Publications
276 results found
Lalvani A, Millington KA, 2009, The Predictive Value of the ELISpot-Based Interferon-γ-Release Assay for Tuberculosis Disease Response, ANNALS OF INTERNAL MEDICINE, Vol: 150, Pages: 429-430, ISSN: 0003-4819
Bakir M, Dosanjh DPS, Deeks JJ, et al., 2009, Use of T Cell-Based Diagnosis of Tuberculosis Infection to Optimize Interpretation of Tuberculin Skin Testing for Child Tuberculosis Contacts, CLINICAL INFECTIOUS DISEASES, Vol: 48, Pages: 302-312, ISSN: 1058-4838
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- Citations: 19
Bakir M, Millington KA, Soysal A, et al., 2008, Prognostic value of a T-cell-based, interferon-gamma biomarker in children with tuberculosis contact., Ann Intern Med, Vol: 149, Pages: 777-787
BACKGROUND: Enzyme-linked immunospot (ELISpot) assay is an increasingly widely used, T-cell-based, interferon-gamma-release assay for diagnosing tuberculosis infection, but whether positive results are prognostic of active tuberculosis is not known. OBJECTIVE: To determine whether ELISpot results predict the development of active tuberculosis among persons with recent tuberculosis exposure. DESIGN: Longitudinal cohort study of children and adolescents with tuberculosis contact recruited from October 2002 to April 2004. SETTING: Community-based contact investigations in Turkey. PATIENTS: 908 children and adolescents with recent household tuberculosis exposure. INTERVENTION: Enzyme-linked immunospot assay, incorporating early secretory antigenic target-6 and culture filtrate protein-10, and tuberculin skin test were done at baseline. MEASUREMENTS: Incidence rates ratios of progression to active tuberculosis for contacts with positive tuberculin skin test and ELISpot results, and relative incidence rates comparing contacts with positive and negative test results. RESULTS: Isoniazid preventive therapy was given to 688 (76%) contacts according to local guidelines. Fifteen contacts developed active tuberculosis over 1201 person-years of follow-up. Of 381 contacts with positive ELISpot results, 11 developed active tuberculosis over 536 person-years of follow-up (incidence rate, 21 per 1000 person-years [95% CI, 10.2 to 36.7 per 1000 person-years]), a statistically significant 3- to 4-fold increased risk for progression relative to ELISpot-negative contacts. Of 550 contacts with positive tuberculin skin test results, 12 developed active tuberculosis over 722 person-years of follow-up (incidence rate, 17 per 1000 person-years [CI, 8.6 to 29.0 per 1000 person-years]). LIMITATION: Only 3 of the 15 incident cases were confirmed by culture. CONCLUSION: Positive ELISpot results predict subsequent development of active tuberculosis in recent tuberculosis contacts. Although tubercu
Bakir M, Millington KA, Soysal A, et al., 2008, Prognostic Value of a T-Cell-Based, Interferon-γ Biomarker in Children with Tuberculosis Contact, ANNALS OF INTERNAL MEDICINE, Vol: 149, Pages: 777-W163, ISSN: 0003-4819
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- Citations: 127
Hinks TSC, Dosanjh DPS, Innes JA, et al., 2008, FREQUENCY OF <i>MYCOBACTERIUM TUBERCULOSIS</i> ANTIGEN-SPECIFIC IFN-Γ-SECRETING T CELLS CORRELATES WITH PRESENCE OF PATHOLOGY IN TUBERCULOSIS, Winter Meeting of the British-Thoracic-Society, Publisher: B M J PUBLISHING GROUP, Pages: A63-A64, ISSN: 0040-6376
Hingley-Wilson S, Lalvani A, 2008, An exit strategy for the tubercle bacillus?, NATURE REVIEWS MICROBIOLOGY, Vol: 6, Pages: 954-954, ISSN: 1740-1526
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- Citations: 1
Connell DW, Lalvani A, O'Donoghue M, et al., 2008, TUBERCULOSIS-ASSOCIATED VITAMIN D DEFICIENCY IS NOT SECONDARY TO MYCOBACTERIAL DISEASE ACTIVITY, Winter Meeting of the British-Thoracic-Society, Publisher: B M J PUBLISHING GROUP, Pages: A113-A113, ISSN: 0040-6376
Lalvani A, Millington KA, 2008, Screening for tuberculosis infection prior to initiation of anti-TNF therapy, Congress on Infections, Rheumatism and Autoimmunity, Publisher: ELSEVIER SCIENCE BV, Pages: 147-152, ISSN: 1568-9972
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- Citations: 102
Lalvani A, Millington KA, 2008, T-cell interferon-γ release assays: can we do better?, EUROPEAN RESPIRATORY JOURNAL, Vol: 32, Pages: 1428-1430, ISSN: 0903-1936
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- Citations: 25
Koesters K, Nau R, Bossink A, et al., 2008, Rapid Diagnosis of CNS Tuberculosis by a T-Cell Interferon-γ Release Assay on Cerebrospinal Fluid Mononuclear Cells, INFECTION, Vol: 36, Pages: 597-600, ISSN: 0300-8126
