Dijagnostička vrijednost interferona gama iz limfocita djece mlađe od pet godina s latentnom tuberkuloznom infekcijom [Diagnostic value of interferon gamma from lymphocytes of children under five years with latent tuberculosis infection]

Pavić, Ivan (2013) Dijagnostička vrijednost interferona gama iz limfocita djece mlađe od pet godina s latentnom tuberkuloznom infekcijom [Diagnostic value of interferon gamma from lymphocytes of children under five years with latent tuberculosis infection]. PhD thesis, Sveučilište u Zagrebu.

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Abstract

Background: Determination of concentration of IFN-γ released from T lymphocytes upon stimulation with M. tuberculosis-specific antigens allows testing of cellular immune response in immunocompentent children who are infected with M. tuberculosis because of exposure to a case of active TB. ----- Aims: 1) to assess the influence of epidemiological factors on the concentration of IFN-γ, 2) to assess the influence of infectivity of adult source case on the occurrence of LTBI, 3) to investigate the impact of age on results of IFN-γ, and 4) to determine the agreement between IFN-γ and TST results. ----- Subjects and methods: We investigated children who had received compulsory BCG vaccination at birth because of history of exposure to a case of TB. TST was performed with two tuberculin units of standardized purified protein derivative (PPD) solution (Tuberculin PPD RT 23, Statens Serum Institute, Copenhagen, Denmark) by Mantoux method and transverse induration was measured 72 hours later. IFN-γ, using a commercial QuantiFERON-TB Gold In Tube test (Cellestis Ltd., Carnegie, Australia) was measured by ELISA method after the stimulation of T lymphocytes with M. tuberculosis-specific antigens (ESAT-6, CFP-10 and TB7.7). ----- Results: The results of the study demonstrate that the presence of cavitary lesions in adult source case, close contact with adult source case, AFB smear positivity status and positive culture status were associated with occurrence of LTBI in children. There was no evidence of age having impact on the concentration of IFN-γ. A moderate concordance between TST and IFN-γ was confirmed (85%, κ = 0,588). ----- Conclusion: Determination of IFN-γ may contribute to more precise diagnosis of LTBI in immunocompetent children less than five years of age, especially in children with discordant TST and IFN-γ results.

Abstract in Croatian

Uvod: Određivanje koncentracije IFN-γ nakon stimulacije limfocita s antigenima mikobakterija tuberkuloze omogućuje ispitivanje staničnog imunološkog odgovora u imunokompetentne djece koja su zbog bliskog kontakta s odraslom oboljelom osobom, inficirane s M. tuberculosis. ----- Ciljevi: 1. odrediti utjecaj epidemioloških čimbenika na koncentraciju IFN-g, 2. ispitati utjecaj rizika infektivnih indikatora na pojavu pojavu latentne tuberkulozne infekcije (LTBI), 3. odrediti utjecaj dobi na koncentraciju IFN-γ, te 4. odrediti podudarnost nalaza IFN-γ i rezultata TST-a. ----- Materijal i metode: Uključena su BCG-irana djeca u dobi do 5 godina, koja su zbog kontakta s bolesnikom oboljelim od tuberkuloze bila upućena radi otkrivanja LTBI-a. Tuberkulinski kožni test proveden je s 2 jedinice standardizirane otopine PPD-a (Tuberkulin PPD RT23, Statens Serum Institute, Copenhagen, Danska) metodom Mantouxa, a veličina induracije očitavala se nakon 72 sata. Koncentracija IFN-γ izmjerena je metodom ELISA nakon inkubacije limfocita s antigenima mikobakterija tuberkuloze (peptidi ESAT-6, CFP-10 i TB7.7). Primijenjena je metoda QuantiFERON-TB Gold In Tube (Cellestis Ltd., Carnegie, Australija). ----- Rezultati: Na pojavu LTBI utjecali su: bliski kontakt s tuberkuloznim bolesnikom, nalaz kaverni u radiogramu pluća, nalaz acidorezistentnih bacila i nalaz mikobakterija tuberkuloze u biološkim uzorcima odraslih osoba iz kontakta s ispitivanom djecom. Koncentracija IFN-γ nije ovisila o dobi djece. Ukupna sukladnost TST-a i IFN-γ postojala je u 85% djece (koeficijent sukladnosti, κ = 0,588). ----- Zaključak: Određivanje koncentracije IFN-γ može doprinijeti preciznijoj dijagnostici LTBI u imunokompetentne djece mlađe od pet godina, poglavito u djece s nesukladnim rezultatima TST-a i IFN-γ.

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