Defining the role of cellular immune signatures in diagnostic evaluation of suspected tuberculosis
| Autor: | Robert Parker, Jonathan J Deeks, Tereza Masonou, Onn Min Kon, Long Hoang, Pooja Jain, Yanping Guo, Amarjit Badhan, Luis C Berrocal-Almanza, Yemisi Takwoingi, Alice Halliday, Peter Beverley, Aime Boakye, Ajit Lalvani, Mica Tolosa-Wright, Ishita Marwah |
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| Přispěvatelé: | National Institute for Health Research |
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
0301 basic medicine
Tuberculosis T cell latent tuberculosis infection Immunology diagnostic Diagnostic evaluation Microbiology Flow cytometry Mycobacterium tuberculosis 03 medical and health sciences 0302 clinical medicine Immune system Latent Tuberculosis Immunology and Allergy Medicine TOOL Humans 030212 general & internal medicine Prospective Studies Medical diagnosis 11 Medical and Health Sciences Science & Technology biology medicine.diagnostic_test business.industry flow cytometry ACTIVE TUBERCULOSIS 06 Biological Sciences biology.organism_classification medicine.disease 030104 developmental biology medicine.anatomical_structure Infectious Diseases tuberculosis Case-Control Studies Cohort MYCOBACTERIUM-TUBERCULOSIS business Life Sciences & Biomedicine Interferon-gamma Release Tests RESPONSES |
| Zdroj: | Halliday, A, Masonou, T, Tolosa-Wright, M R, Guo, Y, Hoang, L, Parker, R, Boakye, A, Takwoingi, Y, Badhan, A, Jain, P, Marwah, I, Berrocal-Almanza, L C, Deeks, J J, Beverley, P, Kon, O M & Lalvani, A 2021, ' Defining the role of cellular immune signatures in diagnostic evaluation of suspected tuberculosis ', Journal of Infectious Diseases . https://doi.org/10.1093/infdis/jiab311 |
| Popis: | Background Diagnosis of paucibacillary tuberculosis (TB) including extrapulmonary TB is a significant challenge, particularly in high-income, low-incidence settings. Measurement of Mycobacterium tuberculosis (Mtb)-specific cellular immune signatures by flow cytometry discriminates active TB from latent TB infection (LTBI) in case-control studies; however, their diagnostic accuracy and clinical utility in routine clinical practice is unknown. Methods Using a nested case-control study design within a prospective multicenter cohort of patients presenting with suspected TB in England, we assessed diagnostic accuracy of signatures in 134 patients who tested interferon-gamma release assay (IGRA)-positive and had final diagnoses of TB or non-TB diseases with coincident LTBI. Cellular signatures were measured using flow cytometry. Results All signatures performed less well than previously reported. Only signatures incorporating measurement of phenotypic markers on functional Mtb-specific CD4 T cells discriminated active TB from non-TB diseases with LTBI. The signatures measuring HLA-DR+IFNγ + CD4 T cells and CD45RA−CCR7−CD127− IFNγ −IL-2−TNFα + CD4 T cells performed best with 95% positive predictive value (95% confidence interval, 90–97) in the clinically challenging subpopulation of IGRA-positive but acid-fast bacillus (AFB) smear-negative TB suspects. Conclusions Two cellular immune signatures could improve and accelerate diagnosis in the challenging group of patients who are IGRA-positive, AFB smear-negative, and have paucibacillary TB. |
| Databáze: | OpenAIRE |
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