Article Text

other Versions

PDF
Comparison of in vitro-specific blood tests with tuberculin skin test for diagnosis of latent tuberculosis before anti-TNF therapy
  1. Jérémie Sellam (jeremsellam{at}yahoo.fr)
  1. Rhumatologie, Hôpital Bicêtre, Le Kremlin Bicêtre, France
    1. Haifa Hamdi (hayfahamdi{at}hotmail.com)
    1. INSERM UMR-S764, Microbiologie-Immunologie Biologique, Hôpital Antoine Béclère, Clamart, France
      1. Carine Roy (carine.roy{at}bch.aphp.fr)
      1. Epidemiologie, Biostatistique et Recherche Cinique, INSERM U738, Hôpital Bichat, Paris, France
        1. Gabriel Baron (gabriel.baron{at}bch.aphp.fr)
        1. Epidemiologie, Biostatistique et Recherche Cinique, INSERM U738, Hôpital Bichat, Paris, France
          1. Marc Lemann (marc{at}lemann.com)
          1. Gastro-entérologie, Hôpital Saint-Louis, Paris, France
            1. Xavier Puéchal (xpuechal{at}ch-lemans.fr)
            1. Rhumatologie, Centre hospitalier du Mans, Le Mans, France
              1. Maxime Breban (maxime.breban{at}abc.aphp.fr)
              1. Rhumatologie, Hôpital Ambroise Paré, Boulogne, France
                1. Francis Berenbaum (francis.berenbaum{at}sat.aphp.fr)
                1. Rhumatologie, Hôpital Saint-Antoine, Paris, France
                  1. Marc Humbert (marc.humbert{at}abc.aphp.fr)
                  1. Pneumologie, Hôpital Antoine Béclère, Clamart, France
                    1. Karin Weldingh (kwe{at}ssi.dk)
                    1. Infectious Disease and Immunology, Statens Serum Institut, Copenhagen, Denmark
                      1. Dominique Salmon (dominique.salmon{at}cch.aphp.fr)
                      1. Médecine interne et maladies infectieuses, Hôpital Cochin, Paris, France
                        1. Philippe Ravaud (philippe.ravaud{at}bch.aphp.fr)
                        1. Epidemiologie, Biostatistique et Recherche Cinique, INSERM U738, Hôpital Bichat, Paris, France
                          1. Dominique Emilie (emilie{at}ipsc.u-psud.fr)
                          1. INSERM UMR-S764, Microbiologie-Immunologie Biologique, Hôpital Antoine Béclère, Clamart, France
                            1. Xavier Mariette (xavier.mariette{at}bct.aphp.fr)
                            1. Rhumatologie, Hôpital Bicêtre, Le Kremlin Bicêtre, France

                              Abstract

                              Introduction. Latent tuberculosis infection (LTBI) is detected with the tuberculin skin test (TST) before anti-TNF therapy. We aimed to investigate in vitro blood assays with TB-specific antigens (CFP-10, ESAT-6), in immune-mediated inflammatory diseases (IMID) for LTBI screening.

                              Patients and Methods. 68 IMID patients with (n=35) or without (n=33) LTBI according to clinico-radiographic findings or TST results (10 mm cut-off value), underwent cell proliferation assessed by thymidine incorporation and PKH-26 dilution assays, and IFNƒ×-release enzyme-linked immunosorbent spot (ELISPOT) assays with TB-specific antigens.

                              Results. In vitro blood assays gave higher positive results in patients with LTBI than without (p<0.05), with some variations between tests. Among the 13 patients with LTBI diagnosed independently of TST results, 5 had a negative TST (38.5%) and only 2 a negative blood assays result (15.4%). The 5 LTBI patients with negative TST results all had blood assays positive results. Ten patients without LTBI but with intermediate TST results (6-10mm) had no different result than patients with TST result „T 5 mm (p>0.3) and lower results than those with LTBI (p<0.05) on CFP-10+ESAT-6 ELISPOT and CFP-10 proliferation assays.

                              Conclusion. Anti-TB blood assays are beneficial for LTBI diagnosis in IMID. Compared to TST, they show better sensitivity, as seen by positive results in 5 patients with certain LTBI and negative TST, and better specificity, as seen by negative results in most patients with intermediate TST as the only criteria of LTBI. In the absence of clinico-radiographic findings for LTBI, blood assays could replace TST for antibiotherapy decision before anti-TNF.

                              • anti-TNF
                              • anti-tuberculosis blood assays
                              • rheumatic diseases
                              • tuberculin skin test
                              • tuberculosis

                              Statistics from Altmetric.com

                              Request permissions

                              If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.