Podcasts about ltbi

El evento se celebra hoy y mañana en el salón de actos Isaac Peral de la facultad de Ciencias de la Empresa. Es de carácter híbrido, presencial y online, y se puede seguir también a través del cana de YouTube de la Universidad Politécnica de Cartagena. El profesor Kahale ha destacado que el Congreso ofrecerá la posibilidad de escuchar experiencias de primera mano, además de debates sobre las dificultades a las se enfrentan las mujeres lesbianas, trans, bisexuales e intersexuales (LTBI) en el ámbito laboral. Algunos aspectos a tratar son: Discriminaciones en el trabajo, incluyendo acoso, violencia y dificultades de acceso a la justicia o ponencias sobre medidas laborales para la igualdad y discriminación por la maternidad.

En torno a los actos del Día para la Eliminación de la Violencia contra la Mujer se celebraron unas jornadas de mujeres lesbianas, trans, bisexuales e intersex en el que se abordaron las múltiples discriminaciones a las que se ven sometidas las mujeres de nuestras comunidades. Hablamos de esas jornadas y sus conclusiones con Leticia Ojeda, coorganizadora del encuentro. Y tenemos recomendación de la semana. El cantautor gallego David Martínez, Mío Corvo es su nombre artístico, ha publicado su primer álbum. Acompañados de su música, vamos a conocerlo mejor.Escuchar audio

Today we speak with Professor Jann-Yuan Wang, a clinician and researcher in Taiwan, about his work in latent tuberculosis. Professor Wang speaks about his experience using 3HP and the challenges of systemic drug reactions. Professor Wang talks about his research into predicting which patients will experience systemic drug reactions based on research algorithms of clinical characteristics, plasma drug levels and transcriptomic factors.REFERENCES:1) Lee, Ming‐Chia, et al. "Isoniazid level and flu‐like symptoms during rifapentine‐based tuberculosis preventive therapy: A population pharmacokinetic analysis." British journal of clinical pharmacology (2022).2) Peng, Tzu-Rong, et al. "Advantages of short-course rifamycin-based regimens for latent tuberculosis infection: an updated network meta-analysis." Journal of Global Antimicrobial Resistance 29 (2022): 378-385.3) Huang, Hung-Ling, et al. "Whole-blood 3-gene Signature as a Decision Aid for Rifapentine-based TB Preventive Therapy." Clinical Infectious Diseases: an Official Publication of the Infectious Diseases Society of America (2022).4) Huang, Hung-Ling, et al. "Impact of age on outcome of rifapentine-based weekly therapy for latent tuberculosis infection." Clinical Infectious Diseases 73.5 (2021): e1064-e1071.5) Lee, Meng-Rui, et al. "Isoniazid concentration and NAT2 genotype predict risk of systemic drug reactions during 3HP for LTBI." Journal of clinical medicine 8.6 (2019): 812.6) Sun, Hsin-Yun, et al. "Twelve-dose weekly rifapentine plus isoniazid for latent tuberculosis infection: A multicentre randomised controlled trial in Taiwan." Tuberculosis 111 (2018): 121-126.7) Lee, Meng-Rui, et al. "Plasma Concentration of Isoniazid and Single-Nucleotide Polymorphisms of N-Acetyltransferase 2 Predict Risk of Systemic Drug Reactions During Weekly Rifapentine and Isoniazid Therapy for Latent Tuberculosis Infection: A Prospective Observational Cohort Study." Available at SSRN 3297903 (2018).

Episode 1: Introduction The first podcast in this three-part series introduces the topic of paediatric tuberculosis (TB) and the concept of latent TB infection (L TBI). Statistics on the risk of progression from LTBI to active TB, as well as the risk of severe TB disease, dissemination, and death in children versus adults are shared.   The publication of these podcasts was funded by QIAGEN.

