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@#Abstract: Objective To explore the relationship between peripheral blood and pleural effusion tuberculosis (TB) infection effector T cells, and to further evaluate the value of combined pleural effusion adenosine deaminase (ADA) for rapid diagnosis of tuberculous pleurisy. Methods The test data of 80 cases of tuberculous pleurisy and 70 cases of nontuberculous pleurisy treated in the Sixth People's Hospital of Nantong City from January 2017 to December 2020 were analyzed. The TBinfected effector T cells were also detected simultaneously in the peripheral blood and the pleural effusion by the T-SPOT technique, and the pleural effusion ADA was detected by the rate method. The subject operating characteristic curve (ROC) was applied to take the optimal pleural effusion ADA threshold to compare the sensitivity and specificity of different critical values. Person phase analysis was applied to analyze the correlation between peripheral blood and pleural effusion T-SPOT.TB. Data of peripheral blood, pleural effusion T-SPOT.TB and ADA were integrated. Results When pleural effusion ADA>45 U/L, the sensitivity and specificity for the diagnosis of tuberculous pleurisy were 50.0% and 94.3%, respectively; when ADA > 25.15 U/ L, the sensitivity and specificity were 80.0% and 72.9%. When ADA > 45 U / L, pleural/ blood T-SPOT.TB spot ratio (spot forming cells, SFCs) > 2 times, the specificity for the diagnosis of tuberculous pleurisy was 100% (highest); when 25.15 U/L< pleural effusion ADA ≤ 45 U/L, pleural/blood T-SPOT.TB spot ratio > 2 times, the specificity for the diagnosis of tuberculous pleurisy was 92.3% (second). When pleural effusion ADA ≤ 25.15 U/L, and the pleural effusion/blood T-SPOT.TB spot number ratio > 2 times, with 83.3% specificity (the lowest of the three groups). Conclusions The level of pleural effusion ADA is one of the most used methods for diagnosing tuberculous pleurisy. Further combination of pleural effusion and blood T-SPOT.TB, if the ratio of pleural effusion / blood T-SPOT. TB spots is greater than 2 times, it can further improve the diagnosis rate of tuberculous pleurisy.
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Objective:To investigate the risk and temporal characteristics of tuberculosis (TB) in persons with latent tuberculosis infection (LTBI) among close contacts of TB patients in Shanghai.Methods:This was a prospective observational study, the study subjects were the close contacts of TB patients who tested positive for Mycobacterium tuberculosis infection by T-cell spot test of tuberculosis infection (T-SPOT.TB) among the registered population in seven districts of Shanghai from 2009 to 2010. Questionnaire interview was applied to investigate the basic information and contact history.The LTBI cases during nine consecutive years were identified through the TB registration and reporting system.Cumulative incidence rate and incidence density of TB in tuberculosis-infected close contacts were estimated. Chi-square test was used to compare the incidence rate among different sex and age groups. Results:In total, 376 pulmonary TB patients and their 982 close contacts were enrolled in the baseline survey from 2009 to 2010. Of them, 287 close contacts were tested positive for Mycobacterium tuberculosis infection by T-SPOT.TB.The median age of persons with LTBI at the time of survey was 54 years old, and 36.6%(105/287) were male. By the end of December 2019, five new TB cases were detected among the 287 close contacts with LTBI. The two-year and five-year cumulative incidence were 0.35% and 1.05%, respectively. The nine-year cumulative incidence was 1.74%(95% confidence interval 0.57%-4.02%). The median duration for TB occurrence was 3.67 years. The incidence density of TB was 1.875/1 000 person-years with a total of 2 666.75 observation person-years. There were no significant differences in the nine-year cumulative incidence of TB among close contacts with LTBI by age and sex ( χ2=0.600, <0.001, respectively, both P>0.05). Conclusion:The occurrence of TB among close contacts with LTBI is concentrated in the first five years after TB contact.
