Purified Protein Derivative Skin Test Research Articles

The impact of purified protein derivative prior to intravesical bacillus Calmette-Guérin for the treatment of patients with non-muscle invasive bladder cancer.

The aim of this study is to investigate the impact of the intradermal injection of purified protein derivative (PPD) and PPD skin test reactions on the oncological outcomes of patients with non-muscle invasive bladder cancer (NMIBC) treated by trans-urethral resection of bladder tumor (TURBT) and adjuvant intravesical BCG. The study included 100 consecutive patients with NMIBC prospectively given intradermal PPD 1-2 weeks before starting BCG therapy. Another 100 patients with NMIBC not given intradermal PPD before starting BCG were chosen as a historical control. The control group was chosen to be matching with the study group regarding baseline characteristics. The study group was divided into 2 subgroups with positive and negative reaction to PPD skin test. Oncological outcomes, immunological markers (TNF-α and IL-6) changes and BCG side effects were evaluated. There were no significant differences between patients who received PPD or not regarding the 2-year recurrence free survival (RFS) rates and progression-free survival (PFS) rates and immunological markers changes. The 2-year RFS and PFS rates were significantly higher in patients with positive reactions. Post-induction values of immunological markers increased in all patients with a significant increase in patients with positive reactions. BCG side effects were significantly higher in patients with positive reactions. The intradermal injection of PPD before intravesical BCG has no impact on oncological outcomes of patients with NMIBC treated with TURBT and intravesical BCG. However, the PPD skin test reactions before BCG therapy can predict the oncological outcomes, BCG side effects and the immunological outcomes of patients.

Purified Protein Derivative Response in Type 1 Diabetics

Aim: The aims of our study were to identify the role of suppressor T1 helper cells in the immunopathogenesis of type 1 diabetes mellitus (T1D) and to investigate the purified protein derivative (PPD) response, which is a delayed type of skin sensitivity response that develops secondarily to the effect of the T1 helper cell response. Method: Twenty-four newly diagnosed patients with T1D were included in the study (12 girls, 12 boys), and 30 (18/12) age/sex matched healthy children were included as controls. All patients underwent the PPD skin test (TST) in the first diagnostic 24–48 h (study group-1) and again 1 month after diagnosis (study group-2). The PPD response was compared with the response of healthy children. The lower limit of PPD positivity was accepted as ≥ 10 mm. Results: The mean PPD induration value taken in the study group-2 was statistically greater than both the study group-1 and the control group PPD (p=0.014, p=0.001). Regarding the increase in duration, the PPD positivity rate was statistically higher after the first month than in the control group (p= 0.005) and the initial PPD positivity rate (p=0.023). Conclusion: Interesting results emerged for the PPD response of the study group-2, because the PPD positivity rate increased over time.

Interleukin-18 serum level before and after intralesional immunotherapy with tuberculin purified protein derivative in patients with cutaneous and genital warts.

Several studies demonstrated the efficacy of intralesional purified protein derivative (PPD) immunotherapy in warts eradication. Nevertheless, the precise induced immune mechanisms are undetermined. Injected PPD is hypothesized to induce a delayed hypersensitivity reaction associated with cytokines release. Interleukin (IL)-18 has a major role in defense against viral infection via inducing interferon-γ release from T-helper 1 and natural killer (NK) cells. Moreover, IL-18 triggers Fas ligand expression on cytotoxic T cells and NK cells enhancing their cytotoxicity against virally infected cells. The aim of this study was to assess the role of IL-18 in the response to intralesional PPD injection in patients with warts. The study included 25 patients with warts and 25 HCs. Patients underwent PPD skin test, and only patients with positive tests were included and received intralesional PPD injections starting 72 h after the test then every 2 weeks until wart clearance or a maximum of 3 sessions. Serum IL-18 level was measured via enzyme-linked immune-sorbent assay in patients (pre-treatment and 2 weeks after the last injection) and HCs. After 3 sessions of injection, six (24%) patients were designated responders, nine (36%) patients showed partial response, and 10 (40%) patients were designated non-responders. Serum IL-18 level, post-treatment, was significantly higher than pre-treatment level (p =0.025) and level in HCs (p =0.036). Furthermore, the post-treatment level was significantly higher in responders than non-responders (p= 0.025). IL-18 is probably implicated in the immune mechanisms induced by PPD injection that cause eradication of warts.

