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NDT Advance Access originally published online on January 31, 2006
Nephrology Dialysis Transplantation 2006 21(7):2029; doi:10.1093/ndt/gfl001
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© The Author [2006]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Letter

Tests for latent tuberculosis

Email: timho{at}doctors.org.uk

Sir,

In their article, Shankar and colleagues underline the significant burden of tuberculosis within their population and the importance of identifying latent infection in those with end stage renal disease (ESRD) [1]. They found significant rates of anergy to cutaneous tuberculin skin testing in those with ESRD (44% vs 16% in control group). The study adds to the evidence in other populations and supports the notion that cutaneous anergy limits the value of this test [2]. We have previously reported the use of molecular biological techniques to help improve the diagnostic certainty of clinical infection with tuberculosis in this patient group [3]. Similarly, novel molecular techniques have recently been developed to detect the presence of latent tuberculous infection. Immunoassays based on the detection of interferon-{gamma} to specific Mycobacterium tuberculosis antigens ESAT6 and CFP10, appear to be specific and sensitive for the diagnosis of latent tuberculosis [4]. These techniques can detect latent infection in immunosuppressed patients and can differentiate between those previously vaccinated with the Bacillus Calmette Guérin (BCG) strain, a known confounding factor with tuberculin skin testing [5]. Importantly, the detection of latent disease using these assays seems to correlate with patients who will develop clinical infection [6]. We, therefore, recommend the consideration of these techniques to improve the management of this complex group of patients.

Conflict of interest statement. None declared.

Timothy B. L. Ho and James H. Hull

Respiratory Medicine Frimley Park Hospital NHS Foundation Trust, Camberley Surrey, UK

References

  1. Shankar MS, Aravindan AN, Sohal PM et al. The prevalence of tuberculin sensitivity and anergy in chronic renal failure in an endemic area: tuberculin test and the risk of post-transplant tuberculosis. Nephrol Dial Transplant 2005; 20: 2720–2724[Abstract/Free Full Text]
  2. Jasmer RM, Nahid P, Hopewell PC. Clinical practice. Latent tuberculosis infection. N Engl J Med 2002; 347: 1860–1866[Free Full Text]
  3. Jefferson HJ, Ho TB. Tuberculosis after renal transplantation. Nephrol Dial Transplant 1999; 14: 1341–1342[Free Full Text]
  4. Pai M, Riley LW, Colford JM, Jr. Interferon-gamma assays in the immunodiagnosis of tuberculosis: a systematic review. Lancet Infect Dis 2004; 4: 761–776[CrossRef][ISI][Medline]
  5. Chapman AL, Munkanta M, Wilkinson KA et al. Rapid detection of active and latent tuberculosis infection in HIV-positive individuals by enumeration of Mycobacterium tuberculosis-specific T cells. Aids 2002; 16: 2285–2293[CrossRef][ISI][Medline]
  6. Doherty TM, Demissie A, Olobo J et al. Immune responses to the Mycobacterium tuberculosis-specific antigen ESAT-6 signal subclinical infection among contacts of tuberculosis patients. J Clin Microbiol 2002; 40: 704–706[Abstract/Free Full Text]

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This Article
Right arrow Extract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
21/7/2029    most recent
gfl001v1
Right arrow Alert me when this article is cited
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Right arrow Email this article to a friend
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Right arrow Similar articles in ISI Web of Science
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Google Scholar
Right arrow Articles by Ho, T. B. L.
Right arrow Articles by Hull, J. H.
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PubMed
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Right arrow Articles by Ho, T. B. L.
Right arrow Articles by Hull, J. H.
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