Interferon-γ Release Assays for Diagnosing Mycobacterium tuberculosis Infection in Renal Dialysis Patients

Winthrop, Kevin; Nyendak, Melissa; Calvet, Helene; Oh, Peter; Lo, Melanie; Swarbrick, Gwendolyn; Johnson, Carol; Lewinsohn, Deborah A.; Lewinsohn, David; Mazurek, Gerald H.

doi:10.2215/cjn.01010208

Cited by 74 publications

(80 citation statements)

References 19 publications

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“…In contrast to previous studies done in dialysis patients in low-incidence countries (25,26) where aging was associated with a positive TST, we found that older patients were more likely to have a negative TST. However, we also found that QGIT positivity correlated with aging (test for trend: OR 1.93, P ϭ 0.04), in patients Ͻ70 years of age, whereas TST reactivity displayed a negative trend with increasing age (OR 0.65, P ϭ 0.05).…”

Section: Discussioncontrasting

confidence: 99%

“…et al (25) also found during a contact investigation of dialysis patients that a positive QFT-G, but not a positive TST, was associated with increasing age.…”

Section: Discussionmentioning

confidence: 92%

“…In Geneva, Switzerland, QGIT positivity rate was 21% and 19% by TST (26). In the United States, within the setting of contact investigation, QFT-G positivity was 22% and 26% by TST (25). A study done in Tokyo, Japan (34) used QFT-G to evaluate dialysis patients with suspected active TB and found a positive rate of 17.9%.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

High Prevalence of Latent Tuberculosis Infection in Dialysis Patients Using the Interferon-γ Release Assay and Tuberculin Skin Test

Lee¹,

Chou²,

Dou³

et al. 2010

Clinical Journal of the American Society of Nephrology

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Section: Discussioncontrasting

confidence: 99%

“…et al (25) also found during a contact investigation of dialysis patients that a positive QFT-G, but not a positive TST, was associated with increasing age.…”

Section: Discussionmentioning

confidence: 92%

See 1 more Smart Citation

High Prevalence of Latent Tuberculosis Infection in Dialysis Patients Using the Interferon-γ Release Assay and Tuberculin Skin Test

Lee¹,

Chou²,

Dou³

et al. 2010

Clinical Journal of the American Society of Nephrology

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“…This approach has resulted in a decrease in the number of cases of tuberculosis in patients treated with certain medications, such as anti-TNF-a targeting drugs [72]. However, the tuberculin skin test has a reduced sensitivity in subjects who are already using immunosuppressive drugs [12] or in those suffering from chronic illnesses such as rheumatoid arthritis [73][74][75], chronic renal insufficiency [11,13,76] or HIV infection [77][78][79][80][81]. Reduced sensitivity in patients on immunosuppressive drug therapy may be a direct result of inhibitory drug action (e.g.…”

Section: Sectionmentioning

confidence: 99%

LTBI: latent tuberculosis infection or lasting immune responses toM. tuberculosis? A TBNET consensus statement

et al. 2009

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Tuberculosis control relies on the identification and preventive treatment of individuals who are latently infected with Mycobacterium tuberculosis. However, direct identification of latent tuberculosis infection is not possible. The diagnostic tests used to identify individuals latently infected with M. tuberculosis, the in vivo tuberculin skin test and the ex vivo interferon-c release assays (IGRAs), are designed to identify an adaptive immune response against, but not necessarily a latent infection with, M. tuberculosis. The proportion of individuals who truly remain infected with M. tuberculosis after tuberculin skin test or IGRA conversion is unknown. It is also uncertain how long adaptive immune responses towards mycobacterial antigens persist in the absence of live mycobacteria. Clinical management and public healthcare policies for preventive chemotherapy against tuberculosis could be improved, if we were to gain a better understanding on M. tuberculosis latency and reactivation. This statement by the TBNET summarises knowledge and limitations of the currently available tests used in adults and children for the diagnosis of latent tuberculosis infection.In summary, the main issue regarding testing is to restrict it to those who are known to be at higher risk of developing tuberculosis and who are willing to accept preventive chemotherapy.

