This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Supplemental material
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrowReprints and Permissions
Right arrow Copyright Information
Right arrow Books from ASM Press
Right arrow MicrobeWorld
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Steingart, K. R.
Right arrow Articles by Laal, S.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Steingart, K. R.
Right arrow Articles by Laal, S.

 Previous Article  |  Next Article 

Clinical and Vaccine Immunology, February 2009, p. 260-276, Vol. 16, No. 2
1071-412X/09/$08.00+0     doi:10.1128/CVI.00355-08
Copyright © 2009, American Society for Microbiology. All Rights Reserved.

Performance of Purified Antigens for Serodiagnosis of Pulmonary Tuberculosis: a Meta-Analysis{triangledown} ,{dagger}

Karen R. Steingart,1* Nandini Dendukuri,2 Megan Henry,3,{ddagger} Ian Schiller,2 Payam Nahid,4 Philip C. Hopewell,1,4 Andrew Ramsay,5 Madhukar Pai,2 and Suman Laal6,7,8

Francis J. Curry National Tuberculosis Center, University of California, San Francisco, California,1 Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montréal, Quebec, Canada,2 San Joaquin County Public Health Services, Stockton, California,3 Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California, San Francisco, California,4 UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases, World Health Organization, Geneva, Switzerland,5 Departments of Pathology,6 Microbiology, New York University Langone Medical Center, New York, New York,7 Veterans Affairs Medical Center, New York, New York8

Received 26 September 2008/ Returned for modification 4 November 2008/ Accepted 24 November 2008

Serological antibody detection tests for tuberculosis may offer the potential to improve diagnosis. Recent meta-analyses have shown that commercially available tests have variable accuracies and a limited clinical role. We reviewed the immunodiagnostic potential of antigens evaluated in research laboratories (in-house) for the serodiagnosis of pulmonary tuberculosis and conducted a meta-analysis to evaluate the performance of comparable antigens. Selection criteria included the participation of at least 25 pulmonary tuberculosis patients and the use of purified antigens. Studies evaluating 38 kDa, MPT51, malate synthase, culture filtrate protein 10, TbF6, antigen 85B, {alpha}-crystallin, 2,3-diacyltrehalose, 2,3,6-triacyltrehalose, 2,3,6,6'-tetraacyltrehalose 2'-sulfate, cord factor, and TbF6 plus DPEP (multiple antigen) were included in the meta-analysis. The results demonstrated that (i) in sputum smear-positive patients, sensitivities significantly ≥50% were provided for recombinant malate synthase (73%; 95% confidence interval [CI], 58 to 85) and TbF6 plus DPEP (75%; 95% CI, 50 to 91); (ii) protein antigens achieved high specificities; (iii) among the lipid antigens, cord factor had the best overall performance (sensitivity, 69% [95% CI, 28 to 94]; specificity, 91% [95% CI, 78 to 97]); (iv) compared with the sensitivities achieved with single antigens (median sensitivity, 53%; range, 2% to 100%), multiple antigens yielded higher sensitivities (median sensitivity, 76%; range, 16% to 96%); (v) in human immunodeficiency virus (HIV)-infected patients who are sputum smear positive, antibodies to several single and multiple antigens were detected; and (vi) data on seroreactivity to antigens in sputum smear-negative or pediatric patients were insufficient. Potential candidate antigens for an antibody detection test for pulmonary tuberculosis in HIV-infected and -uninfected patients have been identified, although no antigen achieves sufficient sensitivity to replace sputum smear microscopy. Combinations of select antigens provide higher sensitivities than single antigens. The use of a case-control design with healthy controls for the majority of studies was a limitation of the review. Efforts are needed to improve the methodological quality of tuberculosis diagnostic studies.

* Corresponding author. Mailing address: Francis J. Curry National Tuberculosis Center, University of California, San Francisco, 3180 18th Street, Suite 101, San Francisco, CA 94110-2028. Phone: (415) 502-4600. Fax: (415) 502-4620. E-mail: karenst{at}u.washington.edu

{triangledown} Published ahead of print on 3 December 2008.

{dagger} Supplemental material for this article may be found at http://cvi.asm.org/.

{ddagger} Present address: California Department of Public Health, Sacramento, CA.

Clinical and Vaccine Immunology, February 2009, p. 260-276, Vol. 16, No. 2
1071-412X/09/$08.00+0     doi:10.1128/CVI.00355-08
Copyright © 2009, American Society for Microbiology. All Rights Reserved.



This article has been cited by other articles:

  • Koh, K. W., Soh, S. E, Seah, G. T. (2009). Strong Antibody Responses to Mycobacterium tuberculosis PE-PGRS62 Protein Are Associated with Latent and Active Tuberculosis. Infect. Immun. 77: 3337-3343 [Abstract] [Full Text]  
  • Lange, C., Pai, M., Drobniewski, F., Migliori, G. B. (2009). Interferon-{gamma} release assays for the diagnosis of active tuberculosis: sensible or silly?. Eur Respir J 33: 1250-1253 [Full Text]  
  • Raqib, R., Mondal, D., Karim, M. A., Chowdhury, F., Ahmed, S., Luby, S., Cravioto, A., Andersson, J., Sack, D. (2009). Detection of Antibodies Secreted from Circulating Mycobacterium tuberculosis-Specific Plasma Cells in the Diagnosis of Pediatric Tuberculosis. CVI 16: 521-527 [Abstract] [Full Text]  


Copyright © 2009 by the American Society for Microbiology.   For an alternate route to Journals.ASM.org, visit: http://intl-journals.asm.org | More Info»