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To evaluate the performance of interferon gamma release assays and tuberculin skin test in Bacillus Calmette-Guerin vaccinated young children. Methods: A cross-sectional study was conducted in healthy children younger than 5 years who were recently diagnosed with tuberculosis or had recent exposure to active tuberculosis. QuantiFERON-TB Gold, T-SPOT.TB and tuberculin skin test were performed in each patient. Results: Of the 60 children, median age 3.3 years, 17 had tuberculosis and 43 had recent tuberculosis exposure. Overall, 15 (25.0%) children had tuberculin skin test reaction =10 mm; 8 (13.3%) were positive by QuantiFERON-TB Gold In-Tube test, and 12 (20.0%) by T-SPOT.TB. Nineteen (31.7%) children had at least one positive test. There was a moderate agreement between interferon gamma release assays and tuberculin skin test. Conclusions: The positive rates of interferon gamma release assays and tuberculin skin test were low in young children who were infected with tuberculosis, supporting the management strategy of not testing children younger than 5 years. (IGRA) do not react to BCG and most NTM[2], are preferred to TST in older children and adults[3], but may be less reactive in young children with immature T-cell function. Due to the limited knowledge of IGRA in BCG-vaccinated young children, we evaluated the performance and correlation of IGRA tests and TST in young children in a high TB burden setting who received BCG vaccination at birth and recently diagnosed with LTBI, or with active TB.
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As a new immunoassay,T-SPOT.TB has been widely used in the diagnosis of tuberculosis in children.A large number of clinical trials show that it has better sensitivity and specificity simultaneously,compared with other diagnostic methods for tuberculosis in children.This article focuses on the principle,influence factors and specific applieation,and reviews advances in other body fluids except blood of T-SPOT.TB.
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To evaluate the performance of interferon gamma release assays and tuberculin skin test in Bacillus Calmette-Guerin vaccinated young children. Methods: A cross-sectional study was conducted in healthy children younger than 5 years who were recently diagnosed with tuberculosis or had recent exposure to active tuberculosis. QuantiFERON-TB Gold, T-SPOT.TB and tuberculin skin test were performed in each patient. Results: Of the 60 children, median age 3.3 years, 17 had tuberculosis and 43 had recent tuberculosis exposure. Overall, 15 (25.0%) children had tuberculin skin test reaction =10 mm; 8 (13.3%) were positive by QuantiFERON-TB Gold In-Tube test, and 12 (20.0%) by T-SPOT.TB. Nineteen (31.7%) children had at least one positive test. There was a moderate agreement between interferon gamma release assays and tuberculin skin test. Conclusions: The positive rates of interferon gamma release assays and tuberculin skin test were low in young children who were infected with tuberculosis, supporting the management strategy of not testing children younger than 5 years. (IGRA) do not react to BCG and most NTM[2], are preferred to TST in older children and adults[3], but may be less reactive in young children with immature T-cell function. Due to the limited knowledge of IGRA in BCG-vaccinated young children, we evaluated the performance and correlation of IGRA tests and TST in young children in a high TB burden setting who received BCG vaccination at birth and recently diagnosed with LTBI, or with active TB.
