Abstract
Screening for latent tuberculosis (TB) infection (LTBI) prior to anti-tumor necrosis factor (TNF) therapy is complicated by the decreased sensitivity of the purified protein derivative tuberculin skin test in immunosuppressed patients, as well as the poor specificity of the tuberculin skin test in bacillus Calmette–Guérin (BCG)-vaccinated patients. Interferon-γ-release assays that utilize specific TB antigens (e.g. ESAT-6/CFP-10) have greater specificity for LTBI, but their relative sensitivity is unknown in the setting of immune suppression. Dinser et al. evaluated a novel flow-cytometric interferon-γ detection assay in 97 patients with inflammatory arthritis during LTBI screening for anti-TNF therapy. Overall, 39% of patients had purified protein derivative reactivity in vitro versus 14% cutaneously, and 16% exhibited reactivity in vitro to ESAT-6/CFP-10. The results suggest that flow cytometry using TB-specific antigens might eventually provide another tool for diagnosing LTBI in patients undergoing screening prior to anti-TNF or other immunosuppressive therapies. Further evaluation of the sensitivity and specificity of this novel whole-blood assay is warranted.
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References
Winthrop KL et al. (2005) Tuberculosis associated with therapy against tumor necrosis factor alpha. Arthritis Rheum 52: 2968–2974
Dinser R et al. (2008) Evaluation of latent tuberculosis infection in patients with inflammatory arthropathies before treatment with TNF-alpha blocking drugs using a novel flow-cytometric interferon-gamma release assay. Rheumatology (Oxford) 47: 212–218
Tissot F et al. (2005) Influence of bacille Calmette–Guérin vaccination on size of tuberculin skin test reaction: to what size? Clin Infect Dis 40: 211–217
Menzies D et al. (2007) Meta-analysis: new tests for the diagnosis of latent tuberculosis infection: areas of uncertainty and recommendations for research. Ann Intern Med 146: 340–354
Matulis G et al. (2008) Detection of latent tuberculosis in immunosuppressed patients with autoimmune disease: performance of a Mycobacterium tuberculosis antigen-specific interferon gamma assay. Ann Rheum Dis 67: 84–90
Ponce de Leon D et al. (2008) Comparison of an interferon-gamma assay with tuberculin skin testing for detection of tuberculosis (TB) infection in patients with rheumatoid arthritis in a TB-endemic population. J Rheumatol 35: 1–6
Vassilopoulos D et al. (2008) Usefulness of enzyme-linked immunospot assay (Elispot) compared to tuberculin skin testing for latent tuberculosis screening in rheumatic patients scheduled for anti-tumor necrosis factor treatment. J Rheum 35: 1464
Piana F et al. (2006) Use of a T-cell-based test for detection of tuberculosis infection among immunocompromised patients. Eur Respir J 28: 31–34
Acknowledgements
The authors thank David Lewinsohn MD, PhD for his assistance with this manuscript.
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Winthrop, K., Daley, C. A novel assay for screening patients for latent tuberculosis infection prior to anti-TNF therapy. Nat Rev Rheumatol 4, 456–457 (2008). https://doi.org/10.1038/ncprheum0865
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DOI: https://doi.org/10.1038/ncprheum0865