TY - JOUR. T1 - Diagnostic utility of QuantiFERON-TB Gold In-Tube test in pediatric tuberculosis disease in Taiwanese children. AU - Wong, Kin Sun. AU - Huang, Yen Chun. AU - Hu, Han Chung. AU - Huang, Yhu Chering. AU - Wen, Chang Hui. AU - Lin, Tzou Yien. PY - 2017/6/1. Y1 - 2017/6/1. N2 - Purpose To compare the performance of a commercial interferon-gamma release assay, QuantiFERON TB Gold-in-Tube (QFG-IT) with the tuberculin skin test (TST) in Taiwanese children for the diagnosis of active tuberculosis (TB). Methods A retrospective chart analysis of pediatric patients (,18 years of age) who underwent QFG-IT tests and TST for the confirmation of active TB between January 2008 and June 2014. Results The sensitivity of QFG-IT was 100% [95% confidence interval (CI): 63.1-100], versus sensitivity of 62.5% for TST (95% CI 24.5-91.5). The positive predictive value of QFG-IT was 100 (95% CI: 89.7-100), while the negative predictive value for TST was 86.9% (95% CI: 67-96.3). Among three patients with ...

TY - JOUR. T1 - Serial interferon-gamma release assays after rifampicin prophylaxis in a tuberculosis outbreak. AU - Lee, Seung Heon. AU - Lew, Woo Jin. AU - Kim, Hee Jin. AU - Lee, Hyun Kyung. AU - Lee, Young Min. AU - Cho, Chong Hee. AU - Lee, Eun Joo. AU - Lee, Dong Yeol. AU - Ryu, Sung Weon. AU - Oh, Soo Yeon. AU - Kim, Sin Ok. AU - Shim, Tae Sun. PY - 2010/3/1. Y1 - 2010/3/1. N2 - Even though some studies have reported the results of serial interferon-gamma release assays (IGRAs) during isoniazid prophylactic treatment, serial results have not been reported after rifampicin prophylaxis. A contact investigation was conducted after a tuberculosis (TB) outbreak in an accommodation facility. The tuberculin skin test (TST) and the QuantiFERON-TB Gold In-Tube (QFT-GIT) test were performed in 214 contacts with normal chest radiographs. Rifampicin prophylaxis was initiated in TST+/QFT-GIT+ subjects, and the QFT-GIT test was repeated upon completion of 4 months of rifampicin treatment. Among the 214 ...

This webinar is intended for the prescribing physician and healthcare staff who may be involved with the decision to utilize an interferon gamma release assay (IGRA) test in screening individuals for tuberculosis .

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. 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 manufacturers recommendations. IGRA sensitivity and specificity were determined using mycobacterial culture results as the reference standard. 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,

Although widely used, the tuberculin skin test (TST) has limited diagnostic accuracy for Mycobacterium tuberculosis (M. tb) infection. TST sensitivity is particularly limited in children with compromised immune status due to HIV (Human Immunodeficiency Virus) infection, young age and/or severe malnutrition. Very limited data exists regarding the diagnostic utility of Interferon Gamma Release Assays (IGRAs) to detect M. tb infection in children. The proposed study will address major gaps in current knowledge regarding the diagnosis of M. tb infection in HIV-infected children and may be a powerful tool to spur policy change that would dramatically improve health in children in countries endemic for tuberculosis (TB) and HIV. The primary objectives of the study will be to assess the agreement between the TST and IGRAs in HIV-infected and uninfected children less than or equal to age 5 and to assess the performance of TST and IGRAs across a standard gradient of M. tb exposure in HIV-infected and ...