Tsukamurella pneumonia misdiagnosed as pulmonary tuberculosis

A 72-year-old man, with a 10-year history of oral dexamethasone (5 mg once a day) for intermittent pneumonia, had been previously hospitalised due to cough, expectoration, and chest tightness for approximately 9 months. In his previous hospitalisation, 3 months before admission to the Chest Hospital of Hebei Province (Shijiazhuang, China), a chest CT scan showed left pyopneumothorax and a cavity in the right upper lobe, a purified protein derivative skin test was positive, and a sputum smear showed acid-fast bacilli; however, the sputum nucleic acid amplification test for Mycobacterium tuberculosis was negative. The patient was initially diagnosed with pulmonary tuberculosis and underwent a closed thoracic drainage and anti-tuberculosis chemotherapy, including oral pasiniazide (0·50 g twice a day), oral rifapentine (0·60 g twice a week), oral pyrazinamide (0·50 g three times a day), and oral ethambutol (0·75 g once a day).

S2173 An Unusual Case of Dysphagia: Tuberculous Bronchoesophageal Fistula

Introduction: A tuberculous bronchoesophageal fistula (BEF) is a rare cause of dysphagia, with only a handful of cases in the literature, and a lack of consensus on its diagnosis and appropriate management. Case Description/Methods: A 30-year-old male presented with weight loss, worsening dysphagia, and cough on swallowing for 4 months. He also reported having pleuritic chest pain, malaise, and low-grade fever in the week before presentation. He was on immunosuppressive therapy for a renal transplant due to chronic renal failure and had a history of bariatric surgery for morbid obesity. Laboratory testing revealed normocytic anemia, normal white blood cell count, and significantly elevated erythrocyte sedimentation rates as well as C-reactive protein. A purified protein derivative skin test performed 3 months prior to presentation was reportedly negative. The remainder of his laboratory testing, including troponin, cardiac enzymes, and HIV status was negative. A chest x-ray showed left hilar prominence. High-resolution computerized tomography (CT) imaging of the chest showed subcarinal and left hilar lymphadenopathy and a soft-tissue density measuring 3 cm x 2 cm in the subcarinal region, inseparable from the right lateral wall of the mid-esophagus (Figure 1). Upper endoscopy showed an esophageal opening at 30 cm from the incisors (Figure 2). Bronchoscopy showed an opening into the left main bronchus with no airway stenosis. Contrast injection under fluoroscopic guidance confirmed a bronchoesophageal fistula (BEF) (Figure 3). A fully covered self-expanding metal stent was placed to aid in closure (Figure 4). A bronchoalveolar lavage and a Quantiferon test both confirmed active tuberculosis. The patient commenced anti-tuberculosis medications and required repeat endoscopy and replacement of the stent after 8 weeks. A repeat CT chest with oral contrast after 16 weeks showed resolution of the BEF which was confirmed after subsequent stent removal. Discussion: A BEF is uncommon, and not initially considered in patients presenting with dysphagia. In retrospect, our patient reported coughing while drinking, raising suspicions for a BEF. A tuberculous BEF is rare but becomes a distinct possibility in the setting of immunosuppression. Clinicians should remain vigilant for atypical infections in immunosuppressed patients presenting with dysphagia.Figure 1.: CT/ fluoroscopy and endoscopic imaging demonstrating bronchoesophageal fistula.

Pathologically and Bacteriologically Unconfirmed Esophageal Tuberculosis Diagnosed by Endoscopic Ultrasound Combined with the T-SPOT.TB test: A Case Report

Esophageal tuberculosis (TB) is relatively a rare disease, and its diagnosis is often unknown due to the lack of specific clinical symptoms and endoscopic manifestations, as well as the low success rate of pathological biopsy. In this case report, we describe a patient who presented with dysphagia as the chief complaint, manifested as a submucosal eminence under endoscopy. Endoscopic ultrasonography showed hypoechoic changes, disappearance of some layers and esophageal boundaries, and echo of fused lymph nodes around the esophagus. The patient had strongly positive results of the purified protein derivative skin test and T-SPOT.TB. Subsequently, the patient received treatment of anti-TB drugs, and the clinical symptoms improved. According to the patient’s medical history and endoscopic ultrasonography results, esophageal TB was the most probable diagnosis. Therefore, this case report offers new ideas that endoscopic ultrasonography and a review of clinical manifestations can be used to diagnose esophageal TB.

