Prospective Comparison of the Tuberculin Skin Test and 2 Whole-Blood Interferon-  Release Assays in Persons with Suspected Tuberculosis

Mazurek, Gerald H.; Weis, Stephen E.; Moonan, Patrick K.; Daley, Charles L.; Bernardo, John; Lardizabal, Alfred; Reves, Randall; Toney, Sean; Daniels, Laura; LoBue, Philip

doi:10.1086/521107

Cited by 106 publications

(88 citation statements)

References 28 publications

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“…After obtaining consent, we drew 30 ml of blood before the subject was connected to the hemodialysis machine. Blood was transported to the Long Beach Public Health Laboratory (Long Beach, CA) at room temperature where QFT-G was performed and interpreted as described previously (12). For the ELISPOT assay, blood was collected in a BD Vacutainer CPT cell preparation tube with sodium citrate and centrifuged for 20 min according to the manufacturer's instructions (BD Biosciencs, Franklin Lakes, NJ) and shipped overnight to the laboratory in Portland, OR where the peripheral blood mononuclear cells were prepared and cryopreserved for future analysis.…”

Section: Methodsmentioning

confidence: 99%

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

Winthrop

Nyendak

Calvet³

et al. 2008

Clinical Journal of the American Society of Nephrology

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Section: Methodsmentioning

confidence: 99%

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

Winthrop

Nyendak

Calvet³

et al. 2008

Clinical Journal of the American Society of Nephrology

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“…Interferon-gamma release assays have been tested and found to perform reasonably well in healthy populations as well as in patients with end-stage liver disease. [16][17][18][19] …”

Section: Diagnosis Of Tuberculosis In End-stage Liver Diseasementioning

confidence: 99%

A Guide to the Management of Tuberculosis in Patients with Chronic Liver Disease

Dhiman

Saraswat

Rajekar

et al. 2012

Journal of Clinical and Experimental Hepatology

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Tuberculosis remains one of the 'Captains of the Men of Death' even today, particularly in the developing world. Its frequency is increased 14-fold in patients with chronic liver diseases (CLD) and liver cirrhosis, more so in those with decompensated disease, probably due to the cirrhosis-associated immune dysfunction syndrome, and case-fatality rates are high. The diagnosis of tuberculosis, particularly the interpretation of the Mantoux test, is also fraught with difficulties in CLD, especially after previous BCG vaccination. However, the greatest challenge in the patient with CLD or liver cirrhosis and tuberculosis is managing their therapy since the best first-line anti-tuberculosis drugs are hepatotoxic and baseline liver function is often deranged. Frequency of hepatotoxicity is increased in those with liver cirrhosis, chronic hepatitis B and chronic hepatitis C, possibly related to increased viral loads and may be decreased following antiviral therapy. If hepatotoxicity develops in those with liver cirrhosis, particularly decompensated cirrhosis, the risk of severe liver failure is markedly increased. Currently, there are no established guidelines for anti-tuberculosis therapy (ATT) in CLD and liver cirrhosis although the need for such guidelines is self-evident. It is proposed that ATT should include no more than 2 hepatotoxic drugs (RIF and INH) in patients with CLD or liver cirrhosis and stable liver function [ChildTurcotte-Pugh (CTP) #7], only a single hepatotoxic drug (RIF or INH) in those with advanced liver dysfunction and no hepatotoxic drugs with very advanced liver dysfunction (CTP $11). A standard protocol should be followed for monitoring ATT-related hepatotoxicity and for stop rules and reintroduction rules in all these patients, on the lines proposed here. It is hoped that these proposals will introduce uniformity and result in streamlining the management of these difficult patients. ( J CLIN EXP HEPATOL 2012;2:260-270)

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“…These newer tests enumerate the frequency of peripheral blood effector T cells driven by RD-1 TB-specific antigens (early secreted antigenic target 6 [ESAT-6] and culture filtrate protein 10 [CFP-10]) (15,16). However, this blood-based immunologic approach is unsuitable for the diagnosis of active TB because the test cannot distinguish effector cells in the context of LTBI from cells present during active disease (17)(18)(19)(20)(21). An alternative approach is to quantify the frequency of antigen-specific effector cells at the site of disease rather than in whole blood.…”

Section: What This Study Adds To the Fieldmentioning

confidence: 99%

Cerebrospinal T-Cell Responses Aid in the Diagnosis of Tuberculous Meningitis in a Human Immunodeficiency Virus– and Tuberculosis-Endemic Population

Patel

Singh²,

Connolly³

et al. 2010

Am J Respir Crit Care Med

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Rationale: Current tools for the rapid diagnosis of tuberculous meningitis (TBM) are suboptimal. We evaluated the clinical utility of a quantitative RD-1 IFN-g T-cell enzyme-linked immunospot (ELISPOT) assay (T-SPOT.TB), using cerebrospinal fluid cells for the rapid immunodiagnosis of TBM. Objectives: To evaluate the diagnostic utility of the RD1 antigenspecific ELISPOT assay for the diagnosis of tuberculous meningitis. Methods: The ELISPOT assay was evaluated in 150 patients with suspected TBM who were categorized as definite-TBM, probable-TBM, and non-TBM. Culture or polymerase chain reaction positivity for Mycobacerium tuberculosis served as the reference standard. To determine the diagnostic value of the ELISPOT assay, a clinical prediction rule was derived from baseline clinical and laboratory parameters using a multivariable regression model. Measurements and Main Results: A total of 140 patients (81% HIVinfected; median CD4 count, 160 cells/mm 3 ) were included in the final analysis. When comparing the definite-TBM (n 5 38) and non-TBM groups (n 5 48), the ELISPOT assay (cut point of >228 spot-forming cells per 1 million mononuclear cells) was a useful rule-in test: sensitivity 58% (95% confidence interval [CI], 41-74); specificity 94% (95% CI, 83-99). However, ELISPOT outcomes improved when other rapid tests were concurrently used to exclude bacterial (Gram stain) and cryptococcal meningitis (latex-agglutination test) within the non-TBM group. Using this approach, the ELISPOT assay (cut point of >46 spot-forming cells) was an excellent rule-in test: sensitivity 82% (95% CI, 66-92); specificity 100% (95% CI, 78-100); positive predictive value, 100% (95% CI, 89-100); negative predictive value, 68% (95% CI, 45-86); area under the curve, 0.90. The ELISPOT assay had incremental diagnostic value compared with the clinical prediction rule. Conclusions: The RD-1 ELISPOT assay, using cerebrospinal fluid mononuclear cells and in conjunction with other rapid confirmatory tests (Gram stain and cryptococcal latex-agglutination test), is an accurate rapid rule-in test for TBM in a TB and HIV endemic setting.

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Prospective Comparison of the Tuberculin Skin Test and 2 Whole-Blood Interferon- Release Assays in Persons with Suspected Tuberculosis

Abstract: The TST, QFT, and QFT-G have similar sensitivity in persons with culture-confirmed infection. As with the TST, negative QFT and QFT-G results should not be used to exclude the diagnosis of tuberculosis in persons with suggestive signs or symptoms.

Cited by 106 publications

References 28 publications

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

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

A Guide to the Management of Tuberculosis in Patients with Chronic Liver Disease

Cerebrospinal T-Cell Responses Aid in the Diagnosis of Tuberculous Meningitis in a Human Immunodeficiency Virus– and Tuberculosis-Endemic Population

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