Usefulness of the QuantiFERON test for the diagnosis of tubercular uveitis and the predictions of response to antituberculosis treatment

AimsFew studies have evaluated the contribution of QuantiFERON test for the diagnosis of tubercular uveitis in non-endemic countries for tuberculosis (TB). The objective of the present study was to evaluate the value of the QuantiFERON test in a large cohort of patients with uveitis for both the diagnosis of tubercular uveitis and antituberculosis treatment (ATT) response prediction.MethodsA single-centre retrospective study including consecutive adult patients with uveitis who were prescribed a QuantiFERON test between January 2003 and December 2019 was performed. Adjusted ORs (aORs) were calculated between patients with uveitis responding and not responding to ATT according to the Collaborative Ocular Tuberculosis Study (COTS) group diagnostic criteria. Sensitivity (SE), specificity (Sp), and positive and negative predictive values of the QuantiFERON test were calculated.ResultsA total of 1075 patients were included in the study; 178 (16.5%) were found positive using the QuantiFERON test. Among the 178 positive patients, 62 (35%) had a diagnosis of tubercular uveitis according to the updated COTS classification; all received ATT for 6 months; and 44/62 (71%) responded to ATT. A QuantiFERON test value of >2 IU/mL was associated with a greater chance of responding to ATT (aOR=36.7, 95% CI 7.2 to 185.9, p<0.001). The optimal threshold to maximise both Sp and SE for diagnosis of TB uveitis was 4 IU/mL.ConclusionOne-sixth of the patients diagnosed with uveitis had a positive QuantiFERON test. The QuantiFERON threshold with the optimal SE and Sp for the diagnosis of tubercular uveitis was 4 IU/mL.Trial registration numberNCT03863782.

Peritoneal Tuberculosis during Infliximab Treatment in a Patient with Ulcerative Colitis Despite a Negative Quantiferon Test

Infliximab is an IgG1 antitumor necrosis factor monoclonal antibody that is commonly used to treat inflammatory bowel disease (IBD) and other autoimmune disorders. However, it is known to increase the risk of reactivation of latent tuberculosis (LTBI) due to its capability to disrupt TB granulomas. We describe a case of extrapulmonary TB in a patient with ulcerative colitis who was treated with Infliximab after a negative Quantiferon Test. In addition, we report briefly on the current controversy about the appropriateness, interval, and methods for the repeated screening of latent TB in IBD patients that are treated with antitumor necrosis factor alpha (TNF-α) antibodies.

Tuberculosis infection in children with negative reactions to the diaskintest

Variants of the course of tuberculosis infection in 54 children from two to 14 years old, negatively reacting to a sample with an allergen tuberculosis recombinant (Diaskintest) were analyzed. There were 3 groups: 1st – 27 children infected with Mycobacterium tuberculosis (MBT), 50. 0% of cases; 2nd – 16 children with newly diagnosed residual post-tuberculosis changes (OPTI), 29. 6% of cases; 3rd group – 11 patients with active tuberculosis, 20. 4% of cases. Methods of examination: intradermal Mantoux test with 2TE and Diaskintest, according to the testimony of a number of patients in vitro tests: QuantiFERON test (QFT), – SPOT test.TV, multispiral computed tomography, bacteriological, molecular genetic methods of investigation on MBT. The method of mass tuberculin diagnostics revealed 70. 4 ± 8. 8% of children of the 1st group, 93. 8 ± 4. 7% of the 2nd group and 54. 6 ± 15. 0% of children of the 3rd group. The duration of infection with MBT in children was different and was less than 1 year in children of the 1st and 2nd groups – 51. 9 ± 9. 6% and 43. 8 ± 12. 4% of cases, respectively, which was significantly more frequent than in patients of the 3rd group (18. 2 ± 11. 6% of cases). Tuberculosis disease occurred in the form of complicated forms of the primary period-in 45. 5 ± 15. 0 % of cases, uncomplicated forms – in 27. 3 ± 3. 4% of cases, generalized lesions – in 27. 3 ± 13. 4% of cases. Diagnosis of a specific lesion occurred equally in the manifest phases of inflammation: infiltration, infiltration and decay (45. 5 ± 15. 0% of cases), and in the phase of ongoing reverse development (incomplete calcination – in 45. 5 ± 15. 0% of cases), one child had a combination of infiltration and calcination phases (9. 1 ± 8. 7% of cases). Residual posttuberculosis changes in children of group 2 were more often formed in the form of calcifications in the organs of the thoracic cavity – in 87. 5% of cases, in 12. 5 ± 8. 3% of patients OPTI was formed by the formation of seals. Conclusion: in children with negative reactions to the Diaskintest requires individual comprehensive diagnosis of tuberculosis infection.

