Interferon-γ release assays or tuberculin skin test for detection and management of latent tuberculosis infection: a systematic review and meta-analysis

Zhou, Guozhong; Luo, Qingyi; Luo, Shiqi; Teng, Zhaowei; Ji, Zhenhua; Yang, Jiaru; Wang, Feng; Wen, Shiyuan; Ding, Zhe; Li, Lianbao; Chen, Taigui; Abi, Manzama-Esso; Jian, Miaomiao; Luo, Lisha; Liu, Aihua; Bao, Fukai

doi:10.1016/s1473-3099(20)30276-0

Cited by 81 publications

(65 citation statements)

References 49 publications

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“…These individuals are defined as positive by either one or both of TST or IGRA. Reviewed extensively elsewhere, 13 these two tests have similar performance characteristics, but there is significant discordance between them. TSTs are subject to a false‐positive result, especially early in life, due to prior BCG vaccination.…”

Section: Evidence For Bcg‐induced Protection Against M Tuberculosis Infectionmentioning

confidence: 99%

BCG‐induced protection against Mycobacterium tuberculosis infection: Evidence, mechanisms, and implications for next‐generation vaccines

Foster

Hill

Setiabudiawan

et al. 2021

Immunological Reviews

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Bacillus Calmette-Guérin (BCG) is a live-attenuated vaccine derived from Mycobacterium bovis of the Mycobacterium tuberculosis (Mtb) complex and was first used in medical practice in 1921. It is administered intradermally after birth, while repeat dosing in adolescence and at other stages of life have been adopted inconsistently in different parts of the world. Efficacy trials have yielded hugely variable results, ranging from 0-80% efficacy against TB disease across different locations. 1 Furthermore, the mechanisms of BCG protection remain poorly understood after 100 years of research and practice, making it difficult to determine what new generation TB vaccines need to induce to provide improved protection.The discovery that BCG protects against Mtb infection (as defined by a positive interferonγ release assay (IGRA) result) and not just progression from Mtb infection to TB disease 2,3 has significant

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Section: Evidence For Bcg‐induced Protection Against M Tuberculosis Infectionmentioning

confidence: 99%

BCG‐induced protection against Mycobacterium tuberculosis infection: Evidence, mechanisms, and implications for next‐generation vaccines

Foster

Hill

Setiabudiawan

et al. 2021

Immunological Reviews

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“…A combination of a positive tuberculin skin test (TST) and either heterogeneous echotexture or coagulation necrosis sign had a specificity of 98% and positive predictive value of 91% for a diagnosis of tuberculosis ( 11 ). Use of an interferon-γ (IFN-γ) release assay has been reported to demonstrate a better predictive ability than tuberculin skin tests ( 12 ). Culture although time-consuming is still considered as a gold standard test for the diagnosis of Tuberculosis ( 13 ).…”

Section: Introductionmentioning

confidence: 99%

Sarcoidosis: Pitfalls and Challenging Mimickers

Narula

Iannuzzi

2021

Front. Med.

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Sarcoidosis, a systemic granulomatous disease of unknown etiology, may mimic other conditions at presentation often resulting in delayed diagnosis. These conditions include infections, neoplasms, autoimmune, cardiovascular, and drug-induced diseases. This review highlights the most common sarcoidosis mimics that often lead to pitfalls in diagnosis and delay in appropriate treatment. Prior to invasive testing and initiating immunosuppressants (commonly corticosteroids), it is important to exclude sarcoid mimickers.

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“…Even in the era of the GeneXpert MTB/RIF Ultra, challenge remains due to unsatisfactory sensitivity for clinical requirement (6,7), which highlights the fact that better diagnostics might have to be achieved based on host factors rather than pathogen detection. However, the current use of blood-based available immunological tests including T-SPOT.TB (T-SPOT) and QuantiFERON-TB Gold In-Tube (QFT-GIT) was limited by their poor ability to reliably stratify ATB from LTBI especially in TB endemic areas (8,9). Recent advances have been developed in blood signatures including transcriptome (10), proteome (11), genome (12), metabolome (13), cytokines (14,15), and markers on immune cells (16,17) for identifying ATB, raising hopes for translation into available assays.…”

Section: Introductionmentioning

confidence: 99%

Lymphocyte Non-Specific Function Detection Facilitating the Stratification of Mycobacterium tuberculosis Infection

et al. 2021

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BackgroundInadequate tuberculosis (TB) diagnostics, especially for discrimination between active TB (ATB) and latent TB infection (LTBI), are major hurdle in the reduction of the disease burden. The present study aims to investigate the role of lymphocyte non-specific function detection for TB diagnosis in clinical practice.MethodsA total of 208 participants including 49 ATB patients, 64 LTBI individuals, and 95 healthy controls were recruited at Tongji hospital from January 2019 to October 2020. All subjects were tested with lymphocyte non-specific function detection and T-SPOT assay.ResultsSignificantly positive correlation existed between lymphocyte non-specific function and phytohemagglutinin (PHA) spot number. CD4+ T cell non-specific function showed the potential for differentiating patients with negative T-SPOT results from those with positive T-SPOT results with an area under the curve (AUC) of 0.732 (95% CI, 0.572-0.893). The non-specific function of CD4+ T cells, CD8+ T cells, and NK cells was found significantly lower in ATB patients than in LTBI individuals. The AUCs presented by CD4+ T cell non-specific function, CD8+ T cell non-specific function, and NK cell non-specific function for discriminating ATB patients from LTBI individuals were 0.845 (95% CI, 0.767-0.925), 0.770 (95% CI, 0.683-0.857), and 0.691 (95% CI, 0.593-0.789), respectively. Application of multivariable logistic regression resulted in the combination of CD4+ T cell non-specific function, NK cell non-specific function, and culture filtrate protein-10 (CFP-10) spot number as the optimally diagnostic model for differentiating ATB from LTBI. The AUC of the model in distinguishing between ATB and LTBI was 0.939 (95% CI, 0.898-0.981). The sensitivity and specificity were 83.67% (95% CI, 70.96%-91.49%) and 90.63% (95% CI, 81.02%-95.63%) with the threshold as 0.57. Our established model showed superior performance to TB-specific antigen (TBAg)/PHA ratio in stratifying TB infection status.ConclusionsLymphocyte non-specific function detection offers an attractive alternative to facilitate TB diagnosis. The three-index diagnostic model was proved to be a potent tool for the identification of different events involved in TB infection, which is helpful for the treatment and management of patients.

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Interferon-γ release assays or tuberculin skin test for detection and management of latent tuberculosis infection: a systematic review and meta-analysis

Cited by 81 publications

References 49 publications

BCG‐induced protection against Mycobacterium tuberculosis infection: Evidence, mechanisms, and implications for next‐generation vaccines

BCG‐induced protection against Mycobacterium tuberculosis infection: Evidence, mechanisms, and implications for next‐generation vaccines

Sarcoidosis: Pitfalls and Challenging Mimickers

Lymphocyte Non-Specific Function Detection Facilitating the Stratification of Mycobacterium tuberculosis Infection

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