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BACKGROUND: Latent tuberculosis infection is a condition where there is a persistent immune response to Mycobacterium tuberculosis without clinical manifestations of tuberculosis. Currently, there is no gold standard to diagnose latent tuberculosis infection. The tuberculin skin test and interferon-gamma release assay are currently used to diagnose latent tuberculosis infection. However, studies have shown inconsistencies regarding the level of agreement between these tests in different settings. In this study, we aimed to evaluate the agreement between these two tests for diagnosing latent tuberculosis infection in human immunodeficiency virus (HIV)-infected individuals. METHODS: We screened HIV patients with no clinical symptoms of tuberculosis, a normal chest X-ray, and no history of tuberculosis or use of antituberculous drugs. Participants were tested with tuberculin skin test (TST) and T-SPOT.TB (an interferon gamma release assay) simultaneously. Participants' HIV stage was determined by measuring the level of CD4+ T-lymphocytes. Tuberculosis status was confirmed by sputum examination using GeneXpert. The level of agreement between the TST and T-SPOT.TB results was measured using Cohen's κ coefficient. RESULTS: Of the 112 participants, 20 had a positive T-SPOT.TB test result, and 21 had a positive TST result. The TST and T-SPOT.TB test results showed a high level of agreement (κ = 0.648, P < 0.001). Performance of the tests did not vary with CD4+ level. However, in participants with CD4+ < 200 cells/mm³, T-SPOT.TB detected more latent tuberculosis infections than the TST. CONCLUSION: There was good agreement between the TST and T-SPOT.TB results of latent tuberculosis infection in participants. TST is the preferred test for diagnosing latent tuberculosis infection in HIV-infected patients, especially in resource-limited settings, because it is simple and cost-effective. However, T-SPOT.TB may be useful to rule out latent tuberculosis infection in patients with severe immunodeficiency.
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Humans , HIV , Indonesia , Interferon-gamma Release Tests , Interferons , Latent Tuberculosis , Mycobacterium tuberculosis , Skin Tests , Skin , Sputum , T-Lymphocytes , Thorax , Tuberculin , TuberculosisABSTRACT
Objective@#To analyze and summarize the clinical characteristics of tubercular lymphadenitis, and to improve the ability of diagnosis. @*Methods@#Clinical records of 129 patients first confirmed with tubercular lymphadenitis were collected retrospectively from Nanfang Hospital of Southern Medical University between January 2012 and December 2016. The categorical variables were described with the percentage (%) and compared with the chi-squaue test. Non-normal distribution data were described with M(P25, P75) and compared with rank sum test.@*Results@#The disease courses were different in all cases, mostly of 1-3 months (45.7%). Among the cases, 83 cases (73.6%) complained of lymph node enlargement. The predominant involved lymph node site was cervical (56.6%) with main presentation of single lymph node (61.2%). Only a few cases presented with fever (34.1%). The positive rate of histological examinations was 94.3%, while the positive rate of T cell spot test of tuberculosis infection (T-SPOT.TB) test was 93.3% and purified protein derivative (PPD) test was 69.6%. In the diagnosis of tubercular lymphadenitis, 100 cases (77.5%) were confirmed by histological examinations, 27 cases (20.9%) were given diagnostic treatment, and only 2 case (1.6%) was confirmed by culture. The average period of diagnosis was (10.4±6.5) days. The median age of patients with fever was 50.5 years old with a median disease course of 2.5 months, while the median age of patients fever was 35(24, 49) years old with a median disease course of 1.2(0.5, 6.0) months. The differences between two groups were statistically significant (Z=-3.118 and -2.982, respectively, both P<0.05). Patients with fever had higher proportion of swollen deep lymph nodes (54.5% vs 11.8%), elevated white blood cell counts (34.1% vs 7.1%) and neutrophils (31.8% vs 1.8%), elevated erythrocyte sedimentation rate (97.1% vs 56.1%), elevated C-reactive protein (95.0% vs 40.0%) and received diagnostic treatment (47.7% vs 7.1%) than patients with no fever (χ2=27.337, 15.545, 13.567, 19.347, 25.410 and 28.974, respectively, all P<0.05). @*Conclusions@#Most patients of tubercular lymphadenitis do not present with typical symptoms which might lead to misdiagnose in early stage. The histological examinations and T-SPOT.TB test are especially essential, and histological examinations is the most important diagnostic method. Patients without symptoms of tuberculous poisoning are more common in young people, and the confirmation of diagnosis are mainly based on histological examinations. Patients with symptoms of tuberculous poisoning are more common in middle-aged, with longer duration and deep lymph node involved, which is more serious and nearly half of which are confirmed with diagnostic treatment.
