Evaluation of the diagnostic utility of a whole-blood interferon-γ assay for determining the risk of exposure to Mycobacterium tuberculosis in Bacille Calmette-Guerin (BCG)-vaccinated individuals

Eum, Seok Yong; Lee, Ye-Jin; Kwak, Hyun Kyung; Min, Jin Hong; Hwang, Sung-Kyun; Via, Laura E.; Barry, Clifton E.; Cho, Sang Nae

doi:10.1016/j.diagmicrobio.2008.01.002

Cited by 18 publications

(12 citation statements)

References 27 publications

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“…df: degrees of freedom. [34] BABA [25] BIANCHI [28] BARTU [27] DHEDA [32] DHEDA [17] GOLETTI [35] CHEGOU [31] EUM [34] BABA [25] BIANCHI [28] BARTU [27] DHEDA [32] DHEDA [17] GOLETTI [35] CHEGOU [31] EUM [34] BABA [25] BIANCHI [28] BARTU [27] DHEDA [32] DHEDA [17] GOLETTI [35] [37] GOLETTI [36] KIM [39] KIM [41] KIM [40] KOBASHI [42] LOSI [19] MEIER [44] JAFARI [14] JAFARI [16] NICOL [45] DHEDA [32] DHEDA [17] GOLETTI [35] The situation is different in extrasanguinous samples, where the pooled sensitivity was significantly higher for T-SPOT.TB1 (88%) compared with QFT-G-IT (48%). In addition, the specificity of T-SPOT.TB1 in extrasanguinous samples was higher compared to that recorded in blood (82% versus 59%), whereas specificity of QFT-G-IT did not differ in the two compartments (79% versus 82%).…”

Section: Discussionmentioning

confidence: 99%

Interferon-γ release assays for the diagnosis of active tuberculosis: a systematic review and meta-analysis

et al. 2010

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Interferon-γ release assays (IGRAs) are now established for the immunodiagnosis of latent infection with Mycobacterium tuberculosis in many countries. However, the role of IGRAs for the diagnosis of active tuberculosis (TB) remains unclear. Following preferred reporting items for systematic reviews and meta-analyses (PRISMA) and quality assessment of diagnostic accuracy studies (QUADAS) guidelines, we searched PubMed, EMBASE and Cochrane databases to identify studies published in January 2001-November 2009 that evaluated the evidence of using QuantiFERON-TB® Gold in-tube (QFT-G-IT) and T-SPOT.TB® directly on blood or extrasanguinous specimens for the diagnosis of active TB. The literature search yielded 844 studies and 27 met the inclusion criteria. In blood and extrasanguinous fluids, the pooled sensitivity for the diagnosis of active TB was 80% (95% CI 75-84%) and 48% (95% CI 39-58%) for QFT-G-IT, and 81% (95% CI 78-84%) and 88% (confirmed and unconfirmed cases) (95% CI 82-92%) for T-SPOT.TB®, respectively. In blood and extrasanguinous fluids, the pooled specificity was 79% (95% CI 75-82%) and 82% (95% CI 70-91%) for QFT-G-IT, and 59% (95% CI 56-62%) and 82% (95% CI 78-86%) for T-SPOT.TB®, respectively. Although the diagnostic sensitivities of both IGRAs were higher than that of tuberculin skin tests, it was still not high enough to use as a rule out test for TB. Positive evidence for the use of IGRAs in compartments other than blood will require more independent and carefully designed prospective studies.

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Section: Discussionmentioning

confidence: 99%

Interferon-γ release assays for the diagnosis of active tuberculosis: a systematic review and meta-analysis

et al. 2010

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“…Fourteen studies26 30 32 35 36 40 42 43 46 49 50 52 55 57 reported a positive association between IGRA positivity and occupational risk factors, including higher risk for clinical staff working in a high-risk ward, TB clinic or geriatric care and increased duration of healthcare employment. Two studies38 39 reported no association between test positivity and risk factors; the remaining studies either did not perform the TST or did not calculate ORs for risk factors associated with test positivity.…”

Section: Resultsmentioning

confidence: 99%

Interferon-gamma release assays for tuberculosis screening of healthcare workers: a systematic review