Risk Factors for Tuberculosis Conversion in a State Prison

A case-control study determined the risk factors for latent tuberculosis (TB) conversion among Oregon Department of Correction (ODOC) inmates from July 2000 - July 2001. The first objective was to identity the converters. These were inmates who tested negative for the Purified Protein Derivative (PPD) skin test on entry and subsequently tested positive on annual testing. The second objective was determining the risk factors for conversion by comparing the converters with randomly selected controls. The Correctional Information System (CIS) and Mental Health databases were accessed to obtain health and demographic information. With ninety-nine percent of PPD positive inmates on anti-tuberculosis medications, nearly all male inmates who tested positive from July 00-01 (n = 307) were identified through the ODOC pharmacy records. A medical chart review (276 of 307 or 90%) separated the converters (n = 72) from the reactors who tested positive on entry (n = 123) and the prior positives on medications (n = 81). The conversion rate was 5.0 per 1,000 person-years. Differences between the cases (converters) and controls were analyzed using multivariate logistic regression. The converters were 6 times more likely to be Latino (p < .005) vs. Caucasian, over 19 times less likely to live in medium vs. minimum (p < .001) or maximum vs. minimum (p < .001) security prisons, and over 5 times less likely to live in a medium vs. low (.012 < p < .031) or high vs. low (.002 < p < .007) density prison. They had 1.4-1.5 times fewer PPD skin tests (.002 < p < .009) and lived in 1.5-1.7 times fewer prisons (.005 < p < .017). Age, education, county of incarceration, number of incarcerations, and number of visitors were not found to be significant variables. The results revealed a low conversion rate compared to other U.S. prisons. Prison health officials should consider performing two-step skin testing in order to distinguish the booster phenomenon from intramural conversion.

Comparison of Cattle Serum Antibody Responses to Five Different Mycobacterial Antigens in an ELISA System.

The presence of common zoonosis diseases caused byMycobacterium tuberculosiscomplex (MTBC) and nontuberculous mycobacteria (NTM), such as Johne's and Crohn's diseases, poses a public health threat and economic losses to Iranian livestock. Therefore, the early detection of mycobacteria is of paramount importance. In this regard, enzyme-linked immunosorbent assay (ELISA) is a new, simple to use, rapid, and useful diagnostic tool. This study was performed to evaluate different crude antigens obtained from Mycobacterium species using an indirect ELISA test to identify the mycobacterial infection in infected livestock. Five different strains of Mycobacteria including M. tuberculosis,M. phlei,M. bovis,M. avium subspecies paratuberculosis, andM. bovisAN5 were cultured. The crude antigens in the samples were precipitated with trichloroacetic acid 4%. Thesodium dodecyl sulfate-polyacrylamide gel electrophoresis of crude antigens isolated from different Mycobacterium species was reported. The total level of protein was determined by the Lowry protein assay. After the crude antigen preparation, the ELISA test was performed and the results were compared with the purified protein derivative skin test. Data analysis was performed using SPSS software version 25. All five strains were detected in more than 92% of healthy animals. The highest sensitivity of ELISA tests was inM. bovisAN5 antigen which was greater than 83%. The highest diagnostic specificity and efficiency of assays were in M.aviumsubspecies paratuberculosiswhich was 95.83% and over 83%, respectively. Regarding the results,M. aviumsubspeciesparatuberculosisandM. bovisAN5 antigens were promising candidates for the design of diagnostic ELISA due to their sensitivity, specificity, and efficiency.

