Nontuberculous Mycobacteria and Testing for Latent Tuberculosis Infection.
Nontuberculous Mycobacteria and Testing for Latent Tuberculosis Infection.
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非结核分枝杆菌和潜伏性结核感染检测。
DOI：
10.1093/cid/ciy290
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发表时间：
2018
期刊：
影响因子：
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通讯作者：
C. R. Horsburgh
中科院分区：
文献类型：
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作者：
C. von Reyn;C. R. Horsburgh
致编辑-Muñoz等人[1]的研究表明，当使用干扰素γ释放试验排除假阳性结核菌素皮肤试验（TST）结果时，活动性结核病的健康家庭接触者的治疗需求可以安全地减少20%。由于这项研究是在西班牙进行的，28%的试验参与者以前接种过卡介苗（BCG）疫苗，这似乎是TST假阳性结果的主要原因。作者推测，假阳性结果的剩余部分可能是由于暴露于非结核分枝杆菌（NTM）。我们以前已经表明，NTM感染是美国健康医护人员中大多数TST阳性结果的原因，而之前没有接种卡介苗。结核分枝杆菌纯化蛋白衍生物和鸟分枝杆菌致敏素（一种NTM纯化蛋白）的双重皮肤试验显示，在培养证实的疾病患者中，可区分2种分枝杆菌[2]。当使用相同的双重皮肤试验标准解释来自美国北方和南方的784名医护人员的试验结果时，我们发现82%的5-9-mm TST反应和50%的10-14-mm反应是由于NTM [3]。这些数据强调了使用2种市售干扰素γ释放检测试剂之一进行检测的价值，不仅在BCG免疫接种常见的国家，而且在BCG疫苗从未广泛使用的国家。
To the Editor—The study by Muñoz et al [1] demonstrates that the need for treatment of healthy household contacts of active tuberculosis can be safely reduced by 20% when an interferon γ release assay is used to exclude false-positive tuberculin skin test (TST) results. Because the study was conducted in Spain, 28% of trial participants had been previously immunized with Bacille Calmette Guerin (BCG) vaccine, a factor that seemed to be the predominant cause of false-positive TST results. The authors surmise that the remaining proportion of false-positive results may have been due to exposure to nontuberculous mycobacteria (NTM). We have shown previously that infection with NTM is responsible for the majority of positive TST results among healthy healthcare workers in the United States without prior BCG immunization. Dual skin tests with Mycobacterium tuberculosis purified protein derivative andMycobacterium avium sensitin (an NTM purified protein) were shown to discriminate between the 2 mycobacteria in patients with culture-confirmed disease [2]. When the same dual skin test criteria were used to interpret test results in 784 healthcare workers from the northern and southern United States, we found that 82% of 5–9-mm TST reactions and 50% of 10–14-mm reactions were due to NTM [3]. These data highlight the value of testing with 1 of the 2 commercially available interferon γ release assays, not only in countries where BCG immunization is common but also in countries where BCG vaccine has never been used widely.