Tuberculose infantil: novas formas de diagnóstico
DOI:
https://doi.org/10.25753/BirthGrowthMJ.v24.i4.8479Palavras-chave:
Tuberculose infantil, Prova tuberculínica, QuantiFERON®-TB Gold In-tube, T-SPOT®.TB, Interferon Gamma Release AssayResumo
Introdução: A tuberculose ainda é um grave problema de saúde pública em Portugal. Para diminuir o número de casos de tuberculose ativa em populações de baixa e intermédia incidência, é necessário um diagnóstico rápido e um tratamento eficaz. A prova tuberculínica é o método de rastreio recomendado, mas as suas limitações são conhecidas. Em 2001, foi aprovado o primeiro de diversos interferon gamma release assays, considerados úteis no diagnóstico de infeção latente por Mycobacterium tuberculosis, amplamente utilizados na abordagem da tuberculose nos adultos.
Objectivos: Sumarizar a informação disponível sobre os interferon gamma release assays, nomeadamente no que diz respeito à técnica; às vantagens no diagnóstico da infeção latente por Mycobacterium tuberculosis; à sensibilidade e especificidade quando aplicados à população pediátrica; à caracterização de fatores interferentes; e ao seu significado na monitorização do tratamento com antituberculosos.
Desenvolvimento: Os interferon gamma release assays são testes imunologicamente seletivos, desenvolvidos com base em antigénios do Mycobacterium tuberculosis. Têm sido aplicados na Pediatria, em regiões com diferentes taxas de prevalência de tuberculose, de forma a compará-los com a prova tuberculínica relativamente à sensibilidade e especificidade.
Conclusões: A utilização destes testes como forma de rastreio em Pediatria apresenta limitações. São necessários estudos a nível nacional que permitam mostrar de que forma a prova tuberculínica e os interferon gamma release assays se devem articular. Atualmente, os interferon gamma release assays apenas complementam a prova tuberculínica.
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Referências
World Health Organization. Global Tuberculosis Report 2014. World Health Organization 2013.
Duarte R, Diniz A. Programa Nacional de Luta Contra a Tuberculose - Ponto da situação epidemiológica e de desempenho (dados provisórios). Direcção-Geral de Saúde 2013; 1-16.
Starke JR and Committee on Infectious Disease. Interferon-γ release assays for diagnosis of tuberculosis infection and disease in children. Pediatrics 2014; 134:e1763-73.
Bergamini BM, Losi M, Vaienti F, Amico R, Meccugni B, Meacci M, et al. Performance of commercial blood tests for the diagnosis of latent tuberculosis infection in children and adolescents. Pediatrics 2009; 123:419-24.
Direcção-Geral de Saúde. Circular Informativa Nº 04/PNT de 11/02/2010: Tuberculose Latente: Projecto de expansão dos testes IGRA. Direcção-Geral de Saúde 2010; 1-11.
Administração Regional de Saúde do Norte, I.P. Departamento de Saúde Pública. Programa de Luta contra a Tuberculose – Planeamento do Rastreio de Contatos de Doentes com Tuberculose. Administração Regional de Saúde do Norte 2013; 1-11.
Pediatric Tuberculosis Collaborative Group. Targeted tuberculin skin test and treatment of latent tuberculosis infection in children and adolescents. Pediatrics 2004; 114:1175-201.
Duarte R. Teste tuberculínico. Como optimizar? Rev Port Pneumol 2009; XV:295-304.
Cruz AT, Geltemeyer AM, Starke JR, Flores JA, Graviss EA, Smith KC. Comparing the tuberculin skin test and T-SPOT.TB blood test in children. Pediatrics 2011; 127:31-8.
Pai M, Menzies D. Interferon-gamma release assays for diagnosis of latent tuberculosis infection. Uptodate 2015. Disponível em: http://www. uptodate.com/contents/interferon-gamma-release-assays-for-diagnosis-of-latent-tuberculosis-infection.
European Centre for Disease Prevention and Control. Use of interferon-gamma release assays in support of TB diagnosis. European Centre for Disease Prevention and Control 2011; 1-32.
Bamford ARJ, Crook AM, Clark JE, Nademi Z, Dixon G, Paton JY, et al. Comparison of interferon-γ release assays and tuberculin skin test in predicting active tuberculosis (TB) in children in the UK: a paediatric TB network study. Arch Dis Child 2010; 95:180-6.
Haustein T, Ridout DA, Hartley JC, Thaker U, Shingadia D, Klein NJ, et al. The likelihood of an indeterminate test result from a whole-blood interferon-γ release assay for the diagnosis of mycobacterium tuberculosis infection in children correlates with age and immune Status. Pediatr Infect Dis J 2009; 28:669-73.
Direcção-Geral de Saúde. Orientação Nº 012/2011 de 06/05/2011: Posição da Direcção-Geral de Saúde sobre o uso dos testes IGRA para o diagnóstico da infecção tuberculosa latente. Direcção-Geral de Saúde 2011; 1-4.
Okada K, Mao TE, Mori T, Miura T, Sugyama T, Yoshyama T, et al. Performance of an interferon-gamma release assay for diagnosing latent tuberculosis infection in children. Epidemiol Infect 2008; 136:1179-87.
Hill PC, Brookes RH, Adetifa IMO, Fox A, Jackson-Sillah D, Lugos MD, et al. Comparison of enzyme-linked immunospot assay and tuberculin skin test in healthy children exposed to mycobacterium tuberculosis. Pediatrics 2006; 117:1542-8.
