Usefulness of the Combination of Tuberculin Skin Test and Interferon-Gamma Release Assay in Diagnosing Children with Tuberculosis

Shimizu, Hiroyuki; Mori, Masaaki

doi:10.1620/tjem.243.205

Cited by 3 publications

(3 citation statements)

References 17 publications

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“…Current literature comparing the performance of IGRA (Quantiferon and T-Spot) and TST to identify TB infection in young children reveals limited evidence and conflicting results [5,[30][31][32][33]. Studies focusing on performance of T-Spot in comparison to TST may show discordant results with TST positive and T-Spot negative cases.…”

Section: Viability Of T-spot In Contact Infantsmentioning

confidence: 99%

Low secondary attack rate after prolonged exposure to sputum smear positive miliary tuberculosis in a neonatal unit

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Kaelin

Kuster

et al. 2022

Antimicrob Resist Infect Control

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Background Several neonatal intensive care units (NICU) have reported exposure to sputum smear positive tuberculosis (TB). NICE guidelines give support regarding investigation and treatment intervention, but not for contact definitions. Data regarding the reliability of any interferon gamma release assay (IGRA) in infants as a screening test for TB infection is scarce. We report an investigation and management strategy and evaluated the viability of IGRA (T-Spot) in infants and its concordance to the tuberculin skin test (TST). Methods We performed an outbreak investigation of incident TB infection in a NICU after prolonged exposure to sputum smear positive miliary TB by an infant’s mother. We defined individual contact definitions and interventions and assessed secondary attack rates. In addition, we evaluated the technical performance of T-Spot in infants and compared the results with the TST at baseline investigation. Results Overall, 72 of 90 (80%) exposed infants were investigated at baseline, in 51 (56.7%) of 54 (60%) infants, follow-up TST at the age of 6 months was performed. No infant in our cohort showed a positive TST or T-Spot at baseline. All blood samples from infants except one responded to phytohemagglutinin (PHA), which was used as a positive control of the T-Spot, demonstrating that cells are viable and react upon stimulation. 149 of 160 (93.1%) exposed health care workers (HCW) were investigated. 1 HCW was tested positive, having no other reason than this exposure for latent TB infection. 5 of 92 (5.5%) exposed primary contacts were tested positive, all coming from countries with high TB incidences. In total, 1 of 342 exposed contacts was newly diagnosed with latent TB infection. The secondary attack rate in this study including pediatric and adult contacts was 0.29%. Conclusion This investigation highlighted the low transmission rate of sputum smear positive miliary TB in a particularly highly susceptible population as infants. Our expert definitions and interventions proved to be helpful in terms of the feasibility of a thorough outbreak investigation. Furthermore, we demonstrated concordance of T-Spot and TST. Based on our findings, we assume that T-Spot could be considered a reliable investigation tool to rule out TB infection in infants.

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Section: Viability Of T-spot In Contact Infantsmentioning

confidence: 99%

Low secondary attack rate after prolonged exposure to sputum smear positive miliary tuberculosis in a neonatal unit

Pop

Kaelin

Kuster

et al. 2022

Antimicrob Resist Infect Control

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“…The median number of contacts undergoing advanced imaging was relatively small, at 32. Twelve studies examined children to adolescents [ 13 – 16 , 18 , 21 , 23 – 25 , 27 , 28 , 30 ], while the other studies included adults. One study was conducted on contacts infected with HIV [ 35 ], while the other 24 studies were conducted in immunocompetent contacts.…”

