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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...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2015
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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 |
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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 |
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