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Objective@#To evaluate the value of T cell spot test of tuberculosis infection(T-SPOT.TB) and inflammatory indicators for diagnosis of active tuberculosis in patients with fever of unknown origin (FUO). @*Methods@#Patients with FUO in Tongji Hospital from Jan 1st 2014 to Feb 28th 2015 were retrospectively enrolled, and general condition, laboratory examination including T-SPOT.TB, blood routine test, procalcitonin (PCT), high sensitivity C-reactive protein (hs-CRP), erythrocyte sedimentation rate (ESR), lactate dehydrogenase (LDH), serum ferritin (SF) and final diagnosis were collected and analyzed. @*Results@#A total of 395 hospitalized patients with FUO were retrospectively enrolled into this study, among which there were 36 (9.11%) confirmed active tuberculosis (including 7 pulmonary cases and 29 extra-pulmonary cases), 189 (47.85%) bacterial infections, 50 (12.66%) viral infections, 4 (6.32%) fungal infections, 20 (5.06%) neoplastic diseases, 51(12.91%) autoimmune diseases, 25 (6.32%) other diseases. While 20 (5.06%) patients remained un-diagnosed. The sensitivity of T-SPOT.TB for the diagnosis of active TB in patients with FUO was 80.56% (95%CI: 63.43%-91.20%), and the specificity was 83.57% (95%CI: 79.23%-87.16%). The positive predictive value was 32.95% (95%CI: 23.52%-43.89%), and the negative predictive value was 97.72% (95%CI: 95.16%-99.00%). There were significant differences in positive LDH levels (187[141, 255] U/L vs 209[160, 343] U/L) and SF levels (296.2[191.3, 494.8] g/L vs 528.1[281.1, 1 022.0] μg/L) between active tuberculosis group and bacterial infection group (χ2=77.692, H=13.442, H=16.142, all P<0.05). The combination of T-SPOT.TB and multiple inflammatory indicators obtained most valuable efficiency (AUC=0.866) for TB diagnosis. Similarly, there were significant differences in positive ESR (31[15, 78] mm/1 h vs 10[6, 19] mm/1 h), ratio of neutrophil granulocytes ([71.17±12.59]% vs [57.08±20.38]%) between active tuberculosis group and viral infection group (H=32.797, F=6.171, all P<0.05). The combination acquired most valuable efficiency (AUC=0.929). @*Conclusions@#For patients with FUO, T-SPOT.TB combined with inflammatory indicators are valuable for the diagnosis of active tuberculosis.
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Objective To investigate the treatment evaluating value of ESAT－6 and CFP－10 in T－SPOT.TB kit for tuberculous vertebral osteomyelitis.Medthods This retrospective study analyzed 29 cases diagnosed as TVO in the First Affiliated Hospital of Kunming Medical University from January 2013 to January 2016. All cases were the first－time consultancy. The Wilcoxon－singed－rank－test and chi－square test were used to analyze the changes of ESAT－6 and CFP－10 in the procedure of treatment. The linear－regression analysis was used to analyze the relationship between ESR, CRP, VAS and two specific antigens.Results The pretherapeutic spot counts of ESAT－6 and CFP－10 were compared with the first and the last follow－up respectively. The results of two antigenic spots change showed a higher consistency (P＜0.05) .The positive rates of CFP－10 at the prior treatment, the first follow－up and the last follow－up were 86.20% , 79.31% and 58.62% respectively. The result of chi－square test showed a higher consistency (P＜0.05) . ESAT－6 only correlated with VAS. CFP－10 had the relationship with VAS and ESR. But all of these relativities were weak.Conclusion The decrease in the spot counts of ESAT－6 and CFP－10 suggest that the treatment is effective,and CFP－10 may be one available index to evaluate the treatment effect.
