RESUMO
ObjectiveTo investigate the latent tuberculosis infection （LTBI） of close contacts in schools of Xuhui District， and to explore the tuberculin skin test （TST）- interferon-γ release assay （IGRA） two-step method in order to discover the screening strategy of tuberculosis in Xuhui District. MethodsClose contacts of tuberculosis in schools of Xuhui District from 2020 to 2022 were selected as research subjects. Screening was conducted using symptom questionnaire， TST， chest X-rays， IGRA， and the information including the etiological results and grade of the index cases， as well as gender， age， and relationship with the index cases of the research subjects were collected. ResultsTotally 615 close contacts of 32 tuberculosis cases occurred in the schools were finally included. Of the 609 close contacts who completed tuberculosis infection screening and underwent TST testing， 153 TST（+） individuals underwent IGRA testing. The final LTBI rate was 4.6%， and the pulmonary tuberculosis detection rate was 163 per 100 000. The relationship with the index cases was an influencing factor for LTBI. The IGRA positivity rate was higher among close contacts with TST ≥15 mm than among those with 10 mm≤ TST <15 mm （χ2=14.41， P<0.05）. ConclusionThe latent tuberculosis infection among close contacts of school tuberculosis cases in Xuhui District remains serious. TST-IGRA two-step method can assist in the accurate diagnosis of LTBI and pulmonary tuberculosis cases.
RESUMO
Objective:To analyze the influencing factors related to false-negative results of interferon-γ release assay (IGRA) QFT-GIT in patients with confirmed pulmonary tuberculosis.Methods:Clinical data of 389 patients with bacteriologically confirmed pulmonary tuberculosis who underwent QFT-GIT in Quzhou Hospital Affiliated to Wenzhou Medical University between January 1 and December 31 2020 were retrospectively analyzed. Univariate and multivariate logistic regression were used to analyze the influencing factors related to the false-negative results of QFT-GIT.Results:Among 389 confirmed patients, 347 cases had positive QFT-GIT results and 42 cases had negative results. Univariate analysis showed that the false-negative results of QFT-GIT were associated with low BMI, reduced CD4 + T lymphocyte count, decreased lymphocyte count, increased C-reactive protein, negative sputum smear, anemia, diabetes mellitus, malignant tumor and sepsis ( P<0.05 or P<0.01). Multivariate conditional logistic regression analysis showed that BMI <18.5 kg/m 2( OR=1.585, 95% CI 1.076-2.336), complicated with diabetes( OR=5.157, 95% CI 2.340-11.365), malignant tumors ( OR=5.596, 95% CI 2.048-15.295)and sepsis ( OR=4.141, 95% CI 1.042-16.459) were independent risk factors for the false-negative results of QFT-GIT ( P<0.05 or P<0.01). Conclusion:When the pulmonary tuberculosis patients are extreme emaciation, complicated with diabetes, malignant tumor or sepsis, the QFT-GIT results will be false negative.
RESUMO
Objective:To investigate five kinds of tuberculin skin test (TST), tubercle bacillus-antibody(TB-Ab), interferon-γ release assay(IGRA), tubercle bacillus-DNA (TB-DNA) and collection of bacterial centrifugal smears methods, the application value of combined detection in improving the diagnostic efficiency of pneumoconiosis complicated with tuberculosis.Methods:A total of 150 eligible patients with pneumoconiosis from January 2018 to January 2019 in Zhangjiakou Pulmonary Hospital were selected as the research subjects, and all of them underwent TST, TB-Ab, IGRA, TB-DNA and bacterial centrifugal smear detection. Compared the positive rates of five detection methods in pneumoconiosis and its different stages, and compare the proportion of tuberculosis infection and tuberculosis in different stages of pneumoconiosis.Results:Among the 150 patients with pneumoconiosis, 41 cases (27.33%) were with pneumoconiosis complicated with tuberculosis infection, 24 cases (16.00%) with pneumoconiosis complicated with clinically diagnosed pulmonary tuberculosis, 21 cases (14.00%) with pneumoconiosis complicated with confirmed pulmonary tuberculosis, and 45 cases (30.00%) with pneumoconiosis complicated with pulmonary tuberculosis; with the improvement of pneumoconiosis stage, the proportion of pneumoconiosis combined with tuberculosis infection and pulmonary tuberculosis increased significantly ( P<0.05). Compared with TB-Ab, TB-loop-mediated isothermal amplification(LAMP), and interlayered cup collection centrifuge smear method, the overall positive rate of IGRA detection and pneumoconiosis stage Ⅲ were higher ( P<0.05), but there was no significant difference compared with TST detection ( P>0.05). The positive rate of combined detection was higher, but there was no significant difference compared with IGRA detection ( P>0.05). With the increase of pneumoconiosis stage, the positive reaction intensity of TST decreased, and the positive value of TB-Ab and IGRA increased. Conclusions:The combined detection of TST, TB-Ab, IGRA, TB-DNA and bacterial centrifugal smear method can significantly improve the diagnostic efficiency of pneumoconiosis combined with tuberculosis.