Episode 87: Latent TB Infection.  By Mariana Gomez, MD (Romulo Gallegos University School of Medicine, Carillion Clinic Infectious Disease), and Hector Arreaza, MD (Romulo Gallegos University School of Medicine, Rio Bravo Family Medicine Residency Program). Dr. Gomez explains how to screen for and treat Latent TB infection. Today is March 18, 2022.Dr. Mariana Gomez graduated from medical school at the Romulo Gallegos University in Venezuela. She completed her residency in Internal Medicine in St Barnabas Hospital, which is affiliated with the Albert Einstein School of Medicine, Bronx, New York. She then completed a fellowship in Infectious Diseases at Carilion Clinic, which is affiliated with Virginia Tech School of Medicine. She currently works in Virginia, United States.  This is Rio Bravo qWeek, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA, and it's sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. Some questions discussed during this episode: Who should be screened for latent TB infection? A CDC questionnaire can determine the risk for latent TB infection. Some patients who may be screened are those who resided for 1 month in a country with high TB prevalence, those who are currently immunosuppressed or planning immunosuppression in the near future (50 mg of prednisone or equivalent a day for 1 month), and those who had close contact with patients with TB infection (Latent Tuberculosis Infection: A Guide for Primary Health Care Providers (cdc.gov)). The USPSTF recommends screening for latent tuberculosis infection (LTBI) in populations at increased risk.Screening Tests: Currently, there are two types of screening tests for LTBI in the United States: the tuberculin skin test (TST, also known as PPD) and the Interferon Gamma Release Assay (IGRA, brand names QuantiFERON®-TB and T-SPOT®.TB). The TST requires intradermal placement of purified protein derivative and interpretation of response 48 to 72 hours later. The induration is measured in millimeters. The induration is the palpable, raised, hardened area or swelling, not the erythema.IGRA requires a single venous blood sample, and the result is obtained in 1-2 days. Two types of IGRAs are currently approved by the US Food and Drug Administration: T-SPOT.TB (Oxford Immunotec Global) and QuantiFERON-TB Gold In-Tube (Qiagen). The CDC recommends screening with either test (TST or IGRA) but not both. IGRAs is preferred for patients who received a BCG vaccine (bacille Calmette–Guérin) or if they are unlikely to return for TST interpretation.Why should we screen for LTBI? How can we decide between Questionnaire only vs PPD vs QuantiFERON Gold? What is the next step in assessing asymptomatic individuals with positive PPD?A useful resource is the online TST/IGRA Interpreter (tstin3d.com). You can calculate the risk of latent TB infection and the risk of INH-induced hepatitis. How can we decide to treat LTBI? What are the recommended regimens? CDC recommends three preferred regimens. These are chosen for effectiveness, safety, and high treatment completion rates. These regimens are rifamycin-based. They are:INH+rifapentine for 3 months: once-weekly isoniazid plus rifapentine for adults and children older than age 2, regardless of HIV status.Rifampin for 4 months: daily rifampin.INH+rifampin for 3 months: daily isoniazid plus rifampin. ____________________________Now we conclude our episode number 86 “Latent TB Infection.” Dr. Gomez taught us how to screen and treat latent TB infections. Remember to screen only those who are at risk of TB infection. Once you get a positive screen test, select the patients who will receive treatment of LTBI to prevent reactivation of TB infection. You have at least 4 regimens to treat LTBI. The regimens that include rifamycin are recommended by the CDC. Even without trying, every night you go to bed being a little wiser.Thanks for listening to Rio Bravo qWeek. If you have any feedback about this podcast, contact us by email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. This podcast was created for educational purposes only. Visit your primary care physician for additional medical advice. This week we thank Hector Arreaza and Mariana Gomez. Audio edition: Suraj Amrutia. See you next week! _____________________References: Latent Tuberculosis Infection: Screening, September 06, 2016,  United States Preventive Services Taskforce, uspreventiveservicestaskforce.org. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/latent-tuberculosis-infection-screening. Lewinsohn, David M., et al, Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention Clinical Practice Guidelines: Diagnosis of Tuberculosis in Adults and Children. Clinical Infectious Diseases, 2017;64(2):e1–e33, Infection Diseases Society of America, https://www.idsociety.org/globalassets/idsa/practice-guidelines/official-american-thoracic-society.infectious-diseases-society-of-america.centers-for-disease-control-and-prevention-clinical-practice-guidelines-diagnosis-of-tuberculosis-in-adults-and-children.pdf.   Sterling TR, Njie G, Zenner D, et al. Guidelines for the Treatment of Latent Tuberculosis Infection: Recommendations from the National Tuberculosis Controllers Association and CDC, 2020. MMWR Recomm Rep 2020;69(No. RR-1):1–11. DOI: http://dx.doi.org/10.15585/mmwr.rr6901a1. The Online TST/IGRA Interpreter, McGill University and McGill University Health Center Montreal Quebec, Canada, http://tstin3d.com/. 

