European researchers develop test to pinpoint TB

A group of European researchers have developed a test that can diagnose active tuberculosis (TB) in people even when traditional tests have failed. the findings are published in the American Journal of Respiratory and Critical Care Medicine.

The research team, the Tuberculosis Network European Trialsgroup (TBNET), a scientific consortium founded in 2006 to research new methods of TB diagnosis, used the ELISPOT (enzyme-linked immunospot assay) test to develop the new method. they found that immune cells that are specific to TB bacilli are concentrated in the airways of patients who have active tuberculosis. these cells can be identified quickly using the ELISPOT test. the test can distinguish between latent TB infection, known as lasting tuberculosis immune responses (LTBI), and active TB by comparing the frequencies of TB-specific lymphocytes in the blood with those in the lung.

About a third of the world’s population is infected with the mycobacterium that causes TB but only about 10% to 20% of those will go on to develop the disease. the others have LTBI which can develop into TB at any time.

Sputum testing has traditionally been used for TB diagnosis: when TB bacilli show up on sputum tests, a positive diagnosis of TB can be established quickly. unfortunately, in about 50% of these tests the TB bacilli cannot be identified so a more accurate method is needed.

Dr Christoph Lange from the Research Center Borstel Leibniz-Center for Medicine and Biosciences in Germany, who led the TBNET research, said: in this study we showed that a differentiation between active pulmonary tuberculosis and LTBI is possible by using the ELISPOT test.

TB spreads quickly because it is disseminated through the air when infected people sneeze, spit or talk. It is the seventh leading cause of death worldwide and its incidence is rising again after a period of decline from the 1960s when the successful use of the Bacille Calmette-Guérin (BCG) vaccine led to a decline in the disease. TB usually attacks the lungs but other parts of the body can be affected too including the spine and the circulatory system.

To test the ELISPOT method, the TBNET researchers recruited 347 patients who were believed to have TB, but were either unable to produce sputum or had had 3 negative sputum tests. the ELISPOT test was performed using bronchoaveolar lavage (BAL, a method in which fluid is squirted into the lung and then withdrawn for analysis).

Of the 347 patients, 71 were diagnosed with active pulmonary TB and the results for patients with active TB were accurate in 91.5% of cases.

‘these findings show us that positive results in the BAL ELISPOT were highly indicative of actual cases of active TB,’ Dr Lange said. ‘A negative BAL ELISPOT result almost excludes active tuberculosis.

‘Future research about the immunodiagnosis of tuberculosis will need to identify indicators of treatment success that will allow safe discontinuation of anti-tuberculosis therapy without an increased risk of the reactivation,’ he pointed out. ‘This will be of great clinical importance to guide the treatment of individuals with LTBI and active tuberculosis, especially in cases of drug-resistant strains of mycobacterium tuberculosis.’

Dr Lange also pointed out that in 2008 a 27-institution consortium was established in Europe for the study of drug resistant tuberculosis (tbpannet.eu/>) and was granted EUR 12 million by the EU. the result is the TB PAN-NET (Pan-European network for the study and clinical management of drug resistant tuberculosis) project, supported by the Health Thematic area of the EUs Seventh Framework Programme (FP7).

Signs and symptoms of tuberculosis may be sluggish in creating and initially resemble those of influenza – common malaise, coughing, and loss of appetite, night sweats, chest discomfort, and reduced grade fever. At first, the cough might be nonproductive, but because the disease progresses, increasing amounts of sputum are created. because the condition worsens, fever, night sweats, persistent fatigue, weight loss, chest discomfort, and shortness of breath might happen, and the sputum might become bloody. In advanced instances tuberculosis of the larynx can occur, generating it unattainable to speak over a whisper.

Diagnosis of tuberculosisPatient historical past and bodily examination and chest x-rays. Tuberculin skin check and a little quantity of protein derived from mycobacterium are injected in to the skin around the arm, and the region is examined after 48 to 72 hours. a somewhat raised, hard, red patch of skin at the website signifies the presence of tuberculosis (even though not always active illness). Nevertheless, a positive tuberculosis skin check might also from prior immunization with BCG. Sputum smears and culture. Examining sputum for organisms are current; smears are negative, however, in many patients who’ve tuberculosis and some positive smears may be caused by organisms other than tuberculosis. the results from the tradition may take 3 to six weeks to develop. a constructive culture confirms diagnosis. Bone marrow biopsy. a sample of bone marrow is generally taken from your hip bone. Bronchoscopy (using a thin, hollow, flexible tube passed via the mouth in to the windpipe to watch the primary bronchial passages).

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