Leiden University Scholarly Publications

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Franken, W.P.J. (2009)

Immunodiagnosis of latent tuberculosis : new answers to an old question?

Doctoral Thesis
Tuberculosis (TB) remains one of the most serious public health problems with one third of the world population latently infected with Mycobacterium tuberculosis. The diagnosis of LTBI relied until recently on the tuberculin skin test (TST) where a crude mixture of antigens is injected intradermally and induration is measured after 74 hours. False-positive test results occur frequently and are due to cross-reactivity with prior BCG-vaccination or infection with other Mycobacteria. A few years ago new in-vitro assays have been developed who use the TB-specific antigens ESAT-6 and CFP-10. They are commonly referred to as interferon-g release assays (IGRA) and have been evaluated in the studies described in this thesis. These studies have shown that IGRA have added value for the specific diagnosis of LTBI, but as is the case for any other assay, they have limitations as well. The results of IGRA should therefore be interpreted carefully in the light of the setting and the complete...Show moreTuberculosis (TB) remains one of the most serious public health problems with one third of the world population latently infected with Mycobacterium tuberculosis. The diagnosis of LTBI relied until recently on the tuberculin skin test (TST) where a crude mixture of antigens is injected intradermally and induration is measured after 74 hours. False-positive test results occur frequently and are due to cross-reactivity with prior BCG-vaccination or infection with other Mycobacteria. A few years ago new in-vitro assays have been developed who use the TB-specific antigens ESAT-6 and CFP-10. They are commonly referred to as interferon-g release assays (IGRA) and have been evaluated in the studies described in this thesis. These studies have shown that IGRA have added value for the specific diagnosis of LTBI, but as is the case for any other assay, they have limitations as well. The results of IGRA should therefore be interpreted carefully in the light of the setting and the complete clinical data. Future research should not be limited to enhance the performance of IGRA but also include new opportunities, like an improved skin test of the detection of bacterial products in clinical specimens.Show less
Latent tuberculosis
Tuberculin skin test
IGRA (interferon-gamma release assays)
QuantiFERON-TB Gold in-tube
T-SPOT.TB
ESAT-6
CFP-10
All authors
Franken, W.P.J.
Supervisor
Dissel, J.T. van
Co-supervisor
Arend, S.M.
Qualification
Doctor (dr.)
Awarding Institution
Leiden University Medical Center (LUMC), Leiden University
Date
2009-06-10
ISBN (print)
9789490122195

Funding

Sponsorship
Work described in this thesis was in part financially supported by grants from the Royal Netherlands Academy of Arts and Science (ZonMW), the Dutch Ministry of Defense and the Rozenboom-Bakhuizen Stichting. Publication of this thesis was sponsored by KNCV Tuberculosis Foundation, Cellestis and BD Biosciences