Diagnosis of Active Tuberculous Serositis by Antigen-Specific Interferon-  Response of Cavity Fluid Cells

Ariga, Hiroko; Kawabe, Yojiro; Nagai, Hirokazu; Kurashima, Atsuyuki; Masuda, Kimihiko; Matsui, Hirotoshi; Tamura, Atsuhisa; Nagayama, Naohiro; Akagawa, Shinobu; Machida, Kazuko; Hebisawa, Akira; Nakajima, Yutsuki; Yotsumoto, Hideki; Mori, Toru

doi:10.1086/523591

Cited by 44 publications

(49 citation statements)

References 26 publications

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“…Two recent preliminary studies from low-burden countries (Europe and Japan) suggested that RD-1-based commercial IGRAs, using pleural mononuclear cells, appear promising as diagnostic tools for TB-PE [13,14]. In the last several months, two case-control studies from high-burden countries (South Africa) and using QFT-TB-GIT have been published [15,16].…”

Section: Pleural Hbha and Ppd Elispot Responsesmentioning

confidence: 99%

“…We therefore hypothesised that TB antigen-specific responses could distinguish active pleural TB from alternative diagnoses and should have better discriminatory value than unstimulated IFN-c, a nonspecific biomarker of inflammation. A recent case-control study from Europe showed a high diagnostic accuracy with the T-SPOT.1TB assay (Oxford Immunotec, Abingdon, UK) [13] but overall data on the utility of two known IFN-c release assays (IGRAs), T-SPOT.1TB and QuantiFERON1-TB Gold In-tube (QFT-TB-GIT; Cellestis, Carnegie, Australia), including a head-to-head comparison, for the diagnosis of TB-PE are limited [13][14][15][16]. There are several other unresolved questions, including the optimal cell number and pleural fluid volume required, optimal cut-off point and utility in high HIV-prevalence settings [17].…”

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confidence: 99%

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Utility of quantitative T-cell responses versus unstimulated interferon- for the diagnosis of pleural tuberculosis

Dheda

Zyl-Smit²,

Sechi³

et al. 2009

European Respiratory Journal

110

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The clinical utility of antigen-specific interferon (IFN)-c release assays (IGRAs) using pleural mononuclear cells, for the diagnosis of tuberculosis (TB), requires clarification.We compared the diagnostic utility of unstimulated pleural IFN-c levels with several pleural antigen-specific T-cell IGRAs (early secretory antigenic target-6 and culture filtrate protein-10 (T-SPOT.1TB, QuantiFERON1-TB Gold In-tube), purified protein derivative (PPD) and heparinbinding haemagglutinin (HBHA)) in 78 South African TB suspects. Test results were compared against a clinical score and a reference standard.Out of 74 evaluable subjects 48, seven and 19 had definite, probable and no TB, respectively. 11 (15%) out of 74 pleural samples (nine (19%) out of 48 of the definite TB cases) had total cell counts that were inadequate for T-cell processing. In the remaining 63 samples, the sensitivity, specificity, positive predictive value and negative predictive value of different diagnostic methods were as follows. Maximal bioclinical score: 54, 89, 92 and 43%, respectively; T-SPOT.1TB: 86, 60, 84 and 64%, respectively; QuantiFERON1-TB Gold In-tube: 57, 80, 87 and 44%, respectively; HBHA-specific IGRA: 59, 31, 64 and 27%, respectively; PPD-specific IGRA: 81, 40, 76 and 46%, respectively; and pleural fluid unstimulated IFN-c: 97, 100, 100 and 94%, respectively. Unstimulated IFN-c was the most accurate test for distinguishing TB from non-TB effusions in a high-burden setting. The antigen-specific T-cell IGRAs were limited by suboptimal accuracy and the inability to isolate sufficient mononuclear cells to perform the assay.

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Section: Pleural Hbha and Ppd Elispot Responsesmentioning

confidence: 99%

mentioning

confidence: 99%

Utility of quantitative T-cell responses versus unstimulated interferon- for the diagnosis of pleural tuberculosis

Dheda

Zyl-Smit²,

Sechi³

et al. 2009

European Respiratory Journal

110

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“…Bu nedenle PT hastalarında plevral sıvı İGST ile periferik kan örneği İGST karşılaştırılmıştır. Plevral sıvı T hücre yanıtı birçok çalışmada periferik kan T hücre yanıtına göre daha yüksek bulunmuştur (16)(17)(18)(19). Ariga ve ark.…”

Section: Qft-g Ve Qft-git Testleriunclassified

“…Ariga ve ark. aktif PT hastalarında ESAT-6 ve CFP-10 antijenleri ile aktive ettikleri plevral sıvı IFN-γ cevabı ile periferik kan IFN-γ cevabını ve plevral sıvı ADA seviyelerini karşılaştırmışlardır (16). Antijenlere plevral sıvı IFN-γ cevabı, hem periferik kan IFN-γ cevabı hem de plevral sıvı ADA seviyesine göre anlamlı olarak yüksek bulunmuştur.…”

