% CI 1.159-2.347), chronic liver disease ( OR=1.868, 95% CI 1.213-2.876), cardiovascular disease ( OR=2.353, 95% CI 1.361-4.069) and blood albumin level ( OR=0.956, 95% CI 0.928-0.985) were independent influencing factors for the inconsistency between the results of QFT-GIT and tuberculosis etiology. Conclusion:Patients with advanced age, smoking, chronic liver disease, cardiovascular disease and low albumin level are more likely to have inconsistent results between QFT-GIT and tuberculosis etiological tests.
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In view of the high burden of latency of tuberculosis (TB) in India, tackling latent TB in the right way is a menace. All latent TB’s infection (LTBI) are treated in countries having low burden such as the United States. However, this approach cannot be implemented in high burden countries like India until concrete evidence or consensus by experts on this subject is made. There are very specific risk groups where these patients are to be treated as far as current evidence-based medicine is concerned. Hence, the need to develop a document was felt, through which the treatment of LTBI becomes homogeneous by each and every physician who is practicing and treating TB. The last attempt to review the topic was made in 2015, after which there have been many changes and update in this subject.
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In order to eliminate tuberculosis worldwide by 2050, effective management of latent tuberculosis infection is essential, and policy-makers have begun to recognize the importance of scaling up preventive therapy. The current guideline recommends targeted latent tuberculosis infection testing that identifies high-risk groups based on risk stratification for progression from latent infection to active disease. Both the tuberculin skin test and interferon-gamma releasing assay have a similar diagnostic efficacy for predicting progression to active tuberculosis. The Korean guideline recommends 9-month isoniazid monotherapy as the standard treatment; however, more evidence supports that short course rifampicin-based regimen is both more effective and tolerable than isoniazid monotherapy.
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Diagnosis , Interferon-gamma , Interferon-gamma Release Tests , Isoniazid , Latent Tuberculosis , Skin Tests , Tuberculin , TuberculosisABSTRACT
Objective@#Ongoing transmission of tuberculosis (TB) continues in Indigenous communities in New South Wales (NSW), Australia. In a pilot project, a Public Health Unit TB team partnered with an Aboriginal Community Controlled Health Service (ACCHS) in a community with a cluster of TB to augment screening for latent TB infection (LTBI) using interferon-gamma release assay (IGRA). This study examined screening data and programme outcomes at 12 months post hoc to advise practice and policy formulation.@*Methods@#We conducted a retrospective, cross-sectional analysis of demographic and clinical data of ACCHS patients, stratified by IGRA testing status. Differences in sex and age distribution between the groups and cases of a genetically and epidemiologically linked TB cluster in Aboriginal people in NSW were assessed using non-parametric tests.@*Results@#Of 2019 Aboriginal and Torres Strait Islander people seen by general practitioners during the study period, 135 (6.7%) participated in the screening. Twenty-four (17.8%) participants were IGRA positive. One person was diagnosed with active TB. Twelve participants received a chest X-ray at the time of the positive test, and six participants had an additional chest X-ray within 12 months. None commenced preventive treatment for LTBI.@*Discussion@#ACCHS screening for LTBI reached individuals in the age group most commonly affected by TB in these Aboriginal communities. No conclusions can be made regarding the population prevalence due to the low screening rate. Further strategies need to be developed to increase appropriate follow-up and preventive treatment.
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Objective@#To explore the application value of interferon gamma release assay (IGRA) combined with tuberculin skin test (TST) in diagnosis of intraocular tuberculosis and latent tuberculosis infection.@*Methods@#One hundred and ten patients with pulmonary tuberculosis (observation group) and 80 healthy persons (control group) in Hebei Chest Hospital from January 2016 to December 2018 were selected. Among the 110 patients with pulmonary tuberculosis, intraocular tuberculosis was in 35 cases, and latent tuberculosis infection was in 75 cases. All the patients were examined by ocular secretions IGRA and TST.@*Results@#The positive rates of IGRA and TST in observation group were significantly higher than those in control group: 88.18% (97/110) vs. 11.25% (9/80) and 83.64% (92/110) vs. 41.25% (33/80), and there were statistical differences (χ2 = 113.138 and 36.971, P<0.01). The positive rate of IGRA in patients with intraocular tuberculosis was significantly higher than that in latent tuberculosis infection: 97.14% (34/35) vs. 84.00% (63/75), and there was statistical difference (χ2 = 3.955, P<0.05). There was no statistical difference in the positive rate of TST between the patients with intraocular tuberculosis and patients with latent tuberculosis infection: 91.43% (32/35) vs. 80.00% (60/75), χ2 = 2.277, P>0.05. The consistency rate of IGRA and TST was 89.90% (Kappa = 0.867, P>0.05). The sensitivity of IGRA combined with TST was significantly higher than the single detection of IGRA and TST (97.83% vs. 88.18% and 83.64%), while the specificity of IGRA combined with TST was significantly lower than the single detection of IGRA and TST (61.11% vs. 92.31% and 83.33%), and there were statistical differences (P<0.05). The receiver operating characteristic curve analysis result showed that the area under curve of IGRA in diagnosis of intraocular tuberculosis and latent tuberculosis infection was 0.781, area under curve of TST was 0.604, and area under curve of IGRA combined with TST was 0.679.@*Conclusions@#IGRA has high value in the diagnosis of intraocular tuberculosis and latent tuberculosis infection, and can be used as a diagnostic means of intraocular tuberculosis.