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Objective To evaluate the diagnostic value of interferon-γ release assay of blood and pleural effusion for tuberculous pleurisy.Methods Fifty-six adult patients with suspected tuberculous pleurisy were enrolled in our study.The blood and pleural effusion interferon-γ release assay were measured by T-SPOT.TB test in 38 pleural tuberculosis patients and 18 nontuberculous pleurisy controls.The diagnostic sensitivity,specificity,predictive value of T-SPOT.TB in pleural effusion mononuclear cells (PE-MC) and peripheral mononuclear cells (PBMC) were analyzed.Results The sensitivities and specificities,positive predictive values and negative predictive values,respectively,of the PE-MC and PBMC for diagnosing were as follows:86.5％(95％ confidence interval[CI] 71.2％-95.5％) and 100％(95％CI 90.5％-100％);52.9％(95％CI 27.8％-77.0％) and 35.3％(95％CI 14.2％-61.7％);80.0％(95％CI 64.4％-90.9％) and 77.1％(95％CI 62.7％-88.0％);64.3％(95％CI 35.1％-87.2％) and 100％(95％CI 54.1％-100％).By ROC curve analysis,a cut-off value of 47SFC/2.5 × 105 cells in PE-MC showed a sensitivity of 89.2％ and a specificity of 88.2％.Conclusion T-SPOT.TB in PE-MC could be an accurate diagnostic method for tuberculous pleurisy in TB endemic settings.Moreover,47SFC/2.5 × 105 cells might be the optimal cut-off value for diagnosing tuberculous pleurisy.
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Objective To analyze the application value of T-SPOT .TB and PPD test in the diagnosis of bone and joint tuberculo-sis .Methods A total of 94 patients with tuberculosis of the bone and joint receiving surgery or conservative treatment from January 2014 to August 2016 were collected in this study ,50 patients with osteoarthritistreated by surgical treatment of bone surgery were recruited as objects too .All the objects received T-SPOT .TB and PPD test ,and the diagnosis value were compared .Results The diagnostic sensitivity ,specificity ,positive predictive value ,negative predictive value and accuracy of PPD test were 46 .81% , 98 .00% ,97 .78% ,49 .49% ,64 .58% ,those of T-SPOT .TB were 93 .62% ,100% ,100% ,89 .29% ,95 .83% .The sensitivity ,nega-tive predictive value and the coincidence rate of PPD test were less than those of T-SPOT .TB and joint test ,the differences were statistically significant(P<0 .05) ,T-SPOT .TB ,combined with the diagnostic sensitivity ,specificity ,positive predictive value ,nega-tive predictive value ,with rate no significant difference(P>0 .05) .Six cases were misdiagnosed by T-SPOT .TB ,they were all in the early stage of spinal tuberculosis ,showed cavities ,but no spinal nerve defect .One cases were erroneous diagnosis ,while 50 cases were misdiagnosed by PPD test ,all the symptoms of misdiagnosed patients were relatively mild ,with rheumatoid arthritis and other autoimmune diseases .Conclusion T-SPOT .TB is an ideal method for diagnosis of bone and joint tuberculosis ,but present interfer-ence factors ,the operation of PPD testis simply ,but lack of sensitivity ,however it has certain value in screening .
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Objective To evaluate the clinical value of T-SPOT.TB in the diagnosis of tuberculous pleu-risy. Methods A total of 180 cases of hospitalized patients with pleural effusion ( hospitalized between January 2013 to January 2015)were enrolled. Efficiency of T-SPOT.TB in the diagnosis of tuberculosis was evaluated and the effects of immune state on the number of spot forming cells were analyzed. Results The sensitivity and speci-ficity of the T-SPOT.TB in diagnosis of tuberculous pleural effusion were 82.24％(88/107)and 72.60％(53/73). The sensitivity and specificity of the T-SPOT.TB in immunocompromised patients were72.73％(40/55) and 52.63％(20/38).The sensitivity and specificity of the T-SPOT.TB in non-immunocompromised were 92.31％(48/52) and 94.29％(33/35).The sensitivity and specificity of those in non-immunocompromised were significantly higher than those in immunocompromised. ESAT-6 and CFP-10 specific SFCs of immunocompromised patients de-creased significantly compared with non-immunocompromised(Z is -26.817 and-43.756,P<0.05 ). Conclusion T-SPOT.TB has high sensitivity ,specificity in the diagnosis of tuberculous pleurisy.T-SPOT.TB and is a promising clinical test in the diagnosis of non-immunocompromised with suspected TB ,but its diagnostic performance in im-munocompromised patients is reduced compared with in non-immunocompromised patients.
