These are described in the Methods section on page 762.
ReviewInterferon-γ assays in the immunodiagnosis of tuberculosis: a systematic review
Section snippets
Search strategy
We searched PubMed (1990 to August, 2004), Embase (1997 to 2003), Web of Science (1990 to 2003), BIOSIS (1990 to 2003), and the Cochrane Library (2003, issue 3). The search terms used included the following: “tuberculosis”,“Mycobacterium tuberculosis”, “tuberculin”, “interferon-gamma”, “cytokines”, “Quantiferon”, “ELISPOT”, “T-cell response”, “ESAT6”, “CFP10”, “interferon gamma assay”, “ELISA”, “accuracy”, “sensitivity”, and “specificity”. We identified additional studies by contacting experts
Results
Of the 1882 citations identified after literature searches, 75 articles met our eligibility criteria.20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94 Table 1 shows only the main clinical questions of interest, and, therefore, includes only a subset
Principal findings
Our review shows that the sensitivity and specificity of interferon-γ assays varies across studies. This may be due to variability in study populations (eg, disease spectrum, treatment, and HIV status), antigens (PPD vs RD1), incubation periods (short vs long), specimens used (whole blood vs PBMCs), assay formats (ELISA vs ELISPOT), and diagnostic cut-off points of the TST and interferon-γ assays. Despite this variability, certain trends are noticeable. In head-to-head comparisons against TST,
Conclusions
Current evidence suggests that interferon-γ assays, particularly those based on cocktails of RD1 antigens, have the potential to become useful diagnostic tools in clinical and public-health settings. Whether this potential can be realised in practice remains to be confirmed in large, well designed trials and long-term follow-up studies. Because interferon-γ assays might cost much more than the TST, cost will be a critical factor in determining the global applicability of this new assay. It will
Search strategy and selection criteria
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