Luca Richeldi, MD, PhD; Katie Ewer, BSc; Monica Losi, BSc; David M. Hansell, MD; Pietro Roversi, MD; Leonardo M. Fabbri, MD; Ajit Lalvani, MRCP, DM
Richeldi L, Ewer K, Losi M, Hansell DM, Roversi P, Fabbri LM, et al. Early Diagnosis of Subclinical Multidrug-Resistant Tuberculosis. Ann Intern Med. 2004;140:709-713. doi: 10.7326/0003-4819-140-9-200405040-00010
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Published: Ann Intern Med. 2004;140(9):709-713.
Tuberculosis control hinges on prompt diagnosis of active cases and screening of contacts by tuberculin skin testing. Rapid blood tests for Mycobacterium tuberculosis infection are a new alternative to the tuberculin skin test, but whether they improve clinical outcomes is unknown.
To describe how a novel T-cellâ€“based test for M. tuberculosis infection helped diagnose tuberculosis in an asymptomatic, immunosuppressed adult with a negative result on a tuberculin skin test.
Asymptomatic man receiving maintenance azathioprine therapy for Crohn disease whose wife had multidrug-resistant pulmonary tuberculosis.
Enzyme-linked immunospot (ELISPOT) assay, computed tomography, and bronchoalveolar lavage cultures.
The man had a negative tuberculin skin test result and a positive ELISPOT assay result. High-resolution computed tomography of the chest showed consolidation with early cavitation. Bronchoalveolar lavage and culture confirmed multidrug-resistant tuberculosis.
This single case report is a proof of concept and is not a formal evaluation of clinical utility.
A positive ELISPOT assay result helped diagnose subclinical active tuberculosis in an immunosuppressed patient with a false-negative tuberculin skin test result. Large prospective studies that compare benefits and costs of this alternative to tuberculin skin testing are needed.
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Infectious Disease, Mycobacterial Infections.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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