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Objective To analyze the application value of T-SPOT .TB and PPD test in the diagnosis of bone and joint tuberculo-sis .Methods A total of 94 patients with tuberculosis of the bone and joint receiving surgery or conservative treatment from January 2014 to August 2016 were collected in this study ,50 patients with osteoarthritistreated by surgical treatment of bone surgery were recruited as objects too .All the objects received T-SPOT .TB and PPD test ,and the diagnosis value were compared .Results The diagnostic sensitivity ,specificity ,positive predictive value ,negative predictive value and accuracy of PPD test were 46 .81% , 98 .00% ,97 .78% ,49 .49% ,64 .58% ,those of T-SPOT .TB were 93 .62% ,100% ,100% ,89 .29% ,95 .83% .The sensitivity ,nega-tive predictive value and the coincidence rate of PPD test were less than those of T-SPOT .TB and joint test ,the differences were statistically significant(P<0 .05) ,T-SPOT .TB ,combined with the diagnostic sensitivity ,specificity ,positive predictive value ,nega-tive predictive value ,with rate no significant difference(P>0 .05) .Six cases were misdiagnosed by T-SPOT .TB ,they were all in the early stage of spinal tuberculosis ,showed cavities ,but no spinal nerve defect .One cases were erroneous diagnosis ,while 50 cases were misdiagnosed by PPD test ,all the symptoms of misdiagnosed patients were relatively mild ,with rheumatoid arthritis and other autoimmune diseases .Conclusion T-SPOT .TB is an ideal method for diagnosis of bone and joint tuberculosis ,but present interfer-ence factors ,the operation of PPD testis simply ,but lack of sensitivity ,however it has certain value in screening .
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Objective To evaluate the clinical value of T-SPOT.TB in the diagnosis of tuberculous pleu-risy. Methods A total of 180 cases of hospitalized patients with pleural effusion ( hospitalized between January 2013 to January 2015)were enrolled. Efficiency of T-SPOT.TB in the diagnosis of tuberculosis was evaluated and the effects of immune state on the number of spot forming cells were analyzed. Results The sensitivity and speci-ficity of the T-SPOT.TB in diagnosis of tuberculous pleural effusion were 82.24％(88/107)and 72.60％(53/73). The sensitivity and specificity of the T-SPOT.TB in immunocompromised patients were72.73％(40/55) and 52.63％(20/38).The sensitivity and specificity of the T-SPOT.TB in non-immunocompromised were 92.31％(48/52) and 94.29％(33/35).The sensitivity and specificity of those in non-immunocompromised were significantly higher than those in immunocompromised. ESAT-6 and CFP-10 specific SFCs of immunocompromised patients de-creased significantly compared with non-immunocompromised(Z is -26.817 and-43.756,P<0.05 ). Conclusion T-SPOT.TB has high sensitivity ,specificity in the diagnosis of tuberculous pleurisy.T-SPOT.TB and is a promising clinical test in the diagnosis of non-immunocompromised with suspected TB ,but its diagnostic performance in im-munocompromised patients is reduced compared with in non-immunocompromised patients.