Prevalence and Risk Factors for Latent Tuberculosis Infection among Healthcare Workers in a Low Incidence Country

Background: Tuberculosis prevention is a major goal in the hospital setting. Because of the possible progression or reactivation of latent disease, the screening of healthcare workers is an important issue in the TB control program. The aim of the study was to assess the prevalence of LTBI (latent tuberculosis infection) and to evaluate the main risk factors related to this condition in a teaching hospital in Italy. Methods: We reviewed the data of a tuberculosis screening conducted on 3622 healthcare professionals in a teaching hospital in Rome. All subjects were evaluated by QuantiFERON test which if positive, was followed by appropriate clinical and diagnostic procedures. Results: Latent Tuberculosis Infection LTBI condition was detected in 2.1% of the cases, most commonly in men. Male gender, higher age class, country of birth and nurse job were statistically related with the positivity to QuantiFERON test. Conclusion: LTBI was relatively uncommon in our population, however, given the potential risk of reactivation and progression to overt disease, the screening of healthcare workers and students is recommended in the hospital of low-incidence countries.

Reisebericht CK Spies – ASSH International Traveling Fellowship 2018

Es ist mir eine außerordentliche Freude und Ehre über mein ASSH (American Society for Surgery of the Hand) Reisestipendium, das von der Deutschen Gesellschaft für Handchirurgie gefördert wurde, zu berichten. Im Rahmen des akademischen weltweiten Austausches erlässt die amerikanische Gesellschaft die Kongressgebühren für den jährlichen Handchirurgenkongress und organisiert Hospitationen, sog. „Observerships“, verteilt über die Vereinigten Staaten in renommierten Abteilungen, die sich auf die Hand spezialisiert haben. Man konnte sich im Vorfeld eine Reiseroute wünschen. Es gab sieben Gruppen mit i. d. R. drei Stipendiaten. Meine Wunschkliniken wurden mir zu meiner Freude zugewiesen. Danach erfolgte die Korrespondenz mit den jeweiligen Institutionen, um die Aufenthalte gründlich zu planen. Man bekam stapelweise Unterlagen zu Datenschutzerklärungen, Verhaltensregeln usw. zugeschickt, die unterschrieben werden mussten. Der Impfschutznachweis war ebenfalls obligatorisch. Dies bedurfte einiger Mühe und Planung, da auch ein TBC-Status mit dem Quantiferon-Test vorgelegt werden musste. Nachdem alles organisiert war, startete der Flieger am fünften September vom Frankfurter Flughafen Richtung Ann Arbor, Michigan. Am folgenden Tag sollten wir uns um 6:30 Uhr am Haupteingang einfinden, wo wir unseren Ausweis mit Lichtbild bekamen. Zu diesem Zeitpunkt traf ich meine Mitreisenden, eine Kollegin aus Spanien und einen Kollegen aus Südkorea, zum ersten Mal. Zusammen ging es dann mit einem Fellow (Arzt in der Weiterbildung zum Handchirurgen und bereits Facharzt für Orthopädie bzw. plastische Chirurgie) zur sog. „Grand Round“ von 7:00 Uhr bis 8:00 Uhr. Ein Forum, in dem Forschergruppen ihre Projekte vor Investoren vorstellen dürfen. Ziel dieses Symposiums ist die Einwerbung von Drittmittel bzw. Planung eines „Start-ups“. Danach trafen wir Professor Kevin Chung, Leiter der Abteilung für Handchirurgie, und verbrachten einen sehr interessanten und lehrreichen Tag im Operationssaal. Wir hatten die Möglichkeit zu einem ungezwungenen Austausch. Aufgrund der juristischen Umstände durften wir in allen Abteilungen lediglich beobachten und nicht assistieren. Wir sahen u. a. einen ECRL-Sehnentransfer auf die FDP 3–5-Sehnen bei komplexer Nervenschädigung nach Crush-Verletzung, eine Neurolyse des Nervus ulnaris in Kombination mit einer Tenolyse der Flexoren nach alter Nervus ulnaris Läsion und auch eine Revision einer sekundär dislozierten distalen Radiusfraktur nach Plattenosteosynthese. Danach trafen wir uns mit dem Ärzteteam in der Abteilungsbibliothek. Wir durften Präsentationen über unsere Forschungsprojekte mit anschließender Diskussion vortragen.