Latent Tuberculous Infection Research Articles

Contribution of QuantiFERON TB gold in tube to the diagnosis of tuberculous pleurisy: a monocentric prospective study

Introduction The diagnosis of tuberculous (TB) pleurisy remains difficult because of its paucibacillary character. Several authors have studied the usefulness of interferon gamma release assays in the early diagnosis of TB pleurisy, whereas these tests are designed for the detection of latent TB infection. Our objective is to study the performance and clinical relevance of QuantiFERON TB Gold in Tube (QFT-GIT) in the diagnosis of TB pleurisy in Algeria. Patients and methods QFT-GIT was tested in vitro in serum and pleural fluid on a prospective recruitment of 158 immunocompetent patients with pleural effusion. Results Of the 158 cases of pleurisy identified, 84 (53.84%) were TB, diagnosed and proven by conventional methods, and 72 (46.15%) were non-TB, of whom 67 (93%) were confirmed of neoplastic origin, five (7%) secondary to a systemic disease and two of nonspecific inflammatory origin. Our results showed a high pleural sensitivity of QFT-GIT (97.62%) compared to serum sensitivity (80.95%). In contrast, serum specificity (83.78%) was higher than pleural specificity (72.97%). When we used the optimal values from the receiver operation characteristics curve analysis, the area under the curve of interferon-gamma produced by the QFT-GIT test was significantly higher in the pleural fluid than in the blood. Area under the curve of TB antigen interferon-gamma response was 92, 18 [95% confidence interval (CI)=87.56–96.79], nil tube was 95.71% (95% CI=92.43–99), and mitogen tube was 65.34 (95% CI=57.71–72.98). Conclusion QFT-GIT in pleural fluid appears in our study as a useful test for the diagnosis of TB pleurisy, but its diagnostic accuracy needs to be validated in further large-scale research.

Improvement of Organizational Measures for Detection and Diagnosing of Tuberculous Infection and Tuberculosis in Adolescents in the Republic of Kazakhstan

The objective: to improve organizational measures for detection and diagnosing of tuberculous infection and tuberculosis in adolescents in the Republic of Kazakhstan.Subjects and Methods. Screening was conducted among 27,648 adolescents aged 15-17 years from regions of the Republic of Kazakhstan with a high burden of tuberculosis. It was planned to use TRA tests and fluorography in parallel, while local doctors, district and school nurses, and nurses in vaccination rooms were preliminary trained by pediatric phthisiologists to perform the test, evaluate its results and monitor manifestations of adverse events (AEs) caused by TRA test.Results. 27,648 adolescents (aged 15-17 years) were given TRA test. No adverse events were observed during TRA skin test. Latent tuberculous infection was diagnosed in 320 (1.2%) adolescents. During further examination, 10 patients were diagnosed with drug susceptible pulmonary tuberculosis with no bacillary excretion. Based on the study results, to detect LTBI and tuberculosis in adolescents, in addition to fluorography examination, it is necessary to use TRA skin test with in the groups facing a high risk of tuberculosis.

PREVALENCE OF LATENT TUBERCULOSIS IN DIABETIC AND NON-DIABETIC INDIVIDUALS IN A TERTIARY CARE CENTER: A COMPARATIVE STUDY