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- Citations: 23
Montamat-Sicotte D, Millington K, Willcox C, et al., 2008, Monitoring of mycolic acid-specific T cell responses in TB patients during treatment, Annual Congress of the British-Society-of-Immunology, Publisher: WILEY-BLACKWELL PUBLISHING, INC, Pages: 139-139, ISSN: 0019-2805
Lee B, Lim A, Lalvani A, et al., 2008, The clinical significance of radiologically detected silent pulmonary nodules in early breast cancer, ANNALS OF ONCOLOGY, Vol: 19, Pages: 2001-2006, ISSN: 0923-7534
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- Citations: 23
Lalvani A, Millington KA, 2008, Screening for tuberculosis infection prior to initiation of anti-TNF therapy., Autoimmun Rev, Vol: 8, Pages: 147-152
T-cell interferon-gamma release assays (IGRAs) are more specific and probably more sensitive than the tuberculin skin test (TST) for the diagnosis of latent tuberculosis infection (LTBI). Patients with immune-mediated inflammatory diseases (IMID) and suspected LTBI who are candidates for anti-TNF therapy are at a significant risk of TB reactivation yet are prone to false-negative TST results because they are already on immunosuppressive medications. The role of these new blood tests in this patient population is therefore of considerable interest but is currently unclear. The limited published evidence-base shows that agreement between IGRA and TST results is poor in patients with IMID compared to patients without IMID, due to lower proportions of TST-positive results in patients with IMID. Discordant TST-positive, IGRA-negative results are associated with prior BCG vaccination and discordant TST-negative, IGRA-positive results are associated with steroid therapy. Notably, positive IGRA results are more closely associated with the presence of risk factors for LTBI than TST. The percentage of indeterminate IGRAs can be up to 12%. IGRA results in patients already taking anti-TNF agents currently remain uninterpretable. Given the clinical imperative to prevent reactivation of TB in patients starting anti-TNF therapy, screening algorithms should maximise diagnostic sensitivity for detection of LTBI. Therefore, a positive result to either an IGRA or TST, in addition to currently recommended clinical screening for risk factors for LTBI, should prompt consideration of preventive treatment of LTBI in this population.
Thomas MM, Hinks TSC, Raghuraman S, et al., 2008, Rapid diagnosis of <i>Mycobacterium tuberculosis</i> meningitis by enumeration of cerebrospinal fluid antigen-specific T-cells, INTERNATIONAL JOURNAL OF TUBERCULOSIS AND LUNG DISEASE, Vol: 12, Pages: 651-657, ISSN: 1027-3719
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- Citations: 79
Lalvani A, Millington KA, 2008, T cells and tuberculosis:: Beyond interferon-γ, JOURNAL OF INFECTIOUS DISEASES, Vol: 197, Pages: 941-943, ISSN: 0022-1899
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- Citations: 41
Dosanjh D, Hinks T, Innes J, et al., 2008, Improved diagnostic evaluation of suspected tuberculosis by use of T cell-based assay in routine practice, JOURNAL OF INFECTION, Vol: 56, Pages: 302-302, ISSN: 0163-4453
Dosanjh DPS, Hinks TSC, Innes JA, et al., 2008, Improved diagnostic evaluation of suspected tuberculosis, ANNALS OF INTERNAL MEDICINE, Vol: 148, Pages: 325-336, ISSN: 0003-4819
Lalvani A, Meroni PL, Millington KA, et al., 2008, Recent advances in diagnostic technology: applications in autoimmune and infectious diseases, CLINICAL AND EXPERIMENTAL RHEUMATOLOGY, Vol: 26, Pages: S62-S66, ISSN: 0392-856X
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- Citations: 16
Pollock KM, Lalvani A, 2008, Tuberculosis of the central nervous system: recognition, diagnosis and treatment in a low-prevalence country., Acute Med, Vol: 7, Pages: 113-121, ISSN: 1747-4884
Tuberculosis (TB) is one of the greatest threats to global public health, with 9.2 million new cases in 20061 and has become increasingly common in the UK. Central nervous system (CNS) infection with Mycobacterium tuberculosis (MTB) is relatively rare but is associated with a serious risk of neurological morbidity or death. Delays in diagnosis worsen prognosis and even with anti-tuberculous therapy up to 30% of tuberculous meningitis (TBM) patients may die.2 TBM and tuberculomas can mimic other CNS pathologies. Careful analysis of the clinical features, CSF examination and pragmatic use of diagnostic tests can aid the diagnosis. Prolonged anti-tuberculous treatment is required and presumptive treatment should not be delayed for microbiological confirmation of the disease.
