Diagnosis and Treatment of Tuberculosis

Ruiz-Manzano, Juan; Blanquer, Rafael; Calpe, J.L.; Caminero, José A.; Caylà, Joan A.; Domínguez, José; García, José María; Vidal, Rafael

doi:10.1016/s1579-2129(08)60102-0

Cited by 33 publications

(21 citation statements)

References 42 publications

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“…The ADA assay has been recommended for use as a diagnostic test for TB peritonitis (Ruiz-Manzano et al, 2008). Also, ADA assay in biological fluids has been used as a tool for the differential diagnosis of different forms of extrapulmonary TB, such as pleuritis, synovitis, meningitis, TB of female genitals and peripheral lymph nodes, and uveitis (Titarenko et al, 2006).…”

Section: Discussionmentioning

confidence: 99%

“…The QuantiFERON-TB (QFT) assay uses an ELISA to measure the release of interferon-c (IFN-c) after in vitro stimulation of whole-blood samples by the purified protein derivative from M. tuberculosis (Ruiz-Manzano et al, 2008). The second-generation assay QuantiFERON-TB Gold (QFT-G) also measures the release of IFN-c after in vitro stimulation of samples with specific region of difference 1 (RD1) antigens from M. tuberculosis: early secretory antigenic target-6 (ESAT-6) and culture filtrate protein-10 (CFP-10).…”

Section: Introductionmentioning

confidence: 99%

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Use of adenosine deaminase measurements and QuantiFERON in the rapid diagnosis of tuberculous peritonitis

Saleh¹,

Hammad

Ramadan

et al. 2012

Journal of Medical Microbiology

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Peritoneal tuberculosis (TB) is a considerable problem in certain developing nations. Current diagnostic tests for peritoneal TB are difficult and time-consuming. This study aimed to determine the effectiveness of an adenosine deaminase (ADA) assay and the QuantiFERON-Gold (QFT-G) assay in the rapid diagnosis of TB peritonitis. Forty-one patients with a presumptive diagnosis of TB peritonitis with ascites were admitted to Mansoura University Hospital and included in the study. Ascitic fluid and blood samples were collected from each patient. Fluid samples were examined biochemically (protein concentration), cytologically (white blood cell count) and microbiologically (Ziehl-Neelsen stain and TB culture in Lö wenstein-Jensen media), and ADA levels were determined using colorimetry. Interferon-c levels in whole-blood samples were measured using the QFT-G assay. Fourteen (34 %) patients received a final clinical diagnosis of TB peritonitis; these patients were subclassified as definite (positive culture for Mycobacterium tuberculosis; eight patients), highly probable (four patients) and probable (two patients) for TB peritonitis. Of the 14 patients with a final clinical diagnosis of TB peritonitis, 3 (21 %) tested positive using an acid-fast bacilli smear, which showed a sensitivity of 21 % and a specificity of 100 %. A receiver operating characteristic curve showed that a cut-off value of 35 IU l "1 for the ADA level produced the best results as a diagnostic test for TB peritonitis, yielding the following parameter values: sensitivity 100 %, specificity 92.6 %, positive predictive value (PPV) 87.5 % and negative predictive value (NPV) 100 %. The QFT-G assay yielded the following values: sensitivity 92.9 %, specificity 100 %, PPV 100 % and NPV 96.4 %. The ADA and QFT-G assays might be used to rapidly diagnose TB peritonitis and initiate prompt treatment while waiting for a final diagnosis using the standard culture approach.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Use of adenosine deaminase measurements and QuantiFERON in the rapid diagnosis of tuberculous peritonitis

Saleh¹,

Hammad

Ramadan

et al. 2012

Journal of Medical Microbiology

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“…In order to reduce this possibility we have focused our study on unexposed children with 5 to 9 mm of TST induration. Based in the classical studies performed by NYBOE et al [35], the main guidelines in screening children population consider as a cut-off for M. tuberculosis infection a TST induration o10 mm, in order to avoid false positive TST results induced by NTM immunisation [36]. Therefore, our results, in part, reinforce the guidelines [10], in that unnecessary chemoprophylaxis treatment in unexposed population could be avoided, and that IFN-c based assays could help to confirm a positive TST result.…”

