1887

Access Microbiology open research platform logo

Volume 6, Issue 9

A case of pleural infection with reversion of Quantiferon Gold Plus results from positive to negative Open Access

Abstract

(MTB) infections continue to have a high mortality and morbidity burden globally. Interferon-gamma release assays such as Quantiferon Gold Plus (QFG-Plus) aid in diagnosis of latent TB but diagnosis of pleural TB remains challenging. We present a case of active pleural MTB infection with reversion from positive to negative of IGRA result as well as negative Xpert MTB/RIF Ultra PCR result from tissues obtained from pleural biopsy.

A 52-year-old otherwise healthy male presented in August 2022 with a 2 week history of pleuritic chest pain associated with modest elevation in inflammatory markers. The patient had had a positive QFG-Plus result in 2018, however QFG-Plus during this admission was negative. Computed-tomography pulmonary angiogram and needle thoracocentesis showed an exudative left pleural effusion with predominant lymphocytes. The patient’s symptoms failed to resolve with empiric antimicrobial therapy for community-acquired pneumonia. Broncho-alveolar lavage as well as biopsies of pleural tissues via video-assisted thoracoscopic surgery from the left lower lobe yielded negative results on routine microbiological culture as well as Xpert Ultra PCR. Growth of acid-fast bacilli was noted from mycobacterial cultures of pleural tissues which was identified as MTB.

Despite significant technological advances, microbiological diagnosis of MTB infections remains challenging. We document QFG-Plus reversion during development from latent to active pleural TB. Decline in the ability of CD4 and CD8 T cells to produce interferon gamma in response to TB antigens (ESAT-6 and CFP-10) was likely associated with loss of host control of latent MTB. This case serves as a reminder that despite exhaustive testing with state-of-art diagnostic platforms, MTB infections can still elude discovery.

  • Received:
  • Accepted:
  • Published Online:
Keyword(s): IGRA , Mycobacterium tuberculosis , PCR , pleural TB , quantiferon gold and reversion
© 2024 The Authors
  • This is an open-access article distributed under the terms of the Creative Commons Attribution License. This article was made open access via a Publish and Read agreement between the Microbiology Society and the corresponding author’s institution.
Loading

Article metrics loading...

/content/journal/acmi/10.1099/acmi.0.000737.v3
2024-09-05
2024-10-09
Loading full text...

Full text loading...

/deliver/fulltext/acmi/6/9/acmi000737.v3.html?itemId=/content/journal/acmi/10.1099/acmi.0.000737.v3&mimeType=html&fmt=ahah

