Rapid detection of Mycobacterium tuberculosis infection by enumeration of antigen-specific T cells

被引:367
作者
Lalvani, A
Pathan, AA
McShane, H
Wilkinson, RJ
Latif, M
Conlon, CP
Pasvol, G
Hill, AVS
机构
[1] Univ Oxford, John Radcliffe Hosp, Nuffield Dept Clin Med, Oxford OX3 9DU, England
[2] Univ London Imperial Coll Sci Technol & Med, Northwick Pk Hosp, Wellcome Ctr Clin Trop Med, London, England
基金
英国惠康基金;
关键词
D O I
10.1164/ajrccm.163.4.2009100
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
There is no reliable means of detecting latent M. tuberculosis infection, and even in patients with active tuberculosis, infection is often unconfirmed. We hypothesized that M. tuberculosis antigen-specific T cells might reliably indicate infection. We enumerated peripheral blood-derived interferon gamma (IFN-gamma)-secreting T cells responding to epitopes from ESAT-6, an antigen that is highly specific for M. tuberculosis complex but absent from BCC, in four groups of individuals. Forty-five of 47 patients with bacteriologically confirmed tuberculosis had ESAT-6-specific IFN-gamma -secreting T cells, compared with four of 47 patients with nontuberculous illnesses, indicating that these T cells are an accurate marker of M. tuberculosis infection. This assay thus has a sensitivity of 96% (95% confidence interval [CI] 92-100) for detecting M. tuberculosis infection in this patient population. By comparison, of the 26 patients with tuberculosis who had a diagnostic: tuberculin skin test (TST), only 18 (69%) were positive (p = 0.003). In addition, 22 of 26 (85%) TST-positive exposed household contacts had ESAT-6-specific T cells, whereas zero of 26 unexposed BCC-vaccinated subjects responded. This approach enables rapid detection of M. tuberculosis infection in patients with active tuberculosis and in exposed asymptomatic individuals at high risk of latent infection; it also successfully distinguishes between M, tuberculosis infection and BCC vaccination. This capability may facilitate tuberculosis control in nonendemic regions.
引用
收藏
页码:824 / 828
页数:5
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