Diagnostic performance of an enzyme-linked immunospot assay for interferon-γ in extrapulmonary tuberculosis varies between different sites of disease

Liao, Chun-Hsing; Chou, Chien‐Hong; Lai, Chih‐Cheng; Huang, Yu-Tsung; Tan, Che-Kim; Hsu, Han Lin; Hsueh, Po-Ren

doi:10.1016/j.jinf.2009.10.001

Cited by 69 publications

(55 citation statements)

References 30 publications

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“…Our search strategy was broader as we queried two databases without linguistic restrictions. We identified 15 additional studies for review, including two publications overlooked by the previous meta-analysis (32,35). Compared to the earlier metaanalysis, we summarized blood IGRA data for more than three times as many patients and pleural fluid IGRA data for more than twice as many patients.…”

Section: Discussionmentioning

confidence: 99%

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Interferon Gamma Release Assays for Diagnosis of Pleural Tuberculosis: a Systematic Review and Meta-Analysis

et al. 2015

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The role of interferon gamma release assays (IGRAs), although established for identifying latent tuberculosis, is still evolving in the diagnosis of active extrapulmonary tuberculosis. We systematically evaluated the diagnostic performance of blood-and pleural fluid-based IGRAs in tuberculous pleural effusion (TPE). We searched the PubMed and Embase databases for studies evaluating the use of commercially available IGRAs on blood and/or pleural fluid samples for diagnosing TPE. The quality of the studies included was assessed through the QUADAS-2 tool. The pooled estimates of sensitivity and specificity with 95% confidence intervals (95% CI) were generated using a bivariate random-effects model and examined using forest plots and hierarchical summary receiver operating characteristic (HSROC) curves. Indeterminate IGRA results were included for sensitivity calculations. Heterogeneity was explored through subgroup analysis and meta-regression based on prespecified covariates. We identified 19 studies assessing the T.SPOT.TB and/or QuantiFERON assays. There were 20 and 14 evaluations, respectively, of whole-blood and pleural fluid assays, involving 1,085 and 727 subjects, respectively. There was only one good-quality study, and five studies used nonstandard assay thresholds. The pooled sensitivity and specificity for the blood assays were 0.77 (95% CI, 0.71 to 0.83) and 0.71 (95% CI, 0.65 to 0.76), respectively. The pooled sensitivity and specificity for the pleural fluid assays were 0.72 (95% CI, 0.55 to 0.84) and 0.78 (95% CI, 0.65 to 0.87), respectively. There was considerable heterogeneity; however, multivariate meta-regression did not identify any covariate with significant influence. There was no publication bias for blood assays. We conclude that commercial IGRAs, performed either on whole-blood or pleural fluid samples, have poor diagnostic accuracy in patients suspected to have TPE.T uberculosis (TB) is a common etiology of pleural effusion, especially in developing countries (1). A definitive microbiological diagnosis is achieved by tuberculous pleural effusion (TPE) in only a few patients, and the diagnostic accuracy of other pleural fluid investigations is suboptimal (1, 2). Estimation of adenosine deaminase or interferon gamma and detection of the mycobacterial genome in pleural fluid are used as diagnostic surrogates (2). Pleural biopsies may improve the diagnostic yield; however, these procedures are invasive, require expertise, and are not free from complications (3-5).In recent years, interferon gamma release assays (IGRAs) have emerged as an immunodiagnostic tool to detect tuberculous infection. IGRAs quantify interferon gamma released by T-lymphocytes in response to stimulation by specific antigens encoded in region of difference 1 (RD1) of the Mycobacterium tuberculosis genome. An enzyme-linked immunosorbent spot (ELISpot) assay (T-SPOT.TB; Oxford Immunotec Limited, United Kingdom) and an enzyme-linked immunosorbent assay (ELISA) (QuantiFERON; Cellestis Limited, Australia) are commercially avail...

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Section: Discussionmentioning

confidence: 99%

“…Of these, pleural fluid data were not further analyzed in one study describing only nine TPE patients (32). Among the 13 studies providing information on HIV status, a substantial proportion of TPE patients were HIV seropositive in only 3 (Table 1) (29,33,34).…”

Section: Study Characteristicsmentioning

confidence: 99%

Interferon Gamma Release Assays for Diagnosis of Pleural Tuberculosis: a Systematic Review and Meta-Analysis

et al. 2015

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“…The onset of symptoms had started 3 months before ELISPOT testing. Furthermore, we have found two case series describing the diagnostic aid of ELISPOT testing in extrapulmonary forms of TB (10,14). These studies reported that three patients with tuberculous pericarditis tested positive by an ELISPOT assay of blood.…”

Section: Resultsmentioning

confidence: 99%

“…Unfortunately, no ELISPOT testing on pericardial fluid was performed, and little data were described in these cases. We retrieved unpublished additional data of two cases and present these in Table 1 (14).…”

Section: Resultsmentioning

confidence: 99%

Diagnostic Potential of an Enzyme-Linked Immunospot Assay in Tuberculous Pericarditis

Bathoorn

Limburg

Bouwman

et al. 2011

Clin. Vaccine Immunol.

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Tuberculous pericarditis is a rare disease in developed countries. The diagnosis is difficult to set since there are no robust rapid tests, and culture of pericardial fluid for Mycobacterium tuberculosis is often negative. T-SPOT.TB, an enzyme-linked immunospot (ELISPOT) test, measures the gamma interferon response of lymphocytes against tuberculosis antigens and can be performed on blood and body fluids. We describe a patient with tuberculous pericarditis for which the diagnosis was rapidly set by positive T-SPOT.TB results, which were confirmed by isolation of Mycobacterium tuberculosis in pericardial fluid culture. We performed a literature search to assess the diagnostic potential of ELISPOT testing in tuberculous pericarditis. The limited data on this subject indicate that T-SPOT.TB aids in diagnosing active tuberculosis (TB) infection and results in a more rapid decision to start antituberculosis treatment. Enumerating TB-specific lymphocytes and testing blood/compartmental fluid simultaneously can provide useful information on active tuberculous pericarditis.

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“…1 It has been shown that clinically suspected CRBSI can be detected by the differential time to positivity (DTP) method or Gram/acridine-orange leukocyte cytospin (AOLC) test without catheter removal. 2,3 Whether microorganisms can be detected in blood drawn from CVCs before symptoms of CRBSI become manifest using the Gram/AOLC method has not been investigated.…”

Section: Fundingmentioning

confidence: 99%

Improving evaluations of T-cell assays for diagnosing active Mycobacterium tuberculosis infection

Kirby

2010

Journal of Infection

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Diagnostic performance of an enzyme-linked immunospot assay for interferon-γ in extrapulmonary tuberculosis varies between different sites of disease

Cited by 69 publications

References 30 publications

Interferon Gamma Release Assays for Diagnosis of Pleural Tuberculosis: a Systematic Review and Meta-Analysis

Interferon Gamma Release Assays for Diagnosis of Pleural Tuberculosis: a Systematic Review and Meta-Analysis

Diagnostic Potential of an Enzyme-Linked Immunospot Assay in Tuberculous Pericarditis

Improving evaluations of T-cell assays for diagnosing active Mycobacterium tuberculosis infection

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