Episode 60: Variety of Topics.  Gabrielle Robinson (MS3) discusses with Dr Arreaza these topics: IsoPSA, 3HP for LTBI, shingles vaccine, and DELC.Introduction: You will hear a conversation between Gabrielle Robinson, a 3rd year medical student, and Hector Arreaza. They discussed 4 articles about topics that are relevant to current clinical practice in family medicine.This is Rio Bravo qWeek, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA, and it's sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home.Variety of Topics. By Gabrielle Robinson, MS3, Ross University School of Medicine, and Hector Arreaza, MD.  The IsoPSA testH: Cleveland Clinic published this article in July 2020[1]. G: According to that article, the IsoPSA test is a new clinically relevant screen for prostate cancer. The data suggests that ISoPSA can potentially decrease unnecessary prostate biopsies by 45%. The IsoPSA evaluates changes in the structure of PSA rather than measuring the concentration of PSA.  G: IsoPSA is meant to be used in patients who are over 50 years old with PSA > 4ng/mL that have not had a previous diagnosis for prostate cancer or are under surveillance.H: Is PSA a bad screening test?G: Measuring the concentration of PSA has proven to be a less sensitive screening tool because PSA is specific for tissues and nonspecific for cancer. This means that a high PSA does not necessarily mean cancer is present.  The PSA can be elevated due to a multitude of reasons including but not limited to prostatitis, benign prostatic hyperplasia, etc.  Unfortunately, this has led to the overdiagnosis of low-grade cancers that were in fact benign conditions. However, PSA is an effective tool for monitoring of recurrence of prostate cancer and it reduces the need for treatment of metastatic disease.H: As a reminder, screening for prostate cancer in asymptomatic individuals by using PSA is a grade D recommendation from the USPSTF. D means “Do not do it!” However, IsoPSA is not included in that recommendation. We'll see if evidence suggests IsoPSA as an alternative in the future.  3HP for latent TB infection treatmentH: This information was published by CDC on June 28, 2018. G: Previously, the treatment for latent TB included 3–9 months of DAILY Isoniazid (INH) or Rifampin (RIF), either alone or combined.  Now, new data according to CDC recommends that INH-RPT (isoniazid-rifaPENtine) treatment once a week for 12 weeks (AKA 3HP regimen) is adequate in controlling the reactivation of latent TB[2].H: RifaPEntine is not Rifampin.G: It is also worth mentioning that this treatment is also approved for patients 2-11 years of age as well as patients who have HIV/AIDS who are currently taking anti-retroviral.H: Currently, the regimens for LTBI treatment are: -Monotherapy with INH for 6-9 months-Monotherapy with Rifampin daily for 4 months-Combinations: INH-Rifampin daily for 3 months (3HR therapy), and INH-RifaPENTINE weekly for 3 months (3HP therapy). Shingles vaccine may reduce risk of strokeG: Why do we think having shingles increases risk of stroke in the first place? The mechanism is not well understood but there is a strong index of suspicion that the inflammation resulting from the outbreak plays a significant role.  H: So, you read a study, a chart review published by the American Heart Association, tell us about it.In this study, patients who received the shingles vaccine (live vaccine) were compared to patient who did NOT receive the vaccine. The results showed that getting the shingles vaccine decreased the risk of stroke by 16%.  