Latent tuberculosis infection (LTBI) represents a major global health concern as it constitutes the principal reservoir for future tuberculosis (TB) disease. Its identification is particularly important in Bacille Calmette–Guérin (BCG)-vaccinated populations, where cross-reactivity of purified protein derivative limits the specificity of the tuberculin skin test and hampers targeted preventive therapy. Early Mycobacterium tuberculosis antigens encoded within the RD1 region, especially ESAT-6, CFP-10 and TB7.7, have enabled the development of antigen-specific interferon-gamma release assays (IGRAs) and recombinant skin tests with improved BCG-independent specificity. This narrative review integrates and critically appraises current evidence on the immunobiological properties of early and latency-associated antigens, the cellular mechanisms underlying T-cell-dependent immune reactivity, and the diagnostic performance of IGRAs and ESAT-6/CFP-10-based skin tests, rather than merely summarizing individual studies. Although these platforms rely on different assay principles (in vitro cytokine release versus in vivo delayed-type hypersensitivity), both measure antigen-specific T-cell memory and do not define the biological stage of infection or reliably distinguish latent from incipient or active TB. Across most adult populations, IGRAs demonstrate high specificity and acceptable sensitivity, whereas reduced sensitivity and higher rates of indeterminate results are observed in young children and immunocompromised individuals. ESAT-6/CFP-10-based skin tests show diagnostic accuracy comparable to IGRAs and may offer operational advantages in resource-limited settings. Latency-associated antigens and host biomarkers such as IP-10, together with multi-analyte immune signatures, represent promising avenues for improving diagnostic sensitivity and prognostic stratification but currently lack sufficient validation for routine clinical use. Overall, RD1-encoded antigens remain central to LTBI immunodiagnosis, while future research should focus on developing stage-resolving and prognostic biomarkers, optimized antigen panels, and standardized interpretive frameworks.

The interferon-gamma release assays (IGRAs) are characterized by their complexity and reliance on specific instrumentation. The recombinant Mycobacterium tuberculosis (MTB) fusion protein skin test (C-TST) utilizes the same MTB fusion protein as IGRAs. If the C-TST demonstrates consistent results and greater cost-effectiveness, it could potentially replace IGRAs and be used alongside the tuberculin skin test (TST) for the screening of latent tuberculosis infection (LTBI). This study aims to assess whether the TST/C-TST screening strategy offers superior diagnostic efficacy and cost-effectiveness compared to the conventional TST/IGRAs strategy, thereby evaluating the potential application of the combined C-TST and TST approach for LTBI screening. The study population consisted of young males, aged 18 to 40 years, who attended the outpatient clinic of a hospital in 2023. These participants underwent TST and C-TST, followed by IGRAs between October and December 2023. The sensitivity, specificity, and reliability of the screening results were assessed. Furthermore, a hybrid decision tree and Markov model were utilized to evaluate the costs and health outcomes associated with five active screening strategies-TST, C-TST, IGRAs, TST combined with C-TST, and TST combined with IGRAs-from a societal perspective over a 20-year period. In this study, valid results were obtained from 1412 participants: 202 individuals completed three tests, while 1210 completed two tests. The sensitivity for the TST, the C-TST, and IGRA (QFT-GIT) was 92.7%, 52.9%, and 58.8%, respectively, with corresponding specificities of 56.0%, 83.6%, and 83.6%. Notably, the C-TST and IGRA (QFT-GIT) exhibited high concordance, as indicated by a Kappa value of 0.869. However, through a simulation-based analysis of this single-center cohort, which consisted exclusively of male participants and included a small subgroup subjected to all three tests, and under predefined model assumptions, the combination of TST and C-TST emerged as a more effective screening strategy. This combination achieved an AUC of 0.821, achieved the optimal balance between accuracy and cost-effectiveness. Within the context of this study, the novel screening strategy that integrates TST and C-TST demonstrates promising efficacy and economic advantages when compared to the traditional TST/IGRAs approach for the detection of LTBI.