Although widely used, the tuberculin skin test (TST) has limited diagnostic accuracy for Mycobacterium tuberculosis (M. tb) infection. TST sensitivity is particularly limited in children with compromised immune status due to HIV (Human Immunodeficiency Virus) infection, young age and/or severe malnutrition. Very limited data exists regarding the diagnostic utility of Interferon Gamma Release Assays (IGRAs) to detect M. tb infection in children. The proposed study will address major gaps in current knowledge regarding the diagnosis of M. tb infection in HIV-infected children and may be a powerful tool to spur policy change that would dramatically improve health in children in countries endemic for tuberculosis (TB) and HIV. The primary objectives of the study will be to assess the agreement between the TST and IGRAs in HIV-infected and uninfected children less than or equal to age 5 and to assess the performance of TST and IGRAs across a standard gradient of M. tb exposure in HIV-infected and ...

Ninety-seven subjects had results from three labs. Eleven (11.3%) had discordant interpretations and 72 (74.2%) had discrepancies >0.05 IU/mL using unreconciled results. After correction of manual data entry errors for 9 subjects, and exclusion of 6 subjects due to methodological errors, 7 (7.7%) subjects were discordant. Of these, 6 (85.7%) had all TB Responses within 0.25 IU/mL of the manufacturers recommended cutoff. Non-uniform error of measurement was observed, with greater variation in higher IFN-γ measurements. Within-subject standard deviation for TB Response was as high as 0.16 IU/mL, and limits of agreement ranged from −0.46 to 0.43 IU/mL for subjects with mean TB Response within 0.25 IU/mL of the cutoff ...

the probability of being cost-effective for a willingness to pay of £20,000/QALY was 26% and 21%, when patients with indeterminate test results were excluded or included, respectively. In comparison, the QFT-GIT probabilities were 8% and 6%. Although the use of IGRAs is cost saving, the health detriment is large owing to delay in diagnosing active TB, leading to prolonged illness. There was substantial between-patient variation in the tests used in the diagnostic pathway ...

Specimen Type: Whole Blood. Container/Tube: Dark green Lithium heparin. Specimen Volume: 6mL. Specimen Minimum Volume: 6mL. Immune compromised patients should have 2 full tubes collected.. Collection Instructions: Must be collected between the hours of 0600 and 1800 Monday through Friday only. Must arrive in lab by 1900 due to sample stability.. ...

Figure 2: Adjusted risk ratios for QFT conversion (IFN-γ ≥ 0.70 IU/mL) at 18 months based on the final multivariable Poisson regression model with robust variance which included the following covariates: quartiles of the number of cigarettes smoked daily, education, age, gender, and alcohol use. IFN-γ: interferon-gamma. QFT: QuantiFERON-TB Gold In-Tube ...

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TY - JOUR. T1 - The Responses of Multiple Cytokines Following Incubation of Whole Blood from TB Patients, Latently Infected Individuals and Controls with the TB Antigens ESAT-6, CFP-10 and TB7.7. AU - Kim, S. Y.. AU - Park, M. S.. AU - Kim, Y. S.. AU - Kim, S. K.. AU - Chang, J.. AU - Lee, H. J.. AU - Cho, S. N.. AU - Kang, Y. A.. PY - 2012/12. Y1 - 2012/12. N2 - The development of clinically relevant biomarkers is important for diagnosing latent tuberculosis infection (LTBI) and active tuberculosis (TB) and predicting their prognoses. This study examined whether the responses of multiple cytokines can be used as a biomarker to distinguish the TB infection status and mycobacterial load. We analysed the responses of multiple cytokines (IFN-γ, IL-2, IL-10, IL-13, IL-17 and TNF-α) in the supernatant from the QuantiFERON-TB Gold In-Tube assay following stimulation of whole blood from the TB group (n = 32), LTBI group (n = 19) and healthy controls (n = 30) with TB antigens (ESAT-6, CFP-10 and ...

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Multiple cytokines and inflammatory markers control TB infection. We aimed to investigate the changes in multiple cytokines and inflammatory markers in active TB patients following anti-TB drug therapy. Twenty-nine patients with active TB were recruited prospectively between December 2010 and July 2017. Blood samples were collected before (T0), after 2 months (T2), and at the end of anti-TB treatment (Tend). We measured the levels of Interferon (IFN)-γ, interleukin (IL)-2, IL-12, IL-10, IL-13 and tumor necrosis factor (TNF)-α in supernatants collected from the QuantiFERON-TB Gold In-Tube assay (QFT-GIT), as well as the WBC, neutrophil, platelet count and neutrophil to lymphocyte ratio (NLR) in whole blood ...