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Objective To explore the application value of interferon gamma release assay (IGRA) combined with tuberculin skin test (TST) in diagnosis of intraocular tuberculosis and latent tuberculosis infection. Methods One hundred and ten patients with pulmonary tuberculosis (observation group) and 80 healthy persons (control group) in Hebei Chest Hospital from January 2016 to December 2018 were selected. Among the 110 patients with pulmonary tuberculosis, intraocular tuberculosis was in 35 cases, and latent tuberculosis infection was in 75 cases. All the patients were examined by ocular secretions IGRA and TST. Results The positive rates of IGRA and TST in observation group were significantly higher than those in control group: 88.18% (97/110) vs. 11.25% (9/80) and 83.64% (92/110) vs. 41.25% (33/80), and there were statistical differences (χ2=113.138 and 36.971, P﹤0.01). The positive rate of IGRA in patients with intraocular tuberculosis was significantly higher than that in latent tuberculosis infection: 97.14% (34/35) vs. 84.00% (63/75), and there was statistical difference (χ2=3.955, P﹤0.05). There was no statistical difference in the positive rate of TST between the patients with intraocular tuberculosis and patients with latent tuberculosis infection: 91.43% (32/35) vs. 80.00% (60/75), χ2 = 2.277, P＞0.05. The consistency rate of IGRA and TST was 89.90% (Kappa=0.867, P＞0.05). The sensitivity of IGRA combined with TST was significantly higher than the single detection of IGRA and TST (97.83% vs. 88.18% and 83.64% ), while the specificity of IGRA combined with TST was significantly lower than the single detection of IGRA and TST (61.11% vs. 92.31% and 83.33% ), and there were statistical differences (P﹤0.05). The receiver operating characteristic curve analysis result showed that the area under curve of IGRA in diagnosis of intraocular tuberculosis and latent tuberculosis infection was 0.781, area under curve of TST was 0.604, and area under curve of IGRA combined with TST was 0.679. Conclusions IGRA has high value in the diagnosis of intraocular tuberculosis and latent tuberculosis infection, and can be used as a diagnostic means of intraocular tuberculosis.
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Background: Crohn's disease (CD) and intestinal tuberculosis (ITB) share similarities in disease manifestations, but their treatment methods are totally different. Thus, the differential diagnosis between CD and ITB is of great clinical importance. Aims: To investigate the significance of positive tuberculosis interferon-gamma release assay (TB-IGRA) in differential diagnosis and treatment of CD and ITB. Methods: Fifty-six consecutive patients with positive TB-IGRA and definite diagnosis of CD (n=23) or ITB (n=33) in the Tenth People's Hospital of Tongji University from Jan. 2015 to May 2018 were enrolled. All these patients have been proposed as CD at their first visit. The effects of TB-IGRA on diagnosis and treatment were analyzed. Results: ROC curve analysis demonstrated that the cut-off value, sensitivity and specificity of TB-IGRA for diagnosis of tuberculosis infection were 100 pg/mL, 88% and 74%, respectively. In patients with TB-IGRA≥100 pg/mL, 4 were CD and 29 were ITB, while in patients with TB-IGRA<100 pg/mL, 19 were CD and 4 were ITB (P<0.05); 75.0% (3/4) of the CD patients with TB-IGRA≥100 pg/mL and 5.3% (1/19) of the CD patients with TB-IGRA<100 pg/mL had a history of tuberculosis infection (P<0.05). Thirty-five patients received diagnostic anti-tuberculosis therapy, the efficacy of those with TB-IGRA≥100 pg/mL was significantly higher than those with TB-IGRA<100 pg/mL (96.2% vs. 22.2%, P<0.05). Conclusions: 100 pg/mL might be set as the cut-off value of TB-IGRA for differential diagnosis between CD and ITB. Diagnostic anti-tuberculosis therapy is preferred for patients with TB-IGRA≥100 pg/mL, while patients with TB-IGRA<100 pg/mL need comprehensive analysis. For patients with history of tuberculosis infection, false positive TB-IGRA is prone to occur.