Aims and Objectives: The aims of this study were as follows: (1) To study the prevalence of latent tuberculosis (TB) in diabetic and non-diabetic population attending the tertiary care hospital. (2) To investigate the association between diabetes mellitus (DM) and latent TB, evaluating the prevalence of positive tuberculin tests and assessing glycemic parameters in diabetic patients with latent TB. Methods: This was a single-center, hospital-based, observational, and comparative study conducted in the department of general medicine of a tertiary care medical college. One hundred and thirty-six diabetic patients of either gender or 137 healthy individuals acting as control group were included in this study on the basis of a predefined inclusion and exclusion criteria. Patients were evaluated by detailed history and clinical examination. The diagnosis of latent TB was based on a positive tuberculin test without any clinical features of active TB. The prevalence of latent TB infection was compared in both the groups. p<0.05 was taken as statistically significant. Results: Patients in both the groups were found to be comparable in terms of gender distribution and mean age. Predominant patients were found to have type 2 DM. The mean duration of DM was noted to be 91.58±60.68 months. The most common diagnoses of patients in non-diabetes group were COVID-19 (9.49%), neurological diseases (8.76%), infections (7.3%), acute myocardial infarction (6.57%), and iron deficiency anemia (5.84%). About 21.32% of cases in DM group were noted to have latent TB, while the proportion of latent TB was noted to be 7.30% in the non-diabetes group. The mean fasting blood sugar, mean post-prandial blood sugar, as well as mean HbA1c were significantly higher (p<0.05) in the subgroup with latent TB versus the subgroup without latent TB. Conclusion: Individuals with diabetes mellitus were found to have increased risk of latent TB infection. In addition, male gender and elevated glycemic parameters were found to be key factors associated with latent tuberculous infection in diabetes.

Treatment Responses to Integrase Strand-transfer Inhibitor-containing Antiretroviral Regimens in Combination With Short-course Rifapentine-based Regimens for Latent Tuberculosis Infection Among People With HIV.

Real-world experience with combinations of short-course rifapentine-based regimens and integrase strand-transfer inhibitor-containing antiretroviral therapy (ART) in management of latent tuberculous infection (LTBI) is limited among people with human immunodeficiency virus (PWH). From August 2019 to October 2022, PWH receiving 3 months of weekly rifapentine plus isoniazid (3HP) or 1 month of daily rifapentine plus isoniazid (1HP) in combination with ART were included. The primary outcome was virologic response within 12 months after LTBI treatment; secondary outcomes included treatment completion rate and safety of LTBI regimens. During the study period, 479 PWH (94.6% male; median age, 43 years) were included: 142 received 1HP and bictegravir (BIC)-containing regimens (1HP/BIC group), 46 1HP and dolutegravir (DTG)-containing regimens (1HP/DTG group), 38 3HP and BIC-containing regimens (3HP/BIC group), 214 3HP and DTG-containing regimens (3HP/DTG group), 17 1HP and other ART regimens (1HP/others group), and 22 3HP/other ART regimens (3HP/others group). In the intention-to-treat analysis, the proportions of PWH maintaining plasma HIV-1 RNA <200 copies/mL within 12 months after LTBI treatment completion were 96.5% (1HP/BIC), 100% (1HP/DTG), 100% (3HP/BIC), 95.8% (3HP/DTG), 100% (1HP/others), and 100% (3HP/others). The overall completion rates were >80% for all treatment groups, whereas >50% of the included PWH experienced any adverse event. LTBI regimens and ART combinations were not associated with virologic response and completion rate. Combinations of short-course rifapentine-based regimens and integrase strand-transfer inhibitor-containing ART maintained viral suppression for most PWH within 12 months of LTBI treatment completion with low rates of grade 3 or higher adverse events.

Adherence and Toxicity during the Treatment of Latent Tuberculous Infection in a Referral Center in Spain.

The screening and treatment of latent tuberculosis infection (LTBI) in countries with a low incidence of TB is a key strategy for the elimination of tuberculosis (TB). However, treatment can result in adverse events (AEs) and have poor adherence. This study aimed to describe treatment outcomes and AEs for LTBI patients at two departments in Vall d'Hebron University Hospital in Barcelona, Spain. A retrospective study was conducted on all persons treated for LTBI between January 2018 and December 2020. Variables collected included demographics, the reason for LTBI screening and treatment initiation, AEs related to treatment, and treatment outcome. Out of 261 persons who initiated LTBI treatment, 145 (55.6%) were men, with a median age of 42.1 years. The indications for LTBI screening were household contact of a TB case in 96 (36.8%) persons, immunosuppressive treatment in 84 (32.2%), and recently arrived migrants from a country with high TB incidence in 81 (31.0%). Sixty-three (24.1%) persons presented at least one AE during treatment, and seven (2.7%) required definitive discontinuation of treatment. In the multivariate analysis, AE development was more frequent in those who started LTBI treatment due to immunosuppression. Overall, 226 (86.6%) completed treatment successfully. We concluded that LTBI screening and treatment groups had different risks for adverse events and treatment outcomes. Persons receiving immunosuppressive treatment were at higher risk of developing AEs, and recently arrived immigrants from countries with a high incidence of TB had greater LTFU. A person-centered adherence and AE management plan is recommended.