Multiple cytokines and inflammatory markers control TB infection. We aimed to investigate the changes in multiple cytokines and inflammatory markers in active TB patients following anti-TB drug therapy. Twenty-nine patients with active TB were recruited prospectively between December 2010 and July 2017. Blood samples were collected before (T0), after 2 months (T2), and at the end of anti-TB treatment (Tend). We measured the levels of Interferon (IFN)-γ, interleukin (IL)-2, IL-12, IL-10, IL-13 and tumor necrosis factor (TNF)-α in supernatants collected from the QuantiFERON-TB Gold In-Tube assay (QFT-GIT), as well as the WBC, neutrophil, platelet count and neutrophil to lymphocyte ratio (NLR) in whole blood ...

Background: The performance of the tuberculosis specific Interferon Gamma Release Assays (IGRAs) has not been sufficiently documented in tuberculosis- and HIV-endemic settings. This study evaluated the sensitivity of the QuantiFERON TB-Gold In-Tube (QFT-IT) in patients with culture confirmed pulmonary tuberculosis (PTB) in a TB- and HIV-endemic population and the effect of HIV-infection and CD4 cell count on test performance. Methodology/Principal Findings: 161 patients with sputum culture confirmed PTB were subjected to HIV- and QFT-IT testing and measurement of CD4 cell count. The QFT-IT was positive in 74% (119/161; 95% CI: 67-81%). Sensitivity was higher in HIV-negative (75/93) than in HIV-positive (44/68) patients (81% vs. 65%, p = 0.02) and increased with CD4 cell count in HIV-positive patients (test for trend p = 0.03). 23 patients (14%) had an indeterminate result and this proportion decreased with increasing CD4 cell count in HIV-positive patients (test for trend p = 0.03). Low CD4 cell ...

Background: Interferon gamma release assays, including the QuantiFERON® TB Gold In Tube (QFT) have been shown to be accurate in diagnosing Mycobacterium tuberculosis infection. These assays however, do not discriminate ...

Interferon gamma (IFNγ) is a dimerized soluble cytokine that is the only member of the type II class of interferons. The existence of this interferon, which early in its history was known as immune interferon, was described by E. F. Wheelock as a product of human leukocytes stimulated with phytohemagglutinin, and by others as a product of antigen-stimulated lymphocytes or tuberculin-sensitized mouse peritoneal lymphocytes challenged with PPD; the resulting supernatants were shown to inhibit growth of vesicular stomatitis virus. Those reports also contained the basic observation underlying the now widely employed interferon gamma release assay used to test for tuberculosis. In humans, the IFNγ protein is encoded by the IFNG gene. IFNγ, or type II interferon, is a cytokine that is critical for innate and adaptive immunity against viral, some bacterial and protozoal infections. IFNγ is an important activator of macrophages and inducer of Class II major histocompatibility complex (MHC) molecule ...

An Interferon Gamma Release Assay (IGRA), or TB blood test, is a method for detecting infection with M. tuberculosis. It is an acceptable alternative to the TB skin test in most situations ...

A 26-year-old woman from Pakistan presented to our institution in New York with episodic right-sided weakness and expressive aphasia. She was at 36 weeks gestation of an uncomplicated third pregnancy. On presentation, the patient appeared well, had normal vital signs and was afebrile. Her neurological examination was normal between recurrences. The patient reported usual fetal movement, and fetal monitoring displayed a reassuring tracing. MRI of the brain without gadolinium revealed numerous ring-like hyperintense lesions most consistent with an inflammatory or infectious aetiology (figure 1A). CT of the chest demonstrated multiple bilateral lung nodules with areas of coalescence (figure 1B). The patient denied respiratory symptoms. HIV and vasculitis testing was negative. Interferon gamma release assay had been positive earlier in the pregnancy. Lumbar puncture was performed: there was an elevated opening pressure, lymphocytic pleocytosis, low glucose and high protein. Cerebrospinal fluid ...

