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slide1

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
slide2

IGRAs for the diagnosis of tuberculosis:

... is the party over?

Christoph Lange

Christoph Lange

slide3

Incidenceoftuberculosis in Germany

Robert-Koch-Institute 2011

slide4

Incidenceoftuberculosis in Germany

2010

2011

2012

2013

2014

2015

2016

2017

2018

Robert-Koch-Institute 2020?

slide6

Tuberculosis

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

WHO 2011

slide7

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

slide9
x

Prevention

Diagnosis

Treatment

slide15

ProteomofM. tuberculosis und M. bovis BCG

M. tuberculosis

M. bovis BCG

Jungblut PR et al.; Mol Microbiol 1999

slide20

The risk for tuberculosis

Horseburgh et al. NEJM 2011

slide21

The risk of tuberculosis in

TST +ve individuals

Comstock GW et al.; Am J Epidemiol 1974

slide22

Contacttracing

Diel R et al.; AJRCCM 2011

slide23

HIV-seropositives

Aichelburg MC et al.Clin Infect Dis 2009

slide24

Transplantation

Kim SH et al. Am J Transplant 2011

slide25

Silicosis

Leung CC et al. AJRCCM 2010

slide26

NPV of the TST and

IGRAs for the development of tuberculosis

Diel R et al. EurRespir J 2011

slide27

PPV and NPV of the TST and

IGRAs for the development of tuberculosis

Diel R et al. EurRespir J 2011

slide28

Unadjusted cumulative incidence risk ratios for positive vs negative IGRA test results

including studies with possible bias

Rangaka M et al. Lancet 2011

slide29

Unadjusted incidence rates by test result

Rangaka M et al. Lancet 2011

slide31

Preventionoftuberculosis

Isoniazid

Rifampicin

slide34

www.tb-net.org

FZB Retreat Nov. 2011

slide35

Whatisthepredictivevalueof IGRAs forthediagnosisoftuberculosis?

n = 3449

22 european centers

Update May 2012: n= 4500

slide36

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

slide37

Whatisthepredictivevalueof IGRAs forthediagnosisof TB in immunosuppressedindividuals?

19 european centers