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  1. Thank you for viewing this presentation. • We would like to remind you that this material is the property of the author.It is provided to you by the ERS for your personal use only, as submitted by the author. • 2012 by the author

  2. IGRAs for the diagnosis of tuberculosis: ... is the party over? Christoph Lange Christoph Lange

  3. Incidenceoftuberculosis in Germany Robert-Koch-Institute 2011

  4. Incidenceoftuberculosis in Germany 2010 2011 2012 2013 2014 2015 2016 2017 2018 Robert-Koch-Institute 2020?

  5. Global incidenceoftuberculosis WHO 2010

  6. Tuberculosis • 8. positionofleadingcausesofdeaths • 1/3 oftheworld´spopulationcouldbeinfected • > 80% canbecured • preventioncanbe > 90% effective WHO 2011

  7. SpectrumofM. tuberculosisinfection Septic TB active TB Miliary TB Extrapulmonary TB Pulmonary TB Low grade TB LTBI “percolating“ Dormant infection Clearance Lin P et al. J Immunol 2010

  8. x Prevention Diagnosis Treatment

  9. An allergy-test for the diagnosis of tuberculosis v Pirquet C; Wien Med Wschr 1907

  10. An allergy-test for the diagnosis of tuberculosis v Pirquet C; Wien Med Wschr 1907

  11. TB cowboys

  12. ProteomofM. tuberculosis und M. bovis BCG M. tuberculosis M. bovis BCG Jungblut PR et al.; Mol Microbiol 1999

  13. LTBI isdefinedby a positive reaction in the TST or IGRA

  14. The risk for tuberculosis Horseburgh et al. NEJM 2011

  15. The risk of tuberculosis in TST +ve individuals Comstock GW et al.; Am J Epidemiol 1974

  16. Contacttracing Diel R et al.; AJRCCM 2011

  17. HIV-seropositives Aichelburg MC et al.Clin Infect Dis 2009

  18. Transplantation Kim SH et al. Am J Transplant 2011

  19. Silicosis Leung CC et al. AJRCCM 2010

  20. NPV of the TST and IGRAs for the development of tuberculosis Diel R et al. EurRespir J 2011

  21. PPV and NPV of the TST and IGRAs for the development of tuberculosis Diel R et al. EurRespir J 2011

  22. Unadjusted cumulative incidence risk ratios for positive vs negative IGRA test results including studies with possible bias Rangaka M et al. Lancet 2011

  23. Unadjusted incidence rates by test result Rangaka M et al. Lancet 2011

  24. „Intention to test is intention to treat“

  25. Preventionoftuberculosis Isoniazid Rifampicin

  26. Sterling T et al. NEJM 2011

  27. www.tb-net.org FZB Retreat Nov. 2011

  28. Whatisthepredictivevalueof IGRAs forthediagnosisoftuberculosis? n = 3449 22 european centers Update May 2012: n= 4500

  29. IGRAs and skin-testing in immunocompromised patients: a multicenter study Skin test PPD ESAT-6/CFP-10/TB7.7 Negative controls Positive control APC IGRA IFN-g release assay T cell cytokine induction cytokine induction cytokine induction ELISA ELISPOT assay

  30. Whatisthepredictivevalueof IGRAs forthediagnosisof TB in immunosuppressedindividuals? 19 european centers

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