Section: Discussionmentioning

confidence: 99%

Diagnosing TB infection in children: analysis of discordances usingin vitrotests and the tuberculin skin test

Altet-Gómez¹,

Souza-Galvão²,

Latorre³

et al. 2010

Eur Respir J

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The aim of the present study was to compare the performance of the interferon (IFN)-c tests (QuantiFERON1-TB Gold In-Tube (QFT-G-IT) and T-SPOT1.TB) with the tuberculin skin test (TST) in diagnosing tuberculosis (TB) infection in children, and to analyse discordant results.This was a prospective study including 98 children from contact-tracing studies and 68 children with TST indurations o5 mm recruited during public health screenings.Positive IFN-c tests results were associated with risk of exposure (p,0.0001). T-SPOT.TB was positive in 11 (78.6%) out of 14 cases with active TB and QFT-G-IT in nine (64.3%) out of 14 cases. Sensitised T-cells against Mycobacterium avium were detected in six out of 12 children not vaccinated with bacille Calmette-Guérin (BCG), a TST induration 5-9 mm in diameter and both IFN-c tests negative. In concordant IFN-c tests results, a positive correlation was found (p50.0001) between the number of responding cells and the amount of IFN-c released. However, in discordant IFN-c tests results this correlation was negative (p50.371): an increase in the number of spot-forming cells correlated with a decrease in the amount of IFN-c released.The use of IFN-c tests is helpful for the diagnosis of TB infection, avoiding cross-reactions with BCG immunisation and nontuberculous mycobacterial infections. The analysis of highly discordant results requires further investigation to elucidate possible clinical implications.KEYWORDS: Agreement, children, interferon-c release assays, nontuberculous mycobacterial sensitins, tuberculin skin test, tuberculosis I n 2007, the estimated global incidence of tuberculosis (TB) cases was 9.27 million. Approximately 11% of these cases were children. In the developed world, the estimated proportion of children with TB is around 3-6%, but in developing countries this percentage can reach 15-20%, with an approximate mortality of 30% [1]. Latent TB infection (LTBI) treatment is an essential strategy to eliminate TB [2], although in order to achieve any epidemiological impact, this strategy must target groups with a high risk of infection and development of the disease if they become infected. Children merit special consideration, as they can develop the disease very quickly after primary infection, with the most severe forms prevailing in younger children [3].The advantages of techniques based on the detection of interferon (IFN)-c secreted by effector T-cells stimulated with specific Mycobacterium tuberculosis antigens to diagnose LTBI over the tuberculin skin test (TST) are the lack of cross-reactivity with vaccinal Mycobacterium bovis bacille Calmette-Guérin (BCG) strains and nontuberculous mycobacteria (NTM), and the absence of booster effect [4,5]. These antigens are the early secretory antigenic target (ESAT)-6 and culture filtrate protein (CFP)-10 encoded in region of difference (RD)1, and TB7.7 encoded in RD11, which are absent in all BCG strains and in the majority of NTM. Two commercial in vitro assays based on this technology are currently availab...

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“…In the subsequent contact tracing studies no index case was found. Based on the classical studies performed by NYBOE [6], the main guidelines in this kind of child population consider as a cut-off for M. tuberculosis infection a TST induration o10 mm, in order to avoid false-positive TST results induced by NTM immunisation [7]. Nevertheless, indurations .15 mm [8] and 20 mm [9] have been reported in children with NTM infections.…”

Section: From the Authorsmentioning

confidence: 99%

Discordance between TSTs and IFN-γ release assays: the role of NTM and the relevance of mycobacterial sensitins

Latorre¹,

Souza-Galvão²,

Ruiz-Manzano³

et al. 2010

Eur Respir J

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Diagnosis and Treatment of Tuberculosis

Cited by 33 publications

References 42 publications

Use of adenosine deaminase measurements and QuantiFERON in the rapid diagnosis of tuberculous peritonitis

Use of adenosine deaminase measurements and QuantiFERON in the rapid diagnosis of tuberculous peritonitis

Diagnosing TB infection in children: analysis of discordances usingin vitrotests and the tuberculin skin test

Discordance between TSTs and IFN-γ release assays: the role of NTM and the relevance of mycobacterial sensitins

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