Tuberculosis contact-tracing results in childhood: a retrospective study in a tertiary-care children’s hospital in Turkey

ABSTRACT Background Smear-positive adults with tuberculosis are the main source of childhood tuberculosis. The evaluation of children exposed to tuberculosis and determination of the disease stages are the cornerstones of managing childhood tuberculosis. Aim To determine the frequency of tuberculous contact, latent tuberculosis infection and tuberculosis disease in children who were in contact with smear-positive adults. Methods This is a single-centre, retrospective study. The medical records of children exposed to tuberculosis (<18 years old) between 2014 and 2018 were investigated. After diagnosing the index cases, the children were referred to the hospital. To identify the children in contact with adults with tuberculosis, a careful medical history, demographic features and physical examination, tuberculin skin test, postero-anterior and lateral chest radiographs, and, if necessary, chest computed tomography and microbiological tests were undertaken. The children’s final diagnosis, treatment regimens and follow-up were documented. The sensitivity, specificity and positive and negative predictive values, tuberculin skin test and chest radiograph imaging were assessed and compared with computed tomography results. Results A total of 150 paediatric patients were exposed to 88 index cases. These were fathers in 29.3% of cases and mothers in 10% of cases. Of the children, 131 (87.3%) were asymptomatic, and physical examination was normal in all children, apart from one who had respiratory symptoms. The tuberculin skin test results were positive in 60 (43%) patients and chest radiograph was abnormal in 100 (66%) children. Findings were consistent with tuberculosis in 34 (40%) of the 84 patients who underwent computed tomography. Fifty (38.5%) of the remaining children were defined as having been in contact with a case of tuberculosis, 41 (31.5%) had latent tuberculous infection and 39 (30%) had tuberculosis disease. Conclusion Pulmonary tuberculosis is asymptomatic in most children but with meticulous use of computed tomography it can be detected in asymptomatic children who have had close contact with tuberculosis. Abbreviation: AFB: acid-fast bacilli; AUC: area under the curve; BCG: bacillus Calmette-Guérin; CI: confidence interval; CT: computed tomography; CXR: chest radiograph; HIV: human immunodeficiency virus; ICD-10: International Classification of Diseases 10; LTBI: latent tuberculosis infection; MDR-TB: multi-drug-resistant tuberculosis; NPV: negative predictive value; PCR: polymerase chain reaction; PPV: positive predictive value; ROC: receiver operating characteristics; SD: standard deviation; TB: tuberculosis; TST: tuberculin skin test; XDR-TB: extensively drug-resistant tuberculosis.

Application of BI-V for contact children and adolescents from focies of multidrug-resistant tuberculous infection: evaluation of effectiveness

