Factors associated with false negative interferon-γ release assay results in patients with tuberculosis: A systematic review with meta-analysis

Yamasue, Mari; Komiya, Kosaku; Usagawa, Yuko; Umeki, Kenji; Nureki, Shin-ichi; Ando, Masayuki; Hiramatsu, Kazufumi; Nagai, Hirokazu; Kadota, Jun‐ichi

doi:10.1038/s41598-020-58459-9

Cited by 48 publications

(47 citation statements)

References 36 publications

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“…Tuberculin skin test (TST) and with a greater sensibility and specificity, the interferon-gamma release assays (IGRAs) are widely used for TB screening [ 63 ]. Given their results are influenced by the host's immune response after MTB (or BCG) exposure [ 64 ], there is a gap for diagnostic errors in individuals with an impaired immune system, such as in a concurrent severe infection [ 65 , 66 ]. Increased age, low peripheral lymphocyte count, high body mass index, and immunosuppressive therapies were also associated with false-negative results [ 66 ] that could lead to missing TB diagnose.…”

Section: Discussionmentioning

confidence: 99%

“…Given their results are influenced by the host's immune response after MTB (or BCG) exposure [ 64 ], there is a gap for diagnostic errors in individuals with an impaired immune system, such as in a concurrent severe infection [ 65 , 66 ]. Increased age, low peripheral lymphocyte count, high body mass index, and immunosuppressive therapies were also associated with false-negative results [ 66 ] that could lead to missing TB diagnose. Moreover, an excess of inflammatory markers could affect IGRAs sensitivity, and the high value of C-reactive protein (CRP) might be a confounder for false-negative results [ 67 ].…”

Section: Discussionmentioning

confidence: 99%

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Tuberculosis and COVID-19: Lessons from the Past Viral Outbreaks and Possible Future Outcomes

Criṣan-Dabija

Grigorescu²,

Pavel³

et al. 2020

Canadian Respiratory Journal

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Background. The threat of contagious infectious diseases is constantly evolving as demographic explosion, travel globalization, and changes in human lifestyle increase the risk of spreading pathogens, leading to accelerated changes in disease landscape. Of particular interest is the aftermath of superimposing viral epidemics (especially SARS-CoV-2) over long-standing diseases, such as tuberculosis (TB), which remains a significant disease for public health worldwide and especially in emerging economies. Methods and Results. The PubMed electronic database was systematically searched for relevant articles linking TB, influenza, and SARS-CoV viruses and subsequently assessed eligibility according to inclusion criteria. Using a data mining approach, we also queried the COVID-19 Open Research Dataset (CORD-19). We aimed to answer the following questions: What can be learned from other coronavirus outbreaks (focusing on TB patients)? Is coinfection (TB and SARS-CoV-2) more severe? Is there a vaccine for SARS-CoV-2? How does the TB vaccine affect COVID-19? How does one diagnosis affect the other? Discussions. Few essential elements about TB and SARS-CoV coinfections were discussed. First, lessons from past outbreaks (other coronaviruses) and influenza pandemic/seasonal outbreaks have taught the importance of infection control to avoid the severe impact on TB patients. Second, although challenging due to data scarcity, investigating the pathological pathways linking TB and SARS-CoV-2 leads to the idea that their coexistence might yield a more severe clinical evolution. Finally, we addressed the issues of vaccination and diagnostic reliability in the context of coinfection. Conclusions. Because viral respiratory infections and TB impede the host’s immune responses, it can be assumed that their lethal synergism may contribute to more severe clinical evolution. Despite the rapidly growing number of cases, the data needed to predict the impact of the COVID-19 pandemic on patients with latent TB and TB sequelae still lies ahead. The trial is registered with NCT04327206, NCT01829490, and NCT04121494.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Tuberculosis and COVID-19: Lessons from the Past Viral Outbreaks and Possible Future Outcomes

Criṣan-Dabija

Grigorescu²,

Pavel³

et al. 2020

Canadian Respiratory Journal

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“…In a previous case report, a patient with a history of TB treatment showed a negative IGRA result at their first visit, but developed TB reactivation during treatment with durvalumab, an anti-PD-L1 antibody, after chemoradiotherapy for stage III NSCLC. False-negative results are a major obstacle to screening for latent TB, and approximately 8-19% of patients show a negative IGRA result even when presenting with active TB ( 23 ). Indeterminate IGRA results are frequently reported in patients with malignancies and patients undergoing immunosuppressive therapy ( 24 ).…”

