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

Autor: den Hertog AL; Royal Tropical Institute (KIT), KIT Biomedical Research, Amsterdam, The Netherlands., Montero-Martín M; Liverpool School of Tropical Medicine, Liverpool, United Kingdom., Saunders RL; Liverpool School of Tropical Medicine, Liverpool, United Kingdom., Blakiston M; Liverpool School of Tropical Medicine, Liverpool, United Kingdom., Menting S; Royal Tropical Institute (KIT), KIT Biomedical Research, Amsterdam, The Netherlands., Sherchand JB; Tribhuvan University Institute of Medicine, Kathmandu, Nepal., Lawson L; Zankli Medical Centre, Abuja, Nigeria., Oladimeji O; Zankli Medical Centre, Abuja, Nigeria., Abdurrahman ST; Abuja Federal Capital Territory Tuberculosis Control Programme, Abuja, Nigeria., Cuevas LE; Liverpool School of Tropical Medicine, Liverpool, United Kingdom., Anthony RM; Royal Tropical Institute (KIT), KIT Biomedical Research, Amsterdam, The Netherlands.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2015 Jun 26; Vol. 10 (6), pp. e0129552. Date of Electronic Publication: 2015 Jun 26 (Print Publication: 2015).
DOI: 10.1371/journal.pone.0129552
Abstrakt: 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.
Databáze: MEDLINE
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