References

  1. World Health Organisation Global Tuberculosis Report 2022 WHO Global TB Programme; 2022
     [Google Scholar]
  2. The Victorian Department of Health Tuberculosis (TB)- Better Health Channel Victoria; 2023 https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/tuberculosis-tb#bhc-content
  3. Barry C, Waring J, Stapledon R, Konstantinos A. National Tuberculosis Advisory Committee, for the Communicable Diseases Network Australia Tuberculosis notifications in Australia, 2008 and 2009. Commun Dis Intell Q Rep 2012; 36:82–94 [PubMed]
     [Google Scholar]
  4. Soni A, Guliani A, Nehra K, Mehta PK. Insight into diagnosis of pleural tuberculosis with special focus on nucleic acid amplification tests. Expert Rev Respir Med 2022; 16:887–906 [View Article] [PubMed]
     [Google Scholar]
  5. Soni A, Dahiya B, Sheoran A, Kumar V, Guliani A et al. Diagnosis of pleural tuberculosis by multi-targeted loop-mediated isothermal amplification assay based on SYBR Green I reaction: comparison with GeneXpert® MTB/RIF assay. Expert Rev Respir Med 2023; 17:1079–1089 [View Article] [PubMed]
     [Google Scholar]
  6. Aggarwal AN, Agarwal R, Gupta D, Dhooria S, Behera D. Interferon gamma release assays for diagnosis of pleural tuberculosis: a systematic review and meta-analysis. J Clin Microbiol 2015; 53:2451–2459 [View Article] [PubMed]
     [Google Scholar]
  7. World Health Organisation Definitions and Reporting Framework for Tuberculosis-2013 Revision WHO Global TB Programme; 2013
     [Google Scholar]
  8. Rindi L. Rapid molecular diagnosis of extra-pulmonary tuberculosis by Xpert/RIF ultra. Front Microbiol 2022; 13:817661 [View Article] [PubMed]
     [Google Scholar]
  9. Gao S, Wang C, Yu X, Teng T, Shang Y et al. Xpert MTB/RIF Ultra enhanced tuberculous pleurisy diagnosis for patients with unexplained exudative pleural effusion who underwent A pleural biopsy via thoracoscopy: a prospective cohort study. Int J Infect Dis 2021; 106:370–375 [View Article] [PubMed]
     [Google Scholar]
  10. World Health Organisation Automated Real-Time Nucleic Acid Amplification Technology for Rapid and Simultaneous Detection of Tuberculosis and Rifampicin Resistance: Xpert MTB/RIF Assay for the Diagnosis of Pulmonary and Extrapulmonary TB in Adults and Children WHO Global TB Programme; 2013 p 79
     [Google Scholar]
  11. Qiagen Quantiferon-TB Gold Plus Blood Collection Tubes Instructions for Use Germany: 2023
     [Google Scholar]
  12. Dewan PK, Grinsdale J, Kawamura LM. Low sensitivity of a whole-blood interferon-gamma release assay for detection of active tuberculosis. Clin Infect Dis 2007; 44:69–73 [View Article] [PubMed]
     [Google Scholar]
  13. Petruccioli E, Chiacchio T, Pepponi I, Vanini V, Gualano G et al. CD8-response associates with active tuberculosis and TB2-tube response in the QuantiFERON-TB-Plus kit. In ERS International Congress 2016 Abstracts 2016 [View Article]
     [Google Scholar]
  14. Bartu V, Havelkova M, Kopecka E. QuantiFERON-TB Gold in the diagnosis of active tuberculosis. J Int Med Res 2008; 36:434–437 [View Article] [PubMed]
     [Google Scholar]
  15. Çavuşoğlu C, Yaşar-Duman M, Sezai Taşbakan M, Işıkgöz-Taşbakan M, Nurullah Orman M. Evaluation of the performance of QuantiFERON®-TB Gold plus test in active tuberculosis patients. J Clin Tuberc Other Mycobact Dis 2021; 23:100223 [View Article] [PubMed]
     [Google Scholar]
  16. Lee J-K, Lee HW, Heo EY, Yim J-J, Kim DK. Comparison of QuantiFERON-TB Gold Plus and QuantiFERON-TB Gold In-Tube tests for patients with active and latent tuberculosis: a prospective cohort study. J Infect Chemother 2021; 27:1694–1699 [View Article] [PubMed]
     [Google Scholar]
  17. Phetsuksiri B, Srisungngam S, Rudeeaneksin J, Boonchu S, Klayut W et al. QuantiFERON-TB Gold In-Tube test in active tuberculosis patients and healthy adults. Rev Inst Med Trop Sao Paulo 2018; 60:e56 [View Article] [PubMed]
     [Google Scholar]
  18. Kim YJ, Kang JY, Kim SI, Chang MS, Kim YR et al. Predictors for false-negative QuantiFERON-TB Gold assay results in patients with extrapulmonary tuberculosis. BMC Infect Dis 2018; 18:457 [View Article] [PubMed]
     [Google Scholar]
  19. Chiacchio T, Petruccioli E, Vanini V, Pepponi I, Cirillo D et al. Modulation of CD4 and CD8 response to QuantiFERON-TB-Plus in active TB patients followed during treatment. In ERS International Congress 2017 Abstracts 2017 [View Article]
     [Google Scholar]
  20. Buldeo S, Murdoch DM, Suchard MS. Pulmonary immune-compartment-specific interferon gamma responses in HIV-infected individuals with active tuberculosis (TB) in an area of high TB prevalence. Clin Dev Immunol 2012; 2012:308473 [View Article] [PubMed]
     [Google Scholar]
  21. Andrews JR, Hatherill M, Mahomed H, Hanekom WA, Campo M et al. The dynamics of QuantiFERON-TB gold in-tube conversion and reversion in a cohort of South African adolescents. Am J Respir Crit Care Med 2015; 191:584–591 [View Article] [PubMed]
     [Google Scholar]
  22. Zhang H, Xin H, Li X, Li H, Li M et al. Reversion of QuantiFERON-TB Gold In-Tube test in individuals with and without prophylactic treatment for latent tuberculosis infection: a systematic review and meta-analysis. J Infect 2018; 77:276–282 [View Article] [PubMed]
     [Google Scholar]
  23. Nguyen DT, Teeter LD, Graves J, Graviss EA. Characteristics associated with negative interferon-γ release assay results in culture-confirmed tuberculosis patients, Texas, USA, 2013–2015. Emerg Infect Dis 2018; 24:534–540 [View Article]
     [Google Scholar]
  24. Khan A, Kamra E, Singh R, Sharma V, Singh V et al. Diagnosis of osteoarticular tuberculosis: multi-targeted loop-mediated isothermal amplification assay versus multiplex PCR. Future Microbiol 2021; 16:935–948 [View Article] [PubMed]
     [Google Scholar]
  25. McNally E, Ross C, Gleeson LE. The tuberculous pleural effusion. Breathe 2023; 19:230143 [View Article] [PubMed]
     [Google Scholar]
  26. Keng L-T, Shu C-C, Chen JY-P, Liang S-K, Lin C-K et al. Evaluating pleural ADA, ADA2, IFN-γ and IGRA for diagnosing tuberculous pleurisy. J Infect 2013; 67:294–302 [View Article] [PubMed]
     [Google Scholar]
  27. Talib A, Bhatty S, Mehmood K, Naim H, Haider I et al. GeneXpert in stool: diagnostic yield in intestinal tuberculosis. J Clin Tuberc Other Mycobact Dis 2019; 17:100131 [View Article] [PubMed]
     [Google Scholar]
  28. Dahiya B, Mehta N, Soni A, Mehta PK. Diagnosis of extrapulmonary tuberculosis by GeneXpert MTB/RIF Ultra assay. Expert Rev Mol Diagn 2023; 23:561–582 [View Article] [PubMed]
     [Google Scholar]
/content/journal/acmi/10.1099/acmi.0.000737.v3
Loading
A case of pleural Mycobacterium tuberculosis infection with reversion of Quantiferon Gold Plus results from positive to negative
Access Microbiology 6, 000737.v3 (2024); https://doi.org/10.1099/acmi.0.000737.v3
/content/journal/acmi/10.1099/acmi.0.000737.v3
/content/journal/acmi/10.1099/acmi.0.000737.v3
Loading

Data & Media loading...

Most cited Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error