• Tuberculosis and Respiratory Diseases
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• 제81권1호
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• pp.59-72
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• 2018

Background: It remains uncertain if $interferon-{\gamma}$ release assays (IGRAs) are superior to the tuberculin skin test (TST) for the diagnosis of active tuberculosis (TB) or latent tuberculosis infection (LTBI) in immunosuppressed populations including people with human immunodeficiency virus (HIV) infection. The purpose of this study was to systematically review the performance of IGRAs and the TST in people with HIV with active TB or LTBI in low and high prevalence TB countries. Methods: We searched the MEDLINE database from 1966 through to January 2017 for studies that compared results of the TST with either the commercial QuantiFERON-TB Gold in Tube (QFTGT) assay or previous assay versions, the T-SPOT.TB assay or in-house IGRAs. Data were summarized by TB prevalence. Tests for concordance and differences in proportions were undertaken as appropriate. The variation in study methodology was appraised. Results: Thirty-two studies including 4,856 HIV subjects met the search criteria. Fourteen studies compared the tests in subjects with LTBI in low TB prevalence settings. The QFTGT had a similar rate of reactivity to the TST, although the first-generation version of that assay was reactive more commonly. IGRAs were more frequently positive than the TST in HIV infected subjects with active TB. There was considerable study methodology and population heterogeneity, and generally low concordance between tests. Both the TST and IGRAs were affected by CD4 T-cell immunodeficiency. Conclusion: Our review of comparative data does not provide robust evidence to support the assertion that the IGRAs are superior to the TST when used in HIV infected subjects to diagnose either active TB or LTBI.

• Journal of Korean Medical Science
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• 제33권47호
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• pp.292.1-292.10
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• 2018

Background: We investigated the incidence of active tuberculosis among patients with inflammatory bowel disease (IBD) treated with tumor necrosis factor (TNF) inhibitors, with or without latent tuberculosis infection (LTBI). Methods: The study was performed at a Korean tertiary referral center between January 2011 and June 2017. In total, 740 patients with IBD who underwent LTBI screening tests and were followed-up for ${\geq}1$ year after TNF inhibitor treatment initiation were enrolled. LTBI was detected on the basis of tuberculin skin test results, interferon-gamma release assay results, chest X-ray findings, and previous tuberculosis treatment history. The patients were classified into LTBI (n = 84) or non-LTBI (n = 656) group. The risk of developing tuberculosis in each group was assessed on the basis of standardized incidence ratio (SIR) and 95% confidence interval (CI) for active tuberculosis. Results: Mean patient age was 33.1 years, and patients with Crohn's disease were predominant (80.7%). Within 1 year after the initiation of TNF inhibitor treatment, 1 patient in the LTBI group (1/84; 1.2%) and 7 patients in the non-LTBI group (7/656; 1.1%) developed active tuberculosis. The overall 1-year incidence of tuberculosis among the patients was significantly higher than that among the general population (SIR, 14.0; 95% CI, 7.0-28.0), and SIR was not affected by LTBI status (LTBI group: 14.5, 95% CI, 2.0-102.6; non-LTBI group: 14.0, 95% CI, 6.7-29.4). Conclusion: Patients with IBD undergoing TNF inhibitor treatment showed a higher 1-year incidence of tuberculosis than the general population irrespective of LTBI status.

• Tuberculosis and Respiratory Diseases
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• 제72권5호
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• pp.416-425
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• 2012

Background: The sensitivities and specificities of interferon-gamma release assays (IGRAs) vary among different population studies, and the data on the routine use of IGRAs are limited. The aim of this study was to evaluate the role of QuantiFERON-TB Gold In-Tube (QFT-GIT) test in the diagnosis of active tuberculosis. Methods: We conducted a prospective study, enrolling 77 patients with suspected pulmonary tuberculosis (TB), at a secondary care teaching hospital in Seoul. Results: In total, 12 (15.6%) patients showed indeterminate results due to positive control failure on the QFT-GIT test. Indeterminate results were significantly associated with the elderly, history of the intensive care unit stay, lymphocytopenia, especially low CD4 count, increased C-reactive protein and decreased protein levels. Of the 77 patients, 44 (57.1%) were diagnosed with active pulmonary tuberculosis, and the percentage of false negative results of the QFT-GIT was 36.4% (vs. 31.8% with TST). In the TB group with >65 years old (n=12), the proportions of the indeterminate (33.3% vs. 3.1%) and the false negative results (58.3% vs. 25.0%) of the QFT-GIT were significantly higher than in the younger TB group (n=32). Conclusion: Indeterminate and false negative results of QFT-GIT test were not infrequent in tuberculosis, especially in the elderly. Care should be considered for the interpretation with the elderly, immunocompromised, chronic and severely diseased patients.