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Objective: This study aimed to determine prevalence of latent tuberculosis infection among medical students and tuberculosis exposure at the health facilities. Methods: A cross-section of study year 1 (n=68) and year 5 (n=75) medical students in a local university were recruited for latent tuberculosis infection testing using QuantiFERON-TB Gold Plus and a questionnaire analyzed for multivariate risk. Results: The majority of the study were vaccinated with BCG. None of year 1 medical students were positive for latent tuberculosis infection, however, six (8.0%) year 5 students were tested positive for latent tuberculosis infection. A higher incidence of year 5 medical students claimed to be exposed to tuberculosis at health facility (65.3% vs. 4.4%) and a higher percentage reported contact with tuberculosis case over the preceding year compared to year 1 students (30.7% vs. 8.8%). Conclusion: We observed a higher incidence of latent tuberculosis infection and higher exposure to tuberculosis in health facilities among year 5 medical students. Baseline screening and monitoring for progression to tuberculosis infection may benefit tuberculosis management programs.
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Objective: This study aimed to determine prevalence of latent tuberculosis infection among medical students and tuberculosis exposure at the health facilities. Methods: A cross-section of study year 1 (n=68) and year 5 (n=75) medical students in a local university were recruited for latent tuberculosis infection testing using QuantiFERON-TB Gold Plus and a questionnaire analyzed for multivariate risk. Results: The majority of the study were vaccinated with BCG. None of year 1 medical students were positive for latent tuberculosis infection, however, six (8.0%) year 5 students were tested positive for latent tuberculosis infection. A higher incidence of year 5 medical students claimed to be exposed to tuberculosis at health facility (65.3% vs. 4.4%) and a higher percentage reported contact with tuberculosis case over the preceding year compared to year 1 students (30.7% vs. 8.8%). Conclusion: We observed a higher incidence of latent tuberculosis infection and higher exposure to tuberculosis in health facilities among year 5 medical students. Baseline screening and monitoring for progression to tuberculosis infection may benefit tuberculosis management programs.
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Objective To investigate the clinical diagnosis value of interferon gamma release assay (IGRA ) for pleural effusion in patients with tuberculous pleurisy .Methods 68 patients with tuberculous pleurisy (tu-berculous group) were included as object of study in Ganzi state people′s hospital ,and selected 70 patients with pneumonic pleurisy(pneumonia group) and 70 patients with malignancy (malignant group) as controls . Enzyme linked immunosorbent assay (ELISA) was used to detect interferon gamma release assay for tubercu-losis infected T cells (TB-IGRA ) in pleural effusion ,and were in progress blood TB-IGRA for tuberculous group .Results The IFN-γ level of patients in tuberculous group[179 .3(158 .1 -276 .2)ng/L] was higher than that those in pneumonia group[86 .7(55 .1 -162 .2)ng/L] and malignant group[92 .7(48 .1 -178 .3) ng/L] ,the difference was statistically significant (P＜0 .05) .The IFN-γ level of TB-IGRA for blood was low-er than that TB-IGRA for pleural effusion ,the difference was statistically significant (P＝0 .012) .The sensi-tivity ,specificity ,positive predictive value ,and negative predictive value of TB-IGRA for pleural effusion high-er than that blood TB-IGRA ,the difference was statistically significant (P＜0 .05) .The AUC of TB-IGRA for pleural effusion was higher than that blood TB-IGRA .Conclusion TB-IGRA for pleural effusion is an impor-tant laboratory index for the diagnosis of tuberculous pleurisy ,and its diagnostic efficiency is higher than that of blood TB-IGRA .
