Yonsei Med J.  2015 Mar;56(2):340-347. 10.3349/ymj.2015.56.2.340.

Potential Role of Immunodiagnosis for Pulmonary Tuberculosis Using Induced Sputum Cells

Affiliations
  • 1Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea.
  • 2International Tuberculosis Research Center, Changwon, Korea. sooli10kr@yahoo.co.kr

Abstract

PURPOSE
To evaluate the diagnostic utility and predictors for determinate results of an enzyme-linked immunospot assay using induced sputum cells (IS ELISPOT) for a rapid diagnosis of pulmonary tuberculosis (TB).
MATERIALS AND METHODS
Subjects suspected of pulmonary TB who had either sputum acid fast bacilli smear-negative or not producing sputum spontaneously were prospectively enrolled. ELISPOT assay was performed using cells from induced sputum.
RESULTS
A total of 43 subjects, including 25 with TB (TB group) and 18 with non-TB disease (non-TB group) were enrolled. Results of IS ELISPOT were determinate in only 17/43 (39%) subjects, but all of determinate results were consistent with the final diagnosis. Of the 43 sputum samples, 11 (26%) were inadequate to perform IS ELISPOT. Of 32 adequate sputum samples, the proportion of determinate results was significantly higher in the TB group (75%, 15/20) than in the non-TB group (17%, 2/12) (p=0.002). The status of active TB was a unique predictor but smear positivity was not a significant predictor for determinate results. In addition, sensitivity of IS ELISPOT (75%, 9/12) in smear negative TB was higher than that of TB-polymerase chain reaction (25%, 3/12).
CONCLUSION
IS ELISPOT showed relatively high diagnostic value and accuracy in the TB group, independent of smear positivity. IS ELISPOT may provide additional diagnostic yield for microbiological tools in the rapid diagnosis of smear-negative TB.

Keyword

Tuberculosis; induced sputum; immunodiagnosis; enzyme-linked immunospot assays

MeSH Terms

Adult
Aged
*Enzyme-Linked Immunospot Assay
Female
Humans
Immunologic Tests/*methods
Male
Middle Aged
Mycobacterium tuberculosis/*isolation & purification
Predictive Value of Tests
Prospective Studies
Reproducibility of Results
Risk Factors
Sensitivity and Specificity
Sputum/*microbiology
Tuberculosis, Pulmonary/*diagnosis/microbiology

Figure

  • Fig. 1 Differential cell counts in induced sputum cells. The adequate sputum samples for 20 TB and 12 non-TB subjects were evaluated. Results are presented as percentage of each cell type. Horizontal lines indicate median values. The difference of each cell type between TB and non-TB group is shown only when it is statistically significant (p<0.05). TB, tuberculosis.

  • Fig. 2 Concentration of interferon-gamma releasing cells reactive to early secretory antigenic target (ESAT)-6 and culture filtrate protein (CFP)-10 measured using enzyme-linked immunospot assay with induced sputum cells in study subjects (n=32). All spots are documented after subtraction of spots in negative control. A value of 0 was assigned when the antigen well spot count minus the nil control was <0. Horizontal lines show median values. TB, tuberculosis.


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