Comparison of T-cell-based assay with tuberculin skin test for diagnosis of Mycobacterium tuberculosis infection in a school tuberculosis outbreak
Comparison of T-cell-based assay with tuberculin skin test for diagnosis of Mycobacterium tuberculosis infection in a school tuberculosis outbreak
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DOI：
10.1016/s0140-6736(03)12950-9
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发表时间：
2003-04-05
期刊：
影响因子：
168.9
通讯作者：
Lalvani, A
中科院分区：
文献类型：
--
作者：
Ewer, K;Deeks, J;Lalvani, A
背景结核菌素皮试（TST）是诊断潜伏性结核感染的主要方法，但存在诸多缺陷。然而，要找出新的测试是否比TST更好是困难的，因为缺乏一个金标准测试潜伏感染。我们开发并评估了一种灵敏的酶联免疫斑点（ELISPOT）检测方法，用于检测对结核分枝杆菌抗原特异性的T细胞，而这种抗原在牛分枝杆菌BCG和大多数环境分枝杆菌中不存在。我们假设，如果ELISPOT是一个更准确的测试潜伏感染比TST，它应该更好地与暴露于结核分枝杆菌的程度。方法一个大的结核病爆发在英国的一所学校导致一个传染性指标的情况下。我们用TST和ELISPOT检测了535名学生的结核分枝杆菌感染。我们比较了这些测试与接触程度的指示情况下，卡介苗接种的相关性。结果虽然测试之间的协议是高（89%的一致性，kappa=0.72，p
Background The diagnosis of latent tuberculosis infection relies on the tuberculin skin test (TST), which has many drawbacks. However, to find out whether new tests are better than TST is difficult because of the lack of a gold standard test for latent infection. We developed and assessed a sensitive enzyme-linked immunospot (ELISPOT) assay to detect T cells specific for Mycobacterium tuberculosis antigens that are absent from Mycobacterium bovis BCG and most environmental mycobacteria. We postulated that if the ELISPOT is a more accurate test of latent infection than TST, it should correlate better with degree of exposure to M tuberculosis.Methods A large tuberculosis outbreak in a UK school resulted from one infectious index case. We tested 535 students for M tuberculosis infection with TST and ELISPOT. We compared the correlation of these tests with degree of exposure to the index case and BCG vaccination.Findings Although agreement between the tests was high (89% concordance, kappa=0.72, p