Chest
Original ResearchRespiratory InfectionsPerformance of Tests for Latent Tuberculosis in Different Groups of Immunocompromised Patients
Section snippets
Materials and Methods
Study participants were evaluated in three different wards of a single referral center (University Hospital of Modena, Italy) during a 12-month period (May 2006 to May 2007). Any consecutive patient with a clinical indication to be tested for LTBI who provided written informed consent was enrolled in the study. Patients with end-stage chronic liver disease in the liver transplantation candidacy period (the LTC group) were enrolled at the solid organ transplant clinic; individuals with chronic
Results
Three hundred sixty-nine participants were enrolled in the protocol. Fourteen patients (3.8%) were excluded from further analysis because IGRA results (TS.TB, 11 patients; QFT-IT, 3 patients) were deemed invalid due to high negative control values. For 24 patients (6.5%), TST results (LTC group, 6 patients; HM group, 1 patient; HIV group, 17 patients) were not read within the allotted time limit and were thus excluded, leaving 331 subjects for statistical analyses. The mean age was 51.4 years,
Discussion
We report here the results of a comparative evaluation of all currently available diagnostic tests for LTBI in different categories of immunocompromised patients at increased risk of TB reactivation. We obtained at least three important results. First, TST detected fewer positive cases in some, but not all, high-risk groups. Therefore, a differential application of TST and IGRA among immunosuppressed patients might be beneficial. For example, in solid organ transplantation candidates, in whom
Acknowledgments
We thank Robert J. Wilkinson (Imperial College, London, UK), Edward Nardell (Harvard Medical School, Boston), Jean-Pierre Zellweger (Lausanne University, Switzerland), and Andrea Cossarizza (University of Modena and Reggio Emilia, Italy) for their critical appraisal of the manuscript.
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2018, Infectious Disease Clinics of North AmericaCitation Excerpt :Tests for LTBI have been approved for clinical use based on their ability to predict active disease and their correlation with epidemiologic risk factors for TB infection. These immunologic tests for LTBI—namely, TST, enzyme-linked immunosorbent assay, and enzyme-linked immunospot—correlate only fairly to moderately with each other, highlighting flaws in their validity.14–21 MTB IGRAs occasionally yield indeterminate results, most commonly in patients with impaired cellular immunity whose lymphocytes fail to sufficiently respond to the mitogen in the positive control tube.14–21
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This work was supported in part by the Azienda Ospedaliero-Universitaria Policlinico di Modena (Italy). Ms. Latorre is an Formación Profesorado Universitario (FPU) predoctoral student and the recipient of a grant from the Ministerio de Educación y Ciencia (Spain). T-SPOT.TB kits were kindly provided by Oxford Immunotec Ltd. and Nanogen Advanced Diagnostics Italy. Neither company had a role in the design or conduct of the study, collection, management, analysis, or interpretation of the data, preparation, review, or approval of this article.
The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).
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Presently at the University of Perugia, Perugia, Italy.
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Presently at Servei de Microbiologia, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Respiratorias, Instituto de Salud Carlos III, Badalona, Spain.