Section: Main Textmentioning

confidence: 99%

CT and 18F-FDG PET abnormalities in contacts with recent tuberculosis infections but negative chest X-ray

et al. 2022

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Close contacts of individuals with pulmonary tuberculosis are at risk for tuberculosis infection and the development of active tuberculosis. In current contact investigations, immunologic tests (the tuberculin skin test and interferon-gamma release assay) and chest X-ray examinations are used to dichotomize contacts with Mycobacterium tuberculosis infections into those with active (X-ray abnormalities) versus latent tuberculosis (normal radiographs). This article is a critical review of computed tomographic (CT) and 18-fluorodeoxyglucose positron emission tomographic (PET) findings of incipient tuberculosis without X-ray abnormalities based on a systematic literature review of twenty-five publications. The CT and 18-fluorodeoxyglucose PET studies revealed minimal pauci-nodular infiltrations in the lung parenchyma and mediastinal lymph nodes abnormalities with metabolic uptake in approximately one-third of asymptomatic close contacts with negative chest radiographic and bacteriological/molecular results for active tuberculosis. Tuberculosis with minimal changes challenge the validity of simply dichotomizing cases of recent M. tuberculosis infections in contacts depending on the presence of X-ray abnormalities as the recent infections may spontaneously regress, remain stagnant, or progress to active tuberculosis in human and nonhuman primate studies. Whether contacts with tuberculosis with minimal changes are interpreted as having active tuberculosis or latent tuberculosis has clinical implications in terms of specific benefits and harms under the current contact management. Advanced imaging tools may help further stratify contacts intensely exposed to M. tuberculosis on a continuous spectrum from latent tuberculosis to incipient, subclinical and active tuberculosis. Identifying incipient tuberculosis would provide an opportunity for earlier and tailored treatment before active tuberculosis is established.

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“…Recent WHO surveys found that one-third of the world’s population was latently affected by tuberculosis, and over 1.5 million patients die annually. Clinical symptoms, radiography, the tuberculin skin test (TST), and the interferon-gamma release assay (IGRA) are the most critical components of a patient’s diagnosis ( Shimizu and Mori 2017 ). Pharmacotherapy is recommended as the initial treatment for tuberculosis patients ( Suarez et al, 2019 ).…”

Section: Introductionmentioning

confidence: 99%

Integrated bioinformatic analyses investigate macrophage-M1-related biomarkers and tuberculosis therapeutic drugs

Deng

Shen²,

Liu³

et al. 2023

Front. Genet.

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Tuberculosis (TB) is a common infectious disease linked to host genetics and the innate immune response. It is vital to investigate new molecular mechanisms and efficient biomarkers for Tuberculosis because the pathophysiology of the disease is still unclear, and there aren’t any precise diagnostic tools. This study downloaded three blood datasets from the GEO database, two of which (GSE19435 and 83456) were used to build a weighted gene co-expression network for searching hub genes associated with macrophage M1 by the CIBERSORT and WGCNA algorithms. Furthermore, 994 differentially expressed genes (DEGs) were extracted from healthy and TB samples, four of which were associated with macrophage M1, naming RTP4, CXCL10, CD38, and IFI44. They were confirmed as upregulation in TB samples by external dataset validation (GSE34608) and quantitative real-time PCR analysis (qRT-PCR). CMap was used to predict potential therapeutic compounds for tuberculosis using 300 differentially expressed genes (150 downregulated and 150 upregulated genes), and six small molecules (RWJ-21757, phenamil, benzanthrone, TG-101348, metyrapone, and WT-161) with a higher confidence value were extracted. We used in-depth bioinformatics analysis to investigate significant macrophage M1-related genes and promising anti-Tuberculosis therapeutic compounds. However, more clinical trials were necessary to determine their effect on Tuberculosis.

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Usefulness of the Combination of Tuberculin Skin Test and Interferon-Gamma Release Assay in Diagnosing Children with Tuberculosis

Cited by 3 publications

References 17 publications

Low secondary attack rate after prolonged exposure to sputum smear positive miliary tuberculosis in a neonatal unit

Low secondary attack rate after prolonged exposure to sputum smear positive miliary tuberculosis in a neonatal unit

CT and 18F-FDG PET abnormalities in contacts with recent tuberculosis infections but negative chest X-ray

Integrated bioinformatic analyses investigate macrophage-M1-related biomarkers and tuberculosis therapeutic drugs

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