Skip to main content
Log in

Suttons’s Law: Local Immunodiagnosis of Tuberculosis

  • Review
  • Published:
Infection Aims and scope Submit manuscript

Abstract

Recently, important advances have been made in the immunodiagnosis of tuberculosis. New T cell interferon-γ release assays (TIGRA) are more specific and more sensitive than the tuberculin skin test (TST) for the diagnosis of Mycobacterium tuberculosis (MTB) infection. However, like the TST, TIGRA are unable to distinguish between active tuberculosis (TB), latent TB infection (LTBI) and treated TB if performed on blood mononuclear cells alone. In active TB, MTB-specific T cells are actively recruited to the site of infection and can rapidly be identified in extrasanguinous fluids, such as pleural effusions, ascites, cerebrospinal fluid, and in bronchoalveolar lavages. This review summarizes recent findings comparing systemic and local immune responses against MTB. Although bacteriological and histological methods have the highest specificity for TB in terms of diagnosing active TB and the number of TB patients in whom extrapulmonary TIGRAs have been evaluated is still limited, a comparison of local and systemic MTB-specific immune responses is a promising technique to rapidly distinguish active TB from latent MTB infection in routine clinical practice.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Thwaites GE, Tran TH: Tuberculous meningitis: many questions, too few answers. Lancet Neurol 2005; 4: 160–170.

    PubMed  Google Scholar 

  2. Quan C, Lu CZ, Qiao J, Xiao BG, Li X: Comparative evaluation of early diagnosis of tuberculous meningitis by different assays. J Clin Microbiol 2006; 44: 3160–3166.

    Article  PubMed  Google Scholar 

  3. Kalita J, Misra UK, Ranjan P: Predictors of long-term neurological sequelae of tuberculous meningitis: a multivariate analysis. Eur J Neurol 2007; 14: 33–37.

    Article  PubMed  CAS  Google Scholar 

  4. Deisenhammer F, Bartos A, Egg R, Gilhus NE, Giovannoni G, Rauer S, et al. Guidelines on routine cerebrospinal fluid analysis. Report from an EFNS task force. Eur J Neurol 2006; 13: 913–922.

    Article  PubMed  CAS  Google Scholar 

  5. Roos KL: Mycobacterium tuberculosis meningitis and other etiologies of the aseptic meningitis syndrome. Semin Neurol 2000; 20: 329–335.

    Article  PubMed  CAS  Google Scholar 

  6. Gleissner B, Chamberlain MC: Neoplastic meningitis. Lancet Neurol 2006; 5: 443–452.

    Article  PubMed  Google Scholar 

  7. Hooker JA, Muhindi DW, Amayo EO, Mc’ligeyo SO, Bhatt KM, Odhiambo JA: Diagnostic utility of cerebrospinal fluid studies in patients with clinically suspected tuberculous meningitis. Int J Tuberc Lung Dis 2003; 7: 787–796.

    PubMed  CAS  Google Scholar 

  8. Thwaites GE, Chau TT, Farrar JJ: Improving the bacteriological diagnosis of tuberculous meningitis. J Clin Microbiol 2004; 42: 378–379.

    Article  PubMed  Google Scholar 

  9. Dinnes J, Deeks J, Kunst H, Gibson A, Cummins E, Waugh N, et al. A systematic review of rapid diagnostic tests for the detection of tuberculosis infection. Health Technol Assess 2007; 11: 1–196.

    PubMed  CAS  Google Scholar 

  10. Lalvani A, Pathan AA, McShane H, Wilkinson RJ, Latif M, Conlon CP, et al. Rapid detection of Mycobacterium tuberculosis infection by enumeration of antigen-specific T cells. Am J Respir Crit Care Med 2001; 163: 824–828.

    PubMed  CAS  Google Scholar 

  11. Richeldi L: An update on the diagnosis of tuberculosis infection. Am J Respir Crit Care Med 2006; 174: 736–742.

    Article  PubMed  Google Scholar 

  12. Menzies D, Pai M, Comstock G: Meta-analysis: new tests for the diagnosis of latent tuberculosis infection: areas of uncertainty and recommendations for research. Ann Intern Med 2007; 146: 340–354.

    PubMed  Google Scholar 

  13. Wilkinson KA, Wilkinson RJ, Pathan A, Ewer K, Prakash M, Klenerman P, et al. Ex vivo characterization of early secretory antigenic target 6-specific T cells at sites of active disease in pleural tuberculosis. Clin Infect Dis 2005; 40: 184–187.

    Article  PubMed  Google Scholar 

  14. Lange C, Hellmich B, Ernst M, Ehlers S: Rapid immunodiagnosis of tuberculosis in a woman receiving anti-TNF therapy. Nat Clin Pract Rheumatol 2007; 3: 528–534.

    Article  PubMed  CAS  Google Scholar 

  15. Losi M, Bossink A, Codecasa L, Jafari C, Ernst M, Thijsen S, et al: Use of a T-cell interferon-{gamma} release assay for the diagnosis of tuberculous pleurisy. Eur Respir J 2007; 30: 1173–1179.

    Article  PubMed  CAS  Google Scholar 

  16. Jafari C, Ernst M, Kalsdorf B, Greinert U, Diel R, Kirsten D, et al. Rapid diagnosis of smear-negative tuberculosis by bronchoalveolar lavage enzyme-linked immunospot. Am J Respir Crit Care Med 2006; 174: 1048–1054.

    Article  PubMed  Google Scholar 

  17. Simmons CP, Thwaites GE, Quyen NT, Torok E, Hoang DM, Chau TT, et al: Pretreatment intracerebral and peripheral blood immune responses in Vietnamese adults with tuberculous meningitis: diagnostic value and relationship to disease severity and outcome. J Immunol 2006; 176: 2007–2014.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to C. Lange.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jafari, C., Lange, C. Suttons’s Law: Local Immunodiagnosis of Tuberculosis. Infection 36, 510–514 (2008). https://doi.org/10.1007/s15010-008-8089-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s15010-008-8089-9

Keywords

Navigation