The types of strokes that were decreased included hemorrhagic stroke which was decreased by 12% and ischemic stroke that was decreased by 18%.  The age range for which this was most effective is 66 to 79 years of age and is worth mentioning that patients under 80 years of age had a decreased risk in stoke by 20% while the patients over 80 years old were decreased by about 10%[3]. Diagonal Ear Lobe Crease: An Association with CADH: Last week we got this information from Dr Cobos, a Kern Medical hematologist. G: Diagonal Ear Lobe Crease (DELC) also known as Frank's sign, is a crease in the ear lobe that is associated with increased risk of coronary artery disease, peripheral vascular disease, and cerebrovascular disease. Although the pathophysiology of this sign is not yet understood, there has been a grading system set in place that is linked to the incidence of cardiovascular events based on length, depth, bilateralism, and inclination according to Stanford Medicine. The classifications are as follows:Unilateral incomplete – least severeUnilateral completeBilateral complete – Most severe Other classification (not associated with increased cardiovascular events):Grade 1 – wrinklingGrade 2a – Superficial crease (floor of sulcus visible)Grade 2b – crease greater than 50% across earlobeGrade 3 – deep cleft across whole earlobe (floor of sulcus not visible) H: As a curious fact, Steven Spielberg and Mel Gibson have the DELC.  Conclusion: Now we conclude our episode number 60 “Variety of Topics.” Future Dr Robinson presented a summary of four interesting articles she read. She explained that IsoPSA may be an alternative for screening for prostate cancer in the future, and she reminded us of the weekly treatment of latent tuberculosis infection with INH and rifaPENtine (also known as 3HP treatment for LTBI). There was a decrease in stroke risk in patients who received shingles vaccine, according to a study published by the American Heart Association in 2020, and the Diagonal Ear Lobe Crease sign was mentioned as a possible association with cardiovascular risk. Even without trying, every night you go to bed being a little wiser. Thanks for listening to Rio Bravo qWeek. If you have any feedback about this podcast, contact us by email RBresidency@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. This podcast was created with educational purposes only. Visit your primary care physician for additional medical advice. This week we thank Hector Arreaza and Gabrielle Robinson. Audio edition: Suraj Amrutia. See you next week! ____________________________References:  The IsoPSA Test Is Available, and It Could Change the Diagnostic Paradigm for Prostate Cancer, Consult QD, Cleveland Clinic, Jul 7, 2020, https://consultqd.clevelandclinic.org/the-isopsa-test-is-available-and-it-could-change-the-diagnostic-paradigm-for-prostate-cancer/ CDC Releases Updated Recommendations for Treatment of Latent TB Infection, Centers for Disease Control and Prevention, June 28, 2018, https://www.cdc.gov/nchhstp/newsroom/2018/treatment-of-latent-TB-infection.html Shingles vaccine may also reduce stroke risk, American Heart Association, February 12, 2020, https://newsroom.heart.org/news/shingles-vaccine-may-also-reduce-stroke-risk Frank's Sign - Diagonal earlobe crease (DELC), Stanford Medicine 25, July 2, 2015, https://stanfordmedicine25.stanford.edu/blog/archive/2015/what-is-the-name-of-this-sign.html 

