Prevalence and risk factors for latent tuberculosis in polish healthcare workers: the comparison of tuberculin skin test and interferon-gamma release assay (IGRA) performance.

BACKGROUND: Tuberculosis (TB) is still one of the most common infectious diseases worldwide. Health care workers (HCW) are at particular risk of the disease due to their constant exposure to TB patients or their specimens, nevertheless no specific surveillance is widely recommended in this group of professionals. Both, tuberculin skin test (TST) and interferon-gamma-release-assays (IGRAs) are widely applied to detect latent tuberculosis infection (LTBI). The aim of the present study was to evaluate the prevalence and risks of LTBI in the population of Polish HCW, to identify factors associated with LTBI, as well as to determine the rate of the discordance between the results of the two applied tests in relation to various factors in a TB endemic setting. The study participants were recruited from several health care facilities (hospitals and outpatients clinics) all over the country. Laboratory personnel included 156 persons from both TB and non-TB laboratories (118 clinical pathologists, 38 laboratory technicians), 31 medical doctors, 29 nurses (from both TB and non-TB wards and from family practices), 6 other medical employees (patients assistants). Out of examined group 88 (40%) declared constant (everyday) occupational contact with TB patients and/or contagious biologic materials, 134 (60%) reported sporadic (incidental) contact (few times a year). Administrative HCWs who were not in direct contact with patients were not included in the study group. MATERIAL AND METHODS: LTBI status was prospectively evaluated in 222 HCW, 204 females, 18 males, aged 40.8 ± 9 years, with tuberculin skin test (TST) and interferon gamma release assay (QuantiFERON-TB-Gold in Tube - QFT GIT). RESULTS: TST ≥ 10 mm was found in 58% of HCW, QFT GIT ≥ 0.35 IU/ml in 23%. Nevertheless the relative number of positive QFT GIT in HCW above 45 years of age exceeded those obtained in general population (prevalence of positive QTF test in polish adult population is around 23%). The risk of obtaining positive QFT GIT was significantly increased in the participants older than 44 years (OR = 4.95, 95%CI:2.375-10.193), in those employed > 10 years (OR = 2.726, 95%CI:1.126-6.599), and in those who reported the direct contact with tuberculous patients or infected biological materials (OR = 8.135, 95%CI:1.297-51.016). The concordance between TST and IGRA was poor (kappa 0.23), especially in younger participants, possibly due to BCG vaccination in childhood. CONCLUSION: The increased risk of LTBI in Polish HCW was related to age, duration of employment and contact with infectious patients or their biological specimens. TB infection control measures in health care facilities in Poland are still insufficient. It is crucial to increase awareness about the importance of detecting and treating LTBI of HCW.

Prognostic value of serum C-reactive protein (CRP) and cytokeratin 19 fragments (Cyfra 21-1) but not carcinoembryonic antigen (CEA) in surgically treated patients with non-small cell lung cancer.

INTRODUCTION: The aim of the study was to assess the prognostic value of cytokeratin 19 fragments (Cyfra 21-1), carcinoembryonic antigen (CEA) and C-reactive protein (CRP) in surgically treated NSCLC patients. MATERIAL AND METHODS: 50 NSCLC patients (25 adenocarcinoma, 21 squamous cell and 4 adenosquamous), clinical stages I and II, age 42-89 years, entered the study. CEA, Cyfra 21-1 and CRP concentrations were measured in serum taken before surgery, CEA and Cyfra 21-1 in 50 patients, CRP - in 46 patients. The survival was calculated from the date of surgical treatment until death or until the end of the observation time. The results were expressed as medians (95%CI). RESULTS: Cyfra 21-1 concentration was 2.1 (0.7-14.5) ng/mL. Survival time in the patients with Cyfra 21-1 ≤ 2 ng/mL, and > 2 ng/ /mL was 79 (14.85-88.2) and 29 (5.7-87.6) months, (p < 0.026). CEA concentration was 2.68 (0.87-72.7) ng/mL, significantly higher in adenocarcinoma than in squamous cell lung cancer - 4.38 ng/mL (1.67-41.35) vs. 2.2 ng/mL (1.0-6.1), p = 0.002. CRP concentration was 5.45 (0-122.6) mg/L. Significant dependence was found between CRP and pathological tumour size (pT). Median CRP values in pT1, pT2 and pT3+4 tumours were: 2.8 mg/L, 6.9 mg/L and 23.5 mg/L, respectively. Survival time of the patients with CRP ≤ 10 mg/L and CRP > 10 mg/L was 79 (14.85-88.2) and 29.5 (5.7-87.6) months, respectively (p = 0.045). CRP > 10 mg/L and Cyfra 21-1 > 2 ng/mL were the only significant preoperative prognostic indicators (HR 2.08 and 2.04, respectively). Among the postoperative parameters, pathological stage of disease (p-stage) and pT were the significant prognostic indicators (HR 2.1 and 2.42, respectively). CONCLUSIONS: In the present study, concerning surgically treated NSCLC patients, preoperative CRP > 10 mg/L and Cyfra 21-1 > 2 ng/mL were the only negative prognostic indicators, while pT and p-stage were significant postoperative prognostic indicators.

