ABSTRACT
BACKGROUND: Interferon-gamma release assays (IGRAs) are reported to be more specific for the diagnosis of latent tuberculous infection (LTBI) than the tuberculin skin test (TST). The two-step procedure, TST followed by an IGRA, is reported to be cost-effective in high-income countries, but it requires more financial resources. OBJECTIVE: To assess the added value of IGRA compared to TST alone in the Netherlands. METHODS: Test results and background data on persons tested with an IGRA were recorded by the Public Municipal Health Services in a web-based database. The number of persons diagnosed with LTBI using different screening algorithms was calculated. RESULTS: In those tested with an IGRA, at least 60% of persons who would have been diagnosed with LTBI based on TST alone had a negative IGRA. Among those with a TST reaction below the cut-off for the diagnosis of LTBI, 13% had a positive IGRA. For 41% of persons tested with an IGRA after TST, the IGRA influenced whether or not an LTBI diagnosis would be made. CONCLUSION: With the IGRA as reference standard, a high proportion of persons in low-prevalence settings are treated unnecessarily for LTBI if tested with TST alone, while a small proportion eligible for preventive treatment are missed. Incremental costs of the two-step strategy seem to be balanced by the improved targeting of preventive treatment.
Subject(s)
Interferon-gamma Release Tests , Latent Tuberculosis/diagnosis , Mycobacterium tuberculosis/pathogenicity , Tuberculin Test , Adolescent , Adult , Antitubercular Agents/therapeutic use , Child , Child, Preschool , Cost-Benefit Analysis , False Negative Reactions , False Positive Reactions , Female , Health Care Costs , Humans , Interferon-gamma Release Tests/economics , Latent Tuberculosis/drug therapy , Latent Tuberculosis/economics , Latent Tuberculosis/immunology , Latent Tuberculosis/microbiology , Male , Middle Aged , Mycobacterium tuberculosis/immunology , Netherlands , Predictive Value of Tests , Reproducibility of Results , Tuberculin Test/economics , Unnecessary Procedures , Young AdultABSTRACT
This case report describes how a late diagnosis of a tuberculous abscess combined with daily irrigation of the wound without barrier precautions led to nosocomial transmission of Mycobacterium tuberculosis. Among 372 hospital contacts, 16 had a tuberculin skin test conversion and two developed active pulmonary tuberculosis with the same strain as that isolated from the index patient's abscess. When a culture from an abscess remains negative, Mycobacterium tuberculosis infection should be considered. Furthermore, wound irrigation should be done with proper barrier precautions because infectious aerosols can be created during the irrigation process.
Subject(s)
Abscess/microbiology , Infectious Disease Transmission, Patient-to-Professional , Mycobacterium tuberculosis/isolation & purification , Tuberculosis/transmission , Abscess/diagnosis , Abscess/therapy , Aged , Aged, 80 and over , Anti-Bacterial Agents/administration & dosage , Cross Infection/diagnosis , Drainage/methods , Follow-Up Studies , Humans , Male , Risk Assessment , Tuberculosis/diagnosisABSTRACT
The asymmetric platinum complexes cis-Pt(LL')Cl2 (L = NH3, L' = CH3NH2, (CH3)2NH, C2H5NH2 and (C2H5)2NH and LL' = N,N-dimethylethylenediamine),--one of the NH3 groups of cis-Pt(NH3)2Cl2 was substituted by alkylamine--, were synthesized and their cytotoxic effects have been measured using L-1210 cells. The IC50 values of the asymmetric platinum complexes,--being obtained after 24 h exposure of L-1210 cells to the platinum complexes--, are almost comparable to the corresponding value of cis-Pt(NH3)2Cl2. In 2 h exposure, however, the IC50 values of the platinum complexes were dramatically changed, i.e., a marked difference was observed between those of L' = RNH2 and L' = R2NH. On the other hand, the amounts of platinum taken into the L-1210 cells is little affected by the alkylamino substitution. The results suggest that the bifunctional platinum binding to the target molecule may be responsible for the cytotoxicity.
