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Sensitivity of Whole-Blood Interferon-Gamma Release Assay According to the Severity and the Location of Disease in Patients with Active Tuberculosis

활동성 결핵의 중증도 및 병변 부위에 따른 전혈 인터페론 감마 분비능 측정의 민감도

  • Kim, Yi-Young (Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • Lee, Jae-Hee (Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • Lee, Yoon-Jee (Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • Lee, So-Yeon (Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • Lee, Yong-Hun (Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • Choi, Keum-Ju (Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • HwangBo, Yup (Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • Cha, Seung-Ick (Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • Park, Jae-Yong (Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • Jung, Tae-Hoon (Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • Park, Jun-Sik (Department of Otorhinolaryngology, Kyungpook National University School of Medicine) ;
  • Kim, Chang-Ho (Department of Internal Medicine, Kyungpook National University School of Medicine)
  • 김이영 (경북대학교 의과대학 내과학교실) ;
  • 이재희 (경북대학교 의과대학 내과학교실) ;
  • 이윤지 (경북대학교 의과대학 내과학교실) ;
  • 이소연 (경북대학교 의과대학 내과학교실) ;
  • 이용훈 (경북대학교 의과대학 내과학교실) ;
  • 최금주 (경북대학교 의과대학 내과학교실) ;
  • 황보엽 (경북대학교 의과대학 내과학교실) ;
  • 차승익 (경북대학교 의과대학 내과학교실) ;
  • 박재용 (경북대학교 의과대학 내과학교실) ;
  • 정태훈 (경북대학교 의과대학 내과학교실) ;
  • 박준식 (경북대학교 의과대학 이비인후과학교실) ;
  • 김창호 (경북대학교 의과대학 내과학교실)
  • Received : 2010.11.12
  • Accepted : 2010.12.17
  • Published : 2011.02.28

Abstract

Background: The clinical manifestation of $M.$ $tuberculosis$ infection ranges from asymptomatic latent infection, to focal forms with minimal symptoms and low bacterial burdens, and finally to advanced tuberculosis (TB) with severe symptoms and high bacillary loads. We investigated the diagnostic sensitivity of the whole-blood interferon-${\gamma}$ release assay according to the wide spectrum of clinical phenotypes. Methods: In patients diagnosed with active TB that underwent $QuantiFERON^{(R)}$ (QFT) testing, the QFT results were compared with patients known to be infected with pulmonary tuberculosis (P-TB) and extra-pulmonary TB (EP-TB). In addition, the results of the QFT test were further analyzed according to the radiographic extent of disease in patients with P-TB and the location of disease in patients with EP-TB. Results: There were no statistical differences in the overall distribution of QFT results between 177 patients with P-TB and 84 patients with EP-TB; the positive results of QFT test in patients with P-TB and EP-TB were 70.1% and 64.3%, respectively. Among patients with P-TB, patients with mild extents of disease showed higher frequency of positive results of QFT test than that of patients with severe form (75.2% vs. 57.1%, respectively; p=0.043) mainly due to an increase of indeterminate results in severe P-TB. Patients with TB pleurisy showed lower sensitivity by the QFT test than those with tuberculous lymphadenitis (48.8% vs. 78.8%, respectively; p=0.019). Conclusion: Although QFT test showed similar results between overall patients with P-TB and EP-TB, individual sensitivity was different according to the radiographic extent of disease in P-TB and the location of disease in EP-TB.

