Mantoux και IGRA στη διάγνωση της φυματίωσης στα παιδιά: ...
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Transcript of Mantoux και IGRA στη διάγνωση της φυματίωσης στα παιδιά: ...
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Mantoux IGRA : ;
. A. ,14 2014
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: VianexHonoraria: GSKX :Pfizer, GSK, ELPEN Advisory Boards: GSK, Pfizer : Pfizer, AbbVie
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530,000 74,000 170,000 http://www.who.int/tb/publications/global_report/en/
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10% ???:
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: 9 106
1/3 (2 ) M. tuberculosis
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TST IGRAs (Interferon gamma release assays)
o
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TST IGRAs (Interferon gamma release assays)
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IGRAs
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Andersen, et al. Lancet 2000;356(9235):1099.
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- IGRAs
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- IGRAs ( ) .
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QFT, QFT-IT86 (78-94) (N=15)58 (28-87) (N=2)83 (75-92)T.SPOT.TB 86 (67-100) (N=6)77 (23-100) (N=3)84 (63-100)TST81 (73-90) (N=14)70 (45-94) (N=4)80 (70-90) (%) (N=15) (N=2) QFT, QFT-IT91 (74-100)94 (74-100)91 (78-100)T.SPOT.TB 95 (84-100)93 (83-100)94 (87-100)TST79 (39-100)93 (77-100)85 (63-100)
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antoux IGRAs Regression slopes for exposure gradientsMandalakas AM et al Int J Tuberc Lung Dis 2011 IGRAs : TBHIC: high income countriesLMIC: low-middle income countries
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( +/-) MtbMandalakas AM et al Int J Tuberc Lung Dis 2011 IGRAs : TB
Pooled effects dds Ratio(Random) (95%CI)TST 5 mm 1.3 (0.72.7)TST 10 mm 1.9 (0.983.8)TST 15 mm1.8 (0.75.0)QFT-G/QFT-GIT 3.5 (1.96.7)T-SPOT.TB 1.3 (0.82.3)
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N= 104 (< 16 )- 2 + QFT TST -
N=21, QFT (+) 6/21 (PPV 28%, 95% CI 16-75%)3/7 < 5 (PPV 43%)( QFT+ 10%)N=40, TST >5mm (+) 6/40 (PPV 15%)P=0,33Negative Predictive value 100% : QFT(-) IGRAs TB : IGRA(+) ; Diel R, Am J Respir Crit Care Med, 2011
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IGRA (+) vs IGRA (-) : 2,1 (95% CI 1,293,46)
TST 10 mm vs TST (-) : 1,60 (0,942,72)
TST (+) IGRA
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IGRAs IGRAs (< 5 ) : - ( IFN PHA)
Mantoux TST(+) /IGRA (-) : , BCG, ? Haustein T et al Pediatr Infect Dis J 2009 Connel TG et al Pediatr Infect Dis J 2010
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QFT-IT ?
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TST QFT-IT is Critselis E J Pediatrics 2012; Pavic I et al Pediatr Infect Dis J 2011; Lewisohn DA et al PLoS One 2008 r=0.14; p
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IGRAs ; , : Mantoux , , (-), BCG(+) : Mantoux -
CDC MMWR 2010; ECDC 2011; Red Book, AAP 2009 ;http://www.who.int/tb/features_archive/igra_factsheet_oct2011.pdfAmanatidou A et al Eur J Clin Microbiol 2012; Tsolia M et al PIDJ 2010 .. IGRAs IGRA TB IGRAs TBhttp://guidance.nice.org.uk/CG117/Guidance
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< 5
TST IGRA IGRAs
BCG Mantoux IGRA
Mantoux IGRA
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NICE 2011 (UK) < 5 (, )
TST ( )
IGRA TST (-) TST IGRA
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< 5 Mantoux- /IGRA-/ , (), Mantoux/IGRA(8-10 )IGRA+ Mantoux 5mm Mantoux - /IGRA- BCG?IGRA+ antoux 5mm / , CDC, MMWR 2005; 54 (RR15); CDC, MMWR 2010;59 (RR50)
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TST-/IGRA-, / TST/IGRA 8-10 TST+/IGRA-AIGRA+TST-/IGRA-STOP BIGRA+/TST+ or TST-/ , TST+/IGRA- / ,
/ / CDC, MMWR 2005; 54 (RR15); CDC, MMWR 2010;59 (RR50) > 5
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IP-10 IGRAs? C-tb: ESAT-6 and CFP10(Statens Serum Institute)Tuuminen T BMJ OPEN 2012; Aaybe MG ERJ 2013
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Hierarchical cluster analysis of 116 genes:prediction error 11% for TB vs LTBI vs healhty controlsSet of 9 genes prediction error of 9% for TB vs LTBI and prediction error of 17% and 23% in previous adult cohortsLTBIHCs TB
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IGRAs
Mantoux BCG (+)
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MANTOUX BCG IGRAS BCG
- Management of household contactsNeonatesInitiate INH 3 mosRepeat TST TST (-)Repeat IGRAIf both negativeD/C treatment BCGTST (+)Evaluate for active TBactive TB ruled outTreat for LTBI Contacts < 2 yrs BCG (-) TST TST (6)Evaluate for active TBactive TB ruled outTreat for LTBI TST (
- Contacts 2- 5 yrs TST TST (6) TST (