In vitro and in vivo assessments for developing an oral BCG vaccine formulation

The aim of this study was to establish in vitro analytical methods for assessing an investigated oral BCG vaccine formulation. In addition, in vivo immune response was also evaluated in guinea pigs by determining the potentially protective effect of the investigated formulation on tuberculosis. The bicinchoninic acid (BCA) method for BCG protein quantitation was developed for rapid measuring the content of BCG vaccine in the investigated formulation. The analytical method was conducted at 45°C to offer good precision (coefficient of variation <3.5%) and accuracy (error: -3.6∼2.6%) in the range of 150∼4000 μg/mL of BCG vaccine concentrations. In the simulation study of drug release from the investigated formulation in the gastrointestinal tract under physiological conditions, the investigated oral formulation could protect active component at lower pH (0.1 N HCl) and completely release active component at higher pH (phosphate buffer, pH 6.8). Although the investigated oral BCG vaccine formulation showed weak immune response to elicit IgG titer, the PPD (purified protein derivative) skin test in guinea pigs by oral dosing of 4 mg BCG vaccine formulation acquired about equal or higher response than that by 0.5 mg dose by subcutaneous vaccination. The analytical method and in vivo approach could be further applied in the development of oral BCG vaccine formulations.

CDC releases recommendations amid shortage of tuberculin skin test antigens

In June, CDC announced a nationwide shortage of Aplisol (Par Pharmaceuticals), a purified-protein derivative (PPD) tuberculin antigen. According to the agency, the shortage is expected to last 3 to 10 months, with a supply interruption of Aplisol 5 mL (50 tests) beginning in June 2019 and Aplisol 1 mL (10 tests) in November 2019 or sooner if demand increases before November. Aplisol is one of two PPD tuberculin antigens approved by FDA to perform tuberculin skin tests (TST) for the detection of latent Mycobacterium tuberculosis (TB) infection. The other is Tubersol (Sanofi Pasteur). Amid this shortage, CDC has released the following recommendations to mitigate the limited supply of Aplisol and prevent a decline in TB testing capability:▪Substitute interferon-gamma release assay (IGRA) blood tests for TSTs.▪Substitute Tubersol for Aplisol.▪Prioritize allocation of TSTs to at-risk groups in consultation with state and local public health authorities. According to the agency, the high-risk groups that take priority are as follows:▪People who have been recently exposed to persons with TB disease▪People born in or who frequently travel to countries where TB disease is common▪People who currently live or used to live in large group settings such as homeless shelters or correctional facilities▪People with weaker immune systems, such as those with certain health conditions or taking medications that may alter immunity▪Children, especially those younger than age 5 years, if they are in one of the risk groups mentioned above With the release of these new recommendations, CDC assured providers that the overall concordance among the different tests for TB disease is high. However, the agency cautioned that “switching between PPD skin test products or between TSTs and blood tests in serial testing may cause apparent conversions of results from negative to positive or reversions from positive to negative.” The agency explained that this may be due to “inherent inter-product or inter-method discordance, rather than change in M. tuberculosis infection status.” False-positive reactions may occur with TSTs. Causes may include, but are not limited to, infection with nontuberculosis mycobacteria, previous bacilli Calmette-Guerin (BCG) vaccination, incorrect method of TST administration, incorrect interpretation of reaction, and incorrect bottle of antigen used. IGRA blood tests or TSTs (but not both) can be used in most situations when testing for TB infection. However, when substituting IGRA blood tests for TSTs, CDC reminds clinicians that the interpretation criteria for IGRA blood tests differ from that of TSTs. Pharmacists should keep in mind that IGRA blood tests are preferred in persons who have received BCG either as a vaccine or for cancer therapy, as well as in individuals from groups that historically have had poor rates of return for TST reading. On the other hand, TSTs are preferred in children younger than 5 years because data are limited on use of IGRA blood tests in this patient population. In settings with low likelihood of TB exposure or infection, clinicians should consult with public and occupational health authorities and consider deferring routine serial testing. In addition, new CDC guidelines state that annual TB testing of health care personnel who do not have latent TB disease is no longer required. CDC reported that the United States saw a total of 9,029 new TB cases in 2018, which is a 0.7% decrease from the 9,094 cases in 2017. Among the 9,029 TB cases, 69.5% occurred in non–U.S.-born individuals, and 29.5% occurred in U.S.-born individuals. Alaska reported the highest incidence of TB in the nation, with 8.5 cases per 100,000 people. However, CDC said that four states—California, Florida, New York, and Texas—accounted for approximately one-half of the reported cases of TB in the country, “as has been the case for over 2 decades.” While the number of TB cases in the United States continues to decrease, the rate of decline has slowed. As such, CDC reported that the goal of eliminating TB in the country (annual incidence of < 1 case per 1 million persons) is unlikely to become a reality in the 21st century without increased investment and effort. Clinicians can monitor the status of the Aplisol shortage at www.fda.gov/vaccines-blood-biologics/safety-availability-biologics/cber-regulated-products-current-shortages.

