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

Early diagnosis of subclinical multidrug-resistant tuberculosis.

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



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.


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.


Case report.


Household contact.


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


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


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.


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


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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