Mantoux και IGRA στη διάγνωση της φυματίωσης στα παιδιά: ...

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Σεμινάριο Παιδιατρικών Λοιμώξεων Θεσσαλονίκη, 14 Φεβρουαρίου 2014. Mantoux και IGRA στη διάγνωση της φυματίωσης στα παιδιά: αντίπαλοι η συνεργάτες;. Μ. Τσολιά A ναπλ . Καθηγήτρια Β΄ Παιδιατρική Κλινική Πανεπιστημίου Αθηνών. Δήλωση αντικρουόμενων συμφερόντων. - PowerPoint PPT Presentation

Transcript of Mantoux και IGRA στη διάγνωση της φυματίωσης στα παιδιά: ...

  • Mantoux IGRA : ;

    . A. ,14 2014

  • : VianexHonoraria: GSKX :Pfizer, GSK, ELPEN Advisory Boards: GSK, Pfizer : Pfizer, AbbVie

  • 530,000 74,000 170,000 http://www.who.int/tb/publications/global_report/en/

  • 10% ???:

  • : 9 106

    1/3 (2 ) M. tuberculosis

  • -

    TST IGRAs (Interferon gamma release assays)

    o

  • TST IGRAs (Interferon gamma release assays)

    -

  • IGRAs

  • Andersen, et al. Lancet 2000;356(9235):1099.

  • - IGRAs

  • - IGRAs ( ) .

    (%)

    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)

  • 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

  • ( +/-) 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)

  • 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

  • IGRA (+) vs IGRA (-) : 2,1 (95% CI 1,293,46)

    TST 10 mm vs TST (-) : 1,60 (0,942,72)

    TST (+) IGRA

  • 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

  • QFT-IT ?

    :

    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

  • 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

  • < 5

    TST IGRA IGRAs

    BCG Mantoux IGRA

    Mantoux IGRA

    //

  • NICE 2011 (UK) < 5 (, )

    TST ( )

    IGRA TST (-) TST IGRA

  • < 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)

  • 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

  • IP-10 IGRAs? C-tb: ESAT-6 and CFP10(Statens Serum Institute)Tuuminen T BMJ OPEN 2012; Aaybe MG ERJ 2013

  • 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

  • IGRAs

    Mantoux BCG (+)

  • 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 (