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Objective To evaluate the performance of T-SPOT.TB Test and serological tuberculosis antibody(TB-Ab) in tuberculosis-assisted diagnosis.Methods Patients were diagnosed as tuberculosis from 2015 January to 2016 March in the hospital.T-SPOT.TB and tuberculosis antibody detection were performed for those patients.Results In 112 cases of tuberculosis patients,101 cases of T-SPOT.TB test were positive and the sensitivity was 90.18%,32 cases of tuberculosis antibody detection were positive and the sensitivity was 28.57%.In 41 cases of pulmonary tuberculosis,T-SPOT.TB assay showed positive results in 40 patients and the sensitivity was 97.56%,tuberculosis antibody detection showed positive results in 18 patients and the sensitivity was 43.9%;in 71 cases of extrapulmonary tuberculosis,T-SPOT.TB assay showed positive results in 61 patients and the sensitivity was 85.91%,tuberculosis antibody detection showed positive results in 14 patients and the sensitivity was 19.7%.Conclusion T-SPOT.TB was superior to serological tuberculosis antibody(TB-Ab),and the diagnosis of active tuberculosis was higher,and the sensitivity of T-SPOT.TB was higher than that of T-SPOT.TB value.
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Objective To assess the value of T?SPOT.TB test in the diagnosis of active tuberculosis. Methods The clinical data of 975 hospitalized patients receiving T?SPOT.TB test were collected in our hospital. The clinical information and testing results were analyzed. The receiver operating curve (ROC) was used to determine the optimal threshold of T?SPOT.TB test for differentiating active tuberculosis. Results T?SPOT.TB test results showed that the positive rate was 29.26%for the non?active tuberculosis group(n=793),but was 91.21%for active tuberculosis patients group (n = 182),which indicated that the test had a significant value in active tuberculosis detection(P<0.001). The sensitivity of T?SPOT.TB test was 0.912 and the specificity was 0.707. The detection threshold of T?SPOT.TB was optimized. As the spot?forming count(sfc)of ESAT?6 antigen threshold was 11.5 and that of the CEP?10 threshold was 9.5,the efficiency of T?SPOT.TB test for detection of active pulmonary tuberculosis was the highest. Conclusions T?SPOT.TB test has a good diagnostic performance for active tuberculosis, and it can be further optimized to better serve the clinical practice.
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The aim of this study was to evaluate the diagnostic value of the cerebrospinal fluid (CSF) T-SPOT.TB test for the diagnosis of TB meningitis (TBM). A retrospective analysis of 96 patients with manifested meningitis was conducted; T-SPOT.TB test was performed for diagnosing TBM to determine the diagnostic sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). A receiver operating characteristic (ROC) curve was also drawn to assess the diagnostic accuracy. The sensitivity, specificity, PPV, and NPV of CSF T-SPOT.TB test were 97.8%, 78.0%, 80.3%, and 97.5%, respectively, for 52 patients (54.2%) of the 96 enrolled patients. The area under the curve (AUC) was 0.910, and the sensitivities of CSF T-SPOT.TB for patients with stages I, II, and III of TBM were 96.7%, 97.2%, and 98.9%, respectively. CSF T-SPOT.TB test is a rapid and accurate diagnostic method with higher sensitivity and specificity for diagnosing TBM.
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Humans , China , Epidemiology , Sensitivity and Specificity , Tuberculosis, Meningeal , Cerebrospinal Fluid , Diagnosis , EpidemiologyABSTRACT
Objective To summarize the clinical experience of diagnosis and treatment of nontuberculosismycobacterium (NTM) infection after liver transplantation. Methods Clinical experience of effective treatment of 1 case with NTM at 7th month after liver transplantation at the Shanghai Changzheng Hospital affiliated to the Second Military Medical University was summarized and literature review was performed. Results Following liver transplantation, the NTMpatient was clinically manifested with fever in the afternoon. CT scan prompted the progression of the disease. The lesions were enlarged and fused with thin-walled cavity in the right upper lung. The diagnosis of NTM infection was validated by fiberoptic bronchoscopy (brush or lavage approach), spot test of T cells infected with mycobacterium tuberculosis (T-SPOT. TB), multiple phlegm culture and empirical anti-tuberculosis therapy. The patient was effectively treated and successfullydischarged after diagnostic quadruple anti-tuberculosis therapy. The patient was followed up until the day of manuscript submission. The patient was physically stable without the symptoms of fever and cough with asthma. The liver function was normal. Conclusions The incidence of NTM infection is rare and inneglectable after liver transplantation. Application of fibrobronchoscopy via brush or lavage approach can enhance the positive diagnostic rate. Diagnostic quadruple antituberculosis therapy is efficacious for NTM infection.