TB clinical presentation is complex. This is because TB may involve any tissue or organ, the severity of symptoms range from none to overwhelming, the tempo of the illness ranges from indolent to rapid, symptoms/ findings may be local or systematic, the presentation varies in immunocompromised and diagnostic tests such as TST or IGRA cannot provide an official diagnosis alone. Due to the complexity of TB, clinician's may find difficulty in recognising. TB presentation. Dr Hazel Goldberg provides an insight into understanding TB clinical presentation. Dr Hazel Goldberg is a Respiratory Consultant who runs the Tuberculosis clinic at the Prince of Wales Hospital in Randwick, Sydney. She oversees services which include diagnosing and managing active TB, screening for latent TB infection (LTBI) among health care workers, those exposed to TB, migrants and the immune suppressed and treating LTBI, organising radiology surveillance as well as BCG vaccination service. 

Catch up on the latest guidelines and insights on tuberculosis with help from Dr. Laila Woc-Colburn, @docwoc71 (Baylor)! We cover new recommendations for screening health care workers, treatment of both latent and active TB, and best practices for counseling patients throughout the process. Listen to find out more… And say goodbye to the annual PPD? ACP members can claim CME-MOC credit at https://www.acponline.org/curbsiders (CME goes live at 0900 ET on the episode’s release date).  Full notes https://thecurbsiders.com/episode-list. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Written and Produced by: Hannah R. Abrams Cover Art and Infographic by: Hannah R. Abrams Hosts: Hannah R. Abrams; Matthew Watto MD, FACP Editors: Matthew Watto MD, FACP; Emi Okamoto MD Guest: Laila Woc-Colburn, MD, FACP Partners   Win a prize! Celebrate National Internal Medicine Day and tell us why you’re I.M. Proud. Tell us why you are I.M. Proud and enter the contest by visiting www.acponline.org/improud to submit your story today! Answer one of the three questions below and share your story on social media using the hashtags #IMProud #NationalInternalMedicineDay, and tag @acpinternists. Prizes will be given out 3 times through June of 2020. The first group of winners will be announced on the first ever National Internal Medicine Day October 28, 2019! What makes you proud to practice internal medicine or one of the I.M. subspecialties?  What recent patient experience made you proud to be an internist or subspecialist? How is internal medicine unique from other subspecialties? See us at the CHEST 2019 Annual Meeting in New Orleans! We’ll be doing two live interviews on stage, plus recording two recap episodes to bring you high yield clinical pearls from the conference. Look out for us in our red Curbsiders shirts and say hello. Take a picture with Stuart! Give Paul a hug!  Sunday October 20 3:30-4:30 room 265-   Dr. Quinn Capers - Implicit Bias Monday October 21 7:30-8:30 room 281- Dr. Christine Won - Update in Sleep Medicine Time Stamps 00:00 Sponsor: ACP’s National Internal Medicine Day I.M. Proud Story Contest 00:24 Disclaimer, Intro, Guest bio, Pun 03:51 Guest one-liner, Career Advice; Picks of the Week*: Leonardo Da Vinci by Walter Isaacson; Aditya Shah (@IDdocAdi) antibiotic stewardship on Twitter; @EpicEMRParody on Twitter; Zima is a presumably delicious beverage (we’ve never tried it...ha) 09:52 Sponsor: ACP’s National Internal Medicine Day I.M. Proud Story Contest 11:30 Case of latent TB; Interpretation of PPD (Tuberculin Skin Test) 17:05 PPD and BCG vaccine; Who needs an IGRA? 19:20 LTBI treatment threshold; IGRA explained including what to do with “indeterminate results” 25:22 LTBI natural history; Why endemic countries don’t treat LTBI 30:08 TB infection, immunity and reinfection 33:33 How to counsel patients about latent tuberculosis treatment 38:25 Dietary and alcohol restrictions during LTBI therapy 44:18 Screening of healthcare workers 48:02 Case of active TB; AFB smears and nucleic acid amplification tests 56:05 Initiation of antibiotics for tuberculosis and how to handle TB resistance 58:13 Airborne precautions; Who needs them and how to isolate patients 61:24 Direct observed therapy and why adherence to tuberculosis therapy is challenging 68:11 Tuberculosis UV light and sanatoriums 71:00 Take home points 72:25 Outro *The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on my Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra. Goals Listeners will learn the current standard of care for diagnosis, treatment, and surveillance of tuberculosis. Learning objectives After listening to this episode listeners will…   Recognize updates in tuberculosis screening and treatment guidelines Identify best diagnostic modalities for latent and active tuberculosis Identify best practices for the management of tuberculosis during the diagnostic period Employ treatment algorithms and best practices for latent and active tuberculosis Disclosures Dr. Woc-Colburn reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.  Citation Woc-Colburn L, Abrams HR, Watto MF. “#178 Tuberculosis Updates with Laila Woc-Colburn MD”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list October 21, 2019.

LTBI Podcast Mixdown by Leah Graziano

Solidify your knowledge on latent TB! Quiz yourself on the 5 pearls we will be covering: Who should be screened for latent tuberculosis infection (LTBI)? (1:45) What screening tests are available and how do they differ? (6:30) What are the LTBI treatment options available? (10:24) What are the major adverse drug effects to consider? (13:28) How frequently should you check liver function tests in a patient being treated for LTBI? What do you do with the results? 17:43 Dr. Caplan-Shaw Recap (21:29) For full show notes: https://www.coreimpodcast.com/2018/03/28/5-pearls-latent-tuberculosis-infection/

David McAfee is the esteemed author of the Bachiyr series of vampire novels, starting with his very successful "33 A.D." He is kind enough to stick around the Benbow Inn and talk about vampires, writing, and why Todd Barselow needs serious help. We also added some after show stuff we had sitting around to stretch out the episode and it's quite obvious we did that but screw you, listen. It's charming. Powered by Thirdscribe. Featuring the voice acting of: Forbes West (Author of Time Looter) forbeswestbooks.com Todd Barselow (Editor and Publisher of Auspicious Apparatus Press) http://www.apparatuspress.com/ David McAfee (Author of "33 A.D.") https://mcafeeland.wordpress.com/ Recorded Live at the Benbow Inn, a place of mystery and madness in the realms man forgot and elf-kind never discuss; permanently flooded. Intro Track: Alkaline Technocrat) www.technocratmusic.com Outro Track: I Just Landed In Your Town (Memphis Slim)

