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Diagnostic usefulness of a T-cell-based assay for extrapulmonary tuberculosis in immunocompromised patients

Cited 64 time in Web of Science Cited 72 time in Scopus
Authors
Kim, Sung-Han; Song, Kyoung-Ho; Choi, Su-Jin; Kim, Hong-Bin; Kim, Nam-Joong; Oh, Myoung-don; Choe, Kang-Won
Issue Date
2009-02-03
Publisher
Elsevier
Citation
Am J Med. 2009 Feb;122(2):189-95.
Keywords
AdultAntigens, Bacterial/immunologyBacterial Proteins/immunology*Enzyme-Linked Immunosorbent AssayFemaleHumans*Immunocompromised HostInterferon-gamma/metabolismMaleMiddle AgedPredictive Value of TestsSensitivity and SpecificityT-Lymphocytes/*immunologyTuberculin TestTuberculosis/*diagnosis/immunology
Abstract
BACKGROUND: The low reactivity of the tuberculin skin test limits its clinical use in immunocompromised patients with extrapulmonary tuberculosis. A recently developed T-cell-based assay for diagnosing tuberculosis infection gave promising results. However, there were few data on the usefulness of this assay for diagnosing extrapulmonary tuberculosis in immunocompromised patients. METHODS: All adult patients with suspected extrapulmonary tuberculosis were prospectively enrolled at 2 university-affiliated hospitals over an 18-month period. In addition to the conventional tests for diagnosing extrapulmonary tuberculosis, enzyme-linked immunospot (ELISPOT) assay for the interferon-gamma-producing T-cell response to early secretory antigenic target-6 and culture filtrate protein-10 was performed. The final diagnoses in patients with suspected extrapulmonary tuberculosis were classified by clinical category. RESULTS: There were 179 patients with suspected extrapulmonary tuberculosis enrolled: 59 (33%) were classified as immunocompromised. Of the 179 patients, 75 (42%) were classified as extrapulmonary tuberculosis, including 56 confirmed tuberculosis plus 19 probable tuberculosis, and 97 (54%) were classified as not tuberculosis. The remaining 7 (4%) had possible tuberculosis and were excluded from the final analysis. The tuberculin skin test (induration size >or=10 mm) was less sensitive in immunocompromised patients (38%; 95% confidence interval [CI], 19%-59%) than in immunocompetent patients (69%; 95% CI, 54%-81%, P=.01). In contrast, the ELISPOT assay retained a high sensitivity: (88%; 95% CI, 68%-97%) in immunocompromised patients compared with 96% (95% CI, 87%-100%) in immunocompetent patients (P=.32). CONCLUSION: The immunosuppressive condition does not affect the diagnostic sensitivity of the ELISPOT assay for extrapulmonary tuberculosis.
ISSN
1555-7162 (Electronic)
Language
English
URI
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19185094

http://www.sciencedirect.com/science?_ob=MImg&_imagekey=B6TDC-4VG98GH-J-1&_cdi=5195&_user=168665&_orig=search&_coverDate=02%2F28%2F2009&_sk=998779997&view=c&wchp=dGLzVlz-zSkWz&md5=c30c37ae87947c9a197058e6f70b11f9&ie=/sdarticle.pdf

http://hdl.handle.net/10371/45949
DOI
https://doi.org/10.1016/j.amjmed.2008.07.028
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College of Medicine/School of Medicine (의과대학/대학원)Internal Medicine (내과학전공)Journal Papers (저널논문_내과학전공)
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