1921
Volume 75, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

To determine immunologic and epidemiologic correlates of acute infection in household contacts of infectious tuberculosis cases, we performed a prospective, community-based cohort study of index cases and their household contacts in Kampala, Uganda. Contacts were evaluated for tuberculin skin test (TST) conversion over two years. Interferon-γ expression was measured using a whole blood assay after stimulating with culture-filtrate. In 222 contacts with a TST less than 5 mm at baseline, the one-year rate of TST conversion was 27%. The TST conversion was associated with the infectiousness of the index case and proximity of contact. Interferon-γ levels at baseline were greater among TST converters compared with those who did not convert. The risk of TST conversion increased four-fold as the baseline interferon-γ increased 10-fold, but only in contacts with BCG vaccination. In household contacts of tuberculosis, interferon-γ responses to non-specific mycobacterial antigens may be used to make an early diagnosis of tuberculosis infection, especially in resource-limited settings where bacille Calmette-Guérin vaccination is commonly used.

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2006-07-01
2017-09-20
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References

  1. Dye C, Scheele S, Dolin P, Pathania V, Raviglione MC, 1999. Consensus statement. Global burden of tuberculosis: estimated incidence, prevalence, and mortality by country. WHO Global Surveillance and Monitoring Project. JAMA 282 : 677–686.
  2. Chaulk CP, Moore-Rice K, Rizzo R, Chaisson RE, 1995. Eleven years of community-based directly observed therapy for tuberculosis. JAMA 274 : 945–951.
  3. China Tuberculosis Control Collaboration, 2004. The effect of tuberculosis control in China. Lancet 364 : 417–422.
  4. Whalen CC, 2006. Failure of directly observed treatment for tuberculosis in Africa: a call for new approaches. Clinical Infect. Dis. 432 : 1048–1050.
  5. China Tuberculosis Control Program, 1996. Results of directly observed short-course chemotherapy in 112,842 Chinese patients with smear-positive tuberculosis. Lancet 350 : 169–172.
  6. Colditz GA, Brewer TF, Berkey CS, Wilson ME, Burdick E, Fineberg HV, Mosteller F, 1994. Efficacy of BCG vaccine in the prevention of tuberculosis. JAMA 271 : 698–702.
  7. Rodrigues LA, Diwan VK, Wheeler JG, 1993. Protective effect of BCG against tuberculous meningitis and miliary tuberculosis: a meta-analysis. Int J Epidemiol 22 : 1154–1158.
  8. Ferebee SH, Mount FW, 1962. Tuberculosis morbidity in a controlled trial of the prophylactic use of isoniazid among household contacts. Am Rev Respir Dis 85 : 490–521.
  9. Comstock G, 1982. Epidemiology of tuberculosis. Am Rev Respir Dis 125 : 8–15.
  10. Espinal MA, Perez EN, Baez J, Henriquez L, Fernandez K, Lopez M, Olivo P, Reingold AL, 2000. Infectiousness of Mycobacterium tuberculosis in HIV-1-infected patients with tuberculosis: a prospective study. Lancet 355 : 275–280.
  11. Klausner JD, Ryder R, Baende E, Lelo U, Williame J, Ngamboli K, Perriens JH, Kaboto M, Prignot J, 1993. Mycobacterium tuberculosis in household contacts of human immunodeficiency virus type-1 seropositive patients with active pulmonary tuberculosis in Kinshasa, Zaire. J Infect Dis 168 : 106–111.
  12. Reichler MR, Reves RR, Bur S, Thompson V, Mangura B, Ford J, Valway SE, Onorato IM; Contact Investigation Study Group, 2002. Evaluation of investigations conducted to detect and prevent transmission of tuberculosis. JAMA 287 : 991–995.
  13. Lienhardt C, Fielding K, Sillah J, Tunkara A, Donkor S, Manneh K, Warndorff D, McAdam KP, Bennett S, 2003. Risk factors for tuberculosis infection in sub-Saharan Africa: a contact study in The Gambia. Am J Respir Crit Care Med 168 : 448–455.
  14. Bailey WC, Gerald LB, Kimerling ME, Redden D, Brook N, Bruce F, Tang S, Duncan S, Brooks CM, Dunlap ME, 2002. Predictive model to identify positive tuberculosis skin test results during contact investigations. JAMA 287 : 996–1002.
  15. Ewer K, Deeks J, Alvarez L, Bryant G, Waller S, Andersen P, Monk P, Lalvani A, 2003. Comparison of T-cell-based assay with tuberculin skin test for diagnosis of Mycobacterium tuberculosis infection in a school tuberculosis outbreak. Lancet 361 : 1168–1173.
  16. Lalvani A, Pathan AA, Durkan H, Wilkinson KA, Whelan A, Deeks JJ, Reece WH, Latif M, Pasvol G, Hill AV, 2001. Enhanced contact tracing and spatial tracking of Mycobacterium tuberculosis infection by enumeration of antigen-specific T cells. Lancet 357 : 2017–2021.
  17. Hill PC, Brookes RH, Fox A, Fielding K, Jeffries DJ, Jackson-Sillah D, Lugos MD, Owiafe PK, Donkor SA, Hammond AS, Out JK, Corrah T, Adegbola RA, McAdam KP, 2004. Large-scale evaluation of enzyme-linked immunospot assay and skin test for diagnosis of Mycobacterium tuberculosis infection against a gradient of exposure in The Gambia. Clin Infect Dis 38 : 966–973.