Objective — to study the need of using the natural immunomodulator ВІ-V for contact children and adolescents from focies of multidrug-resistant tuberculous infection (MDR-TBI) for a non-specific immunoprevention of tuberculosis (TB). Materials and methods. A retrospective analysis of the medical records of 120 contacts (75 children and 45 adolescents) from focies of MDR-TBI and 102 adult with TB, who became the source of infection was carried out. Microbiological examination in adults included the detection of Mycobacterium tuberculosis (MBT) in sputum by smear microscopy, sowing of material on Levenstein—Jensen medium, typing of isolated MBT on BACTEC MGIT 960, determination of the drug susceptibility test (DST) of MBT to antimycobacterial drugs (AMBDs) of first- and second-line, as well as molecular genetic researched of sputum, in particular by the method of GeneXpert MTB/RIF and linear probe analysis. In the contact children from focies of MDR-TBI the determination of the population and subpopulation composition of blood lymphocytes was carried out among 25 children before and among 22 children after immuno­preven­tion. Results and discussion. Most contact children and adolescents (61.7 %) from focies of MDR-TBI had concomitant diseases. The prophylactic administration of the BI-V immunomodulator reduced the frequency of acute respiratory viral infections and exacerbations of non-specific bronchopulmonary diseases by 2.0 times, the development of an active process from the latent tuberculous infection by 2.6 times, the frequency of transformation of latent tuberculosis infection into an active process by 2.6 times, improved appetite, memory, learning outcomes and increased physical activity. The latent tuberculous infection based on the Mantoux test results was found in 82.5 % (99) children. The quantiferon test confirmed the presence of a latent form of tuberculosis in 104 (86.7 %) contacts, the rest of the test results were negative. In children who received ВІ-V, latent tuberculous infection turned into an active process 2.8 times less often than in infected children who did not take this immunomodulator. The existing deviations into the regulatory system and the cellular response system disappeared after the autumn-spring course of ВІ-V. Conclusions. Immunomodulator ВІ-V is an effective preventive means for bronchopulmonary diseases, including MDR-TB among contact children and adolescents from focies of MDR-TBI.

Life expectancy decline in people with treated tuberculosis and the possible benefits of prophylaxis

Background: Evidence of significant, measurable, and preventable loads of mortality risk even after anti-tuberculosis therapy and cure would be a convincing, tangible, and meaningful indicator of the efficacy of prevention. Aims &amp; Objectives: To study of a life expectancy decline in people with treated tuberculosis and the possible benefits of prophylaxis Methods &amp; Materials: We examined the years of potential life lost between 918 people with latent tuberculous infection and a cohort of 386 cured tuberculosis (TB) patients. To estimate the anticipated years of potential life lost for each cohort and for demographic groupings, we built a regression model. Results: When compared to a group without active TB, decedents with a history of thoroughly treated TB are anticipated to lose an additional 3.6 years of life on average. White and Hispanic people were expected to see greater longevity losses than their Black and Asian counterparts. Conclusion: The expected lifetime of treated TB survivors was significantly different from that of a comparable group without active TB, according to our research. With a total of 1485 lifeyears lost, or the equivalent of more than 180 75-year lifespans, these excess losses are considerable. These results highlight an important lost opportunity cost for each TB case that could have been prevented: an average of 3.6 years of life. We come to the conclusion that despite adequate anti-tuberculosis treatment, there is still a significant burden of preventable mortality, which is a strong argument in favour of more widespread and organised use of prevention.

Diffuse anterior scleritis following micropulse transscleral laser

We report a case of scleritis following micropulse transscleral laser therapy (TLT) in an elderly female with medically uncontrolled primary open-angle glaucoma. She had completed antitubercular treatment (ATT) for pulmonary tuberculosis 20 years ago. Along with scleritis, there were vitritis and macular edema post laser. Systemic blood investigations for connective tissue disorders were negative. She had latent tuberculous infection with positive Mantoux test and quantiferon TB gold. She responded favorably to topical steroids with no vision loss. Though TLT, with its pulsed laser delivery, is considered safe, caution must be exercised in patients susceptible to inflammation.

Translated article] Diagnosis of tuberculous infection in immunosuppressed patients and/or candidates for biologics using a combination of 2 IGRA tests: T-SPOT.TB/QuantiFERON TB Gold In-Tube vs. T-SPOT.TB/QuantiFERON TB Gold Plus