Section: Qft-g Ve Qft-git Testleriunclassified

Interferon-Gamma Release Assays for Diagnosing

Tutar¹

2012

Plev Bult

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Tüberküloz günümüzde morbidite ve mortalitenin önemli bir nedenidir. Dünya çapında tek enfeksiyöz ajan ile ölüme en sık neden olan hastalıktır (1). Plevra tüber-külozu (PT) ise lenf nodu tüberkülozundan sonra aktif Mycobacterium tuberculosis enfeksiyonunun en sık ikinci ekstrapulmoner tutulum yeridir. Fakat PT'yi diğer lenfositik plevra sıvılarından ayırmak kolay değildir. PT tanısında kullanılan plevral sıvının Ziehl Nielsen ile boyanmasının pozitifliği %5'in altındadır (2, 3). Plevra sıvı kültürü sensitivitesi %24-58 arasındadır ve geç tanı vermektedir (3). Plevra biopsisi ve biopsi materyalinin kültürü, tanıyı doğrulamak için en iyi yöntem olarak görülmektedir (4). Fakat plevra biopsisi invaziv ve komplikasyonları olan bir işlemdir. 1980'lerde kullanıl-maya başlanan bir diğer test ise plevral sıvı adenozin deaminaz (ADA) ölçümüdür. Plevral sıvı ADA seviyesinin ölçümünün PT tanısında toplam sensitivitesi %92 ve spesifitesi %89 olarak bulunmuştur (5). ADA testinden Derleme

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“…Despite the fact that IGRA do not discriminate LTBI from active TB, pooled sensitivity of blood assays has recently been estimated to be higher than 80% in detecting active TB disease as a surrogate of TB infection, at least in developed countries (11)(12). Some reports indicate that IGRAs might be helpful in selected cases of pulmonary TB cases (13)(14)(15)(16)(17) and in patients with extra-pulmonary TB, including plTB and TB meningitis, by detecting the release of IFN-y by antigen-specific T cells directly at the infection site (18)(19)(20)(21)(22)(23)(24)(25).…”

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confidence: 99%

Role of the Quantiferon-TB Test in Ruling Out Pleural Tuberculosis: A Multi-Centre Study

Losi

Bocchino

Matarese

et al. 2011

Int J Immunopathol Pharmacol

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The first two authors contributed equally to the study Diagnosing pleural tuberculosis (pITB) might be difficult due to limited sensitivity of conventional microbiology tools. As M. tuberculosis (MTB)-specific T cells are recruited into pleural space in pITB, their detection may provide useful clinical information. To this aim, in addition to standard diagnostic tests, we used the QuantiFERON-TB Gold In-Tube (QFT-IT) test in blood and pleural effusion (PE) samples from 48 patients with clinical suspicion of pITB, 18 (37.5%) of whom had confirmed pITB. Four of them (22.2%) tested positive with a nucleic acid amplification test for MTB. The tuberculin skin test was positive in most confirmed plTB cases (88.9%). Positive QFT-IT tests were significantly more frequent in patients with confirmed pITB, as compared to patients with an alternative diagnosis, both in blood (77.7 vs 36.6%, p=0.006) and in PE samples (83.3% vs 46.6%, p=0.02). In addition, both blood and PE MTB-stimulated IFN-y levels were significantly higher in plTB patients (p=0.03 and p=0.0049 vs non-pITB, respectively). In blood samples, QFT-IT had 77.8% sensitivity and 63.3% specificity, resulting in 56.0% positive (PPV) and 82.6% negative (NPV) predictive values. On PE, QFT-IT sensitivity was 83.3% and specificity 53.3% (PPV 51.7% and NPV 84.2%). The optimal AVe-derived cut-off for MTBstimulated pleural IFN-y level was 3.01 IU/mL (77.8% sensitivity, 80% specificity, PPV 68.4% and NPV 82.8%). These data suggest that QFT-IT might have a role in ruling out plTB in clinical practice.Pleural tuberculosis (pITB) is an extra-pulmonary manifestation of active tuberculosis (TB), representing about 4% of all TB cases (I). Despite the characteristic finding of increased count of lymphocytes in pleural effusion (PE), confirmation of pITB diagnosis based on PE analysis is problematic

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Diagnosis of Active Tuberculous Serositis by Antigen-Specific Interferon- Response of Cavity Fluid Cells

Abstract: The cavity fluid IFN-gamma assay could be a method for accurately and promptly diagnosing active tuberculous serositis.

Cited by 44 publications

References 26 publications

Utility of quantitative T-cell responses versus unstimulated interferon- for the diagnosis of pleural tuberculosis

Utility of quantitative T-cell responses versus unstimulated interferon- for the diagnosis of pleural tuberculosis

Interferon-Gamma Release Assays for Diagnosing

Role of the Quantiferon-TB Test in Ruling Out Pleural Tuberculosis: A Multi-Centre Study

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