Zwerling

Hof²,

Scholten³

et al. 2011

Thorax

221

195

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Healthcare workers (HCWs) are at increased risk of exposure to tuberculosis (TB). Traditionally, screening for latent TB infection (LTBI) is done using the tuberculin skin test (TST). Interferon-gamma release assays (IGRAs) are now increasingly being used for diagnosis of LTBI, but their role in HCW screening is unclear. A systematic review was conducted of all IGRA studies in HCWs to summarise their performance in cross-sectional and serial testing settings. By searching four electronic databases and other sources, all available studies using any one of the commercial IGRA assays in HCWs were retrieved and screened. 50 unique studies were identified which met the inclusion criteria including five from high TB incidence settings. Among 24 cross-sectional studies in low TB incidence settings, the pooled prevalence of positive IGRA using either test was significantly lower than for a positive TST. However, in high-incidence settings (n¼2) there were no consistent differences in the prevalence of positive tests. IGRAs showed good correlation with occupational risk factors for TB exposure in low-incidence settings. Only 10 studies assessed use of IGRA for serial testing and all showed large variation in the rates of conversions and reversions, with no data suggesting that IGRAs are better at identifying the incidence of new TB infection than the TST. The use of IGRAs instead of TST for one-time screening may result in a lower prevalence of positive tests and fewer HCWs who require LTBI treatment, particularly in low TB incidence settings. However, the use of IGRAs for serial testing is complicated by lack of data on optimum cut-offs for serial testing and unclear interpretation and prognosis of conversions and reversions. Further longitudinal research will be required to inform guidelines on serial testing using IGRAs.

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“…However, current diagnostic methods have limited use, because only 5-16% of children with suspected TB have positive acid fast bacillis smears and positive cultures are reported in only 20-50% of suspected cases (36)(37)(38)(39)(40)(41)(42)(43)(44). Although commercial IFN-g release assays are more specific than the TST in adults (45) and children (46), IFN-g release assays have limited use in TB-endemic settings because they do not reliably differentiate TB from latent TB (47)(48)(49). In this regard, we also found that measurement of ESAT-6/CFP-10-specific PBMC responses did not distinguish healthy children exposed to Mtb from children with TB.…”

Section: Discussionmentioning

confidence: 99%

CD8⁺T Cells Provide an Immunologic Signature of Tuberculosis in Young Children

Lancioni

Nyendak²,

Kiguli

et al. 2012

Am J Respir Crit Care Med

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Rationale: The immunologic events surrounding primary Mycobacterium tuberculosis infection and development of tuberculosis remain controversial. Young children who develop tuberculosis do so quickly after first exposure, thus permitting study of immune response to primary infection and disease. We hypothesized that M. tuberculosis-specific CD8 1 T cells are generated in response to high bacillary loads occurring during tuberculosis. Objectives: To determine if M. tuberculosis-specific T cells are generated among healthy children exposed to M. tuberculosis and children with tuberculosis.Methods: Enzyme-linked immunosorbent spot assays were used to measure IFN-g production in response to M. tuberculosis-specific proteins ESAT-6/CFP-10 by peripheral blood mononuclear cells and CD8 1 T cells isolated from Ugandan children hospitalized with tuberculosis (n ¼ 96) or healthy tuberculosis contacts (n ¼ 62). Measurements and Main Results: The proportion of positive CD8 1 T-cell assays and magnitude of CD81 T-cell responses were significantly greater among young (,5 yr) tuberculosis cases compared with young contacts (P ¼ 0.02, Fisher exact test, P ¼ 0.01, Wilcoxon rank-sum, respectively). M. tuberculosis-specific T-cell responses measured in peripheral blood mononuclear cells were equivalent between groups. Conclusions: Among young children, M. tuberculosis-specific CD8 1 T cells develop in response to high bacillary loads, as occurs during tuberculosis, and are unlikely to be found after M. tuberculosis exposure. T-cell responses measured in peripheral blood mononuclear cells are generated after M. tuberculosis exposure alone, and thus cannot distinguish exposure from disease. In young children, IFN-g-producing M. tuberculosis-specific CD8 1 T cells provide an immunologic signature of primary M. tuberculosis infection resulting in disease.

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Evaluation of the diagnostic utility of a whole-blood interferon-γ assay for determining the risk of exposure to Mycobacterium tuberculosis in Bacille Calmette-Guerin (BCG)-vaccinated individuals

Cited by 18 publications

References 27 publications

Interferon-γ release assays for the diagnosis of active tuberculosis: a systematic review and meta-analysis

Interferon-γ release assays for the diagnosis of active tuberculosis: a systematic review and meta-analysis

Interferon-gamma release assays for tuberculosis screening of healthcare workers: a systematic review

CD8⁺T Cells Provide an Immunologic Signature of Tuberculosis in Young Children

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Evaluation of the diagnostic utility of a whole-blood interferon-γ assay for determining the risk of exposure to Mycobacterium tuberculosis in Bacille Calmette-Guerin (BCG)-vaccinated individuals

Cited by 18 publications

References 27 publications

Interferon-γ release assays for the diagnosis of active tuberculosis: a systematic review and meta-analysis

Interferon-γ release assays for the diagnosis of active tuberculosis: a systematic review and meta-analysis

Interferon-gamma release assays for tuberculosis screening of healthcare workers: a systematic review

CD8+T Cells Provide an Immunologic Signature of Tuberculosis in Young Children

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CD8⁺T Cells Provide an Immunologic Signature of Tuberculosis in Young Children