Asthma is a prevalent chronic inflammatory disease in childhood, associated with high morbidity and impact on quality of life. The clinical variability of symptoms can make diagnosis difficult, making a detailed analysis of the clinical profile essential for proper management. The clinical and epidemiological profile of children diagnosed with asthma who were followed in an immunoallergology outpatient clinic of a university hospital was obtained. This was an observational, retrospective, and descriptive study, conducted through the analysis of 30 medical records of pediatric patients diagnosed with asthma. Demographic variables, initial symptoms, allergic comorbidities, family history, hospitalizations, laboratory tests (total and specific IgE, immediate reading skin test), spirometry, and instituted treatment were evaluated. The data was organized in spreadsheets and analyzed using descriptive statistics. The average age of the patients was 7.6 years, with a predominance of illnesses. The most frequent symptoms were recurrent dry cough, wheezing, and exertional dyspnea, with functional impact such as school absenteeism. A family history of allergic diseases was present in 76.6% of cases. A high prevalence of allergic comorbidities was observed, suggesting atopic march. Patients with positive allergy tests showed greater clinical severity and a higher number of hospitalizations. Spirometry revealed mild to moderate obstructive ventilatory disorder in part of the sample. Treatment with inhaled corticosteroids showed good clinical response and satisfactory adherence. The findings demonstrate the predominance of asthma with an allergic component, highlighting the importance of specialized follow-up, environmental control, and appropriate treatment for disease management and quality of life improvement.

Translated article] Evaluation of penicillin allergy labeling in the emergency department: Retrospective study on the impact of a hospital pharmacist-led intervention algorithm.

MOFs-on-MOFs modified wearable electrochemical microneedle array for uric acid detection.

<sec><title>BACKGROUND</title>Transmission of Mycobacterium tuberculosis often occurs in the community before diagnosis of TB is made. To measure the force of infection in an African city with endemic TB, we conducted a prospective cohort study of adults in Kampala, Uganda, to estimate the incidence of M. tuberculosis infection.</sec><sec><title>METHODS</title>Consenting volunteers with both a negative interferon-γ release assay (IGRA) and a negative tuberculin skin test were enrolled and followed for 18 months with quarterly IGRAs. New M. tuberculosis infection was defined as IGRA conversion and further classified by sustained positive assays after conversion.</sec><sec><title>RESULTS</title>In 998 eligible adults, the median age was 26 years, 61% were women, 62% had received bacille Calmette-Guérin vaccination, 12% were HIV-infected, and 25% drank alcohol. The overall annual risk of M. tuberculosis infection was 3.3%. Older age, male sex, and drinking alcohol outside the home were associated with an increased risk of incident M. tuberculosis infection (rate ratio: 3.7).</sec><sec><title>CONCLUSION</title>This prospective cohort study found a high rate of annual TB infection in an African city with endemic TB, especially among older men who drank alcohol outside the home. Screening for M. tuberculosis among men in the community could lead to novel case-finding interventions.</sec>.

BACKGROUNDScreening for latent tuberculosis (LTB) before initiating advanced therapy for inflammatory bowel disease (IBD) helps reduce the risk of tuberculosis (TB) development. However, there is limited data on screening practices from TB-endemic regions.AIMTo study the practices of screening for LTB and study the incidence of TB in patients with IBD on biological and small molecule inhibitors.METHODSThis retrospective multicentre study analyzed LTB screening practices in IBD patients starting advanced therapies between 2018 and 2022. We included patients who were initiated on biologics (infliximab, adalimumab, vedolizumab) or small molecule inhibitors (tofacitinib). We assessed compliance with LTB screening methods, including the tuberculin skin test, interferon-gamma release assay (IGRA), chest X-ray, and computed tomography chest, both at initiation and annually. We also evaluated the incidence of active TB and its predictors.RESULTSOf 378 patients (mean age: 36.9 ± 14.9 years, males: 56.9%), 158 (41.8%) and 216 (57.1%) had ulcerative colitis and Crohn’s disease, respectively. Advanced therapy used were anti-tumor necrosis factor in 309 (81.74%), tofacitinib in 41 (10.84%) and vedolizumab in 28 (7.40%). Standard screening and diligent screening strategy was employed in 59% and 33% of patients, respectively. Compliance with tuberculin skin test and IGRA was noted in 261 (69.04%) and 298 (78.83%) patients, respectively. Chest X-Ray and computed tomography chest were performed in 300 (79.36%) and 242 (64.02%), respectively. Annual screening in those on advanced therapy for > 1 year was performed in 27.2% (50/184). Active TB developed in 17 (4.49%); 15 (88.23%) were on anti-tumor necrosis factor. LTB was detected in 40 (10.72%), with most diagnosed on the basis of IGRA (21/40, 52.50%). Among 17 patients who developed active TB, LTB screen was negative in 12 (70.58%).CONCLUSIONStandard screening practices for LTB, prior to starting advanced therapy, remain suboptimal (< 60%) in India despite high TB endemicity.

