Performance of Tests for Latent Tuberculosis in Different Groups of Immunocompromised Patients

Richeldi, Luca; Losi, Monica; D'Amico, Roberto; Luppi, Mario; Ferrari, Ângela; Mussini, Cristina; Codeluppi, Mauro; Cocchi, Stefania; Prati, Francesca; Paci, Valentina; Meacci, Marisa; Meccugni, Barbara; Rumpianesi, Fabio; Roversi, Pietro; Cerri, Stefania; Luppi, Fabrizio; Ferrara, Giovanni; Latorre, Irene; Gerunda, G.E.; Torelli, Giuseppe; Esposito, Roberto; Fabbri, Leonardo M.

doi:10.1378/chest.08-2575

Cited by 136 publications

(121 citation statements)

References 28 publications

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“…16 Previous studies including different groups of immunocompromised patients found impaired performance of IFN-γ-based tests related to malfunction of cellular immune system, but they performed better than TST nonetheless. 17,18 In a prospective study including 369 immunosuppressed participants, Richeldi et al 19 found that IFN-γ tests detected more patients as being infected with M. tuberculosis than did TST.…”

Section: Immunocompromised Patientsmentioning

confidence: 99%

Diagnosis of tuberculosis infection using interferon-γ-based assays

Cerezales

Benítez

2011

Enfermedades Infecciosas y Microbiología Clínica

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Section: Immunocompromised Patientsmentioning

confidence: 99%

Diagnosis of tuberculosis infection using interferon-γ-based assays

Cerezales

Benítez

2011

Enfermedades Infecciosas y Microbiología Clínica

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“…12 Another study comparing QFT to PPD testing in patients with chronic liver disease revealed fewer positive results with PPD testing. 13 Currently, there is no reported advantage for one test versus the other; but in normal hosts, interferon-c release assays have the advantage of differentiating people whose positive skin test reflects prior vaccination against Bacille Calmette-Guérin (BCG) infection. Although this ability to differentiate TST positivity related to BCG immunization has not been studied specifically in liver transplant candidates, the assays are likely to have similar performance characteristics and therefore may be advantageous in patients with a history of prior BCG immunization.…”

Section: Diagnosis Latent Tbmentioning

confidence: 99%

Mycobacterium tuberculosis infection in liver transplantation

Yehia

Blumberg

2010

Liver Transpl

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Mycobacterium tuberculosis can cause significant infections in liver transplant candidates and recipients. Its nonspecific clinical features and prolonged growth time in culture make the diagnosis difficult, and treating tuberculosis (TB) remains challenging because of significant toxicities and drug-drug interactions. The diagnosis of a latent TB infection may be accomplished with tuberculin skin testing and with the newer interferon-c release assays, although this infection may be underrecognized because of host factors. Latent TB should be treated, but the degree of liver failure and the likelihood of progression to active TB will dictate whether this should occur before or after transplantation. Patients who have a history of TB, have used muromonab-CD3 or anti-T lymphocyte antibodies, or have experienced allograft rejection or coinfection with cytomegalovirus, Pneumocystis jiroveci, or Nocardia are at the greatest risk of developing active TB. Active TB in transplant patients is difficult to treat because of drug-induced hepatotoxicity and the significant interaction between rifampin and calcineurin inhibitors. In this article, we review the epidemiology, clinical features, and evaluation of transplant candidates and recipients. In addition, we offer recommendations on the appropriate diagnostic and treatment regimens for patients with latent and active TB infections. Liver Transpl 16:1129-1135, 2010. V C 2010 AASLD.Received April 5, 2010; accepted July 6, 2010.Tuberculosis (TB) is a serious global infection with an estimated prevalence of 13.7 million cases worldwide. 1 Transplant recipients have a 36-to 74-fold higher risk of developing TB versus the general population. 2 TB in liver transplant recipients presents unique challenges, including a delayed diagnosis secondary to insensitive testing and treatment complications due to antituberculous drug toxicities and interactions with immunosuppressive agents. This review focuses on the epidemiology, clinical features, diagnosis, clinical evaluation, and treatment of liver transplant patients infected with TB. EPIDEMIOLOGYRates of 0.47% to 2.3% for active TB in adult liver transplant recipients has been reported. [2][3][4][5] Because of the difficulty of accurately diagnosing symptomatic TB, these figures most likely underestimate the burden of the disease. In addition, the frequency of the disease varies geographically, with particular regions (Asia and Africa) having a higher prevalence than other areas of the world. 6 Several factors place transplant patients at greater risk of developing active TB.A previous TB infection increases the likelihood of TB developing after transplantation. 5 The RESITRA (Spanish Network of Infection in Transplantation) cohort documented a relative risk of 4.3 for the development of symptomatic TB when the purified protein derivative (PPD) test was positive instead of negative. 4 In a systematic review of 139 cases of active TB infection after liver transplantation, 37% had a positive tuberculin skin test (TST), 23% had abnorm...

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“…These tests have many advantages over the TST (19,20) in terms of higher specificity and less cross-reactivity in the BCG-vaccinated population and nontuberculous mycobacteria infections. It also demonstrates better correlation with exposure to M. tuberculosis and better performance in immunocompromised patients, including patients with HIV infection and rheumatoid arthritis (21)(22)(23). Only a few studies have evaluated the performance of IFN-␥ release assays in diagnosing M. tuberculosis infection in renal dialysis patients.…”

mentioning

confidence: 99%