Clinical,radiological and molecular diagnosis correlation in serum samples from patients with osteoarticular tuberculosis

Objective:To assess the role of polymerase chain reaction(PCR)in serum sauples,in the diagnosis of osteoarticular tuberculosis(OTB)in a setting where only clinical and imaging diagnoses determine the treatment.Methods:A total of 44 consecutive serum specimens were collected from clinically suspected OTB patients,based on clinical and radiological[X-ray or magnetic resonance imagng/computecl tomography]features.They were scrcened by in-house nested PCR.In addition,a few specimens were examined by Gram stain,acid-fast bacilli stain,histand routine bacterial culture.A total of 39 specimens were collected from patients suffering from other bone diseases of nontuberculous origin and included as negative controls.Results:of the 44 clinically suspected OTB patients,in-house nested PCR was positive in 40(91%)cases;PCR was negative in 38(97%)negative controls.Sensitivity and specificity of our in—house nested PCR was 90.3%and 97.4%,respectively.The PCR report was available within 48 h.It was possible to standardize serum PCR technique and in positive cases,a good n was observed in terms of an adequate treatment response.Conclusions:Nested PCR in serum samples is a rapid,highly sensitive and specific modality for OTB detection,PCR should be performed in addition to clinical evaluation,imaging studies,acidfast bacilli staining,culture and histopathology diagnosis,if possible.

-592 and -1082 interleukin-10 polymorphisms in pulmonary tuberculosis with type 2 diabetes

Objective:To determine the polymorphisms of Interleukin-10(IL-10)(-592,-1082) in pulmonary tuberculosis(PTB)with and without type 2 diabetes(T2D).Methods:We studied a Mexican mestizo population of 37 patients with TB in remission(TBr) and 40 with active pulmonary TB (PTB),21 patients with TB + T2D.47 blood donors accepted,and 13 healthy health-care workers with tuberculin skin lest positive.Determination of IL-10 polymorphisms was performed by real-lime Polymerase chain reaction.Results:IL-10-592C/A presented in a greater proportion in healthy individuals than in patients with type 2 diabetes and TB in a not quite significant statistically manner.IL-10-1082A/A presented more frequently in the group of patients with both diseases,not being statistically significant in comparison with the group of healthy subjects. Conclusions:This study describes two important new findings.First,it reveals that the IL-10 (-592 A/A and -592 C/C) polymorphisms were found in a greater proportion in a group of patients with T2D and TB than in healthy subjects.Second,the study provides evidence that the(-1082 G/G) polymorphism presented with greater frequency in healthy individuals than in patients with both ol these diseases.

在有 HIV/AIDS 和怀疑或潜伏的肺结核感染的病人的干扰素

【正】Objective:To assess the usefulness of IGRA test(QuantiFERON? -Cell mediated immune) compared with the tuberculin skin test.Methods:A cross-sectional study was carried out in Mexico,25 infected patients with HIV-AIDS and the suspicion or with latent tuberculous infection （LTBI） who were】18 years of age and without treatment for tuberculosis（TB）,were enrolled in the study.Results:Median cluster of differentiation（CD4） count was 364 cells/μL and median HIV viral load was 50 copies/mL.Overall,20 patients（80%） had at least one positive diagnostic test for LTBI:four（16%） had a positive tuberculin skin test and 19（76%）,a positive QuantiFERON ? -tuberculosis.Conclusions:No agreement is found between the two diagnostic tests:k = -0.004,95%confidence interval（-0.2219,0.2210）.Additional longitudinal studies among HIV-infected populations with high prevalence of TB are needed to further assess the usefulness of IGRAs in this patient population.

Tuberculosis and hematopoietic stem cell transplant: Review of a difficult and often underestimated problem

Recipients of solid organ transplants(SOT) and stem cell transplants(SCT) constitute a group of patients at risk for tuberculosis(TB) development. The prevalence of active TB in patients undergoing SOT is higher than in patients undergoing SCT, probably due to the shorter period of immunosuppression in the latter. We reviewed the importance of SCT in individuals with hematological malignancies. Most TB cases occur in transplant patients by reactivation of latent infection after immunosuppression, most often within the first year after transplant, leading to graft loss and in some cases, death. Relevant variables to assess the risk of TB infection in a transplant recipient include the donor's and recipient's medical histories, imaging results, microbiology and tuberculin skin test(TST) and interferon-gamma release assays(IGRA). TST is routinely performed in the donor and recipient before transplantation. If TST is > 5 mm in the recipient or > 10 mm in the donor, it is necessary to exclude active TB(pulmonary and renal). Chemopro-phylaxis is recommended in TST(+) recipients and in recipients with recent seroconversion, in donors with a history of untreated TB or in contact with an individual with active TB, if radiological images are suspicious and the IGRA is(+). The drug of choice is isoniazid. These topics are herewith reviewed.