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Diagn Microbiol Infect Dis. 2015 Sep;83(1):41-5. doi: 10.1016/j.diagmicrobio.2015.05.007. Epub 2015 May 19.

In vitro immunomodulation for enhancing T cell-based diagnosis of Mycobacterium tuberculosis infection.

Author information

1
Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
2
University of California, San Francisco School of Medicine, San Francisco, CA, USA.
3
Clinical Microbiology Laboratory, Stanford University Medical Center, Palo Alto, CA, USA.
4
Hanoi Lung Hospital, Hanoi, Vietnam.
5
Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA.
6
Division of Pulmonary and Critical Care Medicine, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, CA, USA.
7
Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA; Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA; Clinical Microbiology Laboratory, Stanford University Medical Center, Palo Alto, CA, USA.

Abstract

Interferon-gamma release assays have limited sensitivity for detecting latent tuberculosis infection. In this study, we determine if the addition of immunomodulators to the QuantiFERON-TB Gold In-Tube (QFT-GIT) increased test sensitivity without compromising specificity. We prospectively compared QFT-GIT results with and without incubation with 2 immunomodulators (lipopolysaccharide [LPS] and polyinosine-polycytidylic acid [PolyIC]) in 2 cohorts-113 culture-confirmed tuberculosis (TB) subjects in Hanoi, Vietnam, and 226 documented QFT-GIT-negative, low TB risk health care workers undergoing annual TB screening at a US academic institution. Sensitivity of the tests in TB subjects was 84.1% with the standard QFT-GIT and 85.8% and 74.3% after incubation with LPS and PolyIC, respectively. Specificity in low TB risk health care workers was 100% with the standard QFT-GIT by design and 86.7% with LPS and 63.3% with PolyIC. In conclusion, use of the 2 immunomodulators did not improve sensitivity of the QFT-GIT in TB patients and reduced specificity in low-risk health care workers.

KEYWORDS:

Interferon gamma release assays; Pathogen associated molecular patterns; Quantiferon; Tuberculosis

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