[ new blood tests for the diagnosis of tuberculosis infection]

The diagnosis of latent tuberculosis infection was based until now on the positivity of the tuberculin skin test. This test poses considerable technical problems of implementation, reading and interpretation. Moreover, it lacks both specificity in cases of previous BCG vaccination and sensitivity in case of immunosuppression. The understanding of cellular immunity with the contribution of molecular biology have helped to develop blood tests that measure in vitro release of interferon Gamma by T cells after stimulation by highly specific antigens of Mycobacterium tuberculosis that are ESAT6 [Early Secretory Antigenic Target 6Kda] and CFP10 [culture filtrate protein 10] and recently the Ag tb 7.7. These antigens are absent in the BCG vaccine and most nontuberculous mycobacteria. Two tests are commercialised, one measures the interferon-secreting cells by ELISpot method: the Enzyme-Linked Immuno Spot. As another measure directly interferon by ELISA: Enzyme-Linked Immuno-Sorbent Assay. The current clinical data suggest that these blood tests are more specific than the tuberculin skin test because they did not cross-react with BCG. This high specificity avoids the costs and possible side effects of unnecessary treatment among persons vaccinated with a positive tuberculin test. However in cases of active tubersulosis, the ELISA has the same sensitivity as the TST, while ELISpot appears more sensitive. In patients with negative tuberculin test with a high risk to progress to tuberculosis disease, the sensitivity of these blood tests can be considered a treatment for tuberculosis. The purpose of this paper is to recall the principles of these diagnostic tests, review the evidence on their usefulness, their limitations and their indications

[Obesity and asthma]

Asthma is a chronic disease whose prevalence continues to increase. Obesity is a comorbidity makes it difficult to support and control of asthma. A retrospective study on 39 cases of obese asthmatics, whose body mass index [BMI] exceeds 30 kg/m2, followed by allergy consultation service between January 2007 and August 2009. 31 women and 8 men aged between 23 and 79 years [average age: 48.5 years]. Diabetes is associated in 2 cases, hypertension in 5 cases and a sicca syndrome in one case. The asthma was intermittent in 17 cases [43.5%], mild persistent in 7 cases [18%], moderate persistent in 11 cases [28.25%] and severe persistent in 4 cases [10.25%]. The gastro-esophageal reflux was found in 25%, an allergic rhinitis in 41% cases, conjunctivitis in 28% of cases, eczema in 7.6% cases, food allergy in 10% of cases especially Fish and drug in 0.7% cases intolerance to aspirin. A family atopy was noted in 10% of cases. The recommended treatment based on inhaled corticosteroids and beta 2 mimetiques long duration of action in 22 cases associated with xanthine in 4 cases, antihistamines and nasal corticosteroids in 16 cases and inhibitors of proton pump in 10 cases. Asthma is well controlled in 60% of cases, partially controlled in 30% of cases and uncontrolled in 10% of cases. The flow volume curve done in all our patients had obstructive ventilatory disorder objectified in 89.7% and mixed in 10.3%. The obstructive ventilatory disorder was mild in 60% of cases, moderate in 28.6% cases and severe in 11.4%. Obesity is a bad factor in controlling asthma and a multidisciplinary care must be taken to assure the best therapeutical approach

[Lymphangioleiomyomatosis and tuberous sclerosis association]

The Lymphangioleiomyomatosis is a rare lung disease encountered almost exclusively in women of childbearing age. The combination with tuberous sclerosis is even more rare. Lung affection is characterized by thin walled multiple pulmonary cysts, recurrent pneumothorax, an obstructive ventilatory trouble, and an evolation to chronic respiratory failure within an average of 10 years. A patient aged 51 years old with a history of generalized seizures, hospitalized in the department for exertional dyspnea of NYHA stage III of gradual onset since 5 years, combined with a dry cough and some episodes of minimal hemoptysis leading to weakness of the general condition. Clinical examination found diffuse bilateral crepitational rale. The chest radiograph showed diffuse bilateral interstitial syndrome. The cardiovascular examination with ECG and echocardiography showed a mild PAH of 42 mmHg. The chest CT revealed multiple diffuse thin-walled cystic formations highly suggestive of lymphangioléimyomatose. Abdominal and kidney ultrasound showed no appearance of renal angiomyolipoma or uterine fibroids. Furthermore, cerebral CT showed encephalic calcifications objectified for a Tuberous sclerosis of Bourneville. Plethysmography showed a mixed ventilatory disorder predominantly obstructive. The diagnosis of pulmonary Lymphangioleiomyomatosis associated with Tuberous sclerosis of Bourneville has been retained. The patient was put on a long term oxygen therapy with good evolution. The combination Lymphangioleiomyomatosis and tuberous sclerosis of Bourneville is rare, interesting almost exclusively young women. International diagnostic criteria have been proposed for the diagnosis of these disorders. The prognosis remains reserved