Diagnostic value of bronchoalveolar lavage in the subset of patients with negative sputum/smear and mycobacterial culture and a suspicion of pulmonary tuberculosis

BackgroundThe diagnostic value of bronchoalveolar lavage in patients with negative sputum/smear for tuberculous bacilli has been well studied. However, its value in the subset of patients with both negative sputum/smear and culture is seldom reported. MethodsA retrospective study of patients referred for diagnostic bronchoscopy for the suspicion of pulmonary tuberculosis during the period from April 1st, 2015 to March 30th, 2016, and who had negative sputum/smear and culture for tuberculous bacilli. ResultsOne hundred and ninety patients fulfilled the inclusion criteria. Bronchoalveolar lavage detected further 61/190 (32.1%) pulmonary tuberculosis cases. Bronchoalveolar lavage mycobacterial culture and polymerase chain reaction (positive in 60/190 (31.6%) and 58/190 (30.5%) of patients respectively) provided the highest diagnostic yield, whereas direct smear provided the lowest yield. Bronchoalveolar lavage had a sensitivity of 89.7%, a specificity of 100%, a positive predictive value of 100%, a negative predictive value of 94.6%, and a test accuracy of 96.3% in suspected pulmonary tuberculosis cases with negative sputum/smear and culture. Positive bronchoalveolar lavage yield for tuberculosis was significantly associated with a positive QuantiFERON-TB Gold In-Tube test, positive purified protein derivative skin test, radiological evidence of upper zone abnormality and patient’s origin being from the Indian subcontinent. ConclusionBronchoalveolar lavage should be pursued as a useful diagnostic tool for suspected pulmonary tuberculosis cases when sputum/smear and culture are negative. Its value is higher in the subset of patients with positive QuantiFERON-TB Gold In-Tube test, positive purified protein derivative skin test, upper zone abnormality on radiograph or being from the Indian subcontinent.

Tuberculosis of the parotid lymph nodes: clinical and imaging features.

ObjectivesTo characterize clinical, computed tomography (CT) and magnetic resonance imaging (MRI) features of tuberculosis (TB) of the parotid nodes.Materials and methodsCT (n=21) and MR (n=7) images, and clinical data from 25 patients with TB of the parotid nodes were retrospectively analyzed by two experienced radiologists who reached consensus.ResultsYounger patients (aged <50 years) accounted for 72%. Eighty percent of patients were asymptomatic, and had no history of TB exposure. According to clinical and imaging findings, 64% and 60% patients were misdiagnosed as having tumors, respectively. A total of 43 lesions were identified. Thirty-eight (88.4%) lesions involved the superficial lobe. Fourteen (56%) cases had multiple lesions. There were four types of changes in the parotid fascia: local thickening (40%, n=10); local rupture with thickened adjacent skin (28%, n=7); focal bulge (20%, n=5); and no changes (12%, n=3). Cervical lymphadenopathy was seen in 14 out of 25 cases (56%). The lesions were contrast-enhanced in four patterns on CT images: homogeneous enhancement (37.1%, n=13), irregular cyst-like enhancement (37.1%, n=13), thick-walled ring enhancement (14.2%, n=5), and garland-like enhancement (11.4%, n=4). On MRI, the signal intensity of lesions was isointense on T1-weighted image, hyperintense on T2-weighted image, markedly hyperintense on diffusion-weighted imaging, and low on the apparent diffusion coefficient map. The surrounding parotid parenchymal edema was identified clearly on coronal MR images.ConclusionTB of the parotid nodes tend to simulate tumors clinically and radiologically. Their preferential sites are the superficial lobe. In young patients with positive purified protein derivative skin test and lesions accompanied by cervical lymphadenopathy, changes in the parotid fascia and parotid parenchymal edema adjacent to the lesions on CT and MRI may be helpful in the diagnosis and to facilitate differential diagnosis.