A study in this month s American Journal of Gastroenterology compares the interferon-gamma release assay vs the tuberculin skin test for tuberculosis screening in IBD.. ...

The TB service offers conventional imaging, bronchoscopy, blood tests, tuberculin skin test, Sputum Induction and Interferon-Gamma Release Assay (IGRA).

Santin M, Garcia-Garcia J-M, Rigau D, Altet N, Anibarro L, Casas I, Diez N, Garcia-Gasalla M, Martinez-Lacasa X, Penas AA, Perez-Escolano E, Sanchez F, Dominguez J, García-García J-M, Rigau D, Altet N, Anibarro L, Casas I, Díez N, García-Gasalla M, Martínez-Lacasa X, Penas AA, Pérez-Escolano E, Sánchez F, Domínguez J, Grupo de expertos del Grupo de Estudio de Micobacterias (GEIM) de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC) y la Sociedad Española de Enfermedades Respiratorias y Cirugía torácica (SEPAR), Panel of experts from the Mycobacteria Study Group (GEIM) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) and the Spanish Society of Respiratory Diseases and Thoracic Surgery (SEPAR). Executive summary of the guidelines for the use of interferon-gamma release assays in the diagnosis of tuberculosis infection. Enferm Infecc Microbiol Clin. 2016 May;34(5):304-8. PMID: 26926262. DOI: 10.1016/j.eimc.2015.11.021. ...

Canada Communicable Disease Report CCDR June 2010 Volume 36 ACS-5 An Advisory Committee Statement (ACS) Canadian Tuberculosis Committee (CTC)* Recommendations on Interferon Gamma Release Assaysfor the

Epibase® Cytokine Release Assay assesses the immediate interaction of the biotherapeutic protein itself (or other product-related factors such as formulation components and production contaminants) with the cells of the immune system.

Background: A new generation of diagnostic tests, the interferon-gamma release assays (IGRAs), have been developed for the detection of latent tuberculosis infection (LTBI). Limited data are available on their use in HIV-infected persons. Methods: A cross-sectional study was carried out at 2 HIV clinics in Atlanta to assess the utility of two IGRA tests (T-SPOT. TB [TSPOT] and QuantiFERON-TB Gold in Tube [QFT-3G]) compared to the tuberculin skin test (TST). Results: 336 HIV-infected persons were enrolled. Median CD4 count was 335 cells/mu l and median HIV viral load was 400 copies/ml. Overall, 27 patients (8.0%) had at least 1 positive diagnostic test for LTBI: 7 (2.1%) had a positive TST; 9 (2.7%) a positive QFT-3G; and 14 (4.2%) a positive TSPOT. Agreement between the 3 diagnostic tests was poor: TST and TSPOT, [kappa = 0.16, 95% CI (-0.06, 0.39)], TST and QFT-3G [kappa = 0.23, 95% CI (-0.05, 0.51)], QFT-3G and TSPOT [kappa = 0.06, 95% CI (-0.1, 0.2)]. An indeterminate test result occurred ...

Diagnosis and treatment of latent tuberculosis infection (LTBI) is the most effective strategy to control tuberculosis (TB) among patients with HIV infection. The tuberculin skin test (TST) was the only available method to identify LTBI. The aim of the present work was to evaluate the usefulness of the interferon-gamma release assays (IGRAs): QuantiFERON-tuberculosis (TB) Gold-In-Tube test (QFG) and T-SPOT.TB for the diagnosis of LTBI in a diverse cohort of HIV-infected patients. A prospective study was carried out in consecutive patients cared for in a single institution in Spain from January 2009 to October 2010. IGRAs and TST were performed simultaneously. TST induration ≥ 5 mm was considered positive. QFG, T-SPOT.TB and TST were performed in 373 subjects. Median CD4 cell count was 470/μl with a median nadir of 150/μl. TST, QFG and T-SPOT.TB were positive in 13.3%, 7.5% and 18.5% cases respectively. Among 277 patients with neither past or current TB nor previous treatment for LTBI and who had TST

