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'''T-SPOT.''TB''''' is a type of [[ELISPOT]] assay used for [[tuberculosis diagnosis]], which belongs to the group of [[interferon-gamma]] release assays. The test is manufactured by [http://www.oxfordimmunotec.com Oxford Immunotec Ltd.] in the UK. It is available in most European countries, the United States as well as various other countries. It was developed by researchers at the University of Oxford in England.<ref>http://www.isis-innovation.com/news/news/oxfordimmunotec-nov02.html</ref> It counts the number of anti-mycobacterial [[effector T cells]], [[white blood cell]]s that produce [[interferon-gamma]], in a sample of blood. This gives an overall measurement of the host immune response against mycobacteria, which can reveal the presence of infection with ''[[Mycobacterium tuberculosis]]'', the causative agent of [[tuberculosis]] (TB). Because this does not rely on production of a reliable [[antibody]] response or recoverable [[pathogen]], the technique can be used to detect [[latent tuberculosis]].<ref>{{Cite web|url=http://www.oxfordimmunotec.com/How_It_Works_International|title=How T-SPOT.TB Works}}</ref> This technique has the advantage that it is comparatively fast (results within 24 hours), and less influenced by previous [[Bacillus_Calmette-Guérin|BCG]] vaccination compared with the traditional testing method for latent tuberculosis, the [[tuberculin skin test]]. This is due to the fact that both tests use different [[antigens]] for stimulation. While the tuberculin skin test uses purified protein derivative, a heterogeneous mixture of more than two hundred different mycobacterial peptides, the T-SPOT.''TB'' uses relatively ''Mycobacterium tuberculosis''-specific antigens (peptides called ESAT-6 and CFP-10). ESAT-6 and CFP-10 are expressed by ''[[Mycobacterium tuberculosis]]'', but absent are from all currently used [[Bacillus_Calmette-Guérin|BCG]] vaccines and most [[nontuberculous mycobacteria]]. Based on those test principles, it is thought that the T-SPOT.''TB'' is more specific than the [[tuberculin skin test]].
'''T-SPOT.''TB''''' is a type of [[ELISPOT]] assay used for [[tuberculosis diagnosis]], which belongs to the group of [[interferon-gamma]] release assays. The test is manufactured by [http://www.oxfordimmunotec.com Oxford Immunotec Ltd.] in the UK. It is available in most European countries, the United States as well as various other countries. It was developed by researchers at the University of Oxford in England.<ref>http://www.isis-innovation.com/news/news/oxfordimmunotec-nov02.html{{full}}</ref> It counts the number of anti-mycobacterial [[effector T cells]], [[white blood cell]]s that produce [[interferon-gamma]], in a sample of blood. This gives an overall measurement of the host immune response against mycobacteria, which can reveal the presence of infection with ''[[Mycobacterium tuberculosis]]'', the causative agent of [[tuberculosis]] (TB). Because this does not rely on production of a reliable [[antibody]] response or recoverable [[pathogen]], the technique can be used to detect [[latent tuberculosis]].<ref>{{Cite web|url=http://www.oxfordimmunotec.com/How_It_Works_International|title=How T-SPOT.TB Works}}</ref> This technique has the advantage that it is comparatively fast (results within 24 hours), and less influenced by previous [[Bacillus_Calmette-Guérin|BCG]] vaccination compared with the traditional testing method for latent tuberculosis, the [[tuberculin skin test]]. This is due to the fact that both tests use different [[antigens]] for stimulation. While the tuberculin skin test uses purified protein derivative, a heterogeneous mixture of more than two hundred different mycobacterial peptides, the T-SPOT.''TB'' uses relatively ''Mycobacterium tuberculosis''-specific antigens (peptides called ESAT-6 and CFP-10). ESAT-6 and CFP-10 are expressed by ''[[Mycobacterium tuberculosis]]'', but absent are from all currently used [[Bacillus_Calmette-Guérin|BCG]] vaccines and most [[nontuberculous mycobacteria]]. Based on those test principles, it is thought that the T-SPOT.''TB'' is more specific than the [[tuberculin skin test]].