Perinatal tuberculosis: analysis of six cases

Objective To summarize the clinical manifestations, diagnosis and treatment of perinatal tuberculosis. Methods We retrospectively analyzed the clinical data of six infants with perinatal tuberculosis treated in Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2000 to December 2016. Results (1) The six patients were at the age of 27 to 60 days at the onset, while the mean ages of full-term and preterm infants were (31±4) and (55±6) days, respectively. Three mothers were diagnosed with active tuberculosis (two of which were diagnosed after parturition). (2) Three infants were admitted to the hospital with fever including two having respiratory diseases, one with external auditory canal secretions and deviated mouth, and two with secretions in the external auditory canal and masses in the head and neck. One was diagnosed as hepatosplenic tuberculosis, three as miliary tuberculosis (one was complicated by tuberculous meningitis and one with tuberculous meningitis and cervical lymph node tuberculosis), one with left cervical and temporal tuberculosis, and one with miliary tuberculosis complicated with left temporal, external auditory canal and cervical lymph node tuberculosis. (3) Two cases were positive for purified protein derivative skin test and two were positive for tuberculosis infection T cell spot test. Five cases were negative in anti-tuberculosis antibody test. Typical miliary shadows in the lungs of three infants were shown on chest X-ray. Two cases received auriculotemporal CT/MRI, indicating space-occupying lesions and destruction in the middle ear and mastoid process. Cranial MRI findings indicated one case had tuberculous meningitis. Diagnosis of three cases were confirmed by biopsy or after operation. (4) All six patients survived. Four cases recovered after combined treatment of isoniazid, rifampicin and pyrazinamide and two were transferred to a specialized hospital for further treatment. (5) All six patients were fully recovered in follow-ups at 2-3 years after discharge with normal development comparing with healthy children of the same age. Conclusions Perinatal tuberculosis, with non-specific clinical manifestations, has a low incidence of infection but a high mortality rate. Suspected cases require full consideration including clinical symptoms, dynamic observation of laboratory findings and imaging features, and pathological examination when necessary. Maternal history of tuberculosis should be consulted and timely treatment is mandatory to improve the outcomes. Key words: Tuberculosis; Peripartum period; Infant, newborn; Retrospective studies

This Month in Adult Urology

No AccessJournal of UrologyThis Month in Adult Urology1 Jun 2018This Month in Adult Urology Joseph A. SmithMD Joseph A. SmithJoseph A. Smith More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.076AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail References 1 : Incidence of extraprostatic extension at radical prostatectomy with pure Gleason score 3 + 3 = 6 (Grade Group 1) cancer: implications for whether Gleason score 6 prostate cancer should be renamed “not cancer” and for selection criteria for active surveillance. J Urol2018; 199: 1482. Link, Google Scholar 2 : Complications of recognized and unrecognized iatrogenic ureteral injury at time of hysterectomy: a population based analysis. J Urol2018; 199: 1540. Link, Google Scholar 3 : Worse urinary, sexual and bowel function cause emotional distress and vice versa in men treated for prostate cancer. J Urol2018; 199: 1464. Link, Google Scholar 4 : Detrusor acontractility after acute spinal cord injury—myth or reality?. J Urol2018; 199: 1565. Link, Google Scholar 5 : Development of a nationally representative coordinated registry network for prostate ablation technologies. J Urol2018; 199: 1488. Link, Google Scholar 6 : Effect of starting penile rehabilitation with sildenafil immediately after robot-assisted laparoscopic radical prostatectomy on erectile function recovery: a prospective randomized trial. J Urol2018; 199: 1600. Link, Google Scholar 7 : Comparing outcomes of robotic and open inguinal lymph node dissection in patients with carcinoma of the penis. J Urol2018; 199: 1518. Link, Google Scholar 8 : Purified protein derivative skin test prior to bacillus Calmette-Guérin therapy may have therapeutic impact in patients with nonmuscle invasive bladder cancer. J Urol2018; 199: 1446. Link, Google Scholar 9 : Impact of comorbidities on functional recovery from partial nephrectomy. J Urol2018; 199: 1433. Link, Google Scholar 10 : A randomized comparative study evaluating various cough stress tests and 24-hour pad test with urodynamics in the diagnosis of stress urinary incontinence. J Urol2018; 199: 1557. Link, Google Scholar 11 : Neoadjuvant dose dense MVAC versus gemcitabine and cisplatin in patients with cT3-4aN0M0 bladder cancer treated with radical cystectomy. J Urol2018; 199: 1452. Link, Google Scholar © 2018 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 199Issue 6June 2018Page: 1367-1369 Advertisement Copyright & Permissions© 2018 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joseph A. Smith More articles by this author Expand All Advertisement PDF downloadLoading ...