Background: Expression patterns of microRNAs in body fluids show potential to be used as noninvasive rapid and accurate biomarkers for various diseases.The study aimed to (i) identify patterns of microRNA signatures for diagnosis of tuberculosis (TB) and (ii) assess significance of a patient’s genetic background on signature composition and diagnostic performance. Patients and Methods: The study enrolled consented participants from Europe and Africa. Circulating miRNAs were measured and compared between patients belonging to the following categories; (i) active pulmonary tuberculosis (PTB), (ii) healthy individuals (H), (iii) active pulmonary TB co-infected with HIV (PTB/HIV), (iv) latent TB infection (LTBI) and (v) other pulmonary infection (OPI). As a first step, pooled sera of 10 participants from each category and region of enrolment were measured by TaqMan low-density arrays. Secondly, the identified significant miRNA signatures were applied to 56 individual sera aiming to discriminate between H and PTB patients. Next, the identified miRNA signatures were analysed for their diagnostic performances using multivariate logistic analysis, and Relevance Vector Machine (RVM). The diagnostic performance of both models was evaluated by a leave-one-out-cross-validation (LOOCV).

This video discusses screening for Latent Tuberculosis Infection (LTBI). It covers targeting testing, high risk groups and testing methods.

This video discusses diagnosing Latent Tuberculosis Infection (LTBI). It discusses treatment regimens, including the new 12-dose regimen, recent guidelines, special circumstances, adverse effects and adherence.

This video discusses diagnosing Latent Tuberculosis Infection (LTBI). It compares TB infection and TB disease, discusses testing methods, including IGRAs, and special circumstances and medical evaluation.

This video discusses diagnosing Latent Tuberculosis Infection (LTBI). It discusses treatment regimens, including the new 12-dose regimen, recent guidelines, special circumstances, adverse effects and adherence.

This video discusses diagnosing Latent Tuberculosis Infection (LTBI). It compares TB infection and TB disease, discusses testing methods, including IGRAs, and special circumstances and medical evaluation.

This video discusses screening for Latent Tuberculosis Infection (LTBI). It covers targeting testing, high risk groups and testing methods.