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@#In May 2012, a teacher of a nursing school with about 300 staff members and students in Japan was diagnosed with sputum smear-positive pulmonary tuberculosis (TB), leading to an investigation involving nearly 300 contacts. We describe the contacts’ closeness to the index TB patient and the likelihood of TB infection and disease. A case of TB was defined as an individual with positive bacteriological tests or by a physician diagnosis of TB. A latent TB infection (LTBI) case was defined as an individual who had a positive interferon-gamma release assay (IGRA). A total of 283 persons screened with IGRA were analysed. Eight persons (2.8%, 95% confidence interval [CI]: 1.2–5.4) tested positive by IGRA; one student who had intermediate (less than 10 hours) contact with the index patient was found to have pulmonary TB by chest X-ray. The positivity in IGRA among staff members with very close contact with the index patient (4 of 21, 19%, 95% CI: 5.4–42%) with a statistically significant relative risk of 17 (95% CI: 2.0–140) was high compared with that of the intermediate contacts (1 of 88, 1.1% [95% CI: 0.028–6.2]). There was a statistically significant trend in the risk of TB infection and closeness with the index patient among the staff members and students (P < 0.00022). In congregate settings such as schools, the scope of contact investigation may have to be expanded to detect a TB case among those who had brief contact with the index patient.
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Objective To screen and validate the major histocompatibility complex class-Ⅰ(MHC-Ⅰ) restricted tuberculosis peptides as potential diagnostic reagents in tuberculosis interferon-gamma release assay (IGRA) used among human immunodeficiency (HIV)-infected population.Methods Candidate peptides were encoded by Mycobacterium tuberculosis (TB) RD (Region of difference).Computer software was used to predict and select CD8+ T cell epitopes restricted by MHC-Ⅰ molecules with high frequency and high affinity among HIV-infected people.Then peptides containing CD8+ T cell epitope were synthesized and screened in vitro.The sensitivity and specificity of IGRA using the above mixed peptides as stimulants were compared with those of IGRA using early secretory antigen target-6 (ESAT-6,molecular weight of 6 000) and culture filtrate protein-10 (CFP-10,molecular weight of 10 000) as stimulants among HIV-infected population.Results Eight overlapping peptides,including Rv0222176-191,Rv1980c122-138,Rv1985c105-120,Rv3425141-165,Rv3873133-151,Rv3873158-166,Rv387878-86,Rv3879c673-690,were obtained finally,which were able to stimulate the production of interferon-gamma from peripheral CD8+ T cells of tuberculosis patients,but not from peripheral blood mononuclear cells (PBMC) of healthy controls.Among the 25 patients with HIV/TB co-infection,the sensitivities of IGRA using the combination peptides (CP) and that using rESAT-6/CFP-10 (CE) were low (68％ vs 48％,x2 =2.052,P=0.152).However,the sensitivity increased to 92％ by using the combination of CP and CE,which was significantly higher than that using rESAT-6/CFP-10 alone (x2 =11.523,P ＜ 0.01),and the specificity was not affected.Conclusion These RD peptides with CD8+ T cell epitopes can increase the sensitivity of IGRA in detecting HIV/TB co-infection,which may improve the detection rate of tuberculosis in HIV infected population.
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@#Latent TB infection (LTBI) is defined as a state of persistent immune response to stimulation by M. tuberculosis antigens without evidence of clinically manifested active TB. Current methods for LTBI detection are the tuberculin skin test (TST) and the interferon-gamma release assays (IGRAs). Both these tests indicate prior host immunosensitisation to M. tuberculosis antigens and do not provide information regarding viability of the organism within the host. Around 10 percent of immunocompetent adults with LTBI develop active TB in their lifetime: of these, approximately half (i.e. 5%) develop disease within 2 to 5 years of acquiring the infection. The risk of progression of LTBI to active TB disease is increased in HIV/AIDs, in very young children, and in persons with solid and haematological transplant, end-stage renal failure on haemodialysis, silicosis, head and neck malignancies, and diabetes. Isoniazid preventive therapy has been shown to reduce the risk of developing active TB by 60–90 percent. However, it is associated with a risk of hepatoxicity, which increases with age. It is recommended that LTBI testing be targeted at groups/persons with a high risk of progression to active disease (e.g. close contacts, those with HIV infection) and/or for whom the benefit of PT outweighs the risk of hepatotoxicity.
