Detecting Latent Tuberculosis Infection in Hemodialysis Patients

Passalent, Laura; Khan, Kamran; Richardson, Robert; Wang, Jun; Dedier, Helen; Gardam, Michael

doi:10.2215/cjn.01280406

Cited by 101 publications

(87 citation statements)

References 19 publications

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“…This approach has resulted in a decrease in the number of cases of tuberculosis in patients treated with certain medications, such as anti-TNF-a targeting drugs [72]. However, the tuberculin skin test has a reduced sensitivity in subjects who are already using immunosuppressive drugs [12] or in those suffering from chronic illnesses such as rheumatoid arthritis [73][74][75], chronic renal insufficiency [11,13,76] or HIV infection [77][78][79][80][81]. Reduced sensitivity in patients on immunosuppressive drug therapy may be a direct result of inhibitory drug action (e.g.…”

Section: Sectionmentioning

confidence: 99%

See 1 more Smart Citation

LTBI: latent tuberculosis infection or lasting immune responses to M. tuberculosis? A TBNET consensus statement

Mack

Migliori

Sester

et al. 2009

European Respiratory Journal

509

446

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Tuberculosis control relies on the identification and preventive treatment of individuals who are latently infected with Mycobacterium tuberculosis. However, direct identification of latent tuberculosis infection is not possible. The diagnostic tests used to identify individuals latently infected with M. tuberculosis, the in vivo tuberculin skin test and the ex vivo interferon-c release assays (IGRAs), are designed to identify an adaptive immune response against, but not necessarily a latent infection with, M. tuberculosis. The proportion of individuals who truly remain infected with M. tuberculosis after tuberculin skin test or IGRA conversion is unknown. It is also uncertain how long adaptive immune responses towards mycobacterial antigens persist in the absence of live mycobacteria. Clinical management and public healthcare policies for preventive chemotherapy against tuberculosis could be improved, if we were to gain a better understanding on M. tuberculosis latency and reactivation. This statement by the TBNET summarises knowledge and limitations of the currently available tests used in adults and children for the diagnosis of latent tuberculosis infection.In summary, the main issue regarding testing is to restrict it to those who are known to be at higher risk of developing tuberculosis and who are willing to accept preventive chemotherapy.

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Section: Sectionmentioning

confidence: 99%

“…There is evidence suggesting that the sensitivity of IGRAs is higher than that of skin testing [10][11][12][13][14], although large head-to-head studies in immunocompromised patients are lacking. Furthermore, tuberculin skin test sensitivity depends on the chosen cut-off point and is, thus, co-dependent on the chosen level of test specificity.…”

mentioning

confidence: 99%

LTBI: latent tuberculosis infection or lasting immune responses to M. tuberculosis? A TBNET consensus statement

Mack

Migliori

Sester

et al. 2009

European Respiratory Journal

509

446

View full text Add to dashboard Cite

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“…When screening recipients, the decrease in test sensitivity with increasing immunosuppression has important practical consequences, as screening should be carried out before administration of immunosuppressive drugs to ensure sensitivity and to allow sufficient time to initiate chemoprophylaxis. Studies in transplant candidates prior to liver [62,63] or renal transplantation indicate that IGRAs may be applied, although agreement between TST and IGRAs in renal transplant candidates is only fair to moderate [64][65][66][67][68].…”

Section: Risk Of Tb In Sot Recipientsmentioning

confidence: 99%

The risk of tuberculosis in transplant candidates and recipients: a TBNET consensus statement

Bumbăcea

Arend

Eyüboğlu³

et al. 2012

Eur Respir J

228

261

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Tuberculosis (TB) is a possible complication of solid organ and hematopoietic stem cell transplantation. The identification of candidates for preventive chemotherapy is an effective intervention to protect transplant recipients with latent infection with Mycobacterium tuberculosis from progressing to active disease. The best available proxy for diagnosing latent infection with M. tuberculosis is the identification of an adaptive immune response by the tuberculin skin test or an interferon-c based ex vivo assay. Risk assessment in transplant recipients for the development of TB depends on, among other factors, the locally expected underlying prevalence of infection with M. tuberculosis in the target population. In areas of high prevalence, preventive chemotherapy for all transplant recipients may be justified without immunodiagnostic testing while in areas of medium and low prevalence, preventive chemotherapy should only be offered to candidates with positive M. tuberculosis-specific immune responses. The diagnosis of TB in transplant recipients can be challenging. Treatment of TB is often difficult due to substantial interactions between anti-TB drugs and immunosuppressive medications. This management guideline summarises current knowledge on the prevention, diagnosis and treatment of TB related to solid organ and hematopoietic stem cell transplantation and provides an expert consensus on questions where scientific evidence is still lacking. KEYWORDS: Guideline, management, Mycobacterium tuberculosis, transplantation, tuberculosis T uberculosis (TB) is caused by the pathogenic species of the Mycobacterium tuberculosis complex. Only a minority of individuals who develop an adaptive immune response following infection with M. tuberculosis will ever develop TB, with the actual risk depending on the extent to which the host immune system provides a successful or inadequate response [1,2]. Therefore, individuals with impaired immune response, such as solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients, are more prone to develop TB than immunocompetent persons. TB in transplant recipients is more frequent compared to the general population (estimates from the last decades state 20-74 times as frequent in SOT [3,4] and twice as frequent in HSCT [5]), and more often fatal (up to 31% in SOT [6] and up to 50% in HSCT recipients [7]), thus adding effectiveness to interventions for its prevention, even in the face of difficulties, with treatment related to adverse drug events and drug-drug interactions. Active TB in transplant recipients can result from latent infection with M. tuberculosis (LTBI) in the transplant candidate or in the donor tissue, or from de novo post-transplant infection. These various scenarios prompt for targeted pre-transplant screening of both recipient and, if possible, donors to allow focused management of recipients selected for preventive intervention in the pre-and/or posttransplant period. The term ''preventive chemotherapy'' is used to denote treatmen...