Background Evidence on the accuracy and safety of the ESAT-6/CFP-10–based Diaskintest ® in BCG-vaccinated populations outside Eastern Europe remains limited. In Brazil, recurrent shortages of purified protein derivative (PPD) have challenged the implementation of tuberculin skin testing, underscoring the need to evaluate alternative tools for tuberculosis infection (TBI) screening. This trial compared the diagnostic performance and safety of Diaskintest ® with the tuberculin skin test (TST) using PPD Rt-23 in Brazilian adults, a predominantly BCG-vaccinated population. Method A double-blind randomized clinical trial was conducted at eight centers in Brazil between July 2023 and September 2024. Participants were allocated to the TB group (microbiologically confirmed pulmonary TB), in whom sensitivity was estimated, and the control group (healthy, unexposed adults), in whom specificity was estimated using the QuantiFERON-TB Plus ® (QFT-Plus) as the reference standard. All participants first underwent QFT-Plus testing, followed by intradermal application of Diaskintest ® and TST in opposite arms, with randomized right–left allocation. Induration was measured at 48–96 h using a prespecified 5 mm cutoff. Secondary outcomes included safety, assessed through active monitoring of adverse events (AEs), included injection site reactions. Results A total of 337 controls and 136 TB participants were enrolled. TST showed higher sensitivity than both Diaskintest and QFT-plus (0.84 [95% CI 0.76–0.90] vs. 0.68 [95% CI 0.59–0.76], and 0.63 [95% CI 0.54–0.72], respectively). Diaskintest ® demonstrated higher specificity than TST (0.93 [95% CI 0.90–0.96] vs. 0.75 [95% CI 0.70–0.80]). Injection-site reactions occurred less frequently with Diaskintest ® than with TST (1.7% vs. 4.9%. RR = 0.35 [0.15–0.79]). The most common reactions were phlyctenular reactions and itching. No serious AEs were observed. Conclusion TST had greater sensitivity than Diaskintest ® , whereas Diaskintest ® demonstrated higher specificity and fewer local adverse reactions. In this study, specificity was estimated using QFT-Plus as a surrogate reference standard, acknowledging the absence of a true gold standard for tuberculosis infection. These complementary performance profiles highlight a trade-off between false-positive reduction and case detection, suggesting that the choice of test should consider programmatic priorities and local epidemiological context. Clinical trial registration https://ensaiosclinicos.gov.br/ , identifier RBR-7tn2ysw.

Tumor necrosis factor-alpha (TNF-α) inhibitors, particularly adalimumab (ADA), are widely used for ocular inflammatory diseases but may increase the risk of tuberculosis reactivation. Data on latent tuberculosis infection (LTBI) screening and outcomes are limited. This study aimed to describe LTBI screening outcomes in ADA-treated uveitis and identify patterns of missed cases. A total of 188 patients evaluated for ADA eligibility between December 2021 and April 2025 were retrospectively analyzed. LTBI screening included medical history, tuberculin skin test (TST), interferon-gamma release assay (IGRA), or both. Isoniazid prophylaxis was given when indicated, and tuberculosis occurrence during ADA was assessed. Among 188 patients (mean age 40.3 ± 14.2 years), Behçet's uveitis (39.7%) and sarcoidosis (23.9%) were the most common. TST alone was used in 60.2%, IGRA in 13.4%, and both in 26.3% among those with baseline testing. TST and IGRA results were significantly associated (p = 0.001). INH prophylaxis rates varied by screening method (p = 0.003). Tuberculosis occurred in 1.6% (n = 3), including two despite prophylaxis. LTBI screening and prophylaxis reduce but do not eliminate TB risk under ADA. Combined TST/IGRA and periodic re-evaluation may reduce missed cases in BCG-vaccinated populations.

