Negative and Positive Predictive Value of a Whole-Blood Interferon-γ Release Assay for Developing Active Tuberculosis

Diel, Roland; Loddenkemper, R.; Niemann, Stefan; Meywald-Walter, Karen; Nienhaus, Albert

doi:10.1164/rccm.201006-0974oc

Cited by 271 publications

(251 citation statements)

References 18 publications

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“…The limited number of studies so far indicates that its value may be higher in low-prevalence countries [69][70][71][72] as compared to highly endemic regions [46,73]. At present, recommendations that favour the use of IGRAs over TST in immunocompromised patients are largely based on potential superiority in identifying individuals with LTBI.…”

Section: Risk Of Tb In Sot Recipientsmentioning

confidence: 99%

“…Although the predictive value of IGRAs and the TST for progression to active disease have been studied in immunocompetent subjects [46,69,70] its value to predict active TB after transplantation, the impact of various immune suppression regimens and pathogen prevalence have not been assessed [163]. Current generations of immunodiagnostic tests are poor predictors of future TB risk because of relatively low specificity for live bacilli in immunocompetent individuals, e.g.…”

Section: Improvements In the Diagnosis Of Ltbi In Transplant Candidatmentioning

confidence: 99%

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

Bumbăcea

Arend

Eyüboğlu³

et al. 2012

Eur Respir J

234

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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Section: Risk Of Tb In Sot Recipientsmentioning

confidence: 99%

Section: Improvements In the Diagnosis Of Ltbi In Transplant Candidatmentioning

confidence: 99%

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

Bumbăcea

Arend

Eyüboğlu³

et al. 2012

Eur Respir J

234

261

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“…While DIEL et al [5] found a clear superiority of an IGRA over the TST for the development of tuberculosis in household contacts, KIK et al [6] found IGRAs and the TST equally ineffective at predicting the development of tuberculosis in immigrants to the Netherlands. As the study populations investigated were different and KIK et al [6] performed IGRAs only when the TST was positive, the results of both studies are not directly comparable.…”

Section: From the Authorsmentioning

confidence: 99%

“…In countries of low-to-medium tuberculosis prevalence, shortterm progression rates to tuberculosis in individuals belonging to tuberculosis risk groups have been reported to range from 3.3% to 12.9% [5][6][7][8][9]. Although the potential cost-effectiveness of an IGRA for the investigation of LTBI has recently been demonstrated in immigrant screening in the UK [10], information on the predictive values of IGRAs for the development of tuberculosis still relies on a small number of at-risk individuals who actually developed tuberculosis.…”

Section: From the Authorsmentioning

confidence: 99%

Interferon-γ release assays for the diagnosis of latentMycobacterium tuberculosisinfection

et al. 2011

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“…Das Risiko für die Progres sion zu einer aktiven Tuberkulose nach einem positiven IGRA ist allerdings noch unbekannt. Es scheint bei Beschäftigten im Gesundheitsdienst geringer zu sein als bei engen Kontaktpersonen, die nach dem Infektionsschutzgesetz untersucht wer den (< 1 % vs. 12 %; [7,25] …”

Section: Introductionunclassified

Berufsbedingte Infektionskrankheiten bei Beschäftigten im Gesundheitsdienst 2014

et al. 2015

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Zusammenfassung Einführung Beschäftigte im Gesundheitsdienst haben aufgrund ihrer Tätigkeiten ein erhöhtes Infektionsrisiko. Die Häufigkeit von berufsbedingten Infektionen (BK 3101) kann anhand der Anzahl der gemeldeten und anerkannten Berufskrankheiten geschätzt werden. Methoden Als Datenquelle wird die Berufskrankheiten-Dokumentation (BK-DOK) der Berufsgenossenschaft für Gesundheitsdienst und Wohlfahrtspflege (BGW) verwendet. Die Daten zur BK 3101 werden für die Jahre 2010 bis 2014 dargestellt. Die Entwicklung wird anhand der absoluten Zahlen für Verdachtsanzeigen und anerkannte Berufskrankheiten (BK) dargestellt. Das Erkrankungsrisiko wird mittels BK-Quoten [Häufigkeiten je 100.000 Vollarbeiter (VA)] beschrieben. Ergebnisse Im Berichtsjahr 2014 gingen bei der BGW 927 Verdachtsanzeigen auf eine BK 3101 ein. In 496 Fällen wurde die Infektion als BK anerkannt (ein Anstieg gegenüber 2013 um 6,9 %). In 43 Fällen wurde eine neue BK-Rente bewilligt. Wesentliche Anteile am BK-Geschehen hatten Tuberkulose, Hepatitis B und C sowie Skabies (zusammen 93 % aller anerkannten Fälle). Die Häufigkeit der anerkannten BK 3101 je 100.000 VA war von 9,5 im Jahr 2010 auf 10,9 im Jahr 2014 gestiegen. Das Erkrankungsrisiko für die Beschäftigten variierte je nach Versorgungsbereich stark (zwischen 6,8 Fällen je 100.000 VA in der ambulanten Pflege und 37,4 in Krankenhäusern). Diskussion Bei den als BK anerkannten Infektionskrankheiten sind nach wie vor Tuberkulose und Hepatitis vorherrschend. Dies betrifft sowohl den klinischen Bereich wie auch Arztpraxen und ambulante Dienste. Die Skabies nahm in den vergangenen Jahren insbesondere in der Altenpflege deutlich zu. Die wenigen, aber zum Teil schweren Krankheitsverläufe bei Infektionen mit multiresistenten Erregern sprechen dafür, dass deren Entwicklung beobachtet werden muss.

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Negative and Positive Predictive Value of a Whole-Blood Interferon-γ Release Assay for Developing Active Tuberculosis

Abstract: results suggest that QFT is more reliable than the TST for identifying those who will soon progress to active TB, especially in children.

Cited by 271 publications

References 18 publications

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

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

Interferon-γ release assays for the diagnosis of latentMycobacterium tuberculosisinfection

Berufsbedingte Infektionskrankheiten bei Beschäftigten im Gesundheitsdienst 2014

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