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Lymphocyte transformation assays as a diagnostic tool in tuberculosis in children
Insights
Lymphocyte transformation (LT) assays show a strong correlation with tuberculosis skin tests in children. However, LT assays are unlikely to be useful for diagnosing childhood tuberculosis due to limited additional diagnostic value.
Area of Science:
- Pediatric Infectious Diseases
- Immunology
- Diagnostic Medicine
Background:
- Tuberculosis remains a significant global health challenge, particularly in pediatric populations.
- Accurate and timely diagnosis of childhood tuberculosis is crucial for effective treatment and public health control.
- Existing diagnostic methods, such as skin tests, have limitations in sensitivity and specificity.
Purpose of the Study:
- To evaluate the utility of lymphocyte transformation (LT) assays as a diagnostic aid for tuberculosis in children.
- To assess the correlation between LT responses and traditional tuberculin skin test (TST) reactivity.
- To determine if LT assays provide additional diagnostic value beyond skin testing in suspected pediatric tuberculosis cases.
Main Methods:
- Lymphocyte transformation (LT) assays and skin tests were performed on children with confirmed tuberculosis, suspected tuberculosis, and healthy controls.
- Purified protein derivative (PPD) and nonmycobacterial antigens were used for stimulation in LT assays.
- Statistical analysis was employed to assess the correlation between skin test reactivity and LT responses.
Main Results:
- A highly significant correlation (p < 0.0001) was observed between skin test reactivity and LT responses to PPD.
- The majority of children with positive skin tests demonstrated a significant LT response to PPD.
- Only a small percentage of tuberculosis suspects with negative skin tests showed a positive LT response, and similarly few healthy children exhibited positive LT assays without skin test reactivity.
Conclusions:
- Lymphocyte transformation assays demonstrate a strong correlation with PPD skin test reactivity in children.
- The limited additional diagnostic yield of LT assays in tuberculosis suspects without skin test reactivity suggests they are unlikely to be a useful diagnostic aid for childhood tuberculosis.
- Further research may be needed to explore alternative immunodiagnostic approaches for pediatric tuberculosis.
Abstract:
Lymphocyte transformation (LT) assays were evaluated as a diagnostic aid in tuberculosis of children. Skin tests and LT assays were performed in 6 children with culture-proved tuberculosis (Group I), 32 children suspected of having tuberculosis (Group II), and 20 healthy children (Group III). Five of 6 children in Group I, 16 of 32 in Group II, and 8 of 20 in Group III had positive skin test reactions to PPD. The correlation between skin test reactivity and LT responses to PPD was highly significant (p less than 0.0001). Four (80%), 14 (88%), and 6 (75%) of the 29 subjects with positive skin test reactions in Groups I, II, and III showed a significant LT response to PPD. Only 2 (13%) of 16 tuberculosis suspects with negative skin test reactions in Group II exhibited an LT response to PPD. One (8%) of 12 healthy children with negative skin test reactions had a positive reaction in LT assays. All but 4 (7%) of 58 children in Groups I, II, and III were skin test reactive to PPD and/or 1 or more of 5 nonmycobacterial antigens. One (2% of 58) of these failed to exhibit an LT response to nonmycobacterial antigens. The strong correlation between LT responses and skin test reactivity to PPD and our finding that only 2 of 16 tuberculosis suspects had positive reactions in LT assays in the absence of PPD skin test reactivity argues against the likelihood that LT assays will prove useful in the diagnosis of this disease.