Diagnostic value of interferone-γ in tuberculous pleurisy: A metaanalysis
ABSTRACT Conventional tests are not always helpful in making a diagnosis of tuberculous pleurisy. Many studies have investigated the usefulness of interferon (IFN)-gamma measurements in pleural fluid for the early diagnosis of tuberculous pleurisy. We conducted a metaanalysis to determine the accuracy of IFN-gamma measurements in the diagnosis of tuberculous pleurisy.
After a systematic review of English-language studies, sensitivity, specificity, and other measures of accuracy of IFN-gamma concentrations in the diagnosis of pleural effusion were pooled using random-effects models. Summary receiver operating characteristic curves were used to summarize overall test performance.
Twenty-two studies met our inclusion criteria. The summary estimates for IFN-gamma in the diagnosis of tuberculous pleurisy in the studies included were as follows: sensitivity, 0.89 (95% confidence interval [CI], 0.87 to 0.91); specificity, 0.97 (95% CI, 0.96 to 0.98); positive likelihood ratio, 23.45 (95% CI, 17.31 to 31.78); negative likelihood ratio, 0.11 (95% CI, 0.07 to 0.16); and diagnostic odds ratio, 272.7 (95% CI, 147.5 to 504.2).
IFN-gamma determination is a sensitive and specific test for the diagnosis of tuberculous pleurisy. The measurement of IFN-gamma levels in pleural effusions is thus likely to be a useful tool for diagnosing tuberculous pleurisy. The results of IFN-gamma assays should be interpreted in parallel with clinical findings and the results of conventional tests.
- SourceAvailable from: Silvana Gaudieri
Understanding Tuberculosis - Global Experiences and Innovative Approaches to the Diagnosis, 02/2012; , ISBN: 978-953-307-938-7
- "A summary of the main features of current diagnostics for active Mtb infection is given in Table 1. Liquid culture more sensitive than solid cultures and higher turnover rate Biochemical Adenosine deaminase Detection of host enzyme released in response to intracellular pathogen Pleuritis, pericarditis, peritonitis ADA levels in pleural, pericardial and ascitic fluid has high specificity and sensitivity for extrapulmonary Mtb infection Pathogen Nucleic acid amplification tests Detection of Mtb genetic material Pulmonary and extra- pulmonary Variable sensitivity especially in smear -ve and extrapulmonary disease High specificity and positive predictive value Mtb antigens Detection of circulating Mtb antigens Pulmonary and extra- pulmonary Variable sensitivity Quick and relatively easy assay to perform Serological Detection of host humoral response to pathogen Active and latent Mtb disease Inconsistent estimates of sensitivity and specificity Fast turnaround and can be used for children Diagnosis of active tuberculosis Platform/ Target Assays Description Disease/ site Disadvantages Advantages Immuno- logical markers TST Measurement of induration as a result of exposure to intradermal tuberculin BCG vaccinated subjects more likely to be positive Quick and relatively easy assay to perform IGRAs Measurement of interferon gamma released from lymphocytes when stimulated with Mtb antigens Cannot distinguish between latent and active Mtb infection, sensitivity may be lower in HIV+ subjects High specificity and unaffected by previous BCG vaccination References include (Wallis et al., 2010), (Daley et al., 2007; Greco et al., 2003; Mase et al., 2007), (Dinnes et al., 2007), (Jiang et al., 2007), (Flores et al., 2005; Greco et al., 2006; Ling et al., 2008), (Pai et al., 2003; Pai et al., 2004), (Sarmiento et al., 2003; Steingart et al., 2007a; Steingart et al., 2007b; Steingart et al., 2006a; Steingart et al., 2006b), (Pai et al., 2010), (Pai et al., 2008), (Goto et al., 2003; Kalantri et al., 2005), (Liang et al., 2008; Riquelme et al., 2006; Tuon et al., 2006). "
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- "). Our data agree with findings in other studies that the sensitivities of the three tests (62–71%) are lower than those in adults (70–89%) (Jiang et al., 2007; Pai et al., 2008; Diel et al., 2010). The results of the three tests are based on the reaction of the immunological effecter cells. "
ABSTRACT: Although interferon gamma release assays (IGRAs) have been widely used for the diagnosis of latent and active tuberculosis in adults, a relative lack of validation studies in children has led to caution in their clinical interpretation. This meta-analysis systematically evaluated two IGRAs (ELISA and ELISPOT) and the tuberculin skin test (TST). We searched databases (PubMed, MEDLINE, Ovid) between January 2000 and January 2011 using search terms of latent tuberculosis infection or tuberculosis and interferon gamma release assay, or T-SPOT.TB test, or QuantiFERON-TB Gold, or ESAT-6, or CFP-10, and child, or childhood, or pediatrics. We also collected data by performing a manual search of references from relevant articles and communicating with selected authors. The meta-analysis was conducted with random effects models to account for heterogeneity between selected studies. The sensitivities of all three tests in active tuberculosis were similar. The pooled sensitivity was 70% for ELISA studies, 62% for ELISPOT studies and 71% for TST. Calculated sensitivities for IGRAs and the TST differ in culture-confirmed tuberculosis [ELISA (85%) vs. ELISPOT (76%) vs. TST (85%)] and clinical diagnosed cases [ELISA (64%) vs. ELISPOT (58%) vs. TST (66%)]. The pooled specificity was 100% for ELISA and 90% for ELISPOT, but was much lower for TST [56% in all included studies and 49% in children with bacillus Calmette-Guerin (BCG) vaccination]. The agreement between the TST and IGRAs in non-BCG-vaccinated children is higher than that in BCG-vaccinated children. In the diagnosis of active tuberculosis in children, the TST and IGRAs have similar sensitivity. By contrast, the specificity of IGRAs is far greater than the TST, particularly in children with previous BCG vaccination.FEMS Immunology & Medical Microbiology 11/2011; 63(2):165-73. DOI:10.1111/j.1574-695X.2011.00838.x · 2.55 Impact Factor