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“…When screening recipients, the decrease in test sensitivity with increasing immunosuppression has important practical consequences, as screening should be carried out before administration of immunosuppressive drugs to ensure sensitivity and to allow sufficient time to initiate chemoprophylaxis. Studies in transplant candidates prior to liver [62,63] or renal transplantation indicate that IGRAs may be applied, although agreement between TST and IGRAs in renal transplant candidates is only fair to moderate [64][65][66][67][68].…”

Section: Risk Of Tb In Sot Recipientsmentioning

confidence: 99%

The risk of tuberculosis in transplant candidates and recipients: a TBNET consensus statement

Bumbăcea

Arend

Eyüboğlu³

et al. 2012

Eur Respir J

232

261

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Tuberculosis (TB) is a possible complication of solid organ and hematopoietic stem cell transplantation. The identification of candidates for preventive chemotherapy is an effective intervention to protect transplant recipients with latent infection with Mycobacterium tuberculosis from progressing to active disease. The best available proxy for diagnosing latent infection with M. tuberculosis is the identification of an adaptive immune response by the tuberculin skin test or an interferon-c based ex vivo assay. Risk assessment in transplant recipients for the development of TB depends on, among other factors, the locally expected underlying prevalence of infection with M. tuberculosis in the target population. In areas of high prevalence, preventive chemotherapy for all transplant recipients may be justified without immunodiagnostic testing while in areas of medium and low prevalence, preventive chemotherapy should only be offered to candidates with positive M. tuberculosis-specific immune responses. The diagnosis of TB in transplant recipients can be challenging. Treatment of TB is often difficult due to substantial interactions between anti-TB drugs and immunosuppressive medications. This management guideline summarises current knowledge on the prevention, diagnosis and treatment of TB related to solid organ and hematopoietic stem cell transplantation and provides an expert consensus on questions where scientific evidence is still lacking. KEYWORDS: Guideline, management, Mycobacterium tuberculosis, transplantation, tuberculosis T uberculosis (TB) is caused by the pathogenic species of the Mycobacterium tuberculosis complex. Only a minority of individuals who develop an adaptive immune response following infection with M. tuberculosis will ever develop TB, with the actual risk depending on the extent to which the host immune system provides a successful or inadequate response [1,2]. Therefore, individuals with impaired immune response, such as solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients, are more prone to develop TB than immunocompetent persons. TB in transplant recipients is more frequent compared to the general population (estimates from the last decades state 20-74 times as frequent in SOT [3,4] and twice as frequent in HSCT [5]), and more often fatal (up to 31% in SOT [6] and up to 50% in HSCT recipients [7]), thus adding effectiveness to interventions for its prevention, even in the face of difficulties, with treatment related to adverse drug events and drug-drug interactions. Active TB in transplant recipients can result from latent infection with M. tuberculosis (LTBI) in the transplant candidate or in the donor tissue, or from de novo post-transplant infection. These various scenarios prompt for targeted pre-transplant screening of both recipient and, if possible, donors to allow focused management of recipients selected for preventive intervention in the pre-and/or posttransplant period. The term ''preventive chemotherapy'' is used to denote treatmen...

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Interferon-γ Release Assays for Diagnosing Mycobacterium tuberculosis Infection in Renal Dialysis Patients

Abstract: Conclusions: Positive IFN-␥ assay results were more closely associated with recent TB exposure than were positive TST results. QFT-G and ELISPOT might offer a better method for detecting TB infection in ESRD patients.

Cited by 74 publications

References 19 publications

High Prevalence of Latent Tuberculosis Infection in Dialysis Patients Using the Interferon-γ Release Assay and Tuberculin Skin Test

High Prevalence of Latent Tuberculosis Infection in Dialysis Patients Using the Interferon-γ Release Assay and Tuberculin Skin Test

LTBI: latent tuberculosis infection or lasting immune responses toM. tuberculosis? A TBNET consensus statement

The risk of tuberculosis in transplant candidates and recipients: a TBNET consensus statement

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