Purified Protein Derivative Skin test prior to bacillus Calmette-Guérin Therapy May have Therapeutic Impact in Patients with Nonmuscle Invasive Bladder Cancer

We investigated the clinical impact of the purified protein derivative skin test prior to bacillus Calmette-Guérin therapy in patients with nonmuscle invasive bladder cancer treated with adjuvant bacillus Calmette-Guérin therapy. A total of 498 patients with nonmuscle invasive bladder cancer treated with adjuvant bacillus Calmette-Guérin were included in study, of whom 320 underwent the purified protein derivative skin test 1 to 2 weeks prior to therapy. Oncologic outcomes and the rate of bacillus Calmette-Guérin related side effects were statistically evaluated. The mean ± SD 5-year recurrence-free survival rate in patients who did vs did not undergo the purified protein derivative skin test was 66.6% ± 2.8% and 59.1% ± 4.1%, respectively, which was significantly different (p = 0.048). No significant difference was observed in the progression-free survival rate between patients who did vs did not undergo the test. Multivariate Cox regression analysis revealed that a history of recurrence (HR 1.59, p = 0.02), multiple tumors (HR 1.95, p <0.01), the bacillus Calmette-Guérin Connaught strain (HR 0.71, p = 0.04), 7 or more bacillus Calmette-Guérin instillations (HR 0.70, p = 0.04) and undergoing the purified protein derivative skin test (HR 0.72, p = 0.04) were independently associated with tumor recurrence. Major bacillus Calmette-Guérin related side effects were noted in 77 of the 320 patients (24.1%) who did vs 27 of the 178 (15.2%) who did not undergo the test, which was significantly different (p = 0.02). The purified protein derivative skin test prior to bacillus Calmette-Guérin treatment enhances the therapeutic effects of this treatment and potentially results in a higher incidence of major bacillus Calmette-Guérin related side effects. Combination therapy with bacillus Calmette-Guérin using the purified protein derivative skin test may improve the oncologic outcomes of that therapy.

P158 - Purified protein derivative skin test reactions are associated with tumor recurrence rate in patients with non-muscle invasive bladder cancer treated with bacillus-Calmette Guérin

P158 - Purified protein derivative skin test reactions are associated with tumor recurrence rate in patients with non-muscle invasive bladder cancer treated with bacillus-Calmette Guérin

Purified protein derivative skin test reactions are associated with clinical outcomes of patients with nonmuscle invasive bladder cancer treated with induction bacillus Calmette-Guérin therapy

