Discordance of tuberculin skin test and interferon gamma release assay in recently exposed household contacts of pulmonary TB cases in Brazil.
Discordance of tuberculin skin test and interferon gamma release assay in recently exposed household contacts of pulmonary TB cases in Brazil.
复制标题
DOI：
10.1371/journal.pone.0096564
复制
发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Salgame P
中科院分区：
文献类型：
--
作者：
Ribeiro-Rodrigues R;Kim S;Coelho da Silva FD;Uzelac A;Collins L;Palaci M;Alland D;Dietze R;Ellner JJ;Jones-López E;Salgame P
干扰素γ (IFN-γ)释放试验（IGRAs），如Quantiferon Gold in -tube试验，是一种体外试验，用于测量T细胞对结核分枝杆菌（Mtb）特异性抗原反应时IFN-γ的释放。与结核菌素皮肤试验（TST）不同，IGRA具有特异性，能够将mtb感染与卡介苗接种区分开来。在本研究中，我们评估了TST与IGRA的一致性，以及IGRA对肺结核（PTB）家庭接触者（HHC）新发Mtb感染的诊断效果。对巴西Vitória地区357例HHC结核病例进行了研究。在HHC入组后2周内进行TST检查，如果阴性，在8-12周进行第二次TST检查。HHC分为最初TST阳性（TST+）、持续TST阴性（TST-）或TST转化（TSTc），后者代表新感染。入组后8-12周进行IGRA检查，TST+阳性率为82%，TSTc阳性率为48%，TST-阳性率为12%，说明HHC各类别中两项检查结果的一致性较差。评估IGRA上清子集中的CXCL10水平或降低IGRA截止值以确定阳性测试可增加TST和IGRA测试结果之间的一致性。然而，ROC曲线显示，这导致IGRA对TST的敏感性和特异性之间的权衡。总之，研究结果表明，在完全了解TST和IGRA之间不一致的基础之前，可能有必要利用这两种测试来诊断最近暴露的HHC的新结核分枝杆菌感染。在操作上，对于IGRA阴性的HHC，采用较低的IGRA截止值可能有用，以便更密切地监测潜在的转化。
Interferon-gamma (IFN-γ) release assays (IGRAs) such as the Quantiferon Gold In-tube test are in vitro assays that measure IFN-γ release from T cells in response to M. tuberculosis (Mtb)-specific antigens. Unlike the tuberculin skin test (TST), IGRA is specific and able to distinguish Mtb-infection from BCG vaccination. In this study we evaluated the concordance between TST and IGRA and the efficacy of IGRA in diagnosing new Mtb infection in household contacts (HHC) of pulmonary tuberculosis (PTB) cases. A total of 357 HHC of TB cases in Vitória, Brazil were studied. A TST was performed within 2 weeks following enrollment of the HHC and if negative a second TST was performed at 8-12 weeks. HHC were categorized as initially TST positive (TST+), persistently TST negative (TST-), or TST converters (TSTc), the latter representative of new infection. IGRA was performed at 8–12 weeks following enrollment and the test results were positive in 82% of TST+, 48% of TSTc, and 12% of TST-, indicating poor concordance between the two test results among HHC in each category. Evaluating CXCL10 levels in a subset of IGRA supernatants or lowering the IGRA cutoff value to define a positive test increased agreement between TST and IGRA test results. However, ROC curves demonstrated that this resulted in a trade-off between sensitivity and specificity of IGRA with respect to TST. Together, the findings suggest that until the basis for the discordance between TST and IGRA is fully understood, it may be necessary to utilize both tests to diagnose new Mtb infection in recently exposed HHC. Operationally, in IGRA negative HHC, it may be useful to employ a lower cutoff value for IGRA to allow closer monitoring for potential conversion.
登录
查看更多内容
影响因子：
24.3
作者：
Kampmann, B.;Whittaker, E.;Anderson, S. T.
通讯作者：
Anderson, S. T.
影响因子：
3.7
作者：
Adetifa, Ifedayo M. O.;Lugos, Moses D.;Hill, Philip C.
通讯作者：
Hill, Philip C.
DOI：
10.1164/rccm.200608-1099oc
发表时间：
2007-03-15
影响因子：
24.7
作者：
Arend, Sandra M.;Thijsen, Steven F. T.;Bossink, Ailko W. J.
通讯作者：
Bossink, Ailko W. J.
DOI：
10.1164/ajrccm.159.1.9801120
发表时间：
1999-01-01
影响因子：
24.7
作者：
Menzies, D
通讯作者：
Menzies, D
DOI：
10.1183/09031936.00070812
发表时间：
2013-01
期刊：
The European respiratory journal
影响因子：
--
作者：
Fox GJ;Barry SE;Britton WJ;Marks GB
通讯作者：
Marks GB