Latent tuberculosis infection (LTBI) is a noncommunicable, asymptomatic condition that persists for many years in individuals and may progress to tuberculosis (TB) disease. The main purpose of diagnosing LTBI is to consider medical treatment for preventing active tuberculosis disease. Until recently, the tuberculin skin test (TST) was the only method available for diagnosing LTBI. Unfortunately, the TST is a subjective test that can be falsely positive for individuals who have been vaccinated with bacille Calmett-Guerin (BCG), who are infected with other mycobacteria than Mycobacterium tuberculosis complex, or due to other factors such as a digital palpitation error when reading the test.. The QuantiFERON-TB Gold In-Tube test is a measure of cell-mediated immune response to antigens simulating the mycobacterial proteins ESAT-6, CFP-10, and TB7.7. Individuals infected with M tuberculosis complex organisms including M tuberculosis, M bovis, M africanum, M microti, and M canetti usually have ...

Each year 1 million persons acquire permanent U.S. residency visas after tuberculosis (TB) screening. Most applicants undergo a 2-stage screening with tuberculin skin test (TST) followed by CXR only if TST-positive at > 5 mm. Due to cross reaction with bacillus Calmette-Guérin (BCG), TST may yield false positive results in BCG-vaccinated persons. Interferon gamma release assays exclude antigens found in BCG. In Vietnam, like most high TB-prevalence countries, there is universal BCG vaccination at birth ...

Objective: We compared the usefulness of tuberculin skin test (TST) and three interferon-gamma release assays (IGRAs) (QuantiFERON-TB Gold (QFT-2G), QuantiFERON-TB Gold In-tube (QFT-3G), T-SPOT.TB) as the supportive method of diagnosing pulmonary tuberculosis (TB).. Methods: The subjects were 70 patients who required the differentiation of pulmonary TB clinically. The final clinical diagnosis of pulmonary TB in 22 patients and non-pulmonary TB disease in 48 patients was established by clinical specimens.. Results: In 22 patients with pulmonary TB, the positive response rate was 60% on TST, 80% on QFT-2G, 85% on QFT-3G and 95% on T-SPOT.TB. In 48 patients with non-pulmonary TB disease, the positive response rate was 47% on TST, 9% on QFT-2G, 9% on QFT-3G, 13% on T-SPOT.TB. Indeterminate results on three IGRAs were recognized in one patient each on QFT-2G and QFT-3G among patients with pulmonary TB in three patients on QFT-2G and two patients on QFT-3G among patients with non-pulmonary TB disease. ...

Interferon-gamma release assays (IGRAs) are diagnostic tools for latent tuberculosis infection (LTBI). They are surrogate markers of Mycobacterium tuberculosis infection and indicate a cellular immune response to M. tuberculosis. IGRAs cannot distinguish between latent infection and active tuberculosis (TB) disease, and should not be used as a sole method for diagnosis of active TB, which is a microbiological diagnosis. A positive IGRA result may not necessarily indicate TB infection, but can also be caused by infection with non-tuberculous mycobacteria. A negative IGRA does not rule out active TB disease; a number of studies have shown that up to a quarter of patients with active TB have negative IGRA results. Because IGRAs are not affected by Bacille Calmette-Guérin (BCG) vaccination status, IGRAs are useful for evaluation of LTBI in BCG-vaccinated individuals, particularly in settings where BCG vaccination is administered after infancy or multiple (booster) BCG vaccinations are given. In ...

