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Eur Respir J 2007, doi:10.1183/09031936.00002607
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ORIGINAL ARTICLE |
Molecular evidence for the role of mycobacteria in sarcoidosis: a meta-analysis
1 Dept of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
* To whom correspondence should be addressed. E-mail: dheeraj{at}indiachest.org.
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Abstract |
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The etiology of sarcoidosis remains unknown. Because of the clinical and histological similarities with tuberculosis, the role of mycobacteria has been repeatedly investigated as etiologic agent for sarcoidosis. This meta-analysis is aimed at evaluating the available molecular evidence on the possible role of mycobacteria in causation of sarcoidosis.
We searched the MEDLINE, EMBASE, CINAHL, DARE, CENTRAL databases for relevant studies published from 1980 to 2006, and included studies that have evaluated the presence of mycobacteria using molecular techniques in biological samples of patients with sarcoidosis. We then calculated the 95% confidence intervals (CI) for the expected proportion (of individual studies) and pooled the data to get a summary success rate with 95% CI. We also calculated the odds ratio (OR) and 95% CI to assess the presence of mycobacteria in samples of patients with sarcoidosis versus those from non-sarcoidosis control samples.
Our search yielded 31 studies. All studies had used polymerase chain reaction (PCR) for nucleic acid amplification followed by identification of nucleic acid sequences specific for different types of mycobacteria. Overall, 231 out of the 874 patients were positive for mycobacteria with a positive signal rate of 26.4% (95% CI, 23.6-29.5), and the odds of finding mycobacteria in samples of patients with sarcoidosis versus controls were 9.67 (95% CI, 4.56-20.5) using the random effects model and 19.49 (95% CI, 11.21-35.54) using the exact method. There was methodological and statistical heterogeneity (Cochran Q statistic 30.31, P=0.034; I2 40.6%; 95% CI, 8.2% to 73.1%; chi-square statistic 35.02, P <0.0001) and evidence of publication bias.
The results of this study show that there is a demonstrable mycobacterial presence in sarcoidosis lesions suggesting an association between mycobacteria and some cases of sarcoidosis. To avoid methodological diversity, larger multicenter trials with a central laboratory for testing of the samples should be designed.
Keywords: Mycobacteria, polymerase chain reaction, sarcoidosis, tuberculosis
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