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Objective To compare the sensitivity and specificity of interferon-gamma release assay(IGRA) in the Tibetan and Han patients with pulmonary tuberculosis(TB),and to investigate its clinical application value for screening Tibetan patients with pulmonary TB.Methods Sixty-four Tibetan cases of pulmonary TB,41 Tibetan cases of non-pulmonary TB,40 Han cases of pulmonary TB and 38 Han cases of non-pulmonary-TB in our hospital from April 2013 to April 2015 were selected and performed IGRA.T cells infected by mycobacterium tuberculosis were detected by ELISA.The difference between Tibetan abd Han nationalities was compared.The clinical value of IGRAfor screening Tibetan patients with pulmonary TB was evaluated by calculating the statistical indicators.Results The sensitivity,specificity,positive predictive value and negative predictive value of IGRA for diagnosing Tibetan pulmonary TB were 90.62%(58/64),80.49%(33/41),87.88%(58/66) and 84.62%(33/39) respectively,which for diagnosing Han patients with pulmonary TB were 92.50%(37/40),84.21%(32/38),86.05%(37/43) and 91.43%(32/35) respectively.The sensitivity and specificity of IGRA for diagnosing Tibetan and Han pulmonary TB had no statistical difference(χ2=0.005,P=0.944;χ2=0.018,P=0.893).Conclusion IGRA has high value for early diagnosis of Tibetan pulmonaty TB and is conducive to screening of early pulmonary TB.
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Introduction Although the incidence of tuberculosis (TB) in Japan has been decreasing yearly, Japan remains ranked as an intermediate-burden country for TB. Objective This study aims to investigate the current situation of head and neck extrapulmonary TB (EPTB) diagnosed in our department. Methods We retrospectively reviewed the clinical records of 47 patients diagnosed with EPTB in the head and neck in our department between January 2005 and December 2014. The extracted data included sex and age distribution, development site, chief complaint, presence or absence of concomitant active pulmonary TB (PTB) or history of TB, tuberculin skin test (TST) results, interferon-gamma release assay (IGRA) results, and duration from the first visit to the final diagnosis of EPTB. Results The subjects consisted of 20 men and 27 women, and age ranged from 6 to 84 years. The most common site was the cervical lymph nodes (30 patients), with the supraclavicular nodes being the most commonly affected (60%). Histopathological examination was performed on 28 patients. TST was positive in 9 out of 9 patients and the IGRA was positive in 18 out of 19 patients. We observed concomitant PTB in 15 out of the 47 patients. Mean duration from the first visit to the final diagnosis of EPTB was 56 days. Conclusion The clinical symptoms of TB, especially those in the head and neck region, are varied. Otolaryngologists should be especially aware of the extrapulmonary manifestations of TB to ensure early diagnosis and treatment from the public health viewpoint.
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Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Ear, Middle , Larynx , Lymph Nodes , Tuberculosis , Interferon-gamma , Polymerase Chain ReactionABSTRACT
PURPOSE: This study aimed to describe the results of a contact investigation on health care workers after exposure to a house officer with smear-positive pulmonary tuberculosis (TB). METHODS: Eighty nine out of 101 subjects who had close contact with the index patient agreed to be enrolled in the investigation. The first contact investigation was conducted approximately 30 days after the index patient's onset of symptoms, followed by the second investigation after 10 weeks. In both, clinical manifestations were studied, and chest X-ray and tuberculin skin test (TST)/QuantiFERON-TB Gold (QFT-G) in dual screening strategy were conducted. RESULTS: The first TST resulted in positive in 34 subjects (38.2%). QFT-G was conducted on 16 subjects who tested positive in the first TST and aged under 36. Six of them (37.5%) were positive. The second TST was conducted on 41 subjects with negative results in the first TST. Seventeen (41.5%) were positive and among them, three (17.6%) showed positive QFT-G. None of the subjects were diagnosed with active TB. The probability of TB infection through contact with the index patient was 7.3% (3/41) in dual screening strategy while it was 41.5% (17/41) in TST strategy. CONCLUSIONS: This first hospital-setting contact investigation for tuberculosis in Korea revealed that latent tuberculosis infection (LTBI) rates vary depending on different diagnostic strategies. This indicates the need for systematic guidelines for diagnosing LTBI in health care workers who have professional exposure to TB.
