A 100 year update on diagnosis of tuberculosis infection
A 100 year update on diagnosis of tuberculosis infection
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DOI：
10.1093/bmb/ldp039
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发表时间：
2010-03-01
影响因子：
6.7
通讯作者：
Pareek, Manish
中科院分区：
文献类型：
--
作者：
Lalvani, Ajit;Pareek, Manish
潜伏性结核感染（LTBI）的诊断和治疗是发达国家结核病（TB）控制的基石。在上个世纪，结核菌素皮肤试验（TST）是诊断LTBI的唯一方法。ELISpot和全血ELISA，统称为干扰素-γ释放试验（IGRAs），是有前途的新工具。IGRAs比TST更特异性地诊断LTBI，因为它们不会被先前的卡介苗（BCG）疫苗接种混淆。在缺乏LTBI金标准的情况下评估IGRA敏感性具有挑战性。因此，研究使用了替代标记，如活动性结核病和与接触调查中结核病暴露程度的相关性。这些研究表明，ELISpot的灵敏度高于TST，而全血ELISA的灵敏度与TST相似。最近的纵向研究表明，这些测试的发展活动性TB的预后能力提供了明确的证据，阳性IGRA结果反映感染休眠但活bacilli.Is IGRAs的预后能力大于TST？有进展为活动性结核病高风险的免疫功能低下的LTBI患者的假阴性率是多少？IGRA已被纳入国家指南，尽管其在诊断算法中的最佳部署正在演变。利用IGRAs的健康经济效益越来越多地认识到，部分是因为他们的高特异性，避免了不必要的化学预防卡介苗接种的人与假阳性TST results.Current IGRAs正在改善和下一代测试，提高灵敏度，可以使可靠的排除LTBI免疫功能低下的个人。
Diagnosis and treatment of latent tuberculosis infection (LTBI) is a cornerstone of tuberculosis (TB) control in the developed world. In the last century, the tuberculin skin test (TST) was the only means of diagnosing LTBI. ELISpot and whole-blood ELISA, collectively known as interferon-gamma release assays (IGRAs), are promising new tools.IGRAs are more specific than TST for diagnosis of LTBI as they are not confounded by previous bacille Calmette-Guerin (BCG) vaccination. Assessing IGRA sensitivity in the absence of a gold standard for LTBI is challenging. Studies have therefore used surrogate markers such as active TB and correlation with degree of TB exposure in contact investigations. These studies suggest that sensitivity of ELISpot is higher than TST while whole-blood ELISA has similar sensitivity to TST. Recent longitudinal studies demonstrating the prognostic power of these tests for development of active TB provide definitive evidence that positive IGRA results reflect infection with dormant yet viable bacilli.Is the prognostic power of IGRAs greater than the TST? What are the false-negative rates in immunocompromised individuals with LTBI at high risk of progressing to active TB?IGRAs have been incorporated into national guidelines, although their optimal deployment in diagnostic algorithms is evolving. The health economic benefits of utilizing IGRAs are increasingly recognized, partly because their high specificity avoids unnecessary chemoprophylaxis in BCG-vaccinated persons with false-positive TST results.Current IGRAs are being improved and next-generation tests, with improved sensitivity, could enable the reliable exclusion of LTBI in immunocompromised individuals.