Keywords

References

  1. Mazurek GH, Jereb J, Vernon A, LoBue P, Goldberg S, Castro K, et al. Updated guidelines for using Interferon Gamma Release Assays to detect Mycobacterium tuberculosis infection - United States, 2010. MMWR Recomm Rep 2010;59:1-25.
  2. Madariaga MG, Jalali Z, Swindells S. Clinical utility of interferon gamma assay in the diagnosis of tuberculosis. J Am Board Fam Med 2007;20:540-7. https://doi.org/10.3122/jabfm.2007.06.070109
  3. Pai M, Zwerling A, Menzies D. Systematic review: T-cell-based assays for the diagnosis of latent tuberculosis infection: an update. Ann Intern Med 2008; 149:177-84. https://doi.org/10.7326/0003-4819-149-3-200808050-00241
  4. Dheda K, van Zyl Smit R, Badri M, Pai M. T-cell interferon- gamma release assays for the rapid immunodiagnosis of tuberculosis: clinical utility in high-burden vs. low-burden settings. Curr Opin Pulm Med 2009;15:188-200. https://doi.org/10.1097/MCP.0b013e32832a0adc
  5. Brodie D, Schluger NW. The diagnosis of tuberculosis. Clin Chest Med 2005;26:247-71, vi. https://doi.org/10.1016/j.ccm.2005.02.012
  6. Burgess LJ, Maritz FJ, Le Roux I, Taljaard JJ. Use of adenosine deaminase as a diagnostic tool for tuberculous pleurisy. Thorax 1995;50:672-4. https://doi.org/10.1136/thx.50.6.672
  7. Kobashi Y, Sugiu T, Mouri K, Obase Y, Miyashita N, Oka M. Indeterminate results of QuantiFERON TB-2G test performed in routine clinical practice. Eur Respir J 2009;33:812-5. https://doi.org/10.1183/09031936.00075008
  8. Kobashi Y, Mouri K, Yagi S, Obase Y, Miyashita N, Oka M. Transitional changes in T-cell responses to Mycobacterium tuberculosis-specific antigens during treatment. J Infect 2009;58:197-204. https://doi.org/10.1016/j.jinf.2008.08.009
  9. Ferrara G, Losi M, D'Amico R, Roversi P, Piro R, Meacci M, et al. Use in routine clinical practice of two commercial blood tests for diagnosis of infection with Mycobacterium tuberculosis: a prospective study. Lancet 2006;367:1328-34. https://doi.org/10.1016/S0140-6736(06)68579-6
  10. Nishimura T, Hasegawa N, Mori M, Takebayashi T, Harada N, Higuchi K, et al. Accuracy of an interferon- gamma release assay to detect active pulmonary and extra-pulmonary tuberculosis. Int J Tuberc Lung Dis 2008;12:269-74.
  11. Munk ME, Arend SM, Brock I, Ottenhoff TH, Andersen P. Use of ESAT-6 and CFP-10 antigens for diagnosis of extrapulmonary tuberculosis. J Infect Dis 2001; 183:175-6. https://doi.org/10.1086/317663
  12. Ravn P, Munk ME, Andersen AB, Lundgren B, Lundgren JD, Nielsen LN, et al. Prospective evaluation of a whole-blood test using Mycobacterium tuberculosis- specific antigens ESAT-6 and CFP-10 for diagnosis of active tuberculosis. Clin Diagn Lab Immunol 2005;12:491-6.
  13. Winqvist N, Bjorkman P, Noren A, Miorner H. Use of a T cell interferon gamma release assay in the investigation for suspected active tuberculosis in a low prevalence area. BMC Infect Dis 2009;9:105. https://doi.org/10.1186/1471-2334-9-105
  14. Dewan PK, Grinsdale J, Kawamura LM. Low sensitivity of a whole-blood interferon-gamma release assay for detection of active tuberculosis. Clin Infect Dis 2007; 44:69-73. https://doi.org/10.1086/509928
  15. Sodhi A, Gong J, Silva C, Qian D, Barnes PF. Clinical correlates of interferon gamma production in patients with tuberculosis. Clin Infect Dis 1997;25:617-20. https://doi.org/10.1086/513769
  16. Pathan AA, Wilkinson KA, Klenerman P, McShane H, Davidson RN, Pasvol G, et al. Direct ex vivo analysis of antigen-specific IFN-gamma-secreting CD4 T cells in Mycobacterium tuberculosis-infected individuals: associations with clinical disease state and effect of treatment. J Immunol 2001;167:5217-25.
  17. Goletti D, Butera O, Bizzoni F, Casetti R, Girardi E, Poccia F. Region of difference 1 antigen-specific CD4+ memory T cells correlate with a favorable outcome of tuberculosis. J Infect Dis 2006;194:984-92. https://doi.org/10.1086/507427
  18. Song KH, Jeon JH, Park WB, Kim SH, Park KU, Kim NJ, et al. Usefulness of the whole-blood interferon- gamma release assay for diagnosis of extrapulmonary tuberculosis. Diagn Microbiol Infect Dis 2009;63: 182-7. https://doi.org/10.1016/j.diagmicrobio.2008.10.013
  19. Lee HM, Cho SG, Kang HK, Park SW, Lee BO, Lee JH, et al. The usefulness of whole-blood interferon-gamma release assay for the diagnosis of extra-pulmonary tuberculosis. Tuberc Respir Dis 2009;67:331-7. https://doi.org/10.4046/trd.2009.67.4.331
  20. Joshi R, Pai M. Can pleural tuberculosis be diagnosed using interferon-gamma release assays? Respiration 2008;76:128-30. https://doi.org/10.1159/000135933
  21. Barnes PF, Lu S, Abrams JS, Wang E, Yamamura M, Modlin RL. Cytokine production at the site of disease in human tuberculosis. Infect Immun 1993;61:3482-9.
  22. Dieli F, Friscia G, Di Sano C, Ivanyi J, Singh M, Spallek R, et al. Sequestration of T lymphocytes to body fluids in tuberculosis: reversal of anergy following chemotherapy. J Infect Dis 1999;180:225-8. https://doi.org/10.1086/314852
  23. Okamoto M, Hasegawa Y, Hara T, Hashimoto N, Imaizumi K, Shimokata K, et al. T-helper type 1/T-helper type 2 balance in malignant pleural effusions compared to tuberculous pleural effusions. Chest 2005;128:4030-5. https://doi.org/10.1378/chest.128.6.4030
  24. Baba K, Sornes S, Hoosen AA, Lekabe JM, Mpe MJ, Langeland N, et al. Evaluation of immune responses in HIV infected patients with pleural tuberculosis by the QuantiFERON TB-Gold interferon-gamma assay. BMC Infect Dis 2008;8:35. https://doi.org/10.1186/1471-2334-8-35
  25. Chegou NN, Walzl G, Bolliger CT, Diacon AH, van den Heuvel MM. Evaluation of adapted whole-blood interferon- gamma release assays for the diagnosis of pleural tuberculosis. Respiration 2008;76:131-8. https://doi.org/10.1159/000128575

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