Hinks TSC, Dosanjh DPS, Innes JA, et al., 2007, The role of T cell based interferon-γ release assays in the evaluation of patients with suspected active tuberculosis, Winter Meeting of the British-Thoracic-Society, Publisher: B M J PUBLISHING GROUP, Pages: A22-A22, ISSN: 0040-6376
Seyler L, Lalvani A, Collins L, et al., 2007, Safety and cost savings of an improved three-day rule for stool culture in hospitalised children and adults, JOURNAL OF HOSPITAL INFECTION, Vol: 67, Pages: 121-126, ISSN: 0195-6701
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- Citations: 13
Lange C, Jafari C, Lalvani A, 2007, Rapid diagnosis of smear-negative tuberculosis by bronchoalveolar lavage enzyme-linked immunospot, AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, Vol: 176, Pages: 317-317, ISSN: 1073-449X
Lalvani A, 2007, Diagnosing tuberculosis infection in the 21st century - New tools to tackle an old enemy, CHEST, Vol: 131, Pages: 1898-1906, ISSN: 0012-3692
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- Citations: 265
Lalvani A, Millington KA, 2007, T cell-based diagnosis of childhood tuberculosis infection, CURRENT OPINION IN INFECTIOUS DISEASES, Vol: 20, Pages: 264-271, ISSN: 0951-7375
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- Citations: 66
Millington KA, Innes JA, Hackforth S, et al., 2007, Dynamic relationship between IFN-γ and IL-2 profile of <i>Mycobacterium tuberculosis</i>-specific T cells and antigen load, JOURNAL OF IMMUNOLOGY, Vol: 178, Pages: 5217-5226, ISSN: 0022-1767
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- Citations: 227
Gooding S, Chowdhury O, Hinks T, et al., 2007, Impact of a T cell-based blood test for tuberculosis infection on clinical decision-making in routine practice., J Infect, Vol: 54, Pages: e169-e174
New T cell-based blood tests for tuberculosis infection could improve diagnosis of tuberculosis but their clinical utility remains unknown. We describe the role of the ELISpot test in the diagnostic work-up of 13 patients presenting with suspected tuberculosis in routine practice. Of the seven patients with a final diagnosis of active tuberculosis, all were positive by ELISpot including three with false-negative tuberculin skin test results. Rapid determination of tuberculosis infection by ELISpot accelerated the diagnosis of tuberculosis, enabling early treatment initiation.
Lalvani A, Millington K, Ewer K, 2007, Should individuals who are tuberculin skin test negative and positive to RD1-IFN-γ assay receive preventive therapy?: From the authors, AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, Vol: 175, Pages: 199-199, ISSN: 1073-449X
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- Citations: 1
Dinnes J, Deeks J, Kunst H, et al., 2007, A systematic review of rapid diagnostic tests for the detection of tuberculosis infection., Health Technol Assess, Vol: 11, Pages: 1-196, ISSN: 1366-5278
OBJECTIVES: To evaluate the effectiveness of available rapid diagnostic tests to identify tuberculosis (TB) infection. DATA SOURCES: Electronic databases were searched from 1975 to August 2003 for tests for active TB and to March 2004 for tests for latent tuberculosis infection (LTBI). REVIEW METHODS: Studies were selected and evaluated that (1) tested for LTBI, (2) compared tuberculin skin test (TST) and interferon-gamma assays based on ESAT-6 and CFP-10 antigens and (3) provided information on TB exposure or bacille Calmette-Guerin (BCG) vaccination or HIV status. For each test comparison, the sensitivity, specificity and 95% confidence intervals (CIs) were calculated. Sources of heterogeneity were investigated by adding covariates to the standard regression model. The authors examined whether interferon-gamma assays were more strongly associated with high versus low TB exposure than TST. Odds ratios (ORs) were calculated for the association between test results and exposures from each study along with their 95% CIs. Within each study, the OR value for one test was divided by that for another to produce a ratio of OR (ROR). RESULTS: A total of 212 studies were included, providing 368 data sets. A further 19 studies assessing fully automated liquid culture were included. Overall, nucleic acid amplification test (NAAT) accuracy was far superior when applied to respiratory samples as opposed to other body fluids. The better quality in-house studies, were, for pulmonary TB, much better at ruling out TB than the commercial tests (higher sensitivity), but were less good at ruling it in (lower specificity), but it is not possible to recommend any one over another owing to a lack of direct test comparisons. The specificity of NAAT tests was high when applied to body fluids, for example for TB meningitis and pleural TB, but sensitivity was poor, indicating that these tests cannot be used reliably to rule out TB. High specificity estimates suggest that NAAT tests should be
Dinnes J, Deeks J, Kunst H, et al., 2007, A systematic review of rapid diagnostic tests for the detection of tuberculosis infection, HEALTH TECHNOLOGY ASSESSMENT, Vol: 11, Pages: 1-+, ISSN: 1366-5278
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- Citations: 357
Richeldi L, Ewer K, Losi M, et al., 2007, T-cell-based diagnosis of neonatal multidrug-resistant latent tuberculosis infection, PEDIATRICS, Vol: 119, Pages: E1-E5, ISSN: 0031-4005
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- Citations: 27
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