Introduction. Screening for latent tuberculosis infection (LTBI) prior to the prescribing of anti-TNF agents and monitoring for infection during treatment are recommended. Aims. We assessed the efficacy of serial interferon-gamma release assays (IGRAs) for the diagnosis and monitoring of latent tuberculosis infection (LTBI) in patients receiving immunosuppressive agents for treatment of rheumatic diseases, in an endemic area. Methods. We conducted a prospective study on patient candidates to biologic agents. QuantiFERON-TB Gold In-Tube (QFT-GIT) was performed at baseline and after 3 and 6 months since biologic onset. A further follow-up period of 6 months was observed. Results. Among patients enrolled (n = 66, F = 57.6%), 13 (19.7%) had at least 1 risk factor for LTBI. Fifty-three were taking immunosuppressants at the time of TB testing. At baseline, 16 (24.2%) patients displayed positive, 43 (65.2%) negative, and 7 (10.6%) indeterminate QFT-GIT results.69.7% (n=46) pacients showed consistent ...

This study evaluated two commercial IGRAs in patients with chronic inflammatory arthritis who were undergoing conventional screening for LTBI before starting anti-TNFα therapy. Less than 10% of the patients in this study had a positive IGRA result, which is consistent with previous reports.46 47 In contrast, a positive TST ,5 mm was seen in 18% of patients, 20% had a positive risk history, and 20% had a CXR that was consistent with previous TB infection. In all, 38% of patients had at least one positive conventional risk factor for LTBI. Statistically significant associations were seen between each IGRA and both TST and risk history. Interestingly, in multivariate analysis the association between the T-SPOT.TB assay and risk history was shown to be independent of the other study variables. Owing to the relatively small sample sizes, multivariate analysis of the QuantiFERON-TB Gold results was not appropriate. This study suggested that a positive IGRA result was significantly associated with ...

I am a 30 years old female and have been planning a baby for the last one year but did not succeed. My husbands and my fertility tests have yielded normal results. Recently, I got an interferon gamma release assay (IGRA), which tested positive for latent Tuberculosis. My gynecologist asked me get a chest X-ray, a transvaginal scan and other ultrasounds done, which were all normal. She asked me to go for an endometrial biopsy, which I was not willing to undergo. I have also got my fallopian tube imaging done and it is all clear and normal. Now, I have been put on anti-TB medication for six months. I have finished one month of these medicines and also got a liver test done to see if the medicines were not adversely affecting the liver and the test results were fine and within reference range. My concern is that can latent TB be a cause of infertility and will this treatment help?

Dr. Lloyd Friedman recently published the results of a multicenter trial investigating the incidence of reversion of latent tuberculosis infection through the use of skin tests and interferon gamma release assays. He has been following a cohort of welfare patients in New York to assess the incidence of tuberculosis, AIDS, and death. His major focus currently is an experimental project on the association of a tuberculosis and asthma. His critical care efforts include participation as a study site principal investigator in a recently reported study on the use of drotrecogin alpha (activated) in early sepsis. He also has an interest in the improvement of medical care through the use of electronic medical records.. Specialized Terms: tuberculosis; AIDS; ...

IGRA Workgroup Workgroup Purpose As interferon gamma release assay (IGRA) testing has been introduced in the United States over the past decade and a half, we

Want a better test for TB infection?. Then you want a TB blood test! The TB blood test is more specific than a TB skin test (less likely to cause a false positive) and it requires only one visit, while a TB skin test requires several visits (four visits over a 10 to 21 day period for a two-step test).. TB blood tests (also called interferon-gamma release assays or IGRAs) measure how the immune system reacts to the bacteria that cause TB. An IGRA is a laboratory test that measures how strongly a persons immune system reacts to TB bacteria.. Two IGRAs are approved by the U.S. Food and Drug Administration (FDA) and are available in the United States: ...

Prior to the development of interferon-gamma release assays (IGRA), the tuberculin skin test (TST) was the only test available for identifying an immune response to infection with tuberculosis.

