&lt;I&gt;M. tuberculosis&lt;/I&gt; DNA detection in nasopharyngeal mucosa can precede tuberculosis development in contacts

Balcells, María Elvira; M, Huilcamán; Peña, Carlos; Castillo, Claudia; Carvajal, Camila; Scioscia, Natalia; García, Patricia

doi:10.5588/ijtld.15.0872

Cited by 9 publications

(4 citation statements)

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“…Many of these 59 studies did not have the primary aim of assessing diagnostic accuracy. Many recorded few cases of active TB (often < 10) 22,[25][26][27][29][30][31][32][33][35][36][37][38]40,[42][43][44][45]47,48,50,51,[56][57][58][59][62][63][64][65][67][68][69][70][71][72][73][74][75]77,78 and/or were restricted to groups such as patients infected with HIV, 9,28,29,36,49,51,56,60,65,…”

Section: Diagnostic Performance Of Interferon Gamma Release Assays Fomentioning

confidence: 99%

Two interferon gamma release assays for predicting active tuberculosis: the UK PREDICT TB prognostic test study

Abubakar

Lalvani

Southern

et al. 2018

Health Technol Assess

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Background Despite a recent decline in the annual incidence of tuberculosis (TB) in the UK, rates remain higher than in most Western European countries. The detection and treatment of latent TB infection (LTBI) is an essential component of the UK TB control programme. Objectives To assess the prognostic value and cost-effectiveness of the current two interferon gamma release assays (IGRAs) compared with the standard tuberculin skin test (TST) for predicting active TB among untreated individuals at increased risk of TB: (1) contacts of active TB cases and (2) new entrants to the UK from high-TB-burden countries. Design A prospective cohort study and economic analysis. Participants and setting Participants were recruited in TB clinics, general practices and community settings. Contacts of active TB cases and migrants who were born in high-TB-burden countries arriving in the UK were eligible to take part if they were aged ≥ 16 years. Main outcome measures Outcomes include incidence rate ratios comparing the incidence of active TB in those participants with a positive test result and those with a negative test result for each assay, and combination of tests and the cost per quality-adjusted life-year (QALY) for each screening strategy. Results A total of 10,045 participants were recruited between May 2010 and July 2015. Among 9610 evaluable participants, 97 (1.0%) developed active TB. For the primary analysis, all test data were available for 6380 participants, with 77 participants developing active TB. A positive result for TSTa (positive if induration is ≥ 5 mm) was a significantly poorer predictor of progression to active TB than a positive result for any of the other tests. Compared with TSTb [positive if induration is ≥ 6 mm without prior bacillus Calmette–Guérin (BCG) alone, T-SPOT®.TB (Oxford Immunotec Ltd, Oxford, UK), TSTa + T-SPOT.TB, TSTa + IGRA and the three combination strategies including TSTb were significantly superior predictors of progression. Compared with the T-SPOT.TB test alone, TSTa + T-SPOT.TB, TSTb + QuantiFERON® TB Gold In-Tube (QFT-GIT; QIAGEN GmbH, Hilden, Germany) and TSTb + IGRA were significantly superior predictors of progression and, compared with QFT-GIT alone, T-SPOT.TB, TSTa + T-SPOT.TB, TSTa + QFT-GIT, TSTa + IGRA, TSTb + T-SPOT.TB, TSTb + QFT-GIT and TSTb + IGRA were significantly superior predictors of progression. When evaluating the negative predictive performance of tests and strategies, negative results for TSTa + QFT-GIT were significantly poorer predictors of non-progression than negative results for TSTa, T-SPOT.TB and TSTa + IGRA. The most cost-effective LTBI testing strategies are the dual-testing strategies. The cost and QALY differences between the LTBI testing strategies were small; in particular, QFT-GIT, TSTb + T-SPOT.TB and TSTb + QFT-GIT had very similar incremental net benefit estimates. Conclusion This study found modest differences between tests, or combinations of tests, in identifying individuals who would go on to develop active TB. However, a two-step approach that combined TSTb with an IGRA was the most cost-effective testing option. Implications for practice and future research The two-step TSTb strategy, which stratified the TST by prior BCG vaccination followed by an IGRA, was the most cost-effective approach. The limited ability of current tests to predict who will progress limits the clinical utility of tests. The implications of these results for the NHS England/Public Health England national TB screening programme for migrants should be investigated. Study registration This study is registered as NCT01162265. Funding The National Institute for Health Research Health Technology Assessment programme.

