Cargando…

Cytokine Kinetics in the First Week of Tuberculosis Therapy as a Tool to Confirm a Clinical Diagnosis and Guide Therapy

BACKGROUND: Many patients treated for tuberculosis (TB) in low and middle income countries are treated based on clinical suspicion without bacteriological confirmation. This is often due to lack of rapid simple accurate diagnostics and low healthcare provider confidence in the predictive value of cu...

Descripción completa

Detalles Bibliográficos
Autores principales: den Hertog, Alice L., Montero-Martín, María, Saunders, Rachel L., Blakiston, Matthew, Menting, Sandra, Sherchand, Jeevan B., Lawson, Lovett, Oladimeji, Olanrewaju, Abdurrahman, Saddiq T., Cuevas, Luis E., Anthony, Richard M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4482639/
https://www.ncbi.nlm.nih.gov/pubmed/26115421
http://dx.doi.org/10.1371/journal.pone.0129552
_version_ 1782378476969394176
author den Hertog, Alice L.
Montero-Martín, María
Saunders, Rachel L.
Blakiston, Matthew
Menting, Sandra
Sherchand, Jeevan B.
Lawson, Lovett
Oladimeji, Olanrewaju
Abdurrahman, Saddiq T.
Cuevas, Luis E.
Anthony, Richard M.
author_facet den Hertog, Alice L.
Montero-Martín, María
Saunders, Rachel L.
Blakiston, Matthew
Menting, Sandra
Sherchand, Jeevan B.
Lawson, Lovett
Oladimeji, Olanrewaju
Abdurrahman, Saddiq T.
Cuevas, Luis E.
Anthony, Richard M.
author_sort den Hertog, Alice L.
collection PubMed
description BACKGROUND: Many patients treated for tuberculosis (TB) in low and middle income countries are treated based on clinical suspicion without bacteriological confirmation. This is often due to lack of rapid simple accurate diagnostics and low healthcare provider confidence in the predictive value of current tests. We previously reported in an animal TB model that levels of host markers rapidly change in response to treatment initiation. METHODS: We assessed the potential of host biomarker kinetics of TB patients during the first two weeks of therapy to identify patients responding to treatment. Adult patients clinically diagnosed with and treated for TB, 29 in Nigeria and 24 in Nepal, were analyzed. RESULTS: Changes in concentrations of non-specific host biomarkers, particularly IP-10, in response to the first week of anti-TB therapy were strongly associated with bacteriological confirmation of TB. A decrease in IP-10 level of >300pg/ml between 0 and 7 days of treatment identified 75% of both smear-positive and smear-negative culture positive patients and correctly excluded TB in all nine culture negative patients. CONCLUSIONS: Monitoring of early IP-10 responses to treatment could form the basis of a simplified assay and could help identify patients who were erroneously clinically diagnosed with TB or those infected with drug resistant strains on inappropriate treatment. We believe this approach may be particularly appropriate for difficult to diagnose patients, e.g. smear-negative HIV-positive, or those with extra-pulmonary TB, often treated without bacterial confirmation.
format Online
Article
Text
id pubmed-4482639
institution National Center for Biotechnology Information
language English
publishDate 2015
publisher Public Library of Science
record_format MEDLINE/PubMed
spelling pubmed-44826392015-06-29 Cytokine Kinetics in the First Week of Tuberculosis Therapy as a Tool to Confirm a Clinical Diagnosis and Guide Therapy den Hertog, Alice L. Montero-Martín, María Saunders, Rachel L. Blakiston, Matthew Menting, Sandra Sherchand, Jeevan B. Lawson, Lovett Oladimeji, Olanrewaju Abdurrahman, Saddiq T. Cuevas, Luis E. Anthony, Richard M. PLoS One Research Article BACKGROUND: Many patients treated for tuberculosis (TB) in low and middle income countries are treated based on clinical suspicion without bacteriological confirmation. This is often due to lack of rapid simple accurate diagnostics and low healthcare provider confidence in the predictive value of current tests. We previously reported in an animal TB model that levels of host markers rapidly change in