TST and IGRAs are markers of a contact of the immune system with tubercle bacilli. In a TB endemic area, a high ELISPOT response may reflect increased bacterial replication that may subsequently be associated with development of TB disease and may have a prognostic value. Further longitudinal data a …

In June 2019, Par Pharmaceutical Companies, Inc. reported that Tuberculin, Purified Protein Derivative Aplisol® was expected to be in limited supply for 3-10 months. The CDC had not modified its recommendations for baseline TB testing due to the shortage. However, serial TB testing schedules were recommended to be modified in settings with a low likelihood of TB exposure. The shortage has since been resolved. Normal TB testing schedules may be resumed without the need to substitute Tubersol® or an interferon-gamma release assay (IGRA) blood test.. ...

Definition of Serotonin Release Assay in the Financial Dictionary - by Free online English dictionary and encyclopedia. What is Serotonin Release Assay? Meaning of Serotonin Release Assay as a finance term. What does Serotonin Release Assay mean in finance?

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Latent tuberculosis infection (LTBI) is a noncommunicable, asymptomatic condition that persists for many years in individuals and may progress to active tuberculosis disease, particularly in immunosuppressed patients. The primary goal for diagnosis of LTBI is to initiate medical treatment in order to prevent progression to active disease. Historically, detection of LTBI has been done using the tuberculin skin test (TST). The TST has certain limitations however, including subjective interpretation, limited sensitivity in immunosuppressed patients, and the possibility of false-positive results in individuals who have received the bacille Calmett-Guerin (BCG) vaccine or are infected with other mycobacteria.. The QuantiFERON-TB Gold Plus (QFT-Plus) test is an interferon (IFN)-gamma release assay (IGRA), which assesses the cell-mediated immune response to 2 Mycobacterium tuberculosis complex antigens, ESAT-6 and CFP-10, by measuring IFN-gamma levels in plasma. These 2 proteins are absent from all BCG ...

Tuberculosis (TB) has recently surpassed HIV as the primary infectious disease killer worldwide, but the two diseases continue to display lethal synergy. The burden of TB is disproportionately borne by people living with HIV, particularly where HIV and poverty coexist. The impact of these diseases on one another is bidirectional, with HIV increasing risk of TB infection and disease progression and TB slowing CD4 recovery and increasing progression to AIDS and death among the HIV infected. Both antiretroviral therapy (ART) and latent TB infection (LTBI) treatment mitigate the impact of coinfection, and ART is now recommended for HIV-infected patients independent of CD4 count. LTBI screening should be performed for all HIV-positive people at the time of diagnosis, when their CD4 count rises above 200, and yearly if there is repeated exposure. Tuberculin skin tests (TSTs) may perform better with serial testing than interferon gamma release assays (IGRAs). Any patient with HIV and a TST induration of ≥5

IJERPH, Vol. 17, Pages 581: Risk of Occupational Latent Tuberculosis Infection among Health Personnel Measured by Interferon-Gamma Release Assays in Low Incidence Countries-A Systematic Review and Meta-Analysis International Journal of Environmental Research and Public Health doi: 10.3390/ijerph17020581 Authors: Claudia Peters Agnessa Kozak Albert Nienhaus Anja Schablon Healthc...

The tuberculin skin test has a long and venerable history as the screening test of choice for latent tuberculosis infection in the United States. A 2009 AFP article called it the most acceptable method of tuberculosis screening. However, the tuberculin skin test has limitations: it requires 2 patient visits, and may be difficult to interpret in persons from other countries that have received bacille Calmette-Guerin (BGC) vaccinations. In contrast, interferon-gamma release assays (IGRAs) performed on blood samples require only a single patient visit, do not cross-react with BCG, and according to a recent systematic review, have comparable specificity to TSTs. The Centers for Disease Control and Prevention now recommends that IGRAs be the preferred test for patients with prior BCG vaccinations and those who are unlikely to return for a TST reading (e.g. homeless persons). But why not go one step further and abandon the tuberculin skin test entirely ...

