TB/Non-TB Mycobacterial Infections
Diagnostic Study: Enhanced prediction of TB progression with IGRAs compared to tuberculin skin test
27 Apr, 2024 | 18:53h | UTCStudy Design and Population:
This prospective diagnostic study analyzed the predictive accuracy of tuberculosis (TB) tests among 22,020 high-risk participants across 10 US sites from 2012 to 2020. Participants included individuals with close contacts to infectious TB cases, those born in or travelers to high-incidence countries, individuals living with HIV, or belonging to locally prevalent high-risk groups. Testing included two interferon-γ release assays (IGRAs), QuantiFERON-TB Gold In-Tube (QFT-GIT) and SPOT.TB (TSPOT), alongside the traditional tuberculin skin test (TST).
Main Findings:
The study found that both IGRAs, TSPOT and QFT-GIT, showed significantly superior positive predictive value (PPV) for predicting TB disease progression compared to the TST, with PPV ratios of 1.65 (95% CI, 1.35-2.02) and 1.47 (95% CI, 1.22-1.77) respectively. Additionally, when considering a positive TST result, further positive results from either IGRA significantly increased the PPV, emphasizing the enhanced predictive capability of IGRAs over TST alone.
Implications for Practice:
The superior predictive performance of Interferon-γ Release Assays (IGRAs) suggests they should be considered in clinical settings for high-risk populations, if available and feasible, to better identify individuals at increased risk of progressing to active tuberculosis (TB). This enhanced detection capability could guide more targeted preventive treatments, ultimately supporting global efforts toward TB elimination. Clinicians should assess the accessibility and cost-effectiveness of IGRAs to refine decision-making processes in TB prevention strategies, ensuring that the benefits of these advanced diagnostics are balanced against their costs.
Reference (free full-text):
M-A | Exposure to smoke, overcrowding, poor living conditions, and contact with TB cases identified as risk conditions for pediatric TB
24 Jul, 2023 | 12:43h | UTC
M-A | Risk factors for non-tuberculous mycobacterial pulmonary disease
27 Jun, 2023 | 13:27h | UTCCommentary: Comorbid respiratory disease key predictor of NTM-PD – MDedge
M-A | CRP at 5 mg/L cut-off efficient for tuberculosis screening in HIV outpatients
21 Jun, 2023 | 13:30h | UTC
Commentary on Twitter
ERR: C-reactive protein at a 5 mg cut-off and two newly developed clinical prediction models from this study show clinical utility for TB screening among outpatient PLHIV, while the WHO-recommended four-symptom screen showed suboptimal clinical utility https://t.co/msm13KXR0Y pic.twitter.com/O0wS1Xv4da
— ERS publications (@ERSpublications) June 11, 2023
M-A | Residual respiratory disability after successful treatment of pulmonary tuberculosis
2 Jun, 2023 | 12:20h | UTC
USPSTF Statement | Asymptomatic adults at increased risk should be screened for latent TB
5 May, 2023 | 15:34h | UTCEvidence Report: Screening for Latent Tuberculosis Infection in Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force – JAMA
Editorials:
Screening for Latent Tuberculosis Infection – JAMA Network Open
JAMA Patient Page: Screening for Latent Tuberculosis
Author Interview: USPSTF Recommendation: Screening for Latent Tuberculosis Infection in Adults
Brief Review | Management of latent tuberculosis infection
5 May, 2023 | 15:32h | UTCManagement of Latent Tuberculosis Infection – JAMA (free for a limited period)
Review | Transforming tuberculosis diagnosis
5 May, 2023 | 15:18h | UTCTransforming tuberculosis diagnosis – Nature Microbiology (if the link is paywalled, try this one)
Commentary on Twitter
Diagnosis is the weakest aspect of tuberculosis care and control. A Comment article in @NatureMicrobiol describes seven critical transitions that can close the diagnostic gap and enable TB programmes worldwide to recover from the pandemic setbacks. ? https://t.co/hZyBmVJfRR pic.twitter.com/NDgXF8O9W5
— Nature Portfolio (@NaturePortfolio) May 2, 2023
Post-tuberculosis lung impairment: systematic review and meta-analysis of spirometry data from 14 621 people
26 Apr, 2023 | 14:11h | UTC
WHO releases first-ever Standard on universal access to rapid TB diagnostics
24 Apr, 2023 | 14:04h | UTCNews Release: WHO releases first-ever Standard on universal access to rapid TB diagnostics – World Health Organization
WHO Standard: Universal access to rapid tuberculosis diagnostics – World Health Organization
Improving cascade outcomes for active TB | A global systematic review and meta-analysis of TB interventions
30 Mar, 2023 | 14:17h | UTC
M-A | The natural history of untreated pulmonary tuberculosis in adults
28 Mar, 2023 | 14:42h | UTCThe natural history of untreated pulmonary tuberculosis in adults: a systematic review and meta-analysis – The Lancet Respiratory Medicine (free registration required)
Commentary from the author on Twitter
Very excited to have this work released into the open on #WorldTBDay in @LancetRespirMed: we used historical data to study the natural history of untreated TB https://t.co/IijrKfs13N @alexsrichards @hanifesmail_tb @Rein_Houben 1/n