• 한국산업보건학회지
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• 제29권4호
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• pp.582-589
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• 2019

Objectives: Although active pulmonary tuberculosis(active PTB) is manifested as one of the complications of pneumoconiosis, attacks of active PTB among patients with pneumoconiosis is still unexplored. The objective of the present study was to identify the attack rate of active PTB among workers in dusty environments who were diagnosed with pneumoconiosis. Methods: The study was performed using the results of the Pneumoconiosis Examination Council's assessment from the Korea Workers' Compensation and Welfare Service(KCOMWEL) database between January 1, 1984 and December 31, 2017. Pneumoconiosis was defined as Category 1 or more in the radiological findings of pneumoconiosis. Active PTB was defined as a positive result for active PTB in the results of the Pneumoconiosis Examination Council's assessment. Results: A total of 37,946 workers in dusty environments who received a health examination for diagnosing pneumoconiosis between January 1, 1984 and December 31, 2017 were selected as study subjects. The attack rate of active TB among subjects who were diagnosed with pneumoconiosis and those who were diagnosed without pneumoconiosis were 8.5% and 1.4%, respectively. In the multivariate logistic analysis including age, sex, radiological findings, complications, male[odds ratio(OR), 2.0; 95% confidence interval(CI), 1.4-3.1] and pneumoconiosis(OR, 6.5; 95% CI, 5.7-7.4) were associated with an increased risk of developing active PTB. Conclusions: The present study determined that dusty workers who were diagnosed with pneumoconiosis had a high rate of active PTB compared to TB patients and patients who were diagnosed with silicosis. Therefore, in addition to silicosis, it is necessary to include pneumoconiosis among the high-risk groups for TB.

• Tuberculosis and Respiratory Diseases
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• 제39권4호
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• pp.334-342
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• 1992

연구배경 : Mycobacteria 감염에 의한 폐결핵은 세포매개성 면역 반응이 관계한다고 알려져 있는 바, 먼저 Mycobacteria가 흡입되면 T 임파구가 활성화되어 세포매개성 면역 반응을 나타낸다. 결핵환자에서 tuberculin-purified protein derivative에 대한 피부 면역반응은 주로 세포매개성 면역반응에 의해 이루어짐으로 활동성 폐결핵 환자에서는 양성반응을 나타내어야하나 활동성 폐결핵 환자에서도 음성반응(anergy)을 나타내는 경우가 있다. 저자들은 폐결핵 환자에서 말초혈액 및 기관지 폐포세액내의 임파구의 세포조성과 이들이 피부반응에 미치는 영향을 조사함으로써 활동성 폐결핵 환자에서의 PPD에 대한 피부반응 검사상 음성으로 나타나는 이유를 알아보고자 하였다. 방법 : 11명의 정상대조군, 20명의 활동성 폐결핵 환자를 대상으로 PPD에 대한 피부 반응 검사 및 말초 혈액 및 기관지 폐포세척액의 임파구의 아형을 분석하였다. 결과 : 1) 기관지 폐포세척액내의 임파구는 환자군에서 정상대조군에 비하여 유의하게 증가되어 있었고($25.2{\pm}4.8$ vs $6.6{\pm}1.3%$, p<0.01), 단구세포(monocyte)는 환자군에서 정상 대조군에 비하여 유의하게 감소되어 있었다($69.6{\pm}5.7$ vs $89.2{\pm}1.4%$, p<0.05). 2) PPD에 대한 양성 반응을 보인 환자군과 음성 반응을 보인 환자군 사이의 기관지 폐포세척 세포 조성의 비는 차이가 없었다. 3) 환자군에서 기관지 폐포세척액 내의 $CD3^+$, $CD4^+$ 임파구의 조성비는 말초혈액보다 유의하게 증가되어 있었고($CD3^+$: $76.56{\pm}2.18$ vs $57.59{\pm}2.17%$, p<0.001; $CD4^+$: $51.24{\pm}2.33$ vs $35.20{\pm}2.32%$, p<0.005), $CD3^+IL-2R^+$, $CD3^+HLA-DR^+$ 임파구의 조성비도 말초혈액보다 증가되어 있었다($CD3^+IL-2R^+$:$2.41{\pm}0.57$ vs $0.93{\pm}0.16%$, p<0.005; $CD3^+$ HLA-$DR^+$: $16.92{\pm}3.89$ vs $3.94{\pm}0.70%$, p<0.005). 4) 환자군중 PPD에 대한 양성반응을 보인 군과 음성반응을 보인 군 사이에는 기관지 폐포세척액내의 임파구의 조성의 차이 및 수에서 차이가 없었다. 5) 환자군에서 PPD에 대한 피부반응과 기관지 폐포세척 세포의 조성비 사이에는 모두 상관관계가 없었으며, PPD에 대한 피부반응과 기관지 폐포세척액 및 말초 혈액내의 임파구아형의 조성과도 상관관계가 없었다. 결론 : 결론적으로 기관지 폐포세척액내의 염증 세포와 세포매개성 면역 반응과는 직접적인 관계가 없음을 알수 있었으며, 활동성 폐결핵 환자에서의 지연성 피부 반응의 저하는 임파구의 구획에 의한 결과라는 것을 배제할 수 없었다.

