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dc.contributor.authorCattamanchi, Adithya
dc.contributor.authorSsewenyana, Isaac
dc.contributor.authorNabatanzi, Rose
dc.contributor.authorDen Boon, Saskia
dc.contributor.authorAndama, Alfred
dc.contributor.authorWorodria, William
dc.contributor.authorCao, Huyen
dc.contributor.authorHuang, Laurence
dc.contributor.authorDavis, J. Lucian
dc.contributor.authorMiller, Cecily R.
dc.date.accessioned2013-01-04T09:53:57Z
dc.date.available2013-01-04T09:53:57Z
dc.date.issued2012-06-26
dc.identifier.citationCattamanchi A., Ssewenyana I., Nabatanzi R., Miller C.R., Den Boon S., Davis, J.L., Andama, A., Worodria, W., Yoo, S.D., Cao, H., Huang, L. (2012) Bronchoalveolar lavage enzyme-linked immunospot for diagnosis of smear-negative tuberculosis in HIV infected patients. PLoS Oon 7(6)en_US
dc.identifier.issn1932-6203
dc.identifier.uridoi:10.1371/journal.pone.0039838
dc.identifier.urihttp://hdl.handle.net/10570/951
dc.description.abstractBackground: Peripheral blood interferon-gamma release assays (IGRAs) have sub-optimal sensitivity and specificity for diagnosis of active pulmonary tuberculosis (TB). However, assessment of local immune responses has been reported to improve the accuracy of TB diagnosis. Methods: We enrolled HIV-infected adults with cough $2 weeks’ duration admitted to Mulago Hospital in Kampala, Uganda and referred for bronchoscopy following two negative sputum acid-fast bacillus smears. We performed an ELISPOT-based IGRA (T-SPOT.TBH, Oxford Immunotec, Oxford, UK) using peripheral blood and bronchoalveolar lavage (BAL) fluid mononuclear cells, and determined the accuracy of IGRAs using mycobacterial culture results as a reference standard. Results: 94 HIV-infected patients with paired peripheral blood and BAL IGRA results were included. The study population was young (median age 34 years [IQR 28–40 years]) and had advanced HIV/AIDS (median CD4+ T-lymphocyte count 60 cells/ml [IQR 22–200 cells/ml]). The proportion of indeterminate IGRA results was higher in BAL fluid than in peripheral blood specimens (34% vs. 14%, difference 20%, 95% CI 7–33%, p = 0.002). BAL IGRA had moderate sensitivity (73%, 95% CI 50– 89%) but poor specificity (48%, 95% CI 32–64%) for TB diagnosis. Sensitivity was similar (75%, 95% CI 57–89%) and specificity was higher (78%, 95% CI 63–88%) when IGRA was performed on peripheral blood. Conclusions: BAL IGRA performed poorly for the diagnosis of smear-negative TB in a high HIV/TB burden setting. Further studies are needed to examine reasons for the large proportion of indeterminate results and low specificity of BAL IGRA for active TB in high HIV/TB burden settings.en_US
dc.description.sponsorshipThe study was funded by grant numbers K23 HL094141 (AC), K24 HL087713 (LH), R01 HL090335 (LH), and K23AI080147 (JLD) from the National Institutes of Health (NIH).en_US
dc.language.isoenen_US
dc.publisherPublic Library of Scienceen_US
dc.subjectPulmonary tuberculosisen_US
dc.subjectTBen_US
dc.subjectHIV/AIDSen_US
dc.subjectTB-HIV coinfectionen_US
dc.subjectMycobacterium tuberculosisen_US
dc.subjectCD4 T-cell counten_US
dc.titleBronchoalveolar lavage enzyme-linked immunospot for diagnosis of smear-negative tuberculosis in HIV infected patientsen_US
dc.typeJournal article, peer revieweden_US


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