  18. Soysal A, Millington KA, Bakir M, Dosanjh D, Aslan Y, Deeks JJ, Efe S, Staveley I, Ewer K, Lalvani A, 2005. Effect of BCG vaccination on risk of Mycobacterium tuberculosis infection in children with household tuberculosis contact: a prospective community-based study. Lancet 366 : 1443–1451.
  19. Fine PE, Bruce J, Ponnighaus JM, Nkhosa P, Harawa A, Vynnycky E, 1999. Tuberculin sensitivity: conversions and reversions in a rural African population. Int J Tuberc Lung Dis 3 : 962–975.
  20. Menzies R, Vissandjee B, Rocher I, St.Germain Y, 1994. The booster effect in two-step tuberculin testing among young adults in Montreal. Ann Intern Med 120 : 190–198.
  21. Gordin FM, Perez-Stable EJ, Reid M, Schecter G, Cosgriff L, Flaherty D, Hopewell PC, 1991. Stability of positive tuberculin tests: are boosted reactions valid? Am Rev Respir Dis 144 : 560–563.
  22. Louther J, Rivera P, Feldman J, Villa N, DeHovitz J, Sepkowitz KA, 1997. Risk of tuberculin conversion according to occupation among health care workers at a New York City hospital. Am J Respir Crit Care Med 156 : 201–205.
  23. Blumberg HM, Sotir M, Erwin M, Bachman R, Shulman JA, 1998. Risk of house staff tuberclin skin test conversion in an area with a high incidence of tuberculosis. Clin Infect Dis 27 : 826–833.
  24. Guwatudde D, Nakakeeto M, Jones-Lopez EC, Maganda A, Chiunda A, Mugerwa RD, Ellner JJ, Bukenya G, Whalen CC, 2003. Tuberculosis in household contacts of infectious cases in Kampala, Uganda. Am J Epidemiol 158 : 887–898.
  25. Centers for Disease Control and Prevention, 2003. Treatment of tuberculosis, American Thoracic Society, CDC, and Infectious Diseases Society of America. MMWR Morb Mortal Wkly Rep 52 : 36–41.
  26. Centers for Disease Control and Prevention, 1998. Prevention and treatment of tuberculosis among patients infected with human immunodeficiency virus: principles of therapy and revised recommendations. MMWR Morb Mortal Wkly Rep 47 : 2–58.
  27. Menzies D, 1999. Interpretation of repeated tuberculin tests. Boosting, conversion, and reversion. Am J Respir Crit Care Med 159 : 15–21.
  28. Hussain R, Kaleem A, Shahid F, Dojki M, Jamil B, Mehmood H, Dawood G, Dockrell HM, 2002. Cytokine profiles using whole-blood assays can discriminate between tuberculosis patients and healthy endemic controls in a BCG-vaccinated population. J Immunol Methods 264 : 95–108.
  29. Zeger SL, Liang KY, Albert PS, 1988. Models for longitudinal data: a generalized estimating equation approach. Biometrics 44 : 1049–1060.
  30. Thompson N, Glassroth J, Snider DE, Farer LS, 1979. The booster phenomenon in serial tuberculin testing. Am Rev Respir Dis 119 : 587–597.
  31. Gordin FM, Perez-Stable EJ, Flaherty D, Reid ME, Schecter G, Joe L, Slutkin G, Hopewell PC, 1988. Evaluation of a third sequential tuberculin skin test in a chronic care population. Am Rev Respir Dis 137 : 153–157.
  32. Nguyen M, Perry S, Parsonnet J, 2005. QuantiFERON-TB predicts tuberculin skin test boosting in U.S. foreign-born. Int J Tuberc Lung Dis 9 : 985–991.
  33. Schlovinck E, Wilkinson KA, Whelan AO, Martineau AR, Levin M, Wilkinson RJ, 2004. Gamma interferon-based immunodiagnosis of tuberculosis: comparison between whole-blood and enzyme-linked immunospot methods. J Clin Microbiol 42 : 829–831.
  34. McShane H, Pathan AA, Sander CR, Keating SM, Gilbert SC, Huygen K, Fletcher HA, Hill AV, 2004. Recombinant modified vaccinia virus Ankara expressing antigen 85A boosts BCG-primed and naturally acquired antimycobacterial immunity in humans. Nat Med 10 : 1240–1244.
  35. Seder RA, Hill AV, 2000. Vaccines against intracellular infections requiring cellular immunity. Nature 406 : 793–798.
  36. Andersen P, Munk ME, Pollock JM, Doherty TM, 2000. Specific immune-based diagnosis of tuberculosis. Lancet 356 : 1099–1104.
  37. Pai M, Riley LW, Colford JM Jr, 2004. Interferon-gamma assays in the immunodiagnosis of tuberculosis: a systematic review. Lancet Infect Dis 4 : 761–776.
  38. Mazurek GH, LoBue PA, Daley CL, Bernardo J, Lardizabal AA, Bishai WR, Iademarco MF, Rothel JS, 2001. Comparison of a whole-blood interferon gamma assay with tuberculin skin testing for detecting latent Mycobacterium tuberculosis infection. JAMA 286 : 1740–1747.
  39. Whalen CC, 2005. New diagnostic tests for latent tuberculosis infection: measure for measure. JAMA 293 : 2785–2787.
  40. Ferebee SH, 1970. Controlled chemoprophylaxis trials in tuberculosis: a general review. Adv Tuberc Res 17 : 28–106.
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  • Received : 22 Sep 2005
  • Accepted : 22 Mar 2006

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