• Tuberculosis and Respiratory Diseases
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• 제50권5호
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• pp.599-606
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• 2001

연구배경 : 기존의 결핵진단 방법이외에 신속하고, 정확한 결핵진단법으로 결핵환자의 말초혈액에서 결핵균 PCR 검사를 시행하여 검사의 유용성과 말초혈액 결핵 PCR 검사 양성인 환자의 면역학적 상태 및 방사선학적 소견을 살펴보았다. 대상 및 방법 : 1998년 7월부터 1999년 8월까지 한림대학교 의료원에 내원하여 결핵이 의심 되었던 환자를 대상으로 하였다. 검체에서 항산균 도말검사 및 결핵균 배양 검사를 시행하였고 진단에 필요한 경우 조직검사를 시행한 환자들 중에서 3개월 이상 경과관찰이 가능하였던 59명의 환자를 대상으로 하였다. 대상 환자 모두에서 말초혈액 결핵 PCR검사를 시행하였다. 결 과 : 대상환자 59명중 남자 39예, 여자 20예였으며, 평균 연령은 44.7세였다. 45예에서 결핵으로 최종 진단되었고, 이중 41예는 결핵균 배양검사 및 조직검사로 확진되었고, 4예는 임상적으로 진단되었다. 활동성 폐결핵이 아닌 14예 중 13예는 비활동성 결핵, 1예는 폐암으로 진단되었다. 말초혈액 결핵균 PCR 양성환자는 14예였으며, 이중 활동성 결핵이 13예, 폐암이 1예였다. 이들 말초혈액 결핵균 PCR 양성인 13예의 결핵 환자의 6예(46%) 에서 면역상태의 저하를 보였다. 결핵의 진단에 있어서 말초혈액 결핵균 PCR 검사의 민감도 29%, 특이도 93%, 양성 예측도와 음성 예측도가 각각 93%, 29% 였다. 결 론 : 말초혈액 결핵균 중합효소 연쇄반응 검사는 특이도가 높은 반면 민감도는 낮아 결핵 선별 검사로는 유용하지 않을 것으로 보인다. 그러나 양성예측도가 높아 검사가 양성인 경우 활동성 결핵의 조기 진단에 도움을 줄 것으로 사료된다.

• Genomics & Informatics
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• 제21권2호
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• pp.25.1-25.12
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• 2023

Adaptation of infections and hosts has resulted in several metabolic mechanisms adopted by intracellular pathogens to combat the defense responses and the lack of fuel during infection. Human tuberculosis caused by Mycobacterium tuberculosis (MTB) is the world's first cause of mortality tied to a single disease. This study aims to characterize and anticipate potential antigen characteristics for promising vaccine candidates for the hypothetical protein of MTB through computational strategies. The protein is associated with the catalyzation of dithiol oxidation and/or disulfide reduction because of the protein's anticipated disulfide oxidoreductase properties. This investigation analyzed the protein's physicochemical characteristics, protein-protein interactions, subcellular locations, anticipated active sites, secondary and tertiary structures, allergenicity, antigenicity, and toxicity properties. The protein has significant active amino acid residues with no allergenicity, elevated antigenicity, and no toxicity.

• Clinics in Shoulder and Elbow
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• 제25권2호
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• pp.158-162
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• 2022

The incidence of musculoskeletal tuberculosis (TB) is on the rise due to the current Acquired Immunodeficiency Syndrome (AIDS) pandemic. Spine is the most common osseous site, followed by other joints. TB identified in the elbow accounts for 2%-5% of skeletal TB cases, which are secondary to pulmonary TB. Primary elbow TB is rare. We report a case of primary TB of the elbow which had a negative synovial biopsy. A 46-year-old right-hand dominant female patient with chronic pain and disability of the right elbow was diagnosed with chronic non-specific arthritis based on an arthroscopic synovial biopsy. The case was diagnosed retrospectively as active TB from bone cuts post total elbow arthroplasty. Anti-tuberculosis treatment (ATT) was given postoperatively for 12 months. The patient reported good functional outcomes at 3 years of follow-up. Such atypical presentations of osteoarticular TB are challenging to diagnose. Therefore, particularly in endemic areas, clinicians should be careful before excluding such a diagnosis even after a negative biopsy. Further research should investigate whether active TB of small joints such as the elbow can be treated with ATT, and early arthroplasty should be a focus of this research.

