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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. IGRAs for the diagnosis of tuberculosis: ... is the party over?.
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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
IGRAs for the diagnosis of tuberculosis: ... is the party over? Christoph Lange Christoph Lange
Incidenceoftuberculosis in Germany Robert-Koch-Institute 2011
Incidenceoftuberculosis in Germany 2010 2011 2012 2013 2014 2015 2016 2017 2018 Robert-Koch-Institute 2020?
Global incidenceoftuberculosis WHO 2010
Tuberculosis • 8. positionofleadingcausesofdeaths • 1/3 oftheworld´spopulationcouldbeinfected • > 80% canbecured • preventioncanbe > 90% effective WHO 2011
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
x Prevention Diagnosis Treatment
An allergy-test for the diagnosis of tuberculosis v Pirquet C; Wien Med Wschr 1907
An allergy-test for the diagnosis of tuberculosis v Pirquet C; Wien Med Wschr 1907
ProteomofM. tuberculosis und M. bovis BCG M. tuberculosis M. bovis BCG Jungblut PR et al.; Mol Microbiol 1999
The risk for tuberculosis Horseburgh et al. NEJM 2011
The risk of tuberculosis in TST +ve individuals Comstock GW et al.; Am J Epidemiol 1974
Contacttracing Diel R et al.; AJRCCM 2011
HIV-seropositives Aichelburg MC et al.Clin Infect Dis 2009
Transplantation Kim SH et al. Am J Transplant 2011
Silicosis Leung CC et al. AJRCCM 2010
NPV of the TST and IGRAs for the development of tuberculosis Diel R et al. EurRespir J 2011
PPV and NPV of the TST and IGRAs for the development of tuberculosis Diel R et al. EurRespir J 2011
Unadjusted cumulative incidence risk ratios for positive vs negative IGRA test results including studies with possible bias Rangaka M et al. Lancet 2011
Unadjusted incidence rates by test result Rangaka M et al. Lancet 2011
Preventionoftuberculosis Isoniazid Rifampicin
www.tb-net.org FZB Retreat Nov. 2011
Whatisthepredictivevalueof IGRAs forthediagnosisoftuberculosis? n = 3449 22 european centers Update May 2012: n= 4500
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
Whatisthepredictivevalueof IGRAs forthediagnosisof TB in immunosuppressedindividuals? 19 european centers