RESUMO
Assuntos
Humanos , Sistema Nervoso Central , Interferons , Linfonodos , Prontuários Médicos , Mycobacterium tuberculosis , TuberculoseRESUMO
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.
RESUMO
Objective To evaluate the value of peripheral blood Mycobacterium tuberculosis interferon-γ release assay(TB-IGRA )in early adjuvant diagnosis of tuberculous meningitis(TBM).Methods 56 patients with TBM (trial group) and 56 patients with non-TB meningitis (control group) admitted to West China Hospital of Sichuan University in January-December 2015 were analyzed, results of TB-IGRA, cerebrospinal fluid(CSF) Mycobacterium tuberculosis(MT) culture, and CSF TB-DNA testing of two groups of patients were analyzed, the sensitivity and specificity of each diagnostic method were calculated.Results The sensitivity of TB-IGRA, CSF MT culture, and CSF TB-DNA for diagnosis of TBM were 87.5％(49/56), 19.6％(11/56), and 60.7％(34/56) respectively,specificity were 89.3％(50/56), 100.0％(56/56), and 76.8％(43/56)respectively.The sensitivity of TB-IGRA for diagnosing TBM was higher than that of CSF TB-DNA and CSF MT culture, specificity of TB-IGRA was higher than that of CSF TB-DNA(89.3％>76.8％), pairwise comparison showed a significant difference(all P<0.01).Among 11 cases confirmed by CSF culture, 10 (90.9％[10/11])were positive for TB-IGRA;among 45 cases with clinical diagnosis and effective anti-tuberculosis treatment, 39 (86.7％[39/45])were positive for TB-IGRA.Conclusion TB-IGRA is highly sensitive and specific in the early adjuvant diagnosis of TBM, it is convenient, rapid, effective, and worthy to be popularized in clinical practice.
RESUMO
Objective:To investigate the application value of interferon-γ release assay ( IGRA ) in immunocompromised patients with pulmonary tuberculosis. Methods:180 cases were chose including immunocompromised patients,pulmonary tuberculosis patients,immunocompromised patients with pulmonary tuberculosis and healthy volunteers to undergo IGRA in order to determine and compare the content of specific interferon-γ( IFN-γ) in plasma. At the same time, the result of immunocompromised patients with pulmonary tuberculosis was compared with tuberculin skin test (TST). Results:180 cases of the list were tested,included 40 immuno-compromised patients ( group A ) , 50 pulmonary tuberculosis patients ( group B ) , 40 immunocompromised patients with pulmonary tuberculosis patients(group C),and 50 cases in healthy control group(group D). The median of specific IFN-γ contents in the four groups were respectively 0. 112,7. 835,5. 726,0. 697 U/ml. The comparison of differences among the four groups was statistically significant (χ2=74. 046,P<0. 001). Pairwise comparisons among the four groups,and the differences between group B and group C were no significant,but specific IFN-γ content of the two groups was significantly higher than the other two groups,while the group D was higher than group A,the differences were statistically significant. The positive rate of IGRA was significantly higher than that of TST in group C(χ2=11. 314,P=0. 001). Conclusion: IGRA diagnosis in the application of immunocompromised patients with pulmonary tuberculosis was less affected by immune status and was more sensitive than TST,which can be used as auxiliary diagnosis.