Einleitung: Zur in-vitro Diagnostik der Tuberkulose (TB) und latenten TB Infektion (LTBI) im Kindesalter werden derzeit zunehmend „Interferon-gamma (IFN-γ) release assays“ (IGRA) verwendet. Die Sensitivität der IGRA insbesondere im Kindesalter ist umstritten. Auch eine diagnostische Unterscheidung zwischen TB und LTBI ist mittels IGRA und anderen bisherigen basierten Testverfahren nicht möglich. In vorangegangen Studien zeigte sich der Biomarker „IFN-γ-inducible-protein-10“ (IP-10) als viel versprechend zur Diagnose der TB und LTBI. Ziele: In der vorliegenden Dissertationsschrift wurden die IP-10-Plasmakonzentrationen von Kindern mit TB, LTBI, Atemwegsinfektion (AWI) oder nicht-tuberkulöse Mykobakterien (NTM)-Erkrankung ohne Stimulation der Proben, nach unspezifischer Mitogen-Stimulation und nach spezifischer Mycobacterium tuberculosis (M. tuberculosis)-Antigen-Stimulation bestimmt. Die Antigen-stimulierten IP-10-Plasmakonzentrationen der TB- und LTBI-Gruppe wurden mit denen der NTM- und AWI-Gruppe verglichen. Darüberhinaus wurde beurteilt, ob eine Unterscheidung zwischen TB und LTBI anhand der IP-10-Plasmakonzentration möglich ist. Außerdem wurde die Konkordanz und Korrelation zwischen dem IP-10-ELISA und QuantiFERON® -TB Gold In-Tube (QFT-IT) Test beurteilt und untersucht, ob der Biomarker IP-10 altersabhängig sezerniert wird. Material & Methoden: 48 Kinder wurden in die Studie eingeschlossen. Das mittlere Alter der Studienteilnehmer war 54 Monate. Alle Studienteilnehmer wurden zuvor in Deutschland entweder mit einer TB (n=11), LTBI (n=14), NTM (n=8) oder AWI (n=15) diagnostiziert. Unabhängig von der vorliegenden Studie wurden bei allen teilnehmenden Kindern IFN-γ-Werte mittels des QFT-IT-Testes bestimmt. Im Rahmen des QFT-IT wurden die für den Test notwendigen Blutproben entweder nicht stimuliert, mit einer unspezifischen Mitogenen-Substanz oder mit spezifischen M.tuberculosis-Antigenen stimuliert. Die jeweiligen Plasma-Überstände wurden asserviert und zur Bestimmung von IP-10 verwendet. Die IP-10-Konzentrationen wurden, in Zusammenarbeit mit dem Klinischen Forschungszentrums der Universität von Kopenhagen, mittels einem zu Forschungszwecken entwickelten ELISAs gemessen. Ergebnisse: Die IP-10-Plasmakonzentrationen ohne Stimulation, mit unspezifischer Mitogen- und spezifischer Antigen-Stimulation betrug für die TB-Gruppe 704 pg/ml, 12.966 pg/ml und 12.702 pg/ml; für die LTBI-Gruppe 366,5 pg/ml, 10.232 pg/ml und 9.109 pg/ml; für die NTM-Gruppe 309 pg/ml, 11.197 pg/ml und 97 pg/ml; und für die AWI-Gruppe 694 pg/ml, 5.401 pg/ml und 84 pg/ml. Es konnte kein signifikanter Unterschied zwischen der IP-10-Konzentration der TB- und LTBI-Gruppe festgestellt werden (p-Wert= 0,24). Die IP-10- und IFN-γ- Plasmakonzentrationen der Kinder mit TB und LTBI korrelierten stark miteinander (rsp=0,65; p-Wert = 0,03 und rsp=0,79; p-Wert < 0,001). Der IP-10-ELISA und QFT-IT Test zeigten ebenso eine hohe Konkordanz (κ =0,96). Die IP-10-Sekretion war 18fach höher im Vergleich zur IFN-γ-Sekretion. Es konnte keine Korrelation zwischen dem Alter und der Mitogen-stimulierten IP-10-Konzentration nachgewiesen werden. Schlussfolgerungen: Die IP-10-Plasmakonzentration von Kindern mit TB und LTBI im Vergleich zu Kindern mit NTM und AWI ist signifikant nach spezifischer M.tuberculosis-Antigen-Stimulation erhöht (p-Wert > 0,001). Die qualitativen und quantitativen Testergebnisse des IP-10-ELISAs korrelieren stark mit denen des QFT-IT-Testes. Im Vergleich zu IFN-γ scheint IP-10 in höheren Konzentrationen und möglicherweise unabhängig vom Alter sezerniert zu werden. Das legt die Vermutung nahe, dass IP-10 zur Diagnose der TB und LTBI im Kindesalter in Zukunft Verwendung finden könnte.

Background: A new generation of diagnostic tests, the interferon-gamma release assays (IGRAs), have been developed for the detection of latent tuberculosis infection (LTBI). Limited data are available on their use in HIV-infected persons. Methods: A cross-sectional study was carried out at 2 HIV clinics in Atlanta to assess the utility of two IGRA tests (T-SPOT. TB [TSPOT] and QuantiFERON-TB Gold in Tube [QFT-3G]) compared to the tuberculin skin test (TST). Results: 336 HIV-infected persons were enrolled. Median CD4 count was 335 cells/mu l and median HIV viral load was 400 copies/ml. Overall, 27 patients (8.0%) had at least 1 positive diagnostic test for LTBI: 7 (2.1%) had a positive TST; 9 (2.7%) a positive QFT-3G; and 14 (4.2%) a positive TSPOT. Agreement between the 3 diagnostic tests was poor: TST and TSPOT, [kappa = 0.16, 95% CI (-0.06, 0.39)], TST and QFT-3G [kappa = 0.23, 95% CI (-0.05, 0.51)], QFT-3G and TSPOT [kappa = 0.06, 95% CI (-0.1, 0.2)]. An indeterminate test result occurred among 6 (1.8%) of QFT-3G and 47 (14%) of TSPOT tests. In multivariate analysis, patients with a CD4 = 200 cells/mu l were significantly more likely to have an indeterminate result [ OR = 3.6, 95% CI (1.9, 6.8)]. Conclusion: We found a low prevalence of LTBI and poor concordance between all 3 diagnostic tests. Indeterminate test results were more likely at CD4 counts