T cells contribute to immune protection and pathogenesis in tuberculosis, but measurements of polyclonal responses have failed to resolve correlates of outcome. We report the temporal evaluation of the human in vivo clonal repertoire of Mycobacterium tuberculosis (Mtb)-reactive T cell responses, by T cell receptor (TCR) sequencing at the site of the tuberculin skin test, as a model for a standardised antigenic challenge. Initial non-selective recruitment of T cells is followed by enrichment of Mtb-reactive clones arising from oligoclonal T cell proliferation. We introduce a modular computational pipeline, Metaclonotypist, to sensitively cluster distinct TCRs with shared epitope specificity, which we apply here to establish a catalogue of public Mtb-reactive HLA-restricted T cell metaclones. Although most in vivo Mtb-reactive T cells are private, 10 metaclones were sufficient to identify Mtb-T cell reactivity across our study population (N≥128), indicating striking population level immunodominance of specific TCR-peptide interactions that may inform patient stratification and vaccine development.

Tuberculosis (TB) infection control is a combination of measures aimed at minimizing the risk of transmission within a population. It is well established that health care workers (HCWs) have a considerably higher risk of occupationally acquired tuberculosis (TB). To reduce the transmission of TB to HCWs and patients, TB infection control programs should be implemented in health care settings. The first and most important level of all protection and control programs is administrative control. Its goals are to prevent HCWs, other staff, and patients from being exposed to TB, and to reduce the transmission of infection by ensuring rapid diagnosis and treatment of affected individuals. Administrative control measures recommended by the United States Centers for Disease Control and Prevention and the World Health Organization include prompt identification of people with TB symptoms, isolation of infectious patients, control of the spread of the pathogen, and minimization of time spent in health care facilities. Another key component of measures undertaken is the baseline and serial screening for latent TB infection in HCWs who are at risk of exposure to TB. Although the interferon-gamma release assay has some advantages over the tuberculin skin test, the former has serious limitations, mostly due to its high conversion rate. Objectives: To develop and administer structured teaching programme regarding management and prevention of tuberculosis in health care personnel among B.Sc. Nursing 2nd year student in selected Nursing college of Bhilai (C.G.). To assess the pre-test and post-test knowledge regarding management and prevention of tuberculosis in health care personnel among B.Sc. Nursing 2nd year student in selected Nursing college of Bhilai (C.G). To assess the effectiveness of structured teaching programme on post-test knowledge regarding management and prevention of tuberculosis in health care personnel among B.Sc. Nursing 2nd year students. To find association between pre-test knowledge regarding management and prevention of tuberculosis in health care personnel and selected socio demographic variables. Material and Methods: The research approach used was an experimental approach, and the research design of the study was pre-experimental one group pre-test, post-test research design. The non-probability convenient sampling techniques was used to select 60 nursing students from P.G. College of Nursing Bhilai, Durg (C.G). The variables under the study are independent and dependent variables. Independent variables is structured teaching programme regarding Management and prevention of TB in health care personnel and dependent variables is knowledge of nursing student regarding Management and prevention of TB. A self-structured questionnaire was prepared to assess knowledge regarding Management and prevention of TB in health care personnel. Reliability of the tool was 0.98. The data obtained were analyzed and interpreted in terms of objective and hypothesis. Descriptive and inferential statistics were used for data analysis, the level of highly significance was at 0.001. Results: major findings of these studies are out of 60 sample, in relation over all Analysis related to pre-test and post-test knowledge score regarding management and prevention of tuberculosis in health care personnel among B.Sc. Nursing 2nd year student. In post-test, majority of subjects 36 (60%) had excellent knowledge, 24 (40%) had good knowledge, and none of subjects had average poor knowledge.

With the growing use of immunosuppressive therapies, clinicians are increasingly faced with the question of how to manage positive interferon-gamma release assays (IGRA). Atuberculosis infection (TBI, formerly referred to as "latent tuberculosis") is clinically silent and non-contagious but can reactivate as active tuberculosis under immunosuppressive conditions. Diagnosis involves either an IGRA or atuberculin skin test (TST), alongside microbiological and imaging studies to exclude active disease. Screening is recommended for individuals at increased risk, including those living with human immunodeficiency virus (HIV), those in close contact with tuberculosis patients, and those scheduled to receive certain immunosuppressive treatments, as well as individuals undergoing transplantation or dialysis, or those suffering from silicosis. Preventive therapy with tuberculostatic medication markedly reduces the risk of reactivation and should ideally be initiated at least 4weeks before starting immunosuppressive therapy.