— Bianca Sossen (@bianca_sossen) March 24, 2023
SR | Post-tuberculosis sequelae in children and adolescents
27 Mar, 2023 | 13:16h | UTCPost-tuberculosis sequelae in children and adolescents: a systematic review – The Lancet Infectious Diseases (free registration required)
M-A | Completion, safety, and efficacy of tuberculosis preventive treatment regimens containing rifampicin or rifapentine
27 Mar, 2023 | 13:14h | UTCCompletion, safety, and efficacy of tuberculosis preventive treatment regimens containing rifampicin or rifapentine: an individual patient data network meta-analysis – The Lancet Respiratory Medicine (free registration required)
Invited Commentary: Shorter regimens for tuberculosis preventive treatment: piecing together the global implementation jigsaw – The Lancet Respiratory Medicine (free registration required)
Commentary on Twitter
NEW Research—3HP provided an increase in treatment completion vs 4R but was associated with a higher risk of adverse events. The trade-off between completion and safety must be considered when deciding TPT
From Prof Dick Menzies & colleagues#WorldTBDayhttps://t.co/UY7l9OuI03 pic.twitter.com/GoKnu9BXoi
— The Lancet Respiratory Medicine (@LancetRespirMed) March 24, 2023
M-A | Development of treatment-decision algorithms for children evaluated for pulmonary tuberculosis
23 Mar, 2023 | 12:50h | UTCNews Release: New Algorithms Could Improve Pediatric Tuberculosis Diagnosis – Yale School of Public Health
Commentary from the author on Twitter (thread – click for more)
1/ Excited to share our #openaccess work in @LancetChildAdol where we evaluate existing algorithms and develop pragmatic, evidence-based algorithms to support evaluation for #pediatric pulmonary #tuberculosis
Link: https://t.co/tjDkk9xJm2
A summary ?
— Kenneth Gunasekera (@kennyguna) March 16, 2023
Review | Evidence-based approach to diagnosis and management of abdominal tuberculosis
16 Mar, 2023 | 13:17h | UTCEvidence-based approach to diagnosis and management of abdominal tuberculosis – Indian Journal of Gastroenterology (if the link is paywalled, try this one)
Commentary from the author on Twitter
Our review on abdominal tuberculosis, where we summarise all the evidence on gastrointestinal tuberculosis and peritoneal tuberculosis, has been published in @ijg_journal
Great effort by @JhaDayakrishna and @menon_mythilihttps://t.co/spPXILGNw2 pic.twitter.com/SxnGs0n9DE— Vishal Sharma (@drvishal82) March 11, 2023
RCT | An initial 8-week bedaquiline-linezolid regimen shows promise for the treatment of rifampin-susceptible tuberculosis
22 Feb, 2023 | 12:50h | UTCSummary: This randomized trial compared a standard 6-month rifampin-based tuberculosis treatment to a strategy that involved shorter initial treatment with extended therapy for persistent disease, monitoring, and retreatment for relapse. The results showed that the strategy involving an 8-week bedaquiline-linezolid regimen was noninferior to standard treatment for clinical outcomes. The experimental strategy was associated with a shorter total duration of treatment with no evident safety concerns.
Article: Treatment Strategy for Rifampin-Susceptible Tuberculosis – New England Journal of Medicine (link to abstract – $ for full-text)
Commentary: Shorter drug regimen shows promise in TB trial – CIDRAP
Review | Contemporary pharmacotherapies for nontuberculosis mycobacterial infections
17 Feb, 2023 | 13:03h | UTC
Review | Female genital tuberculosis
16 Feb, 2023 | 14:42h | UTCFemale Genital Tuberculosis – Open Forum Infectious Diseases
M-A | Assessing the diagnostic performance of new commercial IGRAs for Mycobacterium tuberculosis infection
24 Jan, 2023 | 14:25h | UTC
Commentary on Twitter
Assessing the diagnostic performance of new commercial IGRAs for Mycobacterium tuberculosis infection: a systematic review and meta-analysis
✅ Just Accepted
? Open Access
? https://t.co/8eO3ugZdfl pic.twitter.com/Fc2AjJyIw9— Clinical Infectious Diseases (@CIDJournal) January 23, 2023
Brief review and algorithm | Management of latent tuberculosis infection
23 Jan, 2023 | 13:35h | UTCManagement of Latent Tuberculosis Infection – JAMA (free for a limited period)
Consensus statement | Use of a 4-month treatment regimen for drug susceptible TB in children with uncomplicated disease
18 Jan, 2023 | 14:25h | UTC
RCT | A 24-week, all-oral regimen for rifampin-resistant tuberculosis
12 Jan, 2023 | 13:27h | UTCA 24-Week, All-Oral Regimen for Rifampin-Resistant Tuberculosis – New England Journal of Medicine
Commentary: Trial results show superiority of shorter, all-oral treatment for drug-resistant TB – CIDRAP
WHO consolidated guidelines on tuberculosis | Drug-resistant tuberculosis treatment, 2022 update
12 Jan, 2023 | 13:30h | UTCSee also:
– WHO consolidated guidelines on tuberculosis: module 1: prevention: tuberculosis preventive treatment
Collection of Cochrane evidence on diagnosing tuberculosis.
1 Dec, 2022 | 13:56h | UTCCollection of Cochrane evidence on diagnosing tuberculosis – Cochrane Library