The scientific basis of drug treatment for both active tuberculosis (TB) disease and TB infection, has been established, with treatment in children being largely extrapolated from adult active disease trials. It is essential that active TB disease is excluded before asymptomatic TB infection is diagnosed and treated. Nearly half of all children with active TB disease are found as asymptomatic tuberculin, or interferon gamma release assay (IGRA), positive contacts on screening by local TB services, usually of sputum TB microscopy positive adult relatives or other index cases, but with evidence of lung infiltrate or mediastinal lymphadenopathy on the childs chest x-ray. New drug regimens for both active disease and latent infection are in development, and also some novel drugs. However, none of these have yet been tested in children, and so again data will need to be extrapolated from adult results. In addition, there are issues regarding pharmacokinetics and dosing for current drugs, ...

A insuficiência suprarrenal primária (ISRP) é relativamente rara na infância e adolescência.. Apresenta‐se o caso de um adolescente, com 16 anos, internado por dor abdominal, astenia, perda de peso, náuseas, vómitos ocasionais, tonturas e hiponatremia/hipercaliemia, com história de tuberculose pulmonar no pai há 15 anos. Ao exame objetivo tinha hiperpigmentação da pele e mucosas, hipotensão postural e aspeto emagrecido sem sinais de desidratação. O estudo analítico confirmou o diagnóstico de ISRP. A avaliação imagiológica em conjunto com o teste tuberculínico e os testes interferon‐gamma release assay (IGRA) sugeriram um processso crónico de origem tuberculosa.. O diagnóstico de insuficiência suprarrenal, embora relativamente simples, só é possível se o médico mantiver um elevado índice de suspeição. A tuberculose, sendo uma causa rara nos países desenvolvidos, não pode ser esquecida na população portuguesa.. ...

Reactivation of latent tuberculosis infection (LTBI) is well recognized as an adverse event associated with anti-tumor necrosis factor-α (anti-TNF-α) therapy. The strengths and weaknesses of current techniques for detecting LTBI in patients with chronic inflammatory diseases such as rheumatoid arthritis (RA) and psoriasis have not been fully examined. T cell hyporesponsiveness due to immunosuppression caused by illness or drugs, referred to as anergy, may produce false-negative tuberculin skin test (TST) and interferon-γ release assay (IGRA) results. The literature suggests that anergy may influence screening performance of TST and IGRA tests in candidates for anti-TNF-α therapy. Conversely, the potential for false-positive TST and IGRA results must be considered, as treatment for LTBI may be associated with significant morbidity. This review examines the reliability issues related to LTBI diagnostic testing and provides practical direction to help prevent LTBI reactivation and facilitate ...

Chiappini E, Fossi F, Bonsignori F, Sollai S, Galli L, de Martino M, 2012. Utility of interferon-gamma release assay results to monitor anti-tubercular treatment in adults and children. Clin Ther 34: 1041-1048 ...

This is the first three-way assessment of different screening methods for LTBI in recent immigrants which provides comparative estimates of test performance and positivity stratified by demographic factors and risk factors for LTBI. Consequently we have been able to evaluate, using a decision-analysis model, the cost effectiveness of screening with port-of-arrival CXRs and for LTBI. Our analysis reveals that UK policy could be modified by removing the current requirement for CXR on arrival and concentrating on LTBI testing using single-step IGRA testing targeted at adult immigrants arriving from countries with moderate TB incidence (rather than from countries with TB incidence ,40/100 000 as recommended currently).10 In this cohort the proportion positive by TST (30.3%; 36.7% with 10 mm cut-off) was significantly higher than with QFN-GIT (16.6%) or T-SPOT.TB (22.5%). Previous studies have assessed LTBI prevalence in immigrants with TST and found that positivity varies from 26% to 72% depending ...

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On 3/14/19 7:20 PM, Petr Vorel wrote: , Hi Alexey, , ,,,,, Since we have the information about the device, enable the ,,,,, usage of the option, when starting netstress. , ,,,,, It can be disabled with TST_NETLOAD_BINDTODEVICE=0. , ,,, Having any reason not to push this patch? , , ,, Yes, at least this patch breaks mpls and ipsec/vti tests. , Right, all but mpls01 are broken, havent noticed this. , Any idea why? mpls01 just creates/deletes routes, checks options - its not using tst_netload(). , , Kind regards, , Petr , ...