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Role of interferon-gamma release assays in the diagnosis of pulmonary tuberculosis in patients with advanced HIV infection

BACKGROUND: T-cell interferon-gamma release assays (IGRAs) may have a role in the diagnosis of active tuberculosis when evaluating patients for whom standard microbiology has limited sensitivity. Our objective was to examine the accuracy of a commercial IGRA for diagnosis of active tuberculosis in H...

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Autores principales: Cattamanchi, Adithya, Ssewenyana, Isaac, Davis, J Lucian, Huang, Laurence, Worodria, William, den Boon, Saskia, Yoo, Samuel, Andama, Alfred, Hopewell, Philip C, Cao, Huyen
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2010
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846947/
https://www.ncbi.nlm.nih.gov/pubmed/20302657
http://dx.doi.org/10.1186/1471-2334-10-75
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author Cattamanchi, Adithya
Ssewenyana, Isaac
Davis, J Lucian
Huang, Laurence
Worodria, William
den Boon, Saskia
Yoo, Samuel
Andama, Alfred
Hopewell, Philip C
Cao, Huyen
author_facet Cattamanchi, Adithya
Ssewenyana, Isaac
Davis, J Lucian
Huang, Laurence
Worodria, William
den Boon, Saskia
Yoo, Samuel
Andama, Alfred
Hopewell, Philip C
Cao, Huyen
author_sort Cattamanchi, Adithya
collection PubMed
description BACKGROUND: T-cell interferon-gamma release assays (IGRAs) may have a role in the diagnosis of active tuberculosis when evaluating patients for whom standard microbiology has limited sensitivity. Our objective was to examine the accuracy of a commercial IGRA for diagnosis of active tuberculosis in HIV-infected persons. METHODS: We enrolled HIV-infected patients admitted to Mulago Hospital in Kampala, Uganda with cough ≥ 2 weeks. All patients underwent standard medical evaluation. We collected peripheral blood specimens at enrollment and performed a commercial, ELISPOT-based IGRA according to the manufacturer's recommendations. IGRA sensitivity and specificity were determined using mycobacterial culture results as the reference standard. RESULTS: Overall, 236 patients were enrolled. The median CD4+ T-lymphocyte count was 49 cells/μl and 126 (53%) patients were diagnosed with active pulmonary tuberculosis. IGRAs were not performed in 24 (10%) patients due to insufficient mononuclear cell counts. In the remaining 212 patients, results were indeterminate in 54 (25%). IGRAs were positive in 95 of 158 (60%) patients with interpretable results. The proportion of positive test results was similar across CD4+ count strata. IGRA sensitivity was 73% and specificity 54%. IGRA results did not meaningfully alter the probability of active tuberculosis in patients with negative sputum smears. CONCLUSIONS: An ELISPOT-based IGRA detected a high prevalence of latent tuberculosis infection in a hospitalized population of tuberculosis suspects with advanced HIV/AIDS but had limited utility for diagnosis of active tuberculosis in a high prevalence setting. Further research is needed to identify stronger and more specific immune responses in patients with active tuberculosis.
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spelling pubmed-28469472010-03-30 Role of interferon-gamma release assays in the diagnosis of pulmonary tuberculosis in patients with advanced HIV infection Cattamanchi, Adithya Ssewenyana, Isaac Davis, J Lucian Huang, Laurence Worodria, William den Boon, Saskia Yoo, Samuel Andama, Alfred Hopewell, Philip C Cao, Huyen BMC Infect Dis Research Article BACKGROUND: T-cell interferon-gamma release assays (IGRAs) may have a role in the diagnosis of active tuberculosis when evaluating patients for whom standard microbiology has limited sensitivity. Our objective was to examine the accuracy of a commercial IGRA for diagnosis of active tuberculosis in HIV-infected persons. METHODS: We enrolled HIV-infected patients admitted to Mulago Hospital in Kampala, Uganda with cough ≥ 2 weeks. All patients underwent standard medical evaluation. We collected peripheral blood specimens at enrollment and performed a commercial, ELISPOT-based IGRA according to the manufacturer's recommendations. IGRA sensitivity and specificity were determined using mycobacterial culture results as the reference standard. RESULTS: Overall, 236 patients were enrolled. The median CD4+ T-lymphocyte count was 49 cells/μl and 126 (53%) patients were diagnosed with active pulmonary tuberculosis. IGRAs were not performed in 24 (10%) patients due to insufficient mononuclear cell counts. In the remaining 212 patients, results were indeterminate in 54 (25%). IGRAs were positive in 95 of 158 (60%) patients with interpretable results. The proportion of positive test results was similar across CD4+ count strata. IGRA sensitivity was 73% and specificity 54%. IGRA results did not meaningfully alter the probability of active tuberculosis in patients with negative sputum smears. CONCLUSIONS: An ELISPOT-based IGRA detected a high prevalence of latent tuberculosis infection in a hospitalized population of tuberculosis suspects with advanced HIV/AIDS but had limited utility for diagnosis of active tuberculosis in a high prevalence setting. Further research is needed to identify stronger and more specific immune responses in patients with active tuberculosis. BioMed Central 2010-03-20 /pmc/articles/PMC2846947/ /pubmed/20302657 http://dx.doi.org/10.1186/1471-2334-10-75 Text en Copyright ©2010 Cattamanchi et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Cattamanchi, Adithya
Ssewenyana, Isaac
Davis, J Lucian
Huang, Laurence
Worodria, William
den Boon, Saskia
Yoo, Samuel
Andama, Alfred
Hopewell, Philip C
Cao, Huyen
Role of interferon-gamma release assays in the diagnosis of pulmonary tuberculosis in patients with advanced HIV infection
title Role of interferon-gamma release assays in the diagnosis of pulmonary tuberculosis in patients with advanced HIV infection
title_full Role of interferon-gamma release assays in the diagnosis of pulmonary tuberculosis in patients with advanced HIV infection
title_fullStr Role of interferon-gamma release assays in the diagnosis of pulmonary tuberculosis in patients with advanced HIV infection
title_full_unstemmed Role of interferon-gamma release assays in the diagnosis of pulmonary tuberculosis in patients with advanced HIV infection
title_short Role of interferon-gamma release assays in the diagnosis of pulmonary tuberculosis in patients with advanced HIV infection
title_sort role of interferon-gamma release assays in the diagnosis of pulmonary tuberculosis in patients with advanced hiv infection
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846947/
https://www.ncbi.nlm.nih.gov/pubmed/20302657
http://dx.doi.org/10.1186/1471-2334-10-75
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