All strategies on the pathway to tuberculosis (TB) elimination prioritise, among other measures, addressing tuberculosis infection (TBI), particularly the identification of individuals and population groups who should be candidates for tuberculosis preventive treatment (TPT). In Spain, a TBI test is required before recommending TPT. An interferon-gamma release assay (IGRA) is preferred over the tuberculin skin test (TST), although the latter may be used in settings where IGRAs are not available or when deemed necessary to increase diagnostic sensitivity. On the other hand, new skin tests employing specific antigens (TBST) may play a key role. As a general principle, screening for TBI should include all individuals at high risk for progressing from TBI to TB, as described in this guideline, prioritising pulmonary TB contacts, people living with HIV, immunocompromised individuals and those in other situations associated with an elevated risk of developing TB. Once TBI has been diagnosed in these high-risk groups, the algorithm set out in this guideline should be applied to rule out TB disease. Once TB has been excluded, TPT should be recommended. The preferred regimen is daily isoniazid (H) plus rifampicin (R) for 3 months (3HR). However, once rifapentine becomes available in Spain, both the 1-month daily (1HP) and the 3-month weekly (3HP) regimens combining H and rifapentine (P) may also be used. Finally, measures must be taken to ensure adherence to TPT and to monitor and manage potential drug-related adverse effects.

Introduction: Tuberculosis (TB) remains a major global health problem affecting both adults and children, particularly in TB-endemic countries. Children are vulnerable to TB infection, especially those with malnutrition, which significantly impairs immune function and increases disease severity, mortality, and diagnostic challenges. Malnutrition may obscure typical clinical manifestations and reduce the sensitivity of standard diagnostic tests, leading to delayed diagnosis and treatment. Case description: a four-year-old girl with severe wasting, multiple cervical lymphadenopathy, hypoalbuminemia, and severe dehydration. The patient had a history of incomplete immunization and close contact with a TB case. Initial investigations revealed a negative tuberculin skin test and chest radiography suggestive of bilateral bronchopneumonia. Despite intravenous ceftriaxone and supportive therapy, no clinical improvement was observed. Further evaluation using a rapid molecular test from a gastric aspirate confirmed TB. Discussion: Severe malnutrition likely contributed to immune anergy, resulting in false-negative initial diagnostic findings and delayed TB diagnosis. This case highlights the limitations of conventional diagnostic methods in malnourished children and underscores the importance of molecular testing in high-risk pediatric patients. Conclusion: TB and malnutrition have a bidirectional relationship that worsens clinical outcomes. Early TB screening in malnourished children and routine nutritional assessment in TB patients are essential to improve diagnosis, treatment outcomes, and survival.

Chronic spontaneous urticaria (CSU) is a clinically heterogeneous, mast cell–driven inflammatory disease in which disease expression, treatment response, and resistance are determined by distinct but overlapping immunopathogenic mechanisms. Growing evidence supports the existence of two principal molecular endotypes: type I (autoallergic) CSU, mediated by autoreactive IgE antibodies against self-antigens such as thyroid peroxidase and interleukin-24, and type IIb (autoimmune) CSU, characterized by IgG (and less frequently IgA or IgM) autoantibodies directed against IgE or its high-affinity receptor FcεRI. These endotypes differ substantially in biomarker profiles, clinical severity, and therapeutic responsiveness. Patients with type I CSU typically exhibit elevated total IgE levels, allergic comorbidities, and rapid, robust responses to omalizumab, whereas those with type IIb CSU more often present with low IgE, positive autologous serum skin test or basophil activation assays, thyroid autoantibodies, eosinopenia, basopenia, and delayed or insufficient responses to anti-IgE therapy. Importantly, accumulating data indicate that strict dichotomous classification is insufficient, as many patients display concurrent IgE- and IgG-mediated autoreactivity, supporting the concept of an immunological continuum summarized under the broader framework of “autoreactivity.” Beyond immunoglobulin-driven mechanisms, eosinophils, basophils, complement activation, and coagulation pathways critically contribute to disease amplification and treatment refractoriness. Biomarkers such as total IgE, anti-thyroid antibodies, eosinophil and basophil counts, C-reactive protein, and functional assays including ASST and BAT enable pragmatic endotype stratification and prediction of therapeutic outcomes. Integrating molecular endotypes with clinical phenotypes provides a rational basis for personalized management, allowing earlier identification of likely non-responders, optimization of omalizumab dosing, and timely consideration of alternative or emerging targeted therapies. This evolving endotype-guided approach represents a key step toward precision medicine in CSU.