IntroductionThe diagnosis of latent tuberculous infection (LTI) by IGRA continues to generate debate. Experience in the simultaneous use of 2 IGRA tests is scant. The aim of this study was to compare the results of 2 versions of QuantiFERON-TB Gold (In-Tube/Plus) with those of T-SPOT.TB, and to analyse the effectiveness of a dual strategy (T-SPOT.TB + QTF) for the diagnosis of LTI in an immunosuppressed population. MethodsWe conducted a prospective study (May 2015–June 2017) that included 2999 immunosuppressed patients and/or candidates for biologics, in whom 2 simultaneous IGRA tests were performed: Group 1 (1535 patients): T-SPOT.TB + QuantiFERON-TB Gold-In-Tube (QTF-GIT); Group 2 (1464 patients): T-SPOT.TB + QuantiFERON-TB Gold Plus (QTF-Plus. ResultsThe concordance between QTF-GIT and T-SPOT.TB was 83.19% (κ = 0.532). The percentage of positive, negative, and indeterminate results were, respectively: 14.33% vs. 17.06%; 82.41% vs. 74.46%; and 3.25% vs. 8.46%. The concordance between QTF-Plus and T-SPOT.TB was 87.56% (κ = 0.609). The percentage of positive, negative, and indeterminate results were, respectively: 15.02% vs. 15.36%; 82.92% vs. 79.37%; and 2.04% vs. 5.25%. Discrepancies between T-SPOT.TB and QTF-Plus were 12.43%, suggesting that 103 patients were positive and another 79 were negative due exclusively to 1 of the 2 IGRAs. ConclusionsGreater concordance was found between QTF-Plus and T-SPOT.TB than between QTF-GIT and T-SPOT.TB. However, we believe that the proportion of discrepancies between T-SPOT.TB and QTF-Plus is sufficiently important from a clinical point of view to justify the simultaneous use of 2 IGRA in this specific patient group.

Prevalence of Latent Tuberculous Infection in Patients With Nontuberculous Mycobacterial Lung Disease and Colonization: A Prospective Study in an Intermediate Tuberculosis Burden Country.

BackgroundControlling latent tuberculosis infection (LTBI) is important in eliminating tuberculosis (TB); however, the prevalence of LTBI has rarely been studied in patients with nontuberculous mycobacterial (NTM) lung disease (LD) and colonization (LC).MethodsWe prospectively recruited subjects with NTM isolated from sputum mycobacterial cultures from December 2011 to June 2019. NTM-LD and NTM-LC were defined according to the American Thoracic Society guidelines. Patients with negative cultures were recruited as controls. Patients with a history of active TB or positive TB cultures were excluded. LTBI was confirmed using a QuantiFERON-TB Gold In-tube test. The prevalence and factors associated with LTBI were analyzed.ResultsA total of 406 participants were enrolled, including 171 in the NTM-LD group, 153 in the NTM-LC group, and 82 in the control group. The prevalence of LTBI was higher in the NTM-LD and NTM-LC groups than in the controls (21.6%, 20.9%, and 6.1%; P = .006). Multivariable analysis showed that old age (adjusted odds ratio [aOR], 1.021, per year increment; P = .042), NTM-LD (aOR, 4.030; P = .005), NTM-LC (aOR, 3.610; P = .011, compared with the controls), and pulmonary cavitary lesions (aOR, 3.393; P = .034) were independently associated with LTBI.ConclusionsThe prevalence of LTBI was higher in the patients with NTM-LD and NTM-LC than in the controls. Old age, pulmonary cavitation, and NTM isolated from sputum were associated with a higher risk of LTBI.

P6‐7: Is nontuberculous mycobacterial lung disease a risk factor of latent tuberculous infection? ‐ A prospective study in a medical center

P6‐7: Is nontuberculous mycobacterial lung disease a risk factor of latent tuberculous infection? ‐ A prospective study in a medical center

POS1437 LATENT TUBERCULOSIS INFECTION IN RHEUMATIC DISEASES: A REAL-LIFE STUDY OF THREE APULIAN CENTRES. DATA FROM BIOPURE REGISTRY

