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Free Content Use of bronchoalveolar lavage enzyme-linked immunospot for diagnosis of smear-negative pulmonary tuberculosis

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OBJECTIVE: To compare the diagnostic validity of blood enzyme-linked immunospot assay (ELISpot), broncho-alveolar lavage (BAL) ELISpot and the tuberculin skin test (TST) in patients with pulmonary smear-negative tuberculosis (TB) in a country with high TB prevalence.

DESIGN: In a prospective, hospital-based study, 107 patients with suspected TB were tested simultaneously using blood and BAL ELISpot and TST.

RESULTS: Of 102 patients with active pulmonary TB, 36 (35.3%) were diagnosed with TB, while 66/102 (64.7%) had a non-TB diagnosis. The sensitivity and specificity for ELISpot on mononuclear cells from BAL fluid was respectively 94.4% (95%CI 81.9–98.5) and 78.1% (95%CI 66.6–86.5). The specificity of BAL ELISpot was significantly higher than that of blood ELISpot (P = 0.011). Compared with blood ELISpot and TST, BAL ELISpot was not significantly influenced by previous history of TB (OR 2.05, P > 0.05) or household contact with a patient with active TB (OR 2.41, P > 0.05).

CONCLUSION: ELISpot on BAL appears to be a more rapid and sensitive supplementary test than on blood for the diagnosis of active TB patients with a negative sputum smear in a developing country setting with high TB prevalence and access to bronchoscopy and ELISpot assay. However, the test's utility was limited by its moderate specificity.
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Keywords: ELISpot assay; bronchoalveolar lavage; interferon-gamma; tuberculin skin test; tuberculosis

Document Type: Research Article

Affiliations: 1: Department of Occupational and Environmental Health, School of Public Health, Guangxi Medical University, Nanning, China 2: Department of Immunology, School of Pre-clinical Medicine, Guangxi Medical University, Nanning, China 3: Department of Epidemiology, Robert Stempel School of Public Health, Florida International University, Miami, Florida, USA; Department of Medicine, Medical Information Systems Unit, Boston Medical Center, Boston, Massachusetts, USA

Publication date: 2012-12-01

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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