Evaluation of an interferon gamma assay in the diagnosis of latent tuberculosis infection in patients with rheumatoid arthritis

Marques, Cláudia Diniz Lopes; Duarte, Ângela Luzia Branco Pinto; Lorena, Virgínia Maria Barros de; Souza, Joelma Rodrigues de; Souza, Wayner Vieira de; Gomes, Yara de Miranda; Carvalho, Eduardo Maia Freese de

doi:10.1007/s00296-009-0910-y

Cited by 24 publications

(20 citation statements)

References 15 publications

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“…On the other hand, patients with rheumatoid arthritis (RA) have also been shown to present decreased TST reactivify: the proportion of TST reactors was at least two-fold higher in healthy adults than in RA patients in endemic countries, such as Peru and Brazil, or non-endemic countries, such as Japan (22)(23)(24). This was also shown for patients with inflammatory bowel diseases (25).…”

Section: Discussionsupporting

confidence: 61%

Evaluation of an IFN-gamma Assay in the Diagnosis of Latent Tuberculosis in Patients with Psoriasis in a Highly Endemic Setting

Lima¹,

Lima²,

Lorena³

et al. 2011

Acta Derm Venerol

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Screening for latent tuberculosis infection is mandatory before starting anti-tumour necrosis factor treatments, but its diagnosis still poses a challenge. While studies performed in developed countries have demonstrated superior performance of T-cell based interferon-γ release assay (IGRA) compared with the tuberculin skin test, there is a debate about whether this holds true in tuberculosis endemic areas. The performance of an IGRA kit T-SPOT.TB was evaluated in 33 moderate-to-severe untreated psoriasis patients and, as controls, 30 patients with common dermatological diseases at a tuberculosis highly endemic setting. The frequency of positive tuberculin skin test responses and induration size in controls were higher than in psoriasis patients (53% vs. 18% and 9.3 ± 1.4 vs. 2.6 ± 0.7 mm, respectively, p < 0.001). In contrast, the frequency of positive response and mean number of spots elicited with the T-SPOT.TB test were not significantly different between patients and controls (47% vs. 43% and 14.7 ± 3.2 vs. 20.5 ± 3.1 spots/well, respectively). The two tests presented good agreement in the control, but not the psoriasis group (κ values of 0.625 and 0.375, respectively). Thus, in a highly tuberculosis-endemic setting the T-SPOT.TB test was superior to the tuberculin skin test in diagnosing latent tuberculosis infection in psoriasis, probably because the immune dysregulation of psoriasis shows a lower interference in the in vitro test.

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Section: Discussionsupporting

confidence: 61%

Evaluation of an IFN-gamma Assay in the Diagnosis of Latent Tuberculosis in Patients with Psoriasis in a Highly Endemic Setting

Lima¹,

Lima²,

Lorena³

et al. 2011

Acta Derm Venerol

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“…The specificity of the T. SPOT.TB ranged from 87% to 90% and NPV from 94.4% to 100%, with similar sensitivity to TST. Authors suggested that the low sensitivity of T. SPOT.TB in endemic areas for TB could be explained by the fact that the antigens in the T. SPOT.TB plate, although specific for M. tb , represented a small portion of numerous antigens, and more reliable results could be achieved by adding new antigens to the method [33]. In Gambia, a TB- endemic region, T. SPOT.TB and TST had similar results in the diagnosis of LTBI in children vaccinated with BCG at an early age.…”

Section: Discussionmentioning

confidence: 99%

Tuberculin skin test and ELISPOT/T. SPOT.TB in children and adolescents with juvenile idiopathic arthritis

et al. 2014

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BackgroundThere are controversies regarding the accuracy of the tuberculin skin test (TST) and methods based on the production of interferon gamma by sensitized T cells for the diagnosis of latent tuberculosis infection (LTBI) in pediatrics and immunosuppressed patients. Our objectives are to study TST and ELISPOT/T. SPOT.TB in the diagnosis of LTBI in children and adolescents with JIA undergoing methotrexate, the correlation between both and the sensitivity and specificity of T. SPOT.TB.MethodsThis is an observational prospective longitudinal study in which children and adolescents with JIA undergoing methotrexate therapy were assessed for clinical and epidemiological data for LTBI, in addition to performing TST and T. SPOT.TB at baseline and after 3 and 12months.ResultsThere were 24 patients. The prevalence of LTBI at inclusion was 20.8%, the incidence after initiation of immunosuppressions 26.3% and the prevalence at the end of the study 41.6%. Epidemiological history positive for TB showed a relative risk of 2.0 for the development of LTBI. Only 2 patients had positive T. SPOT.TB but only in one it was useful for detecting early LTBI. T. SPOT.TB presented a sensitivity of 10%, specificity of 92.8%, and low correlation with TST. No patient developed TB disease at a mean follow-up of 47months.ConclusionsWe found a high prevalence of ILTB that doubled with immunosuppression and that epidemiological history was an important relative risk. T. SPOT.TB showed low sensitivity and high specificity, and no superiority over TST. There was low agreement and little influence of immunosuppression on the results of both tests.

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“…It is also not sensitive in immune-compromised patients. Sensitivity of only 56 % with tuberculin testing in rheumatoid arthritis patients on immuno-suppressant with TB infection was reported [7]. Interferon gamma-release assays (IGRA) is a relatively new method for detecting T cells specific for Mycobacterium tuberculosis antigens.…”

Section: Clinical Presentation and Diagnosismentioning

confidence: 99%

Clinical and radiological outcomes after conservative treatment of TB spondylitis: is the 15 years’ follow-up in the MRC study long enough?

Cheung

Luk

2012

Eur Spine J

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IntroductionTuberculosis of the spine is a still a common disease entity, not only in developing countries but is also returning in developed countries especially in the immune-compromised patients. Conservative treatment with chemotherapy is still the main stay of treatment. This article focuses on the clinical and radiological outcomes, and problems with conservative treatment.MethodThe available literature of anti-tuberculosis chemotherapy in managing spinal tuberculosis was reviewed. Data sources included relevant literature of the English language identified through Medline search from 1946 to 2011. Personal experience and unpublished reviews from the authors’ institution were also included.ResultsAlthough majority of patients respond well to anti-tuberculosis chemotherapy, about 15 % of them develop paradoxical response. The Medical Research Council (MRC) studies have shown that for patients without significant neurological deficits, operative and conservative treatment could produce the same clinical outcome at 15 years follow-up. Patients treated operatively with debridement and spinal fusion with strut graft had faster bony fusion and less kyphotic deformity. In contrast, those treated with drugs alone or with simple debridement without fusion may result in disease reactivation, severe kyphosis or late instability, which in turn may lead to late-onset Pott’s paraplegia, back pain, sagittal imbalance and compromised pulmonary function that are difficult or risky to treat.ConclusionRecognition of the clinical and radiologic features of these late sequels is important for the management. Prevention of deformity in the early disease has been added to the modern standard of treatment of TB spine.

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Evaluation of an interferon gamma assay in the diagnosis of latent tuberculosis infection in patients with rheumatoid arthritis

Cited by 24 publications

References 15 publications

Evaluation of an IFN-gamma Assay in the Diagnosis of Latent Tuberculosis in Patients with Psoriasis in a Highly Endemic Setting

Evaluation of an IFN-gamma Assay in the Diagnosis of Latent Tuberculosis in Patients with Psoriasis in a Highly Endemic Setting

Tuberculin skin test and ELISPOT/T. SPOT.TB in children and adolescents with juvenile idiopathic arthritis

Clinical and radiological outcomes after conservative treatment of TB spondylitis: is the 15 years’ follow-up in the MRC study long enough?

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