[Evaluation of humoral immune response against mycobacterial antigens in bronchoalveolar lavage fluid from patients with pulmonary tuberculosis confirmed by genetic and culture methods]. / Ocena odpowiedzi humoralnej przeciwko antygenom pratkaw popluczynach oskrzelowo-pecherzykowych u chorych na gruzlicepluc potwierdzona bakteriologicznie i metodami genetycznymi.

INTRODUCTION: The resistance to TB is cells-mediated but humoral response is common and may be correlated with the lack of effective local cellular defence mechanisms. The goal of the study was to evaluate IgG, IgA and IgM mediated humoral immune response against 38kDa plus 16kDa and 38kDa plus lipoarabinomannan (LAM) mycobacterial antigens in BALF from patients with culture confirmed and PCR positive pulmonary tuberculosis (TB) compared to non-tuberculous controls (NTB). MATERIAL AND METHODS: 79 BALF samples (46 TB and 30 NTB) were examined. In 25 BALF samples from TB patients nucleic acids from M. tuberculosis were detected by PCR method. Commercially available ELISA - based assays against proteins 38kDa and 16kDa or 38kDa plus LAM were used. Three different dilutions of BALF: 1 : 1 and 1 : 10 were tested. Mean IgG level against 38 + LAM was significantly higher in TB group compared to control (p < 0,0001). No difference was observed between TB and NTB group in titer of IgM antibodies. RESULTS: Sensitivity of the tests based on IgG anti38kDa + 16kDa was 49%, IgG anti38kDa + LAM - 33%, IgA anti38kDa + LAM - 100%, IgM anti38kDa + LAM - 35%. Specificity of examined assays: IgA anti38kDa + LAM - 13%, IgM anti38kDa + LAM - 75%, IgG anti38kDa + 16kDa - 87%, IgG anti38kDa + LAM - 93%. The findings of the study indicate that TB is associated with the presence of detectable levels of antibodies in the BALF. CONCLUSIONS: Examined tests detecting IgG in BALF can be used in combination with other diagnostic methods to increase diagnostic accuracy of pulmonary TB.

[Humoral immune response against mycobacterial antigens in patients with tuberculosis and mycobacterial infections other than tuberculosis]. / Odpowiedz humoralna na antygeny pratka u chorych na gruzlice i mikobakteriozy.

The aim of the study was to compare humoral immune response against various mycobacterial antigens in TB and MOTT vs healthy control group. 350 serum samples from TB patients, 20 samples from MOTT patients and 58 samples from healthy donors were examined. ELISA detecting IgG, IgA and IgM against antigens: 38 kDa and 16 kDa, 38kDa and lipoarabinomannan, and A-60 were used. Mean IgG level was higher in TB compared to healthy controls (p<0,001). Mean IgG level against 38kDa and 38 + 16 kDa mycobacterial antigens was higher in TB than in MOTT group. Mean level of the IgG, IgA and IgM antibodies against LAM was higher in MOTT compared to TB patients. In all subgroups person-to-person heterogeneity of antigen recognition was observed. Humoral immune response to recombinant mycobacterial antigens significantly differs in TB and MOTT patients.