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Objective To analyze the diagnostic sensitivity and related impact factors of T cell spot test of tuberculosis (T‐SPOT .TB ) test in acquired immunodeficiency syndrome (AIDS )/tuberculosis (TB) patients .Methods Ninety‐two confirmed cases with AIDS/TB coinfection were tested by T‐SPOT . TB ,and the impact of CD4+ T cells counts on the diagnostic sensitivity was analyzed .Multivariate Logistic analysis was used for the analysis of impact factors of T‐SPOT .TB sensitivity .Blood samples of 19 cases with advanced stage AIDS/TB from January 2015 to January 2016 were collected ,and peripheral blood mononuclear cell (PBMC ) were isolated by Ficoll method , and lymphocytes were isolated by Percoll method .McNemar test was used for the comparison of these two methods .Results Among the 92 patients with AIDS/TB ,T‐SPOT .TB tests were positive in 51 cases ,with positive rate of 55 .4% .The sensitivity was 26 .3% (10/38) when CD4+ T cell count less than 20/μL ,and that was 92 .9% (13/14) when CD4+ T cell more than 200/μL .In Logistic analysis ,the sensitivity of T‐SPOT .TB test in patients with extra‐pulmonary tuberculosis was better than that in pulmonary tuberculosis patients (OR=3 .042 , P=0 .038) .The sensitivity of T‐SPOT .TB was positively correlated with CD4+ T cell count ,and the sensitivity increased by 2 .889 times when CD4+ T cells increasing 100/μL (OR=3 .889 ,P=0 .016) .The percentage of lymphocytes in PBMC was also positively correlated with T‐SPOT .TB positivity ,and the sensitivity increased by 1 .393 times when the percentage increasing 30% (OR=2 .393 ,P=0 .045) .When Percoll was used for lymphocytes isolation ,the T‐SPOT .TB sensitivity was 52 .6% (10/19) ,and when Ficoll was used for PBMC isolation ,the sensitivity was 36 .8% (7/19) .The difference was not statistically significant (P=0 .375) .Conclusion The sensitivity of T‐SPOT .TB test based on lymphocytes is higher than that based on PBMC .
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Objective:To combine the detection of serum levels of adenosine deaminase (ADA) and T-cell spot test (T-spot.TB),and to explore their significances in diagnosis of pulmonary tuberculosis.Methods:159 patients suspected with pulmonary tuberculosis were selected and divided into pulmonary tuberculosis group and non-tuberculosis group (n=68);80 healthy people were randonly selected as healthy control group.The serum ADA levels and number of T-spot of the subjects in three groups were detected.Ther serum ADA levels and the positive rates of T-spot.TB in various groups and their sensitivities and specifities were compared. Results:The serum ADA level of the patients in pulmonary tuberculosis gruop was (22.10±6.60)U·L-1;those in non-tuberculosis group and healthy control group were (16.90±6.35)and (8.70±5.98)U·L-1;the serum ADA level in pulmonary tuberculosis group was significantly higher than those in non-tuberculosis group and heathy control group (P<0.05).The positive rate of serum ADA level in diagnosis of pulmonary tuberculosis was 56% and the T-spot.TB positive rate in diagnosis of pulmonary tuberculosis was 87.9%. Combined use of parallel test, the detection sensitivity was 91.2%;using the series of joint tests,the specificity was 94.6%.Conclusion:Combined detection of serum level of ADA and T-spot.TB can significantly improve the clinical diagnosis efficacy of pulmonary tuberculosis.