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FIORIO, SILVIA (2010) ANALISI DI UNA NUOVA METODICA DI LABORATORIO PER LO STUDIO DELLA RISPOSTA IMMUNOLOGICA ALL'INFEZIONE LATENTE DA MYCOBACTERIUM TUBERCULOSIS. [Tesi di dottorato]

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Abstract (inglese)

Identification and treatment of individuals with latent tuberculosis infection (LTBI) is an important component of tuberculosis elimination strategies in low incidence countries. In this context, health care workers (HCWs) represent an important target population for LTBI screening programmes and serial testing is recommended for HCWs. Interferon-gamma release assays (IGRAs) are alternatives to the tuberculin skin test (TST) and have been recommended for serial testing, but data are scarce on the interpretation of repeated IGRAs results. Existing studies, although limited, suggest that conversions, reversions and non-specific variations occur. However, there is no definitive consensus on how to define and interpret IGRA conversions and reversions.
At Padua Hospital (Italy) we conducted two different studies. In the first, run during 2006, 1715 HCWs were requested to perform both a TST and a blood sample for QuantiFERON-TB Gold In-Tube (QF-GIT) to compare the effectiveness and qualitative reproducibility of the QF-GIT versus TST for screening HCWs for LTBI. In the second investigation, which lasted three years since 2006 and was recently concluded, 530 HCWs were repeatedly screened (three or more times) for LTBI only with QF-GIT. The occurrence of consistently positive (or negative) results and different QF-GIT variations were thoroughly studied, and the variability and reproducibility of quantitative results evaluated. An analysis of association between consistently positive (or negative) results and personal characteristics was also performed, showing that the probability of being affected by LTBI is positively correlated with gender, age and professional qualification. Based on our results, it emerges that the QF-GIT test is reliable, its results are reproducible over time making it a valuable tool in selected populations, such as the HCWs, in surveillance programs and control of LTBI.

Abstract (italiano)

L'identificazione ed il trattamento dei soggetti affetti da infezione tubercolare latente (LTBI) è un importante obiettivo al fine di eliminare la tubercolosi nei paesi a bassa incidenza. In questo contesto, i lavoratori della sanità costituiscono una popolazione target nei confronti della quale sono orientati i programmi di screening della LTBI e per la quale sono raccomandati controlli ripetuti. I test immunologici basati sul rilascio di interferone gamma (IGRAs) costituiscono un'alternativa al test tubercolinico cutaneo (TST) e sono raccomandati nei test di screening, anche se i dati di letteratura riguardanti l'interpretazione dei risultati seriali sono di fatto scarsi. Vi sono studi, peraltro limitati, che hanno dimostrato che gli IGRAs possono presentare conversioni, reversioni ed alterazioni non specifiche.
Presso una realtà ospedaliera di Padova sono stati condotti due diversi studi. Nel primo, svolto nel 2006, 1715 operatori sanitari sono stati invitati ad effettuare sia il TST che un prelievo ematico per il QuantiFERON TB Gold in Tube (QF-GIT) allo scopo di confrontare l'efficacia e la riproducibilità dell'esito qualitativo del QF-GIT con quello del TST nello screening di LTBI. Nel secondo studio, durato circa tre anni a partire dal 2006 e recentemente concluso, 530 operatori sanitari sono stati ripetutamente sottoposti a screening per LTBI (in 3 o più occasioni) solo con il QF-GIT. Sono state studiate la frequenza di risultati concordemente positivi (o negativi) e le differenti variazioni del QF-GIT riscontrate. E' stata analizzata l'associazione tra i risultati persistentemente positivi (o negativi) e le caratteristiche individuali dei soggetti indagati, potendo dimostrare che l'LTBI è positivamente correlata con il sesso, l'età, e la qualifica professionale. Dai risultati di questo studio emerge che il QF-GIT è un test dai risultati affidabili e riproducibili nel tempo che lo rendono un valido strumento diagnostico nelle programmi di prevenzione e controllo della LTBI in popolazioni selezionate, quali i lavoratori della sanità.

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Tipo di EPrint:Tesi di dottorato
Relatore:FIORIO, SILVIA
Correlatore:SAIA, BRUNO
Dottorato (corsi e scuole):Ciclo 21 > Scuole per il 21simo ciclo > TERRITORIO, AMBIENTE, RISORSE E SALUTE > UOMO E AMBIENTE
Data di deposito della tesi:NON SPECIFICATO
Anno di Pubblicazione:07 Gennaio 2010
Parole chiave (italiano / inglese):latent tuberculosis infection; interferon gamma release assay; tuberculin skin test; QuantiFERON-TB Gold In-Tube; reproducibility; serial testing; health care workers. Infezione tubercolare latente; test immunologici basati sul rilascio di interferone gamma; test tubercolinico cutaneo; QuantiFERON-TB Gold In-Tube; riproducibilità; test seriali; operatori sanitari
Settori scientifico-disciplinari MIUR:Area 06 - Scienze mediche > MED/44 Medicina del lavoro
Struttura di riferimento:Dipartimenti > Dipartimento di Medicina Ambientale e Sanità pubblica
Codice ID:2279
Depositato il:04 Nov 2010 11:18
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