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“…36 When the five studies that evaluated the performance of the tests in immunosuppressed patients were examined separately, two showed a slight response reduction of more specific tests in immunosuppressed patients compared to immunocompetent patients, and three studies that evaluated the results of the T-SPOT.TB test compared with the PPD test identified a significantly higher prevalence of positive results in the first test. 35,[37][38][39][40] The cost/benefit of using the T-SPOT.TB test has frequently been debated. Diel et al 41 conducted a study in Germany to evaluate the cost/benefit of screening LTBI and compared results of the PPD and T-SPOT.TB tests in household contacts of patients with tuberculosis.…”

Section: New Tools For the Diagnosis Of Ltbimentioning

confidence: 99%

Investigação de infecção tuberculosa latente em pacientes com psoríase candidatos ao uso de drogas imunobiológicas

Lima

Duarte

et al. 2011

An. Bras. Dermatol.

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The use of tumor necrosis factor inhibitors for the treatment of patients with psoriasis has been related to a higher incidence of tuberculosis, specially the disseminated and extrapulmonary forms. Despite their efficacy, these drugs increase the risk of reactivating latent tuberculosis infection, thus requiring diagnosis of the condition before their administration. Investigation of latent tuberculosis infection with tuberculin skin test is ineffective due to its low specificity and the dubious results that it generates in patients with psoriasis. Assays based on the detection of synthesis of gamma interferon in vitro by peripheral monoclonal cells, stimulated by specific antigens (ESAT-6 and CFP-10), seem to offer better accuracy when compared to the Mantoux test in identifying latent tuberculosis infection. This diagnosis tool has demonstrated higher specificity, since it has no correlation with indirect forms of exposure to M. tuberculosis such as BCG vaccination or with infections by other mycobacteria. Keywords: Psoriasis; Tuberculosis; Tumor necrosis factor-alpha Resumo: O uso dos ini bi do res do fator de necro se tumo ral no tra ta men to de pacien tes com pso ría se vem sendo rela cio na do a uma maior inci dên cia de tuber cu lo se, par ti cu lar men te, nas suas for mas extrapul mo nar e dis se mi na da. Apesar de sua indis cu tí vel efi cá cia, essas dro gas ele vam o risco da rea ti va ção de infec ção tuber cu lo sa laten te (ITBL), tor nan do obri ga tó rio o diag nós ti co da refe ri da con di ção antes da sua admi nis tra ção. A inves ti ga ção da infec ção tuber cu lo sa laten te pelo teste cutâ neo da tuber cu li na é falha, dada sua baixa espe ci fi ci da de, além de apre sen tar resul ta dos duvi do sos em pacien tes com psoría se. Ensaios basea dos na detec ção da pro du ção de inter fe ron-gama in vitro por célu las mono clo nais peri fé ri cas, esti mu la das por antí ge nos espe cí fi cos (Esat-6 e CFP-10), pare cem ofe re cer maior acu rá cia quan do com pa ra dos ao teste de Mantoux na iden ti fi ca ção de infec ção tuber cu lo sa laten te. Essa fer ramen ta diag nós ti ca tem ofe re ci do maior espe ci fi ci da de, já que não apre sen ta cor re la ção com medi das indi re tas de expo si ção ao M. tuber cu lo sis, como a vaci na ção por BCG, e com infec ções por outras micobac té rias. Palavras-chave: Fator de necro se tumo ral alfa; Tuberculose; Psoríase

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Detecting Latent Tuberculosis Infection in Hemodialysis Patients

Cited by 101 publications

References 19 publications

LTBI: latent tuberculosis infection or lasting immune responses to M. tuberculosis? A TBNET consensus statement

LTBI: latent tuberculosis infection or lasting immune responses to M. tuberculosis? A TBNET consensus statement

The risk of tuberculosis in transplant candidates and recipients: a TBNET consensus statement

Investigação de infecção tuberculosa latente em pacientes com psoríase candidatos ao uso de drogas imunobiológicas

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