Section: Discussionmentioning

confidence: 99%

Readministration of Pembrolizumab after Treatment of Tuberculosis Activated by Initial Pembrolizumab Therapy

et al. 2021

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Increasing the T-cell immune response to Mycobacterium tuberculosis with an anti-programmed cell death 1 (anti-PD-1) antibody may ultimately have detrimental effects. We present the case of a patient with advanced non-small cell lung cancer who developed active tuberculosis (TB) after initial treatment with pembrolizumab, an anti-PD-1 antibody. Pembrolizumab was resumed after completing anti-TB treatment, and no relapse of TB was observed clinically or radiologically. Checkpoint inhibitor-related pneumonitis (CIP) is first suspected when a pulmonary shadow presents during treatment with an anti-PD-1 antibody. It is sometimes difficult to diagnose CIP using computed tomographic images alone. Careful testing, including bacterial examinations and bronchoscopic biopsy, should be performed.

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“…Tuberculin skin test (TST), and with a greater sensibility and specificity the interferon-gamma release assays (IGRAs), are widely used for TB screening (56). Given their results are influenced by the host’s immune response after MTB (or BCG) exposure (57), there is a gap for diagnostic errors in individuals with an impaired immune system, such as in a concurrent severe infection (58, 59). Increased age, low peripheral lymphocyte count, high body mass index and immunosuppressive therapies were also associated with false negative results (59) that could lead to missing TB diagnose.…”

Section: Discussionmentioning

confidence: 99%

“…Given their results are influenced by the host’s immune response after MTB (or BCG) exposure (57), there is a gap for diagnostic errors in individuals with an impaired immune system, such as in a concurrent severe infection (58, 59). Increased age, low peripheral lymphocyte count, high body mass index and immunosuppressive therapies were also associated with false negative results (59) that could lead to missing TB diagnose. Moreover, an excess of inflammatory markers could affect IGRAs sensitivity and the high value of C-reactive protein (CRP) might be a confounder for false negative results (60).…”

Section: Discussionmentioning

confidence: 99%

Tuberculosis and COVID-19 in 2020: lessons from the past viral outbreaks and possible future outcomes

Criṣan-Dabija

Grigorescu

Pavel³

et al. 2020

Preprint

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words)Background.The threat of contagious infectious diseases is constantly evolving, as demographic explosion, travel globalization and changes in human lifestyle increase the risk of spreading pathogens, leading to accelerated changes in disease landscape. Of particular interest is the aftermath of superimposing viral epidemics (especially SARS-CoV-2) over long-standing diseases, such as tuberculosis (TB), which remains a significant disease for public health worldwide and especially in emerging economies. Methods and Results.PubMed electronic database was requested for relevant articles linking TB, influenza and SARS-CoV viruses and subsequently assessed eligibility according to inclusion criteria.Using a data mining approach, we also queried the COVID-19 Open Research Dataset . We aimed to answer the following questions: What can be learned from other coronavirus outbreaks (with a focus on TB patients)? Is coinfection (TB and SARS-CoV-2) more severe? Is there a vaccine for SARS-CoV-2? How does the TB vaccine affect COVID- 19? How does one diagnosis affect the other? Discussions.Few essential elements about TB and SARS-CoV coinfections were discussed. First, lessons from the past outbreaks (other coronaviruses), as well as influenza pandemic / seasonal outbreaks have taught the importance of infection control to avoid the severe impact on TB patients. Second, although challenging due to data scarcity, investigating the pathological pathways linking TB and SARS-CoV-2 leads to the idea that their coexistence might yield a more severe clinical evolution. Finally, we addressed the issues of vaccination and diagnostic reliability in the context of coinfection. Conclusions.Because viral respiratory infections and TB impede the host's immune responses, it can be assumed that their harmful synergism may contribute to more severe clinical evolution.Despite the rapidly growing number of cases, the data needed to predict the impact of the COVID-19 pandemic on patients with latent TB and TB sequelae still lies ahead.

show abstract

Factors associated with false negative interferon-γ release assay results in patients with tuberculosis: A systematic review with meta-analysis

Cited by 48 publications

References 36 publications

Tuberculosis and COVID-19: Lessons from the Past Viral Outbreaks and Possible Future Outcomes

Tuberculosis and COVID-19: Lessons from the Past Viral Outbreaks and Possible Future Outcomes

Readministration of Pembrolizumab after Treatment of Tuberculosis Activated by Initial Pembrolizumab Therapy

Tuberculosis and COVID-19 in 2020: lessons from the past viral outbreaks and possible future outcomes

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