Response to selected RD1 peptides in Ugandan HIV-infected patients with smear positive pulmonary tuberculosis: a pilot study-0

Cate individuals with tuberculosis (TB patients) and unshaded symbols indicate individuals without tuberculosis (No active TB). Horizontal lines indicate median values. The TB patient group had a significantly higher response to the sum of ESAT-6 and CFP-10 peptides compared with the group without active TB (p = 0.02).<p><b>Copyright information:</b></p><p>Taken from "Response to selected RD1 peptides in Ugandan HIV-infected patients with smear positive pulmonary tuberculosis: a pilot study"</p><p>http://www.biomedcentral.com/1471-2334/8/11</p><p>BMC Infectious Diseases 2008;8():11-11.</p><p>Published online 28 Jan 2008</p><p>PMCID:PMC2267196.</p><p></p

Response to selected RD1 peptides in Ugandan HIV-infected patients with smear positive pulmonary tuberculosis: a pilot study-1

Ming cells (SFCs) per million PBMC for each individual at the time of diagnosis and 6 months after therapy are reported. For 9/12 individuals data are reported also after 3 months of therapy. The p value denotes the difference between the responders in each group.<p><b>Copyright information:</b></p><p>Taken from "Response to selected RD1 peptides in Ugandan HIV-infected patients with smear positive pulmonary tuberculosis: a pilot study"</p><p>http://www.biomedcentral.com/1471-2334/8/11</p><p>BMC Infectious Diseases 2008;8():11-11.</p><p>Published online 28 Jan 2008</p><p>PMCID:PMC2267196.</p><p></p

Distribution of the tuberculin skin test results in the pulmonary tuberculosis patients and controls.

<p>Histogram of the continuous distribution of the tuberculin skin test results in the pulmonary tuberculosis patients (black bar) and controls (white bar): (A) in all included individuals, (B) in those recruited in Zhejiang Province, (C) in those in Heilongjiang Province. <b>Abbreviations:</b> TST: tuberculin skin test; PTB: pulmonary tuberculosis.</p

Diagnostic values of the single test or combined test for active tuberculosis assessed in the PTB patients and healthy community controls.

<p><b>Footnotes</b>: PTB: pulmonary tuberculosis; <b>SM</b>: smear microscopy; <b>QFT</b>: QuantiFERON-TB G In-tube; <b>TST</b>: tuberculin skin test (cut-off point); % Sensitivity: percentage of positive, calculated with available SM, QFT-GIT and TST results; 95% CI: Confidence interval; % Specificity: percentage of negative, calculated with available SM, QFT and TST results; <b>PPV</b>: positive predictive value; NPV: negative predictive value; <b>LR1</b>, likelihood ratio for a positive test; <b>LR2</b>, likelihood ratio for a negative test.</p><p>Diagnostic values of the single test or combined test for active tuberculosis assessed in the PTB patients and healthy community controls.</p

QFT-GIT and TST values in pulmonary TB patients stratified by smear microscopy status and in the group of controls.

<p>Individual values of the QFT-GIT (A) and TST diameter (B) in the groups of pulmonary TB patients stratified by smear microscopy status and in the entire group of controls. Horizontal lines represent the median and interquartile range (25%-75%). <b>Abbreviations:</b> IFN: interferon-gamma, TST: tuberculin skin test; QFT-GIT: QuantiFERON TB Gold In-Tube; PTB: pulmonary tuberculosis.</p

QFT-GIT and TST values in the different groups of PTB patients stratified by smear microscopy status.

