Infection

, Volume 36, Issue 6, pp 510–514

Suttons’s Law: Local Immunodiagnosis of Tuberculosis

Review

Abstract

Recently, important advances have been made in the immunodiagnosis of tuberculosis. New T cell interferon-γ release assays (TIGRA) are more specific and more sensitive than the tuberculin skin test (TST) for the diagnosis of Mycobacterium tuberculosis (MTB) infection. However, like the TST, TIGRA are unable to distinguish between active tuberculosis (TB), latent TB infection (LTBI) and treated TB if performed on blood mononuclear cells alone. In active TB, MTB-specific T cells are actively recruited to the site of infection and can rapidly be identified in extrasanguinous fluids, such as pleural effusions, ascites, cerebrospinal fluid, and in bronchoalveolar lavages. This review summarizes recent findings comparing systemic and local immune responses against MTB. Although bacteriological and histological methods have the highest specificity for TB in terms of diagnosing active TB and the number of TB patients in whom extrapulmonary TIGRAs have been evaluated is still limited, a comparison of local and systemic MTB-specific immune responses is a promising technique to rapidly distinguish active TB from latent MTB infection in routine clinical practice.

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References

  1. 1.
    Thwaites GE, Tran TH: Tuberculous meningitis: many questions, too few answers. Lancet Neurol 2005; 4: 160–170.PubMedGoogle Scholar
  2. 2.
    Quan C, Lu CZ, Qiao J, Xiao BG, Li X: Comparative evaluation of early diagnosis of tuberculous meningitis by different assays. J Clin Microbiol 2006; 44: 3160–3166.PubMedCrossRefGoogle Scholar
  3. 3.
    Kalita J, Misra UK, Ranjan P: Predictors of long-term neurological sequelae of tuberculous meningitis: a multivariate analysis. Eur J Neurol 2007; 14: 33–37.PubMedCrossRefGoogle Scholar
  4. 4.
    Deisenhammer F, Bartos A, Egg R, Gilhus NE, Giovannoni G, Rauer S, et al. Guidelines on routine cerebrospinal fluid analysis. Report from an EFNS task force. Eur J Neurol 2006; 13: 913–922.PubMedCrossRefGoogle Scholar
  5. 5.
    Roos KL: Mycobacterium tuberculosis meningitis and other etiologies of the aseptic meningitis syndrome. Semin Neurol 2000; 20: 329–335.PubMedCrossRefGoogle Scholar
  6. 6.
    Gleissner B, Chamberlain MC: Neoplastic meningitis. Lancet Neurol 2006; 5: 443–452.PubMedCrossRefGoogle Scholar
  7. 7.
    Hooker JA, Muhindi DW, Amayo EO, Mc’ligeyo SO, Bhatt KM, Odhiambo JA: Diagnostic utility of cerebrospinal fluid studies in patients with clinically suspected tuberculous meningitis. Int J Tuberc Lung Dis 2003; 7: 787–796.PubMedGoogle Scholar
  8. 8.
    Thwaites GE, Chau TT, Farrar JJ: Improving the bacteriological diagnosis of tuberculous meningitis. J Clin Microbiol 2004; 42: 378–379.PubMedCrossRefGoogle Scholar
  9. 9.
    Dinnes J, Deeks J, Kunst H, Gibson A, Cummins E, Waugh N, et al. A systematic review of rapid diagnostic tests for the detection of tuberculosis infection. Health Technol Assess 2007; 11: 1–196.PubMedGoogle Scholar
  10. 10.
    Lalvani A, Pathan AA, McShane H, Wilkinson RJ, Latif M, Conlon CP, et al. Rapid detection of Mycobacterium tuberculosis infection by enumeration of antigen-specific T cells. Am J Respir Crit Care Med 2001; 163: 824–828.PubMedGoogle Scholar
  11. 11.
    Richeldi L: An update on the diagnosis of tuberculosis infection. Am J Respir Crit Care Med 2006; 174: 736–742.PubMedCrossRefGoogle Scholar
  12. 12.
    Menzies D, Pai M, Comstock G: Meta-analysis: new tests for the diagnosis of latent tuberculosis infection: areas of uncertainty and recommendations for research. Ann Intern Med 2007; 146: 340–354.PubMedGoogle Scholar
  13. 13.
    Wilkinson KA, Wilkinson RJ, Pathan A, Ewer K, Prakash M, Klenerman P, et al. Ex vivo characterization of early secretory antigenic target 6-specific T cells at sites of active disease in pleural tuberculosis. Clin Infect Dis 2005; 40: 184–187.PubMedCrossRefGoogle Scholar
  14. 14.
    Lange C, Hellmich B, Ernst M, Ehlers S: Rapid immunodiagnosis of tuberculosis in a woman receiving anti-TNF therapy. Nat Clin Pract Rheumatol 2007; 3: 528–534.PubMedCrossRefGoogle Scholar
  15. 15.
    Losi M, Bossink A, Codecasa L, Jafari C, Ernst M, Thijsen S, et al: Use of a T-cell interferon-{gamma} release assay for the diagnosis of tuberculous pleurisy. Eur Respir J 2007; 30: 1173–1179.PubMedCrossRefGoogle Scholar
  16. 16.
    Jafari C, Ernst M, Kalsdorf B, Greinert U, Diel R, Kirsten D, et al. Rapid diagnosis of smear-negative tuberculosis by bronchoalveolar lavage enzyme-linked immunospot. Am J Respir Crit Care Med 2006; 174: 1048–1054.PubMedCrossRefGoogle Scholar
  17. 17.
    Simmons CP, Thwaites GE, Quyen NT, Torok E, Hoang DM, Chau TT, et al: Pretreatment intracerebral and peripheral blood immune responses in Vietnamese adults with tuberculous meningitis: diagnostic value and relationship to disease severity and outcome. J Immunol 2006; 176: 2007–2014.PubMedGoogle Scholar

Copyright information

© Springer 2008

Authors and Affiliations

  1. 1.Division of Clinical Infectious DiseasesResearch Center BorstelBorstelGermany

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