ObjectivesTo investigate the relationship between purified protein derivative (PPD) skin test reactions before bacillus Calmette-Guérin (BCG) therapy and the clinical outcomes of BCG-naïve nonmuscle invasive bladder cancer patients treated with adjuvant BCG therapy. Materials and methodsA total of 288 nonmuscle invasive bladder cancer patients subjected to the PPD skin test before BCG therapy were included. PPD skin test reactions were categorized into 3 groups: positive, slightly positive, and negative. The presence of an induration was positive. If an induration was absent, erythema of 10mm or more and less than 10mm corresponded to slightly positive and negative, respectively. ResultsA total of 66 (22.9%), 149 (51.7%), and 73 (25.3%) patients exhibited a positive, slightly positive, and negative to PPD skin test, respectively. The 5-year recurrence-free survival rate of patients with positive PPD skin test reactions was 89.4 ± 4.1%, which was significantly higher than those of patients with slightly positive (65.5 ± 4.2%, P = 0.001) and negative reactions (56.4 ± 6.6%, P<0.001). A multivariate Cox regression analysis revealed that a positive PPD skin test reaction was independently associated with tumor recurrence (hazard ratio of 0.233, P<0.001), but not with stage progression. The incidence of fever persisting for more than 2 days or fever of ≥38°C was significantly higher in patients with a positive PPD skin test reaction (18.2%) than in patients with slightly positive (8.7%) and negative PPD skin test reactions (4.1%). ConclusionsThe PPD skin test reactions before BCG therapy may predict clinical outcomes following BCG therapy and help clinicians counsel patients exhibiting strong therapeutic effects with BCG therapy and potentially major BCG-related side effects.

S.16.02 - Glucocorticoid receptor-dependent signalling in astrocytes as target of opioid action

To investigate the relationship between purified protein derivative (PPD) skin test reactions before bacillus Calmette-Guérin (BCG) therapy and the clinical outcomes of BCG-naïve nonmuscle invasive bladder cancer patients treated with adjuvant BCG therapy.A total of 288 nonmuscle invasive bladder cancer patients subjected to the PPD skin test before BCG therapy were included. PPD skin test reactions were categorized into 3 groups: positive, slightly positive, and negative. The presence of an induration was positive. If an induration was absent, erythema of 10 mm or more and less than 10 mm corresponded to slightly positive and negative, respectively.A total of 66 (22.9%), 149 (51.7%), and 73 (25.3%) patients exhibited a positive, slightly positive, and negative to PPD skin test, respectively. The 5-year recurrence-free survival rate of patients with positive PPD skin test reactions was 89.4 ± 4.1%, which was significantly higher than those of patients with slightly positive (65.5 ± 4.2%, P = 0.001) and negative reactions (56.4 ± 6.6%, P<0.001). A multivariate Cox regression analysis revealed that a positive PPD skin test reaction was independently associated with tumor recurrence (hazard ratio of 0.233, P<0.001), but not with stage progression. The incidence of fever persisting for more than 2 days or fever of ≥38°C was significantly higher in patients with a positive PPD skin test reaction (18.2%) than in patients with slightly positive (8.7%) and negative PPD skin test reactions (4.1%).The PPD skin test reactions before BCG therapy may predict clinical outcomes following BCG therapy and help clinicians counsel patients exhibiting strong therapeutic effects with BCG therapy and potentially major BCG-related side effects.

46-Year-Old Man With Lower Back Pain

46-Year-Old Man With Lower Back Pain

Smear grading and the Mantoux skin test can be used to predict sputum smear conversion in patients suffering from tuberculosis.

Purpose: Smear scores and induration sizes resulting from the PPD (tuberculin purified protein derivative) test can serve as indicators of whether a patient suffering from tuberculosis shows smear conversion or not. Methods: Using microbiological methods smear and sputum tests, patients diagnosed as infected with Mycobacterium tuberculosis between 2002 and 2015 were included in this study. All of the assumed factors that may have a role in smear conversion were studied, in addition to the prolongation of tuberculosis. Results: 398 of 512 patients fulfilled all the inclusion criteria and formed the basis of this study. 215 patients (54%) were females and 183 (46%) were males. The median age for both men and women was 36 years. We found a statistically significant difference between the size of induration resulting from the PPD skin test and the rate of non-conversion (P=0.002). Further univariate analysis also showed that smear grading and an induration size of ≥10 mm were independently associated with delayed smear conversion. Patients with cavitary lesions showed a higher rate of non-conversion after two months, which was not significant. We could not find any association between some of the variables, such as age, sex, weight, smoking, alcoholism, addictions, respiratory diseases, diabetes mellitus, alternative anti-TB treatment, and smear conversion. Conclusion: Intensified treatment and precautions against transmission should be especially considered for TB patients with high smear grading and an induration size of more than 10 mm.