Rapid Diagnosis of Recurrent Paucibacillary Tuberculosis.

Q1 Medicine

Pathogens and Immunity Pub Date : 2022-01-01 DOI:10.20411/pai.v7i2.565

Claudia Jafari, Ioana D Olaru, Franziska Daduna, Christoph Lange, Barbara Kalsdorf

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Abstract

Introduction: The rapid diagnosis of tuberculosis recurrence can be challenging due to persistently positive detection of Mycobacterium tuberculosis-specific DNA from sputum and bronchopulmonary samples in the absence of active disease.

Methods: We compared the diagnostic accuracy of the detection of M. tuberculosis-specific DNA by either Xpert (January 2010-June 2018) or Xpert Ultra (July 2018-June 2020) and M. tuberculosis-specific ELISPOT in bronchoalveolar lavage (BAL) samples with M. tuberculosis culture results from sputum or bronchopulmonary samples in patients with suspected recurrence of pulmonary tuberculosis.

Results: Among 44 individuals with previous tuberculosis and a presumptive diagnosis of recurrent pulmonary tuberculosis, 4/44 (9.1%) were diagnosed with recurrent tuberculosis by culture. DNA of M. tuberculosis was detected by Xpert in BAL fluid in 1/4 (25%) individuals with recurrent tuberculosis and in 2/40 (5%) cases with past tuberculosis without recurrence, while BAL-ELISPOT with a cut-off of >4,000 early secretory antigenic target-6-specific or culture filtrate protein-10-specific interferon-γ-producing lymphocytes per 1 million BAL-lymphocytes was positive in 4/4 (100%) individuals with recurrent tuberculosis and in 2/40 (5%) cases of past tuberculosis without recurrence.

Conclusion: M. tuberculosis-specific BAL-ELISPOT is more accurate than BAL-Xpert for the diagnosis of paucibacillary tuberculosis recurrence.

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复发性少杆菌结核的快速诊断。

在没有活动性疾病的情况下，由于痰和支气管肺样本中结核分枝杆菌特异性DNA的持续阳性检测，结核病复发的快速诊断可能具有挑战性。方法:我们比较了Xpert(2010年1月- 2018年6月)或Xpert Ultra(2018年7月- 2020年6月)和M. tuberculosis-specific ELISPOT对疑似复发肺结核患者痰液或支气管肺样本中结核分枝杆菌培养结果的支气管肺泡灌洗(BAL)样本检测结核分枝杆菌特异性DNA的诊断准确性。结果:44例推定为肺结核复发的既往结核患者中，4/44(9.1%)通过培养诊断为肺结核复发。在1/4(25%)复发结核患者和2/40(5%)既往无复发结核患者的BAL液中，Xpert检测到结核分枝杆菌的DNA，而BAL- elispot在4/4(100%)复发结核患者和2/40(5%)既往无复发结核患者中，每100万个BAL淋巴细胞中有>4,000个早期分泌抗原靶6特异性或培养滤液蛋白10特异性干扰素γ产生淋巴细胞中检测到阳性。结论:结核分枝杆菌特异性BAL-ELISPOT比BAL-Xpert诊断少杆菌性结核复发更准确。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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