Background:Latent tuberculous infection (LTBI) is very common in the world and screening for it is essential before starting treatment with biotechnological drugsObjectives:The aims of our study were to assess the prevalence in Apulia of LTBI among patients affected with rheumatic disease and to record the cases of tuberculosis (TB) infection among patients treated with biologic agents.Methods:We analysed data of patients included in BIOPURE registry from 2008 to 2018, who underwent Quantiferon (QTF) test as routinely screening for biologic treatment. Demographic and clinical data were recorded at the time of the first QTF assessment and this time point was considered the “baseline” of the study. Data regarding further QTF tests performed during follow-up was also acquired by electronic charts. Prophylaxis administration and bDMARD treatments were recorded for patients with positive QTF test. All tuberculosis infections were recorded during the entire time of follow-up.Results:Three thousand thirty-five patients (female 67.2%, mean age 52 ± 18.3 years) were included in these study, 2692 patients (88.7%) had inflammatory arthritis (28.2% rheumatoid arthritis, 33% psoriatic arthritis and 27.4% spondyloarthritis), 129 (4.2%) patients had connective tissue disease, whereas 214 (7.1%) patients were affected by others rheumatic diseases. The prevalence of LTBI was 10.7% (326 patients) at baseline. Comparisons between positive and negative patients for QTF are reported in Table 1. We acquired data of LTBI prophylaxis of 284 patients; 235 out 265 patients treated with isoniazid completed the treatment, whereas 19 out 19 patients treated with rifampicin completed the prophylaxis regimen. The main cause of isoniazid withdrawal was hypertransaminasemia, but 8 patients then completed prophylaxis with rifampicin. During the entire follow-up (42.6±30.5 months), we recorded 5 (0.02%) cases of primary TB infection in patients on anti-TNFα agents treatment, which had baseline screening negative for LTBI. Data and outcome of these patients are reported in Table 2. The mean time of follow-up of patients on bDMARDs treatment with positive QTF at baseline was 52.7±35.2 months. bDMARD treatment regimens are reported in Table 3. No case of TB reactivation was found among patients with positive baseline QTF. Moreover, of 1563 (51.5%) patients who repeated QTF during follow-up, 62 (4%) of them showed a change in the test result. We observed a change to a positive state in 36 patients with previous negative QTF test, whereas 26 patients with previous positive QTF showed a shift to a negative test during follow-up.Conclusion:Our study shows a prevalence of LTBI of 10.7% in Apulian patients affected with rheumatic disease. bDMARDs therapy appears to be safe in patients with positive QTF test treated according to current recommendations1. However, cases of primary TB infections, especially in patients receiving anti-TNFα drugs, have been observed.

Management of childhood and adolescent latent tuberculous infection (LTBI) in Germany, Austria and Switzerland.

Majority of active tuberculosis (TB) cases in children in low-incidence countries are due to rapid progression of infection (latent TB infection (LTBI)) to disease. We aimed to assess common practice for managing paediatric LTBI in Austria, Germany and Switzerland prior to the publication of the first joint national guideline for paediatric TB in 2017. Online-based survey amongst pediatricians, practitioners and staff working in the public health sector between July and November 2017. Data analysis was conducted using IBM SPSS. A total of 191 individuals participated in the survey with 173 questionnaires included for final analysis. Twelve percent of respondents were from Austria, 60% from Germany and 28% from Switzerland. Proportion of children with LTBI and migrant background was estimated by the respondents to be >50% by 58%. Tuberculin skin test (TST) and interferon-γ-release-assay (IGRA), particularly Quantiferon-gold-test, were reported to be used in 86% and 88%, respectively. In children > 5 years with a positive TST or IGRA a chest x-ray was commonly reported to be performed (28%). Fifty-three percent reported to take a different diagnostic approach in children ≤ 5 years, mainly combining TST, IGRA and chest x-ray for initial testing (31%). Sixty-eight percent reported to prescribe isoniazid-monotherapy: for 9 (62%), or 6 months (6%), 31% reported to prescribe combination therapy of isoniazid and rifampicin. Dosing of isoniazid and rifampicin below current recommendations was reported by up to 22% of respondents. Blood-sampling before/during LTBI treatment was reported in >90% of respondents, performing a chest-X-ray at the end of treatment by 51%. This survey showed reported heterogeneity in the management of paediatric LTBI. Thus, regular and easily accessible educational activities and national up-to-date guidelines are key to ensure awareness and quality of care for children and adolescents with LTBI in low-incidence countries.

