Serial Testing for Tuberculosis Can We Make Sense of T Cell Assay Conversions and Reversions 英文参考文献.docVIP

Perspectives Serial Testing for Tuberculosis: Can We Make Sense of T Cell Assay Conversions and Reversions? Madhukar Pai , Richard O’Brien * Serial Testing for Tuberculosis Linked Research Article Are individuals with strong conversions (i.e., large increases in IFNγ responses over time) at higher risk of progression to active disease than individuals with weak conversions or negative results? (5) Will treatment of individuals with IGRA conversions reduce their risk of progression to active disease? Unfortunately, none of the published studies provide strong evidence on any of these and other key questions (Box 1). For example, there are virtually no data on the reproducibility of IGRAs, particularly with regard to within-subject variability of T cell responses during serial testing [6]. There are limited data on how much In many high-income countries This Perspective discusses the following new study published in PLoS Medicine: Hill PC, Brookes RH, Fox A, Jackson- Sillah D, Jeffries DJ, et al. (2007) Longitudinal assessment of an ELISPOT test for Mycobacterium tuberculosis infection. PLoS Med 4(6): e192. doi:10.1371/journal.pmed.0040192 Philip Hill and colleagues report that both ELISPOT conversion and reversion occur after M. tuberculosis exposure in an endemic country and that the ELISPOT tests results agree poorly with results from the tuberculin skin test. with low rates of tuberculosis (TB), serial testing for latent TB infection (LTBI) is recommended for persons at increased risk of TB exposure. For example, periodic screening of health care workers for LTBI is an important component of nosocomial TB infection control programs. Serial testing is also performed during household contact investigations. However, the conventional tuberculin skin test (TST) has known limitations in accuracy and reliability [1,2]. Furthermore, the interpretation of serial TST results is particularly complicated because of non-speci?c variations in test results, boosting, conversi