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Free Content Uncommon presentations of tuberculosis: the potential value of a novel diagnostic assay based on the Mycobacterium tuberculosis-specific antigens ESAT-6 and CFP-10

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SETTING: Leiden University Medical Center, Leiden, the Netherlands.

OBJECTIVE: To illustrate the potential value of a recently developed diagnostic assay for detection of tuberculosis (TB), based on T cell responses to the early secreted antigenic target 6 kDa protein (ESAT-6) and culture filtrate protein 10 (CFP-10). These antigens are Mycobacterium tuberculosis specific because they are expressed by M. tuberculosis but absent from M. bovis bacille Calmette-Guérin (BCG) and most environmental mycobacteria. In recent studies, the assay had a high sensitivity and specificity for detection of active TB.

DESIGN: We describe five patients with uncommon presentations of tuberculosis, in whom the diagnosis was delayed by negative or conflicting results of diagnostic procedures aimed at detection of M. tuberculosis and an uninformative tuberculin skin test. IFN-γ production in response to ESAT-6 and CFP-10 by peripheral blood mononuclear cells from these patients was evaluated before and during anti-tuberculosis treatment.

RESULTS: In all five patients, IFN-γ responses to ESAT-6 and/or CFP-10 were above the cut-off level defined in a previous study. During treatment, IFN-γ responses generally increased.

CONCLUSION: These results indicate that T cell responses to M. tuberculosis-specific antigens have potential diagnostic value when TB is suspected and the results of other diagnostic tests are inconclusive, especially in BCG-vaccinated individuals.
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Keywords: CFP-10; ESAT-6; antigens; diagnosis; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Departments of Infectious Diseases and Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, the Netherlands 2: Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, the Netherlands 3: Department of Tuberculosis Immunology, Statens Serum Institute, Copenhagen, Denmark 4: Department of Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands

Publication date: July 1, 2001

More about this publication?
  • 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 lung health world-wide.

    To share scientific research of immediate concern as rapidly as possible, The Union is fast-tracking the publication of certain articles from the IJTLD and publishing them on The Union website, prior to their publication in the Journal. Read fast-track articles.

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

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