Head and neck cancer (HNC) has a high recurrence rate. Safety and effectiveness of PepCan in reducing recurrence for HNC patients were assessed. PepCan consists of four human papillomavirus 16 (HPV 16) E6 peptides and a Candida skin testing reagent (Candin®, Nielsen Biosciences) as a vaccine adjuvant. Since Candida was known to have a general immune stimulating effects, patients were recruited regardless of their HPV status. Men and women with HNC who had no evidence of disease after standard surgery, chemotherapy, and/or radiation treatments were enrolled. They were randomized at 3:1 to PepCan versus placebo. Seven intradermal injections of PepCan or placebo (saline) were given every 3 weeks (first 4 injections) or 3 months (last 3 injections). They were followed with two visits 6 months apart. Safety was assessed using Common Terminology Criteria for Adverse Events version 5, and efficacy was assessed based on not having recurrence within 2 years. In addition, immune responses were examined using enzyme-linked immunospot assay for HPV 16 E6 response, fluorescent-activated cell sorter analysis for peripheral immune cells, and T cell repertoire analysis. Peripheral cytokines and gut and oral microbiome were also analyzed. Seventeen patients were enrolled. The most common adverse events were grades 1 and 2 injection site reactions, and they occurred more frequently in the PepCan group ( p <0.0001). Two patients had allergic reactions (grade 2 and grade 3), at the 6th vaccination, which were considered to be a dose-limiting toxicity (DLT). No serious adverse events were reported. In the intention-to-treat analysis (ITT), 45% (5/11) had non-recurrence in the PepCan group while 80% (4/5) had non-recurrence in the placebo group. For the per-protocol (PP) analysis, non-recurrence was 56% (5/9) for PepCan and 80% (4/5) for placebo. These differences were not statistically significant. Those who received PepCan and experienced non-recurrence had higher new T cell immune responses to HPV 16 E6 ( p =0.05 for ITT and p =0.02 for PP). Pre-vaccination T helper type 1 cells were higher in the PepCan non-recurrence group compared to the PepCan recurrence group ( p =0.01 for ITT and PP). PepCan is safe although DLT can occur after multiple injections of PepCan. PepCan does not seem to be effective in reducing recurrence; however, the results are inconclusive given the small patient numbers. What is already known on this topic Head and neck cancer (HNC) has a high recurrence rate after reaching no evidence of disease status after standard therapies including chemotherapy, radiation, immunotherapy and survey. However, no intervention is available to reduce recurrence. What this study adds A therapeutic human papillomavirus vaccine called PepCan was tested in a clinical trial and has been shown to be safe. How this study might affect research, practice or policy If a sufficiently powered study demonstrates efficacy in reducing recurrence rate, then how HNC patients are treated after achieving the no evidence of disease status will change.

BackgroundThe blood monocyte-to-lymphocyte ratio (MLR) is associated with active tuberculosis (TB) in adults, but has not been evaluated as a TB diagnostic biomarker in HIV-infected children in whom respiratory sampling is difficult. Clinical paediatric tuberculosis (TB) diagnosis may lead to overdiagnosis particularly among children with human immunodeficiency virus (CHIV). Interferon-gamma release assay and tuberculin skin test use is limited by cost and cross-reactivity with non-tuberculous mycobacteria and Bacille Calmette-Guerin (BCG) vaccination respectively. We assessed the performance of monocyte-lymphocyte ratio (MLR) as a diagnostic biomarker to improve specificity of TB diagnosis in PLHIV with limited access to microbiologic testing.MethodsWe collected data from PubMed, Embase and the Google Scholar. Diagnostic test accuracy studies using MLR to diagnose TB in PLHIV were included. QUADAS tool was used for quality assessment of the included studies.ResultsWe screened 4526 publications and included four studies with 3078 participants (adults:2317 and children:761) (age range, children: 0.9 to 6.2 years; mean age range, adult one study mean age 24.5, the other had majority of patients with more than 45 years). All included studies had a high risk of bias. MLR was significantly higher in the HIV patients with TB than those without TB. The cut-off for identification of tuberculosis in PLWHIV among the studies ranged from 0.35 to 0.378. The sensitivity ranged from 12.8 % to 77%, and specificity ranged from 78% to 91.6%. In the study y Naranbhai et al, after adjustment for sex, World Health Organization HIV disease stage, CD4+ T-cell counts, and previous history of tuberculosis, hazards of disease were significantly higher for patients with ML ratios of less than the 5th percentile or greater than the 95th percentile (adjusted hazard ratio, 2.47; 95% CI, 1.39–4.40; P = .002). After, TB treatment, median MLR declined in children with confirmed TB by Choudhary et al.ConclusionThe MLR ratio may be a useful, readily available tool to stratify the risk of tuberculosis in PLHIV and further to assess the response to anti-tubercular therapy.DisclosuresAll Authors: No reported disclosures