Connell TG, Curtis N, Ranganathan SC, Buttery JP. Performance of a whole blood interferon gamma assay for detecting latent infection with mycobacterium tuberculosis in children. Thorax 2006; 6:616-20.
Lighter J, Rigaud M, Eduardo R, Peng CH, Pollack H. Latent tuberculosis diagnosis in children by using the QuantiFERON-TB gold in-tube test. Pediatrics 2009; 123:30-7.
Kampmann B, Whittaker E, Williams A, Walters S, Gordon A, Martinez-Alier N, et al. Interferon-γ release assays do not identify more children with active tuberculosis than the tuberculin skin test. Eur Respir J 2009; 33:1374-82.
Nkurunungi G, Lutangira JE, Lule SA, Akurut H, Kizindo R, Fitchett JR, et al. Determining mycobacterium tuberculosis infection among BCG-immunised Uganda children by T-SPOT.TB and tuberculin skin testing. Plos ONE 2012; 7:e47340.
Adetifa IMO, Ota MOC, Jeffries DJ, Hammond A, Lugos MD, Donkor S, et al. Commercial interferon gamma release assays compared to the tuberculin skin test for diagnosis of latent mycobacterium tuberculosis infection in childhood contacts in the Gambia. Pediatr Infect Dis J 2010; 29:439-43.
Nicol MP, Davies MA, Wood K, Hatherill M, Workman L, Hawkridge A, et al. Comparison of T-SPOT.TB assay and tuberculin skin test for the evaluation of young children at high risk for tuberculosis in a community setting. Pediatrics 2009; 123:38-43.
Debord C, Lauzanne AD, Gourgouillon N, Guérin-El Khourouj V, Pédron B, Gandelus J, et al. Interferon-gamma release assay performance for diagnosing tuberculosis disease in 0- to 5-year-old children. Pediatr Infect Dis J 2011; 30:995-7.
Bianchi L, Galli L, Moriondo M, Veneruso G, Becciolini L, Azzari C. Interferon-gamma release assay improves the diagnosis of tuberculosis in children. Pediatr Infect Dis J 2009; 28:510-4.
Detjen AK, Keil T, Roll S, Hauer B, Mauch H, Wahn U, et al. Interferon-y release assays improve the diagnosis of tuberculosis and nontuberculous mycobacterial disease in children in a country with a low incidence of tuberculosis. CID 2007; 45:322-8.
Altet-Gómez N, Souza-Galvao M, Latorre I, Milà C, Jiménez MA, Solsona J, et al. Diagnosing TB infection in children analysis of discordances using in vitro tests and the tuberculin skin test. Eur Respir J 2011; 37:1166-74.
Ling DI, Nicol MP, Pai M, Pienaar S, Dendukuri N, Zar HJ. Incremental value of T-SPOT.TB for diagnosis of active pulmonary tuberculosis in children in a high-burden setting: a multivariable analysis. Thorax 2013; 68:860-6.
Mandakalas AM, Hesseling AC, Chegou NN, Kirchner HL, Zhu X, Marais BJ, et al. High level of discordant IGRA results in HIV-infected adults and children. Int J Tuberc Lung Dis 2008; 12:417-23.
Carvalho AC, Schumacher RF, Bigoni S, Soncini E, Notarangelo L, Apostoli A, et al. Contact investigation based on serial interferon-gamma release assays (IGRA) in children from the hematology-oncology ward after exposure to a patient with pulmonary tuberculosis. Infection 2013; 41:827-31.
Banfield S, Pascoe E, Thambiran A, Siafarikas A, Burgner D. Factores associated with the performance of a blood-based interferon-γ release assay in diagnosing tuberculosis. Plos ONE 2012; 7:e38556.
Critselis E, Amanatidou V, Syridou G, Spyridis NP, Mavrikou M, Papadopoulos NG, et al. The effect of age on whole blood interferon-gamma release assay response among children investigated for latent tuberculosis infection. J Pediatr 2012; 161:632-8.
Thomas TA, Mondal D, Noor Z, Liu L, Alam M, Haque R, et al. Malnutrition and helminth infection affect performance of an interferon γ-release assay. Pediatrics 2010; 126:1522-9.
Mahomed H, Hawkridge T, Verver S, Abrahams D, Geiter L, Hatherill M, et al. The tuberculin skin test versus QuantiFERON TB Gold in predicting tuberculosis disease in an adolescent cohort study in South Africa. Plos ONE 2011; 6:e17984.
Rose MV, Kimaro G, Kroidl I, Hoelscher M, Bygbjerg IC, Mfinanga SM, et al. Evaluation of QuantiFERON microtube using 0,9 mL blood, for diagnosing tuberculosis infection. Eur Respir J 2013; 41:909-16.
Chee CBE, KhinMar KW, Gan SH, Barkham TM, Koh CK, Shen L, et al. Tuberculosis treatment effect on T-cell interferon-γ responses to mycobacterium tuberculosis-specific antigens. Eur Respir J 2010; 36:355-61.
Chiappini E, Bonsignori F, Mangone G, Galli L, Mazzantini R, Sollai S, et al. Serial T-SPOT.TB and QuantiFERON-TB-Gold in-tube assays to monitor response to antitubercular treatment in italian children with active or latent tuberculosis infection. Pediatr Infect Dis J 2012; 31:974-7.
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