The prevalence and characteristics of adults with latent tuberculous infection in the United States and the implications for healthcare in Texas

The Centers for Disease Control and Prevention reported 8,916 cases of tuberculosis in 2019. Reducing the number of cases of active tuberculosis requires identification of patients with latent tuberculous infections (LTBI). Optimal screening for LTBI requires information about the demographics and characteristics of people who are more likely to have had tuberculous infection. Information from the 2011–2012 National Health and Nutrition Examination Survey (NHANES) was used to determine the number and characteristics of adults from a representative sample of the United States who had LTBI. Latent tuberculous infection was identified either by a positive skin test or by a positive QuantiFERON blood test. Information about the number of patients with active tuberculosis in Texas was determined from reports from the Texas State Department of Health Services. The NHANES database for the years 2011-2012 included 5,684 adults. Participants with a positive QuantiFERON blood test were more likely in the age group 45-64, male, foreign born, and have less than a high school education. Participants with a positive skin test had similar characteristics. Participants who had both a positive skin test and positive QuantiFERON test were more likely to be in the age group 45-64, males, foreign born, and Hispanic. In addition, they had diabetes, self-reported fair/poor health, and an educational level less than high school. In the State of Texas tuberculosis occurred more frequently in individuals older than 75 who were male and were not US born Texas residents. Important clinical diagnoses included diabetes, alcohol abuse, correctional facility residence, non-injection drug use, positive HIV status, and homelessness. Information from the NHANES study and from the State Department of Health Services in Texas provides information needed to develop screening programs for latent tuberculosis and active tuberculosis.

Diagnosis of latent tuberculosis infection among pediatric household contacts of Iranian tuberculosis cases using tuberculin skin test, IFN- \u03b3 release assay and IFN-\u03b3-induced protein-10

BackgroundAlthough the World Health Organization has recommended the diagnosis and prophylactic treatment of latent tuberculous infection (LTBI) in child household contacts of tuberculosis (TB) cases, the national programs in high-burden TB regions rarely implement adequate screening of this high-risk group, mainly because of resource limitations. We aimed to evaluate the prevalence of LTBI among pediatric household contacts of TB cases in two high-burden provinces in Iran.MethodsWe conducted a cohort study in children who had been in household contact with a TB index. All subjects were assessed for active TB disease. For LTBI diagnosis, tuberculin skin test (TST) and QuantiFERON®-TB Gold Plus (QFT-Plus) were performed at the time of the index TB case diagnosis, as well as, 3, 12, and 18 months, if the first results were negative. In addition, interferon-γ-induced protein-10(IP-10) concentrations were measured for all participants.ResultsA total of 230 children were enrolled, who had contact with an index TB case. Three contacts were diagnosed with active TB. According to the TST/QFT-Plus results, 104 (45.2%) children were identified with LTBI during our study. Significantly increased IP-10 levels were found in LTBI patients compared to healthy contacts. Accordingly, more than 50% of LTBI contacts and about 10% of healthy contacts were considered as IP-10-positive.ConclusionThis study alarmingly illustrates a high prevalence of LTBI among Iranian children exposed to TB cases. We, therefore, emphasize that the children living in close contact with an infectious TB case should be screened effectively and receive prophylactic therapy.

Screening of Latent Tuberculous Infection (LTBI) before Starting Anti-Tumor Necrosis Factor Therapy in Patients with Psoriasis: A Primer for Clinical Dermatologist.