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Humans , Delivery of Health Care , Interferon-gamma Release Tests , Korea , Latent Tuberculosis , Mass Screening , Skin Tests , Thorax , Tuberculin , Tuberculosis , Tuberculosis, PulmonaryABSTRACT
Objective To evaluate the diagnostic value of T-cell enzyme-linked immunosorbent spot assay (T-SPOT.TB) using both pleural effusion and peripheral blood in tuberculous pleurisy.Methods One hundred and two cases of in patients with pleural effusion treated in Anhui Chest Hospital from January 2014 to October 2015 were enrolled in this study.T-SPOT.TB was performed using both serous effusion mononuclear cells (SEMC) and peripheral blood mononuclear cells (PBMC),and the diagnostic sensitivity and specificity were calculated.Chi square test was used for categorical variables and MannWhitney U test was used for continuous variables in non-normal distribution.Results Of the 102 participants,71 (69.61 ％) were microbiologically or clinically diagnosed with tuberculous pleurisy and 31 (30.39 ％) were diagnosed with other diseases.In tuberculous pleurisy group,the median spot forming cells (SFC) of T-SPOT.TB for early secretory antigenic target 6 (ESAT-6) and culture filtrate protein 10 (CFP-10) using SEMC were 159/2.5 × 105 (120/2.5 × 105-200/2.5× 105) and 160/2.5 × 105 (110/2.5 × 105-210/2.5 × 105),respectively;and the median SFC of T-SPOT.TB using PBMC were 30/2.5×105 (15/2.5×105-55/2.5×105) and 40/2.5×105(8/2.5×105-87/2.5 ×105),respectively.The SFC counts of SEMC were obviously higher than those of PBMC,and differences were statistically significant (for ESAT-6,Z=-7.818;for CFP-10,Z=-7.120,both P＜0.05).The ROC curve analysis showed that using a cut-off value of 38 SFC per 2.5 × 105 SEMC,the area under the curve is 0.969.The sensitivity and specificity of T-SPOT.TB using PBMC were 90.14％ and 77.42％,respectively;and those of T-SPOT.TB using SEMC were 95.77％ and 93.55％,respectively.When combined the T-SPOT.TB assay using both PBMC (≥6 spots) and SEMC (≥38 spots),the sensitivity and specificity were 90.14％ and 96.77％,respectively.Conclusion The joint detection of T-SPOT.TB using both PBMC and SEMC can be an effective diagnostic method for tuberculous pleurisy.
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PURPOSE: Latent tuberculosis infection (LTBI) in young children may progress to severe active tuberculosis (TB) disease and serve as a reservoir for future transmission of TB disease. There are limited data on interferon-γ release assay (IGRA) performance in young children, which our research aims to address by investigating the usefulness of IGRA for the diagnosis of LTBI. METHODS: We performed a tuberculin skin test (TST) and IGRA on children who were younger than 18 years and were admitted to Chung-Ang University Hospital during May 2011-June 2015. Blood samples for IGRA were collected, processed, and interpreted according to manufacturer protocol. RESULTS: Among 149 children, 31 (20.8%) and 10 (6.7%) were diagnosed with LTBI and active pulmonary TB, respectively. In subjects lacking contact history with active TB patients, TST and IGRA results were positive in 41.4% (29 of 70) and 12.9% (9 of 70) subjects, respectively. The agreement (kappa) of TST and IGRA was 0.123. The control group, consisting of non-TB-infected subjects, showed no correlation between age and changes in interferon-γ concentration after nil antigen, TB-specific antigen, or mitogen stimulation in IGRAs (P=0.384, P=0.176, and P=0.077, respectively). In serial IGRAs, interferon-γ response to TB antigen increased in IGRA-positive LTBI subjects, but did not change considerably in initially IGRA-negative LTBI or control subjects. CONCLUSION: The lack of decrease in interferon-γ response in young children indicates that IGRA could be considered for this age group. Serial IGRA tests might accurately diagnose LTBI in children lacking contact history with active TB patients.
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Child , Humans , Diagnosis , Interferon-gamma Release Tests , Latent Tuberculosis , Skin Tests , Tuberculin , TuberculosisABSTRACT
Tuberculosis (TB) is one of the most important occupational risks for healthcare workers (HCWs) in South Korea. Many policies regarding the control and prevention of TB in healthcare settings recommend that HCWs are tested for latent tuberculosis infection (LTBI) in addition to active TB. Moreover, the Korean Tuberculosis Prevention Act also recommends that HCWs receive regular testing for LTBI. However, there are no specific or detailed guidelines for dealing with LTBI in HCWs. Herein, we discuss the diagnosis and treatment of LTBI in HCWs and focus particularly on the baseline screening of hired HCWs, routine follow-up, and contact investigation.