• Tuberculosis and Respiratory Diseases
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• 제45권2호
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• pp.271-279
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• 1998

연구배경: 결핵의 유병률은 감소하는 추세이나 노인, 항암약물요법, HIV 감염 풍에 의해 면역기능이 약화된 환자에 있어서 결핵의 발생이 문제가 되고 있으며, 특히 다제내성균주의 출현은 큰 문제이다. 결핵진단법 중 체액에서 도말검사나 배양검사를 통해서 Myco-bacterium tuberculosis를 검출하는 것이 표준진단법이나, 도말검사는 상대적으로 민감도가 낮고 배양검사는 오랜시간이 소요된다. 중함연쇄반응을 이용하여 결핵균의 DNA를 검출하는 방법은 매우 민감하나 비용이 많이 소요된다. ELISA(enzyme linked immunosorbent assay)를 이용하여 혈청에서 결핵균 특이항원에 대한 항체를 검출하는 방법이 객담도말음성인 활동성 폐결핵환자를 다른 비결핵성 폐질환으로부터 감별하는데 유용한지를 확인하고자 하였다. 방 법: 연세대학교 세브란스 병원에 입원한 183명의 객담도 말음성인 폐질환환자에서 항산균에 대한 객담도말 및 배양검사와 결핵균 특이 항원인 recombinant 38 kilo-dalton 항원과 culture filtrate항원을 이용한 ELISA 검사를 시행하였다. 결 과: 35명의 활동성 폐결핵환자 중 18명에서 배양검사상 Mycobacterium tuberculosis를 검출할 수 있었다. 38 kDa와 culture filtrate에 대한 흡광도는 활동성 폐결핵환자들에서 비결핵성 폐질환자들보다 유의하게 높았다 (p<0.05). 활동성 폐결핵환자 중 객담배양양성과 음성군사이에 38 kDa와 culture filtrate에 대한 홉광도의 유의한 차이는 없었다 (p>0.05) 객담도말음성인 환자에 있어서 38 kDa과 culture filtrate의 민감도는 각각 20.0%와 31.4%였고 특이도는 각각 95.3%와 93.9%였다. 결 론: 객답도말검사 음성인 활동성 폐결핵환자에 있어서 ELISA를 이용한 38 kDa과 culture filtrate 항원에 대한 혈청항체검사법은 기존진단방법보다 낮은 민감도를 보여, 비결핵성 폐질환으로부터 활동성 폐결핵을 감별진단하는데 크게 도움이 되지 않을 것으로 여겨진다.

• Tuberculosis and Respiratory Diseases
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• 제38권3호
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• pp.236-244
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• 1991

The prevalence rate of pulmonary tuberculosis is 1.8% in 1990, and endobronchial tuberculosis may exist in 10 to 40% of active disease. Endobronchial tuberculosis usually leaves bronchial stenosis as the complication despite of modern chemotherapy, and it is often misdiagnosed as bronchial asthma. When bronchial stenosis involves major airway, its treatment needs such special measures as steroid therapy, surgical intervention and/or laser therapy, but the therapeutic result is often disappointing. To exploit a new treatment modality for bronchial stenosis, balloon dilatation was carried out in 12 patients with endobronchial tuberculosis. Under local anesthesia, 4F-Fogarty balloon was inserted via bronchofiberscope in ten cases and 10F-Gruentzig balloon was introduced under fluoroscopic guide in two others. Endobronchial tuberculoses were subdivided into two(16.7%) with actively caseating type, seven (58.3%) with fibrostenotic type, and three (25.0%) with stenotic type without fibrosis, according to the bronchoscopic findings. In 7 healed cases which were all stenotic with fibrosis, three (42.9%) took favorable turn in clinical status but four (57.1%) were not improved with balloon dilatation. In 5 active cases, all (two with actively-caseating type and three with stenotic type without fibrosis) were improved with this method. $FEV_{1.0}$ or FVC increased 10% or more after procedure in seven (70.0%) of ten and bronchial lumen remained enlarged in eight (66.7%) of twelve, in whom follow-up examination was done after the procedure. Balloon dilatation of bronchial stenosis is more effective, when endobronchial tuberculosis is in active stage than in healed fibrotic stage. It is suggested that bronchial stenosis can be minimized by early diagnosis and early application of balloon dilatation in the course of disease.