<p>Individual values of the QFT-GIT (A) and TST diameter (B) in the different groups of PTB patients stratified by smear microscopy grade. Horizontal lines represent the median and interquartile range (25%-75%). <b>Abbreviations:</b> IFN: interferon-gamma, TST: tuberculin skin test; QFT-GIT: QuantiFERON TB Gold In-Tube; PTB: pulmonary tuberculosis; P: positive smear microscopy and their grade (P+ to P++++).</p

Diagnostic Values of the QuantiFERON-TB Gold In-Tube Assay Carried out in China for Diagnosing Pulmonary Tuberculosis

<div><p>Background</p><p>Interferon-release assays (IGRAs) for diagnosing active pulmonary tuberculosis (PTB) are not yet fully validated, particularly in high TB-endemic areas as the People's Republic of China (PRC). The aim of this report was to assess the performance of the QuantiFERON-TB Gold In-tube (QFT-GIT) and tuberculin skin test (TST), in addition to microbiological results, as contributors for diagnosing active PTB in the PRC.</p><p>Methods/Principal Findings</p><p>A total of 300 PTB patients, 41 disease controls (DC) and 59 healthy community controls (HCC) were included prospectively between May 2010 and April 2011 from two provinces of the PRC (Heilongjiang and Zhejiang). The QFT-GIT and TST yielded an overall sensitivity for active TB of 80.9% and 86.2%, and a specificity of 36.6% and 26.8%, respectively. The province of origin and smear microscopy status did not significantly impact the diagnostic values for PTB. However, using the TST with a 10 mm cut-off point, a significantly higher proportion of LTBI was observed in the DC than the HCC (p=0.01). Discordant results between the QFT-GIT and TST were found among 1/3 of the PTB, HCC and DC. Two-thirds of the individuals presented TST-positive/QFT-GIT-negative discordant results. The TST-negative/QFT-GIT-positive result was not associated with age or bacillary load. Cumulative QFT-GIT and TST positive results increased the overall sensitivity (95.9%), but it was associated with a dramatic decrease of the overall specificity (24.8%) leading to a suboptimal PPV (80.1%) and a low NPV (61.1%).</p><p>Conclusions/Significance</p><p>The usefulness of the QFT-GIT to diagnose active TB in high TB-endemic countries remains doubtful because like the TST, the QFT-GIT cannot distinguish between LTBI and active TB. Used as single stand-alone tests, both the QFT-GIT and TST have very limited roles in the diagnosis of active PTB. However, the combined use of SM, the TST and QFT-GIT may allow for the exclusion of ATB.</p></div

Comparison of the QFT-GIT and TST results in the groups of PTB patients stratified by sputum smear microscopy grade.

<p><b>Footnotes</b>: QFT-GIT: QuantiFERON-TB G In-tube; TST: tuberculin skin test; PTB: pulmonary tuberculosis; % Sensitivity: percentage of sensitivity, calculated with available QFT-GIT and TST results; 95%CI: Confidence interval; P: smear-positive with varying grade (+ to ++++).</p><p>one patient with indeterminate QFT-GIT results</p><p>4 patients with no return visits for TST readings</p><p>1 patient with no return visit for a TST reading</p><p>3 patients with no return visits for TST readings</p><p>5 patients with no return visits for TST readings</p><p>4 patients with no return visits for TST readings</p><p>Comparison of the QFT-GIT and TST results in the groups of PTB patients stratified by sputum smear microscopy grade.</p

Agreement and concordance value (Kappa coefficient) of the QFT-GIT and tuberculin skin test, using different cut-off points.

<p><b>Footnotes</b>: QFT-GIT: QuantiFERON-TB G in tube; TST: tuberculin skin test; PTB: pulmonary tuberculosis; Percentages quoted in () are percentages by rows.</p><p>* Fisher’s exact test.</p><p>**: 19 unavailable results (17 patients did not return for TST readings and 2 patients had indeterminate QFT-GIT results).</p><p>Agreement and concordance value (Kappa coefficient) of the QFT-GIT and tuberculin skin test, using different cut-off points.</p

QFT-GIT and TST values in the different groups of PTB patients according to the province of recruitment and stratified by smear microscopy status.

<p>Individual values of the QFT-GIT (A) and TST diameter (B) in the different groups of PTB patients according to the province of recruitment and stratified by smear microscopy status. Horizontal lines represent the median and interquartile range (25%-75%). <b>Abbreviations:</b> IFN: interferon-gamma, TST: tuberculin skin test; QFT-GIT: QuantiFERON TB Gold In- Tube; PTB: pulmonary tuberculosis.</p