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Eur Respir J. 2015 Oct;46(4):1095-103. doi: 10.1183/13993003.00263-2015. Epub 2015 Aug 6.

Biomarkers for risk of developing active tuberculosis in contacts of TB patients: a prospective cohort study.

Author information

1
Unité des Mycobactéries, Institut Pasteur de Madagascar, Antananarivo, Madagascar niaina@pasteur.mg.
2
Unité d'Epidémiologie, Institut Pasteur de Madagascar, Antananarivo, Madagascar Unité d'Epidémiologie, Institut Pasteur de Dakar, Dakar, Sénégal.
3
Unité d'Epidémiologie, Institut Pasteur de Dakar, Dakar, Sénégal.
4
Unité de Génétique Mycobactérienne, Institut Pasteur Paris, Paris, France.
5
Staten Serum Institut, Copenhagen, Denmark GlaxoSmithKline, Copenhagen, Denmark.
6
Division of Infection and Immunity, University College London (UCL) and National Institute for Health Research Biomedical Research Centre, UCL Hospital, London, UK The University of Zambia-University College London Medical School (UNZA-UCLMS) Research and Training Project, University Teaching Hospital, Lusaka, Zambia.
7
Unité des Mycobactéries, Institut Pasteur de Madagascar, Antananarivo, Madagascar.

Abstract

Identifying those Mycobacterium tuberculosis latent-infected individuals most at risk of developing active tuberculosis (TB) using routine clinical and laboratory tests remains a huge challenge in TB control efforts. We conducted a prospective longitudinal study of clinical and laboratory markers associated with the risk of developing active TB in contacts with latent M. tuberculosis infection.HIV-negative household contacts (n=296) of pulmonary TB patients underwent monitoring of clinical features, full blood cell counts, tuberculin skin text (TST) and chest radiography performed regularly during 18 months of follow-up. Paired statistical tests, a Kaplan-Meier analysis and Cox proportional hazard modelling were performed on variables between contacts progressing or not progressing to active TB.The appearance of TB disease symptoms in contacts was significantly associated with an elevated peripheral percentage of blood monocytes (adjusted hazard ratio (aHR) 6.25, 95% CI 1.63-23.95; p<0.01), a ≥14 mm TST response (aHR 5.72, 95% CI 1.22-26.80; p=0.03) and an increased monocyte:lymphocyte ratio (aHR 4.97, 95% CI 1.3-18.99; p=0.03). Among contacts having TST ≥14 mm, a strong association with risk of progression to TB was found with an elevated blood monocyte percentage (aHR 8.46, 95% CI 1.74-41.22; p<0.01).Elevated percentage of peripheral blood monocytes plus an elevated TST response are potential biomarkers for identifying contacts of TB patients at highest risk of developing active TB.

PMID:
26250497
DOI:
10.1183/13993003.00263-2015
[Indexed for MEDLINE]
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