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Section: Diagnostic Performance Of Interferon Gamma Release Assays Fomentioning

confidence: 99%

Two interferon gamma release assays for predicting active tuberculosis: the UK PREDICT TB prognostic test study

Abubakar

Lalvani

Southern

et al. 2018

Health Technol Assess

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“…Nonetheless, the findings observed in microbiota diversity in contacts who were about to acquire the infection remain to be confirmed in a larger cohort. Previous work by our group and others has reported that transient Mtb localization in the upper respiratory tract mucosa can rarely occur after exposure to a PTB case 19 , 20 . However, the persistence, replication and direct effect of Mtb in nasopharyngeal mucosa is unlikely, as we did not detect Mtb in the nasopharyngeal samples.…”

Section: Discussionmentioning

confidence: 69%

Reduced microbial diversity of the nasopharyngeal microbiome in household contacts with latent tuberculosis infection

Ruiz-Tagle

Ugalde

Naves

et al. 2023

Sci Rep

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The upper respiratory tract is an obliged pathway for respiratory pathogens and a healthy microbiota may support the host's mucosal immunity preventing infection. We analyzed the nasopharyngeal microbiome in tuberculosis household contacts (HHCs) and its association with latent tuberculosis infection (TBI). A prospective cohort of HHCs was established and latent TBI status was assessed by serial interferon-γ release assay (IGRA). Nasopharyngeal swabs collected at baseline were processed for 16S rRNA gene sequencing. The 82 participants included in the analysis were classified as: (a) non-TBI [IGRA negative at baseline and follow-up, no active TB (n = 31)], (b) pre-TBI [IGRA negative at baseline but converted to IGRA positive or developed active TB at follow-up (n = 16)], and (c) TBI [IGRA positive at enrollment (n = 35)]. Predominant phyla were Actinobacteriota, Proteobacteria, Firmicutes and Bacteroidota. TBI group had a lower alpha diversity compared to non-TBI (padj = 0.04) and pre-TBI (padj = 0.04). Only TBI and non-TBI had beta diversity differences (padj = 0.035). Core microbiomes’ had unique genera, and genus showed differential abundance among groups. HHCs with established latent TBI showed reduced nasopharyngeal microbial diversity with distinctive taxonomical composition. Whether a pre-existing microbiome feature favors, are a consequence, or protects against Mycobacterium tuberculosis needs further investigation.

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“…From included manuscripts (appendix pp 26-33 for study characteristics; appendix p 5 includes full methodological details and results by study), we classified types of upper respiratory tract sampling into four groups: laryngeal swabs (32 studies ), nasopharyngeal aspirate (ten studies [43][44][45][46][47][48][49][50][51][52] ), oral swabs (18 studies [53][54][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69][70] ), and other (mouthwash three studies, [71][72][73] nasal swabs one study, 74 saliva four studies, [75][76][77][78] and other mucosa or dental samples three studies [79][80][81] ). Studies were published between May 13, 1933, and Dec 19, 2022, from South Africa (11 studies), Norway (seven studies), UK (seven studies), Peru (four studies), Uganda (seven studies), Canada (three studies), India (three studies), USA (three studies), Australia (two studies), Germany (two studies), Kenya (two studies), and one study from each of Brazil, Chile, China, Slovakia and Czech Republic, Denmark, Finland, France, Hungary, Italy, Japan, Malawi, Moldova, Mozambique, South Korea, southeast Asia (individual countries not specified), Spain, Sweden, Taiwan, Turkey, and Yemen.…”

Section: Resultsmentioning

confidence: 99%

Accuracy of upper respiratory tract samples to diagnose Mycobacterium tuberculosis: a systematic review and meta-analysis

Savage,

Rickman,

Burke

et al. 2023

The Lancet Microbe

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<I>M. tuberculosis</I> DNA detection in nasopharyngeal mucosa can precede tuberculosis development in contacts

Abstract: The detection of M. tuberculosis DNA in the nasopharyngeal mucosa of contacts is an infrequent event that in this instance preceded the development of pulmonary TB. Its pathogenic role requires further investigation.

Cited by 9 publications

References 0 publications

Two interferon gamma release assays for predicting active tuberculosis: the UK PREDICT TB prognostic test study

Two interferon gamma release assays for predicting active tuberculosis: the UK PREDICT TB prognostic test study

Reduced microbial diversity of the nasopharyngeal microbiome in household contacts with latent tuberculosis infection

Accuracy of upper respiratory tract samples to diagnose Mycobacterium tuberculosis: a systematic review and meta-analysis

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