Mas-related G protein-coupled receptor X2 (MRGPRX2) has emerged as a mediator of mast-cell activation in acute and chronic conditions. Exogenous ligands, such as neuromuscular blocking agents (NMBAs) and fluoroquinolones (FQs), can trigger MRGPRX2-dependent activation and may augment immunoglobulin E (IgE)-mediated pathways. Although investigators have measured serum MRGPRX2 in asthma, mastocytosis, and chronic urticaria, its role in immediate hypersensitivity reactions (IHRs) to FQs or NMBAs remains unclear. We conducted this study to determine whether increased serum MRGPRX2 concentration is a risk factor for IHRs to NMBAs or FQs and whether concentration relate to reaction severity, causative agent, or serum tryptase. We studied 43 patients with a history of IHRs to NMBAs or FQs and compared them with 50 patients with IHRs to Hymenoptera venom and 40 control individuals. Participants underwent a diagnostic evaluation that included skin testing, specific IgE measurement, and basophil activation test when indicated. We measured serum MRGPRX2 by enzyme-linked immunosorbent assay. The median serum MRGPRX2 values with interquartile ranges for the drug-induced reactions group, the Hymenoptera venom-induced reactions group, and the control group were 7.50 (3.73-15.64), 7.00 (3.96-10.62), and 5.89 (2.43-9.98) ng/mL, respectively (P = 0.32). Serum MRGPRX2 concentration showed no relationship with reaction severity, specific causative agents, or serum tryptase. In this cohort, serum MRGPRX2 was not a risk factor for the investigated drug- and venom-induced IHRs. These findings do not support using serum MRGPRX2 as a predictor of reaction occurrence or severity in these settings.

Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis and remains a global health problem, particularly in developing countries. One form of extrapulmonary TB is cutaneous tuberculosis, with the most common variant being tuberculosis verrucosa cutis (TBVC). Tuberculosis cutis verrucosa represents an exogenous reinfection in individuals who have been previously sensitized to the tubercle bacilli, and it typically presents as a chronic verrucous plaque that slowly evolves with centrifugal expansion. The diagnosis of TBVC is established through a multimodal approach, including history taking, physical examination, histopathological findings of tuberculoid granulomas, tuberculin skin test, interferon-gamma release assay (IGRA), polymerase chain reaction (PCR), and culture. Ziehl–Neelsen staining and culture often yield negative results due to the paucibacillary nature of the lesion; therefore, correlation between clinical features and supporting examinations remains essential for diagnostic confirmation. With a comprehensive clinical and diagnostic approach, the management of TBVC can be carried out more effectively.

Background: An Hymenoptera venom allergy diagnosis requires sting-triggered systemic reaction symptoms and evidence of venom-specific immunoglobulin E (IgE) through skin or serologic testing. A lack of concordance between skin and serologic testing has been reported previously; using these tests in a complementary fashion has been emphasized in published guidelines. Objective: We assessed skin and serologic venom-specific IgE testing discordance and factors that impact the testing. Methods: A retrospective review of patients with allergist-diagnosed winged Hymenoptera venom allergy prescribed venom immunotherapy at one center from 2005 to 2023 was completed. Record review included demographics, Mueller grading reaction severity, and venom testing results. Patients were included if they had both skin and serologic testing results. Results: A total of 125 records were reviewed, with 33 meeting inclusion criteria. Patients were 7-69 years old, 55% female, and Mueller grade 2 and above reactions occurred in 94%. Kappa coefficients for both tests for individual winged Hymenoptera were all <0.35. Discordance occurred 37% of the time overall; no venom was found to be more or less discordant than the others. Skin testing results were found to be positive more frequently than were serologic testing results overall (p = 0.0126), in male individuals (p = 0.007), when the initial sting was at >18 years old (p = 0.016), when testing was completed at >30 years old (p = 0.006), and when there were >5 years between the initial sting and testing (p = 0.007). Conclusion: Skin and serologic testing for winged Hymenoptera are frequently discordant, and both should be tested to confirm or refute negative results. In certain populations, skin testing should be completed first.