response to treatment initiation. METHODS: We assessed the potential of host biomarker kinetics of TB patients during the first two weeks of therapy to identify patients responding to treatment. Adult patients clinically diagnosed with and treated for TB, 29 in Nigeria and 24 in Nepal, were analyzed. RESULTS: Changes in concentrations of non-specific host biomarkers, particularly IP-10, in response to the first week of anti-TB therapy were strongly associated with bacteriological confirmation of TB. A decrease in IP-10 level of >300pg/ml between 0 and 7 days of treatment identified 75% of both smear-positive and smear-negative culture positive patients and correctly excluded TB in all nine culture negative patients. CONCLUSIONS: Monitoring of early IP-10 responses to treatment could form the basis of a simplified assay and could help identify patients who were erroneously clinically diagnosed with TB or those infected with drug resistant strains on inappropriate treatment. We believe this approach may be particularly appropriate for difficult to diagnose patients, e.g. smear-negative HIV-positive, or those with extra-pulmonary TB, often treated without bacterial confirmation. Public Library of Science 2015-06-26 /pmc/articles/PMC4482639/ /pubmed/26115421 http://dx.doi.org/10.1371/journal.pone.0129552 Text en © 2015 den Hertog et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
den Hertog, Alice L.
Montero-Martín, María
Saunders, Rachel L.
Blakiston, Matthew
Menting, Sandra
Sherchand, Jeevan B.
Lawson, Lovett
Oladimeji, Olanrewaju
Abdurrahman, Saddiq T.
Cuevas, Luis E.
Anthony, Richard M.
Cytokine Kinetics in the First Week of Tuberculosis Therapy as a Tool to Confirm a Clinical Diagnosis and Guide Therapy
title Cytokine Kinetics in the First Week of Tuberculosis Therapy as a Tool to Confirm a Clinical Diagnosis and Guide Therapy
title_full Cytokine Kinetics in the First Week of Tuberculosis Therapy as a Tool to Confirm a Clinical Diagnosis and Guide Therapy
title_fullStr Cytokine Kinetics in the First Week of Tuberculosis Therapy as a Tool to Confirm a Clinical Diagnosis and Guide Therapy
title_full_unstemmed Cytokine Kinetics in the First Week of Tuberculosis Therapy as a Tool to Confirm a Clinical Diagnosis and Guide Therapy
title_short Cytokine Kinetics in the First Week of Tuberculosis Therapy as a Tool to Confirm a Clinical Diagnosis and Guide Therapy
title_sort cytokine kinetics in the first week of tuberculosis therapy as a tool to confirm a clinical diagnosis and guide therapy
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4482639/
https://www.ncbi.nlm.nih.gov/pubmed/26115421
http://dx.doi.org/10.1371/journal.pone.0129552
work_keys_str_mv AT denhertogalicel cytokinekineticsinthefirstweekoftuberculosistherapyasatooltoconfirmaclinicaldiagnosisandguidetherapy
AT monteromartinmaria cytokinekineticsinthefirstweekoftuberculosistherapyasatooltoconfirmaclinicaldiagnosisandguidetherapy
AT saundersrachell cytokinekineticsinthefirstweekoftuberculosistherapyasatooltoconfirmaclinicaldiagnosisandguidetherapy
AT blakistonmatthew cytokinekineticsinthefirstweekoftuberculosistherapyasatooltoconfirmaclinicaldiagnosisandguidetherapy
AT mentingsandra cytokinekineticsinthefirstweekoftuberculosistherapyasatooltoconfirmaclinicaldiagnosisandguidetherapy
AT sherchandjeevanb cytokinekineticsinthefirstweekoftuberculosistherapyasatooltoconfirmaclinicaldiagnosisandguidetherapy
AT lawsonlovett cytokinekineticsinthefirstweekoftuberculosistherapyasatooltoconfirmaclinicaldiagnosisandguidetherapy
AT oladimejiolanrewaju cytokinekineticsinthefirstweekoftuberculosistherapyasatooltoconfirmaclinicaldiagnosisandguidetherapy
AT abdurrahmansaddiqt cytokinekineticsinthefirstweekoftuberculosistherapyasatooltoconfirmaclinicaldiagnosisandguidetherapy
AT cuevasluise cytokinekineticsinthefirstweekoftuberculosistherapyasatooltoconfirmaclinicaldiagnosisandguidetherapy
AT anthonyrichardm cytokinekineticsinthefirstweekoftuberculosistherapyasatooltoconfirmaclinicaldiagnosisandguidetherapy