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Ann Intern Med. 2004 May 4;140(9):709-13.

Early diagnosis of subclinical multidrug-resistant tuberculosis.

Author information

1
University of Modena and Reggio Emilia and Azienda Ospedaliera Policlinico di Modena, Modena, Italy.

Abstract

BACKGROUND:

Tuberculosis control hinges on prompt diagnosis of active cases and screening of contacts by tuberculin skin testing. Rapid blood tests for Mycobacterium tuberculosis infection are a new alternative to the tuberculin skin test, but whether they improve clinical outcomes is unknown.

OBJECTIVE:

To describe how a novel T-cell-based test for M. tuberculosis infection helped diagnose tuberculosis in an asymptomatic, immunosuppressed adult with a negative result on a tuberculin skin test.

DESIGN:

Case report.

SETTING:

Household contact.

PATIENTS:

Asymptomatic man receiving maintenance azathioprine therapy for Crohn disease whose wife had multidrug-resistant pulmonary tuberculosis.

MEASUREMENTS:

Enzyme-linked immunospot (ELISPOT) assay, computed tomography, and bronchoalveolar lavage cultures.

RESULTS:

The man had a negative tuberculin skin test result and a positive ELISPOT assay result. High-resolution computed tomography of the chest showed consolidation with early cavitation. Bronchoalveolar lavage and culture confirmed multidrug-resistant tuberculosis.

LIMITATIONS:

This single case report is a proof of concept and is not a formal evaluation of clinical utility.

CONCLUSIONS:

A positive ELISPOT assay result helped diagnose subclinical active tuberculosis in an immunosuppressed patient with a false-negative tuberculin skin test result. Large prospective studies that compare benefits and costs of this alternative to tuberculin skin testing are needed.

[Indexed for MEDLINE]

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