Anti-tumor necrosis agents are being increasingly used in the management of moderate to severe psoriasis. Therapy with antitumor necrosis factor alpha (TNF-α) agents is being fraught with reactivation of latent tuberculosis infection (LTBI). This paper addresses the intricate relation between LTBI and anti-TNF-α agents and provides working guidelines for screening of LTBI and its management before prescribing anti-TNF-α therapy in patients with psoriasis.

Aspects of Quality of Life in Children with Latent Tuberculous Infection

Aspects of Quality of Life in Children with Latent Tuberculous Infection

Decreased Expression of CD69 on T Cells in Tuberculosis Infection Resisters.

BackgroundCD69 is a biomarker of T-cell activation status, but its activation status in human Mycobacterium tuberculosis (Mtb) infection remains elusive.MethodsA set of cohorts of patients with different tuberculosis (TB) infection status including active TB patients (ATB), latent tuberculous infection patients (LTBI) and close contacts (CCs) of ATB was designed, and the expression profiles of CD69 and several T-cell markers were determined on Mtb antigen-stimulated T cells by flow cytometry.ResultsThe frequencies of CD4+ and CD8+ T cells were both comparable among Mtb-infected individuals including ATB and LTBI, which guaranteed the consistency of the background level. A t-Distributed Stochastic Neighbor Embedding (tSNE) analysis on a panel of six phenotypic markers showed a unique color map axis gated on T cells in the CCs group compared with ATB and LTBI populations. By further gating on cells positive for each individual marker and then overlaying those events on top of the tSNE plots, their distribution suggested that some markers were expressed differently in the CCs group. Further analysis showed that the expression levels of CD69 on both CD4+ and CD8+ T cells were significantly lower in the CCs group, especially in interferon-γ-responding T cells.ConclusionOur findings suggest that the T-cell activation status of CD69 is associated with Mtb infection and may have the potential to distinguish LTBI from those populations who have been exposed continuously to Mtb but have not become infected.

Diagnóstico de la infección tuberculosa en pacientes inmunodeprimidos y/o candidatos a terapias biológicas mediante el uso combinado de dos pruebas IGRA: T-SPOT.TB/QuantiFERON TB Gold In-Tube vs. T-SPOT.TB/QuantiFERON TB Gold Plus

IntroductionThe diagnosis of latent tuberculous infection (LTI) by IGRA continues to generate debate. Experience in the simultaneous use of 2 IGRA tests is scant. The aim of this study was to compare the results of 2 versions of QuantiFERON-TB Gold (In-Tube/Plus) with those of T-SPOT.TB, and to analyse the effectiveness of a dual strategy (T-SPOT.TB + QTF) for the diagnosis of LTI in an immunosuppressed population. MethodsWe conducted a prospective study (May 2015-June 2017) that included 2,999 immunosuppressed patients and/or candidates for biologics, in whom 2 simultaneous IGRA tests were performed: Group 1 (1535 patients): T-SPOT.TB + QuantiFERON-TB Gold-In-Tube (QTF-GIT); Group 2 (1464 patients): T-SPOT.TB + QuantiFERON-TB Gold Plus (QTF-Plus). ResultsThe concordance between QTF-GIT and T-SPOT.TB was 83.19% (κ=0.532). The percentage of positive, negative, and indeterminate results were, respectively: 14.33% vs. 17.06%; 82.41% vs. 74.46%; and 3.25% vs. 8.46%. The concordance between QTF-Plus and T-SPOT.TB was 87.56% (κ=0.609). The percentage of positive, negative, and indeterminate results were, respectively: 15.02% vs. 15.36%; 82.92% vs. 79.37%; and 2.04% vs. 5.25%. Discrepancies between T-SPOT.TB and QTF-Plus were 12.43%, suggesting that 103 patients were positive and another 79 were negative due exclusively to 1 of the 2 IGRAs. ConclusionsGreater concordance was found between QTF-Plus and T-SPOT.TB than between QTF-GIT and T-SPOT.TB. However, we believe that the proportion of discrepancies between T-SPOT.TB and QTF-Plus is sufficiently important from a clinical point of view to justify the simultaneous use of 2 IGRA in this specific patient group.