Badaro Roberto, Machado Bruna A S, Duthie Malcolm S, Araujo-Neto C A, Pedral-Sampaio D, Nakatani Maria, Reed Steven G
SENAI Institute of Innovation (ISI) in Advanced Health Systems (CIMATEC ISI SAS), University Center SENAI/CIMATEC, National Service of Industrial Learning-SENAI, Salvador, Brazil.
Department of Medicine, Federal University of Bahia, Salvador, Brazil.
AMB Express. 2020 Jul 31;10(1):133. doi: 10.1186/s13568-020-01068-6.
Diagnostic testing for M. tuberculosis infection has advanced with QuantiFERON and GeneXpert, but simple cost-effective alternatives for widespread TB screening has remained elusive and purified protein derivative (PPD)-based tuberculin skin testing (TST) remains the most widely used method. PPD-based tests have reduced performance, however, in BCG vaccinees and in individuals with immune deficiencies. We compared the performance of skin testing with the recombinant DPPD protein against that of a standard PPD-based skin test. Our data indicates similar performance of DPPD and PPD (r = 0.7689) among HIV-negative, active TB patients, all of whom presented greater than 10 mm induration following administration. In contrast to results demonstrating that PPD induced indurations greater than 5 mm (i.e., the recommended threshold for positive results in this population) in only half (19 of 38) of the HIV positive TB patients, 89.5% (34 of 38) of these participants developed indurations greater than 5 mm when challenged with DPPD. Importantly, none of the patients that were positive following PPD administration were negative following DPPD administration, indicating markedly improved sensitivity of DPPD among HIV-infected individuals. Our data indicate that DPPD has superior performance in skin testing than the current TST standard.
结核分枝杆菌感染的诊断检测随着全血γ干扰素释放试验（QuantiFERON）和基因Xpert检测技术的出现而取得了进展，但用于广泛结核病筛查的简单且经济高效的替代方法仍然难以实现，基于纯化蛋白衍生物（PPD）的结核菌素皮肤试验（TST）仍是使用最广泛的方法。然而，基于PPD的检测在接种卡介苗的人群以及免疫缺陷个体中的表现有所下降。我们比较了重组DPPD蛋白皮肤试验与标准PPD皮肤试验的性能。我们的数据表明，在HIV阴性的活动性结核病患者中，DPPD和PPD的表现相似（r = 0.7689），所有这些患者在给药后硬结均大于10毫米。与仅一半（38例中的19例）HIV阳性结核病患者中PPD诱导硬结大于5毫米（即该人群阳性结果的推荐阈值）的结果相反，当用DPPD进行检测时，这些参与者中有89.5%（38例中的34例）硬结大于5毫米。重要的是，PPD给药后呈阳性的患者在DPPD给药后均未呈阴性，这表明DPPD在HIV感染个体中的敏感性显著提高。我们的数据表明，DPPD在皮肤试验中的性能优于当前的TST标准。
