LTBI: latent tuberculosis infection or lasting immune responses to M. tuberculosis? A TBNET consensus statement.
Ulrich Mack,Giovanni Battista Migliori,Martina Sester,Hans L. Rieder,Stefan Ehlers,Delia Goletti,Aik Bossink,Klaus Magdorf,Christoph Hölscher,Beate Kampmann,S. M. Arend,A Detjen,Graham H. Bothamley,Jean-Pierre Zellweger,Heather Milburn,Roland Diel,Pernille Ravn,Frank Cobelens,P J Cardona,B Kan,Ivan Solovic,Raquel Duarte,Daniela Maria Cirillo +22 more
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TLDR
The main issue regarding testing is to restrict it to those who are known to be at higher risk of developing tuberculosis and who are willing to accept preventive chemotherapy, and to identify an adaptive immune response against, but not necessarily a latent infection with, M. tuberculosis.Abstract:
Tuberculosis control relies on the identification and preventive treatment of individuals who are latently infected with Mycobacterium tuberculosis. However, direct identification of latent tuberculosis infection is not possible. The diagnostic tests used to identify individuals latently infected with M. tuberculosis, the in vivo tuberculin skin test and the ex vivo interferon-gamma release assays (IGRAs), are designed to identify an adaptive immune response against, but not necessarily a latent infection with, M. tuberculosis. The proportion of individuals who truly remain infected with M. tuberculosis after tuberculin skin test or IGRA conversion is unknown. It is also uncertain how long adaptive immune responses towards mycobacterial antigens persist in the absence of live mycobacteria. Clinical management and public healthcare policies for preventive chemotherapy against tuberculosis could be improved, if we were to gain a better understanding on M. tuberculosis latency and reactivation. This statement by the TBNET summarises knowledge and limitations of the currently available tests used in adults and children for the diagnosis of latent tuberculosis infection. In summary, the main issue regarding testing is to restrict it to those who are known to be at higher risk of developing tuberculosis and who are willing to accept preventive chemotherapy.read more
Citations
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Journal ArticleDOI
The Immune Response in Tuberculosis
Anne O'Garra,Paul S. Redford,Finlay W. McNab,Chloe I Bloom,Robert J. Wilkinson,Matthew Berry +5 more
TL;DR: What the authors know about the immune response in tuberculosis, in human disease, and in a range of experimental models is summarized, all of which are essential to advancing the mechanistic knowledge base of the host-pathogen interactions that influence disease outcome.
Journal ArticleDOI
Gamma Interferon Release Assays for Detection of Mycobacterium tuberculosis Infection
Madhukar Pai,Claudia M. Denkinger,Claudia M. Denkinger,Sandra V. Kik,Molebogeng X. Rangaka,Alice Zwerling,Olivia Oxlade,John Z. Metcalfe,Adithya Cattamanchi,David W. Dowdy,Keertan Dheda,Niaz Banaei +11 more
TL;DR: To maximize the positive predictive value of existing tests, LTBI screening should be reserved for those who are at sufficiently high risk of progressing to disease and basic research is necessary to identify highly predictive biomarkers.
Journal ArticleDOI
Latent Mycobacterium tuberculosis Infection
TL;DR: The pathogenesis, epidemiology, diagnosis, and treatment of latent tuberculosis infection is reviewed to address critical gaps in the understanding of this complex condition and propose the necessary research agenda.
Journal ArticleDOI
Interferon-γ release assays for the diagnosis of latent Mycobacterium tuberculosis infection: a systematic review and meta-analysis
Roland Diel,Delia Goletti,Giovanni Ferrara,Graham H. Bothamley,Daniela Maria Cirillo,Beate Kampmann,Christoph Lange,Monica Losi,Roumiana Markova,Giovanni Battista Migliori,Albert Nienhaus,Morten Ruhwald,Dirk Wagner,Jean-Pierre Zellweger,Emma Huitric,Andreas Sandgren,Davide Manissero +16 more
TL;DR: IGRAs may have a relative advantage over the TST in detecting LTBI and allow the exclusion of M. tuberculosis infection with higher reliability.
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