In one study in Germany, 70 out of 72 patients with confirmed TB infection were T-SPOT.''TB'' positive, indicating a sensitivity of 97.2%.<ref>{{Cite journal|author=Meier T, Eulenbruch HP, Wrighton-Smith P, Enders G, Regnath T |title=Sensitivity of a new commercial enzyme-linked immunospot assay (T SPOT-TB) for diagnosis of tuberculosis in clinical practice |journal=Eur. J. Clin. Microbiol. Infect. Dis. |volume=24 |issue=8 |pages=529–36 |year=2005 |month=August |pmid=16133410 |doi=10.1007/s10096-005-1377-8 }}</ref>. However, more recent data from a study in children with active TB disease in the UK suggest that the sensitivity of the T-SPOT.''TB'' may in fact be worse than that of the tuberculin skin test (sensitivity reported as 66% and 82%, respectively).<ref>Bamford AR, Crook AM, Clark JE, Nademi Z, Dixon G, Paton JY, Riddell A, Drobniewski F, Riordan A, Anderson ST, Williams A, Walters S, Kampmann B. Comparison of interferon-gamma 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 Mar;95(3):180-6. [http://www.ncbi.nlm.nih.gov/pubmed/19815937 PMID: 19815937]</ref> The performance of [[interferon-gamma]] release assays in children has also been questioned by other publications.<ref>Connell TG, Ritz N, Paxton GA, Buttery JP, Curtis N, Ranganathan SC. A three-way comparison of tuberculin skin testing, QuantiFERON-TB gold and T-SPOT.TB in children. PLoS One. 2008 Jul 9;3(7):e2624. [http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0002624 PMID: 18612425]</ref><ref>Connell TG, Tebruegge M, Ritz N, Bryant PA, Leslie D, Curtis N. Indeterminate interferon-gamma release assay results in children. Pediatr Infect Dis J. 2010 Mar;29(3):285-6. [http://www.ncbi.nlm.nih.gov/pubmed/20190616 PMID: 20190616]</ref><ref>Connell TG, Tebruegge M, Ritz N, Bryant P, Curtis N. The potential danger of a solely interferon-gamma release assay-based approach to testing for latent Mycobacterium tuberculosis infection in children. Thorax. 2011 Mar;66(3):263-4. [http://www.ncbi.nlm.nih.gov/pubmed/20980248 PMID: 20980248]</ref>A metaanalysis of studies in children with active tuberculosis published in 2011 suggests that the sensitivity of the T-SPOT.''TB'' is very similar to that of the [[tuberculin skin test]] (pooled sensitivity reported as 84% and 80%, respectively).<ref>Mandalakas AM, Detjen AK, Hesseling AC, Benedetti A, Menzies D. nterferon-gamma release assays and childhood tuberculosis: systematic review and meta-analysis. Int J Tuberc Lung Dis. 2011 Aug;15(8):1018-32. [http://www.ncbi.nlm.nih.gov/pubmed/21669030 PMID: 21669030]</ref>
In one study in Germany, 70 out of 72 patients with confirmed TB infection were T-SPOT.''TB'' positive, indicating a sensitivity of 97.2%.<ref>{{Cite journal |doi=10.1007/s10096-005-1377-8 }}</ref>. However, more recent data from a study in children with active TB disease in the UK suggest that the sensitivity of the T-SPOT.''TB'' may in fact be worse than that of the tuberculin skin test (sensitivity reported as 66% and 82%, respectively).<ref>{{cite journal |pmid=19815937}}</ref> The performance of [[interferon-gamma]] release assays in children has also been questioned by other publications.<ref>{{cite journal |pmid=18612425}}</ref><ref>{{cite journal |pmid=20190616}}</ref><ref>{{cite journal |pmid=20980248}}</ref> A metaanalysis of studies in children with active tuberculosis published in 2011 suggests that the sensitivity of the T-SPOT.''TB'' is very similar to that of the [[tuberculin skin test]] (pooled sensitivity reported as 84% and 80%, respectively).<ref>{{cite journal |pmid=21669030}}</ref>




Revision as of 12:14, 13 September 2012

T-SPOT.TB is a type of ELISPOT assay used for tuberculosis diagnosis, which belongs to the group of interferon-gamma release assays. The test is manufactured by Oxford Immunotec Ltd. in the UK. It is available in most European countries, the United States as well as various other countries. It was developed by researchers at the University of Oxford in England.[1] It counts the number of anti-mycobacterial effector T cells, white blood cells that produce interferon-gamma, in a sample of blood. This gives an overall measurement of the host immune response against mycobacteria, which can reveal the presence of infection with Mycobacterium tuberculosis, the causative agent of tuberculosis (TB). Because this does not rely on production of a reliable antibody response or recoverable pathogen, the technique can be used to detect latent tuberculosis.[2] This technique has the advantage that it is comparatively fast (results within 24 hours), and less influenced by previous BCG vaccination compared with the traditional testing method for latent tuberculosis, the tuberculin skin test. This is due to the fact that both tests use different antigens for stimulation. While the tuberculin skin test uses purified protein derivative, a heterogeneous mixture of more than two hundred different mycobacterial peptides, the T-SPOT.TB uses relatively Mycobacterium tuberculosis-specific antigens (peptides called ESAT-6 and CFP-10). ESAT-6 and CFP-10 are expressed by Mycobacterium tuberculosis, but absent are from all currently used BCG vaccines and most nontuberculous mycobacteria. Based on those test principles, it is thought that the T-SPOT.TB is more specific than the tuberculin skin test.

In one study in Germany, 70 out of 72 patients with confirmed TB infection were T-SPOT.TB positive, indicating a sensitivity of 97.2%.[3]. However, more recent data from a study in children with active TB disease in the UK suggest that the sensitivity of the T-SPOT.TB may in fact be worse than that of the tuberculin skin test (sensitivity reported as 66% and 82%, respectively).[4] The performance of interferon-gamma release assays in children has also been questioned by other publications.[5][6][7] A metaanalysis of studies in children with active tuberculosis published in 2011 suggests that the sensitivity of the T-SPOT.TB is very similar to that of the tuberculin skin test (pooled sensitivity reported as 84% and 80%, respectively).[8]


References

  1. ^ http://www.isis-innovation.com/news/news/oxfordimmunotec-nov02.html[full citation needed]
  2. ^ "How T-SPOT.TB Works".
  3. ^ . doi:10.1007/s10096-005-1377-8. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)
  4. ^ . PMID 19815937. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)
  5. ^ . PMID 18612425. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)
  6. ^ . PMID 20190616. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)
  7. ^ . PMID 20980248. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)
  8. ^ . PMID 21669030. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)


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